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Cyberknife advise for T2N0M0 NSCLC
pmagdal
Posted: Friday, February 10, 2017 4:45 AM
Joined: 2/10/2017
Posts: 4


I would like your advise and insight on an issue if it is possible. Two and a half years ago (07/2014), my father (75 at that time) removed two peripheral lesions from his right upper lobe (sizes 1.7cmx0.7cm and 1.3×0.5cm at a distance of 1.0cm) with wedge resection (wedge size 4.0×2.0cm). The biopsy showed a highly differentiated adenocarcinoma with BAC features. Oncologist advised only CT and blood check-ups every 6 months. During his last CT check up (12/2016) a mass 4.0×2.7cm appeared on the operation site, a local recurrence (in fact the tissue around the resection scars increased in size). A CT guided needle biopsy was performed last month that confirmed the malignancy; a highly differentiated lung adenocarcinoma. The treatment of choice is lobectomy. However, due to COPD (FEV1 1.52), coronary disease (had a triple bypass back in 2010) and arrhythmia (wears a pacemaker since 01/2014) surgeon is reluctant to perform the operation. Given these facts the oncologist advised for radiation therapy. After performing a PET/CT (everything OK, disease is localized) and talking with several radiation oncologists we consider treating it with SRS/SBRT. We have contacted two different centers; one operates Novalis XK and the other Cyberknife 4G. Now we are trying to figure out which approach is the best. What is the difference between Novalis XK and CyberKnife 4G? My understanding is that we are talking about two different machines that perform the same thing however which is the best for treating a peripheral lung mass of that size? Should we expect any side-effects? We are told that there is a possibility for radiation pneumonitis yet we might not face it because the mass is peripheral. The doctor also informed us that fiducials may not be required because of the size. Is this the case? I’ve also read some papers online claiming that SRS/SBRT exhibits similar results with wedge resection. Is that so? Thank you in advance for your time and help. Peter
radsrus
Posted: Thursday, February 16, 2017 10:07 AM
Joined: 10/10/2008
Posts: 4377


The advantage of the CK is that it tracks tumor motion in real time, and it uses more treatment angles. Our experience is that it results in less normal tissue being treated. However, both can potentially get this taken care of. If you have a choice, go with CK

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
pmagdal
Posted: Thursday, February 16, 2017 1:37 PM
Joined: 2/10/2017
Posts: 4


Thank you for your answer. We opted for the CK as well. Based on your experience, what side-effects should we expect? What about the SBRT - wedge resection comparison?
radsrus
Posted: Thursday, February 16, 2017 5:41 PM
Joined: 10/10/2008
Posts: 4377


CK is as good as wedge resection, maybe even slightly better, for T1 tumors. For T2 tumors, the data is less clear. For T2 I usually advise surgery in healthy individuals. But in someone with the health problems you describe, the risk of death from the surgery probably exceeds the difference (if any) between SBRT and surgery. You should talk with the treating team about side effects. They know all the details and can better advise you

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
HannahForever
Posted: Monday, April 10, 2017 4:04 AM
Joined: 3/8/2017
Posts: 30


CK can help in calculating growth, wedge resection can be a possibility but it totally varies with case to case
pmagdal
Posted: Friday, July 28, 2017 4:58 AM
Joined: 2/10/2017
Posts: 4


Dear Dr. Medbery Coming back after 5 months; CK was delivered to the tumor, 48Gy in 4 fractions. PET/CT after exactly 5 months reports triangularly shaped soft tissue in the place of the tumor, approximately the same size as the original but different shape with medium to high SUV uptake (max SUV 5.9 vs original max 8) suspicious of residual disease. Radiation Oncologist cannot rule out residual disease and suggests close follow up. Based on your experience, are 48Gy enough? I 've read numerous papers reporting other dosages/schemes but I am not a doctor thus I cannot evaluate them properly. Are these a normal results after 5 months? In case of persistent malignancy, is there the possibility of re-treatment? Thank you in advance for your help and advice
pmagdal
Posted: Wednesday, October 04, 2017 12:16 PM
Joined: 2/10/2017
Posts: 4


Coming back after two months (~8 months after cyberknife). CT scan shows exactly the same thing, no change in shape/size, only the triangularly shaped soft tissue. Hope it remains like that. Another comment, just for Greek members of the forum. Typically, in order to do SBRT you have to first get approval from the Central Health Council, a procedure that may well take up to a month. Most people will tell you that you MUST have this approval otherwise you will not get any compensation (if you are reading this you probably already know that there are three possible modalities, all in Athens, and all are quite expensive for average standards) However, we found out that it is possible to do it without approval. You go do your treatment and assuming that you get the approval from the Health Council, you can claim part of your money afterwards. Just to be clear, it is a long bureaucratic procedure, you will definitely not get all your money back, but it is better than waiting for a month.
 

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