This document discusses controversies around treating oligometastatic non-small cell lung cancer (NSCLC) with systemic therapy versus surgery. It reviews evidence that local ablative therapies like surgery and stereotactic body radiotherapy (SBRT) may cure a minority of patients with oligometastatic NSCLC, especially those with few metastases, longer disease-free intervals, and complete resection of metastases. However, the evidence is limited and does not allow for clear recommendations. The decision to use local ablative therapies depends on a case-by-case clinical judgment weighing factors like patient health, number/location of metastases, and whether ablation can render all visible disease.
2017 ASCO RECAP: The Latest in Colorectal Cancer Research #CRCWebinarFight Colorectal Cancer
Don’t miss our recap webinar from the American Society of Clinical Oncology Annual Conference (ASCO) where we discuss the latest research and treatments for colorectal cancer patients presented during the conference.
Dr. Dustin Deming, a medical oncologist and Fight CRC Medical Advisory Board Member will guide us through his findings. Dr. Deming brings a unique perspective as a researcher, oncologist and colorectal cancer survivor. In this webinar we will dive into the research and explain what it means for those living with colorectal cancer.
2017 ASCO RECAP: The Latest in Colorectal Cancer Research #CRCWebinarFight Colorectal Cancer
Don’t miss our recap webinar from the American Society of Clinical Oncology Annual Conference (ASCO) where we discuss the latest research and treatments for colorectal cancer patients presented during the conference.
Dr. Dustin Deming, a medical oncologist and Fight CRC Medical Advisory Board Member will guide us through his findings. Dr. Deming brings a unique perspective as a researcher, oncologist and colorectal cancer survivor. In this webinar we will dive into the research and explain what it means for those living with colorectal cancer.
This class covers what all physicians need to know about colorectal cancer (except prevention and screening, dealt with elsewhere). It is exceedingly simple, but accurate to the best of my knowledge. It is based on Harrison's 19th, Edition.
Author: Dr Christa Maria Joel
Module: Effects of lifestyle on health
Supervisor: Ms Jane Tobias and Dr Daniel Boakye
University of the West of Scotland
Neoadjuvant Chemoradiation in Borderline resectable pancreatic adenocarcinomaDr.Bhavin Vadodariya
Comprehensive review of evidence in Neoadjuvant Chemoradiation in Borderline resectable pancreatic adenocarcinoma which includes classification of pancreatic cancer.
Dr. Dustin Deming led us through a discussion on the latest research and treatments for colorectal cancer patients presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
A few of the topics covered include research on immunotherapy and trials studying:
– MSI-H (review of the Anti-PD-1 trial)
– HER2 amplification
– BRAF mutations
For more updates on colorectal cancer research, visit our blog: http://fightcolorectalcancer.org/category/research-treatment/
This class covers what all physicians need to know about colorectal cancer (except prevention and screening, dealt with elsewhere). It is exceedingly simple, but accurate to the best of my knowledge. It is based on Harrison's 19th, Edition.
Author: Dr Christa Maria Joel
Module: Effects of lifestyle on health
Supervisor: Ms Jane Tobias and Dr Daniel Boakye
University of the West of Scotland
Neoadjuvant Chemoradiation in Borderline resectable pancreatic adenocarcinomaDr.Bhavin Vadodariya
Comprehensive review of evidence in Neoadjuvant Chemoradiation in Borderline resectable pancreatic adenocarcinoma which includes classification of pancreatic cancer.
Dr. Dustin Deming led us through a discussion on the latest research and treatments for colorectal cancer patients presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
A few of the topics covered include research on immunotherapy and trials studying:
– MSI-H (review of the Anti-PD-1 trial)
– HER2 amplification
– BRAF mutations
For more updates on colorectal cancer research, visit our blog: http://fightcolorectalcancer.org/category/research-treatment/
This study aimed to compare the overall and disease specific survivals of patients who underwent laparoscopic and open resection of colorectal cancer in a high volume tertiary center.
advancements in the diagnostics help detect states like oligometastasis ,which can lead to selection of patients for local and MDT and prolong the time to adjuvant therapy, at present There is no consensus on the treatment of oligometastatic cancer and clinical trials can help in evidence formation.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
4. CONTROVERSIAS: CANCER DE PULMON
OLIGOMETASTÁSICO
(TRATAMIENTO SISTÉMICO Vs CIRUGÍA)
Mauricio Lema Medina MD – Clínica de oncología Astorga,
Clínica SOMA, Medellín
ACHO, Bogotá, 29.07.2016
TERAPIA ABLATIVA
5. Oligometastases
“A clinical state of metastasis termed ‘oligometastases’ that refers to
restricted tumor metastatic capacity”
“The implication of this concept is that local cancer treatments are
curative in a proportion of patients with metastases.”
“Usually reserved to 1-3 discreet metastases (1-6 in some cohorts).
