PET CT after RapidArc Radiation of the Lungs - 1251859

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tanjamika
PET CT after RapidArc Radiation of the Lungs - 1251859

Hallo,

My mother had 21 sessions of Rapid Arc radiation for her lungs. She had lesion ih her right lung upper lobe and metastasis on two lymph nodes (paratracheal and right hilar ones).
Before that, she received 4 cycles of Cisplatin/Gemzar without any response.

Radiation treatment finished three months ago and we just had first PET CT. First words by our oncologist were that she thinks it is a good response but that there is possibility of residual and new metastase near the treated lymph node.

She decided not to do anything for now, but to wait for another three months when all inflammation should disappear and we will see what will be left.
After I read PET CT report I was really scared as Nuclear Medicine Physician wrote the following:

"FDG uptake of lesion at right lung upper lobe has significantly decreased (ˇ-75%), but a focal FDG uptake suspicious for residual is still discernible.
A focal increased FDG uptake at right hilus is seen without a corresponding lymph node, suspicious for lymph node metastasis, right hilar FDG uptake was not at this exact location in previous study."

I am really scared about the possibility that something new, untreated at all, can appear in these three months, and how big these residual and metastase can grow?

I would really like to hear some opinions and experiences...

Dr West
Reply To: PET CT after RapidArc Radiation of the Lungs

Unfortunately, it's definitely possible for a new hilar node or some other new area of disease to appear in a three month interval. If cancer, they can get to be several cm: there's no upper limit I can give.

It's possible that the finding represents an inflammatory response to the treatment. There's a good reason why we're wary about using PET/CT within the first few months after radiation, since it can induce inflammatory changes. And while you'd generally expect to see inflammation right where the radiation was delivered, I can also envision the possibility that inflammation near a radiation site could also travel to nearby draining nodes, since they can reflect everything going on in the area from which they drain, including not just cancer but infection or inflammation.

A follow-up scan should clarify things: you'd expect the nodal area to get less hypermetabolic and smaller if inflammation is the cause, but the opposite should occur over time if it's actually cancer. Alternatively, the questionable node could potentially be biopsied at bronchoscopy by an interventional pulmonologist.

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

tanjamika
Reply To: PET CT after RapidArc Radiation of the Lungs

Thank you very much. They did not say anything about bronchoscopy, but our pulmonologist suggested we make CT of the lung in a month or so?

Do you think that CT could clarify something?

catdander
Reply To: PET CT after RapidArc Radiation of the Lungs

Hello tanjamika,
I'm so sorry your mom is in such a position of wait and see. It really is one of the most uncomfortable states we all have been through. You would think that knowing there is cancer is hands down much worse but there is some comfort in knowing what's going on and having a plan.

We were there with my husband in the beginning and it seemed just as difficult. Now as my signature indicates we are back in a wait and see situation and it feels a whole lot better than before. Still tough, still worry about every little thing, still dealing with symptoms and lingering side effects, still waiting for the cancer to return, but we have moments of pure joy that are worth a million, every time.

A follow up CT is the standard follow up procedure. Often 3 months but sometime sooner or later. My husband's always been on a 3 month interval.

I hope for the best for your mom,
Janine

tanjamika
Reply To: PET CT after RapidArc Radiation of the Lungs

Thanks Janine very much...You are so right about the feeling of waiting and not knowing. This is a very hard trip but we have to enjoy every good moment and hope for the best I guess.
All the best to you and your family

Dr West
Reply To: PET CT after RapidArc Radiation of the Lungs

Yes, a repeat CT could also very likely provide useful information about the probability that it's a cancer vs. post-treatment effect, depending on how/if that area changes over time.

-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