Late delayed radiation toxicity or side effects from SRS on excision site?

Portal Forums Radiation Oncology Brain Metastases / PCI Late delayed radiation toxicity or side effects from SRS on excision site?

This topic contains 35 replies, has 8 voices, and was last updated by  Dr. Weiss 1 year, 8 months ago.

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January 8, 2014 at 7:01 am  #1261390    

My wife’s advocate

My wife is on Tarceva 100mg since oct 2011. Tarceva side effects has been difficult but tolerable. She has been NED for over 2 yr and 3 months since SR irradiation of the excision bed (site) of the right occipital lobe in 2011. SRS of the surgical site was given instead of WBR because we were reluctant to consent to whole brain radiation since overall she has practically no cancer burden anywhere else. Her situation matches closely to the single “precocious solitary brain mets” case I have read somewhere on this site.

She has about a fifth of her left vision field on both eyes not able to see clearly since the occipital lobe surgery from 2011. However over time since the SRS, her eyes has developed hyper-sensitivy to light and she has been having frequent visual migraine with multi-color ora but no headache since Sept 2012. Orpthalmologist ruled out specific eye defects but stated symptoms likely neurological.

Q1: Are visual migraine known to be side effect of radiation toxicity or narcosis from the SRS?

Q2: Is there any treatment known that will reverse or retard progression of possibly radiation toxicity resulting from high single fraction of SRS?


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

January 8, 2014 at 12:37 pm  #1261400    
Dr West
Dr West

I’m sorry to hear of her complications.

We can forward your questions to Dr. Loiselle, a radiation oncologist who does SRS.

I’m pretty sure the answer to the question of visual migraines will be a function of the location and very specific parameters of radiation, so there is nothing that could be anticipated as a general side effect of SRS in terms of migraines.

Also, to my knowledge there is no intervention currently known to reverse or retard progression of radiation toxicity/necrosis from SRS.

-Dr. West

January 8, 2014 at 4:17 pm  #1261415    

Dr Loiselle

Hi –

Visual migranines are not a common side effect after stereotactic radiation in the occipital region, but seems possibly related.

In such a case as you described, if an MRI and/or other imaging studies (like a brain PET/CT since you are years out from treatment) strongly suggest radionecrosis, treatment with bevacizumab (Avastin) can in many cases dramatically reverse symptoms related to radiation necrosis.

Ruling out recurrent disease vs. radionecrosis this kind of situation can be a challenge.

I hope that helps and that you are receiving good guidance from your physician team.

Regards,

Dr Loiselle


Chris Loiselle, MD
Radiation Oncologist
Swedish Cancer Institute

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

January 10, 2014 at 9:04 am  #1261447    

My wife’s advocate

Many thanks to both Dr West and Dr Loiselle for rendering their expert observations. At this point there is no definitive conclusion that my wife is suffering from radiation narcosis or even toxicity or recurrence.

So far, from the multiple MRI’s since the SRS given in Sept 2011 the radiologists who read the scans consistently indicated no new lesion noted in the excision site nor any surrounding white matter edema.

All the reports indicated that “There are postsurgical changes with gliosis and amorphous enhancement at the operative site within the right occipital lobe”… and that ” there are multiple foci of T2 signal hyperintensities identified within the white matter of both cerebral hemispheres. In this age group, they are most likely from small vessel ischemic changes”….

There are simply too much information for a lay person to understand or too little that is really known in medical science (or is it an art?)

Since wife had the one and only lesion detected in her brain, we decline WBR and she was given the SRS “1800 cGy delivered to 80% line” at the occipital surgical site as a “mop up” measure to assure that all the cancer cells are destroyed.

Q1: What are gliosis and amorphous enhancements?

Q2: Are these post surgical changes and T2 signal hyperintensities the results from too many MRI’s or are they results from possibly radiation injuries?

Q3: Is there any new research recommendation on how best to treat a solitary brain met?

Thanks for helping to understand more how to render support to my wife.


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

January 10, 2014 at 9:28 am  #1261449    

My wife’s advocate

Sorry, my last question Q3 should read: Is there any new recommendations for how best to monitor the after care for a patient with a “precocious solitary brain mets”?

