I need information on adrenal metastasis from multifocal nsclc. Initial dx march 2019 surgical lobectomy complications eventually had to undergo pleurodesis 2019. Lungs stable. Now 3+cm adrenal tumor, new since June scan. Need help: radiation best or surgery? Complications? I live in Seattle
Thu, 12/02/2021 - 13:22
Hi Carole, Welcome to Grace. If the adrenal is the only place that cancer has been seen since your lobectomy it could be that it's what's known as a precocious metastasis/oligoprogression or it could be that what was BAC has mutated into a more aggressive nsclc and this is only the first place to be seen. Treating it as though it is the only place of recurrance can lead to sustained benefit or even cure. BAC is a tricky disease so I'm going to ask Dr. West to comment.
Too, we have OncTalk coming up Saturday after next, Dec 11, 2021. It's a live online patient forum with some of our faculty discussing current treatment options in nsclc AND you'll have the opportunity to ask questions AND it's free. Anyone dealing with lung cancer will benefit tremendously by attending. Check out upper right of our home page. https://cancergrace.org/
All the best,
Thu, 12/02/2021 - 20:49
These approaches haven't been directly compared, and it really depends on who can do the job and what they say is appropriate to expect in terms of side effects. In general, I favor non-surgical management in the setting of oligometastatic disease because we really want to minimize the side effects, and surgery tends to often be a lot to go through. However, radiating the adrenal gland may have a fair bit of nausea and potentially other side effects, so I think it would be appropriate to meet with both a radiation oncologist and a surgeon to discuss what they anticipate it would be like, as a specialist who actually does that work. As a medical oncologist, our real role here is more to determine whether a "local therapy" to treat one spot is appropriate for someone with multifocal disease. To be clear, I definitely think it's appropriate to favor treating a solitary area of progression if there isn't any other change elsewhere over the past 4-6 months. This is really where the idea of using local therapy for "oligo-progression" fits in well.
There are sometimes other factors to consider, such as that surgery will give you tissue if you want/need to do more molecular testing, and radiation will tend to leave imaging as hard to interpret in that area for a long while after (you need to be able to tolerate the ambiguity of scans coming back saying that it's not clear if what they see there after radiation is inflammation or possibly evolution of the disease). But there really isn't a wrong choice to make here.
PS: you or other patients with lung cancer in WA can potentially schedule a telemedicine-based visit with me through City of Hope if that would ever be helpful. I don't see patients "live" in WA, but I have my active WA license and can give second opinion consults via telemedicine. If it would ever be helpful, the number to schedule is 626-218-9200, and they'd see about collecting records just as if it were a live consult.
In reply to Carole,These approaches… by Dr West
Sat, 12/04/2021 - 15:07
Thank you so much I will call Monday and get your second opinion going. No ca anywhere else- lungs no change 2 years- but complicated by a gi bleed they cannot find cause but are transfusing me. Camera test next week. Sure appreciate this site and your response.