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It depends what you mean by unresectable. 3c due to nodal involvement, but a small primary is very “resectavle” but traditionally surgey was avoided because the prognosis was poor. When the prognosis changes (pdl1>50 has high cr rate), the role of surgery will change as well.Are you aware of any Pharma trials trying to convert unresectable to resectable? I am not. Nor is there much of an appetite for this in the cooperative groups.
Surgeons have a different mentality than us. When they start seeing 50% high pdl1+ pts having path cr, a lot of them will jump in and start operating. Minimally invasive lobectomy is not a very morbid procedure- probably less than 60-70 gy of radiation. I recall one survey by chest surgeons where 25% thought they should be the ones giving the immunotherapy.
I think radoncs get too focused on the studies. We can opine all we want on the flaws in a hodgkins study ommitting radiation, but at the end of the day xrt will still go bye-bye in that disease.
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