BOOK
Lung Cancer: A Practical Approach to Evidence-Based Clinical Evaluation and Management
Lynn T. Tanoue | Frank C Detterbeck
(2018)
Additional Information
Book Details
Abstract
Get a quick, expert overview of the many key facets of lung cancer evaluation and management with this concise, practical resource by Drs. Lynn T. Tanoue and Frank Detterbeck. This easy-to-read reference presents a summary of today’s best evidence-based approaches to diagnosis and management in this critical area.
- Covers diagnosis and evaluation, treatment considerations, and comprehensive care options for patients with lung cancer.
- Provides insight on evidence for today’s best practices, as well as future directions in the field.
- Consolidates today’s evidence-based information on the clinical aspects of lung cancer into one convenient resource.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Lung Cancer: A Practical Approach to Evidence-Based Clinical Evaluation and Management | i | ||
| Lung Cancer: A Practical Approach to Evidence-Based Clinical Evaluation and Management | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Introduction | ix | ||
| REFERENCES | x | ||
| Contents | xi | ||
| I - DIAGNOSIS AND EVALUATION | 1 | ||
| 1 - The Asymptomatic Patient With a Pulmonary Nodule | 1 | ||
| INTRODUCTION | 1 | ||
| EPIDEMIOLOGY OF THE PULMONARY NODULE | 1 | ||
| ETIOLOGY OF THE PULMONARY NODULE | 2 | ||
| IMAGING OF PULMONARY NODULES | 2 | ||
| DESCRIBING A PULMONARY NODULE | 2 | ||
| The Solid Nodule | 2 | ||
| The Subsolid Nodule | 5 | ||
| DEFINING NODULE GROWTH | 7 | ||
| ASSESSING CANCER RISK | 9 | ||
| Patient Characteristics | 9 | ||
| Computed Tomography | 9 | ||
| Fluorodeoxyglucose Positron Emission Tomography | 9 | ||
| Models of Lung Cancer Risk: Historical Perspective | 10 | ||
| Current Models | 10 | ||
| Mayo Clinic67 | 10 | ||
| Herder81 | 14 | ||
| VA (Veterans' Administration)82 | 14 | ||
| Peking University People's Hospital86,89 | 14 | ||
| Brock83 | 14 | ||
| Thoracic research evaluation and treatment calculator84 | 14 | ||
| Bayesian inference malignancy calculator85 | 14 | ||
| COMPARING RISK MODEL PERFORMANCE | 15 | ||
| GUIDELINES FOR MANAGEMENT OF THE PULMONARY NODULE | 16 | ||
| COST ANALYSIS OF EVALUATION STRATEGIES | 17 | ||
| Models of Cost-Effectiveness for the Solitary Pulmonary Nodule | 18 | ||
| EVALUATION OF THE SUBCENTIMETER NODULE | 19 | ||
| EVALUATION OF MULTIPLE NODULES | 25 | ||
| Multiple Solid Nodules | 26 | ||
| Multiple Ground-Glass Nodules | 26 | ||
| Multiple Nodules With a Dominant Lesion | 26 | ||
| METHODS TO DIAGNOSE THE SOLID PULMONARY NODULE (﹥8MM) | 26 | ||
| Bronchoscopy-Guided Lung Biopsy | 26 | ||
| Transthoracic Needle Lung Biopsy | 28 | ||
| BIOMARKERS TO ASSESS THE PULMONARY NODULE | 28 | ||
| Overview | 28 | ||
| The Next Generation of Risk Stratification Models | 29 | ||
| Quantifying Added Benefit | 29 | ||
| THE FUTURE OF PULMONARY NODULE EVALUATION | 31 | ||
| REFERENCES | 32 | ||
| 2 - Evaluation of the Patient With a Radiographic Abnormality Suspicious for Lung Cancer | 39 | ||
| INTRODUCTION | 39 | ||
| What Defines a Suspicious Nodule? | 39 | ||
