The Role of Thoracic Surgery in Lung Cancer Management at 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 Sasaran penyaringan Langkah penyaringan Tindakan diagnostik Penentuan modalitas terapi Evaluasi
Lung Cancer Screening - How, Who, What Happens Next? Betty C. Tong, MD, MHS, Division of Cardiovascular and Thoracic Surgery Co-Director, Lung Cancer Screening Program, Duke University Medical Center 95 th AATS Annual Meeting 2015, April 25 th -29 th 2015, Seattle, WA, USA 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
http://seer.cancer.gov/statfacts/html/lungb.html
Sasaran Penyaringan Laki laki usia > 40 tahun Perokok berat / Pekerja Industri Batuk > 2 minggu, disertai batuk darah Berat badan turun > 4 kg / 6 bulan
Summary of Current Guidelines CMS Grade B Recommendation 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 cancer survivor > 50 years > 20 pack-yrs AND Added >5% risk of lung CA within 5 years > 50 years > 20 pack-yrs At least one other risk factor (not secondhand smoke) None None
Tindakan Diagnostik Sitologi sputum Toraks foto Endoskopi Bronkoskopi CT Scan / PET Scan Biopsi (Percutaneus Transthoracic Needle Biopsy) Mediastinoskopi VATS Imunologi Biochemical Marker ( CEA )
Langkah Penyaringan Sitologi Sputum Negatif Positif Foto Dada Negatif A C Positif B D A : Penyaringan setiap 6 bulan B, C : Tegakkan diagnosis lebih lanjut D : Tindakan diagnostik (menentukan derajat tumor )
NLST Lung Cancer Cases Lung Cancer Diagnoses: CT (n = 1060) 367 in those who missed screens or after trial completed Lung Cancer Diagnoses: CXR (n = 941) 61.8% 649 from positive screens 29.6% 279 from positive screens 44 after negative screens 137 after negative screens 535 in those who missed screens or after trial completed
Pembagian Kanker Paru Non Small Cell Lung Ca (NSCLC) Small Cell Lung Ca (SCLC)
TNM Staging of NSCLC Stage Ia T1 N0 M0 Stage Ib T2 N0 M0 Stage IIa T1 N1 M0 Stage IIb T2 T3 N1 N0 M0 M0 T=primary tumor; N=nodal involvement; M,=distant metastasis.
TNM Staging of NSCLC Stage IIIa T1-3 T3 N2 N1 M0 M0 Stage IIIb T4 Any T Any N N3 M0 M0 Stage IV Any T Any N M1
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
Data from The Society of Thoracic Surgeons General Thoracic Surgery database: The Surgical management of primary lung tumors Boffa DJ, Allen MS, Grab JD, et al J Thorac Cardiovasc Surg 2008;135: 247-554 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% )
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 Tahun RS 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 non spesifik, 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 Stage Number of pts 5-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 7 Naruke T et al, Prognosis and survival in resected lung cancer based on the new international staging system. J Thorac cardiovasc surg 96:440. 1988
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