UBND TiNH DONG NAISOVTE

S6: yt-D/SYT-NVYVIv trien khai Quyet dinh s6482S/QD-BYT ngay 06/8/2018 cuaBe>Y tS v6 viec ban hanh tai lieuchuyen mon "Huong dftn chandean va di6u tri ung thu phoi khongtS bao nho".

CONG HOA xA HOI cnnNGHiA VIET NAM. . .DQc l~p - TV do - H~nh phuc

Dong Nai, ngay OJ thdng 8 nam 2018

Kinh giri:_Giam d6c cac Benh vien, cac Trung tam Y tS true thuoc;

_Giani d6c Benh vien Da khoa Cao su Dfmg Nai;

_Giam d6c cac Benh vien ngoai cong l~p.

Can cu Quyet dinh s6 4825/QD-BYT ngay 06/8/2018 cua BQ Y tS v@viec

ban hanh tai lieu chuyen mon "Huong dful ch~n doan va di@utri ung thir ph6i

khong tS bao nho" (Quyit dinh dinh kern).Sa Y tS sao giri Quyet dinh s6 4825/QD-BYT ngay 06/8/2018 cua BQY tS

v@viec ban hanh tai li~u chuyen mon "Hu6ng d~n chk doan va di@utri ung thu

ph6i khong tS bao nh6" dSn cac don vi tf\ICthuQc dS biSt va th\Cchi~n.

D@nghi Gifun d6c, Thu truang cac don vi tf\IC thUQCtriSn khai th\Cchi~n

theo quy dinh'/.·~

Noinh~n: .- Nhu tren (de th\Ic hi~n);- BCIDSYT (d~bao CllO);- Website SYT;- LUll: VT, NVY.

.___. -- ~~~;;;;:;;;;:;t=~an Huy Anh Vii

S6 2 _Phan Dinh PhUng, phuOng Quang Vinh, thanh ph6 Bien Hoa, tinh D6ng NaiDT: (02513) 942641, Fax: (02513) 847269, Email: syt@dongnaLgov.vn, Website: syt.dongnaLgov.vn

BQYTE CONG BOA XX BQI CIIUNGBIA m.TNAM.B9c lip - T'F do - H,nb phiicHa N(Ji, ngay {J6thangg nam 2018s6:4~.trIQf)·.sYT

QUYETBINBV~vi~cban hanh tili li~uchuyen mon

"BU'6'ngdin chin c10anva di~u ttl uug thU' phai k.haug ti baa nho"

BQ TRtrONG BOY TE

Can eu Lu~tKham ~nh, ehita benh nam 2009;

Can eu Nghi dinh s6 75/20171NB-CPngay 20 thang 6 nam 2017 eila Chinh philquydinh clnrc nang, nhlem V\1, quy~nhan va co cl.llt5 chuc ellaBO Y tS;

Theo de nghi cua Cue tru6ug Cue Quan It kham, chua b~nh,

QUYET t>JNH:f)i~u 1. Ban hanh kern thea QuySt dinh nay tai li~u chuyen mon ''Huang dftn

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Bi~u 2. Tai .li~ ehuyen mon '~u6ng d§n chAnGoan va diiu ttl ung full' ph6i}<hongt&bao nho" (luge ap dung t~ cae co so kham b~nh, ehiia b~nh trong eRRuae.

Bi~u 3. Ql.lyBt dinh nay c6hi~u ivc kcStir ngayey, ban banh.

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fIQ'Y¥<-

•

ChUng thu: BQY t6Ngay JcY: 06/08/201819:0):34

~,,~ H~ thong VOffice BQY Te

1

HlfCtNG DAN CHAN t>oAN vA BIEU TRJUNG THIf PHOI KHONG TE BAo NHO (UTPKTBN)

(Banhanh kemtheoQuyltiJinh s_QD-BYTngayCkthtmg~nam 2018 cUaB(J trittmg B6 Y tl)

