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
4/finally,it’s illogical to malign existing guidelines as being based on outdated/irrelevant data while in the next breath invoking data from an era even older than that which you are maligning.
I say this in spirit of respect & friendship➡️I’m happy to be corrected if I’ve erred
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More from @biniamkidaneMD

20 Dec
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
Read 4 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

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