uh uh， deah a friend h。

my my name is cucould， do hosteso are the hostethe？

and is so uh， good morning。

and they so welcome to the so so d， uh， east asia， it's foago uh cancer or forum nnaed is so uh， so from this year， okay。

and fufirst of of uh， i ullike to uh experss that uh the sincere gratitude uh for the uh。

so uh， h。

the uh， the your uh time and so contribution uh， and is a commitment for the uh this meeting。

uh IDP uh appappappappreciated uh for the so the uh joining the meeting and did ah so commitment for the uh does this for um so every year。

and this h， this is is so so sousoutime time older。

so i figirl i eat urgent as why you can support around。

uh this problem。

so so begning ning three years ago。

so uh two uh the discuss uh about it。

so as bial um customcustommer many come mas self casshima uh with us。

so argenan creeks uh with us。

so because so as you know， the fifiges come up casumis a dominantree exist， HH indiargent countries。

and this is a so different situation that between the western countries。

and is so uh， the no ssion h ourselves。

so incluh resecountry country。

and we have done that。

so a priay meeting and conconsimeeting before before the last a year。

first。

and then the uh this II of this conference。

so free discuss about sees countries uh countries。

okay。

so。

so oh， finally， uh participand and akers。

so thank thank much ooh。

so you so ah。

so so thank you so much。

okay。

ok next so不懂。

i please give us so uh comment from the uh acguage is a suppprient of the japan s via society。

uh good morning， everyone。

uh many is ratecity from uuh， much universe al medicines es of japan。

uh， i like， say， few words of migrating uh opopening。

any meron behalf of the japan socisociety and jjoggrasocial councia group。

so uh， it is my great pressure and previous to welcome all， were you uh to the third， uh stage。

uh， so h。

cancer hoall a in squich japan。

and also， uh， especially i like to express my senincere appreciation to all distinguh speakers and to your person from overseas。

uh， including korea， uh， china and taiwan。

members， are you you a very important friends for a long time？ thank you very much。

i thank you very much for joining us in spiite of the very business schedule。

so uh and like， and also， uh， i like that。

thank you very much for uh second cuttle。

h。

you know how who is her best president of japanis was your society and IA tear of international affairs committee？

of the ES and接口。

and also which the b verity， which with with the project， which a he will present detail。

i also are all spital were preparing。

thank you very il。

thank you very much。

so uh， anyway， uh， you know， as a cuttle told us， you know， as such， ader of normal predominant in the agent countries and actually， uh， we are leading the management， the ESCA as a leader of the world。

so uh today， we will focus on the algamment SCCI， including the definition and uh diagnosis and uh tredment al trial design of the of asis for UCC patient。

and also， uh， we were procus on the you know of local local set up p。

走。

i sincerely expect you know a fruitful and engaging discussion uh from thisfrom this conference。

uh IH onful and accussion thank h， you know， discufuture。

okay， let t's move to the so sexual one。

so ok， you。

so i come to the。

of both。

good morning， every welsiand。

my mme is， and my myself。

so this uh conn is， is orgle matters is treatment before before going to the main session， we had better understanding um initial standard treatment for each stage and regards for the matters concondition each each ssion consists of to topics。

so in each topics。

uh japanse standard treatment will be presented fastly， then so three uh other country will introduce just just undard treatment。

so fast， and we have a four expert in each countries。

so far speaker from the。

as sarcase a sent the hospital， a doctor or coshelo is hama。

so shall we start to eble presentation？okay。

thank you for your kind attention uh kind of interaction， mister chairmanman。

and。

good morning，玫瑰morning。

i'm issumer the hohost is is what your sigions。

i would like like uuh uh for local stage ESCC in japan。

and this uh table sunrise， uh current strategies and for stage wes the uh camradio therapy or is object to me based on the jacke of trial with a standard treatment。

and for the uh alternative options， uh end of cocopical。

uh， because cause rejetion for the bioc RT is an option for the serective patient。

and for stady， two and three uh nawage， but tritripat chemotherapy DCF， followed by the uh is jecliomy reprepresent minminmum ibage uh approach， and the cause observation is a standard treatment for uh。

based on the two jack of trires。

and the patient refuse or unfit surgeries， the uudifferent different camradio celeapy is um alternative options。

and for a such ger treatment， uh main procedure is trtransassic approaches， but trtranssurbic approach also available in a selected patients。

and after the surgery is uh arjubant chemotherapy， such as uh niabboama， it's also available uh according to the uh recurrence risk。

and for uh， local area to bounced uh tea for unrejectable cases。

uh， it's thunder three mamentain is remaining the uh definitely became radio ceerapates。

but for the induction， uh， camel based uh DF based uh therapies with the uh combaction surgery is under the investigation now。

and for the stage one， the jack zero five to trial， it shows uh comparable survivor surgery and camamradio therapy for clea stage。

one， this is long land。

my trial prospect to moercencentre trials。

and for the five invegaate， the uh organ reservation ation for inininal al proresetions h。

uh uh。

and for uh queinkas day， m three jack ke among zero nine trials， it uh ws the uh superiity outcome for no disc therapy compared to the new saf or safe artips。

and this is a jack of zero nine years to for green， ate to and three for the definitive vary ceerapy。

with the uh vvwith。

the reresult show the three AOS survivation。

and this is organ preservation vvvsevvior around three survival is around the sixties。

所以percent。

and for such approaches， uh trial shows the uh compered with the sarcocopic as as open objectives and ssarroal jectimity shows a nwn compared with the open approach。

and reducing the uh blood and nemonmonia is reduing ing for the copic groups。

and this uh figuure show the onion trend of the s object to me， according to the uh japanese sroasassic surgery association registories。

and has it know， as it can show that majority are uh approach。

the mini money in basasive is object omis uh increasing we are by ear and。

ninety percent is performing MIE and for MYE procedures。

the orange bus shows the transtsitic object me is frightly decreasing。

on the other hand， ds red bbus show the robot asassist increasing is rapiid uh increasing in the recent years。

and popular bar shows the uh twice surerpicc and twice higher dog lar poloaches to avoid the uh。

classic cavity and do not inure ure chest worlds， and this approach is very ideal， a less invasive for surgeries， but the number of transsobic c uh approaches around the uh twenty cases in japan annually。

and after the surgery， uh， uh of the observation is a standard treatment， but the jake to to zero。

six， uh， facthree trials is ongoing to uh about way way， the possible ative uh treatment uh， comparing the observation and uh替eutbobotma， based on the jack mate， five seven seven， the。

二级管s oneto treatment to PG。

uh， it's one which which is uh all launch cancer er drugs。

and uh， light figure shows the uh face to trial of the argband s one for six months after the surgery。

uh。

now camel or debrate CF celebrates and three uuh recon three survivors along uh promising， and along the severty five percent。

and for the uh tea for unresult of uh advanced cases， uh jackal groups， uh conducted the face to trials uh initially approach the camel selection with uh HC of syerapy with the uh combatual surgeries。

and combture surgery uh was performed forty one percent and three year over was promising the forty perpercent。

based on this trial， the um one three， our city trial。

it's uh。

investigated。

compared to the definito became radiosurapy bus as induction DCF with uh comvertial surgeries。

and this uh study is already requiitment is already completed and is uh。

is in thefull of face。

thank you for you感身子。

i get a good presentation next next picaker roroad。

有的。

ok，hello everyone。

so uh， this is uh this session。

we talk about the locted wants the treatment。

uh so in china， we can say， um no matmatter staate one， two， three or t for cases， mostly folfollow lines。

but h chinlines dididiininininchinchinese idelines chinese gulinines chinese ellines japanese colleagues。

so uh， no matter for which stage all the standard and alternative treatment is very common uh in our deal lift。

