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 95th AATS Annual Meeting 2015, April 25th-29th 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
Secondary Criteria
• Lung cancer • > 50 years survivor • > 20 pack-yrs • > 50 years • At least one • > 20 pack-yrs other risk factor AND (not secondAdded >5% risk of hand smoke) lung CA within 5 years
• 55 – 80 years • > 30 pack-yrs • Current smoker or quit < 15 yrs • Asymptomatic
None
• 55 – 77 years • > 30 pack-yrs • Current smoker or quit < 15 yrs • Asymptomatic
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
Foto Dada
A
Negatif Positif
Sitologi Sputum Negatif Positif A C B D
: 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) 649 from positive screens 61.8% 44 after negative screens 367 in those who missed screens or after trial completed
Lung Cancer Diagnoses: CXR (n = 941) 279 from positive screens 29.6% 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 I
II
IIIA
IV
Number of pts
5-year survival (%)
T1N0 (IA)
245
75
T2N0 (IB)
291
57
T1N1 (IIA)
66
52
T2N1 (IIB)
153
38
T3N0 (IIB)
106
33
T3N1 (IIIA)
85
39
T1-3N2 (IIIA)
368
15
T1-3N3 (IIIB)
55
0
T4 any N (IIIB)
104
0
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
TERIMA KASIH
