<p style="color: #0f1419;">Hi there
<p style="color: #0f1419;">I have been on crizotinib for 18 month, had gamma knife in April this year for a few small brain lesions which worked well, and otherwise responding to the crizotinib perfectly. I have brain MRI and CT lung abdo every three months and chest x ray each intervening month. To reduce radiation exposure, Oncologist suggests not having an x ray in the month directly after the CT. This seems reasonable, does Dr West agree, indeed I wondered would CT quarterly be sufficient with no intervening X rays at all or could disease progress very quickly so that without monthly monitoring perhaps a treatment opportunity e.g. for localised treatment of what was a small pocket of resistance was lost?
<p style="color: #0f1419;">Thank you Aalicia
Reply # - September 18, 2014, 06:56 AM
Hi Alicia,
Hi Alicia,
Most oncologists do not follow up with monthly scans when a patient has had good results for 18 months or longer, and most typically use CTs. The resolution of an x ray is such that they are unlikely to reveal small changes with any accuracy. As Dr. West has said:
" My personal view is that a chest x-ray is about as useful as just looking at a person. You’re probably as likely to find someone is progressing by seeing that they look unwell as by finding progression on an x-ray, a technology that is over a century old. While I consider a PET scan an exceptionally sensitive way to detect progression, arguably too sensitive, I see a chest x-ray as an almost disingenuous way to do surveillance for progression. It’s so insensitive for anything short of striking progression that it seems like something just done as a ritual to be doing something that seems almost like doing a meaningful test. There’s no evidence it helps more than just seeing a person in the clinic and monitoring for symptom changes, and I really think it mostly just humors everyone into feeling like imaging is being done. To be frank, I really think of it as the placebo arm of a study of meaningful follow-up.
I don’t mean to say that I never do a chest x-ray, because they can be helpful for certain questions, and they’re easy and low radiation, but they really aren’t very helpful in determining whether there’s mild progression of a cancer being treated." - http://cancergrace.org/topic/x-ray-or-petct#post-1253206
JimC
Forum moderator
Reply # - September 18, 2014, 10:12 AM
Alicia,
Alicia,
I'm not sure why my previous reply isn't showing up on the list of recent posts, but I'm posting this so it's clear that you do have a response to your questions.
JimC
Forum moderator
Reply # - September 18, 2014, 05:54 PM
I tend to get the X-rays when
I tend to get the X-rays when the wheezing is acting up. Even thou the fluid in my Pleural effusion is stable. So what are the chances it is coming from my bronchial or esophopgas? Do you think I should have a Bronch done? Lorrie
Reply # - September 18, 2014, 08:15 PM
It's very clear reasonable to
It's very clear reasonable to extend the interval between scans to every 3 months or even longer, sometimes even out 4-6 months in some patients doing well for a long time. Although there is always a chance that the cancer will suddenly change behavior dramatically and progress rapidly, that's very unlikely -- a cancer that has responded well for many months or longer is far more likely to progress rather gradually before changing dramatically.
As my words Jim quoted above indicate, I don't really do chest x-rays for surveillance, because they're nearly useless, particularly if patients will speak up if they feel a change: you're very unlikely to find clinically silent progression (no symptoms) through a chest x-ray if recent CT scans (past 3-4 months at least) have looked favorable. I routinely extend the interval of CT scans for surveillance of patients doing very well from every 2 months to every 3 months, sometimes every 4 months, and rarely every 6 months. In most cases, I'll have patients come for a clinic visit halfway between scan intervals to check how they are feeling, and if they have new or worse symptoms, I move up the imaging -- the chest CT, I mean, because if you're looking in earnest for a problem that is remotely subtle, you don't do a chest x-ray.
-Dr. West
Reply # - September 19, 2014, 03:29 AM
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Thank you Jim and Dr West, that is very informative,, I think my routine surveillance X-rays can terminate. Alicia
Reply # - September 19, 2014, 06:21 AM
I should really qualify my
I should really qualify my comments by saying that this is an area in which style and judgment prevail. My approach is not the only way to think of these issues, and other approaches are not wrong.
-Dr. West
Reply # - February 21, 2015, 03:08 PM
Hubby just had his 4 month
Hubby just had his 4 month scan which is showing no evidence of disease. He has been on xalkori since Sept 2011 with very manageable side effects. Our doc suggested doing scans in 4 months and if those are stable spacing out to 6 months. Obviously that is a little scary to think about waiting that long. I understand the need to balance monitoring with radiation exposure, just wondering the docs thoughts on when or if you would space out to 6 months.
Reply # - February 21, 2015, 04:31 PM
Hi jmpchic,
Hi jmpchic,
Congratulations on your husband's excellent scan result! NED is definitely something to celebrate.
I can understand your anxiety over lengthening the scan interval, but it is standard practice to do so, especially when scans reveal no evidence of disease. If symptoms are monitored on a frequent basis, that frequency of scanning should be sufficient to detect progression before anything would get out of hand. Dr. West has often stated that in trials and in the clinic, discovering progression a couple weeks or even a month or two earlier with more frequent scans does not generally lead to better outcomes. As long as a patient is followed closely enough so that he or she is healthy enough to resume treatment, the result will be the same, except in the case of especially aggressive cancers, in which case symptoms are often obvious even before a follow up scan has been performed.
JimC
Forum moderator
Reply # - February 21, 2015, 06:00 PM
Thanks, Jim. We are
Thanks, Jim. We are definitely celebrating. I do understand it is standard practice to space out the scans. He has been at every 4 months for the past year so I can see where 6 months would be the next step, if it was our choice we would scan every month! The scans have certainly become a great source of anxiety as well as a security blanket.