1/Sorry, my friend. I’m not seeing the logical connection between your question/premise & the evidence you quoted. Can you please clarify?
Your premise is that cN0 patients should not get invasive mediastinal staging. Your evidence focuses on benefits of adjuvant therapy. #tssmn
2/the whole point of invasive med staging is to ensure that patients with ⬆️likelihood of having N2 disease are directed towards upfront/definitive systemic therapy rather than non-SOC upfront/definitive local therapy. Thus, evidence should focus on Neoadjuvant therapy #tssmn
3/consider this :
do you think it’s ok to go directly to surgery or #SBRT for 6cm highly PET-avid #lungcancer which is cN0 on PET/CT, without EBUS?
@MaldonadoFabien @DanSteinfort @OtisBRickman @PulmCCM @IASLC @thoracic @ThoracicsCanada #tssmn
4/I’ll wait ....
Sorry...I always wanted an opportunity to use that gif

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Biniam Kidane

Biniam Kidane Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @biniamkidaneMD

21 Dec
1/ i was afraid you were hanging your argument on this calculation from @DrAlexLouie (of whom I’m a fan) but this is irrelevant to our current discussions...for so many reasons. Most importantly, these numbers are for clinical stage 1 #lungcancer not our 6cm cN0 mass #tssmn
2/all cancers meeting guideline criteria for invasive mediastinal staging are usually not clinical stage 1 & thus your numbers (even if we accept them as being valid) do not apply. #tssmn
3/most importantly however, these patients with N2 disease are not allowed to get best therapy for their stage upfront (ie systemic therapy). Mediastinal staging is all about how to get #lungcancer patients to the best first therapy (ie neoadjuvant vs upfront local Rx) #tssmn
Read 5 tweets
15 Apr
1/important to understand the realities that have driven our pivot to this protocol
-surgery is SOC
-these healthy & operable patients want surgery for many reasons (including known longterm cure rates)
-surgery is being delayed/cancelled due to #covid19 as is invasive staging
2/
-#sbrt can offer safer therapy while preserving PPE & ⬇️ risk during #covid19
-patients can elect to undergo #sbrt as bridge to surgery
-they can elect not to undergo surgery later
-surgery will allow for appropriate nodal staging & resection as per SOC...& answer🔑questions
3/
-randomization may be something that can be considered in future but these are not patients that are considering #sbrt vs surgery:these patients want surgery but it is either not possible,delayed or highly risky during #covid19
-MISSILE has shown us safety of this approach
Read 5 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!