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The Argument For A Non-Surgical Standard of Care for Stage IIIA N2 NSCLC

June 29, 2007 - 2:51 pm

   In my last post I covered much of the controversy about whether patients with stage IIIA, N2-node positive NSCLC should be treated with induction therapy (chemotherapy or chemo/radiation) followed by surgery, or an alternative approach of chemo along with radiation delivered at a definitive dose (curative, not just the supplemental, lower doses used in induction therapy).   In […]

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The Great Debate: Should Surgery be the “Standard of Care” for Stage IIIA NSCLC with Mediastinal Nodes?

June 28, 2007 - 9:20 pm

  It’s over, and I won (did you doubt me?).  As I mentioned in a recent prior post, today I spoke at the Eighth International Lung Cancer Congress, where I was assigned the topic of speaking in favor of chemo/radiation as the more appropriate standard of care, with the opposing view, that surgery is the […]

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Chemotherapy for Mesothelioma

June 26, 2007 - 12:32 am

   For many years, patients with malignant pleural mesothelioma (MPM) were often not offered treatment.  Surgery was offered to rare, selected patients who tended to be much younger and more fit than a typical patient with MPM, but we’ll talk about surgery later.  Chemotherapy was only very inconsistently offered to the vast majority of unresectable […]

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Introduction to Malignant Pleural Mesothelioma

June 25, 2007 - 12:16 am

  We haven’t covered this on OncTalk yet, but it’s a real shortcoming that I haven’t discussed malignant pleural mesothelioma (MPM).  Although it’s not exactly lung cancer, it’s another chest cancer that is often managed by thoracic oncology specialists like myself, and the only reason I haven’t introduced it until now is that it’s such an unusual cancer, accounting for just 2000-3000 cases […]

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Surgery or No Surgery: What Would You Choose?

June 23, 2007 - 7:38 am

   I’m heading off today to Hawaii (Maui), which I must hasten to add is for a conference, the Eighth International Lung Cancer Congress, not just a vacation, although working in Hawaii often seems better than time off at home.  The meeting not only includes a lot of good lectures and debates, but it gives […]

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Individualizing Chemotherapy Regimens for NSCLC

June 21, 2007 - 10:08 pm

   One of the central ideas in management of advanced NSCLC is that many two-drug chemo combinations have been compared and show essentially superimposable results, as I described in a prior post. 
 (click to enlarge) 
Perhaps we’re underachieving by using a “one size fits all” approach, getting everyone to a middle ground that falls short of what we might do […]

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Prophylactic Cranial Irradiation (PCI) for ED-SCLC

June 19, 2007 - 10:43 pm

  As I described in prior post, prophylactic cranial irradiation (PCI) is established as a treatment approach for patients with LD-SCLC who have had a complete or “good partial” response to chemo and radiation.  Some physicians also recommend PCI for patients with ED-SCLC who have experienced a very good response, since about 10% of the patients on […]

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Genetics, Family History, and Lung Cancer

June 17, 2007 - 9:25 pm

   Many members have asked questions about increased risk of lung cancer among family members of people who have developed lung cancer.  Overall, I have not highlighted this, partly because we don’t tend to highlight genetics as a major contributor of lung cancer risk.  But the fact is that 10-15% of people who develop lung […]

12 Comments

Serum Tumor Markers in Lung Cancer Management

June 16, 2007 - 10:47 am

   I’ve been meaning to write on tumor markers detectable in the blood for the management of lung cancer.   These are proteins that are produced by some tumors, and the idea is that the levels of the tumor markers in the blood can potentially be used to monitor the status of the disease.  For prostate-specific antigen in […]

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MAGE-A3 as a Vaccine Target in NSCLC

June 14, 2007 - 10:53 pm

   One of the more intriguing presentations at ASCO this year was the one in which a novel vaccine against a protein called MAGE-A3 was tested in patients who underwent surgery and then received the vaccine post-operatively.  What is MAGE-A3?  It’s a nearly tumor-specific antigen, which means that it’s a protein seen almost exclusively on […]

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