What is your preferred approach for stage III NSCLC with single station N2 disease amenable to lobectomy?
What are the major factors that impact your decision? If you opt for surgery, what factors impact your decision to offer RT preoperatively vs. postoperatively?
Answer from: Radiation Oncologist at Academic Institution
The question of how to handle operable IIIA patients with limited N2 disease has always been controversial, and the new PACIFIC data just makes it more complicated.At some level, it becomes a duel of unplanned subset analysis and a bit of apples to oranges, which is always to be taken with a grain o...
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Radiation Oncologist at OSF Saint Anthony's Health Center-Alton I agree with Cliff to all of the above. And especi...
Answer from: Radiation Oncologist at Community Practice
Our Intergroup trial of C/RT pre-op or C/RT to full (61Gy) was reported initially to have better PFS. The improved OS never emerged. Some claim the high mortality with pneumonectomy among group surgeons (inexperience, skill deficit), but others claim that the subset having lobect...
Answer from: Radiation Oncologist at Community Practice
Though not randomized, the data from Vyfhuis, et. al reported the outcomes of stage III patients treated to full dose CRT followed by surgery, or those treated with bimodality treatment (either planned or unplanned). The median survival for patients treated with trimodality therapy was ~60 months. T...
Answer from: Radiation Oncologist at Community Practice
Durvulumab is only approved in the definitive setting after chemoradiation. It's a real home run as the follow up data continues to mature from the Pacific trial.
No clear OS benefit to surgery so imo all these patients should be getting chemo/rt+Durvulumab for optimal outco...
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Medical Oncologist at Cancer Care Specialists/Renown Oncology/UNR Agree with chemoXRT-> Durva
Answer from: Radiation Oncologist at Academic Institution
Another complication is that, at least, in my neighborhood, thoracic surgeons will NOT do thoracoscopic lobectomy and lymphadenectomy AFTER preoperative radiotherapy. Many surgeons are no longer interested in doing open surgery at all!Therefore, a very likely scenario we see is that ...
I agree with Cliff to all of the above. And especi...