| Making a Clinical Diagnosis: What Tests Do I Order and Why? | 42 | ||
| Methods of Tissue Acquisition | 43 | ||
| How Do I Manage Intermediate-Risk Nodules? | 45 | ||
| How Do I Evaluate High-Risk Nodules? | 46 | ||
| Clinical example 1: The patient with an isolated lung nodule with high clinical suspicion of malignancy | 47 | ||
| Clinical example 2: The patient with a lung nodule and hilar or mediastinal adenopathy by CT imaging, or the patient with a ... | 48 | ||
| Clinical example 3: The patient with a suspicious lesion in the lung, with or without hilar or mediastinal adenopathy, and ... | 49 | ||
| Clinical example 4: The patient in whom there is clinical suspicion of malignancy based on the index nodule with or without ... | 50 | ||
| Clinical example 5: The patient with a high-risk lung nodule who is a high-risk surgical candidate | 51 | ||
| Other Presentations of Lung Cancer | 51 | ||
| CONCLUSION | 53 | ||
| REFERENCES | 53 | ||
| 3 - The Eighth Edition Lung Cancer Stage Classification | 57 | ||
| INTRODUCTION | 57 | ||
| DERIVATION OF STAGE CLASSIFICATION | 57 | ||
| INFORMING THE STAGE CLASSIFICATION | 57 | ||
| STAGING PREFIXES | 58 | ||
| Additional Notation | 59 | ||
| TNM COMPONENTS | 59 | ||
| T Component | 59 | ||
| N Component | 61 | ||
| M Component | 61 | ||
| STAGE GROUPS | 61 | ||
| THE IMPACT OF MULTIPLE-STAGE DESCRIPTORS AND THE STAGE DESIGNATION | 61 | ||
| MULTIPLE PULMONARY SITES OF LUNG CANCER | 63 | ||
| PRACTICE CONSIDERATIONS | 64 | ||
| Caution: Revisions of Stage Classification | 64 | ||
| Caution: Prognosis | 65 | ||
| CONCLUSION | 65 | ||
| REFERENCES | 65 | ||
| II - TREATMENT CONSIDERATIONS | 67 | ||
| 4 - Treatment of Early-Stage Non–Small Cell Lung Cancer (Stage I and II) | 67 | ||
| INTRODUCTION | 67 | ||
| SURGICAL TREATMENT | 67 | ||
| Surgical Principles | 67 | ||
| Lobectomy | 68 | ||
| Minimally invasive approach | 68 | ||
| Lobectomy variations | 68 | ||
| Pneumonectomy | 68 | ||
| Segmentectomy | 68 | ||
| Wedge Resection | 71 | ||
| Brachytherapy with sublobar resection | 71 | ||
| Lymph Node Evaluation | 71 | ||
| THE ROLE OF ADJUVANT THERAPY IN EARLY-STAGE LUNG CANCER | 72 | ||
| Adjuvant Chemotherapy | 72 | ||
| N0 tumors ≤3cm (eighth ed. stage IA) | 72 | ||
| N0 tumors ﹥3cm (eighth ed. stage T2,3,4 N0 M0) | 74 | ||
| N1 tumors (eighth ed. stage T1-4 N1 M0) | 74 | ||
| Adjuvant Radiation Therapy | 74 | ||
| Tumors Invading the Chest Wall | 75 | ||
| Adjuvant Therapy After Incomplete Resection | 75 | ||
| THE ROLE OF SBRT FOR TREATMENT OF STAGE I NON–SMALL CELL LUNG CANCER | 76 | ||
| NONSURGICAL THERAPY IN STAGE II NON–SMALL CELL LUNG CANCER | 78 | ||
| SUMMARY | 78 | ||
| REFERENCES | 78 | ||
| 5 - Curative Intent Treatment of Stage III Non–Small Cell Lung Cancer | 83 | ||
| BACKGROUND | 83 | ||
| STAGE CLASSIFICATION AND PATTERNS OF CARE | 83 | ||
| TREATMENT FOR STAGE III NON–SMALL CELL LUNG CANCER | 84 | ||
| What Is the Natural History of Untreated Stage III Non–Small Cell Lung Cancer? | 84 | ||
| What Is the Benefit of Combined Treatment With Chemotherapy and Radiation Therapy for Stage III Non–Small Cell Lung Cancer? | 86 | ||
