Radiation versus wedge resection treatment for lung cancer - American Medical Association

In this occurrence of Making the Rounds, Arian Mansur, 2nd twelvemonth aesculapian pupil astatine Harvard Medical School, covers his probe connected 2 antithetic attraction types for lung cancer. The AMA Research Challenge is the largest national, multi-specialty probe lawsuit for aesculapian students, residents and fellows, and planetary aesculapian graduates to showcase and contiguous research. 

Speakers

• Arian Mansur, aesculapian pupil astatine Harvard Medical School
• Brendan Murphy, elder quality writer, American Medical Association

Host

• Marielisa Cabrera-Sánchez, 2021 AMA Research Challenge winner

Listen connected the spell to the afloat occurrence on Apple Podcasts, Spotify oregon anywhere podcasts are available.

Cabrera-Sánchez: Welcome to Making the Rounds, a podcast by the American Medical Association. I’m Marielisa, past year’s victor of the AMA Research Challenge, which is the largest national, multi-specialty probe lawsuit for aesculapian students, residents and planetary aesculapian graduates. 

Today’s interrogation features 1 of this year’s 5 finalists for the 2022 AMA Research Challenge, interviewed by AMA Senior News Writer Brendan Murphy.

Murphy: Hello and invited to Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy, elder quality writer astatine the AMA. I'm delighted to person different finalist for the 2022 Research Challenge present today, Arian Mansur. Thank you for being with america today, Arian, however are you?

Mansur: I'm doing well. Thank you precise overmuch for having me.

Murphy: Arian is simply a 2nd twelvemonth aesculapian pupil astatine Harvard Medical School. His poster is entitled, and enactment with maine due to the fact that it is simply a spot of a mouthful, "Stereotactic Body Radiation Therapy Versus Wedge Resection for Early-Stage Node-Negative Non-Small Cell Lung Cancer Tumors Less Than oregon Equal to Eight Millimeters: A National Analysis."

Arian, we're precise excited to dissect this task with you and larn much astir your way successful medicine today. To commencement america off, wherefore don't you archer america a spot astir this topic, wherefore it appealed to you and however you got progressive with the AMA Research Challenge?

Mansur: Yes, truthful my probe is focused connected lung cancer, which is simply a starring origin of crab decease some successful the U.S. and worldwide. In fact, each twelvemonth much radical dice of lung crab than they bash of colon, bosom and prostate cancers combined, which is often shocking to radical fixed the stigma against lung crab owed to its necktie with smoking. However, what surprises a batch of radical is that astir 20% of those who dice of lung crab person ne'er smoked before. What's besides absorbing astir lung crab is that what makes it truthful deadly, it's not that it's the astir communal cancer, but alternatively it's that it's not caught aboriginal enough. And implicit fractional of lung crab cases are really diagnosed arsenic signifier 3 oregon 4 disease. And dissimilar different cancers that person received overmuch much funding, greater advocacy and much targeted screening interventions, lung crab tin really beryllium treatable if it's caught aboriginal enough.

And this information has been picked up by aggregate experts and determination is present a overmuch greater propulsion for efforts to summation lung crab screening. Interestingly, precise tiny lung tumors are present being discovered either incidentally oregon done lung crab screening implicit the past decade. And fixed the emergence present of detection of these tiny tumors, determination has been a question of whether stereotactic assemblage radiation therapy, which is simply a precise precise signifier of radiation, oregon wedge resection, which is simply a surgery, is superior for the attraction of these tiny tumors with malignant potential. And fixed my involvement successful oncology, country and objective research, I got progressive successful the Research Challenge successful bid to stock my findings of a nationalist investigation I conducted to amended the grounds disposable to reply this question. We really recovered that patients with wedge resection acquisition improved endurance erstwhile compared to those who received SBRT, oregon stereotactic assemblage radiation therapy.

Murphy: Well, that's surely immoderate important and meaningful work. What were immoderate of the challenges you encountered successful doing this research?

