The Role of Thoracic Surgery in Lung Cancer Management...
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The Role of Thoracic Surgery in Lung Cancer Managementat Dr.H.A.Rotinsulu Lung Hospital
Bandung
ACHMAD PETER SYARIEF
Thoracic Surgery Department - Dr.H.A.Rotinsulu Lung Hospital
Bandung
World Cancer Day 2016, Harris Hotel Festival Citylink - Bandung, 6 – 7 Februari 2016“Penatalaksanaan Kanker Paru di Era JKN Pada Semua Lini Pelayanan”
Sejarah Singkat
Menegakkan Diagnosis Tumor Paru
• Sasaranpenyaringan
• Langkahpenyaringan
• Tindakandiagnostik
• Penentuanmodalitas terapi
• Evaluasi
Lung Cancer Screening - How, Who,
What Happens Next ?
• Background and rationale for lung cancer screening
– Current guidelines and recommendations
– Insurance coverage and reimbursement
• Components of a successful lung cancer screening program
– Fundamentals and logistics
– Challenges
• The future
Betty C. Tong, MD, MHS, Division of Cardiovascular and Thoracic Surgery Co-Director, Lung
Cancer Screening Program, Duke University Medical Center
95th AATS Annual Meeting 2015, April 25th-29th 2015, Seattle, WA, USA
http://seer.cancer.gov/statfacts/html/lungb.html
Sasaran Penyaringan
•Laki – laki usia > 40 tahun
•Perokok berat / PekerjaIndustri
•Batuk > 2 minggu, disertaibatuk darah
•Berat badan turun > 4 kg / 6bulan
Summary of Current Guidelines
CMS
Primary Criteria
• 55 – 79 years• > 30 pack-yrs
• 55 – 74 years• > 30 pack-yrs• Current smoker
or quit < 15 yrs• Asymptomatic
• 55 – 80 years• > 30 pack-yrs• Current smoker
or quit < 15 yrs• Asymptomatic
• 55 – 77 years• > 30 pack-yrs• Current smoker
or quit < 15 yrs• Asymptomatic
Secondary Criteria
• Lung cancersurvivor
• > 50 years• > 20 pack-yrs
ANDAdded >5% risk of lung CA within 5
years
• > 50 years• > 20 pack-yrs• At least one
other risk factor (not second-hand smoke)
None None
Grade BRecommendation
Tindakan Diagnostik
• Sitologi sputum
• Toraks foto
• Endoskopi Bronkoskopi
• CT Scan / PET Scan
• Biopsi (Percutaneus TransthoracicNeedle Biopsy)
• Mediastinoskopi
• VATS
• Imunologi
• Biochemical Marker ( CEA )
Langkah Penyaringan
Sitologi SputumNegatif Positif
Foto Dada Negatif A CPositif B D
A : Penyaringan setiap 6 bulan
B, C : Tegakkan diagnosis lebih lanjut
D : Tindakan diagnostik (menentukan derajat tumor )
NLSTLung Cancer Cases
Lung Cancer Diagnoses: CT (n = 1060)
649 from positive screens
44 after negative screens
367 in those who missed screens or after trial completed
Lung Cancer Diagnoses: CXR (n = 941)
279 from positive screens
137 after negative screens
535 in those who missed screens or after trial completed
61.8% 29.6%
Pembagian Kanker Paru
• Non Small Cell Lung Ca (NSCLC)
• Small Cell Lung Ca (SCLC)
Stage Ia T1 N0 M0
Stage Ib T2 N0 M0
Stage IIa T1 N1 M0
Stage IIbT2
T3
N1
N0
M0
M0
TNM Staging of NSCLC
T=primary tumor; N=nodal involvement; M,=distant metastasis.
