Radiation only as a treatment plan

Portal Forums Radiation Oncology Chest Radiation Radiation only as a treatment plan

This topic contains 8 replies, has 3 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 2 weeks, 5 days ago.

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November 21, 2017 at 7:34 am  #1293533    

teamfrank

My mother has been told she has NSCLC and is getting ready to undergo a mediastinoscopy as I am writing this thread. She met with a radiation oncologist yesterday. He indicated that if no cancer is found outside of the mass in her lung that he will provide radiation through a treatment plan where she will only have to come in 5 times, period. However, if they find cancer outside of the mass in her lung (she does have enlarged lymph nodes on the PET Scan but as those are just being biopsied today we do not know if that is due to cancer) then she will have to come in daily, 5 times a week, for 6 to 6.5 weeks. Her general oncologist had indicated that if no cancer was found outside the lung she would be staged at Stage 2 (unsure if A or B at this time) and if she was found to have cancer outside the lung then she would be a Stage 3 (again, unsure if A or B). My concern is that the standard of care, based only upon research I have done, for Stage 3 NSCLC seems to be combination treatment and does not consist of only radiation. She had originally been scheduled for surgery to remove the mass from her lung but her pre-surgery PFT results showed she has marginal lung function and so the surgeon cancelled the surgery. How effective is just radiation treatment for either Stage 2 or Stage 3 NSCLC?

November 21, 2017 at 8:33 am  #1293537    
JimC Forum Moderator
JimC Forum Moderator

Hi teamfrank,

It’s true that in general, the standard of care for stage II lung cancer is surgery (or radiation, if surgery is not feasible), at times followed by chemotherapy, which can add several percentage points to overall survival rates. For stage III, treatment is usually radiation (or in limited cases, surgery) followed by chemotherapy.

The major caveat about any discussion of standard of care for a particular patient is that each set of circumstances is unique, and choices may individualized. Some patients are not healthy enough for certain treatments, so more limited therapy may be recommended.

But it makes sense to have a discussion about why chemotherapy is not being considered, so that would be a good line of questioning for the local medical team.

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

November 21, 2017 at 8:35 am  #1293538    
JimC Forum Moderator
JimC Forum Moderator

Dr. West discusses surgery vs. radiation for early stage lung cancer here: http://cancergrace.org/lung/2007/11/15/surg-vs-rt-st-i-nsclc/

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

November 21, 2017 at 9:48 am  #1293541    

teamfrank

I happen to know that my mother has made it a point to tell every doctor along the way that she will not do chemo under any circumstance. This is most likely why it hasn’t been suggested to her. I’m worried that there will be micrometastases in her body and without chemo the cancer will return. It seems like this is most likely only if she is diagnosed as Stage 3 lung cancer.

November 21, 2017 at 11:34 am  #1293542    
catdander forum moderator
catdander forum moderator

Even if it’s recommended she have chemo it would likely be after radiation. When given concurrently there is more possibility of radiation pneumonitis and since your mom has decreased lung function they would most likely want to give one after the other. Even then it appears to add only a few percentage points (low single digits as I recall) to the possibility of cure. Like Jim said this will be a very individualized treatment plan and your mom will have a lot of time, a couple months at least, to make her final decisions about chemo if it turns out they think it might benefit chances of a cure.

If the time comes to make that decision she has the time to weigh the reasons behind the choices and what side effects might be evolved,and how they can be mitigated. There’s always the option to try and stop at any point. In the end it’s one of the most personal decisions a person can make.

I hope there’s no need to worry about it after results are in. Keep us posted

Janine

November 22, 2017 at 1:46 am  #1293549    

teamfrank

Update on my mom. She had major complications during the procedure and is currently in the surgical ICU of her local hospital. During the procedure a major artery was knicked. She lost all of and was given back all of her blood plus the total blood volume of another entire person. The only way she survived was they took her entire right long. If they had kept trying to repair the damage it was certain she would die. They have her on a ventilator but hope to wean her off of it later today. They said she is not out of the woods yet and there are 3 milestones where complications could arise. I had to jump in my car and drive 3 hours to be with her during this difficult time. I will keep everyone updated.

November 22, 2017 at 6:03 am  #1293552    
JimC Forum Moderator
JimC Forum Moderator

Hi teamfrank,

I’m so sorry to hear of these complications. I hope that your mom heals quickly and that your next update provides good news. We will keep you and your mom and your family in our thoughts.

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

November 27, 2017 at 8:09 am  #1293572    

teamfrank

I am back home and starting to come out of emergency mode. As I posted earlier, they took her right lung. The pulmonary aorta was damaged during the mediastinoscopy. She does have emphysema and COPD (I must admit that I always thought that emphysema was part of COPD and so you wouldn’t be diagnosed with each of them) in her remaining lung. That can’t make her recovery easier. She may be released from the hospital today but the doctor hasn’t been in yet to see her so we are unsure. He told her that all of the cancer is out and there is nothing further to worry about regarding that issue. I am still a little on edge about that because I fear her having micrometastises and it coming back but for now at least they feel she is cancer free and I will try my best to simply enjoy that. She has a long recovery ahead of her but at least she is still with us to have a recovery!

As to my father, he goes in for a follow-up scan this Wednesday to see if what is in his lung has grown or not. He will not let them attempt any further biopsies so this is as good as we will get with him.

November 29, 2017 at 7:24 am  #1293575    
JimC Forum Moderator
JimC Forum Moderator

Hi teamfrank,

It’s good to hear the positive aspects of your update, and I hope your mother’s recovery is as smooth and speedy as possible. And we’ll keep positive thoughts that your father’s scan will show no growth.

Both of them are fortunate to have your love and support.

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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