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Although the role of upfront surgery may be debated, it is less controversial in the patient with oligometastatic disease, the speakers agreed. Is it defined as a patient with three liver. Is it defined by stage—M1a vs M1b vs M1c vs M1d? Most clinicians would not, for instance, view multiple liver metastases as oligometastatic disease, but some surgeons believe they can resect them all, Dr.
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Kudchadkar commented. Being able to define oligometastatic disease helps to determine whether surgery is needed upfront, she said. Surgery needs to be moved to the salvage setting or into treatment of residual disease, rather than in the upfront setting.
The decision to perform surgery should be made via a multidisciplinary discussion, the speakers said, agreeing enrollment in a clinical trial is always the first choice. Otherwise, Dr. For resectable oligometastases, surgery either before or after systemic therapy is a reasonable option.
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According to Dr. Lowe, patients with unresectable disease should go straight to systemic therapy, with surgery considered for those with a good response or oligoprogression after treatment. In patients with widespread disease, surgery should be reserved for palliation.
Kudchadkar said that outside of a trial, she considers surgery for patients with stage III disease and for those who have comorbidities that limit their ability to receive systemic therapy or who have no other good systemic therapy options. Other issues to consider are the ability to achieve R0 resection, the potential for surgical morbidity, and the disease-free interval. If the disease-free interval is short, the patient is not likely to fare well and needs systemic therapy upfront, added Dr.
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Kudchadkar emphasized the role of surgery in other settings, such as in treating residual disease after immunotherapy and locoregional disease progression after systemic therapy. Surgery has always been useful for palliating symptomatic metastases. Its future will be as an adjunct to neoadjuvant therapy, which is now the subject of clinical trials, Dr. Kudchadkar concluded. Lowe reported no conflicts of interest. Debate 2. Presented July 28, Another factor that influenced survival was the use of pemetrexed-based chemotherapies in ALK lung cancer.
Often, in addition to targeted therapy with ALK inhibitors, patients will undergo chemotherapy and sometimes radiation. However, there are many chemotherapies to choose from, and it is often unclear which specific chemotherapies are most successful with specific cancers, stages, and patient characteristics. Ross Camidge, MD, PhD, who is also senior author of the current study, suggested that pemetrexed works especially well against the ALK form of the disease.
Interestingly, the existence of brain metastases at time of diagnosis did not predict shorter survival. And we're doing more careful surveillance of patients to see when they develop brain mets - instead of waiting for symptoms and then treating, we're monitoring for the development of metastases with imaging of the brain and if we see something new, we sometimes treat it before it causes symptoms," Pacheco says.
The most predictive factor of shorter survival was the number of organs that were found to carry cancer at the time of diagnosis. And I think it suggests that for some types of NSCLC, it may become much more of a chronic condition rather than a terminal disease. English Spanish. Login Register. Haematology oncology. Hepatobiliary pancreatic. News Sign up for news alerts Submit your news. News Latest news. Sub-category All.