Hello, My 62-year-old non-smoking husband was diagnosed with NSCLC adenocarcinoma ALK+ in September 2014. He had chemo first line and has been on Crizotinib since December. A recent brain scan showed a 5 mm met and MRI confirmed no others visible and the one is well defined. We are being sent for a consult with a neurosurgeon but are surprised that surgery is even on the table for one small met. I am aware that some ALKies with mets are just put on a second generation inhibitor to deal with small mets, so we were expecting GK or CK as the most invasive options. We are in Canada where perhaps there is a more conservative approach to treatment. We are actively seeking second opinions and would appreciate any comments on whether surgery should even be considered. Needless to say we are not keen on this option but want the best choice as well. THank you in advance for your help.
Surgery for 5 mm brain met???? - 1269505
windersal
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Reply # - May 12, 2015, 05:01 AM
Hi windersal,
Hi windersal,
I'm very sorry about your husband's diagnosis and this hopefully bump in road. I don't know why surgery may be used instead though I will ask a doctor or comment. Perhaps Canadian.
All best,
Janine
Reply # - May 12, 2015, 06:59 AM
Thank you. From our point of
Thank you. From our point of view, finding a Canadian doctor is not the top priority because we are trying to figure out the best treatment option, regardless of borders. From what I can tell from a google search, the closest hospital with GK is in Winnipeg, Manitoba, 3 provinces away. We will be asking our doctors whether Juri could be referred there for treatment. I suppose our question comes down to whether there would ever by any time that a single well defined small brain met (5mm) should be cut out vs zapped.
Reply # - May 12, 2015, 08:04 AM
Hi windersal,
Hi windersal,
About the only reason I could see would be if the brain met's location makes radiation difficult/dangerous. But I would think that would hold true even more for surgery. Have you asked your husband's doctors directly why surgery rather than radiation?
JimC
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Reply # - May 12, 2015, 08:31 AM
Yes we have asked. I should
Yes we have asked. I should explain that we are in a rual area so the doctor we talk to most often is at the regional hospital which delivers chemo, etc. Our oncologist is 6 hours away and while we trust him, my husband is the first AlK patient to be treated at their centre. The local doctor's response is that surgery is worth considering because they want to make sure they get all of the tumour. This is in consultation with the oncologist.
From what I have been reading on Inspire and other sites, this is not the normal response to a 5 mm tumour which is not located close to important centers for sight, etc. The trip for the consult with the neurologist is a 7 hour round trip drive, so tiring, and am wondering whether we should even be doing it.
Reply # - May 12, 2015, 08:10 PM
hi Windersal
hi Windersal
sorry to hear about the brain met, i can understand why you are having trouble getting a definitive answer, especially because you haven't had a chance to talk to a neurosurgeon or radiation oncologist yet - those would be the best people to discuss the pros and cons with you and your husband.
i don't see this as an issue that would have differences in Canada vs the USA but i'm happy to comment. brain mets are something that are very patient specific - the location, size, local effect, general condition of the patient and accessibility to either surgery or specialized radiation facilities are all critical things to take into account. in most cancer centers the rad onc and the surgeon would meet to discuss the best plan for each patient.
in general i'm not opposed to someone having surgery to "scoop" the cancer out, in some places in the brain this actually does work better than radiation. especially if there is only one spot and if it's in a part of the brain that isn't too important (like the visual or motor area - we leave those alone). with either local radiation (like gamma knife or equivalent) or surgery it's most likely he will also need whole brain radiation to treat any possible tiny spots that aren't seen on the scan. so no matter what i think you need to see a radiation oncologist and discuss options. i understand this is a long trip to make, but brain mets demand attention.
it's true that the next generation of ALK inhibitors (which are available in Canada) are thought to get into the brain, but i'm not sure that would be my first choice as definitive treatment and it's certainly not as well proven as radiation or surgery. it is possible to try switching chemo drugs first to see what that met does, the risk is that if it doesn't work he might develop more while on the new drug. tough case, worth a discussion with the specialists for sure.
best of luck
Dr Laskin
Reply # - July 20, 2015, 07:39 PM
Hi. I am wondering whether
Hi. I am wondering whether there is a way to speak to the forum moderator privately. I think it is catdander in this thread. Thank you.