1. B~CU'ONGUng tim phai Ie.mQt trong 3 ung thu thuOng g,p nhAt va lA nguyen .nhan gay tIl vonghang dAu do ung thu crpham vi toan cAu. 'Iheo GLOBOCAN 2012, 4,i Vi~t Nam, ungthu phAi dUng hang thr£,nhl chi sau ung thtr gan vOi tY lQ m!c chufu1 theo tuM fJ cs. haigiro lit25,2. Benh thulrng g~p (J nam giot vOi tY Ie mAc·chuAn theo tu&i hi 41, 1 {J nam va12.2 crnli' gim, u6'c tinh m6i nAmc6 khoang 22.000 tnximghqp mal mAc(16;000 nam va6.000 nit) va tir vong khoang gAn 19.600 b~nh nhan.Ung thu phAi duqc chia thanh hai lo~ chinh lit ung thu ph5i ta bao nho (small celllungcancer) - chi8m khoang 10 - 15% va ung thll ph6i khong te bao nh6 (non small cell lungamcer): chiem khoang 85%.Ung thu ph8i khong ta bao nh6 dll'\yCgay ra boi Mieu nguyen nhan va yen t6·nguy.codu6iday:• Thu6c Ia: \lac tinh 80 -90% ung thn phAi lien quan dan thu6c hi. Nguy co ung thll'

ph6i tmtg theo ,thmgian vit s6 hl'Q11gthu~chi. MQtngll'Oi hut m(Jtg6i thu5c m6i ngayc6 nguy co mAc ung thll' ph6i gAp 20 Ian ngueri khong hut thubc. Nguy cO'ung tbll'ph6i do htit thu6c th\l dong cling dugc ghi nl$l: ngtlOi sbng cung nha v6i ngtrai hutthuac tang 30% nguy cO'ung tlm ph6i S.ovm nguOi khong cimg hom c3nh.

• Tifp xtic amian: ngum hut thubc c6 tiq, xtic amian c6 nguy cO'cao gap 90 IAnnguQikhong tiap "tic. .

• B\li ph6ng xtl va raden: Jam tang nguy CO'ung thll' phAi, nguai ti~p xtic vai mue dQradon cao·toi nha crde mac ung thtl phoi

• Nhiem khuAn: Sieu vi buOu nhu {J nguo-i (Human papilloma virus (HPV) duqc quycho til m,Qt nguy~n nhan gay un~ thu phAi. G§n 25%oog thu ph&i tre~nguOi khonghut thuoc c6 the lien quan den HPV. ChUng da bu<1u nhu tal dien (Recurrentrespiratory papillomatosis (RRP». c6 the gay ho, tAc nghen ho hdp IDIp1 tinh va thoaihoa ac tinh. Nhiem HPV 16/18 thuoog di kem dOtbi~n p53 ~

• Ditruyen: mQtviri dQt bien di truyen 1a yau tb lien <{uan.1>Ot biAn T790M xAy ra trant!baa rob kem the.o ung thu bi~u rootuyen ciia phoi.

• 6 nhi~m khong khi: kh6i b\li trong khong khi <> nhi~ro c6 the lam tang nguy co micung thuphAi~ d~c bi~t la ong thu bieu mo tuyen.

1

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2. CHAN DoAN2.1. Lam sangBi8u hi~ bUll sang my thuQ.cvao vi tri va mire dQ.Ian r"ng cua tAn thuang. Trong. giai4o~ dAutOn thU(Jllgcon khu tni,b~nh nhan tbuimg kbOng cQ tri~u chUng lam sang·~hl~uvil.duQ'cchin doan qua tfun scat hoijc phat hl~ntitili cCrqua chan doanhinh anh, Cactri~u chimg va dllu hi~ lam sang thuOng duQ'cphan tharth ba nhom: tri~u chtmg 41ich6t~ vung, tri~u chtmg do di can xa va cac hQi chUngc~ ung thu. .a) Cac tri~u chUng do xfunlfut ~ ch6, tai veng: lien quan dSn tAcngben duang ho hip,

tham nhiam nhu 010 ph6i, va xAm Ian cae cau true chung qUaIlh nhu thMh ng\l'c~~ch maul(1Il va cac tang trung thAt.Cac tri~u chUng thuOng g~p bao gAm: .

• Ho: g~p trong khoang S()% benh ~ thuang thAYthay d6i. ve tin suAt vamirc dQtren.nguOi lluttbu6c, c6 the ho khan ho~c kem theo kh~ dbm.

• Horamau• Kh6thu• Viem phOi tal diSn·mQlvi tri• Trm dlch mang phdi• Bau n,mrc• Bau vai, tay (hQi chUng Pancoast Tobias)

