NSCLC State 1 T1B

Portal Forums Lung/Thoracic Cancer Stereotactic Radiation NSCLC State 1 T1B

This topic contains 9 replies, has 5 voices, and was last updated by  scohn 3 weeks, 3 days ago.

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May 24, 2018 at 10:56 pm  #1294454    

dbfan

I was just recently diagnosed with NSCLC Stage 1 T1B with a 2.7cm squamous mass in my left lung. The scan so far, so no lymph node is involved. It has been recommended that I look into the SBRT instead of surgery because of the COPD I have. I was just wondering if there are others who might have taken the SBRT route for a Stage 1 event.

Thanks, Dennis

May 25, 2018 at 6:25 am  #1294455    

onthemark

Hi Dennis,

I’m also a stage 1 NSCLC patient, but went the lobectomy route.

However if it were to come back I would seriously look at SBRT in order to preserve lung function and not go through the surgery and recovery.

From what I have read there is no strong evidence that SBRT is inferior to surgery in terms of local control, disease specific survival or overall survival for small lesions like yours. Someone recently posted a paper on inspire, and that is what I recall to be the main results.

I would really like to know what other folks here know about your question too and am looking forward to their replies.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2018 Next scan.

  • This reply was modified 3 weeks, 6 days ago by  onthemark.
  • This reply was modified 3 weeks, 6 days ago by  onthemark.
May 25, 2018 at 6:58 am  #1294457    
JimC Forum Moderator
JimC Forum Moderator

Hi Dennis,

Welcome to GRACE. I’m sorry to hear of your diagnosis, but encouraged that your lung cancer appears to have been discovered at a very early stage.

Recent experience with SBRT for early-stage patients for whom surgery may not be an option has been quite favorable, with results essentially equal to that of surgery. Dr. Jeffrey Bradley, Radiation Oncologist at Washington University in St. Louis discusses this subject here. The links following the transcript of his video also discuss SBRT in place of surgery.

Good luck with treatment, and let us know if you have further questions.

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

May 26, 2018 at 6:08 pm  #1294463    

dbfan

Onthemark and JimC

Thanks for the help and information. Trying to read about this on the web leads me to the not so surprising opinion that Surgeons seem to prefer surgery and Radiation oncologists prefer SBRT. In my case, I’m not sure I have an option due to the COPD.

Thanks again.
Dennis

May 27, 2018 at 7:45 am  #1294466    
JimC Forum Moderator
JimC Forum Moderator

Hi Dennis,

I’m not surprised it didn’t take you long to discover that surgeons and radiation oncologists each have their own type of hammer and see every situation as their own favorite kind of nail! That’s part of the reason that most cancer centers have a tumor board, which reviews patients’ cases and the opinions of the various specialists to find the best treatment options.

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

May 27, 2018 at 4:35 pm  #1294469    

dbfan

JimC

Thanks,

Being somewhat new to this – I guess I should have stated that was a Tumor Board – I’m not entirely sure that was the title the Doctor used, but it was my impression it was made up of different specialists. The trouble for me was confusion I was having doing research on-line. The internet can be a source of great information or one hell of a lot of confusion. I was trying to figure out what there an advantage to one over the other and the bottom line appears, as you stated, who has the hammer/nail. In just reading the material it seems that SBRT for lung cancer has been used for about 20 years while surgery has been the standard for much longer – so is it a matter of the new dog on the block or the old dog on the block. One has to suspect that while no one will say it – there has be vested interests in this debate. As for me I just confused – which is a troubling thing but that is my OCD kicking in.

Thanks again.

Dennis

May 28, 2018 at 11:32 am  #1294474    
catdander forum moderator
catdander forum moderator

Welcome Dennis,

I’m sorry to know about your diagnosis. I think we all know what you mean about the internet, it’s both a world of information and sink hole of confusion. That’s why Dr. West started Grace and why Jim, onthemark, I and many others use Grace as a base for connecting the dots/making the complicated, ever changing, and often unanswerable fit into your individual situation.