Ralph R. Weichselbaum and Samuel Hellman (1995)
Weichselbum RR, Nature Review Clin Oncol, 2011
6. Local ablative therapy for oligometastatic NSCLC
Feasibility: Can it be (safely) done? Crop: What is the yield?
Profit: Is it worth it?
8. Page 8
Colon cancer literature
Liver resection
Pulmonary resection
9. Weichselbum RR, Nature Review Clin Oncol, 2011
In colorectal cancer, liver metastasectomy for both, synchronous
and metachronous, resectable hepatic metastases is a standard
of care.
10. Long-term results of lung metastasectomy: prognostic
analyses based on 5206 cases
Pastorino U, J Thorac Cardiovasc Surg. 1997 Jan;113(1):37-49.
Study design Internationa Registry
Patient population Lung metastasectomy
Enrolled 5206
Complete surgical resection 4572 (88%)
Epithelial 2260
Actuarial 5-yr OS for complete resection 36%
Actuarial 10-yr OS for complete resection 26%
Actuaial 5-yr OS for incomplete resection 13%
5-yr OS for 0-11 months disease-free interval 33%
5-yr OS for disease-free interval longer than 36 months 45
5-yr OS for single lesion 43%
5-yr OS for more than 4 lesions 27%
These results confirm that lung metastasectomy is a safe and potentially curative
procedure.
12. Lung metastasectomy
Lung metastasectomy may cure some
patients with lung metastases,
especially those with single-lesion
metastatic disease, longer disease-free
interval, and in those in which
complete resection was achieved.
Weichselbum RR, Nature Review Clin Oncol, 2011
13. Laparoscopic transperitoneal lateral adrenalectomy
for malignant and potentially malignant adrenal
tumours
Pedziwiater, M, BMC Surg. 2015; 15: 101.
52 patients, 7 with NSLC
14. The American Society of Radiation
Oncology defines SBRT as external
beam radiotherapy used to deliver
a high dose of radiation very
precisely to an extracranial target
within the body, as a single dose or
a small number of fractions
20. Stereotactic body radiotherapy (SBRT) for high-
risk central pulmonary metastases
Lischalk JW et al. Radiat Oncol. 2016; 11: 28.
Study design Cohort
Patient population “High-risk” central pulmonary metastases treated with
SBRT
Enrolled 20
NSCLC 7/20
Isolated intrathoracic disease 35%
Surgery and CT 60% and 75%
1-yr local control rate 70%
1-yr overall survival 75%
Bone (mOS, mo) 4.3 (* poor prognosis by MVA)
Five-fraction SBRT to a total dose of 35 or 40 Gy appears to be a safe and effective
management strategy for high-risk central pulmonary metastatic lesions, though
care should be taken to limit the maximum point dose to the mainstem bronchus.
21. CyberKnife robotic image-guided stereotactic
radiotherapy for oligometastic cancer : A
prospective evaluation of 95 patients/118 lesions.
Jereczek-Fossa BA. Strahlenther Onkol. 2013; 448-55.
Study design Cohort
Patient population Metastatic cancer with 1-5 metastases, amenable to
SBRT
Enrolled 95 patients /118 lesions
Evaluable lesions 87
3-yr In-field PFS 67.5%
3-yr PFS 18.4%
3-yr OS 31.2%
CBK-SRT is a feasible therapeutic approach for oligometastastic cancer patients that
provides long-term in-field tumor control with a low toxicity profile. Further
investigations should focus on dose escalation and optimization of the combination
with systemic therapies.
23. Local ablative therapy for oligometastatic NSCLC
Crop: What is the yield?
Lung cancer literature
24. Surgical Treatment of Extrapulmonary
Oligometastatic Non-small Cell Lung Cancer
Plones T, Indian J Surgery, 2012
Study design Retrospective chart review
Patient population NSCLC + resected synchronous metastases
Screened 56
Evaluable 50
Median OS (mo) 14.6
Soft-tissue metastases (mOS, mo) 23.4
Brain metastases (mOS, mo) 16.7
Adrenal gland (mOS, mo) 9.5
Bone (mOS, mo) 4.3 (* poor prognosis by MVA)
25. Surgical Treatment of Estrapulmonary
Oligometastatic Non-small Cell Lung Cancer
Plones T, Indian J Surgery, 2012
Study design Retrospective chart review
Patient population NSCLC + resected synchronous metastases
Screened 56
Evaluable 50
Median OS (mo) 14.6
Soft-tissue metastases (mOS, mo) 23.4
Brain metastases (mOS, mo) 16.7
Adrenal gland (mOS, mo) 9.5
Bone (mOS, mo) 4.3 (* poor prognosis by MVA)
26. Phase II Trial of Stereotactic Body Radiation Therapy Combined
With Erlotinib for Patients With Limited but Progressive
Metastatic Non–Small-Cell Lung Cancer
Conclusion Use of SBRT with erlotinib for unselected patients with stage IV NSCLC as a second- or
subsequent line therapy resulted in dramatic changes in patterns of failure, was well tolerated, and resulted
in high PFS and OS, substantially greater than historical values for patients who only received systemic
agents.
