Oligometastatic non-small cell lung cancer with only one bone mets

Thu, 05/27/2021 - 01:57

I'm 57 and recently diagnosed with nsclc with negative EGFR, ROS, ALK but with PD-L1 > 80.  The tumor in my lung is in the right lower lobe about 2-2.5 cm in size, and only one bone met about 3cm in my right ala. 

Currently I don't feel any symptoms and it's an incidental finding of the cancer.   I'm relatively healthy othewise.  For the treatment plan, my doctor suggests systemic treatment such as immunotherapy, then evaluate after a few months if I can have surgery pending on there aren't any  progressions  at that point.  Given the relatively small tumor size and met size and my health condition,  would I benefit by having surgery of the lung tumor and surgery/SBRT of the bone met before any immunotherapy treatment?  

JanineT Forum …

Hi Melody,


Welcome to Grace.  I'm so sorry about your diagnosis.  Getting it as right as possible from the beginning is important.  Currently, unresectable stage III nsclc  without progression is treated with chemo/radiation (creative treatment) then imfinzi (immunotherapy drug) is standard of care.  Besides that, there are many ways in which an oncology team decides to proceed in a situation as you've described. 


Fair questions to ask, does the tumor need to be smaller to be able to resect it safely?  If so it makes since to shrink first then do surgery.   Same question for radiating  the sacral ala and how to best stablize it.  It's possible to take immunotherapy before and after. 


On a personal note, my husband was in a similar situation in 2009 well before immunotherapies and the Pacific trial.  He had an unresectable pancoast tumor that was treated with the standard chemo/rads and when it came time to check for possible surgery options a met was found on his spine, not part of the pancoast tumor .  They radiated it, time passed he stopped treatment and he didn't progress.  That was 9 years ago since his last treatment.  There will always be a lot of unanswered questions about what really went down.  The bone met was never biopsied because bones are notoriously difficult to get the tissue and hard to catch a cancer cell after all the processing, so it's just not normally done.  5 oncologists agreed it was cancer, and today they would still agree that oligomets don't show up in the spine, but cancer can do anything...on and on.


All that to say, I'd have to have some conversations with some experts in the field. 

A 2nd opinion from someone who specializes in lung cancer at a large research hospital can add insight into your individual case.  For more on that this is the best article on the subject.   I wouldn't be surprised if there was a trial that's studying along those lines and would be worth looking into.


I'm sorry there are no definitive answers but you're asking the right questions.  Keep us posted.

All the best,