You can see from my signature that my sister-in-law has done remarkably well over nearly four years. I’ve posted here from time-to-time to give updates on her status and ask questions about her treatment. I’ve really appreciated the help. She was at Sloan today to get her latest scan results and treatment. The doctor told her and my brother she is considering stopping treatment but wants to do something about the remaining lesion first. She doesn’t feel comfortable leaving it alone. The doctor’s preference is to have it surgically removed so it can be biopsied, but other options include radiofrequency ablation or stereotactic radiation. I believe the lesion is in a fairly easy location to reach so that’s not an issue in the decision.
My sister-in-law doesn’t really want surgery because even if there is no active cancer in that lesion there’s no guarantee it isn’t somewhere else. So she’s leaning toward the radiofrequency ablation or stereotactic radiation because she thinks they would be less invasive with fewer possible complications. Does that make sense? What kind of questions should she ask about the two methods? Are there reasons to do one over the other?
By the way, her doctor said she spoke to the head of oncology at Sloan and another oncologist about the case and both advised continuing current treatment. So there obviously isn’t a clear answer in cases like hers.
Thanks for any guidance.
Reply # - October 5, 2012, 01:19 PM
Reply To: Surgery vs. Stereotatic Radiation vs. Radiofrequency
It's so good that your sister in law is having this problem. It sounds like you all have done your homework and asking all the right questions. I just don't know if there are any right answers.
But i will certainly reach out to doctor for input. I hope to be in the same position with my husband in a few weeks but for now it's just escalating scanxiety.
Janine
forum moderator
Reply # - October 5, 2012, 04:57 PM
Reply To: Surgery vs. Stereotatic Radiation vs. Radiofrequency
I think the main question is whether, if there's no compelling evidence that there is active cancer (namely that it is new or growing over repeat scans, PET avid, or biopsy proven), it needs to be treated at all. I am not a great fan of RFA, which can have some risks of inflammation and lung collapse, with at least as good if not better results from stereotactic body radiation therapy, but if none of these interventions is risk-free, why do them if it isn't actually known or at least extremely suspicious that the lesion represents active cancer? What if the intervention causes signifcant complications, even if unlikely, for something that wasn't cancer after all?
-Dr. West
Reply # - October 5, 2012, 08:40 PM
Reply To: Surgery vs. Stereotatic Radiation vs. Radiofrequency
Thank you, Dr. West. That's exactly what I've been wondering
Janine, good luck to your husband.
Reply # - October 6, 2012, 09:25 AM
Reply To: Surgery vs. Stereotatic Radiation vs. Radiofrequency
Forgot to ask one thing. If she stops treatment and has progression can she go back on Alimta/Avastin? My brother thought he read somewhere that she would have to have a certain period of time of no progression before she would be allowed back on them. Is that true? If so, what's the time period?
This may not doesn't matter but she's been on Alimta/Avastin since 1/09.
Reply # - October 6, 2012, 09:58 AM
Reply To: Surgery vs. Stereotatic Radiation vs. Radiofrequency
No, there's no rules for that, except that we really prefer to have patients not start Avastin (bevacizumab) again until a patient has recovered from the acute effects of radiation or especially surgery -- usually a matter of weeks (6-8 at the outside), since Avastin can interfere with wound healing. The delay depends on the magnitude/invasiveness of the intervention being done.
-Dr. West