dianndunlevy
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<span style="text-decoration:underline;">I have stage 4 lung cancer with two small mets to hips and was diagnosed 21 months ago. I am in a clinical trial and having good results. Bone mets are stable and lung tumor has shrunk from 3 cm to 1 cm. When lung tumor progresses could this be a possible scenario to advocate for surgical removal of lung tumor and SBRT of hips as long as no other mets?
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Reply # - December 2, 2015, 05:52 AM
Hello,
Hello,
Welcome to GRACE, and congratulations on your good response to the trial therapy. Here is what Dr. West has said in a similar situation:
"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." - http://cancergrace.org/topic/stage-iv-adenocarcinoma-nsclc-oligometasta…
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Reply # - December 2, 2015, 05:57 AM
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If such an approach were pursued, I would think it better to proceed when the cancer is stable rather than progression. At the time of progression it is even more likely that there will be circulating tumor cells throughout the body, making the chance of development of further metastases, as well as the need for systemic treatment, more important. Recovering from significant surgery may delay that needed treatment.
JimC
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