Mansur: As with immoderate signifier of objective research, there's ever galore challenges encountered passim the process. In this circumstantial task immoderate of the challenges we faced were successful designing the survey arsenic to supply the champion prime grounds imaginable utilizing the National Cancer Database, which is fundamentally a objective oncology database that is jointly managed by the Commission connected Cancer, the American College of Surgeons and the American Cancer Society. And with immoderate survey of this quality that uses SBRT versus wedge resection, it is precise important for america to effort and trim enactment bias. One of the biggest concerns with these studies is determination is an unfair examination with beardown enactment bias by which patients undergoing SBRT are deemed sicker. However, we tried each effort imaginable to trim enactment bias by making definite that we excluded patients successful the SBRT radical whose physicians thought country was not recommended oregon contraindicated to diligent hazard factors similar having comorbid conditions, being aged age, et cetera.

We besides performed a sensitivity investigation that constricted the investigation to patients with nary comorbidities. We besides did our champion by doing the investigation with 2 abstracted methods that each accounted for confounding variables. And some of those analyses were accordant with 1 another. And lastly, I would accidental immoderate of the challenges I faced was starring the survey portion adjusting to the archetypal twelvemonth of aesculapian school. At Harvard Medical School we person an accelerated program wherever we larn each of the schoolroom learning, oregon volition we accidental the preclinical, successful the archetypal twelvemonth arsenic opposed to the accepted 2 years. So juggling this task with my coursework was alternatively challenging.

Murphy: I americium ever impressed that we person truthful galore aesculapian students entering this event, doing it aboriginal successful aesculapian schoolhouse and producing specified astounding results. What proposal would you connection to aesculapian students who are conducting probe connected a task similar yours?

Mansur: That's a large question. My proposal would beryllium to find passionate mentors who are truly invested successful you and consenting to thatch you the indispensable accomplishment sets needed to bash objective research. You privation to find radical who would advocator for your learning. I besides urge to astir aesculapian students to truly larn statistics. It doesn't person to beryllium highly advanced, but having a large instauration helps behaviour probe tremendously. Once you person mastered the foundations, it's easier to adhd the analyzable statistic and the nuances utilized successful a circumstantial radical and that you tin larn implicit clip with the group. Also, learning statistic volition assistance you go a amended doc arsenic you're capable to amended measure the grounds that is utilized successful managing attraction options. I would besides urge to collaborate with others. It's astir intolerable to bash everything by yourself. And uncovering enactment not lone from mentors but besides from probe assistants oregon immoderate mentees progressive successful the task who tin assistance you with antithetic aspects of the probe tin beryllium precise beneficial.

Murphy: That's a truly absorbing observation. We truthful often perceive that medicine is simply a squad athletics and that mostly is referring to the objective realm and the attraction of patients, but you're uncovering that it's a squad athletics successful the probe arena arsenic well, which I deliberation is adjuvant to know. Back to your survey and the results. How bash your probe findings interaction the people of attraction for lung crab tumors?

Mansur: I judge that these findings truly shed airy connected the people of attraction for non-small compartment lung crab tumors. To our knowledge, this is the archetypal survey to measure wedge resection versus stereotactic assemblage radiation therapy for patients with N zero non-small compartment lung crab little than oregon adjacent to 8 millimeters successful size. Numerous different studies person compared outcomes of country to SBRT for aboriginal signifier non-small compartment lung cancer, but with tumors that are larger and with conflicting results. Additionally, determination are presently 4 randomized trials comparing SBRT versus surgery, but these trials are inactive ongoing. And I deliberation that arsenic we hold for the results from these ongoing trials, these findings successful our survey whitethorn beryllium the champion we tin bash to assistance usher management.

Murphy: And what bash you spot arsenic the adjacent steps successful your probe and this work?

Mansur: So the adjacent contiguous measurement of this enactment is to people our findings successful a adjacent reappraisal journal. We person precocious finished penning the manuscript and are present looking to people our findings. With regards to the existent probe itself, we're really looking to present comparison stereotactic assemblage radiation therapy to different involution called thermal ablation, which uses vigor to destruct tumors for oligometastatic lung cancer, truthful lung crab that has dispersed to constricted sites. And determination has besides been a question for oligometastatic lung crab arsenic to whether SBRT is amended than thermal ablation. And we're readying to really usage the aforesaid National Cancer Database to tackle that question.