| What Is the Optimal Chemotherapy Regimen? | 86 | ||
| What Is the Optimal Radiation Dose and Technique? | 86 | ||
| How Should Elderly or Poor Performance Status Patients Be Managed? | 89 | ||
| What Is the Role of Consolidative Chemotherapy After Chemoradiation? | 89 | ||
| What Is the Role of Induction Chemotherapy Before Chemoradiation? | 89 | ||
| Is Radiation Better Than Observation? | 89 | ||
| STAGE III NON–SMALL CELL LUNG CANCER TREATMENT: SPECIAL SITUATIONS | 90 | ||
| Discrete (Limited) Mediastinal Nodal Involvement | 90 | ||
| T3N1 or T4N0/1 Disease (No Mediastinal Involvement) | 91 | ||
| Superior Sulcus Tumors | 92 | ||
| Infiltrative Stage III (N2-3) Non–Small Cell Lung Cancer | 92 | ||
| ADJUVANT THERAPY AFTER SURGERY | 93 | ||
| Adjuvant Chemotherapy | 93 | ||
| Adjuvant Radiation Therapy | 93 | ||
| SPECIAL TREATMENT CONSIDERATIONS | 93 | ||
| Isolated Chest Recurrence | 93 | ||
| Prophylactic Cranial Radiation | 93 | ||
| CONCLUSION | 95 | ||
| REFERENCES | 95 | ||
| 6 - Management of Advanced Non–Small Cell Lung Cancer: Noncurative Intent Treatment | 99 | ||
| INTRODUCTION | 99 | ||
| CHEMOTHERAPY | 99 | ||
| Platinum Selection—Carboplatin Versus Cisplatin | 99 | ||
| Selection of the Second Cytotoxic Agent | 101 | ||
| Nonsquamous histology | 101 | ||
| Addition of bevacizumab | 101 | ||
| Maintenance therapy | 101 | ||
| Squamous histology | 102 | ||
| Maintenance therapy | 102 | ||
| Second-Line Chemotherapy | 102 | ||
| All histologies: docetaxel with or without ramucirumab | 103 | ||
| Nonsquamous histology: pemetrexed | 103 | ||
| Squamous histology: afatinib | 103 | ||
| TARGETED THERAPY | 103 | ||
| Epidermal Growth Factor Receptor | 103 | ||
| First-generation tyrosine kinase inhibitors | 103 | ||
| Erlotinib | 103 | ||
| Gefitinib | 104 | ||
| Second-generation epidermal growth factor receptor tyrosine kinase inhibitor | 104 | ||
| Choice of epidermal growth factor receptor tyrosine kinase inhibitor | 105 | ||
| Resistance to epidermal growth factor receptor tyrosine kinase inhibitors | 105 | ||
| Osimertinib | 105 | ||
| ALK Gene Rearrangement | 106 | ||
| Crizotinib | 106 | ||
| Next-generation ALK inhibitors | 106 | ||
| Ceritinib | 106 | ||
| Alectinib | 106 | ||
| ROS1 | 107 | ||
| Other Mutations | 107 | ||
| BRAF | 107 | ||
| IMMUNOTHERAPY | 107 | ||
| PD-1/PD-L1 Pathway | 108 | ||
| First-line immunotherapy | 108 | ||
| Pembrolizumab | 108 | ||
| Second-line immunotherapy | 110 | ||
| Pembrolizumab | 110 | ||
| Nivolumab | 110 | ||
| Atezolizumab | 111 | ||
| Anticytotoxic T-lymphocyte Antigen Pathway | 111 | ||
| Immunotherapy Combinations | 111 | ||
| SPECIAL SITUATIONS | 112 | ||
| Oligometastatic Disease and Role of Local Therapy for a Discordantly Growing Single Site | 112 | ||
| CONCLUSION | 112 | ||
| REFERENCES | 112 | ||
| 7 - A Practical Approach to Management of Small Cell Lung Cancer | 117 | ||
| DIAGNOSIS AND WORKUP | 117 | ||
| SMALL CELL LUNG CANCER STAGING | 117 | ||
| LIMITED-STAGE SMALL CELL LUNG CANCER (BOX 7.1) | 118 | ||
| Combined Chemoradiation for Limited-Stage Small Cell Lung Cancer With Nodal Disease | 118 | ||