, ',- ~".• HQi chirng Horner (S1)P mi3co dongtir, khong ra mo hoi nua m~t)• Tri~u chUng do chen ep: kh6 nu61, khan tiang, hQi chlhlg tinh m~ch chu tren ...b) Cac tri~u chimg do di ciin.nao, moog, chen ep wysOng ...• Di can nao: nhuc diu, bu6n non, non, rOi lo~ nh~ thirc, Vl}n ctQng,trieu chimg thin

kinh khu trU...• Dj cmt xuong: dan, giui h~ v~.4Qng, cam giac ...• Chen cptli)' s5ng: te, yeu, mAtv~ dQng.chi, rbi lo~ co tron ...c) Cac hQi chUng c~ ung fuu:• }{hong ~c hieu; s\lt can (00 ho~c khong kern chan an)• HQi chirng tang ti.et khan.g lqi ni~u (8IADH: syndrome of inappropriate antidiuretic

hormone secretion)• HQichUng tang tiSt ACID• HQi chung Lambert-Eaton• HQi chUng pbl d~i xmmg kh6'p do ph&i• HQichirng carcinoid• Cae hQichirng huyet hQc.hiSrn~p kMc.nhu fuiSumau, tang b~ch cAu ...2.2. C,n lam sang: giup chan doan xac dinh va phan bi~t.

2

a) Chan doan hinh imh• X quang ng\l'c thing, nghieng• Chup cAt 16p vi tinh nguc, bvng, ch~u• Ch1,lpcQng hucrngtir (MRI) nao• X\l hlnh X\lcmg• Chup PET toan than khi cAnb) Cae chAt chi diem u (dfuJ hi~u sinh hQCbtrau): giup chAn doan xac dinh u nguyen

phat t~ ph5i hay chan doan phan hiet u di OWl til vi {if khac.• Cac chAt chi diem buou giup chin doanxac djnh:

- SCC

- CRA- Cyfra21-1- ProGRP, NSE ...

• Cac chAt chi diem bmrn giup chin doan pbAn biet ill coo ph5i: CA 125, CA 15.;3, CA19-9,PSA, ...

c) Cac phucmg phap IAyb~nh phim xac dinh chfut doan gild phlu b~:• NQi soi pbS quan: chai rna te boo, sinh thi~t u.• Cboc hut chAn do6n t~ bao ho~e sinh thi~t u, hach trungth!t duai huang d§n sieu.·&m

qua nQi soi (EBUS: endoscopic bronchial ultrasound; .EQS; endoscopic ultrasound)• Choc hut kim 006 chart doan t!boo teba.o hQc (FNAC) bote· sinh thiet Io.ikim (score

biopsy) u ho~c tAn thU'tmg di cln (nyc tiSp hay dna1 huang din sieu am ho~c ch\1pcitl6p di~ toan)

• C!t u ho~c sinh· thi~t qua phiu thu~t rn6' h()~c nQi soi lOng ng\l'c h()~c trung thAt(VATS: video-assisted thoracoscopy;VAM: video-assisted mediastinoscopy)

d) N¢i sOlph! quan: de xac dinh chin doan vildanh gill gial do\U1b~nh.2.3. Chin daan T~ baa hC)c- M6 b~nh hQc- Sinh h«}cpbin nra) Chin doan te bao hQC:

• B~nhphAm tA baa h<;>c:_ B~ phAro qUa soi phS quAIl: lira phS quan, rna phe quan-phS nang, chai phe

quan, chQc hut xuyen ph! quart d1l6i·hllcrng d!n sieu am (£BUS)._ B~ phAm til' C<l.Cdich khoatIg CQ' the: dich mang phfii, dich miulg tim, djch mang

b1,lUg,dich n!o tUy._ Dich ehoc hut b~& kim OOa (FNA): chQchut hl.tchbing kim nhq, chQchut IllQ

mem, chQc hUt phoi bfutg kim 000, chQc hut caC tAn thuong di din bfulg kimnha ...

- B~OOphlun dam.

• ChAn doan t8 bao hoc: giup chin doan xac Qinh. va chdn do4U Jo~i t8 bao hOCUTPKIBN.

b) Chan doan mo b~nh hoc• B~nhphAro roo b~nh hoc:

• Benh phim qua soiph8 quAn:sinh ~6tph~ qum, sinhthi8t xuyen phS quan, sinhthiet duro hu6ng din sieu am nQiphe qu~n (EHUS).

_ B~nh phim sinh thiet u ph6i hay sinh thiSt p1l6i..mang ph6ldu6i chup cit lOp di~ntoan,

_ Benh phfun qua phiu thoo.t lang ngge: pMu tI:u~t ngyc ha, ph§u th~t qua 1191soidum man hi.nhvideo (VATs), nQisoi trungthat.

_ B~ pharo qua sinh thiSt mang pb6i: sinh thiet mang pb6i bing kim (kimAbrams, kim Castelain ... J, sinh thiet mang phOi qua nQi soi,

- Benh phfun sinh thi8t cac t6n thU<111gdi ciin: hach lyrnpho, roo l'Il~mthanh ng\Ic,roo mem dum da, rno xmmg ...

