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.