Radiation therapy and limited progression

Portal Forums Radiation Oncology Chest Radiation Radiation therapy and limited progression

This topic contains 6 replies, has 4 voices, and was last updated by  Dr Loiselle 1 year, 11 months ago.

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December 2, 2015 at 1:05 pm  #1271992    

wadvocator

Hi,

Just learned of limited and slow progression after on Tarceva for 4 years. In the process of exploring and understanding options. 3 spots (lymph nodes) of progression: One on right Paratracheal (4:21), another on right paratracheal (4:35), and third at RIght hilar inferior (4:50)…don’t know what the numbers with colon mean.

Have read about the concept of “riding the winning horse for as long as possible”. Our oncologist expressed concern about radiation due to the locations of slow progression. Was wondering SRS a viable option, given the locations, to consider.

Thx

December 3, 2015 at 6:57 am  #1271999    
JimC Forum Moderator
JimC Forum Moderator

Hi wadvocator,

I believe the numbers refer to the specific scan images which show the affected lymph nodes. Whether they can be safely irradiated is a question for your local doctors, who have access to all the scan and are best equipped to judge the risks involved.

Even if radiation is possible, in the context of an existing stage 4 lung cancer diagnosis such local treatment is not usually advised unless it is to palliate symptoms, and that would certainly be a factor to consider in weighing the risks versus benefits.

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

December 3, 2015 at 8:14 am  #1272002    

wadvocator

Thanks Jim!

December 4, 2015 at 10:45 am  #1272015    
catdander forum moderator
catdander forum moderator

I’m assuming you’ve seen the acquired resistance patient forum videos but for those who haven’t and if you’ve not, http://cancergrace.org/lung/acquired-resistance-patient-forum-2014-videos/

What an Advocator!
Janine

December 4, 2015 at 2:11 pm  #1272019    

wadvocator

Thanks Janine!

I understand what Jim said about “Even if radiation is possible, in the context of an existing stage 4 lung cancer diagnosis such local treatment is not usually advised unless it is to palliate symptoms, and that would certainly be a factor to consider in weighing the risks versus benefits.” But I do remember reading somewhere in the site that radiating localized slow progression is a viable tactic to continue existing TKI that are still working.

Can a radiologist comment on what parts of the body (specifically are more safely to radiate than other? My specific interests are around right paratracheal and right hilar. We will be talking to radiologist, but just want to get a general perspective via this site.

December 5, 2015 at 3:55 pm  #1272024    
catdander forum moderator
catdander forum moderator

Hi advo, I meant to respond last night so sorry. I imagine you want to hear from a radiation onc, one who provides radiation to cancerous tumors instead of a radiologist, one who reads and interprets scans. It will be at least monday before we hear back from a doctor. If you listened the video you will note that Dr. Weiss has a special interest in using focal treatment in situations where there are just a few (1 or 3ish) slow growing spots of progression in an otherwise durable response to a TKI like tarceva.

Like Jim said it’s very individual as to who and where radiation is appropriate. It’s important to note that SBRT, stereotactic body radiation therapy; another acronym is SABR is a type of radiation treatment that is in the past couple of years, taking hold as an option for tumors outside the brain. So you’ll want to read up on that before seeing the onc (one consideration is that it has more pinpointed accuracy than typical radiation therapy. This is a good start, http://cancergrace.org/lung/2015/08/21/gcvl_lu-d08_inoperable_early_stage_nsclc_sbrt/
Another reason to think focal treatment in this case is treatment for slow growing resistance to tarceva. Dr. West talks about it here, http://cancergrace.org/lung/2013/01/23/acquired-resistance-algorithm/

Hoping your wife is feeling alright for winter festivities.
Janine

December 10, 2015 at 4:09 pm  #1272144    

Dr Loiselle

Hi – I would consider radiation to this area and continuing Tarceva… it is a little hard without specifics to advise regarding longer conventional courses of radiation in comparison to higher dose, image guided, shorter courses. We have done both in the scenario described, depending on the oncologic, anatomic, and life details. Best wishes for your consultation with a local radiation oncologist. 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.

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