Thank you so much for this informative article. My mother, with LD-SCLC (had a 3.8 x 3.6 cm hilar mass or “confluence of lymph nodes”) has just completed her 4th of 6 rounds of Cisplatin and Etopside concurrent with 33 rad treatments (completed a couple wks ago). Her CT (done 1 day prior to her 4th round) shows this adenopathy has essentially resolved. She is a vibrant 67 year young person who prior to this dx was going to water aerobics and kick boxing at least 3xwk and babysitting 2 of her 2 1/2 year old great-grandchildren. I just don’t consider her as “elderly” She seems more like she’s in her late 50s to me activity wise. She had no other health problems. We will see if PCI is suggested when she completes her chemo in January. What a great website you have here. Lots of helpful information. Thanks again, Bonnie

BonnieW

I would say that kickboxing drops your chronical age by at least 5-10 years to a younger “functional age”. That’s pretty impressive. It’s an individual decision, but now you know the basic pros and cons.
-Dr. West

Dr West

Dr. West,
I have heard that if you have PCI and you do happen to later develop brain mets, you can never have radiation to the brain. Is this true? And is PCI a guarantee of no brain mets? I also was told by a patient of mine who had PCI, this was the cause of his Parkinson’s syndrome. My response was yes, he has some tremors but he is still alive going on 4 years after SCLC with mediastinal mets.
Thanks, Bonnie

BonnieW

Bonnie,

PCI is not a guarantee of no brain metastases after that, but we can safely say that PCI markedly reduces the risk of subsequent brain metastases, from 40-70% to about half of that.

If only 1-3 brain lesions are identified after PCI, gamma knife or some other focal radiation or neurosurgical technique would be my recommendation over more whole brain radation. But it’s definitely possible to get at least focal radiation if the need arises after PCI.

As for Parkinson’s disease after PCI, I am not aware of that side effect and don’t know how it could be said that it is from the radiation, since almost every other case of Parkinson’s disease, which is not a rare disease, occurs in people without prior radiation. I don’t know how it be said that those are not two unrelated events, although I suppose it is possible that PCI can reduce the threshold to developing various neurologic problems. But you bring up a good point that we need to remember: it’s often reasonable to assume the risk of some real side effects if the alternative is a higher risk of dying from cancer. That balance is different for different people. Unfortunately, we can’t reliably predict who will get the worst side effects or who will be the beneficiary of more treatment.
-Dr. West

Dr West

Thanks for your reply. You have been very helpful.
Happy Holidays Dr. West,
Bonnie

BonnieW

Hi Dr. West,
I was looking up some of these studies such as the Arriagata and the Gregor, it looks like these studies were done in 1995 and 1997. Are there any more recent studies? I hope by now we’ve got some more improved 2 year survival rates than mentioned above. That’s pretty depressing.
Thanks, Bonnie

BonnieW

Bonnie,

My understanding is that there will be an important trial about PCI in SCLC presented at ASCO 2007, in June, but we won’t have the results available until then. I’ll be sure to update the site.

-Dr. West

Dr West

Hi Dr. West,
Thanks, I’ll be looking for those results in June.
Well we saw the onc. and rad. onc. yesterday. Both seemed very taken back by the PET results, the onc. stating absolutely no pt. of his who has had a complete response to chemo and rad. like my mother did has ever had this come up on a PET, therefore he will treat as an infection. Let me share the findings with you which sound very much like you described to me when I told you of her CT abnormality. The impression states: a 1.2 cm nodular density just lateral to the rt hilum, this does demonstrate increased FDG uptake, SUV measuring 4.5. There is some parenchymal opacity just posterior to this, also demonstrating increased FDG uptake, SUV measuring 4.5. Recurrence or metastasis is not excluded. An inflammatory process could have this appearance as well, however. No other additional nodule or infiltrate is seen within either lung. No pleural effusion or no abnormal pleural uptake is seen. (Now, I must admit, I have no idea what the numbers mean on how much FDG or SUV uptakes measure). The onc. said the only people who have these results are the ones who have no response to chemorad tx (he said “as if you gave them water as treatment). I asked him if this could be a benign nodule, he said no. I asked the rad. onc, he reviewed her films and said it could be a granuloma. Nevertheless, both Drs appeared shocked and somewhat confused (remember her CT just prior to the 4th chemo showed her tumor resolved)She was put on Augmentin for 2 weeks then repeat the PET, in the meantime she will see a pulmonologist on the 19th for “airspace disease beyond this opacity which is concerning for post-obstructive pneumonitis versus second focus of met. disease. Less likely, all of the changes in the right upper lobe could relate to inflammation” I must admit how very frightening this wording is to me. I hope to God the Augmentin clears all this up. We also discussed PCI, the rad. onc. states that 100% of his pts. have PCI because it is just as much as part of the standard of care as the chemorad. Also, stated the radiation dose is so very low, the side effects are minimal such as difficulty doing math calculations and stated her hair will grow back in after about 3 mos. He also states, the probability of mets to the brain are about 25% if no PCI, and 5% with PCI. Also she may have a little temporary forgetfulness.He said she would have 18 treatments.I felt better after the discussion.
Sorry for just going on and on, just wanted to share the visit outcomes with you and get your feedback. (since you’re the only one I know who does research on this subject)
Have a great day and thanks.
Bonnie

