CT scan says Extenstive Pleural Contact - 1271887

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CT scan says Extenstive Pleural Contact - 1271887

Ithe CT or PET scan report says "Extnesive Pleural Contact", it is feasible that the chemo/radiation could shrink it back away from the pleura - or would you expect that to be a very remote possibility?

I'm thinking this is what the doctors are hoping for, since the plan is to do chemo'rad. and then they hope to do surgery . Extensive pleural contact didn't sound very good to me, and I was surprised they even discussed/planned on surgery from the get go?

The follow-up CT after the chemo/rad. if @ 4 1/2 weeks. Is that long enough after to be able to get a clear enough scan picture to base surgery or not surgery on ? (Today I read on this website that more like min. 6 weeks OR MORE would give a clearer more accurate scan.

Hi healmymom

Hi healmymom
I hope that my answer is relevant to your case.
My wife has NSCLC and had pleural fluid in her lung. She was successfully treated with Tarceva (it was verified by PET-CT) but the pleural fluid was still accumulating and was drained daily (250 cc /day). Then her Doc suggested Talc Pleurodesis and this procedure solved the problem.


In general, I do not

In general, I do not routinely advocate for 'preoperative' concurrent radiation for locally advanced lung cancer, if the intent is truly to cure. Many patients are led down the garden path of 'preoperative' chemoradiation, but that path rarely results in a high quality operation, or even any operation at all.

Why? The radiation doses given are inferior (usually only 45-50 Gray), and the chances of converting to a truly curative resection with negative margins are still low. In fact, it is difficult to assess tissue planes (and thereby margin status) during the operation because the anatomic tissue planes are hardened and obscured by radiation effect.
Another problem is that lung tumors tend to shrink 'towards' the same structures that the surgeons are trying to avoid. You can shrink a tumor from 6 cm to 2 cm, but if it is still encroaches into the aorta, it remains unresectable.

Next, we know that giving split-course radiation after an incomplete operation does not work well. Also, we cannot 'mop up' positive margins in this setting, because most of the radiation dose has already been given. For all these reasons, the concept of preoperative chemoradiation for locally advanced lung cancer has big drawbacks.

To my mind, it is better to be honest with the patient upfront, and treat with definitive concurrent chemotherapy with a curative radiation dose, eg 65+ Gray. Or else, if surgery is truly an attractive option, then treat with preoperative chemotherapy only, and reserve radiation for the post-op (adjuvant) setting.