I am very concern that the frequent MRI’s would cause other potential problems such as toxicities and residual ill effects from the dye used for the MRI contrast. I realized that she is in some uncharted territory. When I asked the few questions, her physician team and oncologists almost always have no definitive answers.

Unfortunately despite her low to no cancer load condition and that she is EGFR positive and responding well to Tarceva, medical statistics has already written her off just because she has outlived the average life expectancy of a typical stage IV lung cancer survivor!!


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

January 10, 2014 at 7:20 pm  #1261467    
Dr West
Dr West

The radiologist is really just describing what is characterized as likely vague post-treatment scarring, I think.

It is exceptionally unlikely, even bordering on unfathomable, that her brain imaging is a cause of any of what is being described.

The approach of stereotactic radiosurgery (e.g., gamma knife, cyber knife) really represents the best technology, which is becoming more precise with every hardware and software iteration.

Good luck.

-Dr. West

January 11, 2014 at 9:07 am  #1261475    

My wife’s advocate

Dr West,

I am in total agreement and respectful of your position in terms of not being able to provide medical opinion. Regardless, I appreciate much the existence of this website allowing patients and caregivers to share information and gain insight to make sense of life and how to deal with this “C” monster.

So far, her oncologist, radiologists, ophthalmologist and neurologists have not been able to make any sense of the shimmering in her left vision field “blind spot” and the visual migraine that she recently have experienced. I was hoping that the vast membership of this forum and the faculties may shed some light to her condition.

Thank you for taking time to follow her saga in her battle with cancer.


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

January 15, 2014 at 8:55 pm  #1261580    

My wife’s advocate

Are there any specific diagnostic tools to clearly differentiate between gliosis (scarring from surgical resection) and radiation necrosis vs. recurrence of cancer met in the brain?


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

January 15, 2014 at 10:27 pm  #1261584    
Dr West
Dr West

I’m sorry, but no.

July 4, 2015 at 3:34 pm  #1270369    

My wife’s advocate

Hello Dear Doctors/Faculty of Grace,

I am very much in distress. We are at a crossroad with the symptoms and condition of my wife. Its seems like medical science is at a standstill when it comes to my wife’s treatment. She has been on Tarceva since Sept 2011 (3 yrs & 9 months). Currently she is still considered NED other than the recent finding in her MRI.

On July 2013 she first detected left vision field simmering and eye flashes (with visual migraines and aura) once or twice per week. Now her eye sight and occasional visual migraines has progressively getting worse (24/7 left vision field light shimmering and visual migraines 3 or 4 times a week each with duration of 20 to 30 minutes) MRI’s since May 2014 detected light shadows of enhancement at the original surgical site where SRS was done.

The oncology team has not officially ruled out cancer recurrence. But based on the course and the timeline of her medical condition, they think its more likely radiation necrosis She had not been offered any form of treatment. The proposed intervention is to wait till the symptoms are totally intolerable then she will be offered steroid and possibly surgical or chemo with Avastin Just wondering if “wait until your back is against the wall” is the only approach in her situation or if there is any proactive treatment intervention that she should be on now before she is at a point of no return? Is hyperbaric oxygen treatment a possible choice of early intervention?

Any insight from anyone?


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

July 5, 2015 at 4:20 pm  #1270375    
catdander forum moderator
catdander forum moderator

Hi advocate,

I’m so sorry your wife is having these progressive symptoms. I’ve read through all 3 of your latest posts and adjoining threads and have come to conclusion that the question is whether or not to wait for treating your wife’s symptoms. Is that correct? I don’t want Dr. Loiselle to rehash what has already been said. Let me know and I imagine we can get an answer tomorrow.