- Due kh8i tS baa (Cell Block): dich mang ph6i, dieh mang tim.

• Chin doan rno b~nh hQc: ghip cMn doan X3C dinh va chAn daan lo~i rno hQcUTPKTBN.

c) Chin doan sinh hQc phan tti:• B~ phAmsinh hQcphan tli:

- Cae ky thuit chan doan sinh hQc phan til: deu th\IC hi~n duqc tren cac miu b~nhpharo mo b~nh hQC va ta bao hQc.

- Ngoru ra, xet nghiem sinh hQc .ph~ tu con $\lC hi~Ildl1Q'Ctren mdu· b~nh phArohuy8t tucm&elm yau de pha!hien cae dOtbien EGFRm~ phAihay iliti phatsaukhi dugc .dieuhi cac thuoe khang tyrosine kinase (TKls), trong d6 quan trQngnhdtla d{lt bi~n T790M ~i exon 20 eua gen EGFR. Trang mgt sA truUng hQ'Pmiub~nh phb mo b~nh hQc hay te baa hQc khong du s5 hrQ1lgte baa d8 chAndoansinh hQcphAn nr, c6 th8 dUng m~ubenh phfun huyet wang da chan .do!lndQtbienEGFR.

• Cac ]Olili ley thu~t dang dugc S1.1d\lIlg trong chAn doan UTPKTBN: GiaI trinh tg gentqrc tiSp: Sanger.Sequensing, RealTime-PeR., dOPeR:peR ky thu~sA) Gifti trlhht\lgen chQn 190: Pyrosequensmg, Giai trim t1)' gen the he mm: Next GenerationSequensing.

• Cac xet ngbi~m sinh hOC ph~ tir (MoJacular Pathology):_ Xet nghi~m chAndoan dQtbien gen EGFR: sti d\lllg b~g nhiSu phuang phap: giai

trlnh tv gen trl,fctiep Sanger, ky thu~t RealTime-PCR, ky thu~tPCR kY thu~ts6,gilli trinh f\r gen chQnlQcPyrosequensing, giru tdnh gen the h~ mQi.

_ Xet nghi~m chfut doan cae bieu hi~ tm s~p x~p gen ALK va ROS!: chu yeu dUngnhuQm1m gh6p gen ~ eh6 FISH va .kY·thu~tboa mo mi~n dich.

4

- Xet nghi~ chan dom eac diem kiem soat mien dich PP~lJPD..Ll trong dieu trimi8n dicb: sit d\Ulgk$ thu~th6a mo miSn dich vai cae dAuan. sinh hQc~c hi~1i.

.. Xet nghiem ehAndoan cac lo~ dOtbian gen khac: BRAF V600E, HER-2, 1y1ET~PII(3CA, KRAS ...

d) Cae hlnh thai mo hec trong ung tha ph6i khong t8 baa 006: Phan 1~ mo hQCUTPKTBN eh11ySu d\Ulvao phan lo~ ella T6 chu-cY tS..the gioi I?-atn 2015 (WHO2015). Tuy nhien; trong UTPKTBN c6 eacl0.~mo hoc quan trQng<c@chu y:

• Ung full' bieu .mo tuyen (Adenocarcinoma) vOicac pllan nhom mo hoc dn chu y: ung.thu bieu mo tuyen ~ cha (AIS: Adenocarcinoma in situ); ung iliabieu rna tuyen xamIan fbi thleu (Minimally invasive adenocarcinoma); ung tha bieu roo wyan xam Ian(Invasive adenocarcinoma).

• Ung thu biSu roo tS bao yAy (Squanous Cell Carcinoma).• Ung thu bieu rno wyen-vay (Adenosquamous carcinoma)• Ung thu bien rno tS bao 100(Large Cell Carcinoma)• Cae buOu nQi tietthftn kinh cUaphai (Neuroendocrine TUll)ours).• Ung thu bieu mo d~Ilgsarcom (Sarcomatoid Carcinoma).