uh， as you say。

so i want to talk。

one topic is very controversial that is the t to in zero patients because。

the tey to in several patients， the NCCN guideline， JS guideline and chinese guideline are different。

example， title NGES gulinines es showed new combine， insurerery should should recommended， but but high rik k low gery is recommended in china， of course。

from surgery is recommended and the most of the surgeons。

are willing to do up from surgery and adjument treatment。

all observation。

so this is very hot topic and the need to do some research in the near future。

i think。

because the other stages is very common sense， so i do not talk to mortn。

so a why early， yes， this is still matters。

we know those reasons because。

the most important， i think it is the micromien testasis and lefinonous testasis。

so t one AT one b or t two and zero patients， this uh early stages。

we talk more。

so t one a we have commcommsense se every patients uh in the practices underone to the ESD uh uthe rescepted by the underscopist。

so h。

uh， but you know， for two one patitits some specispecially for the uespecispecifor。

the inybe for the data happen from in china。

the under under scopiies is very aggressive。

yeah， very， very aggressive。

so for example， in our hospital， uh， uh， though this five years， they perform the uh t one b cases gradually increasing。

yeah and after resection。

even，there is a，not enough margin or depth。

uh， over the city scan showed。

wow there。

maybe some lift notes positive。

they will find the radiologist。

yeah， to do the organ preservation ESD combine this systematic therapy and to the patients are willing to choose。

but there's no。

uh， evidence for uh， the t one be just to do the uh and school be combined the CRT。

so i think um。

some clinical traals to primarge calall showed dearous comparative。

ESTCRT versus the surgery， but um II think surgeons。

most of the surgeons think surgery， the most prevalent and benefit for those patients is controververal。

for t two and zero is also ah it is not uh stable disease。

i think yeah uh。

so we can see from the data uh， the forty to fifty percent。

uh of the CT two and the patients to will upstation after surgery。

so that's why i think a japanese colleagues uh h。

uthe guidelines to show the more better for uh new joven treatment， but we can know some some of the patients。

it is the true in zero true t two or even t three better in zero patients those patients。

uh perperformed， the upfound surgeer will leave longer life。

for example， my teacher， uh in his year， they perform a lot of patients like t two patients patient can live very long。

so this is um the topic。

so the asian approach in a western approach is totally different for this acceptable。

TE to answer patients uh so。

uh uh from surgery， i think， is very important for uh comprehensive when for the natomy and accurate station for this patients。

uh， but it's very controversial uh for new adjuvements or up from surgery till now because uh， i also talk to the teacher from american。

uh， he said you must divided the is subdual patients to different levels or different risk， uh characteristics。

and then to decide your treatment strategy。

so i think uh， uh the criticical quality is there are still matters。

if you do the upfront surgery。

so铵。

in fact， it is mike or our current clinical approach。

uh for those patients。

uh because i think uh those t two and zero patients divided to different risk factors。

uh so high risk factors， of course， we should do uh the uh new urgiment treatment， but low risk factors， if we can identify uh up from surgery is uh you use useful for that。

so i think the the take home message is very important for uh。

类似似闺宗。

for CT two in zero research for that and research， even combined the AI is very important to for those patits is different， devoid over trebment for patifor ts。

thank you。

yes， of then， thank you very much for the big intelligence topics。

according to the twenty twenty in japan。

so in uh， terms of h。

uh noh HH， the mamain to is is ansject me， but jejesuininjeto proproject stem。

and for the medicor or patient to to AA definite and prefred red se menu five。

and for stage two， uh and three long treatatuh， our stand treatment is a common radiation ererwith， with ragement， followed by surgery uh for patient， who achieved the pathreeined surperpaent ent our patican without any further treatment。

and for the patient with non PCR cascasuh h， we treent with with nn involvement。

but uh that finite tive conrey y forforfordefinfinfiny erery erereeespecially dempfiny y surgery。

and for the navereum also， we use。

i thank very lunch next romozy times。

and good morning， everyone， and i am yangjen from national taiwan university hospital， and i will briefly introduce the practice at the highest volume， a special cancer center in taiwan， and which may reflect the current trends in taiwan， too。

so this light is an overview of thetreatment strategies across the different stages of disease。

and for early stage， uh， including TIS and t one a uh ESD uh uh into scopy local treatment， including ESD and EMR， is the standard approach now and for longer or whole ocperial legions uh， as of buttomy may be also considered。

and for for disease。

uh， it's project to me is generally uh accepted。

so when the final ragrepreport shows APT one diaddididiis pasion just。

so。

and our institutional data show a comparable cancer specific uh survival between EST and s project me patients。

enforce stage two and three resectable diseases。

uh， the standard treatment is preoperative chemoradiation， followed by its projectomy eegiven envolment or or treatatment for ininicative patients。

and MIA minimbody invasive is jjeommy has become a routine in many centers in taiwan， including vars and ruts。

and in my hospital， unipportvots and ruh is our daily practice and dadapractice and INSP system uis our single port bereruniportal prsystem。

and this is our operation room setting for uraami a uniportal robody associity MIE。

yeah and for stage four， a uh unrecediseases uh and aggressive MDT will be arranged and for outer involvement。

uh n tivfollowlowby ment may allow some patienreceiuh subva treatment， including surgery and for truck and for allowing involvement。

and for very high level or survial a video cancer。

and total hrengle laranggo is is objecommy uh may be conducted in some patient。

if the tumor is locaating within three centy meters below manubrillium。

and the and these are the papers we shed on TTI use。

and this picture shows how we do uh a local rotational skin fap to ilongate the permanent truck o stomy。

and this is quite useful if the tumor is uh located more distal。

yeah and for t fobee disease， oh， no for stage forbee disease。

uh，conversions surgery uh may provide a some survival benefit if the uh meta speculagians are locally controlled。

and。

and the and this is uh research on the the the stage for as a special cancer following cumorradiation。

and who receive conversion surgery。

okay，

thank you very much。

let's study。

is that discussion？ please displays a summary？

哦。

this a this is a summarof。

the standard for each stage in for councountries retrities reregarding stastament。

so standard similar。

so let me start with very difficult question for the export。

if you develop the stage ment cancer ESCC， which three dimay you choose operation was a ratiation。

100~100个asperit谢stastage stagement。

对对，谢谢。

你要再适weeet。

i prefer as by was pressure impatment。

so if there is no such risk factor such as as ambeason， and if there is no uptake on the city scan， yeah， maybe uh。

i need to meet our endoscopies st first and try to undergo the diamond EESD。

yeah。

yeah， yeah， yeah，

possily ESD to assist two tips of the invasion。

yeah， yeah， yeah， yeah， yeah， but yeh，

uh。

if there is AH any click or surery YYYYY， but preererererbut prepreer er surgery。

yeah definitely for stage stage one。

II will choose the more preserved strategy。

yeah， but the t one b is important because the real t one b， as i said， the accurate station is very， very important from the logic is very a really local。

disease， of course， local treatment is enough， but it is a systematic or potential systematic。

i think should combine the combine the treatment heis more better。

thank you，

next，对不到一起吗？

uthank thank you。

i'm sggiant， of course， so i would choose the surgeries。

but uh， it is important to uh the screening or the upper and scopic annually to detect very， very ry stage to performing the underscopic receictions。

and。

so you to the suggest for the statement， even you complaint。

the。

stage again can get，t完毕，对吧？对。

who would you want to perform this operation？

衣服。

i， oh， i was suffered from the diven bebecause at this time。

i would ask uh my mind to the china。

okay， it's far too ry。

i would ask my main conpulation cancer center。

so you would be a good sugthere nice， please。

um for in our hospital uour surgeon also do ESD by themselves。

so for stage， one special al caner er h。

we final al cer for the the final pathology。

decide whether to do as a vegetommy later or or a additional chemoradiation。

yes。

thank you very much so that if you you choose the surgery so that which procedure do you want to prn？

it's米双trsic a。

uh，

a our routine is transorassic and transsurficical is uh we haven't that before before， but we maybe in the future， we can try it。

thank you very much。

uh， i have a quesapso in japan。

the conrent raeris is equivalent equivalent option。

too cergerly。

so uh， when you see， the patient do is click， uh， t one be patient。

so you need to explain both yes options。

so how about the changes of person tage。

yeah， i who select surgery or who select came already？ should i heard the number number who patient who receive。

the camera ation cererapy is increasing。

for stage one this j， this is in japan， right？

so after the。

thank k。

limit，

do i think？

please chochose se holy ESD。

it's good idea， but there is is rerelt of the ESD。

maybe uh。

doctor professlittle uprs stor investigator EESDR before the camera ation ation。

did you introduce a result over the cran cat rier？

surgery is the excess treitself。

maybe is very important because diagnose is not perfect。

and more than and nearly INM councier counvoid。

deep， a cancanady s canvment。

yeah，

i believe yeah， this beliethree popular， but but dededepends on the suraseror depenend on the。