When Don was treated sbrt hadn’t been studied in treating the lungs so he had the more standard radiation that targets larger areas including healthy tissue, at a lower dose over 6 or 7 weeks. As Dr. Bradley discusses in the link in Jim’s post that standard had a less than satisfactory rate of cure compared to sbrt. We were lucky, on so many counts. sbrt has a much higher rate of cure that it would probably contend for best option over surgery (in those given a choice). It’s like the dark ages were just 9 years ago when looking at the advances in nsclc care…very exciting.

You have every reason to be very hopeful for a cure. I like to make the assumption that the best will happen. It doesn’t make anyone look bad as the saying suggests :) and it’s a good way to fake it until you make it. Don’t hesitate to post, let us know how you’re doing. Remember there are many others reading who want to know what other’s have been through and what they have to say about the experience.

All best,
Janine

May 28, 2018 at 4:44 pm  #1294479    

dbfan

Janine:

Thank you for your kind words. I have to admit that the “C” word threw me. When the Dr told me I’m not sure I heard much more of the conversation. Now hopefully I’m getting a better view of the situation at least from the information standpoint. I honestly now have the understanding of the empathy of all of us faced with this disease. I guess then I learned that Lung Cancer kills more women than breast cancer I was shocked.

I have an appointment this week with the Dr. – this time around I’m going to be better informed about the situation. It was kind unique that when he told me – he, in fact, said this is going to take a bit of time to get your head around this situation – write down all your questions, and we will talk in detail. Guess in his line of work he has walked down this road with sadly too many of us.

Thank you again.
Dennis

  • This reply was modified 3 weeks, 3 days ago by  dbfan.
  • This reply was modified 3 weeks, 3 days ago by  dbfan.
May 28, 2018 at 6:10 pm  #1294483    
JimC Forum Moderator
JimC Forum Moderator

Hi Dennis,

Those of us whose lives have been touched by cancer understand all too well the initial shock of diagnosis and feeling like we have been dropped into a foreign country where no one speaks our language. There’s a pretty steep learning curve at first, and sometimes the information you find in your research is difficult to put into context. That’s where we try to help, so that patients and caregivers can get a sense of what information is important as well as authoritative, which really helps you to have intelligent conversations with your doctors.

In that regard, please don’t ever feel that a question is too trivial or basic-most of us began with very little knowledge about cancer, and we’ve all had those seemingly obvious questions that we just can’t seem to find answered in our research.

I hope you have a good discussion with your doctor, and please let us know how it goes.

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

May 28, 2018 at 10:47 pm  #1294491    

scohn

Hi Dennis.

I just want to second the comments that Jim made. The people here at GRACE have been an amazing resource for my wife and me. They have tried to answer all of our questions, with a kindness and compassion that helped us enormously.

I remember those first few weeks after the initial diagnosis vividly, and this sense for me that I wasn’t even sure what it was I didn’t know and what questions I should be asking. The people at GRACE helped me make it through those initial weeks with my myriad of questions large and small, and helped make our discussions with the oncologist more understandable and focused.

May you have a good meeting with your doctor that leads to a course of effective treatment, and soon be on your way to a restoration of health!

– scohn


Wife, lifelong non-smoker, dx 4/24/15 adeno NSCLC stage IV, poorly diff. 2 bone mets, 1 lymph node. HER2 Exon 20 mutation. 6x Carbo/Alimta – >50% reduction in primary tumor, lymph nodes, & bone. Alimta maint. not effective, tumor growth, new liver mets. 11/15 – Opdivo; Not effective-add’l growth. 4/16 – clinical trial drug, large reduction of tumor and mets. 11/16-tumor growth, liver mets stable. 2/17-All Stable. 8/17- Add’l growth-off trial, 9/17 Gemzar- tumor reduction, then stable.

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