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~d~:.Chfn dq6n d~t bl'n EGFIUrongUTPKT8Ngia}'dotn tiln tri'n(-&Iotinib, Gefitlntb, At.lnib, O$imertimb)

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Benchmark hayUltra Veniana

Atezolizumab rl bao lnrau?:.1%, ?: 5%; >5()%rl baomiin dich >1%, > .$%,.> 10%

KhangthSPDL-l

H~thangnhu6m

Cae thuae miln Cae trrsa tfnh di@mbiSu hifil PDL-ldjeh

>1%. >5%Nivotamab28.8 Dako Link 48

22C3 DakoLink48 Pembrolizumad > 1%. > 50%

SP142

SP263 Benchmark hay Durvalumab ~ 25%Ultra Ventana

Bing tom tit:Bi~uhi~n ct\a de diSm liech' nti@ndjch PDL.l

2.4. Chin ttoan xac c1inha) ChAndoan xa.c dinh ung thu phAi pha.i d\ta vAo giirl·ph!u b~nh trong tinh hu6ng co th~

thl}c hi~n duqc. Chan dam giAi phlu benh giup xac diah chfuh nc lo~imohoc vacae diu hi~u sinh hoc phan tir d8 dpm huoog diiu tri. ehub nc han.

b} ·MQts6 ung thu ph5i giai dean sOm duQ'cphat hi~n tinh C(1ho~c tArn soat qua ch\1:Pcitlap di~ntoan lang ngvc bien hi~ndtrOi dQIlgn6t 000·can duqc danh gia va Can nMcxu tn rnQteach th~ ttQng de trBnh bo q1JacO'hQidieu trjkhoi cho mQt s6 b~nh nIlan,

c) chAn dean tAn thuong ph6i kich thucro nhe: Cac t60 thucing n6t ph5i co Deh thucrc2:8mm ·cAn duQ'c hm y danh gia va xu tr.i thea kich thuuc va hguy cO' ac tlnh theokhuy~ncao dum .dAy:

7

Bang: Banb gia ngny CO' ac tinh

Tieu chuAn aanh gia 1-- ___,..:,..;NJ:Z.gu~y ..;;.;.cO';;...•. .:;.ac;:.,.·=fin=h=·----r----------4Vira (5-65%JThip(<5%) Cao (>650/0)

Lam sing Tre tu6i, hut thuAe it,khong tiBn can ung thu,kich thucc Ian, bcr d~u,vatho~c vi trl cr ngoai, thilytren

Co b6n hQP cacd?c diem cua

th t.· ,nguy eo ap vacao

Nhieu .tuAi, huttllU6c" tien em micung .tlur, kich thrr6clan, bet kbongdSuItua gai, v8lho~cvi trf qthUy treri

K~t qua FDG RET Chuy8n boa thdp Chlly~n hoatrung binh b()~cyan

Kat qua sinh thiStngoii phln thn,t(sol pbe quant sinhthiat qua tbinhngU'c)

Lanhtinh Khongxac dinh Nghi ago ne tinh

Kat qui thoo diUqua chVP tli~n toancltl6'p

TAn thmmg tan homtoan ho~e g~ hoantoan, giam kteh thu6cdAn ho~e khong tmgkich threac trong thmgian thoo doi han 2nam (nAt dJc) boJc 3-5nam (nbt hOn hQ"lJ)

Kbong lip dung N6ttiing kich thuoero

, ,.1 .. ". 2:SO'do xli'tri ton thU'Cfllgnot pboi >8mm

f NOtd~C >8mm

a0.utriphauthult

8

Cac tAn thuangn6tnho. du6i 8mm ciing c§n ciugc theo doi djl'lh kY 5lMsaQbbg ch\1pcAtlap vi tinh lang ng\l'c, tir m6i 3 d~n 12 thang tuy thea uac Itrong nguy co ac tinh (lamsang, tinh cMt hinh anh hoc cua t6n thuong ... '),2,5. Chindoall giai do~nAp dung thee bang pilau lQ~ TNM8 40 J:iQi Nghien CUll Ung thtr Ph81 The gi6i (TheInternational Assoclation for the Study ofL\ing Cancer (IASLC) xaY'd\ll1g: .

Phan giai.d0lP11am sang thea TNM,:/]lit:_:, ," :-A. :::::'~:L;-:';'"ITUl::f{gu;y~n.p..'3t'v)TO Khong co u nguyen phat

Kreh tlnroc U :;;30m,bao quanh bOi nhu 1110 h(}~ctnang ph6i t@g,~ -=_-,--___,.,.kh;.:_;..•--,Q--,n~g--,d--,Au=-. x--,am.;.:_;..;.:_;.. .,;_;lAn;.;;..,..• $.~bqll CU~tl&ph5ithiIytren .riQi SOl phS quan ..

I<1chthu6c U <lcm

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Tla.Tib Kich thucc U >lcm nhung<2eJllTlc Kfch tbucrc U>2em nhung < Jcm

T2 Klch tlnrocU >3cm Mung :$ Scm ho~c.c6 bArkY d~c tinh sau day:xarnlAn mang phOit?1lg,xam l~ phS qufqt gac' each carin~ xa han2cm, x~p/viem phAithiIy nhung khong h~t to~ bQphAi.

