Proton Radiation Therapy vs Surgery?

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC Proton Radiation Therapy vs Surgery?

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October 31, 2017 at 9:47 am  #1293429    


Hi — I have NSCLC (stage 4) with mets to spine and brain. I have been on Tagrisso for 4.5 months after progressing on Tarceva after 6-12 mos. My last CT scan 9/28 showed stable disease, however I have been experiencing a lot of pain in my upper back. I had an MRI done a couple of weeks ago by my local oncologist who said there is slight progression at my T8 which had been previously radiated over a year ago. I also had a lesion at T6 that was radiated and a kyphoplasty was done for a compression fracture several months ago. My doctors (Dana Farber and local docs in CT) suggested consulting with a spine surgeon, which I did at Yale, and he referred me to their radiation oncologist to see if T8 can be re-radiated. If not, they are recommending MAJOR surgery to remove the T8 vertebral body including rods and screws to stabilize the spine.
I have been trying to get info on proton therapy as I have read it is safe and effective for re-radiating. I called MGH Boston’s Burr Proton Center and explained my situation and they said that there is no difference between proton and SBRT photon therapy — which is VERY confusing. I have a call into the Maryland Proton Center to see what they say.
Other than the back pain I have been feeling good.
I do not have a good feeling about major surgery with metastatic cancer.
Can you shed some light on proton therapy vs. surgery?
Any info you can offer on the best place to do proton radiation would also be very much appreciated.
Thank you.

November 1, 2017 at 5:40 am  #1293432    
JimC Forum Moderator
JimC Forum Moderator

Hi Schmeggs,

I’m sorry to hear of the back pain you’re experiencing. The advantage of proton therapy is limited to those situations in which extremely fine targeting is necessary, better than that which can be achieved with photon therapy. But photon therapy can be very accurately targeted as well, thus the statement by MGH that the two techniques would be about the same. If the radiation oncologist you consult tells you that the current problem is in a slightly different area than that which was targeted previously, perhaps proton therapy would be appropriate; otherwise, the issue is simply whether the area can be re-irradiated safely.

I can understand your concern about major surgery at this point, and it’s true that in the setting of stage IV cancer in most instances you would try to avoid it. The details of the risks and potential benefits of such surgery demand a thorough discussion with your local doctors.

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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:

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