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Case Discussion with Drs. Blumenschein and Curran: Trying to Interpret Imaging after Chemo/Radiation
Here is the second case in my expert round table discussion on locally advanced NSCLC with medical oncologist Dr. George Blumenschein froMD Anderson Cancer Center and radiation oncologist Dr. Walter Curran from Emory University.
We focus in this case on the decision of which patients with a Pancoast tumor should undergo surgery or a nonsurgical approach of chemo/radiation, the challenge of trying to define the right time to repeat scans after chemo/radiation in locally advanced NSCLC, and we also debate the merits of close observation vs. further interventions in the face of worrisome but still ambiguous imaging findings.
I’ll add that I do find it instructive how varied the advocated treatment approaches are among the various experts when discussing not only this case but so many others I present. These are admittedly challenging cases that don’t fit into any “classic” treatment approach, but these discussions of the range of alternatives offered by experts from so many places speaks to the fact that there is rarely one best strategy.
As always, here is the podcast in both audio and video formats, along with the transcript and figures.
imaging-issues-after-chemoradiation-case-blumenschein-curran-audio-podcast
imaging-issues-after-chemoradiation-case-blumenschein-curran-transcript
imaging-issues-after-chemoradiation-case-blumenschein-curran-figures
Our final case in this discussion series, which will follow shortly, is of someone who has locally advanced NSCLC on the outer reaches of what we can feasibly treat with curative intent.
This program is supported by an educational grant from OSI Pharmaceuticals. We thank them for their support.
Podcast: Play in new window | Download (37.9MB) | Embed
3 Responses to Case Discussion with Drs. Blumenschein and Curran: Trying to Interpret Imaging after Chemo/Radiation
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Thank you for posting this. I learned a great deal from your experience, and the opinions of the commenters, who were great as well.
A lot of information, all very relevant. As usual, for a patient, it’s useful to hear doctors talking amongst themselves, and understand the process. The last comment was revealing–about the difference between reviewing a case history and working with the patient. All three doctors seemed in agreement that they want to go beyond standard-of-care with a patient who has a lot of life left to live. I also found the central discovery very interesting. Exactly how the image interpretation is uncertain in this case, how the consequences of that can be serious, and the constraints around choices.
Why does a patient want to know all this? It helps with trust in one’s oncologist, or maybe lack of trust. Also, patients are often, I think, offered choices. There is not time in the examining room for a complete education. Sometimes even when a choice is not explicitly offered, a patient does well to thoroughly examine and probe what the team of doctors is recommending. This effort on the patient’s part leads to some fine tuning of the treatment, or even a serious reconsideration.
David Fourer.
I really appreciate these case discussions: All the knowledge – and also the knowledge of what we do not know…