STAGE IV ADENOCARCINOMA NSCLC- Oligometastasis Candidate for Surgery? - 1269442

praisesgirl5
Posts:5

Hi:

My 68 year old mother in law was recently diagnosed with Stage IV NSCLC. She has a 4 mm tumor in her right upper lobe and, as of now, only ONE solidary metastasis to the sternum, which is categorized as a hyper metabolic subtle sclerotic lesion on the PET scan. My mother in law is very healthy and active for her age. She has always eaten healthy and, up until diagnosis, did zoomba and yoga weekly. She is interested in aggressive curative care (reaching NED status) over palliative treatment if possible. Given this information, would surgical removal of the primary tumor with later radiation to the sternum (or possibly sternectomy) be an option?
Thanks for your response.

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Reply # - May 5, 2015, 06:45 PM

dldl94
Posts: 17

Hello and just chiming in for a clarification so that discussion pertinent/clear. Is the RUL tumor "just" 4mm? Know that CT directed biopsies technically difficult when that small. All the best to your family!
D

Reply # - May 6, 2015, 06:44 AM

JimC
Posts: 2753

Hi praisegirl5,

Your use of the term "oligometastasis" in the subject of your post indicates that you have read that in most cases stage IV lung cancer is treated with systemic rather than local therapy, but that in certain instances it is advisable to remove the cancer in the lung as well as the sole metastatic lesion. It's impossible to say in advance whether this strategy will be successful, but in your mother-in-law's case since the lesion in the sternum has not been biopsied, it may not even represent cancer, so lung surgery may be worth the risk. That risk is that the lung surgery is not to be taken lightly (and how taxing it will be depends on how extensive a surgery is recommended), and usually means that a patient will need a significant recovery period before chemotherapy can begin if it is later found that the cancer has spread to other organs. It's the kind of decision best put into the hands of the patient after a complete discussion with her medical team, and given your mother-in-law's philosophy it seems that might be the path she would choose.

Good luck to her with her upcoming treatment.

JimC
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Reply # - May 6, 2015, 09:25 AM

Dr West
Posts: 4735

Given what you describe, I suspect the sternum lesion is a true metastasis, even if not technically confirmed with a biopsy.

Treatment of lung cancers as "oligometastatic" is becoming increasingly liberal as stereotactic body radiation therapy (SBRT) is more readily available and enthusiastically endorsed. There are certainly some docs who would pursue a surgical approach, though I fear that it's not recognizing the true reality of the biology of the cancer. I would say that I have never seen a patient with a solitary bone lesion as their only source of metastatic disease who ended up being cured of their lung cancer. The successes with the concept of oligometastatic disease have been considerably more common with a solitary brain or adrenal lesion.

Given the considerable challenge of undergoing surgery for a cancer that can't realistically be considered as curable by conventional standards, I would have a hard time recommending or even endorsing such an approach. Sometimes we start with conventional chemotherapy and see what response you get -- if the primary cancer shrinks well and nothing is growing anywhere else for 6 months or longer, perhaps that'd be a more compelling situation than thinking of this up front. It unfortunately wouldn't be rare to have a patient develop more areas of disease before they've even recovered from the lung surgery that would be needed here, in which case the surgery would have been completely futile and perhaps even harmful if it kept a patient from getting the systemic therapy that is truly of greatest benefit, at least not in a timely way.

Good luck.

-Dr. West

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