一家一角的。

三个月放期。

should do you have any comment question？ begarding a section？

this going to um。

major canvance topics t two and zero。

yeah， we uh analyze the t two and zero and three and patitients that shouh， if if PP from surgery， YPP vthe PT two and zero， the PT is in zero to those groups。

uh so that's why i want to talk about those patients。

if this is real c to papatits ts， maybe h maybe up from surbetter china。

most of the surgeons wants to do the upfront surgery for tea， two in zero or even some of the t three in zero patients。

so this is the。

real world practice in china here。

with a game。

do you have any result？

ah h is a surgery。

in， in other words， in ai prefererererersursurererbecause， because there is a change is surgery。

it's very good idea。

they have any idea for the CD dinn use before such uh now just just cllical trials。

oh。

do you know the result？

uh， during our clnnatatrois of science science clncontroals， we use the city dn a in our single center。

uh this year， as arscle meeting， we will present nearly ninety six cases of a city in na results。

uh exexcelellts for that nty percent treatment。

uh， if it is positive， so the city didn't they decreasing and is very close to the PCR patients？and MPR patients。

yes， thank you very very much。

做的第二遍question， no。

so price unisity has already ACDNNA。

oh， have much much are uh， although，

in the single inn n we dedeveloed our original detection system。

but then i think the single le the CTNNM， so the the r sisim， the detethe CTDNNAH before treatment and alalprotet papatient HH detect a rerea uuso。

so um uh h， the t logc CR。

so even though uh， h， the single DNAN ah the um HHDT tem before the surgery， almost perperation of the preoperct， the CTDNA was remarkable， the the system uh singsingof CTDNN before the。

before surgery， most of those patient did not have the urecurrence after surgery。

so progragnseeseeking this better， but is remarkable， but it's still much ure to select the patient， who has the pathological CRR dedicct APCR before surgery。

so we need to improve our system。

thank thank very very much for after after never the patitient doesn't tell in the brand，我我。

even even ACT delevel to it indicated for the sursursion。

yes， II think so。

so we can say the pation that if you you your CTD became negative after after unchemo， that's why uh once you have。

once you receive for a long term， but ce， we reknow that。

thank you very much。

next going to the naveragment treatment。

so that in taiwans naveragment， the cmoradiation is still standard treatment。

but now so they based on the desire of the crica trial。

说the never are曲penthe camel。

uh， think can to improve the survior comcompres， the chemoradiation。

所以however，说的you follow the CD close region。

a our regiment is platting in the taxo based uh for for cumotherapy。

爱的，就算ally came up here。

i am not very very。

i had clear about the the new egipment regimment， maybe our colleagues next will introduce it more morable thoroughly。

yes。

no。

so so mabe be， maybe you do not use use that right？ right？ in china。

we we do。

we will discuss with the patient。

yeah， we can use the。

ICI yeah，你拨ke MS yeah ah brobroup all other other， just just just on the based on the other five，

seven， five ah yeah。

research risk a give a comment proably can adp some comments about the new elephant， an entire qua。

and uh， i think the common practice of new advent therapy for state three disease is came on radio therapy。

yes。

and most， i think most soup center will adopt cross， try ross ss rangements， but still some still continuto do the uh still spond five new combinations。

and we know the very beautiful data， jack al， we know know new ejumomon therapy intense by chemotherapy should be another good choice for a new edpment therapy。

but i think the piplarity of that approach in taiwan is start to increasing， but still the mage practice still came alright。

thank you very much。

做为立个电影奈基般都imvenal maternor be so the china is。

not not the real standard。

uh， i will talk some real status in china for new join treatment。

because uh， the first chinese is solidual cancer guideline， just the uh。

year twenty twenty nineteen， that's the first chinese guidelines。

mostly we follow the NCCN violes。

so that's why this new gium CRT across regimin is the standard， but we h make quesquestionaire around the china， only ten around the ten hospitals ordinary used the。

camel radio therapy ordinarily most of the hospitals they prefer to use camel therapy。

yeah， they do not use the more days。

so most stly twenty。

face to click trials for camel combined munual study。

uh， so after the clinical traveler， the uh s calld new so ah the chinese guy lines recommended。

uh， it could be。

kind of a choice for new joint treatment uh， i think than ty percent of chinese doctor hospital will at ast ast。

short term study showed the pizza ate around twenty percent to thirty percent yeah for camo HH dom cenate。

in other hospitals。

the perforforming the radiothery combined the uniterapy， but common radioerapy is not rororegime is modified regimen。

more suitable for uh asian patients than that's the the statin china ina now，

which can materiobe the best part ner for the IU treatment。

i think TC is more useful TTCA couple plyou over the best is。

AHHH is。

so a the renso， thank you for the so very interesting is jotion in the china。

so you may想about the。

uh。

so the necitution， so the the PT。

and so the the viviviinking ah h vivivivii ah。

so i the and the the that that that h that the the surviviinso HH rellthis， the the survivithinking HH viviviinking ah ah h chanthe only。

so in chinese guideline also recommend uuh one two two。

so uh， uh recommended uh， the top level， of course， the based down across trial CRT and uh， the h cameltherp from the cocoand and h。

the。

yeah， the next level。

uh， they recommend。

that's it kind of uh experts consensus。

yeah， so you mean that。

so that we not not the first level to recommend it。

so uah， not the strong recommendation for that ah ook IDI understand。

这我害怕，对可怜。

so never case， but。

阿宝肚痛。

i有i cover by our treatment。

do that to希望they have any comment。

这个in jjjan奥new ejban using is still investigational and um not standard， but。

doctor， a maromomto is now conducting new trial， so we will await the result。

is a possibility conduct。

click try using AIU for the recive tive cancer。

maybe i the。

okay。

so unfortunately， there no no to discuss。

so there somebody for the standard treatment for each stages ges。

our strategy is relatively similar。

but now still cergury is mainstream even the AY for b cases。

but next next stadays， maybe IU will be a uunext uh mainstation。

这们持居住。

ok， let let me the this in this field is a very。

minter dishes， i优a syerapbe。

考有640。

没没没不普菲菲，对对，不是。

japapese a apapanese， please japapese in please presin in apapapanese t japantage。

yes， ah。

good morning， i'm am ctor or asinema working forcedro cancer center。

i'd like to present japanese status for metasastic is fajo cancer。

this slide show the h summary of the standard treatment。

and in japan，marketing approval is practically means meaning of we embarronment。

so。

basically the drugs。

are we in birds？

this is the treatment algorithalgorithpublishing two thousand twenty two。

a strong recommended regiments are two kinds， one nys side， toxic chemeter y plus。

