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肺腺癌分級治療 (非小細胞癌 (Stage IIIa (Non-N2 disease (可以切除 (化療或放療 (化療＋放療 (手術)), 手術…
肺腺癌分級治療
非小細胞癌
Stage I, II
經過各項身體檢查評估
Operable
Positive resection
margin
切除＋化療
Free resection
margin
看病理切片分stage
Stage Ia
後續觀察
Stage Ib
後續化療
Stage II or III
Platinum-based
chemotherapy
Stage IV
化療
Medical inoperable
Curative radiotherapy ± chemotherapy
Stage IIIa
Non-N2 disease
可以切除
化療或放療
化療＋放療
手術
手術
佐以化療或放療
無法切除
好的PS
化療或放療
視情況看可否手術切除
PS不好
Radiotherapy ± chemotherapy
N2 disease
Single station and
non-bulky
Neoadjuvant chemotherapy
± radiotherapy
疾病受控制
手術
病程加劇
Chemotherapy ±R/T
Multi-station or
bulky N2
PS好
化療＋接連的放療
情況不錯可考慮手術
PS不好
化療＋放療 或緩和性放療
Stage IIIb
PS好
基本同stage IIIa的 PS好的治療
PS 不好
R/T ±Chemotherapy
支持性療法
Stage IV NSCLC (non-operable)
Adenocarcinoma
EGFR Mutation
(+)
ECOG
PS 0-2
Gefitinib or Erlotinib+ platinum-based 化療
ECOG
PS 3-4
Gefitinib or Erlotinib
EML4-ALK (+)
ECOG
PS 0-2
Crizotinib標靶治療＋platinum-based 化療
ECOG
PS 3-4
Crizotinib
EGFR, EML4-ALK都是wild type
ECOG
PS 0-2
platinum-based 化療
ECOG
PS 3-4
使用支持療法