T2a Kich thucrc U >3cm nhung <4cmT2b Kich thucre U >4cm nhung <Scm

T3 Kich thuac U >5e111nbung:;; 7cm ho~c x~ Ian tnrc ti8p vAothanh ngvc, ccr hoAnh, than kinh homili, mang phAi trung thAt,mang ngoai tim; bo~c btrOu xam 1M phe quan gBc cach carina gAnhan 2Clll.; ho~c x~p ph6i!viem pb6i tic nghen toan hQm{lt benphAf; ho~c nbt di can cllng thuy ph6i.Kich thucrc U >7cm ho~c'bdtlcy kieh thtrac x~ lfuI vaotim, 'm~hmim 16n, khi quan, th§.n.kinh hai thanh quan, thl,TC quan, fban.dfi1sbng, carina; ho~c ubi di call khAc tbuy cung. ben ph6i. .

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NO Khong di can h~ch vimgN 1 Oi can h~ch quaM ph&qum, h~ch r3rt phAi, trong phaI cimg'ben,

kS ca do xam lfut tn.rcti&p. '. .N2 Di can h~ch trung thdt ctmg ben ho~c h{lch dtr6'i carena.

MO !(hongdi can xaMIaMlb Di din ngoa.U6ng ng\fc dan A mQtvftrl

Mic Di din ngoai lang ngvc nhieu bm9t ho~cnhi~uvi tri

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t.Q n~w ne!l ~ilm 'a~lueAn~N 01'£RIl.naIG o~..

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qeUlnz.!;)UA;)q'pgX~Jl~w~d 5unp n.s ~uQtpI AVAoVq vlw9qN •

·{~tlVlqq'uvq~AVA~UQlPJ:VAAVA0Vq ft.QUlny!'l ntp. 5un~I "0.91w9t{U!-eq ooq} llVqd 'trg'Uld go !QPgq Pl ugq 01}A ~np uytp. ~Ol n~!1I:)W !lln~!G •

:t{:J}"P U?!q 19P oyo go ~IIQIPlll\;ll{II t{U~H (p

q-emW:HolqUI~dqOIP l.I~!wlYOStuvPIUlr1P yqo 11.1) 09n1{lWi\.lQUl ognq!ll n,1P o.6np rlll<?O ~O~<l'1 ad ll~N ny!q 8um 90 VAt{oJpu~!q lQP oyo 90 5uQlplUVl{U·t{U9H::~~~f;nmt'UVtt~.n~~o~p mUVq~t{:)JPo~'ll Pln~!p :d~5 Wy!\{ UyN19P o~:J {::>

• Lich trinh: m6i tbang/l l§n trong nam dAu,mOi 2 thanglllfuI trong cae nam sau.• Phuong tien danh gia: kham lam sang, X quang, chup cit .lqp vi tinb ...

S~ TIEN LUQNGCae yen t6 tien luqng quan trong gAm:• Giai do~: yeu t6 tien luqng quan trQng nhal Giai doen I va U phi~ thu~t duqc co

tien lucng sAng 5 nam tlr .50 -.80%, giai do~ m ti Ie· nay giam suong con til 20 -40%. Rieng giaidof;UllV ti Ie sAngS nam rAt thip «5%) .

• Chi sOhoat dQng C(1 the: co y nghia tit quan trQng trong giai dof;Ulti&l xa• MOt sOyeu to tien luqng xiu: sut can (>10% trong luqng CO' the trong yang 3 tllBng)

bach cAuh~t tang eao• yeu to sinh hoc phan ti't:

.. Tien lU<mgxiu: dOt bien K..ras, tang bieu hien BGFR (c--erbB-l ),VEGF), c..MetdOtbienpS3 ...

.. Ti&l lUQIlgtOt: dOtbien hottt hoa EOER ...

6. TAM SoAT vA D1/ PHONG6.1. Tim S03.t: Ch\1pcit lap dien lOcinxoin be nang luqng thip (lieu 1,5 mSv so y6i 8.

mSv cho ch\1P cit lqp dien lOan lang ng\fc thuemg quy) co the duqc sir d\1UgdetAm soat phat bien sam cae t6n thgong nbo a ph6i tren dAi tugng nguOi c6 nguyco cao l1laC ung thu phOi (Urn t96i, tien ~ hutthuOc hqn3Q g6i.nmn).

