My mother has been fighting adeno Ca over two years. When it was discovered she'd already and one brain meta that was treated with gamma knife and so far, so good. No new meta, no neurological deficit.
Considering the primary lung tumor it is 24x38x28 mm in the last CT. After 9 cycles of Alimta (as a second line therapy) it started to regrow again and formed tiny spot also closed-by.
Now, somehow I feel like we are hitting the wall. One option is reirradiation (small doses since the area has already been radiated by 53Gy). New proposal is 64 Gy over 6 weeks. Cyberknife is out of the question since radiation onc said the new meta makes it complicated.
Chemo - after Gemzar and Alimta we could try with Taxotere.
One of the surgeons said it could be operated now, but they are quiet skeptical and onc said he is afraid it could be overtreatment?!
But I guess at this point everything could be considered as overtreatment, even additional irradiation?
My mother is feeling fine, she is walking, cooking, planting flowers, and staying the whole day by herself. She reads, even sews, going to the market and she is 58. I suppose that is a good factor as well as the fact that no new meta appeared for over than two years.
I am afraid of the surgery but on the other hand I can stop thinking that we should deeply analyze that option?!
Reply # - March 17, 2014, 05:32 AM
Reply To: Stage IV NSCLC – Surgery after chemoradiation? Would
Hi tanjamika,
Local therapies such as surgery or radiation are not usually used in Stage IV lung cancer other than to resolve a problem such as pain, compression of a blood vessel or other urgent needs. There is a GRACE faq explaining the reasons for this here: http://cancergrace.org/cancer-101/2011/01/01/cancer-101-faq-i-have-meta…
On the other hand, there are situations in which there is just one metastasis or area of progression which after careful consideration is treated locally. Dr. West has described the reasoning for use of surgery or radiation in these cases here: http://cancergrace.org/lung/2010/09/07/local-therap-for-metastatic-dise…
Good luck with whichever treatment plan is chosen.
JimC
Forum moderator
Reply # - March 17, 2014, 08:27 AM
Reply To: Stage IV NSCLC – Surgery after chemoradiation? Would
Unfortunately this situation you describe is too complicated for any of us to offer guidance about. It all depends on the context. Sometimes scar tissue from radiation can look like new lung lesions too. If there is at least one new metastasis and an enlarging, previously irradiated, lung primary, it seems like more radiation is unlikely to be a home run. Without being a treating or consulting doctor, any information we give would really just be conjecture.
Reply # - March 17, 2014, 09:53 AM
Reply To: Stage IV NSCLC – Surgery after chemoradiation? Would
Thank you all for your quick responses.
It is very hard to make a decision now, and we are trying to get all options.
I had the same opinion on the irradiation but chemo onc is not very optimistic to put her on Taxotere.
I do feel we are hitting the wall!
Reply # - March 17, 2014, 12:19 PM
Reply To: Stage IV NSCLC – Surgery after chemoradiation? Would
Hi tanja, I'm so sorry your mom is in this situation. I just wanted say there are good reasons for treatment of stage IV nsclc. For early stage it's treatment with hopes of a cure, with stage IV the hope is to find a balance where the person can live life well for as long as possible. This means one must take enough treatment to kill enough cancer but not so much that the treatment makes the person too sick to live life. The lingo is quality of life/qol. Dr. Weiss put it this way, "Every cancer therapy has two purposes: to improve duration of life, and to improve quality of life. Every other measure of chemotherapy success, such as response rate or progression-free-survival, is a surrogate to these two true goals."
The words are simple but the idea has been the most daunting for me to consider with my husband. After a turbulent couple of years individual cancer biology proved to act more like a very indolent type such as BAC. For that reason we'll look at any future problems with hopes of treating it the same way as indolent BAC in Dr. West's post, http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/
One more thought and you can find info with a search on the subject, surgery in the area of previous radiation is very difficult after more than a few weeks post radiation.
One more thought, second opinions are very good for situations like you've described. Dr. Weiss wrote this blog post on the subject, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
Know that any decision she makes will be the right one and once the decision is made stress lessens a lot.
Best of luck,
Janine
Reply # - March 17, 2014, 06:15 PM
Reply To: Stage IV NSCLC – Surgery after chemoradiation? Would
Yes, as you've heard from Jim, Janine, and Dr. Creelan, there can be situations in which a local treatment like surgery or radiation may be reasonable for patients with metastatic lung cancer, but that's really only when there's only one spot growing against a background of nothing else growing, over an extended period of time. Otherwise, doing either radiation or surgery to treat a single spot when others are likely to be right behind makes no sense -- it can't be expected to improve survival and is kind of the definition of treating just to treat, without any evidence it helps or even compelling reason to think it will help.
As for hitting a wall, I don't know if that time is now for your mother, but there does come a time when there isn't any further therapy that would have a meaningful probability of helping. It's really not ideal just to treat because of a relentless drive to treat until someone can no longer walk into the cancer clinic. We don't want our treatments to be worse than the disease -- that gets us to a point where our treatments can cause more harm than good.
Good luck.
-Dr. West