Dear Dr West,
Congratulations for this forum; it is really helpful.
I would like you advise on an issue if it is possible.
Two and a half years ago (07/2014), my father (75 at that time) removed two peripheral lesions from his right upper lobe (sizes 1.7cmx0.7cm and 1.3x0.5cm at a distance of 1.0cm) with wedge resection (wedge size 4.0x2.0cm). The biopsy showed a highly differentiated adenocarcinoma with BAC features. Oncologist advised only CT and blood check-ups every 6 months.
During his last CT check up (12/2016) a mass 4.0x2.7cm appeared on the operation site, a local recurrence (in fact the tissue around the resection scars increased in size). A CT guided needle biopsy was performed last month that showed again a highly differentiated lung adenocarcinoma.
The treatment of choice is lobectomy. However, due to COPD, coronary disease (had a triple bypass back in 2010) and arrhythmia (wears a pacemaker since 01/2014) surgeon is reluctant to perform a lobectomy. Given these facts the oncologist advised for radiation therapy. After talking with several radiation oncologists we consider treating it with SRS/SBRT.
We have contacted two different centers; one operates Novalis XK and the other Cyberknife. Now we are trying to figure out which approach is the best.
What is the difference between Novalis XK and CyberKnife? My understanding is that we are talking about two different machines that perform the same thing however which is the best for treating a peripheral lung mass (I am not a field expert but I can tell that a major portion of what I am reading is marketing)? Would you recommend one of them?
Should we expect any side-effects? We are told that there is a possibility for radiation pneumonitis yet we might not face it because the mass is peripheral.
I've also read some papers online claiming that SRS/SRBT exhibits similar results with wedge resection. Is this the case?
Thank you in advance for your time and help.
Peter
Reply # - February 6, 2017, 03:01 PM
Hi Peter,
Hi Peter,
Welcome to GRACE. Compared to older, conventional forms of radiation, stereotactic body radiation (which describes each of the modalities you've mentioned) offers greatly improved control of cancerous tumors, similar to surgical removal. As Dr. West has written:
"For example, if a patient with an isolated lung cancer (T1, T2, N0) was not able to undergo surgery because of other medical conditions such as heart disease, historically success with conventional external beam radiation therapy was limited. With traditional techniques, the chance of locally controlling a cancer such as this was 50% at best. With SBRT, probability of locally controlling such a tumor now exceeds 90%… indeed a dramatic improvement." - http://cancergrace.org/radiation/2012/01/18/sbrt-and-optimal-candidates/
On more than one occasion, the GRACE faculty have indicated that the skill of the radiation oncologist and medical team is often more important than the particular equipment used. There may be circumstances in which one type of modality could be superior, but that's a decision to be made in consultation with your radiation oncologist, who will have detailed knowledge of your situation.
JimC
Forum moderator
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