one incheckpoint inhabitor and another is immchechekpoint inhabitor doulet in pilma plus involve move。

as site took seek him therapy six plus in plus fllow virusl。

exandard and uh， combined with uh one of three univencheck point inhabitors temporismob evolve up what is aliismob。

and in japan， uh no other immadict point in hipters are approvate so far。

uh unimensicheck point inhibitors were approved based on the。

international clincoal trials shown ing， this slide。

i believe you owe a familiar with the results。

and in japan， unimencheck point inhibitors are reimbursed irrespective to pd alone， expression status。

as alternative brigigments substitute uh this plant to other platnum agent oxile plattin what another platton。

these drugs may be combined with immencheck point inhabitors， but uh， the data on these regiments is limited。

let me move to the second or third line therapy。

basically uh the regiments， including not previously use drugs are selected。

parqututasalil is a standard。

if an immunate point inhibitor was not previously， are sorry， inhibit was previously used。

and immuncheck point in inhabitmonmontorpy is selected。

devenenimiminchepoint inhibitter was not previously used。

and tempalism m is also used if。

of the patient ted， the tumor with CPS tenno hire or MSI high。

also select ct tive for examfor exlus vovolved as the first line。

and this is ranow um packet for about parquitax cell japanese round minds face two trial showed uh benefit of weickly parquitax cell over try weekkly does tax cell。

an attraction， three and rational， three or two studies show the superiority of imchechekpoint inhibitor over h psytoxic chemotherapy as second line treatment for patienwho， who not not receive in check point inhibitors。

and recently trust to them of their stick on was approved for patients who had had to amplify as fazo cancer。

and this drug is reimbursed only her to ammplifiation in asassessed using self free DNA。

this is a based， uh rational of the trial in japanese heroal trial included twelve as fuurther council patient with how to amplification。

and half of the patient。

responsponto the trutrust mopstick on irrespective to other gymutations。

and there's no other。

jean testing basase treatmentis is not we we imbirse。

so this kind of patient are。

candidate for drranker trials。

thank you for attension。

thank you， thank you， thank you。

how about pasabout about？

i think it's a less than ten percent。

yes， very limited，

very limited。

i think ok。

thank you for your presentation。

go next to the。

do do分善宁。

without your an explanation。

is hard for me， so i can not prepare but II， the jines we follow different guidelines。

恩随行。

uh GS and kaka or cisco as chinese guidelines and summer uh is small。

yeah， butuh based on the chinese skylines， uh， the medical insurance will cover。

yeah， for the ancestent guidelines of japanese or european guidelines。

it is the kind of explanation for the patient and to the insurance government。

so most of the clinical trials or evidence space， the clinical trials， all guidelines， the chinese doctors will。

learn and read and explain to the patients uh so that that's the status in china。

thank you。

ok， ok， thank you。

wave principaal gay。

get to the okay， please place。

next to the okay， good an status， please。

express。

yeah， this is the briep sde de mmary slide of uh current metasxin reccurrent escipation management， and currently for first rin， the poor uh email serapy regiment uh approved with the various。

a little different， the the PDA on score。

so and recently it's change rapidly。

so i directly introduce uh。

the the recent changes in incquiraration so many home， uh people， people thousand and twenty agent was。

uh in AAA pamo OMMOMMO ore sca DA enouououm MMMI sut t sususo。

so so so means ans， h we need have enououissusue a week。

so。

anyuuh somesomeuh with very high burden patient。

i um used to start a chemmo first and then wait for the peridio testing score and add the insurance that that that situation happened until last year， but we convinced uh our our vininusurum h the best uh。

the data was shown in ECC peridid or p。

so uh， from this year that the the p dio um HPD ten more the pamorperers chemo。

uh got a limbersement uh h， the decistualready uh chem o you in six study and the in this study， even the pedio on uh less than ten uh perberper cheamo uh than the chemo alone。

so yeah， the the uh teacher reports kimma got。

got operatable not reimburshment yet they so， but i heard that uh dissomember maybe disregieman get will will uh the reimbursement。

so this is the seconis seconseconum。

yeah， we the similar with the japan， and sometimes we use。

uh IHI just idenfine some hot application。

and i like to share。

so my uh experience that this is uh the article published last year and the the the first time time hesitation us collected from asthommeticical center and our hospital and totally uh asmedtic center included。

and uh， there's some patient who had load than CPS ten。

but uh， the most of patient would get a pamrops chemo， and the sorry percent of patients get neval brass chemo。

and uh， the the AE uh， the grade or three or more AE uh was reported in a fifty percent cases， but the the SA was very low。

it gowas three percent。

and the data was the epicical data quite similar with the ken， not five ninety， that medium ppirs is about six months。

medium os is the thirteen months。

and we do some suburbn anzes that uh， we identified some high risk features。

that was the the proppose status high based on CRP and low peter exhibition and combine with this uh， the features we developed the promisy scoring model and based our scory model， the survivor cards was classified。

there's some difference in survivor cuard。

yeah， thank you。

thank you for your researok ay， be this this，

this PPPSIP the PPPPPSS so memean PPOS。

so that methe tip PPPSMOM camo prco o。

a patient can receive， but but out of his parking， ok， ok，

thank you。

okay， the the is the the last is taiwand。

okay？

thank you。

my name is that vincent john from until you cancer center。

um it's nice to be here。

let me briefly introduce some um basic big ground numbers before reaching meter study regiment stand off care in taiwan。

so um it suffesuch your cancer in tawan。

this is the statistical trend。

as you can see in the past thirty years。

the case number increase。

fromsix seven hundred thirty years ago， two around three thousand cases per year。

and most of the case， a male squemer sale， e ccnoma a。

this is the uh our AP temiology statistical numbers for you。

and for improving cancer care in taiwan in the past ten twenty years。

uh， we have some laws to regulate the physician like cancer contract cancer care， quality acquidation for cancer care hospital。

so um we try to um。

use the moltidisciplininating here in our daily routing， and we have to develop every institutional treatment guideline for quality control。

so this is our hospital guideline and we should review year by year based on the new clinical trial results。

so for the acquidation。

and um specifically， in taiwan， we have the national health insurance program since ninety ninety five。

this is a single payer， andatory insurances and cobor。

um old chinese population。

and for approval， the drug approval。

is by taiwan FDA。

but drug approve by taiwi DA does does eququal reimbursement by our health insurance。

so if the drug without health insurance in rembmbursement。

the patient should pay one hundred percent by him or herself。

we don't have the copayment systeon now。

for the first linenis demitherapy itself， you can ESC in taiwan。

you can see， there are some taiwan FDA approve。

um option。

but regarding the reinversement。

are things this year？

february。

rainboss。

combine with kimosierpeople first， ma condiditional PDDA one gregrea a perpercent utwenty dash h。

history and the body。

this is the first line。

so you can see the table， the first lies and ocare using the moll map was fly of you see his plaatton n or side the pattin。

four p deo one t secreter than one percent。

and you can use some alternative。

like nevo一批pembra plus chemotherapy。

this plot ting plus paractazof plus five view， we go to TP hyydou FFL have some studies before。

so um doctor want to use all kinds of these options is uh is okay。

and。

fortunately， we have some hospital stud comcompinination。

we will tell all the possibility option to our to our。

in regarding second line， you can see there are some option right？

butonly involvement is rambmbers。

in twenty twenty four april since twenty twenty four april， with the p deo one TC greater and percent ent。

let's see the table ha。

so if the patient doesn't have the huminal syerity before。

the in nevolved map is reimbse。

but we can tell patient， you can use pambro。

it is say that is okay in some chemotherapy。

but。

some chemostery doesn't reimbse in our system。

you can see。

so uh， it is really hard to。

to to say the details to the patient。

so we we have to have to come make decision with patient， but we we we always decided in the second hi setting。

