Hello I am new to cancer grace and grateful there is such a dedicated site for cancer patients and families needing answers without having to wait for answers. I am was diagnosed stage 3a nsclc with a 7 cm X 9 cm lung mass situated near the superior cava thus the chemo oncologist recommended chemo before a possible resection or possible pneumonectomy. The thoracic surgeon wanted chemoradiation to have the tumor shrink faster but it was negated by the radiation oncologists as it would cause too many problems with a right pneumonectomy
After 2 rounds of carbo/alimta (21 days after each cycle) and a PET scan the tumor has shrunk to 4.8 cm X 4.2 cm and the thoracic surgeon wants to do the pneumonectomy on Dec 15th. I have my 3 round of chemo December 1st and he indicated he's ready to go even after 2 weeks after the 3rd treatment
The question I have is should still ask my oncologist to proceed with the 3rd round of treatment with the hope the tumor shrinks even more so the surgeon can have better margins during the operation ? Also if I skip the 3rd round of treatment I would have a lapse of over a month since the last Chemo treatment on Nov 10th as I don't want the cancer to grow back
Can I ask the surgeon to possibly move back the surgery date a week as I know you need at least 3 weeks since your last chemo treatment before surgery starts? Should he also he doing an ebus or mediastocopy to check the lymph node stations before proceeding?
Thank you for your help
Reply # - November 23, 2015, 07:37 AM
Hi tykaylaian,
Hi tykaylaian,
Welcome to GRACE, and congratulations on such a great response to your first two rounds of chemo.
I think this is a situation in which there would be great benefit in having all your doctors confer about the pros and cons of each approach, and if your cancer center has a tumor board (a regular meeting of interdisciplinary physicians including oncologists, radiation oncologists and surgeons), it would be helpful to present your case to that board.
We can't tell you what should be done, as you're not a patient of any of the GRACE faculty and we lack full information on your specific situation, including scans and other test results. But in general, the maximum benefit (tumor shrinkage) from chemo occurs after the first two cycles, with a significantly smaller amount of shrinkage after cycles three and four. So the value of a third cycle here may be limited, and may have a cost in the form of increased toxicity, making surgery a tougher proposition. The difference between waiting two versus three weeks after chemo is an issue best determined by your physicians, who can judge your overall fitness for surgery.
Although anything is possible, the fact that your tumor responded so well to chemo makes it pretty unlikely that a treatment gap of three or four weeks constitutes sufficient time for your cancer to grow in any significant way.
Good luck with surgery.
JimC
Forum moderator
Reply # - November 24, 2015, 03:51 PM
Hi Jim
Hi Jim
Thank you for the reply
I received a second opinion today from the head of thoracic surgery at a major university and he indicated it doesn't hurt to finish the remaining 2 rounds of chemo then he would perform a mediastocpy to examine the lymph nodes before the Pneumonectomy
My first thoracic surgeon indicated he would just do the surgery and then remove the lymph nodes for examination at the same time
I thought a mediastocpy is normal procedure before a Pneumonectomy to examine the lymph nodes stations?
I wanted to ask you if finishing the last 2 rounds of chemo then having the surgery in January instead of December would give the tumor a chance to grow back or the cancer to spread? I am scared the 30 days waiting from the first original surgery date of Dec 15th and waiting to Jan 15, 2016 would give this disease to grow back or metastacize
I am still going to finish the final 2 rounds of chemo for a total of (4) completed then proceed to surgery 3 weeks later and there would not be a lapse in treatment
Thank you and await your reply
Reply # - November 25, 2015, 06:27 AM
Hi tykaylaian,
Hi tykaylaian,
It's really a matter of choice for the surgeon whether to do a mediastinoscopy. Dr. Pennell has said:
"Surgeons often need to perform a mediastinoscopy to confirm the absence of mediastinal lymph node involvement, and if that is positive then referral to medical and radiation oncology is a necessary step." - http://cancergrace.org/lung/2009/11/06/delays-in-treatment-for-lung-can…
But lung cancer surgery is the one area in which it is most important to choose a dedicated thoracic surgeon with a great deal of experience with such surgery, as opposed to a surgeon who splits his/her time performing various types of surgery. Without implying anything about the credentials of the other surgeon, I would expect that the thoracic surgeon at a major university would possess such expertise.
Since you responded so well to the first two rounds of chemo, significant progression while you are receiving the next two rounds of chemo (plus any waiting time after chemo is finished) is pretty unlikely, although not impossible. Your tumor may shrink further in those two cycles but given the prior response, at least stable disease would be likely.
JimC
Forum moderator
Reply # - December 1, 2015, 02:35 PM
Hi Jim
Hi Jim
Thank you for the feedback on choosing the best surgeon for lung surgeryand I think I will go with the USC chief thoracic surgeon in LA
I also got a 3rd opinion from another Kaiser Permanente thoracic surgeon in LA and he too recommended fiinishing the last 2 rounds of chemo then get a Pet scan, CT scan with contrast, and then perform the mediastocopy to test for lymph nodes involvement before proceeding to surgery
So I finished my 3rd round of chemo today and the last one will be Dec 22nd and I am hoping this dreaded tumor shrinks even more but if not at least keep ot stable
THank you for your input on this subject as well as you dont think the tumor will grow in these last 2 rounds of chemo and the 3-4 weeks lapse before surgery
I am praying to God for another good Pet Scan and CT scan and the mediastocopy shows no lymph node involvement so surgery can proceed
THank you again for your assistance and Happy Holidays
God Bless