@ElliotServaisMD @DrewMoghanaki @JackWestMD @IASLC @JTOonline @DoctorJSpicer @FordePatrick @finn_corinne @shalinivinod13 @n8pennell @CharuAggarwalMD @StevenLin_MDPhD @StephenVLiu @ekslim @NitinOhri3 @LindaMThoracic @BrendonStilesMD @FarhoodFarjah @NateEvansMD @BorisSepesi @TomVargheseJr @jdoningtonmd 2/technical resectability: can this disease actually be fully removed with negative margins?
This is really a nexus between tumor characteristics & surgical capacity. Certainly, there can be some subjectivity to this but it is not totally in the eye of the beholder. @ElliotServaisMD @DrewMoghanaki @JackWestMD @IASLC @JTOonline @DoctorJSpicer @FordePatrick @finn_corinne @shalinivinod13 @n8pennell @CharuAggarwalMD @StevenLin_MDPhD @StephenVLiu @ekslim @NitinOhri3 @LindaMThoracic @BrendonStilesMD @FarhoodFarjah @NateEvansMD @BorisSepesi @TomVargheseJr @jdoningtonmd 3/physiologic resectability: can this patient in front of me tolerate this surgery safely?
This can be at the nexus of patient lung function, physiology & overall fitness for sugery as well the type of operation required. It can also be influenced by surgical capacity (ie NiVATS)

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

https://twitter.com/drewmoghanaki/status/1340813506036330496

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

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

https://twitter.com/DrewMoghanaki/status/1340496253545820161

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

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

https://twitter.com/drewmoghanaki/status/1250370638726017026

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