{"id":2079,"date":"2026-06-07T01:00:00","date_gmt":"2026-06-07T04:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2079"},"modified":"2026-06-07T01:00:00","modified_gmt":"2026-06-07T04:00:00","slug":"pgrss-pulmao-oncologico-nsclc-imunoterapia-tki-egfr-alk-sbrt-radioterapia-cancer-pulmao-targeted","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-pulmao-oncologico-nsclc-imunoterapia-tki-egfr-alk-sbrt-radioterapia-cancer-pulmao-targeted\/","title":{"rendered":"PGRSS pulm\u00e3o onc: NSCLC, IO, TKI, SBRT"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente desafiada por gestores de centros de pulm\u00e3o oncol\u00f3gico. Em 2026, h\u00e1 uma demanda crescente de hospitais com unidade pulm\u00e3o oncol\u00f3gico \u2014 NSCLC Non-Small Cell Lung Cancer<\/strong> 80-85% (adenocarcinoma + epidermoide + grandes c\u00e9lulas) com classifica\u00e7\u00e3o driver mutation EGFR \/ ALK \/ ROS1 \/ BRAF \/ KRAS-G12C \/ MET \/ RET \/ NTRK \/ HER2, SCLC Small Cell Lung Cancer<\/strong> 15-20% com extensive disease + atezolizumab Tecentriq + carboplatina + etoposide, imunoterapia checkpoint inhibitor<\/strong> pembrolizumab Keytruda + atezolizumab Tecentriq + durvalumab Imfinzi + nivolumab Opdivo + ipilimumab Yervoy + cemiplimabe Libtayo (Lista C5 R$ 18-30k\/dose \u00d7 12-35 doses), EGFR-TKI<\/strong> osimertinib Tagrisso 3\u00aa gera\u00e7\u00e3o \/ erlotinib Tarceva \/ gefitinib Iressa \/ afatinib Giotrif para EGFR+ Lista C5 R$ 12-25k\/m\u00eas, ALK-TKI<\/strong> alectinib Alecensa \/ brigatinib Alunbrig \/ lorlatinib Lorbrena para ALK+ R$ 18-32k\/m\u00eas, ROS1-TKI<\/strong> crizotinib Xalkori + entrectinib Rozlytrek + repotrectinib Augtyro, BRAF-TKI<\/strong> dabrafenib Tafinlar + trametinib Mekinist, KRAS-G12C<\/strong> sotorasib Lumakras + adagrasib Krazati, MET<\/strong> capmatinib Tabrecta + tepotinib Tepmetko, SBRT Stereotactic Body Radiation Therapy<\/strong> com Varian TrueBeam STx \/ Elekta Versa HD \/ CyberKnife Accuray para early-stage 50-60Gy\/3-5 fra\u00e7\u00f5es + proton therapy<\/strong> Hitachi\/Varian, TARE Yttrium-90<\/strong> opcional para met\u00e1stase pulmonar, EBUS-TBNA<\/strong> Olympus ViziShot diagn\u00f3stico + estadiamento. A consequ\u00eancia \u00e9 a urg\u00eancia de PGRSS dedicado para pulm\u00e3o oncol\u00f3gico<\/strong> \u2014 captura de imunoter\u00e1pico checkpoint inhibitor<\/strong> Keytruda\/Tecentriq\/Imfinzi\/Opdivo Lista C5 R$ 18-30k\/dose \u00d7 12-35 doses + cofre + cadeia fria 2-8\u00b0C + livro 344 + REMS, TKI oral comprimido\/c\u00e1psula<\/strong> Tagrisso\/Tarceva\/Alecensa\/Brigatinib\/Lorbrena\/Lumakras Lista C5 R$ 12-32k\/m\u00eas \u00d7 meses-anos com PIN dispensa\u00e7\u00e3o controlada, agulha EBUS-TBNA 21\/22G<\/strong> Olympus ViziShot R$ 800-2.5k descart\u00e1vel + frasco anatomopatologia + an\u00e1lise NGS Illumina FoundationOne CDx + Guardant360 ctDNA, acelerador linear SBRT<\/strong> Varian TrueBeam STx + colimador Multi-Leaf MLC + m\u00e1scara de imobiliza\u00e7\u00e3o + IGRT cone-beam CT + RAEE eletr\u00f4nico ao fim de vida \u00fatil 8-12 anos, fonte radioativa Co-60<\/strong> decommissioned LINAC obsoleto + RAEE m\u00e9dico CNEN, bolsa de infus\u00e3o imuno<\/strong> + cateter port-a-cath PowerPort Bard + bomba CADD-Solis, NGS panel<\/strong> FoundationOne CDx Roche + Guardant360 ctDNA descart\u00e1vel + reagente Illumina. A realidade \u00e9 que pulm\u00e3o oncol\u00f3gico produz RSS de alt\u00edssima complexidade. PGRSS de pulm\u00e3o oncol\u00f3gico \u00e9 cadeia integrada<\/strong> \u2014 come\u00e7a no diagn\u00f3stico<\/strong> (LDCT screening + biopsia EBUS + NGS + PD-L1 IHC), passa pela terapia<\/strong> (cirurgia + SBRT + IO + TKI) e termina na monitoramento<\/strong> (CT trim + ctDNA + recidiva). O conjunto soma R$ 38.000-78.000\/m\u00eas<\/strong> que muitos gestores subestimam.<\/p>\n

