Cyberknife for.single lung met in spleen?

Portal Forums Radiation Oncology Radiation for Distant Metastases Cyberknife for.single lung met in spleen?

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June 29, 2015 at 5:14 pm  #1270267    

pml99

Last month I had convulsions because of what turned out to be 5 medium and small brain mets. Treated them a month ago with Gamma knife and they show no more activity and incredible shrinkage, thank God. My Onc sent me for a control Pet scan just in case, as I am not on any medication yet (I am ALK+). The Pet scan came back with a 12mm high intake nodule in the spleen (6.2).

This seems to be extremely rare, as the rest of the body is completely clear, except for a 11mm subcutaneal nodule with low intake. My onc suggested starting on Xalkori, but I am against using it yet and am looking into Cyberknife treatment option or 3D radiation to the spleen. When I said this to him he seemed to agree. I do not want to waste time with a biopsy, I am pretty sure it is a met.

Question – can cyberknife be used for a case like this on the spleen? Is it as effective as Gamma Knife is for brain mets? So far, my mets have responded very well to radiation, and given that it is an only spot, I’d rather try this instead of starting Crizotinib. Is 3d.radiation to the spleen another option?

Any suggestions? Ideas?

Thanks!

Peter

June 29, 2015 at 6:53 pm  #1270269    
JimC Forum Moderator
JimC Forum Moderator

Hi Peter,

I don’t think it’s so much a question of whether radiation can be effective in treating a the specific spot in the spleen, but whether this is the correct treatment plan overall. If your cancer has spread to both brain and spleen, that means there are micrometastatic cancer cells in the bloodstream which, in the absence of systemic treatment such as crizotinib (Xalkori), are likely to form another metastasis somewhere else in your body.

Radiation is the preferred method of treating brain metastases because it tends to be effective over a relatively short period of time, while systemic therapies usually don’t cross the blood/brain barrier in high enough concentrations to effectively treat existing brain mets. In a setting of stage IV disease, systemic therapy is preferred for the rest of the body unless radiation is necessary to prevent painful bone fractures or damage to vital body structures. At times, when lung cancer has spread to only on spot (oligometastatic disease), local treatment such as radiation or surgery may be effective. A situation in which the cancer has spread to two distant locations is a different story, so it may be preferable to initiate targeted therapy in order treat the cancer cells which are not yet visible but almost certainly present.

Dr. West has written an FAQ on the subject of local treatment in the setting of metastatic disease here.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

June 30, 2015 at 5:20 am  #1270275    

pml99

Hi Jim,

Thanks for the answer. I had a met to a lymph node in the medisatinum area too which I treated effectively with radiation a year ago.

The problem to make my decision is that I had a kidney primary at the same time as the lung one (both adenos, unrelated) and had the kidney extracted for that one. My doubt is whether the met in the spleen may be from one or the other, something a biopsy would not even confirm completetely (and I don’t want one done). That is why I was considering radiation on that one this time around and hold back on the Xalkori until something else popped up (more confirmable as coming from the lung).

Thanks for your comments

Regards

Peter

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