With regards to the articles attached.
The first and last articles are on
1. Prognosis in severe chronic obstructive pulmonary disease
3. Predictors of survival in pts receiving domicilary o2 therapy or mechanical ventilation, A 10 y analysis of ANTADIR Observatory study.
These above 2 studies have got nothing to do with Operative risk and post op mortality…. Wonder whats the message from those articles ……and what they did with 26,000 patients… pheewwww.
The slightly relevant study 1.e the second ref provided is for pts undergoing lung resection for NSCLC.
This is am important study reported in 1999 ( 11 yrs back)…
If you have not read this paper, and simply cut paste the links from pubmed, i would strongly urge you to read that paper.
This simple Spanish study tells you what real life common hosp scenarios are:——
Advanced age and poor pulmonary function are predictors of high operative risk in patients with NSCLC. It is nor the aim of this report to evaluate early morbi-mortality but long-term survival related to age and pulmonary function in completely resected cases of NSCLC
For patients with localized disease, 3-year probability of survival was 0.80 and 0.37 in the group of extended disease (log-rank test, P<0.0001). In the group of patients with higher calculated postoperative FEV1% 3-year probability of survival was 0.75; while it was only 0.48 for patients with low calculated FEV1% (log-rank test P=0.0002).
Again they do not tell you the early post op mortality but give you the HR overall.
I again, re-iterate my words.. to proponents for surgery that do we really know what FEV1 = 0.59 really means……..
I would strongly advice you to see your hospital anaesthetist and ask him about FEV1=0.59 and APR resection….
The other statement regarding
•cure potential with RTh+CTh = 25%, cure potential with RTh = 5%
Could we have some references for those figure for T2N0 please… are these 10 year or 20 year survival figures.
I cant find any figures at all, cant find any good articles on chemoRT —- perphaps Indranil do u have know any papers…. my ignorance perhaps…
Those toxicity figures… would other members accept the toxicity for the second best treatment options.
•if give 60Gy to lower rectum +/- CTh,
1.acute proctitis rates G1=100%, G2=99%, G3=50%, G4=10%
2.late proctitis rates G1=100%, G2=70%, G3=40%
The little radiotherapy knowledge i possess, from Emamis data, i thought mentioned TD 5/5 (with whole rectum i.e 3/3) to be 60 Gy. which made me suggest total dose of 59.4 Gy at 1.8 Gy per fraction (trying to be more cautious) as opposed to 64 Gy suggested by Indranil. (but indranil … even 64 Gy is acceptable i think).
But u need to check what is the end-point of this complication….. of 60 Gy in Emami s article.
The toxicity figures mentioned appear slightly more exaggerated,
but i would personally sign the consent form for 60 Gy.
But i m sure you are right, some studies may have mentioned this… which i dont know as i could nt find any good articles.
My father ……………. of course if i was in New York or Texas , it would be surgery with lung transplant heart transplant and god knows (just being cynical)….. prolonged hospital ITU stay , prolonged in patient stay ….. these guys at these centres are amazing.
But having surgery at a standard oncology centre - NO WAYS-
As of course - its the best treatment…..
But not logical of course, as this would cost me $ 500,000 which i might not have., unless my dad had such insurance.
I m sorry for being slightly unprofessional, but ppl who may know me…. know it all …………
I hope other members dont get offended, if they do please let me know personally … i ll be more professional.
All what i m trying to apply is SIMPLE PRACTICAL LOGIC….