Create a 20 page slide deck for Karmanos Cancer institute tumor board. use deidentified uploaded recent clinic note, most recent pathology report and imaging reports (images if avaliable). Clinical question related to radiation or surgical approach (regarding local therapy in the form of radiation, surgery or cryotherapy for treatment of biopsy proven oligometastatic disease involving 2 abdominal wall lesions and one right kidney lesion.), patient has seen radiation oncology, to discuss: 77-year-old female with initially stage IIIA (likely cT3N1M0) left upper lobe squamous cell lung carcinoma presenting in [TRIAL-4] with a 3.5x5.4 cm hypermetabolic LUL mass (SUV 20.7) with suspected hilar involvement and PD-L1 5%. She completed neoadjuvant carboplatin/paclitaxel/nivolumab from [DATE-14]-[DATE-15] with good radiographic response, followed by VATS left upper lobectomy on [DATE-18]. Surgical pathology demonstrated invasive keratinizing squamous cell carcinoma with partial pathologic response, including a 4.7 cm tumor bed with ~15% viable tumor (estimated viable tumor size 7 mm), negative margins, and [DATE-19] lymph nodes involved, consistent with ypT1a ypN0 ypMx downstaged disease. She presents today for follow-up. CT chest/abdomen/pelvis from [DATE-25] demonstrates interval left upper lobectomy changes without definite recurrent or metastatic disease. Postsurgical left pleural effusion, atelectatic/volume loss changes, healing left 8th rib fracture, and mild residual postoperative soft tissue thickening near the aortic arch were noted, with recommendation for short-term follow-up imaging. Imaging also identified a new enhancing 1.8 cm right lower pole renal lesion suspicious for RCC, without abdominal/pelvic adenopathy or osseous metastatic disease. She initiated adjuvant nivolumab maintenance and received cycle 1 on [DATE-26]; however, treatment was subsequently discontinued due to worsening shortness of breath reported after infusion per patient and daughter preference. Plan is to discontinue nivolumab and continue guideline-directed surveillance with CT chest every 3 - 6 months. The patients right renal biopsy yielded squamous cell carcinoma , but was inconclusive of origin, high suspicion for lung primary. She will need to be evaluated by radiation oncology and surgery and will refer for tumor board.
Create a 20 page slide deck for Karmanos Cancer institute tumor board. use deidentified uploaded recent clinic note, most recent pathology report and imaging reports (images if avaliable). Clinical question related to radiation or surgical approach (regarding local therapy in the form of radiation, surgery or cryotherapy for treatment of biopsy proven
oligometastatic disease involving 2 abdominal wall lesions and one right kidney lesion.), patient has seen radiation oncology, to discuss:
77-year-old female with initially stage IIIA (likely cT3N1M0) left upper lobe squamous cell lung carcinoma presenting in [TRIAL-4] with a 3.5x5.4 cm hypermetabolic LUL mass (SUV 20.7) with suspected hilar involvement and PD-L1 5%.
She completed neoadjuvant carboplatin/paclitaxel/nivolumab from [DATE-14]-[DATE-15] with good radiographic response, followed by VATS left upper lobectomy on [DATE-18]. Surgical pathology demonstrated invasive keratinizing squamous cell carcinoma with partial pathologic response, including a 4.7 cm tumor bed with ~15% viable tumor (estimated viable tumor size 7 mm), negative margins, and [DATE-19] lymph nodes involved, consistent with ypT1a ypN0 ypMx downstaged disease.
She presents today for follow-up. CT chest/abdomen/pelvis from [DATE-25] demonstrates interval left upper lobectomy changes without definite recurrent or metastatic disease. Postsurgical left pleural effusion, atelectatic/volume loss changes, healing left 8th rib fracture, and mild residual postoperative soft tissue thickening near the aortic arch were noted, with recommendation for short-term follow-up imaging. Imaging also identified a new enhancing 1.8 cm right lower pole renal lesion suspicious for RCC, without abdominal/pelvic adenopathy or osseous metastatic disease.
She initiated adjuvant nivolumab maintenance and received cycle 1 on [DATE-26]; however, treatment was subsequently discontinued due to worsening shortness of breath reported after infusion per patient and daughter preference. Plan is to discontinue nivolumab and continue guideline-directed surveillance with CT chest every 3 - 6 months. The patients right renal biopsy yielded squamous cell carcinoma , but was inconclusive of origin, high suspicion for lung primary. She will need to be evaluated by radiation oncology and surgery and will refer for tumor board.
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This document outlines a comprehensive approach to managing oligometastatic recurrence, starting with case definition and disease biology, including clinical timelines and pathology assessments. It reviews imaging techniques and local therapy evidence, focusing on resectability and treatment strategies. Finally, it details the tumor board's decision-making process, covering treatment options, dose planning, and surveillance protocols to ensure effective patient management.