| Choice of Chemotherapy | 118 | ||
| Optimal Duration of Chemotherapy | 118 | ||
| Timing of Radiation | 118 | ||
| Prophylactic Cranial Irradiation | 119 | ||
| Limited-Stage Small Cell Lung Cancer With No Nodal Involvement—The Role of Surgery | 119 | ||
| EXTENSIVE-STAGE SMALL CELL LUNG CANCER (BOX 7.2) | 119 | ||
| First-Line Treatment | 119 | ||
| Choosing carboplatin versus cisplatin in extensive-stage small cell lung cancer | 120 | ||
| The role of other agents in combination with cisplatin for treatment of extensive-stage SCLC | 121 | ||
| Role of Maintenance Treatment | 122 | ||
| Prophylactic Cranial Irradiation | 122 | ||
| Risk associated with prophylactic cranial irradiation | 122 | ||
| Role of Thoracic Radiation in Extensive-Stage Small Cell Lung Cancer | 123 | ||
| Second-Line Treatment | 123 | ||
| Topotecan | 123 | ||
| Irinotecan | 123 | ||
| Paclitaxel | 123 | ||
| Temozolomide | 123 | ||
| Immunotherapy | 124 | ||
| NEW TREATMENTS ON THE HORIZON | 124 | ||
| Advances in Understanding Small Cell Lung Cancer Biology | 126 | ||
| REFERENCES | 126 | ||
| 8 - Special Types of Lung Cancer | 131 | ||
| PANCOAST TUMORS | 131 | ||
| Introduction | 131 | ||
| Pathology | 131 | ||
| Clinical Features | 132 | ||
| Stage Classification | 132 | ||
| Diagnostic Workup and Stage Evaluation | 132 | ||
| Treatment | 133 | ||
| Limitations to Resection | 134 | ||
| Summary | 134 | ||
| CARCINOID TUMORS | 134 | ||
| Classification | 134 | ||
| Paraneoplastic Syndromes | 135 | ||
| Radiologic Features | 135 | ||
| Positron emission tomography and octreotide scanning | 135 | ||
| Clinical Diagnosis | 135 | ||
| Clinical Workup and Treatment | 136 | ||
| Central tumor cN0 | 137 | ||
| Central tumor cN1/cN2 | 137 | ||
| Peripheral tumor cN0 | 137 | ||
| Peripheral tumor cN1 or N2 | 137 | ||
| Prognosis | 137 | ||
| Surgical Issues | 138 | ||
| Surveillance | 138 | ||
| Summary | 138 | ||
| MULTIPLE PULMONARY SITES OF CANCER | 139 | ||
| Classification | 139 | ||
| Approach to Workup and Treatment | 141 | ||
| General approach | 141 | ||
| Second primary lung cancers | 141 | ||
| Separate tumor nodules | 141 | ||
| Multifocal ground-glass/lepidic lesions | 142 | ||
| Pneumonic type of adenocarcinoma | 143 | ||
| Summary | 143 | ||
| REFERENCES | 143 | ||
| 9 - Follow-Up and Surveillance of the Lung Cancer Patient After Treatment | 147 | ||
| INTRODUCTION | 147 | ||
| FOLLOW-UP AND SURVEILLANCE AFTER CURATIVE-INTENT THERAPY FOR NON–SMALL CELL LUNG CANCER | 147 | ||
| Radiographic Surveillance Following Curative-Intent Surgery | 147 | ||
| Computed tomography | 147 | ||
| Functional imaging | 149 | ||
| Other imaging modalities | 150 | ||
| Radiographic Surveillance After Curative-Intent Radiation Therapy | 150 | ||
| Radiographic surveillance after stereotactic body radiation therapy for early-stage lung cancer | 150 | ||
| Radiographic Surveillance After Curative-Intent Treatment of Locally Advanced Lung Cancer | 152 | ||
| ADDITIONAL SURVEILLANCE ISSUES AFTER CURATIVE-INTENT THERAPY | 152 | ||
| Responsibility for Follow-Up and Surveillance | 152 | ||
| Duration of Surveillance | 152 | ||
