|
楼主 |
发表于 2016-3-1 03:48:52
|
显示全部楼层
来自: 美国
这里医生根据病情给出的说法,和中国的治疗思路总体一致。这也是指南的治疗大纲。
Is she confirmed to have ipsilateral pleural met or malignant pleural effusion? The reason why I am asking is that this result affects her staging. If she is confirmed to have ipsilateral pleural met or malignant pleural effusion, she has stage IV disease. The treatment should be chemotherapy or targeted therapy if she has activating EGFR mutation or ALK translocation. If she does not have ipsilateral pleural met or malignant pleural effusion, she then has stage IIIA disease. She can be treated with chemoradiation therapy with curative intent. Although I think she is likely to have stage IV disease, it should be confirmed. Thoracentesis with cytology could be done first to verify malignant pleural effusion.
If it is stage IV disease, SBRT of the primary lung lesion plays no role in treatment. Testing mutations in genes other than EGFR and ALK is useful in the clinical trial setting, because only targeted therapies for activating EGFR mutation and ALK translocation have been approved by the FDA. If her tumor is negative for activating EGFR mutation or ALK translocation, chemotherapy (such as cisplatin/carboplatin + pemetrexed) should be given as the first-line therapy, with immune therapy (Nivolumab or pembrolizumab) or docetaxol as the second-line therapy. |
|