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SWISS TUMOR BOARD Lung Cancer March 26, 2009 Novotel Bern

SWISS TUMOR BOARD Lung Cancer March 26, 2009 Novotel Bern. Prof. Dr. Mahmut Ozsahin. Lausanne University Medical Center (CHUV), Lausanne. Case #3 R. Morant. 63-year-old woman, limited medical condition 5-cm mass in the left superior lobe, bihilar LAP ≤ 1 cm, 5-mm hepatic lesion

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SWISS TUMOR BOARD Lung Cancer March 26, 2009 Novotel Bern

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  1. SWISS TUMOR BOARDLung CancerMarch 26, 2009Novotel Bern Prof. Dr. Mahmut Ozsahin Lausanne University Medical Center (CHUV), Lausanne

  2. Case #3R. Morant • 63-year-old woman, limited medical condition • 5-cm mass in the left superior lobe, bihilar LAP ≤ 1 cm, 5-mm hepatic lesion • PET: lung mass + ipsilateral hilar LAP, no liver lesion • Moderately differentiated NSCLC (squamous-cell), cT2N1M0, clinical stage IIB • Surgery: left lobectomy (upper and apical inferior lobe), pT2pN2 (6+/36), R0 but close margins; stage IIIA • Board recommended postop RT/CT; patient refused RT, she received 6 cycles of paclitaxel/carboplatin • Patient NED after 5 years

  3. Intermediate stage II NSCLC Surgery alone evidence level B To have clear margins level A Operation by trained surgeon level A Postop RT for R1, R2 or pN2 level C Adjuvant chemotherapy level A Adjuvant RT for R0 level D Neoadjuvant chemo + RT level D Scott, Chest 2003 American College of Chest Physicians

  4. The role of RT in operable NSCLC Postop RT To eliminate microscopic disease (positive margins, pN1,and pN2), or R2 disease Neoadjuvant RT + CT To increase pathological response; therefore, to obtain more R0 resections Final goal To increase survival by increasing loco-regional control

  5. The role of postoperative RT in NSCLC PORT Meta-Analysis Trialists (PMT) Group Lancet, 1998 9 randomized studies Significant decrease in local failure 562 patientsstage I, 7 of 9 studies using Co60, poor RT techniques, different levels of dose, variation in dose/fr., poor staging, etc.

  6. The role of postoperative RT in NSCLC PORT Meta-Analysis Trialists (PMT) Group Lancet, 1998 Increased risk of toxic death (cardio-pulmonary toxicity) Adverse effect of PORT is: Greatest for patients with stage I/II, pN0-pN1 disease Benefit (?) for stage III, pN2 disease

  7. Stage IIIA NSCLC Mediastinal LND evidence level A Neoadjuvant chemo + RT level B If unresectable  continue RT + CT level A Surgery level C Postop RT for R1-2 level B Postop RT for R0 level C Maintenance chemotherapy level I Robinson, Chest 2003 American College of Chest Physicians

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