After 2 years and 4 months with lung cancer (nsclc that transformed to sclc on tarceva) a decision has been made to treat me with curative intent with radiation and chemo after I started to show mild progression on chemo alone.
I have met with two different radiation oncologists. Their recommendations are basically similar - daily radiation for 7 weeks. I will also be having once weekly taxol.
There is a slight variation in the recommendations and i just want to know pros/cons from an oncology radiology viewpoint. I am not seeking specific advice, just want to hear more opinions on how specific doctors approach this situation.
One doctor, will do 4d modeling and then will target the tumor/tumors and any lymph nodes that show up on his modeling. Also said that after radiation is done, he will check everything and if any additional nodes light up, he can use another machine to pinpoint those nodes and hit them.
The other doctor will also do the modeling but plans on hitting the lymph nodes regardless to prevent spread.
He is also getting me in for a pet scan (medical oncologists kept getting turned down lately on this but somehow his office pulled it off) tomorrow to see what's going on better than the cat.
On the one hand, the more aggressive approach sounds wiser especially since i had brain mets in May (5 treated successfully by gamma knife which are stable/gone on mri I had last week). However, I also know that this will compromise more lung so I am not sure.
I am not a textbook case. I've had a top oncologist call me complicated. But, despite any bumps, I am doing amazingly well which is why after all this time the oncologist said "You have just done so well until now. I want this treated with curative intent and see what we can do."
Both radiation oncologists will use the curative intent protocol. I just wonder what radiation oncologists opinions are on the difference in aggressiveness on the lymph nodes. Thanks.
Reply # - October 10, 2013, 11:06 AM
Reply To: Radiation – How aggressive to go
Hi funnymom, I'm so glad you're feeling so well. I'm not sure how much input our radiation onc will be able to give on such a unique situation but I'll ask him to reply and hopefully he'll have something helpful to offer.
All the best and of course keep us posted,
Janine
Reply # - October 10, 2013, 02:41 PM
Reply To: Radiation – How aggressive to go
Dr. Loiselle wasn't able to access the forum at the moment so asked me to paste his comment,
"Excellent question. There is an increasing trend in the field of
radiation oncology to not treat elective lymph nodes in small cell
lung cancer given the very low chances of an isolated lymph node
recurrence in the absence of elective lymph node treatment. This is a
reasonable and evidence based trend - particluarly in the case of
staging with PET.
If one does have an isolated lymph node recurrence, further radiation
treatment is typically feasible. Not treating the initially
uninvolved lymph nodes initially typically leads to lower risk of lung
and esophageal inflammation, which can be significant.
This is not medical advice. The best thing to do depends on
circumstances which you and your physicians know best. I hope this
helps.
Dr Loiselle"
Reply # - October 11, 2013, 06:46 PM
Reply To: Radiation – How aggressive to go
Thank you Dr. Loiselle. I did check with my oncologist simultaneously. He gave me the opposite advice. Since he knows my case best (not textbook and includes a egfr mutant nsclc which transformed to sclc on tarceva) his advice probably makes the most sense. I know that he really wants to give me a shot at a cure, even if it is a longshot. However, I will use your information in speaking with the radiation oncologist as a point of discussion to elicit his opinion since he is the radiation expert that is closely familiarizing himself with my case. When I met with him yesterday, I only had ct scans. He was able to order a pet for me, which I had today. Hopefully, that pet will reveal whether I have lymph node activity to give him the chance to make an informed decision.