and we also have the IDSD second line study in n tu hospital。

so we will discuss with a patient。

and regarding the biolmarker um our embarrsment system。

require every patient to check pity one rembmbse for new wlman。

once。

during the disease journey。

so if you want to do， second， third PDO one IGC study patienship pay by himself。

and the NGS doesn't cover， that is a viduous crimencircars in norma。

in taiwani of d approve defines， what can be describe？

but rembmbursment define what is precalally standard， that is the scenario。

okay。

thank you。

your presenenin in time um III have one question。

why is only neibormarbin bubus？

i think we should ask MSD in taiwan。

okay， thank you，谢谢。

quite different different from kolia kolia has only memberement for ms only。

this is very interesting。

okay，

okay。

thank you。

thank you braendiook ookay in maybe next to in somebody。

some somebody slide should change。

ok ss from fis， s yes， i say。

i， as you know， in japan excelpating is not proproved， but uh not approved for is巴you cancer。

so this， the data is very limited in japan。

so forefox is the。

yes， a promising。

and i think it's a。

maybe better regimen than this plot in based regimen， but。

collecting the data for fox in japan is uh a little bit difficult。

and as you know， we conducted the observastustuand and it uh used for future。

evidence。

thank you。

thank you for comcombbbbis。

it。

can we in practice？

maybe for foxibble is II think why is good opjeal？ i think in the future。

yes。

and as you know， and we can use power fox for gestrc cancer。

so。

对不对？yes。

ok ok。

please come comment from the rover以bbpsuppon。

uh， the purposes does does not uappropriate in yes CC， so we can not use。

but uh， in a crkal trial， i have many experience using purposing， yes， CC。

yeah。

how about experiin in hospital？

thank thank thank mamaybe four foxes compaare to this sppari SA good option。

i think。

好吧，对不对？，都，都给他讲。

uh， uh， i don't know the other centers， but in our we use ua a lot lot for folks。

and we have a experiences for that， especially for the second， there be or recurrence patients。

uh， because in our MGT team， our encoulogist is h very willing to use for fox combined。

uh， some tretreatment uh， not for fox or use the new treatment， like ABC drugs to treat the reats ststaatated patients。

so that， that is the status in our hospital。

ok，

thank you。

how what in taiwan， maybe taiwan？taiwan is the used in the first line is excepperation basis is uuoption ah physician can choose either the as pattern or south pattern。

but in my experience， until l hospital use use， and we will momofy y those schedule to too。

yeah like day one and day eight。

those is gradually。

to mitigate the taxity to make patient can get this button um more tolerable because authly person also have sound neurological complications， so we we we can。

not in cleical trial setting in real real world daily practice will split this buatton or tit it in those gradually。

ok， oh，

dually。

yeah， yeah， yeah splithe split this this part h yechedudefine scheduah，

yeah， yeah yeah。

第三句。

first possipossifast发rai。

think think think。

不是什么不是很多。

discussion。

so i uh ask h and HH you you maybe that chand is no in intion for the how do t in china？

okay， that's good question。

it's a kind of question like fromumarketing manager。

you know， ah this is the same question。

i answered to the marketing manager。

yeah， um most important is the uh safety and suratence for the treatment at the beginning as young surgeon， of course， uh， at the beginning as surgeon， we use the ICI well worrying about the safety because from the collegust， they used the ICI for the first line。

second line patients。

the PS status is not very good good。

they told us the safety is not good。

the is a good good。

uh uplplicications for II worworry about that。

but after use for the surgical patients， we think， yeah， it's it's safety。

it's controllable， no matter for camel。

if you know or so， patiuh easy or safety to manage those patients。

so after that， uh， we know no matter for the nevl amkcheeldor domestic drugs。

uh， we use daily practice or clinkical oals。

we say the same nearly the same， it's comparable for the safety and uuh， uh uh， the uh fercuacy， especially for the patients。

so uh。

uh how to choose those too many drugs。

uh。

i think uh important is for the support for the team later rassia academic， yeah academic support。

uh， if the companies uh is a academic。

uh。

pursuing， and they are good academic。

i think uh they clink trials and data。

and those things are better for your team choice。

but if they just for commercial II， don't think that's that's good good ice。

but so that in our team， we will choose the drug。

uh， it is safety purcuse。

and um。

uh， economic is also very important choice。

yeah， i think i and the safety did HH just PD one。

and the PDO one that body was same the sisiar acroross，

a chinese drug similar。

we just say similar。

but uh similar。

complication site， but yeibbn， the ppeer console，

the neibonthe ppvoy is uh so higher than is so the um that chinese， the IC eyes and inside that i in chright right is is right。

yes。

yes， the right price。

yes， it's is。

very high， yeah， at the beginning。

it's。

ten， i think ten times uh uh uh，

there is some policies decreased the h ah ooay IIPP。

the so the the the the the the proprofor h。

and so so how do you choose that？so so so i papapap system m tatawan。

so， the papatient pp， a stestem， the only pmba stestem， II ppora system and IP pptestem MP and the paagent we can。

the uh h bo is is the the prothe the for h。

patient uh CPS more than ten patient。

the price could pensive than the yeah。

so in on the rembperent ent of ddrucddrudbp cheap。

can i also post question to like to home？ that's about the uh essays of video one expression？

we know that we have useseveral body bodies to to three twenty twenty HHHHSP uh two， six three。

so h， when you say say that you going going， have the going have c specifimy settings for pedeo one pasass cases for pedial c demands h。

specific dedeone eyeah ah ah in most dio um the the by by the。

yeah。

two two， three， three old as well as the two six three TPS。

要ah same考虑。

they know our center。

对对。

gaay any other questions， okay， but much much ter。

i discusian。

please commen。

please a certain no。

uh， we we for the TM stage。

we follow the agg CC， of course， uh， the one of four is h one。

we right。

the record， that is i'm one a， but uh， in our deidelines also said， that is a uh uh can be treated low local reception treated。

i'm one a patients， so uh h one four is。

and the the other luck knows that you said that if is uh evaluated uh to be local locally can be recepted。

we will do like a new ehievement and their surgery。

so what about the print struggle？

you can technicia resector because because it is like the lung cancer stastation to station for not ordinrereseor， but it is kind ray ah is is six preprey。

there is more aggressive uh one of ppery or rasethank。

thank，

but about in tawan an rareer。

entire one as in until hospital， we have。

twice daily mountain disciplinary。

听discussion。

yeah， no， no no twice by weekly sorry by weekly um。

and we have the cancer registry。

so we follow the AJCC eight addition for every case for cancer registry， but for management case by case， as you mention that if the patient have made， et that it live， not only。

um you can choose， you can intensify systeerapy first and follow by response， or we can use the new amam radio o erapy follow by surgery， because some neinininsisteto combine with our extensic combininn inssa o trump， but neto to tentensic n instestestesteerery or to to ininininp d to to inininthe to mgery。

yah smmilar to china ina， the sprk nect proproices considered。

uh receptable amon， so i usually conservative， he you。

要binhe wwants some kind nunuge曲man，

哎呀。

number one的four。

and number， one of cancer， they are regarded as a reasgial。

so for tting。

and if there is mato TR or。

那么sixteen a or sixteen b or one think that is a tree toper。

and one in other part。

uh uh i think that is through metstatic setting。

so uh uh h gecan can can reauthcury surerery ah be finine to those h triccouver thank uah curcurtly reemploy from from primary y。

thank h single one contsurgery uah concondeiningenery think，

redisease yeah ah duication conconfinto think uh currently employeed empof from of surgery。

