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What I Really Do: BAC and Slowly Progressing Cancers

August 27, 2008 - 5:03 pm

   In the last few years BAC has become increasingly studied and recognized as a distinct clinical subtype of lung cancer.  The classic BAC syndrome is characterized by progression limited to the lungs, and its growth can be quite variable.  The definition of BAC based on pathology has been applied pretty variably: although it should […]

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What I Really Do: Advanced Lung Cancer in Never-Smokers (LCINS)

August 25, 2008 - 7:33 pm

  We’re recognizing more and more that lung cancer in never-smokers (LCINS) is a distinct disease, with different patterns of who gets it, how the cancer behaves, and it responds  to treatments.  But this recognition is still a work in progress, coming from a background in which the party line has been that NSCLC is […]

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What I Really Do: First Line Treatment for Avastin Ineligible Patients

August 23, 2008 - 8:52 am

   As I mentioned in another post, one of the first branch points in the decision tree about what I recommend as treatment for fit patients with previously untreated advanced NSCLC is the question of eligibility for avastin.   Although I do routinely recommend avastin for eligible patients, they aren’t the majority; instead, I would estimate that population ineligible for avastin due […]

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What I Really Do: First Line Advanced NSCLC, Avastin Eligible Patients

August 22, 2008 - 7:14 pm

   As I described in a recent post introducing the concept of the series, “What I really do”, I wanted to provide a summary of how interpret the evidence I show here, how I really approach real life patients.    Some of this will illustrate that the experts don’t agree 100%, and that we all add […]

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Actions Speak Louder than Words: When Pathology and the Clinical Picture Don’t Fit

August 13, 2008 - 7:54 pm

   I’ve been involved in a wide range of discussions, both here and in my own clinical, about the fairly common situation of how to approach a situation in which the story on paper and what you see actually happening are incompatible.  For instance, last week I and several of my colleagues participated in a […]

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What follow up should patients have after surgery for early lung cancer?

August 10, 2008 - 8:12 am

   This is my first post on this wonderful site.
   Recently I saw a patient who had undergone surgery for stage II Non-Small Cell Lung Cancer and was receiving chemotherapy with another cancer doctor. He came to me for a second opinion. Among the questions he had was what tests should he get after completing all his […]

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Pre-Operative Chemotherapy as an Alternative to Post-Operative Chemo: Evidence of Stage-Dependent Survival Benefit

July 13, 2008 - 8:08 am

  In contrast with post-operative chemotherapy, which has become a standard treatment approach to reduce the probability of recurrence of resected stage II and IIIA NSCLC (still pretty controversial for stage IB), pre-operative chemotherapy (also known as neoadjuvant, or induction chemotherapy) is less well studied and isn’t a typical approach.  However, a recent study called ChEST, the […]

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Long-Term Risk with Adjuvant Chemo

July 11, 2008 - 7:07 pm

   Over the past few years, the role of post-operative, also known as adjuvant, chemo has become increasingly accepted as a standard of care.  Several trials have shown an improvement in survival at about 5 years that is in the 5-15% range for recipients of chemo.  However, the evidence indicates that the people at higher […]

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Surgery for Small Cell Lung Cancer?

June 29, 2008 - 1:19 pm

   One topic that is rarely considered in the management of SCLC is the role of surgery.  The main reason is that the vast majority of patients presenting with SCLC either have extensive disease that has spread throughout the body (2/3 of SCLC presentations) or at least already have rather bulky nodal disease that would […]

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Removing Lymph Nodes During NSCLC Surgery: “How Does It Play in Peoria?”

June 17, 2008 - 1:57 am

   In the past couple of posts we’ve seen that based on evidence from Japan and Rome, number of lymph nodes resected and also the absolute number of positive nodes and/or proportion of positive nodes may be important prognostic variable.  A third abstract I reviewed on the same subject came from Peoria, IL, and illustrated […]

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