6.2. DI}'phong: Bien phap phong ngira hihI hi~ nhit IS.phong chang tac h~ cUathu6clao

19

TAi lifu tham khao1) IARC. World Cancer Report 20142) DICC Manual of Clinical Oncology 8th Ed 20043) American Cancer Society Textbook of Clinical Oncology. 2nd Ed. 19954) Textbook of Lung Cancer. Hem Hansen 20085) Cancer: Principles and Practice of Oncology. De Vita. 9th Ed. 20146) Ung thu hoc lam sang, Nguy~n Ch§n Hilng. T~p 27) Evaluation of Individuals With Pulm(}fll:tl')'Nodules: When Is It Lung Cancer?

Diagnosis and Management of Lung, Cancer, 3td ed: American College of ChestPhysicians Evidence-Uased Clinical Practice Guidelines; CHEST 2013;143(S)(Suppl): e93S-e120S

8) Evaluation of Pulmonary Nodules Clinical Practice Consensus Guidelirles fOf. ,Asia.CHEST2016; 150(4):877 ..893

9) Non-Small Cell Lung Cancer-NCCNGuidelines Version 3.2018~ 11-32.10)Second ESMO consensus conference on lung cancenpathology and molecular

biomarkers for non-small-cell lung cancer; Annals of Oncology, 1681-1690, 2014,Published. online 8April 2014.

1I)The role of the Pathologist in the diagnosis. and biomarkerprofiling of Lung. Gancer;Keith M Kerr et.al.; Preoeptorship Lung Cancer2018 - ESMQ; Annals of Oncology,1798-1801,2018, Published online 3March 2018. .

12)Updated Molecular Testing Guideline for the Selection of Lung Canc~r Patients forTreatment With Targeted Tyrosine Kinase Inhibitors - Guideline From the.CollegeofAmerican Pathologists, the International Association for the Study of LUng>Caucet,and the Association for Molecular Pathology; Journal of Thoracic Oncology Vol. l~No.3: 323-358.

13)Australian recommendations for EGFR T790M testingin advanced non-small celllung cancer; Thomas JOHN~Jeffrey J BOWDEN, et al.; Asia-Pacif~ Journal ofClinical Oncology 2017; Volume 5, April 2017, 1-15.

14)WHO Classification of Tumours of The Lung, Pleura &.Thymus and Heart; Lyon2015, Intemationa! Agency for Research on Cancer, IARe Library Cataloguing inPublication Data; 5-68.

15)Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines fordiagnosis, treatment and follow-up, Annals of Oncology 27 (Supplement 5): vl-v27,2016

16)Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO ClinicalPractice Guidelines for diagnosis, treatm.ent and follow-up. Annals of Oncology 28(Supplement 4): iv l-iv21. 2017

20

PllQ L1}C: cAe PROI HQP DIEU TlU TOAN THANl)NG rmrPROI KH6NG TE BAG NlIO

1. Hoa tr] tan b6 trQ' ho~c b6 trQ':• Cisplatin SO'mg/m2 ngay 1Ya 8, vinorelbine 25 mg/m2 ngay 1,8, 15,22; chu kYm5i

2Rngayx4 chukY·• CisplatitJ. 100 mg/m2 ngay 1, vinol'elbine 30 mg/m2 ngay 1,8, 15, 22~chu kY m6i 28

ngay x 4 chu Icy.. ' .• Cisplatin 75-80 mg/m2 ngay 1, vinorelbine 25-30 mg/m2 ngay 1+8,. chu Icy m6i 21

ngay.x 4 chu kYo• Cisplatin 100mg/~2 ngay 1, etoposide.lOO mg/m2 ngay 1-3;chu lcy.l1lpi2& nga.y x 4

chuky. '• Cisplatin 75 mg/m2 ngay I, gemcitabine 1250mg/m2 ngay 1, 8; chu IcYm6i21ngay x

4~~ . '

• Cisplatin75 mg/m2 ngay 1, docetaxel 75 mg/m2 nga)' 1; chu ky m6i 18ngay x4 chuIcy.

• Cisplatin,75 mg/m2ngay 1, pemetrexed500mg/m2 ngay 1; chu Icy mal 18ngayx,4chulcy (khong phai t€ bao vAy).