| The Role of Tumor Markers | 153 | ||
| CARCINOID TUMORS | 153 | ||
| SUMMARY | 153 | ||
| REFERENCES | 153 | ||
| III - ORGANIZATION, QUALITY, AND EFFICIENCY OFCARE DELIVERY | 157 | ||
| 10 - Organization of Lung Cancer Care | 157 | ||
| INTRODUCTION | 157 | ||
| THE MULTIDISCIPLINARY THORACIC ONCOLOGY PROGRAM AND MULTIDISCIPLINARY TUMOR CONFERENCE | 158 | ||
| Measuring the Effectiveness of Multidisciplinary Care | 159 | ||
| INVOLVING THE PRIMARY CARE PROVIDER IN LUNG CANCER CARE | 160 | ||
| PALLIATIVE MEDICINE | 161 | ||
| INCORPORATING LUNG CANCER GUIDELINES | 162 | ||
| PATIENT NAVIGATION | 162 | ||
| Navigating the Care of the Complex Patient | 162 | ||
| CONCLUSION | 163 | ||
| REFERENCES | 163 | ||
| 11 - Achieving Better Quality of Lung Cancer Care | 167 | ||
| INTRODUCTION | 167 | ||
| EFFICIENCY OF PATIENT EVALUATION | 168 | ||
| QUALITY OF DIAGNOSTIC AND CLINICAL STAGE EVALUATION TEST INTERPRETATION | 172 | ||
| QUALITY OF DECISION-MAKING | 174 | ||
| QUALITY OF PATHOLOGIC STAGE CLASSIFICATION | 174 | ||
| COMPONENTS OF A HIGH-QUALITY TUMOR BOARD AND TUMOR BOARD DISCUSSION | 176 | ||
| CONCLUSION | 177 | ||
| REFERENCES | 178 | ||
| IV - ADDITIONAL COMPONENTS OFCOMPREHENSIVE CARE | 183 | ||
| 12 - Tobacco Use Disorder and Treatment | 183 | ||
| TOBACCO USE AND DISORDER | 183 | ||
| TOBACCO USE AND LUNG CANCER RISK AND OUTCOMES | 183 | ||
| ADDRESSING TOBACCO USE AND DISORDER IN LUNG CANCER PATIENTS | 184 | ||
| Model for Assessing and Treating Tobacco Use Disorder | 184 | ||
| Treating Tobacco Use Disorder as a Chronic Disease | 186 | ||
| Behavioral Interventions for Tobacco Use and Disorder | 188 | ||
| Pharmacologic Interventions for Tobacco Use and Disorder | 188 | ||
| Nicotine replacement therapy | 190 | ||
| Varenicline | 191 | ||
| Bupropion SR | 191 | ||
| Combination therapy | 191 | ||
| Special Treatment Considerations | 191 | ||
| Pairing tobacco treatment with lung cancer screening | 191 | ||
| TOBACCO TREATMENT FOR LUNG CANCER PATIENTS UNDERGOING SURGERY, CHEMOTHERAPY, AND/OR RADIATION THERAPY | 192 | ||
| Areas of Controversy—Tobacco Harm Reduction | 192 | ||
| Electronic nicotine delivery systems/electronic cigarettes | 192 | ||
| Snus | 193 | ||
| SUMMARY AND KEY POINTS | 193 | ||
| REFERENCES | 193 | ||
| 13 - Healthy Patients at Risk for Lung Cancer: Whether, How, and Who to Screen | 197 | ||
| SHOULD I REFER PATIENTS FOR LUNG CANCER SCREENING? | 197 | ||
| Benefit | 197 | ||
| Harms | 198 | ||
| Balance | 199 | ||
| WHO SHOULD I REFER FOR LUNG CANCER SCREENING? | 200 | ||
| HOW DO I DISCUSS THE BENEFIT AND HARMS OF LUNG CANCER SCREENING WITH MY PATIENTS? | 202 | ||
| HOW SHOULD THE COMPUTED TOMOGRAPHY SCAN BE PERFORMED? | 202 | ||
| HOW SHOULD THE COMPUTED TOMOGRAPHY SCAN BE REPORTED? | 203 | ||
| HOW SHOULD SCREEN-DETECTED LUNG NODULES BE MANAGED? | 203 | ||
| HOW SHOULD INCIDENTAL FINDINGS ON THE SCREENING EXAMINATION BE MANAGED? | 205 | ||
| HOW SHOULD SMOKING CESSATION BE INCORPORATED INTO A LUNG CANCER SCREENING PROGRAM? | 205 | ||
| HOW CAN YOU ENSURE COMPLIANCE WITH FOLLOW-UP AND ANNUAL SCREENING? | 205 | ||
