Subclavian Artery - 1263330

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Subclavian Artery - 1263330

Hi. I am on my way for a second opinion at Memorial Sloan Kettering, NYC. Stage IIIA-B After 35 radiation and cisplatin/etoposide 2 courses, I am "stable" actually .1 cm of shrinkage. I responded well to all of this with fatigue being my main side effect. However, the CT was done way too soon (3 weeks) My docs are basing their decisions upon it in any event. I went for a second opinion to a new oncologist. She is closer to home and I liked what she had to say. My new oncologist is continuing me right away on 2 courses cisplatin/alimta to transition after to just alimta.

My present surgeon said he looked the CT Scan closely and that he could not operate. Bad news. The issue seems to be that the tumor is encasing the subclavian artery and I need a bypass as well as 1/2 my left lung removed. I wonder why they cannot just do the bypass, wait 12 weeks and since it is "stable" then take out the lung after I have recovered. Does this make sense? Again, I responded very well to the chemo and rads. I am lucky that it has not spread, and praising God that it has shrunk (if even a little) and they are calling it "stable." In any event, it is my surgeon who is in process of setting up the second opinion for me at MSK.

My best hope is for this new surgeon to say yes as I want to go through with this surgery, or to put me in a clinical trial...let's try something new and exciting. Or go home with my tail between my legs and go on the alimta maintenance. I feel like I am in a good position either way. I feel really good in general, back to my old self. I feel if they say they cannot do the surgery that the alimta will buy me some time. Do you have any ideas on how well patients like me respond to alimta?

Your thoughts on this type of surgery? Is it uncommon? It is adenocarcinoma with necrosis, poorly differentiated and it was hiding in my media steinum encasing my subclavian artery. it was about 4.9 x 2.8 x 4.1 and now it is overall about a single cm shrunk.

Dr West
Reply To: Subclavian Artery

If the cancer is in a location in which surgery is not appropriate at the time of initial workup, the prevailing view of experts is that you don't revise the plan of operability after treating it. There are perhaps rare exceptions, but it also sounds as if your response has not been so dramatic that surgery would be a feasible or appropriate option. This isn't to say that you couldn't find a surgeon who would do it if you look hard enough, but you can find people to do almost anything, no matter how unwise it is. A cancer that was unresectable to begin with and has responded with modest tumor shrinkage to chemo and concurrent radiation, that tends to be a situation in which surgery does not end well. Those surgeons who recommend against it aren't trying to deprive you, as much as to spare you from a likely unhelpful and dangerously aggressive approach.

I think it will be helpful for you to get that opinion from Memorial Sloan Kettering, and I will be surprised if they favor surgery.

Patients with your characteristics are not plentiful enough in studies to speculate about how you would respond to a platinum/Alimta (pemetrexed) combination, though I think it's a very fine choice for someone with residual viable cancer that is an adenocarcinoma.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education