SWISS TUMOR BOARD Lung Cancer March 26, 2009 Novotel Bern Prof. Dr. Mahmut Ozsahin Lausanne...
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Transcript of SWISS TUMOR BOARD Lung Cancer March 26, 2009 Novotel Bern Prof. Dr. Mahmut Ozsahin Lausanne...
SWISS TUMOR BOARDLung Cancer
March 26, 2009Novotel Bern
Prof. Dr. Mahmut Ozsahin
Lausanne University Medical Center (CHUV), Lausanne
Case #1N. Mach
• Male patient, 79-yr-old
• Left lower lobe tumor (2.2 cm)
• PET: single + lesion (SUV 8) LLL
• Bronchoscopy (–)
• Percutaneous transthoracic bx: not done
• Diagnosis: cT1N0M0 lung cancer (stage I vs. infection (less unlikely)
• Decision: Observation**Patient refused surgery and radiotherapy
Case #1N. Mach
• Surgery is the standard treatment for stage I/II NSCLC
• If surgery not possible, localized RT
• Bad pulmonary function stereotactic extracranial RT (or Tomotherapy®, Cyberknife®, Novalis®) would be proposed (even without histological confirmation)
• No prospective comparison (medically inoperable patients)
Early operable NSCLC (stage IA, IB)
Surgery alone evidence level B
To have clear margins level A
Operation by trained surgeon level A
RT or re-excision for R1, R2 level B
Neo- or adjuvant RT for R0 level D
Adjuvant chemotherapy (stage IB) level B
Neoadjuvant chemotherapy level I
Smythe, Chest 2003
American College of Chest Physicians
RT is treatment of choice in medically inoperable or refusing patients (evidence level B).
5-yr. OS = 30% (meta-analysis)
No randomized comparison between RT vs. supportive care
Rowell, Thorax 2001
Early inoperable NSCLC (stage IA, IB)
Tomotherapy
Stereotactic RT
1x 30 Gy
3 months 6 months
Cybeknife
3x20 Gy
Case #1N. Mach
• Progression 9 months later
• NSCLC, non squamous; 5-cm mass LLL, no lymph node metastases
• Left pneumonectomy, pT2N1M0, re-stage IIB
• If R0, no indication for postoperative RT
• However, adjuvant chemotherapy is indicated (depending on medical conditions): IALT, European Big Lung, ALPI, ANITA, and meta-analysis (Pignon et al, J Clin Oncol 2008)
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
Intermediate stage II NSCLC