Hi Dr. West,
I have written you before and your were very helpful. I had 3 nodules that were being monitored 2 in upper left and 1 in middle right. They were monitored for 2.5 years and were stable until 2013.
One of the them...the 10 mm nodule in upper left started to change in shape and a bit larger...spiculated.
Long story short ...the 2 in the upper left were adenocarcinoma (The PET showed SUV 3.0 in the 10 mm....2.8 in the 7 mm nodule) I had a LUL in April 2013.
I had 4 rounds of Cisplatin/Gemzar.
Since then they have been watching the GGO on the right. It has been stable for these past 2 years. app. 8 mm. On my last CT they felt it may be getting a bit more dense. I went for a few consults for this. It was felt a wedge resection should be done if my PFT's were ok...and they were.
I am so confused because now I have been hearing about the cyber knife...less invasive and preserving more lung tissue. My BIG concern is how my breathing will be after more lung tissue is removed. I have been assured that it will be good. Since I am a an active 60 year old woman.....it is concerning.
But then I keep reading/hearing that the GOLD standard is to have it surgically removed.
My last scan was in April...I have had a few set backs and had to reschedule the surgery...a stubborn UTI and my husband had a major heart attack...I am on IV antibiotics for one more week for UTI and my husband is doing real well.......so I need to get on this as soon as possible.
I guess my main questions are can it be possible to have a left lobectomy and then a right wedge resection and still be able to breathe fine.....and the pro's and con's on surgery vs cyber knife.
Any input you can give me would be so appreciated. Thank you!
By the way...I hope your shoulder is recovering well!
Mara Tripi
Reply # - June 8, 2015, 11:19 AM
Hi Mara,
Hi Mara,
I'm very sorry you're going through ALL this. Glad your husband is doing well and hope you get rid of your infection soon.
Dr. West has written a lot on the subject of indolent lung cancer and is one of the tops in the field of BAC which is often so indolent that no action is considered to be the best action. Even being healthy enough to withstand treatment doesn't make treatment a good idea on it's own. As you have suggested the more lung tissue removed now the less you'll have later when you may need it most. That goes for treatment as well, the more treatments done now the fewer will be available later. In fact many perhaps most people have benign lung tumors that never bother them. So if a tumor is growing very slowly it's often considered best to leave it alone until it causes problems.
If cancer is found in both lungs it's no longer considered curable so neither surgery nor radiation would be considered at all standards of treatment. But if the cancer is so indolent it's not growing considerably then it also may not be life limiting. A cancer that can be treated only when needed may now be considered a chronic problem not a terminal one.
Dr. West has only grown more adamant in his writings about treating indolent lung cancer with as little treatment as possible. It may also be worth noting that posts about indolent BAC (not all BAC is indolent) is the topic most likely to contain information about how to treat indolent lung cancer (BAC or not). As an example my husband's cancer (if he still has any) is andor was very indolent squamous cell known to be quite aggressive. If it were to show itself again we'd treat it first with the idea of less treatment is more. So whether BAC or not it's indolent and can be much longer followed without wasting treatments before they're needed.
The first is newest and relevant. http://cancergrace.org/lung/category/lung-cancer/core-concepts/bronchio…
Best,
Janine
Reply # - June 8, 2015, 06:42 PM
Hi Janine!
Hi Janine!
Thank you for your quick response...I am sitting here ....going crazy...I have been doing research...they scheduled the wedge resection for June 16th. I am supposed to go for pre-op tomorrow.
I have been feeling very uneasy about having this done..right from the get go....I feel that there has NOT been any real progression of this 8/9 mm nodule for years (I had it when I had my original dx in April 2013...it was 7/8 mm then)
The tumor board that has conferred on my case are split with their view.... if it is more dense or not.(50/50)
I have been following Dr. West's publications and views on indolent cancer for a few years now.
I do think my team here are nervous with my case because my other 2 nodules were also very slow growing...and the SUV on the adenocarcinoma's (by the way,I stated the incorrect figures on those) they were 1.7 and 2.4 were so low.
I was not this nervous going in for my first surgery...the nodule changed...got larger....became speculated....and "appeared malignant.".....It was a let's go get it out feeling.
NOT this time.....I am feeling like you stated above. I would love to fly in to have a consult with Dr West...but first I need to make a decision by tomorrow........surgery or not.....I am leaning toward putting off the surgery... having my next CT/PET in mid July....(last one was mid April)....and seeing then.
I just sent out an email to BJA too...I have no idea why....I am so torn. I guess Dr. West will check in,as well...I hope. Thank you,Janine...anything you can add would be so appreciated.
Mara XX
Reply # - June 9, 2015, 10:11 AM
I haven't written many posts
I haven't written many posts about new data in lung cancer, but one key publication compared SBRT (stereotactic body radiation therapy, also known as SABR, for Stereotactic ABlative Radiation) to surgery for early stage NSCLC, the results in two randomized trials that closed early due to slow/poor accrual. The results were pooled and showed that the SBRT arm looked even a bit more favorable, and certainly not worse.
The numbers, even when pooled from two trials, are very small, but they look impressive even so, and suggest that while surgery has been a historical gold standard, there's good reason to question whether that should remain the case.
I think SBRT, wedge resection, or ongoing observation are all feasible and will likely lead to comparably good survival. Only surgery will give tissue (unless a biopsy is done before SBRT and shows cancer), but there's reason to want to not be cavalier about removing any more good lung tissue than necessary if this is going to come up over and over.
Good luck.
-Dr. West