| HOW SHOULD YOU GET INFRASTRUCTURE SUPPORT FOR YOUR SCREENING PROGRAM? | 206 | ||
| SUMMARY | 206 | ||
| REFERENCES | 206 | ||
| 14 - Symptom Management in Lung Cancer | 209 | ||
| HOW DO YOU MANAGE CANCER PAIN? | 209 | ||
| Special Circumstances: Bone Pain | 211 | ||
| Special Circumstances: Brain Metastases | 211 | ||
| HOW DO YOU APPROACH CANCER PATIENTS WITH DYSPNEA? | 212 | ||
| How Do You Manage Dyspnea in Patients With Pleural Effusions? | 213 | ||
| What Options Are Available to Relieve Symptomatic Central Airway Obstruction? | 214 | ||
| How Do You Evaluate and Manage Pulmonary Toxicity From Cancer Treatment? | 215 | ||
| Comorbid Cardiopulmonary Disease | 216 | ||
| Narcotics for Dyspnea | 216 | ||
| PARANEOPLASTIC SYNDROMES | 216 | ||
| SUMMARY | 218 | ||
| REFERENCES | 218 | ||
| 15 - Diagnosis and Management of Treatment-Related Pulmonary Complications | 221 | ||
| INTRODUCTION | 221 | ||
| PULMONARY COMPLICATIONS OF MEDICAL THERAPIES FOR LUNG CANCER: SYSTEMIC CHEMOTHERAPY AND IMMUNOTHERAPY | 221 | ||
| Signs and Symptoms of Drug-Induced Lung Disease | 223 | ||
| The Role for Bronchoalveolar Lavage and Lung Biopsy | 223 | ||
| MANAGEMENT OF DRUG-INDUCED PNEUMONITIS | 224 | ||
| Conventional Chemotherapy Agents | 224 | ||
| Cisplatin and carboplatin | 224 | ||
| Pemetrexed | 225 | ||
| Etoposide and teniposide | 225 | ||
| Gemcitabine | 225 | ||
| Paclitaxel and docetaxel | 225 | ||
| Irinotecan and topotecan | 226 | ||
| Other chemotherapy agents | 226 | ||
| Antiangiogenic Therapy: Bevacizumab | 226 | ||
| Genotype-Directed Targeted Therapies | 227 | ||
| Epidermal growth factor receptor inhibitors | 227 | ||
| Anaplastic lymphoma kinase inhibitors | 227 | ||
| Other mutation-specific therapies | 228 | ||
| Immunotherapy Agents: Nivolumab, Pembrolizumab, and Atezolizumab | 228 | ||
| Epidemiology of immunotherapy-related lung disease | 229 | ||
| Risk factors for immunotherapy-related lung disease | 229 | ||
| Signs and symptoms of immunotherapy-induced lung disease | 229 | ||
| General approach to diagnosis and management of immunotherapy-related pneumonitis | 230 | ||
| COMPLICATIONS OF RADIATION THERAPY | 232 | ||
| Signs and Symptoms of Radiation Therapy–Induced Lung Disease | 232 | ||
| Risk Factors and Prevention | 235 | ||
| General Approach to Management of Radiation Therapy–Related Pulmonary Toxicity | 235 | ||
| SUMMARY | 236 | ||
| REFERENCES | 237 | ||
| V - PERSPECTIVES | 243 | ||
| 16 - Reflections on the Present and Future State of Lung Cancer Research and Management | 243 | ||
| THE CHANGING NATURE OF LUNG CANCER | 243 | ||
| CHANGES IN EPIDEMIOLOGY | 244 | ||
| CHANGES IN CLINICAL RESEARCH | 245 | ||
| CHALLENGES WE FACE TODAY AND TOMORROW | 247 | ||
| WHERE DOES THIS LEAVE US? | 247 | ||
| REFERENCES | 248 | ||
| Index | 251 | ||
| A | 251 | ||
| B | 252 | ||
| C | 252 | ||
| D | 253 | ||
| E | 254 | ||
| F | 254 | ||
| G | 254 | ||
| H | 254 | ||
| I | 255 | ||
| J | 255 | ||
| K | 255 | ||
| L | 255 | ||
| M | 256 | ||
| N | 257 | ||
| O | 257 | ||
| P | 258 | ||
| Q | 259 | ||
| R | 259 | ||
| S | 259 | ||
| T | 260 | ||
| U | 261 | ||
| V | 261 | ||
| W | 262 | ||
| X | 262 | ||
| Z | 262 |