Dr. Loiselle covered this topic a couple of years ago including this passage, “As far as treatment, this is challenging as well. Surgical resection can offer relief of some symptoms, but also can be a direct threat to function. Other strategies such as hyperbaric oxygen and avastin have been examined and reported in specific situations, with mixed results. Hyperbaric oxygen has been most studied in necrosis of the jaw following radiation for head and neck cancer. Avastin has less extensively been reported to potentially help renormalize brain vascularity after treatment with radiation and chemotherapy for primary brain tumors. How effective it is at treating or reversing any actual radionecrosis is yet to be seen, though there does seem to be some improvement according to MRI… but then again, we don’t even know how good MRI is at characterizing radionecrosis (see previous paragraph!).” http://cancergrace.org/radiation/topic/radiation-necrosis/

There are also these posts with a bit of info on the subject. Unfortunately there doesn’t seem to be anything new since Dr. Loiselle last posted. http://cancergrace.org/forums/index.php?topic=9693.0

http://cancergrace.org/forums/index.php?topic=5576.0

All best to you and your wife,
Janine

July 5, 2015 at 11:51 pm  #1270381    

My wife’s advocate

Thank you Janine for do some of the leg work in summarizing ahead of the faculty on all the pertinent posts on the subject of treatments for radiation necrosis. However all the embedded reference postings were at least 2 or 3 years old. Just wondering if there are any new data that point to preference of one method over the other when it comes to actually treating radiation necrosis? I have read this 2014 publication in Translational Cancer Research with a few of the co-authors happened to be from Swedish Radiosurgery Center, Swedish Medical Center, Seattle, WA, USA

http://www.thetcr.org/article/view/2950/html

My question is since Hyperbaric Oxygen seems to be pretty safe why is it not recommended as treatment of choice instead of the more invasive or damaging treatment like surgery and chemo with avastine?


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

July 6, 2015 at 3:15 pm  #1270390    

Dr Loiselle

It is hard to say without looking at the scan.
We would generally look at the size of the enhancing area, the extent of any edema, and how this maps exactly to the area of prior treatment. If the prior metastasis was resected and a cavity was treated with radiosurgery, how does the rest of the cavity margin look? Is the enhancement in a high dose area, intermediate dose area, or low/marginal dose area? If the area was treated to 18 Gy to the 80% line, than a small volume received 20 Gy or more. How does this specific area look? Not to imply any specific rules about interpreting radionecrosis vs. recurrent tumor, but a careful analysis of these aspects of the scan can be quite helpful.

In terms of new treatments, not much new is available, though our experience with Avastin is very good. I have not seen hyperbaric oxygen be helpful in this situation.

In terms of new diagnostic tools, our recent experience with PET/CT has shown it to be quite helpful in a few patients… may patients have intermediate results however, which are difficulty to interpret.

Best of luck to you and your spouse,

Dr Loiselle


Chris Loiselle, MD
Radiation Oncologist
Swedish Cancer Institute

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

December 5, 2015 at 2:23 pm  #1272023    

My wife’s advocate

Dear Dr. Loiselle and other esteemed faculties,

My wife’s most recent monitoring MRI (12/1/15) shows further enlargement of the enhancing area in her right occipital lobe now measuring 3.2 x 2.4 x3.1. In Aug 2015, based on a number of scans including MRI’s, perfusion MRI, and PET/CAT scan, the oncology treatment team concluded that my wife is suffering more from radiation necrosis and not recurrence. She was put on a 3 months MRI monitoring schedule.

But now the enhanced area has increased to almost double the size in all three dimensions since first discovered in May of 2014 (1cm AP x 1.8cm transverse x 1.2cm cranio-caudal), not sure the meaning of these units.

In addition to the 24/7 flashing of lights in a third of her left vision field in both eyes (since day one in May 2014) and occasional 2-3 times a week of 10-15 minutes duration of visual migraines, she now experiencing daily, a dull headaches at her right temple area that radiates to her right eye socket that necessitates her taking an extended release extra strength Tylenol.

The 12/1/15 report also suggests surrounding white matter edema and possible internal hemorrhage.

Is there any medical intervention at this point to control the edema and hemorrhage or do we just sit and wait for the symptoms to run its course and hope and pray that her body will take care of the necrosis?

Ben


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

December 6, 2015 at 9:01 am  #1272025    

My wife’s advocate

Sorry I was remiss not including the following. Since July she was put on Trental and vitamin E for helping with the necrosis healing and Depakote for controlling the visual migraines.