thank h thank h ah。

this is controgy y way。

the prisury y thank for the progery said， is regional。

and what about susuregery？yeah consiical can technical reery。

yeah usually resicery。

yeah yeah yeah。

yeah right， right，

right that。

that japanda ah it is HH discussion。

that is sisin that，

that inina data。

uh happen metest， the regibut h。

it happhappen uit。

it means most of the patient has an and three。

so in yeah， so next i can to send one one six preay and and sixteen eight two is a kind of uh， receptable， everyone。

yes， okay， thank you。

i understand。

ok， good， maybe maybe that's this this y。

ok。

ok， so um very time is very limited。

i would like to cross this session。

thank you。

well， a and sityou， and thank you。

恩是。

你说什么意思？

ok。

adlet us to the to t from universesion。

so uh initially， uh， we will ask for from from uniuniversity who is API of of omproproject h。

so so h here talk about the results of ommust school for a so far。

and after that， you， we will discuss the you know。

ommost project a country proceeding and are other， you know， a step of the a cricical trial。

every pondless can have， you know a hand fun agreeand disaggreement对。

you can use it。

if you are very hot about that。

okay。

uh， i expeexpect better unique and the interesting opinion uh in the discussion session。

so initially， i like like he ask person nmura uh to have your presentation。

so please。

thank you for uh h。

uh uh uh this opportunity， and it is great owner to this uh presentation。

uh uh uh cancaner er forum HI represent the uh uh only school projects。

so this is my discoursure。

why uh uh are 're out line of my project。

so that's the uh edemor real spepreser cancer。

uh uh as pressure cancer is categgrazed into augenocurrach normal。

uh， and this commmoncal curacch normal。

but对，commconsecurttomal instance is highest in our area。

aggressive local strategy for all commmoncercasinoma a providenniic insight into the management of augmental tic disease。

恩那t's。

so the uomomuh the orgle must take， as for for gas， strk can suffer consensus。

it's a great achievement by european key opinion leaders。

that uh there h specificity is uh uh undtretreated uh uh uh that no distinction was made been betwen en。

the uh given the uh this a different uh uh does uh ordinent krituma best strategy and consensus upride。

uh come as the cutionmer。

and uh very important uh uh trial。

so s shhahigh startening trial。

uh， this is a very good。

uh， they does so or sweaper improved the with the addition of locker treatments。

but the uh you can see this uh uh strict riteria。

so that uh egible patient had uh controlled primary tumor for all over three months， a without progression after treatments。

and uh majority of eeever patient had AA very limited disease that uh primarily a primarily is one or two reasgions in a single organ。

this suggests that uh orgmental strategigy for comcomer curar norma is definite from ardenal current normal。

so this difference。

uh我们three is march centre mara a little specstic study。

and most of this a one two three AH ddata h uuh conduducted uuh study。

so we i will uh present the uh my school， one， two， three， four。

and at this results of the this data。

for three II present the results of omsquk one。

this is a systethetic lavel and metanalysis。

so uh， we is touch on for four database uh poamadal and uh embce chanra a and clricktoilal governments。

of this a three hundred uh three thousand eighty， eight hundred four or records uh， while a screen and uthirty four or study where a study protocol is included。

this study for study and sport tuoral ingredidits uh this is uh twenty little respective stustudy and four pastic trial ingdidiin is so shanghai。

and seven ongoing trial protocol。

omica ageeuucapitalized as uh uer uh fifty percent is an abcenent wpool pool and fifty two seventy five percent is fair。

uh over sevenfive uh percent is strong。

so that's the results of the this almost one is is uh singnonoocrew is the one organ weight up to three metastatic culigion。

and meters meticronsoso mask is one organ with， say， one or two meter sticuligim。

but do you you concerder uh uh this， this different were uh uh， this is uh HH medgligibut in a detension is likely in france by aflection by us in a available regature。

but h uh uh study comppared the the h of the local stestemic ery with systemimic apapalone s imcompved with systemic syerapy alone。

the next is showed a result of uh omask too。

this is a case discussion yesterday。

yeah uh totally five fifty eight eight institution is participate this a table showed uh charactercs uh h export participating in much displaininary seems。

to the result。

yeah， that's h fifty patits cases is every casase。

so the results uthe results uh casseis is diseasase only very sorry。

and，next a by authity is a cascash show the unda fifty percent of agreements late。

uh h diagnosis is uh uh all patients uh received um CT。

and uh addition tested is uh pesccount was frequently recommended as further diagnosis， liberation and next was uh in relife for or liberalgion。

the treatment is uh， this h。

orcommdidiase is h。

the cham h recommended treatment to ensure is uh systemic therapy almost uh team。

so or recommended this a systemic therapy。

and a minimum duration of systemic cery requires the three or four months。

uuuorgoma initially algomittic disease， the agagnosis uh uh remained uafter uh orgomestitic disease。

after systemic survey out， lee is seasing。

the next uh showed uh results of我们three，the little speak study in in japanese patients。

now we a rebuild uh uh restustuuh patient uh uh and loved the metasoticc as futers come up to care a patient with uh under five distant metroocc ligion。

the PFS and OS were compelled with between the h systemic alone and the systemic plus local syerapy and upfront local syerapy alone。

the results of the dh comppabebetween nnpapatient， who treated ficdiffedifference between a metegononous disease。

the next is survival outcome， well， a by a number of uh organ metasces ces patient h。

this data a so HH moreHH number number， the organ meta sources is worascing， but the uh。

也能全。

and uh， h survver data uh by number of religion， uh patient， uh ll water it with uh systemic therapy alone。

so uh， you can see this data。

uh， uh， this h， the there is no difference with uh between one to three region。

yeah， next uh uh compured uh uh treatment strategy。

so the uh PFS and OSH， you can see the uh systemic pross uh uuh most longest survivor data。

in this uuh， stort treatment group。

but the uuh， this patient， the selection uh their selection bios。

but uh we used uh uh uh uh analysis using provincy school mountain。

so the uh patients selected the uh systesystem syerapy on the systemic uh syerapy plus a local syerapy in group。

the data uh， that show。

this is so sysymic plus local syerapy is longer uh OS and s compared with systemisteery alone。

搜我不是感对我操。

the next汀eting ok。

so the next uh uh shoulder uh result of almost ffour。

oh， this is a therefore concerns of study。

so all the participating uh uh uh的uh seventy seven uh doctor uh uh uh uh study。

so oh， h。

how of the udoctor or HH of such such ger on project and um almost uh east asian doctor？

and uh this uuh， five conconsensumesterlogy was conducted in three online questionary loans。

uh， this guy questionary statement was derived from preliminary study， almost one two and three。

so the exports buried uh statement using a one a nine point， the icud scare or a selected from a multiplular choice option for uh legion limit。

the response were a based foreiign category， ory， one， two three points udisagree， ree， four， five， six， six and seven seven o agree。

agreements is uh show， wn AA is is HH poor agreement and a fifty to to perir agperenent is a consensus。

so the uh service uuuconconsent source of as h always most four， all this， a definition， the diagnosis on the treatments。

the uh uh insurred definition， uh show uh higher or actually or uh abundable power pooutic or a pabbic。

and engineer refnoence is distount auesthetic influence。

and the number of involved organ is a limited to one discent organ。

but uh， if the primary to more were religion， leink fnoals are present。

uh lilimited to religion in one organ。

so the，what a short table， this is orgspecific undertiming criteria。

so so h， if the patits have a long sources and and h sensuor one religion。

and if the patients uh long ge meteesotic amid techonon's uh disease， so uh uh uh union theator or two regions about to two region。

and uh next uh HHH uh addidiin imagine uh uh bash HH。

and by up sea， it was a not monday， three， but preferred at this， it done。

and uh uh ICRI should be inccooperated wheneof feasible。

and at uh， this HA systemisyery， a duration is at least three months uh。

and uh then then did you making it were uh this making treatments where men must be determine by on uh merticidisment teams。

