Radiation therapy and limited progression - 1271992

wadvocator
Posts:79

Hi,

Just learned of limited and slow progression after on Tarceva for 4 years. In the process of exploring and understanding options. 3 spots (lymph nodes) of progression: One on right Paratracheal (4:21), another on right paratracheal (4:35), and third at RIght hilar inferior (4:50)...don't know what the numbers with colon mean.

Have read about the concept of "riding the winning horse for as long as possible". Our oncologist expressed concern about radiation due to the locations of slow progression. Was wondering SRS a viable option, given the locations, to consider.

Thx

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Reply # - December 3, 2015, 06:57 AM

JimC
Posts: 2753

Hi wadvocator,

I believe the numbers refer to the specific scan images which show the affected lymph nodes. Whether they can be safely irradiated is a question for your local doctors, who have access to all the scan and are best equipped to judge the risks involved.

Even if radiation is possible, in the context of an existing stage 4 lung cancer diagnosis such local treatment is not usually advised unless it is to palliate symptoms, and that would certainly be a factor to consider in weighing the risks versus benefits.

JimC
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Reply # - December 4, 2015, 02:11 PM

wadvocator
Posts: 79

Thanks Janine!

I understand what Jim said about "Even if radiation is possible, in the context of an existing stage 4 lung cancer diagnosis such local treatment is not usually advised unless it is to palliate symptoms, and that would certainly be a factor to consider in weighing the risks versus benefits." But I do remember reading somewhere in the site that radiating localized slow progression is a viable tactic to continue existing TKI that are still working.

Can a radiologist comment on what parts of the body (specifically are more safely to radiate than other? My specific interests are around right paratracheal and right hilar. We will be talking to radiologist, but just want to get a general perspective via this site.

Reply # - December 5, 2015, 03:55 PM

catdander
Posts:

Hi advo, I meant to respond last night so sorry. I imagine you want to hear from a radiation onc, one who provides radiation to cancerous tumors instead of a radiologist, one who reads and interprets scans. It will be at least monday before we hear back from a doctor. If you listened the video you will note that Dr. Weiss has a special interest in using focal treatment in situations where there are just a few (1 or 3ish) slow growing spots of progression in an otherwise durable response to a TKI like tarceva.

Like Jim said it's very individual as to who and where radiation is appropriate. It's important to note that SBRT, stereotactic body radiation therapy; another acronym is SABR is a type of radiation treatment that is in the past couple of years, taking hold as an option for tumors outside the brain. So you'll want to read up on that before seeing the onc (one consideration is that it has more pinpointed accuracy than typical radiation therapy. This is a good start, http://cancergrace.org/lung/2015/08/21/gcvl_lu-d08_inoperable_early_sta…
Another reason to think focal treatment in this case is treatment for slow growing resistance to tarceva. Dr. West talks about it here, http://cancergrace.org/lung/2013/01/23/acquired-resistance-algorithm/

Hoping your wife is feeling alright for winter festivities.
Janine

Reply # - December 10, 2015, 04:09 PM

dr loiselle
Posts: 37

Hi - I would consider radiation to this area and continuing Tarceva... it is a little hard without specifics to advise regarding longer conventional courses of radiation in comparison to higher dose, image guided, shorter courses. We have done both in the scenario described, depending on the oncologic, anatomic, and life details. Best wishes for your consultation with a local radiation oncologist. Dr Loiselle

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