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Gene Signatures to Predict Benefit from Adjuvant Chemo

July 17, 2008 - 7:11 pm

  I had described earlier this week (prior post here) how the long-term follow up of one of the more important adjuvant chemotherapy trials for early stage resected NSCLC patients showed that there may be long-term adverse effects of chemotherapy.  My last post also suggested that the benefit of pre-operative chemotherapy in another trial appeared […]

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More Work with Neoadjuvant (Pre-Op) Chemotherapy: The SWOG Experience

July 15, 2008 - 5:29 am

   In my last post I described the results of the ChEST trial that showed a borderline statistically significant improvement in survival of patients who received cisplatin/gemcitabine chemotherapy for stage IB to IIIA NSCLC prior to surgery.  This study was very similar to another neoadjuvant chemotherapy trial, known as SWOG 9900, which also randomized patients […]

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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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Concerns About Surgery for Lung Cancer in the US: A Hard Look in the Mirror

June 18, 2008 - 11:45 pm

  As a conclusion to the string of posts on the topic of lymph nodes removed at the time of surgery, I wanted to touch on the issue of what our representative experience is in the US, because I described the results of specialized centers in Japan and Italy that typically yielded large numbers of […]

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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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Importance of Number of Lymph Nodes Removed at NSCLC Surgery

June 14, 2008 - 11:47 am

   In the last post I discussed some interesting work from a group in Japan that suggested that the number of lymph nodes that are removed and positive for NSCLC may be a very important prognostic variable, potentially an even more important factor than location of the nodes, which is the basis for how we stage nodal involvement in […]

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Is Number of Positive Lymph Nodes in Resected NSCLC Important for Prognosis?

June 12, 2008 - 9:30 pm

   At this year’s ASCO meeting, I had the opportunity to review and provide commentary on several presentations from other researchers, all on the topic of how to refine our ability to predict how patients will do after surgery for stage I - IIIA NSCLC, with an idea that this information can help guide decisions […]

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Outcomes of Resecting Solitary Adrenal Mets: The “Precocious Metastasis” Revisited

April 18, 2008 - 8:37 pm

   I’ve previously described the concept of the “precocious metastasis”, the situation in which a patient presents with early stage NSCLC, except for a single metastasis, most typically in the brain or adrenal gland (see prior post).  Our conventional teaching is that a patient with any metastatic disease almost certainly has additional micrometastatic disease, cancer […]

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