I understood that Trental is supposedly to help with blood circulation. Should she stop Trental immediately in case it is causing the hemorrhage?

The treatment team members are each so specialized, that they may not have a good integrative picture! God have mercy.


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

December 6, 2015 at 12:44 pm  #1272026    
catdander forum moderator
catdander forum moderator

Hi Ben, I’m so sorry your wife has been through so much.

The standard of care for swelling in the brain are steroids. If hemorrhaging is an issue stopping blood thinners if possible is very appropriate.

As Dr. Loiselle mentioned in several of his post on the subject of necrosis, “treatment with bevacizumab (Avastin) can in many cases dramatically reverse symptoms related to radiation necrosis.”

I wish there was more information and help to offer. You are a great advocate for your wife!
Janine

December 6, 2015 at 6:40 pm  #1272030    

Dr. Ben Creelan

In my limited experience, it seems uncommon to have a pronounced inflammatory process become progressively worse more than 4 years after stereotactic radiation. Of the downsides to radiation is that there is little we can do to ‘reverse’ it once it is given. The side effects can appear late. Nonetheless, as someone mentioned above, one wonders if something else is provoking this condition. Neurologists are often the best equipped to help with this. She requires a detailed assessment of all her medications, vital signs, imaging, and history. We are neither equipped nor allowed to provide medical advice to the level of detail she requires on an internet forum.
If the Trental and Vitamin E have been unsuccessful in controlling the symptoms of radionecrosis, then cessation seems reasonable. Trental is a blood thinner. In general, for situations like this, I would advocate for talking to her doctors promptly about stopping the Trental and possibly starting corticosteroids. Remember we can’t give medical advice on this forum, only education.

December 10, 2015 at 4:16 pm  #1272145    

Dr Loiselle

Ben –
Have you seen a neurosurgeon? Has your team contemplated surgical excision of this lesion in the brain? If things outside of the brain remain without evidence of disease, and this area continues to evolve and be problematic, it is a reasonable consideration. This has risks, including a somewhat worse permanent visual field cut, but would yield a diagnosis and in some manner also be therapeutic whether this is recurrent tumor or radionecrosis. The specific details of the brain issue and your wife’s health are paramount to a good decision here. I encourage you to bring this idea to your treatment team and seek consultation with a recommended neurosurgeon and radiation oncologist to jointly consider all such options and their potential good or bad repercussions.

Kind regards,
Dr Loiselle


Chris Loiselle, MD
Radiation Oncologist
Swedish Cancer Institute

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

February 11, 2016 at 7:43 pm  #1272947    

My wife’s advocate

Surgical excision of this “Necrosis” was done. Surgical notes stated “removed obviously necrotic tissue” for biopsy.

Biopsy report however stated “By immunohistochemistry, the tumor is positive for TTF-1 and Napsin: The morphology and immunophenotype are compatible with lung cancer origin”

My wife is now scheduled for repeat radiation of the “necrotic” site.(she had SRS back in 2011 of the same site where the original solidary cancer met was removed)

Question:

1) Could this positive pathology result is from simply a histological footprints of the original cancer met and not a real recurrence?

2) Now they are treating it as if its a recurrence with 10 fractionized IMRT (something they called Intensity modified radiation treatment?? not sure if I understood correctly) late February. We have to go there 10 consecutive days.

3)Is this second radiation going to cause more necrosis? They said 10 fractions will cause less problem.

.


Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

February 12, 2016 at 8:53 am  #1272955    

cards7up

I’d just like to mention something I read recently on another post on another site. This person had one brain met treated with GK along with treatment for lung cancer. Somewhat similar in following your posts. Headaches that wouldn’t go away and finally a new biopsy done. What happened is there was a new tumor that growing behind the one that had GK and it couldn’t be seen due to scar tissue on the scans. It was just such a way that it was hidden. So this is most likely a new recurrence after original had been treated. I think they’d know if this was from the original. It could be a combo of necrosis and a recurrence. She’s done well if this is positive going back 4 years or so and hopefully she’ll do well this time.
Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

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