Glad to be of help to you and yes, this is a really interesting and important study IMO. You are so right about what you say re smaller hospitals and patients being initially told that their CC is unresectable and not being able to be candidates at some point for possible surgery after chemo etc. I guess that this just goes to show once again that it is so much better for patients to be treated by onc’s, surgeons etc that have a lot of experience in dealing with and diagnosing all aspects of CC, treatment etc.
Much work still to be done on everything and never ever give up hope!
Thanks for posting this, Gavin! This is a really interesting study and, I think, an important one for people who are initially told that their cancer is “marginally resectable” (high risk), or whose doctors (as in the case of my mother) initially tell them that their cancer is unresectable, but who find themselves in the happy position of having a strong response to chemotherapy. Although this study is specifically relating to people whose cancers were staged I-III, I am repeatedly struck by how often I run into examples in the literature of patients whose response to chemotherapy converts them from unresectable to having surgical options (for example, this fascinating study, which Gavin also posted on this site a while ago: https://www.ncbi.nlm.nih.gov/pubmed/28858392).
I think it is very common, especially at smaller hospitals, for patients whose cases are initially classified as “unresectable” to never be reassessed for surgical potential even if they experience significant shrinkage to their tumor. I know that in my mother’s case it took all of us aggressively seeking 2nd opinions, and not just at the beginning of the process but after we’d gone through multiple cycles of the chemo and the scans had shown improvement, in order to get surgery on the table for her. It’s hard to know what might have happened if we hadn’t gone out looking for those 2nd opinions, but I strongly suspect we might have been put onto a ‘holding pattern’ chemo regime and missed our chance at the surgery, if we hadn’t advocated so strongly.
It is really encouraging to see that the ‘neoadjuvant’ therapy, which is essentially what my mom had, is associated with such promising numbers (and for what it is worth, my mom is about to also get a few rounds of adjuvant therapy, so here’s hoping for a ‘best of both worlds’ result).