Stage IIIaT1-3
T3
N2
N1
M0
M0
Stage IIIbT4
Any T
Any N
N3
M0
M0
Stage IV Any T Any N M1
TNM Staging of NSCLC
Stage I Non-Small Cell Lung Cancer
• Cancer is found only in the lung
• Surgical removal recommended
• Radiation therapy and/or chemotherapy may also be used
Stage II Non-Small Cell Lung Cancer
• The cancer has spread to lymph nodes in the lung
• Treatment is surgery to remove the tumor and nearby lymph nodes
• Chemotherapy recommended; radiation therapy sometimes given after chemotherapy
Type of resection :
- wedge resection in 1649 ( 18.1% )
- segmentectomy in 394 ( 4,4% )
- lobectomy in 6042 ( 67,0% )
- bilobectomy in 357 ( 4,0% )
- pneumonectomy in 591 ( 6,5% )
Data from The Society of Thoracic Surgeons
General Thoracic Surgery database:
The Surgical management of primary lung tumorsBoffa DJ, Allen MS, Grab JD, et alJ Thorac Cardiovasc Surg 2008;135: 247-554
Pengalaman Instalasi Bedah
RS Paru H.A. Rotinsulu
(Single Institution Experience)
Diagnosis Operasi (2009-2014)RS Paru H.A. Rotinsulu
n = 159
Jumlah Operasi Per TahunRS Paru H.A. Rotinsulu
Hasil Operasi Kanker Paru (2009-2015)RS Paru H.A. Rotinsulu
No Pasien Diagnosis Stage Jenis operasi
1. Laki, 57 th NSCLC, Squamous T3N1M0, IIIA Lobektomi, 2012
2. Laki, 36 th Tumor paru, jenis ? T4N1M0, IIIA Lobektomi NSCLC, 2012
3. Laki, 66 th NSCLC, Squamous T3N0M0, IIB Lobektomi, 2013
4. Wanita, 57 th NSCLC, Adeno T3N0M0, IIB Lobektomi, 2013
5. Laki, 57 th Tumor paru, jenis ? T4N0M0, IIIA Biopsi tumor NSCLC, 2013
6. Laki, 47 th Tumor paru, jenis ? T2N0M0, IB Lobektomi Carcinoid , 2013
7. Wanita, 63 th NSCLC, Adeno T1N0M0, IA Lobektomi, 2014
8. Laki, 59 th Tumor paru, Neuroendokrin T2N0M0, IB Lobektomi Abses paru nonspesifik, 2015
9. Laki, 56 th Tumor paru, jenis ? T3N0M0, IIB Debulking Large cell, 2015
10. Laki, 45 th NSCLC, Adeno T3N0M0, IIB Bilobektomi, 2015
11. Wanita, 32 th NSCLC, Squamous T3N0M0, IIB Lobektomi, 2015
Evaluasi / Follow up
No Pasien F.u. lanjutan Hasil Ket.
1. Laki, 57 th Kemoradiasi Meninggal, 2014
2. Laki, 36 th Kemoradiasi Loss to f.u DO
3. Laki, 66 th Kemoterapi Loss to f.u DO
4. Wanita, 57 th Kemoterapi Follow up (+)
5. Laki, 57 th Kemoradiasi Loss to f.u DO
6. Laki, 47 th ?? Loss to f.u DO
7. Wanita, 63 th Observasi Follow up (+)
8. Laki, 59 th Konservatif
9. Laki, 56 th Kemoradiasi Follow up (+)
10. Laki, 45 th Kemoterapi Follow up (+)
11. Wanita, 32 th Kemoterapi Follow up (+)
Evaluasi / Follow up
StageNumber
of pts5-year
survival (%)
I T1N0 (IA) 245 75
T2N0 (IB) 291 57
II T1N1 (IIA) 66 52
T2N1 (IIB) 153 38
T3N0 (IIB) 106 33
IIIA T3N1 (IIIA) 85 39
T1-3N2 (IIIA) 368 15
T1-3N3 (IIIB) 55 0
T4 any N (IIIB) 104 0
IV TN any M 293 7Naruke T et al, Prognosis and survival in resected lung cancer based on the new
international staging system. J Thorac cardiovasc surg 96:440. 1988
TERIMA KASIH