¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

Lung cancer ´ëÀå°æ Á¤¸®

1. smoking°ú °ü·ÃÀÖ´Â lung ca : small cell lung ca > squamous cell ca

2. SCLC¿¡¼­ tumor suppressor gene

3p(-), Rb mutation, p53 mutation

3. Oncogene: bcl-2 overexpression, telomerase overexpression, myc family

overexpression

adenocarcinoma : K-ras

myc family(C-, N-, L-)

c-myc : NSCLC , all myc family: SCLC

4. poor prognosis

c-myc amplification : SCLC

ras : NSCLC

±âŸ, Her-2/neu

cf. bcl-2 oncogene overexpression˼ good prognosis

5. lung caÀÇ preneoplastic lesion : hyperplasia, dysplasia, carcinoma

i) Hyperplasia = 3p loss, 9p loss -> earlist event

ii) CIS, invasive ca : 17p(p53) ÀÌ»ó, ras mutation

6. pulmonary hypertrophic osteoarthropathy

3´ë Áõ»ó: clubbing, joint pain, periostitis

Ä¡·á: ¿øÀÎÄ¡·á(Æó¾Ï ÀýÁ¦ or effective chemtherapy),

vagotomy or vags nerveÀÇ percutaneous block

ÁøÅëÁ¦(aspirin or NSAID or other analgesics)

7. ÁøÇ༺ ºñ¼Ò¼¼Æ÷¾ÏÀÇ ÁÖ¿ä ¿¹ÈÄÀÎÀÚ 3°¡Áö

initial performance status, tumor extent(TNM stage), weight loss

8. radiation pneumonitis

ÃÑÁ¶»ç·®ÀÌ 2000 cGyÀÌÇÏ¿¡¼­´Â severe radiation pneumonitis´Â ´ë°³ ÀϾÁö ¾Ê°í

4000ÀÌ»óÀ϶§´Â 30ȸÀÌ»ó ³ª´©¾î Á¶»çÇÏ´õ¶óµµ 100% »ý±ä´Ù.

9. NSCLC¿¡¼­ combined chemotherapyÀÇ È¿´ÉÀÌ ÀÎÁ¤µÈ °æ¿ì

i) stage IIIA¿¡¼­ ¼úÀüÅõ¿©

ii) locally advanced disease(IIIA)¿¡¼­ RT¿Í º´ÇÕ¿ä¹ý

10. °ñÀ°Á¾ÀÇ ÆóÀüÀ̽à ¼ö¼úÀû ÀýÁ¦½Ã °í·ÁÇØ¾ß ÇÒ »çÇ× 3°¡Áö

i) ȯÀÚ°¡ ÆóÀýÁ¦¸¦ °ßµô¼ö ÀÖ¾î¾ß ÇÑ´Ù(tolerableÇØ¾ß ÇÑ´Ù).

ii) ¿ø¹ßº´¼Ò°¡ ¸íÈ®È÷ Ä¡·áµÇ¾î¾ß ÇÑ´Ù.

iii) ÀüÀÌµÈ ºÎºÐÀ» ¸ðµÎ ÀýÁ¦ÇÒ¼ö ÀÖ¾î¾ß ÇÑ´Ù.