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There is a principle in management of lung cancer that some patients who have a very limited degree of metastatic disease or progression after a good response may do unusually well with local treatment, such as radiation or surgery, for the isolated area(s) of disease that are metastatic or growing.
For early stage NSCLC, the historic standard of care is a lobectomy. But the reality is that with the median age of patients with new lung cancer a little over 70 and many patients quite sick from their lung cancer, COPD, and/or other medical problems, not every patient is a great candidate for surgery.

Good morning, GRACErs.
Plenary
This is part 2 of my round table case discussion with Dr. Anne Tsao, a medical oncologist and thoracic oncology expert from MD Anderson Cancer Center in Houston, and Dr. Alex Farivar, a thoracic surgeon with expert training in mesothelioma at Swedish Cancer Institute in Seattle. This particular case covers a patient with a mesothelioma, cancer of the lining around the lung, which is also known as malignant pleural mesothelioma.
Here is the audio and video versions of the podcast, along with the transcript and figures.
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I'm very happy to present an audio interview with Dr. Eric Vallières, an excellent thoracic surgeon and Surgical Director of the Lung Cancer Program at Swedish Cancer Institute. Within the lung cancer community, he actually happens to be among the most well known thoracic surgeons in the country and even world, and he has a major expertise in the integration of chemotherapy and other systemic therapies for early stage lung cancer.
Historically, surgery for lung cancer has been through an open thoracotomy (thorax = chest; otomy = cutting/slicing), which involves a long incision around the side of the chest, removal of ribs, and spreading of the remaining ribs to get a good view of the area of the operation. Even with the most skilled surgeons, it's a procedure that is rigorous for a patient to get through and has a recovery period typically of weeks.
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