Para o gestor que opera ou planeja unidade pulm\u00e3o oncol\u00f3gico, \u00e9 fundamental considerar a complexidade desde o in\u00edcio.<\/p>\n

Os procedimentos pulm\u00e3o oncol\u00f3gico e os RSS espec\u00edficos<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, a cadeia gera RSS espec\u00edficos.<\/p>\n\n\n\n\n\n\n\n\n\n
Procedimento<\/th>\nInsumo cr\u00edtico<\/th>\nF\u00e1rmaco<\/th>\nRisco RSS<\/th>\n<\/tr>\n<\/thead>\n
EBUS-TBNA + NGS<\/td>\nAgulha 21\/22G + FoundationOne<\/td>\nN\u00e3o-aplic\u00e1vel<\/td>\nA4 + RAEE + NGS<\/td>\n<\/tr>\n
Imunoterapia IO<\/td>\nBolsa infus\u00e3o + port<\/td>\nKeytruda+Tecentriq+Imfinzi C5<\/td>\nA4 + B Lista C5<\/td>\n<\/tr>\n
EGFR-TKI Tagrisso<\/td>\nComprimido oral PIN<\/td>\nOsimertinib R$ 12-25k\/m\u00eas C5<\/td>\nA4 + B Lista C5<\/td>\n<\/tr>\n
ALK-TKI Alecensa<\/td>\nC\u00e1psula oral PIN<\/td>\nAlectinib\/lorlatinib R$ 18-32k C5<\/td>\nA4 + B Lista C5<\/td>\n<\/tr>\n
SBRT Varian TrueBeam<\/td>\nM\u00e1scara+IGRT+MLC<\/td>\nN\u00e3o-aplic\u00e1vel<\/td>\nRAEE + Co-60 fim vida<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 entre R$ 38.000-78.000\/m\u00eas<\/strong> em PGRSS dedicado de pulm\u00e3o oncol\u00f3gico vs R$ 14.000-28.000<\/strong> em PGRSS gen\u00e9rico subdimensionado.<\/p>\n

A imunoterapia checkpoint inhibitor: o procedimento de Lista C5 alta volumetria<\/h2>\n

A primeira camada do desafio \u00e9 a IO. Padr\u00e3o setorial inclui (a) pembrolizumab Keytruda<\/strong> Merck 200mg\/3 sem ou 400mg\/6 sem para PD-L1\u226550% + atezolizumab Tecentriq<\/strong> Roche; (b) durvalumab Imfinzi<\/strong> AstraZeneca p\u00f3s-quimiorradio est\u00e1gio III + nivolumab Opdivo + ipilimumab Yervoy<\/strong> CheckMate-9LA; (c) cemiplimabe Libtayo<\/strong> Sanofi para PD-L1\u226550%; (d) bolsa de infus\u00e3o IV<\/strong> + port-a-cath PowerPort Bard<\/strong> R$ 800-2k implante + livro RBI; (e) cofre Lista C5<\/strong> + cadeia fria 2-8\u00b0C + livro 344 + REMS.<\/p>\n

Hospital com 200-600 NSCLCs\/ano \u00d7 30-50% recebe IO \u00d7 18 doses \u00d7 R$ 25k = R$ 27M-135M\/ano em IO + cofre + cadeia fria. Como discutimos no post sobre PGRSS de oncologia geral<\/a>, Lista C5 \u00e9 estruturante.<\/p>\n

O TKI driver-targeted: o est\u00e1gio de medicina de precis\u00e3o<\/h2>\n

A segunda camada \u00e9 o TKI. Padr\u00e3o setorial inclui (a) EGFR-TKI<\/strong> osimertinib Tagrisso 3\u00aa gera\u00e7\u00e3o 80mg\/dia AstraZeneca R$ 18-25k\/m\u00eas \u00d7 24-36 meses para EGFR+ (15-20% NSCLC); (b) ALK-TKI<\/strong> alectinib Alecensa Roche \/ brigatinib Alunbrig Takeda \/ lorlatinib Lorbrena Pfizer R$ 18-32k\/m\u00eas para ALK+ (3-7% NSCLC); (c) ROS1-TKI<\/strong> crizotinib Xalkori \/ entrectinib Rozlytrek \/ repotrectinib Augtyro; (d) KRAS-G12C<\/strong> sotorasib Lumakras Amgen R$ 25-35k\/m\u00eas + adagrasib Krazati MRTX; (e) PIN dispensa\u00e7\u00e3o controlada<\/strong> + REMS teratogenicidade + intera\u00e7\u00e3o medicamentosa.<\/p>\n