Cae phAi hQ'llthay thi cho b~nh nhin dung n~pkern cisplatin:• Cai'boplatin.1\UC 6 ngay 1, paclitaxe1200 mg/m2 ngay 1, chu ky m6i 21 ngay'X 4.

chukY.• Carboplatin AUC 5 ngay 1, gemcitabine 1000 mg/m2 ngay J, 8; chu kY m6i 21 ng~y

X4chuJeY.• CarboplatihAUC 5 ngay 1, pemetrexed 500 mg/m2ngay 1, chu ley m61 21 ngay X4

chu kY (khong phai te bao yAy). "

2. Boa tri pb61hQ'P dang thPi vOix, hi• Cisplatin SOmg/m2 ngay 1, 8, 29 va 36; etoposide 50 mwm2 ngay 1-5, 29-33; ph6i

hQ'Pd6ng thm.vol x~ttl. .• Cisplatin 100 mg/m2 ngay 1 va 29; vinblastine 5 mglm2/tufut )( 5; ph6i hqp d5ng

thoi voi x~ttl. "• Carboplatin AUC 5 ngay 1; pemetrexed 500 mg/m2 ngay 1; chu kY tn6i 21 ngay ~ 4

chu kY; ph3i hero dang thm vm x~tri(kliotig t8 bao viy).• Cisplatin 75 mg/m2 ngi!y 1; pemettexed 500 mg/m2 ngay 1; chu Icym6i 21 ngay X 3

chu Icy; ph&i hQ'Pdang thai v61 x~ tri (khong t~bao va.y).{:I:dllY trl them 4 dIU IcYpemetr~xed 500 mg/m2).

---------------------------

,21

• Paclitaxe145-S0 mg/m2 m6i tuAn, catboplatin AUC 2, ph8i hQ'P d6ng thOi vOi xa tri(khong te bao viy).(± duy tri them 2 chu Icy paclitaxel 200 mg/m2 va carboplatinAUC6).

3. Hoa trj cung c6 sau hoa-x, trj a6ng tbm (giai doan ill, khong tien tri6n b~nhsau 2chu kY hoa-xa tri dAng thM)

• Durvalumab 10 mglkg IV m6i 2 tt$l cho den 12 thang·4. Di~u trj toan thin giai do~n ti@nxa (iai phMIdi can)4.1. f)i~u theo cae dich

- ....Qsi.nlertinib

- A1~- Bri at1nfbg ....

• '~i4n ~~§Rdq.ifg(1eng

~ Alect.inibo,! ..eerititl.ib

~i,~';Ate~olizumafi- Niv.olumab

- ceritiidl

•

4.2. Boa triUng thu bi2umo tuy~n, ung thn' bi@nmo t~bao lan, ung thU'bien mo kh6ng x~ptotO(tbi tl'fng tAt)• Bevacizumab/carbopiatinlpaclitaxel• Bevacizumab/carboplatinlpemetrexed• Bevacizumab/cisplatinlpemetrexed• CarboplatinlaIbumin-bound paclitaxel

• Carboplatinl docetaxel• Carboplatinletoposide• Carboplatinlgemcitabine• Carboplatinlpaclitaxel

• Carbopiatinlpemetrexed• Cisplatinldocetaxel• Cisplatinletoposide• Cisplatin/gemcitabine• Cispiatinlpaclitaxel• Cisplatinlpemetrexed• Gemcitabineldocetaxel• Gemcitabine/vinorelbine• Pembrolizumab/carbopiatinipeme1rexed

22

Ung thJt biiu rn6 tlly~n, ung thu bi@urno t~baol611, ung thu' bi~u rno khong xSp IOfi(thi tr\mg kern)

• Albumin-bound pacli~el• Carboplatinlalbum.in-bound paclitaxel

• CarboplatinfdQc~taxel• Carboplatinfetoposide• Carboplatin/gem.citljlbine• Carboplatinlpaclitaxel

• Carboplatinlpemetrexed

• Docetaxel• Gemcitabine• Gemcitabine/docetax:el• Gelllcitabme/vihoreibinepaclitaxei

• Pemetrexed

• Cisplatinldocetaxel • GemcitabineNinorelbine

• Carboplatinlalbumin ..bound paclitaxel• Carboplatinldocetaxel• Carboplatin/gemcitabine• C.arbopla~paclitaj.{el

• Cisplatinletoposide• CisplatinigemcitabiJ;le• Cisplatinlpaclitaxel• Gemcitabine/docetaxel

• Albumi1;.t-boundpaclitaxel• Carboplatinlalbumin-bound paolitaxel• Carboplatin/docetaxel• Carboplatinletoposide• Carb()platinlgemcitabine• Carboplatin/paclitaxel

• Docetaxel

• Gemcitabne,• Gemcitabineldocetaxel• Gemcitabine/vmtirelbine

• Paclitaxel

23