Aortic invasion or not? - 1251225

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hope78
Aortic invasion or not? - 1251225

August 2012 - Dad (57 years old and in good health) was diagnosed with lung cancer. An almost 7 cm tumor (pet scan showed SUV 16.9) found on his upper left lobe and several medistinum lymph nodes (pet scan showed SUV between 2.0 and 2.5). MRI of the head/chest and bone scan showed clear everywhere else.

October 2012 - Thoracic surgeon performed mediastinsocopy and lymph nodes came back negative, however, tumor diagnosed as a pancoast tumor because of its positioning and surgeon recommended neoadjuvant chemo and radiation before surgery. We also knew if dad were to go to surgery - there would be rib and chest wall reconstructionl. The questionable bit is if there is aortic invasion or not. Tumor abuts the mediastinum adjacent to the left subclavian artery and the aorta (specifically the aortic arch) - concern for possible invasion of adventitia.

November 2012 - Dad went through concurrent chemo (cisplatin/etoposide) and daily 3D CRT radiation for five weeks excluding weekends. He finished at the beginning of last week and did decently well. Major complaints were burning in the stomach and sore throat. Met with the thoracic surgeon at end of November and follow-up MRI scans and pet scans showed cleared everywhere except tumor location. Tumor reduced by about 20% (likely still some more reducing in next few weeks). However...still left with possibe aortic invasion. We will proceed onto surgery but the one decision that still needs to be made is what happens if there is aortic invasion? We were told about aortic resection (about a 15% increase chance for complications) which would involve a cardiothoracic surgeon and my dad being put on a heart-lung bypass machine while this is being completed or the surgeon would resect as much of the lung as possible, leave metal markers on where the aortic invasion is and dad would go onto more radiation and possibly chemo later on. What are some of the questions we should consider before making such decision?

catdander
Reply To: Aortic invasion or not?

hope78, I'm so sorry your dad is in such a difficult situation. One question would be what are the complications that could happen. I know that an open thoracotomy is a complicated surgery to begin with so knowing what other complications could happen needs to be added to the decision making process. Another question may be how many pancoast tumors the surgeon has resected. What if any chest wall structures may need to be resected and how will it affect recuperation and future mobility.

My husband was never able to follow through with the resection of his pancoast tumor but I'd read a lot about them before hand. Though he didn't have the additional complication of aortic invasion. I know this will be an almost impossible decision to make. Much good luck

I'll ask a doctor to comment on your question. You should hear back in a bit.

Janine
forum moderator

Dr West
Reply To: Aortic invasion or not?

It sounds like a very tough situation, and I'm sorry for that.

I think the key questions are what are the probabilities of serious or fatal complications from the surgery, and what are the alternatives if there is active cancer but he weren't to do surgery. If there is no chance of cure without surgery, even a surgery with significant risk could well be seen as very justifiable. It sounds as if there has been a response, but not enough to be very hopeful of cure even with additional chemo/radiation if he doesn't undergo surgical resection. I think the overall key is to try to define the risks and anticipated benefits of the two main strategies of surgery if at all possible, or additional treatment without surgery.

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

laya d.
Reply To: Aortic invasion or not?

Hope78 - -

Just wanted to pop in and wish your Dad lots of luck. . .Please keep us posted.

Laya

hope78
Reply To: Aortic invasion or not?

Thank you catdander, Dr. West and laya d. for posting. Catdander and Dr. West have provided great questions for my family to consider!