(Click on image to enlarge)

   Tomorrow we start our fourth MITOC program, a meeting here on the Seattle waterfront that brings together a group of national experts in pulmonology, surgery, radiation oncology, and medical oncology to discuss new information and options for managing the tough real-life lung cancer cases that don’t have a straightforward answer.  We started this conference for our medical colleagues, knowing that it’s hard to learn that much from 10 hours of one lecture after another, but it’s much easier to learn by doing and discussing.  Each year, I work with great thoracic surgeon Eric Vallieres and expert radiation oncologist Vivek Mehta from my own institution to put together a collection of tough cases that help frame clinical dilemmas that become a springboard for rich (and often slightly heated) discussion.  We present a sketch of how a patient presented, show images from their scans, then ask the audience and faculty in several steps as the case develops what they would do next among several reasonable options.  We have a few short lectures, but the majority of the content is in the form of the discussions among the faculty panel members about the pros and cons of various approaches, along with comments and questions from our audience of doctors who navigate these challenges every day.

    Both the audience and the faculty enjoy learning how other smart people think about managing tough cases.  Hearing other points of view helps us to avoid becoming trapped in my own interpretation and treatment style, or having the same group of doctors from an institution become an “echo chamber” that becomes insulated from other approaches.  There are clearly many ways to approach the cases that fall between the cracks, and it may be refreshing or mortifying to see that even the experts often don’t reach a unanimous (or even consensus) answer on the best course of action.

Here are the basic outlines of thorny cases we’ll be covering this year:

1) An elderly patient who is on the border of feasibility for surgery for early NSCLC

2) A young patient with apparent residual viable tumor after chemo and radiation for locally advanced NSCLC

3) An 81 year old never-smoking Asian woman with stage III NSCLC

4) A middle aged woman with newly diagnosed extensive SCLC

5) A 54 year old man with a solitary brain metastasis and a small NSCLC tumor in the chest

6) A 63 year old man with a large mediastinal mass that is ultimately diagnosed as thymoma (a topic not covered yet here)

7) A woman with a Pancoast (superior sulcus) tumor of borderline potential resectability

8) An elderly woman with metastatic NSCLC and a central tumor wrapped around a major blood vessel

   In the next few weeks I’ll try to present information on these cases and some of the dilemmas and debates that each introduces.

   If I’m a little slow on responding, it’s because this is going to be most of what I think about and work on until Saturday afternoon.

More later.