BonnieW

Bonnie,

I know this is frustrating, but it is quite common to see ambiguous findings on imaging weeks and months after chemo and radiation. Often follow-up scans are very helpful in figuring out what’s going on these settings. With time and antibiotics, inflammation or infection should become less prominent, but cancer generally worsens on the scans over time. Almost every day I encounter these ambiguous situations shortly after treatment is completed.

In terms of PCI, you can see from the posts that PCI is indeed considered the standard of care for patients with LD-SCLC who have had a complete response, and some would consider also including those with a good partial response. So everything your docs discussed with you makes sense to me.

-Dr. West

Dr West

Dr. West.
I recently (finished on March 6th) had PCI. I have limited SCLC. The radiologist scheduled 18 treaments and dropped it to 15 due to headaches. I was given steroids then weaned off them. My question to you is , Is it common to have headaches from this treatment? I am still experiencing a right temple ache that I have to take something for everyday.
Thank you
Cheryl

cgregoire

I’m not sure of the exact stats, but it’s not rare. PCI can cause some inflammation and swelling in the brain, and steroids are often used. it’s possible you may benefit from being on a low dose of steroids a bit longer, but I’d talk with your radiation oncologist and/or medical oncologist about that.

-Dr. West

Dr West

Dr. West,
My husband was diagnosed in Sept. with Limited SCLC shortly before his 66th birthday. Lung radiation was decided against initially (as was surgery) because of his overall health (prior heart attack, stroke, COPD). After completing chemo x 6 four weeks ago, a CT shows that the tumor has shrunk considerably but is not gone. A PET was ordered (had it 2 days ago) to see if it is active Cancer or dead cells, scar tissue, etc. Now the radiation oncologists are bringing up doing 6 weeks of radiation on his lung and 2 weeks of PCI. We are hesitant (to put it mildly) to consent to radiation on his lungs but agree with the PCI. They seem to think if the tumor has shrunk enough to localize the radiation to a small enough area, the risks are outweighed by the benefits. We feel that he has avoided being on oxygen to this point and if we get rid of the cancer but ruin his lungs, his QoL would be so diminished he may not appreciate living longer. I guess my question to you is, if the PET scan still shows cancer in his lung and we decline lung radiation, should we go ahead with PCI and would he benefit from that? I am also aware (especially after reading your comments) that the PET scan has a high incident of false positives. If we agree to the PCI we are scheduled to start in a week in Seattle (we fly down from Alaska) so I’d really appreciate your advise. Thank you.

rayswife

Rayswife,

I’m sorry I didn’t get to this until now — missed it.

I can certainly understand his oncologist’s reasoning — it does make sense. On the other hand, there is some risk associated with the radiation potentially causing damage to the lung tissue. I would need to defer to the radiation oncologists about how great that risk would be, because it really depends on how ill he is and the size of the planned radiation field.

But your question about the potential value of PCI is a separate one, and I’d say that now that we have evidence that PCI appears to improve survival rates in patients with both limited and extensive SCLC and very remarkably decreases the risk of subsequent brain metastases, I’d routinely recommend it to the clear majority of my SCLC patients who have had a good response to chemotherapy.

-Dr. West

Dr. West

Dr. West,
Thank you for your reply. Since I wrote, my husband’s PET scan came back negative for cancer in his chest! Now radiation on his lungs is not an issue but we will be going ahead with PCI for two weeks beginning this Monday. Thank you for your encouragement.
Ray’s wife

rayswife