Iyegar, P, JCO, 2014
Study design Phase II Trial
Patient population NSCLC after 1st-Line CT failure, 1-6non-CNS metastases,
ALL amenable to SBRT
Intervention Erlotinib + SBRT
Endpoint 6-mo PFS of 20%, or more
Patients enrolled 24
Number of metastatic sites 52
# with more than 1 site 16/24
Median PFS (mo) 14.7
Median OS (mo) 20.4
In-field recurrence 3/47 (evaluable) lesions
Grade 4 toxicities (n) 0
EGFR mutation + 0/13
27. Phase II Trial of Stereotactic Body Radiation Therapy Combined
With Erlotinib for Patients With Limited but Progressive
Metastatic Non–Small-Cell Lung Cancer
Iyegar, P, JCO, 2014
28. Phase II Trial of Stereotactic Body Radiation Therapy Combined
With Erlotinib for Patients With Limited but Progressive
Metastatic Non–Small-Cell Lung Cancer
Iyegar, P, JCO, 2014
29. Metastasectomy in Lung Cancer
The evidence of ablative therapies for
metastases in lung cancer is limited,
restricted to (very) small cohorts.
30. Local ablative therapy for oligometastatic NSCLC
Crop: What is the yield?
Lung cancer literature
32. Age 56
Histology Adenocarcinoma
EGFR/ALK EGFR+
Metastases Single lesion
Disease-free interval (PFS) 3-years
Resectability Surgical / SBRT
Comorbidities None-minimal
PS 0
Age 75
Histology Squamous
EGFR/ALK Unmutated
Metastases Single lesion
Disease-free interval 2-months
Resectability SBRT
Comorbidities COPD-oxygen-dependent
PS 1
Good patient, good disease
Could be better patient, good disease
33. Age 56
Histology Adenocarcinoma
EGFR/ALK Unmutated
Metastases 2-3 lesions
Disease-free interval 3-years
Resectability Surgical / SBRT
Comorbidities None-minimal
PS 0
Age 75
Histology Squamous
EGFR/ALK Unmutated
Metastases 2-3 lesions
Disease-free interval 2-months
Resectability SBRT
Comorbidities COPD-oxygen-dependent
PS 1
Good patient, so-so disease
Could be better patient, so-so disease
34. Age 56
Histology Adenocarcinoma
EGFR/ALK Unmutated
Metastases More than 3 lesions
Disease-free interval 3-years
Resectability Surgical / SBRT
Comorbidities None-minimal
PS 0
Age 75
Histology Squamous
EGFR/ALK Unmutated
Metastases More than 3 lesions
Disease-free interval 2-months
Resectability SBRT
Comorbidities COPD-oxygen-dependent
PS 1
Good patient, bad disease
Could be better patient, bad disease
35. Age 56
Histology Adenocarcinoma
EGFR/ALK EGFR+
Metastases Single lesion
Disease-free interval 3-years
Resectability Surgical / SBRT
Comorbidities None-minimal
PS 0
Good patient, good disease
Surgery
SBRT + Erlotinib
Anti EGFR
36. Age 75
Histology Squamous
EGFR/ALK Unmutated
Metastases Single lesion
Disease-free interval 2-months
Resectability SBRT
Comorbidities COPD-oxygen-dependent
PS 1
Could be better patient, good disease
SBRT + Erlotinib
37. Good patient, so-so disease
Could be better patient, so-so disease
56, adenocarcinoma, unmutated, 2-3 lesions, DFI interval, No
comorbidities, PS 0
75, squamous, unmutated, 2-3 lesions, 2 moth DFI interval,
Severe COPD, PS 1
Surgery
SBRT
CT: 1-yr OS
38. Good patient, bad disease
Could be better patient, bad disease
56, adenocarcinoma, unmutated, more than 3 lesions, DFI
interval, No comorbidities, PS 0
75, squamous, unmutated, more than 3 lesions, 2 moth DFI
interval, Severe COPD, PS 1
CT: 1-yr OS
Sandler A, et al. N Engl J Med. 2006;355:2542-2550.
Scagliotti et al., J Clin Oncol 2008; 26:3543-3551
40. Local ablative therapy for oligometastatic NSCLC
Feasibility: Can it be (safely) done? Crop: What is the yield?
Profit: Is it worth it?
41. Ablative therapies for
metastatic NSCLC may
help a minority of
patients.
Poor evidence precludes
clear-cut recommendations
It boils down to clinical judgement, availability
and patient preference in those few patients
with 1-3 oligometastases that can be rendered
R0 with surgery of SBRT.