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非小细胞肺癌治疗后监测

发表者:张品良 人已读

【非小细胞肺癌NCCN指南2017第7版】

Discussion 讨论

Surveillance 监测

Because recurrence is common after treatment for NSCLC, surveillance with H&P and chest CT (with or without contrast) is recommended in the NCCN Guidelines. Data from randomized phase 3 trials are not available to clarify surveillance recommendations; therefore, the most appropriate schedules are controversial. For the 2017 update (Version 1), the surveillance guidelines were revised by polling the NCCN Panel regarding their practice patterns. Details regarding the specific surveillance schedules for patients with no clinical or radiographic evidence of disease after completion of definitive therapy are outlined in the algorithm based on stage (see Surveillance in the NCCN Guidelines for NSCLC). A chest CT scan with (or without) contrast and an H&P are recommended for the initial surveillance schedules (2–5 years) followed by an annual low-dose non-contrast–enhanced CT and an H&P. Patients treated with chemotherapy with (or without) RT who have residual abnormalities may require more frequent imaging. 山东省肿瘤医院呼吸肿瘤内科张品良

因为在NSCLC治疗后复发常见,所以NCCN指南推荐病史与体格检查和胸部强化或平扫CT监测。尚没有随机3期试验的数据阐明监测推荐;因此,最合适的计划是有争议的。2017第1版更新,NCCN小组考虑其实践模式通过投票修订了监测指南。对于完成根治性治疗后无临床或影像学疾病证据的患者,具体的监测计划细节在以分期为基础的工作步骤中概述(见NSCLC NCCN指南中的监测)。最初的监测计划(2-5年)推荐胸部强化或平扫CT和病史与体格检查,然后每年1次低剂量非强化CT和病史与体格检查。接受化疗±放疗治疗的患者有残留异常者可能需要更频繁的影像监测。

Data show that low-dose CT screening decreased the mortality from lung cancer; low-dose CT may be beneficial for identifying recurrences. FDG PET/CT or brain MRI is not routinely recommended for routine surveillance in patients without symptoms. But, PET may be useful for assessing CT scans that appear to show malignant neoplasms but may be radiation fibrosis, atelectasis, or other benign conditions. It is important to note that areas previously treated with RT may remain FDG avid for up to 2 years; therefore, histologic confirmation of apparent “recurrent” disease is needed. Information about smoking cessation (eg, advice, counseling, therapy) should be provided for patients undergoing surveillance to improve their quality of life. The NCCN Guidelines include information about the long-term follow-up care of NSCLC survivors (see Cancer Survivorship Care in the NCCN Guidelines for NSCLC). These recommendations include guidelines for routine cancer surveillance, immunizations, health monitoring, counseling for wellness and health promotion, and cancer screening. An analysis suggests that patients who survive lung cancer have a high symptom burden 1 year after diagnosis and therefore need management after treatment. 

数据显示,低剂量CT筛查降低了肺癌的死亡率;低剂量CT可能有助于发现复发。FDG PET/CT或脑MRI不常规推荐用于常规监测无症状患者。但是,PET可能有助于确定CT扫描显示恶性肿瘤但可能是放射性纤维化、肺不张或其他良性情况。重要的是注意到,既往放射治疗的区域可能长达2年仍然是FDG高摄取;因此,表现“复发性”疾病的组织学确认是必要的。对于正在随访的患者,应提供关于戒烟的信息(如建议、咨询、治疗)以提高其生活质量。NCCN指南包括NSCLC幸存者长期随访管理的信息(见NSCLC NCCN指南中的癌症幸存者管理)。这些推荐包括定期癌症监测、免疫接种、健康监测、疗养与保健咨询以及癌症筛查指南。一项分析提示,在诊断1年后症状负荷高的肺癌幸存患者,在治疗后需要进一步管理。

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发表于:2017-07-07 14:34

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