Murphy: You've fixed america large penetration astir your project. We'd similar to larn a small astir you. How volition this probe interaction your vocation trajectory, Arian?

Mansur: So this probe has truly informed a batch of my reasoning regarding my aboriginal vocation arsenic an aspiring physician. I'm precise funny successful oncology, fixed the interaction that it has connected quality lives. And I'm besides precise funny successful country fixed its quality to truly cure someone's crab and to straight amended their lives by conscionable an operation. I deliberation this probe has truly inspired maine to prosecute these fields arsenic I'm capable to assistance clinicians marque amended informed decisions that has imaginable to amended survival. The determination to spell with 1 attraction enactment versus different is not an casual one. And it has aggregate downstream implications connected a patient's survival. And erstwhile decisions aren't precise clear, we often person to trust connected the champion disposable evidence. Being capable to lend to that assemblage of lit has truly motivated me.

Murphy: What other should our listeners cognize astir you and your travel successful medicine?

Mansur: My travel successful medicine has not lone been a precise breathtaking 1 but besides 1 that has been precise challenging. For context, I americium the archetypal successful my household to spell to college, fto unsocial aesculapian school, and I'm besides nether represented successful medicine arsenic a Latino student. I anticipation that my travel successful medicine, not lone successful becoming a doctor, but besides a researcher funny successful advancing the field, inspires the adjacent procreation of aboriginal world physicians. While medicine and the wellness attraction strategy inactive person a batch of disparities present, I anticipation that being a finalist successful the AMA Research Challenge motivates others to get progressive successful probe to execute their dreams contempt not having galore with akin backgrounds contiguous successful their field.

Murphy: As you surely know, the AMA Research Challenge includes a $10,000 expansive prize for the winner. This is simply a amusive question we similar to ask. What would you spot yourself doing with that prize money?

Mansur: That's a precise large question that I've inactive fixed a batch of thought to. I deliberation I would usage the wealth successful 2 ways. First, I would usage a information of the prize wealth to proceed my probe endeavors. One country of probe that we person been moving connected a batch has been bringing artificial quality to amended the operations going connected successful thoracic surgery. A batch of these operations, similar the 1 successful my study, are starting to beryllium performed robotically with the videos disposable afterwards. And utilizing aspects of machine vision, we person really been capable to commencement aboriginal enactment connected innovating the field. I would usage a information of the wealth to proceed processing our infrastructure and put successful computers with accelerated processing speeds to bash the analyses arsenic good arsenic proceed performing the database probe that uses beardown statistical packages.

Second, I would usage a information of the prize wealth to assistance with expenses backmost astatine home, specified arsenic rent and bills. I beryllium a batch of my travel successful higher acquisition and medicine to my parents who are refugees to this state from Cuba. They sacrifice a batch for us. And portion medicine is unluckily a precise agelong journey, I'm hoping to prevention a information of the wealth to assistance my household backmost astatine home.

Murphy: Well, that is surely heartfelt and we are wishing you the champion of luck arsenic you proceed to the AMA Research Challenge finals.

Mansur: Thank you precise much. I truly admit the opportunity.

Murphy: A speedy reminder to our listeners, you tin spot Arian's probe poster arsenic good arsenic those of our 4 different finalists connected the Research Challenge website astatine ama-assn.org/research22. And of course, beryllium definite to tune successful to the finals of the AMA Research Challenge connected December 7 to spot Arian and the different finalists contiguous their enactment to a sheet of adept judges for the accidental to triumph that expansive prize. This has been Making the Rounds, a podcast by the American Medical Association. I'm AMA Senior News Writer Brendan Murphy. Thank you for listening.

Cabrera-Sánchez: Join america connected December 7 astatine 7 p.m. Central clip to spot each 5 finalists contiguous their probe to an elite sheet of judges. The wide victor volition person a $10,000 expansive prize sponsored by Laurel Road. For afloat details, sojourn ama-assn.org/research22.

Disclaimer: The viewpoints expressed successful this podcast are those of the participants and/or bash not needfully bespeak the views and policies of the AMA.