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84-year-old with poor pulmonary function, smoking history, and recent thromboembolic event
Underwent serial CT scans with these findings
PET Positive there at SUV 10.1
FNA performed: Result C/W NSCLC
Patient considered unsuitable for lobectomy due to co-morbidities
2. Wedge Resection (VATS or Not)?
3. Radiofrequency Ablation?
4. Systemic Therapy?
Chemo or Oral TKI?
5. Radiosurgical Ablation?
The patient received SBRT at 18 Gy times 3 without difficulty. On six -month follow-up, CT chest revealed a new moderate-sized ipsilateral pleural effusion and “scarring” at the primary tumor.
This pleural effusion should be:
Drained and Treated
Evaluated with PET
Evaluated with Thoracoscopy
Treated with Chemotherapy
Walter J Curran, Jr, MD
Winship Cancer Institute of Emory University
Radiation Therapy Oncology Group
Potentially highly effective
Potentially extremely dangerous
Non-small cell lung cancer - biopsy proven
T1, T2 ( 5 cm) and T3 (chest wall only, 5 cm), N0, M0
Medical problems precluding surgery(e.g. emphysema, heart disease, diabetes)
No other planned therapy
Robert Timmerman, MD; Rebecca Paulus, BS; James Galvin, PhD; Jeffrey Michalski, MD; William Straube, PhD; Jeffrey Bradley, MD; Achilles Fakiris, MD; Andrea Bezjak, MD; Gregory Videtic, MD;David Johnstone, MD; Jack Fowler, PhD; Elizabeth Gore, MD; Hak Choy, MD
Japanese Pooled Retrospective Experience with SBRT in OPERABLE Patients
Rogerio C Lilenbaum, MD
Mark A Socinski, MD
Co-Chair and Moderator
Neil Love, MD
Walter J Curran Jr, MD
David Jablons, MD
Mark G Kris, MD
Suresh Ramalingam, MD
Alan B Sandler, MD