so next is the question。

ok，before this discussion， i wanna ask a person mura h about very essenal essensenal a primitive issues， but very important。

in of the examm。

uh， the other opinion， such as a proongation of the a better QL associally ally h of the local set up。

be what i'm thing like that。

uh， can i ask you first？

uh II uh uh， this is uh i hope on the abtient hope the uh cure。

uh this a disease。

so the uh uh。

um benefits of h our patits。

uh， you are AI， which a them。

i do all agree that。

agree disagree。

raisyour friend handhaa。

oh disagree。

yes， ah first first shoop， yes， they have a new line。

thank you very h。

and so II think art with the definition。

security， intend local regudent with their peace。

and。

so i think it's uh it's good to for us to start with the definitions and let us to start from the same line to to have the further discussions。

ok， any other a comment。

from the partners。

cooperate raabally susult okthank thank very， very so um we want do so you can see this sghtly yeh。

ok。

ok，艾德生。

ok so。

so um first question of of the disesea number number one or four four uh。

yeah， distounttal starh you choose a distant mental。

stources is agree， but not distount。

this is a locker is disagree。

ok， are that very good？ yes。

YU only agreed。

yes， there问你闺孙女给们找个something。

i agree with the it is distanomy testises。

yeah， because if this is。

for international。

they see， you must follow international rules。

so no matter the AGCC and JES current TM stage one or four， of course， is am one。

so uh， we all know that is treated。

it can be recepcted a local。

but maybe western。

doctors they cannot understand。

so at the literatature， i think uh。

yeah，

it。

i agree， but as for some个deinand， i agrethe point view because the the the global view about the pattern big rash by as a， we should pay attention， but pattern and eastern pattern is a something different。

from the point view， it is the athnoma in the low sht in the tuper criticical。

we， i think there re's no question。

but in our real world practice in the ema， a very frequent is over there is it's over here。

so。

if we want to treat the this reonon， we we will have reflect the otherwise。

um misleading and someort the interpretation in the the final result。

okay，

very good comment。

what about the south korea riciking？

yeah， it's resuonal reasonalII。

uh studied my patient with the supreanting mattest as this last year and reported to our society meeting。

and impatiently， the super cllpical of mettasasasalso。

also， there are much higher number of metasasasis， not even not in the media sam， but also the aptomen。

and also those pasiadadvdisease。

it could be curgery YY ery， y followby surgery， y。

so only one perperceruh region。

and other other thing is， other thing is h regara resomething ont。

so in real world data in the US， the number rerespititis AA datata a perpercent than perperits， the lethe， ten or eight or something like that。

so。

if they fine， if they find the supercess， that means there must be much more higher。

no agagwe，

the advanccdisease ase ah think the vtion is is ase HH agree。

we preprevious comment。

uh uh uh indicating that much reeum uh HH prepreprecomcombeeeen uh HHHH uh h diction uh h vadvascomces in this occasion。

ok， thank you very much。

so a actually uh， we need to emphayment about agageabout about because in terms of between the in the world。

ok next quesship。

young next uh h tofial sources or not。

uh， some gogo linknoas stands for the one would do or something。

i think， yes。

so。

good answer， agree disagree or something。

oh。

ok。

走哦。

okay， you can you can change that can change。

okay。

thank you。

uh， i need to clarify the definition of a sopical limpluid here， because one one one is origonal limplomid。

but one or OTR or one or to meet。

should be regarded as a distant right。

so that means a wna to。

is ssoficical limplote。

it's one of two， one of do he is indicated he's saying the one i think。

so yes，

that one or one。

那个那知吧，

我。

penniquent from。

不是绪。

的艾子。

my personal opinions that the live nows are about the levels of levellar and medal hiire。

uprier threasc region uh neck sevical regions uh i was treating as mettasa disease。

any difference womment。

ok， next。

yeah， no this a agagreements agreeagageements。

this is a fair agreements。

so uh so next， okay。

yes。

uh the udedesion tion of media reinforonouth inf examor。

this is is quesexexamum uh previously i much。

the。

do we need to separate untreal media in these questions or or we can think together？

ok，will combine together。

ok。

so good jancer。

agree disagree。

ok， that's good。

according to the cancer cording ding， the addition of clasfication is a regional。

so what我我我我what's your opinion in japan。

jmpanese if there is pretrual imploommetasasasis in oppthrush gas for their cancer，

this this uppposor cancer， yeah oppothrush h。

but still what you know， uh？

generally one was six spay is。

but in some cases， just a special， you know， for single bassses in the patient is in the council centre hospital。

you know， those patient can be treated with。

you know， local reaction about six spray。

so in that， in those case， you you you don't buy seacthe pretrtrack a link note。

yes， routinely， but the in some cases actually， uh， you know， especially the uh exexist close close the one record or something we can that technically。

yes。

ok，good you good， you answer again。

ok agry。

disagree erulally。

一个是。

uh， in our practice， we routinely per that sector pretrack er nonot。

yeah， uh， and there seems the nommatter than human location。

the present of metasas is in this area is not so different。

from h。

the。

and how about one one one four four intererereis is region，

do you if we want？

it is is nfrequent councount specispecififiarea desected。

if pletely raraal disease。

we still think it a rethink。

six spray might be local local disease。

uh， with for example， as i told you where the location is very close to the you know of six three club at something。

okbut on on。

so that may be the uh， you know， best， you know a difference。

yeah， between the japan and other agan countries。

okay， h， that what about china？

um这just one comment you can think about uh that。

uh HH common local curon for um。

photo the the TM stage standard。

before the existence ininters itlow。

yeah， yeah，

no ah perform the several pieces for a reception of a reception because do not do。

but after camal， the erais ah the in the is is the in the the is the controversial uah ah h。

the era， but but we can can some oh effect， rereception of of actiity is h。

so next question。

uso sorry。

uh， that is a local treatment uh indicated for the patient with stabl disease， a showing a tend to。

progression， but the uh not progress sive diseuuh uh systemic survey。

what's h treatment is you requimenend。

regard treatment will continue a systemic survey。

ok阿k johner。

ok。

so um h dificfict h yes， yes， yes，

you contcontrol。

the tomnot show the trend progression。

it's not good， kind late for local therapy。

i think。

okay，

any other comso。

yes， i agree with the bottom line progress。

ininicating that that systemic treatment is not controlling the systemic disease。

so though we provide the local treatment，

though papatient the early reccurrence。

so might not be a good for the local ah have a choice。

until clear until this patient showed a clear progress progress ve disease， we will continue as same arrangement。

actually protreressing slowly。

yeah ah。

get any ssage look continues to to be agree。

okay，

good dancer。

yes，

any other comment is it depends on the，local therapy？

so in this case， at dodoctor surgershould should aavoided， but be raraation or maybe considered。

yeah， we have a radiation therapy has a good candidate as the the local therapy。

okay， that will look a good point。

so another question。

no blast question， yeah， no， no， no， no next next。

x is a is a local treatment indicates usimilar aruh score the uh stable disease， but showing the tend to shrink king。

but not not uh achieved uuh h response。

ok， good johster。

good joester。

第三个人。

哦。

我都不收类。

适肺病。

you have a time to go see it right？ yeah。

yeah， because in our daily practice or MDT。

those patients has a trend for sometime somemore。

give more systematic treatment。

very， very good point any other comment。

so it depends on sitution that some patient show uh industal show。

initially， the patient is a lot of the disease， but after after the cheamemail email than some patients， uh， we can induce the patient from some patients in the case。

sometimes we can yecan use the surgery in the case here。

yeah depends on the process game。

yeah yeah，

i think，IIT seems ready to seeseeyeschool。

yeah。

yeah。

because of a qualitive life is also that very important yeah。

ok， hery about the。

uh， i also agreed local trip。

an should should should。

but what can't the local cerp cheat banding on the sight and a condiof of paolve of the resolve of the of the disease？

