only 7% shrinkage after chemo and radiation

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This topic contains 6 replies, has 2 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 3 months ago.

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December 17, 2017 at 3:25 pm  #1293645    

jkkwok1

I was diagnosed with stage 3b NSCLC (T1N3M0) in March 2017. T1N3M0
I have gone through 2 rounds (12 days) of chemo Cisplatin/etoposide and 33 days of radiation. but saddly, I got only 7% shrinkage after 3 months as at Nov. 1, 2017. Hope it will continue to shrink.
Left supraclavicular node is slightly smaller measuring 0.7 cm, prior 0.8 cm. Left para-aortic lymph node is slightly smaller and measures 1.3 cm, prior 1.5 cm. The right para-oesophageal lymph node is smaller measuring 0.7 cm, prior 0.9 cm.
My upper lobe image 35 is slightly smaller and measures 1.4 x 1.2 cm, prior 1.5 x 1.1 cm.
I will be followed up every 3 months (with blood test, Xray) by my oncologist. CT scan on chest and spine after 6 months.
I will be on CRIZOTINIB if LC worsen.
Does anyone here have any idea of my small % of shrinkage? Does it mean my chance of NED is not encouraging.?

December 17, 2017 at 5:34 pm  #1293646    
JimC Forum Moderator
JimC Forum Moderator

Hi jkkwok1,

Welcome to GRACE. I’m sorry to hear that so far you’ve only seen 7% shrinkage, and I hope that you do continue to get further reductions in the size of your nodules. The full effect of radiation treatments can take quite a while to become fully evident, so there is that possibility.

Since crizotinib has been suggested as the next treatment if there is disease progression, I assume that your cancer cells have been tested for certain genetic abnormalities, which has revealed an ALK rearrangement. Crizotinib is specifically designed to target cancer cells bearing the ALK rearrangement, and such targeted therapies can be extremely effective.

Although that means that NED (no evidence of disease) is still a possible outcome, you should be aware that many patients manage to keep their cancer stable for long periods of time before switching to another therapy. In the case of ALK inhibitors such as crizotinib, there are next-generation inhibitors that can be effective should crizotinib cease working. In addition, there are other standard chemotherapy options, plus immunotherapies to which you might turn. Finally, the pace of research and introduction of new treatments is moving faster than ever, so by the time you might need a new treatment, there may be something new available.

Good luck with your follow-up scans, which I hope will show continued shrinkage or stable disease.

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

March 21, 2018 at 1:26 pm  #1294122    

jkkwok1

Hi
Thanks for your reply in December 2017.
I was diagnosed with stage 3b NSCLC (T1N3M0) in March 2017. T1N3M0
I have gone through 2 rounds (12 days) of chemo Cisplatin/etoposide and 33 days of radiation. End day of my treatment was August 3, 2017.

Extract result of my CT scan in October 2017 as below
Left supraclavicular node is slightly smaller measuring 0.7 cm, prior 0.8 cm. Left para-aortic lymph node is slightly smaller and measures 1.3 cm, prior 1.5 cm. The right para-oesophageal lymph node is smaller measuring 0.7 cm, prior 0.9 cm.
My upper lobe image 35 is slightly smaller and measures 1.4 x 1.2 cm, prior 1.5 x 1.1 cm.
I will be followed up every 3 months (with blood test, Xray) by my oncologist. CT scan on chest and spine after 6 months.

I just saw my Dr. yesterday. He told me that he could not see tumor in my lung. The 3 lymph nodes involved: two look normal and the other is shrinking. He is still waiting for the official report.
Before my treatment, I have a Left supraclavicular node, measuring 0,7 cm. which I think is normal now.
But there is a new right supraclavicular lymph node, measuring 1.4 cm x 1.2 cm. shown on my CT, which I did on March 19, 2018.
Can you please tell me what is the implication?
Does it mean the cancer has spread to other side and there is no way to cure and I am waiting for my day to die?
Has my disease progressed?
What is the next thing happen to my body because of right supraclavicular lymph node involved after chemo and radiation?
Is there any other way to cure my cancer?
Thanks.

March 22, 2018 at 6:20 am  #1294124    
JimC Forum Moderator
JimC Forum Moderator

Hi jkkwok1,

Although it’s great to hear that the previous evidence of cancer appears to have diminished, I’m sorry that this latest finding of an enlarged lymph node has caused such concern for you. In the context of an existing lung cancer diagnosis, this finding does raise the suspicion that the cancer has spread to this lymph node, but such nodes can become enlarged for a variety of reasons not related to cancer. Your doctor may want to biopsy the node to check for cancer cells, order blood work to look for an infection or may suggest a period of watchful waiting to see if the node returns to normal over time.

From this lymph node alone, you’re not likely to notice any new symptoms, and at this point there’s no way to know whether your cancer has progressed. Even if it has, there are a number of possible treatments, some of which may significantly prolong your life. If your oncologist feels that this is the only active area of cancer, he or she may even recommend radiation.

I hope that your next meeting with your doctor is productive and helps ease your concerns.

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

March 23, 2018 at 7:34 pm  #1294131    

jkkwok1

Hi JimC

Thanks for your reply.
We got the official CT scan report.
1) The cancer nodule did not disappear.
The report shows:
In the interval, there is improvement in radiation pneumonitis in the left upper lobe and superior segment of left lower lobe with progressed atelectasis and scarring. A 10 mm nodule in the anterior left upper lobe (image 39) appears smaller when compared to prior CT where it measured 15 mm (previously seen on image 36). In today’s scan the nodule is encased wthin the increased left upper lobe atelectasis.

My Oncology gave me two options: 1) to biopsy 2) to have another CT scan after two months.

My new right supraclavicular lymph node, measuring 1.4 cm x 1.2 cm. may be too small to biopsy.

2) Besides this issue, the report also shows

“Continued surveillance of the enlarged right subcarinal node is required as it does appear slightly larger today.”

This subcarinal node is new to me.

I am worried. I don’t know what will happen after 2 months. May be my disease is more progressed.
Can you please give me some knowledge and some opinion? What should I do?
Thanks.

March 23, 2018 at 10:28 pm  #1294132    

jkkwok1

Hi Jim

Please interpret the following impression from the CT scan report:

Impression:
A prominent new right supraclavicular lymph node which likely corresponds to the clinical findings

Does it mean the right supraclavicular lymph node is likely to have cancer?

Thanks.

March 24, 2018 at 10:14 am  #1294134    
JimC Forum Moderator
JimC Forum Moderator

Hi jkkwok1,

With regard to the first of your two new posts, when there is the possibility of new growth or a newly enlarged node, but not clear progression, the options suggested by your doctor are common. You can have a biopsy which, as is the case with any invasive procedure (even one which may be minimally invasive), carries some risks of complications and may not provide a definitive answer. Or you can watch the suspicious areas over a relatively short interval to see if there is further growth. Although many patients worry about the risk involved in watchful waiting, in a situation in which the growth so far has not been rapid that risk is relatively minor, and if progression becomes clear it will be treatable.

Either option is appropriate. Unfortunately we can’t tell you which option you should choose, and the recommendation of your oncologist would be much better informed and of greater value to you.

In the context of an existing cancer diagnosis, any new growth or node enlargement is suspicious for cancer, which is why the radiologist described the new node as likely corresponding to the clinical findings (of cancer). On the other hand, it is only an assumption, as cancer patients develop infections just as anyone else does, and those infections can cause enlargement of a node. In the case of an infection, the node shrinks as the infection resolves, so continued enlargement or further growth can be a sign that it represents cancer. That’s why it can be good to wait a bit to see what happens with the node.

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

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