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Can tumors be treated in remaining lobes after lobectomy
Pepper
Posted: Thursday, January 03, 2013 9:14 AM
Joined: 12/18/2012
Posts: 9


Hi, I'm really looking for answers with these follow-up questions, it would be of great help, for me, in working with my oncologist in finding a proper treatement plan. Is it possible to treat 3 small tumors (about 1cm) in remaining lobes after a single upper lobectomy? or even a double superior lobectomy (both sides)? And secondly, after chemotherapy, would you treat a tumor necrosis negative on fdg-pet scan? is a SUV less than 2.5 safe for observation only? Or would you treat it anyway?
SDC Pepper
radsrus
Posted: Thursday, January 03, 2013 12:00 PM
Joined: 10/10/2008
Posts: 4435


We would need more information to answer intelligently, such as tumor type, what has been done already, what is being planned, lung function studies. Also, I am not sure what you mean by "a tumor necrosis negative on fdg-pet scan"

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Pepper
Posted: Thursday, January 03, 2013 2:09 PM
Joined: 12/18/2012
Posts: 9


Good afternoon! Thank-you for your interest to my questions. I will try to give you as much onformations as I can. I am on 6 cycles of Chemotherapy, Taxotere - Carboplatin - Herceptin 3-weekly regiment for metastasic salivary duct carcinoma to the lungs. Local tumor to left parotid was treated with success, surgery, neck dissection and radiotherapy with no local recurence, in april 2011. My FDG PT-CT scan was negative for metastasis to other sites. I have 8 tumors in lungs ranging from 1cm to 4cmsx3cms (largest), no lymph node involment. 5 of them, including largest one, are in two superior lobes, 3 are spread in remaining lobes. I am a 46 years old male in excellent physical condition. I have not been evaluated for lung capacity but I am very active, road cycling 150 to 200 kms per week and long mountain hiking every two week-ends (prior to diagnosic on a routine check-up x-ray in november). I had no symptoms before starting my chemo except for some little thoracic pain. I am at my second chemo treatment and had an x-ray evaluation just before. My summary evaluation for response, after 3 weeks, was close to 50% shrinkage of every visible tumors, some have desappeared from picture . My oncologist said it was an almost miraculous response and that such a response would enable us to look at options. My questions to you are being pro-active. We have a cyberknife at our medical center and I feel that a multi-disciplinary approach would be the best for me. As regards to tumor necrosis, for me being dead tumor tissue and-or dead tumor ... my chemo objectif is to reach a complete response at end of treatment. Because of tumor burden on two superior lobes (5), an option would be to have, maybe, a double lobectomy. That would leave me with 3 small nodule sites located in remaining lobes, hopefully, negative on pet-scan after completion of treatment. My preference would be to have single lobectomy, right superior lobe (2 nodules and 1 mass 4cmsx3cms) and to treat remaining 5 with cyberknife. Is it a feasible option? HAving to treat both side of lungs being an issue. And would you treat every tumor sites even if showing negative on pet-scan? Hoping these informations will be helpful for you to give me an educated evaluation of possibilities. I am looking for an aggressive, if possible, curative approach for my recidive cancer.

SDC Pepper
radsrus
Posted: Friday, January 04, 2013 3:14 AM
Joined: 10/10/2008
Posts: 4435


Taking out two lung lobes to treat part of your disease makes no sense to me. I think yoiu are best off continuing the successful chemotherapy then consider SBRT to any tumors remaining that are large enough to treat, THe success rate is going to be about 90% for any treated tumor, or perhaps a little bit better, and you will spare a lot of normal lung.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Pepper
Posted: Wednesday, February 27, 2013 12:56 PM
Joined: 12/18/2012
Posts: 9


Hi! After my 4th cycle of chemo, I had my pulmunary scan result monday and my onc is happy. 5 of the smaller tumors are no longer visible, 2 are on their way out, almost gone. The largest one that was 4cm is now a little more than 1.5cm. We've talked about cyberknife and he is a little bit worried of the fact that the remaining one is deep in my upper right lobe close to the spine. I am going to finish my 6 cycles and my onc is saying with 1 or 2 more cycles the remaining one should be gone. I would prefer stopping at 6 and treating what ever is left of the 4 cm one. Question 1; is it true that the rays would damage lots of healthy lung passing through to treat the remaining tumor? Question2; by being close to the spine, would I require the placement of rods? Thanking you in advance for your response once again.

SDC Pepper
radsrus
Posted: Wednesday, February 27, 2013 2:24 PM
Joined: 10/10/2008
Posts: 4435


There would be minimal lung damage with a 1.5 cm tumor, regardless of locatioin. Being near the spine is not a problem, and would not require placement of anything other than possibly gold seeds for tracking, which can be done with a needle

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Pepper
Posted: Thursday, February 28, 2013 8:53 AM
Joined: 12/18/2012
Posts: 9


Thank-you for your response! I would really like to get the cyberknife team, here in montreal, involved with the management of any remaining tumor or lung recurrences. I hope and believe that Herceptin, cyberknife and proper timed chemo could be a good combination for a better quality of life and prolonged survival.

SDC Pepper
Pepper
Posted: Monday, April 29, 2013 10:32 AM
Joined: 12/18/2012
Posts: 9


Hi, Still on chemo ... 7th cycle, my 8th tomorrow. Had my scan result today and my onc is saying that cybeknife could probably be a good option after the final 2 cycles to come. Best news would have been to be at a complete response by now, but all in all, good news! Only 2 lesions remaining, 1.1cm, left upper lobe and 6mm, right upper lobe. The hope is the 6mm will disappear and would be only 1 remaining to treat. Final decision on cyberknife referal will be taken after a PET scan prescribed 2 months after last cycle (9th), so end of July. My questions; does this sound like a proper plan? If still active, how big (or small) should the tumor be to be treated? And should all the original tumor area be treated, approx 4 1/2cms? I would like to thank-you again for your replies, it gave me confidence to bring Cyberknife has an option with my doc ...

SDC Pepper
DoveMed
Posted: Wednesday, December 25, 2013 10:24 AM
Joined: 12/25/2013
Posts: 3


Good luck with treatment. God bless...

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