and it will be possible in the sesease very important contcontl l contcontcontcontcontcontcontcontcontcontrol remofronant in the future。

ok next question。

uh， the results of the uh of mastall and thouort， of which。

滚，我去。

this，progressive progressising progressing SS。

so so this this dis is on the four or those。

so the next is。

there are a little sources in case of metacrons s can you stop and what about see our leader？

yeah， any，yes。

do you need？ you know， local systep before see a region？

was that what？ not？ yeah， that i think it？ it should be an。

you know answered cor why the partners。

yes。

if patient achieve achieve see， are we are？ i think local therapy is not in just right？

continuous systemitic people a while or just observd。

i don't provide。

i don't provide local treatment when the patienters he are。

but actually， you can see that the results you know， agreement and the disagreement is half and half right。

yes。

what is this interpretation that result yeah，

uh that's uh h。

uh very difficult， but um IH complete response redision。

so that the HI think， uh i want to to be the uh。

uh comcrete ser l so don't want rerected cted， but h that's very inmbassive and ui asked。

uh HHHHHHHHI uuh HHHHH tretrement uh HHHH the comments。

so HH uh HI is t teh。

so uthis rerereresorry sorry uso， i don't know。

uh the CO uh acc so h somesomeso we ah h primary with specipriprimary reason especim rereason on regiy。

do them does susuccess ses disappeared disappeared ically。

uh， i think you try to resact the private tumor。

if and one disadisease。

when the uh my tumor is medical control right。

走我者把你强一点儿。

is periit discreprepancy， but in our center， uh， based on the MDT discussion， i think the most of the。

kind of CR patients。

we will not at the。

local therby most systain，systematic or ICI for the patients for organ preservation。

yes， okay， thank you very much。

so next what的？

ok ok， so next question。

yes。

so the next question is lcase ase of megnmsources， should should local treorties。

long， i'm reonatthere three region。

so what'sthe treatment uh your regument local treatments or a continue uh system survey。

this case， we already provided a system treatment。

yes。

and then after that， we sad this theregia。

yeah， very difficult question。

i thank you。

yes， good josser anyway。

okay？

可以是可以是他这里科瑞。

so ligrent did yeyeah gyeyeah gyeyeah ah no，

no primary original evenals。

only only losouce贝德sources。

okay，

first son home any comment。

it also depenend the situation because the the the。

if the patient tais light long middle is in one in up probe， one in mimiddle and one in middle。

i think think that's not be the cantake polwer countriyment， but the patient has the three regions on the light middle low， that will be good， kind tamidle le。

yeah， what about brocess game？

no， what it depends on the location of the mattest dlegision。

if it is located in the spartial legion， we can do by separate wage reception， reading thirty minutes of forty minuand minuminutes one。

uh， if the reason is located deep in the right approable right laorup， uh look has happy。

so especially surgery is is a good acceptable。

i don't know。

one definitely i do twoII do maybe， but three。

maybe the benefit will be it less than that。

i expected。

yeah。

okay，

what about you know？ press eltly？

also， agcoudo is AA。

number is penis is in it SS opopthe， but but other other other other sities and and in very contsiof very quuh。

any additional comment。

no II think is we are talking about the surgical resceptable or technical ressectable relegions， because uh professionally， and our chess surgeons are very capables。

they can， if they consider easy manageables。

uh。

i think we will consider them me as only go mattassis in our center。

i think。

ok泽美。

i think this is the question is。

the bike behavior is that equal to only commantasasis for three。

if the question uh， it is consider three maanteasasis。

plus CDDNA negative， i will choose。

but if uh three testasis， you know the biobehavior for the tumor or cancer， i think it's not receptable or not receptable question， it is um。

quesquestion think think so why II disagree some kind？because based on breast cancer colorrectal cancer， there have a loss of data for showing the lamthe um SSH as on， we cut that， but mostly less than three。

yeah， ok， it's fantastic。

you know idea using a liked biyathy。

thank very much。

okay。

so next， yes， it does a liver medoes the same question。

so in case of metal sances。

ok， good， good answer that。

after a systemic treatment， yes。

yeah我是第三个人以后哦。

precise precission ugly。

哦，

不给哦。

ok presession。

answer is actually the same as the previous questions because this is more even more。

uh uh uh restricted to one not helping localocations。

so so so i've definitely consider that should be considered。

uh all like go， my asask disease。

so a breath game。

爱你，我们。

ok。

i have to met III didn't read the question well， and but i thought it was about the long met as this is snow。

it's only definitely。

it's。

yeah， okah，

even if the number is the same between the long and and liver quite different， i think。

and also um。

you know you h to resct ct three region。

it's not so easy。

i yeah， so very good question。

but okay next。

that that's the results of all relnerlethat that that regibut， but ns refirir agreements。

ok， understand any comments from the pana alist。

ok， uso。

so II think based on these results， you don't worry about that because。

at every time， the uh the results should be improved， not always to follow the former ones。

yeah，

you think it's different like the former is yeah， maybe no。

yeah。

阿thesignase seseon a disease。

okay。

do you agree with his opinion？

any other different comment， ok， ay the the other question is， you know， when go bearing the h omec project and omec project？

the number of acceptions， you know it h。

it is project。

ah。

when compare ject ct course， the diffethe between， for example。

a socprossion，

i think that's better to be started with uh japanese colleagues because at the ommac for many of。

the doctor participated in ommy all mask four， our from japan， right？so it's better to start with a japese se collar。

ok， uh II think we japanese doctors are not too aggressive to。

uh let does take is， but cause sno and and i think it's better to leless。

那不如吧。

my does beknow。

provide II think it's good to provide local terare people。

this number of my dustices。

yes，

i am yes。

i understand that the tween uh， there is difference bebetween。

and but those difference comes from diffedifference in local tretreatthat is the gy y that the YYS ggy y that the SYYS， the the the the twtwethe tretrey that the tween， the tween。

okay。

first，

so i didn't like snormance， and i say totally different。

you know， american based on the consensus from the AATS， they have divided the two different kinds of disease。

so i think uh justice s said，the former literature or references we。

we can read and see， but this is the station。

patient and squsquasasola。

so。

no， no challenge no improvement。

that's your point。

thank you very much， much， okay personally。

yeah， yeh， uh， i just coming about the lonmate tustices because because in diad cancer with lommetthesis， the recession is quite。

no also depending on outcome come come， don't don't t no sibut， but but cancer cancer cansier。

uh outcome should it should very recovery。

no reason to just reject the patient for local treatment for such patient。

ok， a bruce the home。

you ask the difference between the omec and omeask。

uh uh cancer。

uh actually， i don't know because i don't know the surgeons or medical curtries who was participated in omic trial， but i think there may be a difference in philosophy h。

so。

maybe our a asian doctor is gore for only little mattest diseases to cure the patients。

or to prolong their survivor。

so umaybe um HI don't want to didisappoint to our patient。

so if we extend our indication or allemetal disease some patient， uh， we need to any benefit uintreatment。

so indicase， our our treatment or ufort。

so indtile or usually uh cannot want to avoid this situation。

so uh， we need to make the more ststrict indication for all legal disease。

that's the way to make our treatment be effective。

okay。

thank you very much。

so it's time to grow this session。

uh。

finally， replassure。

okay。

think think think think comthink comand think beginning of our of tings。

not only be surgically or locally treatable， but also should be curure with curruptive intent。

so if we go back to that definition said。

i think our uh all mask for conclude with a more strict definition of ollegal testithis will be should be a very good one。

ok， i should congratuate uh doctor。

but that numerous than efforts。

okay， thank you very much for very wonderful presentation， constructive and engaging discussion。

thank you very much。

ok so， group photo。

塑料吗？他隆。