Hospital com 100-300 NSCLCs com driver mutation\/ano \u00d7 R$ 22k\/m\u00eas \u00d7 18 meses = R$ 40-120M\/ano em TKI + cofre + REMS.<\/p>\n

A SBRT + RAEE acelerador: o est\u00e1gio radioter\u00e1pico de precis\u00e3o<\/h2>\n

A terceira camada \u00e9 a SBRT. Padr\u00e3o setorial inclui (a) acelerador linear LINAC<\/strong> Varian TrueBeam STx \/ Elekta Versa HD \/ CyberKnife Accuray R$ 8-25M equipamento; (b) colimador Multi-Leaf MLC<\/strong> + IGRT cone-beam CT + m\u00e1scara imobiliza\u00e7\u00e3o termopl\u00e1stica; (c) dose SBRT<\/strong> 50-60Gy em 3-5 fra\u00e7\u00f5es para early-stage T1-T2N0 inoper\u00e1vel; (d) proton therapy<\/strong> Hitachi PROBEAT \/ Varian ProBeam para casos seletos R$ 80-150M centro; (e) fim de vida \u00fatil LINAC<\/strong> 8-12 anos com decommissioning + Co-60 fonte residual + RAEE m\u00e9dico CNEN.<\/p>\n

Hospital com 100-300 SBRTs\/ano \u00d7 R$ 50-150 mantenimento\/ano + descomissionamento LINAC = R$ 5-15M ciclo de vida.<\/p>\n

Tr\u00eas perfis de PGRSS para pulm\u00e3o oncol\u00f3gico<\/h2>\n

PGRSS gen\u00e9rico subdimensionado.<\/strong> Sem cobertura espec\u00edfica para IO + TKI + SBRT + RAEE LINAC. Custo mensal R$ 14.000-28.000<\/strong>, efic\u00e1cia limitada.<\/p>\n

PGRSS dedicado intermedi\u00e1rio.<\/strong> Cobertura para IO + TKI, sem SBRT + decommissioning LINAC. Custo mensal R$ 28.000-52.000<\/strong>, efic\u00e1cia 100-200%.<\/p>\n

PGRSS dedicado completo pulm\u00e3o oncol\u00f3gico.<\/strong> IO + TKI + SBRT + decommissioning + integra\u00e7\u00e3o com PGRSS de tor\u00e1cica<\/a>. Custo mensal R$ 52.000-78.000<\/strong>, ROI 250-500%.<\/p>\n

Os tr\u00eas erros que aparecem em PGRSS pulm\u00e3o oncol\u00f3gico subdimensionado<\/h2>\n

O primeiro \u00e9 o subdimensionamento de IO Lista C5 alta volumetria<\/strong>. R$ 18-30k\/dose \u00d7 12-35 doses + cofre + cadeia fria + livro 344.<\/p>\n

O segundo \u00e9 a aus\u00eancia de PIN + REMS para TKI oral<\/strong>. Tagrisso\/Alecensa\/Lumakras com dispensa\u00e7\u00e3o controlada + teratogenicidade.<\/p>\n

O terceiro \u00e9 o descarte de LINAC fim de vida como Grupo D<\/strong>. Acelerador 8-12 anos com Co-60 residual + RAEE m\u00e9dico CNEN obrigat\u00f3rio.<\/p>\n

A regula\u00e7\u00e3o de PGRSS no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com pulm\u00e3o oncol\u00f3gico como prioridade. As institui\u00e7\u00f5es que estruturam PGRSS dedicado desde o in\u00edcio \u2014 alinhadas com calend\u00e1rio 2026 de compliance<\/a> \u2014 atravessam o crescimento sem solavanco. Para gestores que precisam alinhar com gest\u00e3o paralela industrial, o portal Seven Res\u00edduos sobre servi\u00e7os completos<\/a> traz a perspectiva integrada. A SBPT Sociedade Brasileira de Pneumologia e Tisiologia<\/a> \u00e9 refer\u00eancia t\u00e9cnica.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS de pulm\u00e3o oncol\u00f3gico<\/a><\/strong> \u2014 cap\u00edtulo dedicado a IO Keytruda\/Tecentriq\/Imfinzi\/Opdivo Lista C5, EGFR-TKI Tagrisso + ALK-TKI Alecensa\/Lorbrena + KRAS-G12C Lumakras, SBRT Varian TrueBeam + Elekta Versa HD + CyberKnife, NGS FoundationOne CDx + Guardant360.<\/p>\n","protected":false},"excerpt":{"rendered":"

Pulm\u00e3o oncol\u00f3gico gera RSS espec\u00edfico \u2014 NSCLC, imunoterapia, TKI, SBRT. PGRSS dedicado.<\/p>\n","protected":false},"author":3,"featured_media":2078,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2069,2893,2892,2894],"class_list":["post-2079","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-imunoterapia","tag-nsclc","tag-pulmao-oncologico","tag-sbrt"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2079","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/comments?post=2079"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2079\/revisions"}],"predecessor-version":[{"id":4265,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2079\/revisions\/4265"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2078"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2079"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2079"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2079"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}