24 1/2 Year Lung Cancer Survivor has SBRT questions - 1249946

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24 1/2 Year Lung Cancer Survivor has SBRT questions - 1249946

My 87 yo mother had adeno ca in her right lung in 1988- RLL lobectomy, no rad/chemo and survived it!!
Also MRSA in both lungs 2008- survived!

Unfortunately she now has 2 adjacent nodules in the left upper lobe (hilar). Health fragile- she has atrial fib, coronary artery disease, moderate emphysema. Following a 3 hr EBUS bronch procedure, her lung partially collapsed, discovered many days later. It resolved on its own with 24/7 oxygen but after a month still needs oxygen part of the day and never needed before. The EBUS confirmed 2 adjacent cancerous nodules, T2N0M0 Stage IIB. Sufficient biopsy to determine celll type was not obtained. Pathologist said NSCLC but onc reports says probably NSCLC. They advised against doing a core biopsy due to risk of another pneumothorax. Brain MRI and PET show no metastasis outside lung. lung nodule SUV,10.5, 1.7 A wedge resection was considered but ruled out by refusal and poor pulmonary function (DLCO diffusion 39% predicted). SBRT was advised.

Is SBRT effective in treating other cell types besides NSCLC if it is some other type?

Would Medicare cover the SBRT costs if it is not NSCLC or without a specific cell type analysis?

Would SBRT result in less pulmonary function loss than a wedge resection?
She wants to be able to maintain a quality of life where she can leave the house with portable oxygen, which was not possible initially after the pneumothorax. I've read SBRT can cause loss of pulmonary function.

Thanks for your help. This is my first post, hope I didn't break the rules, but I am very impressed with the wealth of knowledge on this forum.

Dr West
Reply To: 24 1/2 Year Lung Cancer Survivor has SBRT questions

It's great to hear about a 20+ year survivor!

I'm not familiar with SBRT being used for anything other than NSCLC, and I suspect that there's very, very little information on this (perhaps none). We couldn't speculate on cost issues in this setting.

As for whether SBRT would cause less damage to lung function than a wedge resection, that would often be the case, but it really depends on the size and location of the nodules. If only very tight radiation were done around the lung nodules, that would likely damage less lung than a wedge resection, but her lung function leaves little margin for further deterioration without worsening lung function.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education