rfa vs stereotactic radiation in BAC - 1260308

lembird
Posts:58

Well, I knew my luck would run out at some point so here I am 4 years after diagnosis and I have been sitting very nicely since having my "lead runner" surgically removed back then leaving me several small BAC spots in all remaining lobes (tiny consolidated centers)on some of them with no enlargement on any of them until yesterday.

I had my 6 month scan and it seems that one of my spots has gone from 1 cm to 1.3 cm in the hazy part since the last scan so they are discussing my case at Mayo today. They will give me options after discussing my case....since I understand that there are not a lot of hard facts about treatment for this.

Having said that, I would like to know if you have any statistics as to treatment of a "lead runner" in whether RFA or stereotactic radiation would be useful in BAC. I am disinclined to choose surgery and I am pretty sure that will be one of the options I am offered so I am trying to get a handle on RFA and Stereotactic Radiation and their usefulness in GGOs (with small consolidated center)

I have not seen anything on the site that compares these two treatments in a mostly indolent BAC setting.

Dr West, I have used your perfect narrative "lead runner" which describes perfectly what is happening in my case.

Thanks very much for any information you can provide or any literature you can point me to.

Sincerely,
Lembird

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Reply # - November 5, 2013, 10:51 AM

catdander
Posts:

Lembird's profile:
NSCLC dx 11/09, surgery to remove RML 2/15/2010, pathology 2B Adenocarcinoma with BAC features. 3 tx Cisplatin and Alimta, 1 tx Carboplatin and Alimta. Some residual neuropathy in hands and feet. Small nodules and GGOs in all remaining lobes. Scans every three months...stable as of 11/4/11...very little growth in one nodule but essentially stable as of 3/30/12, next scan in 6 months. Scan 9/12 stable, scan 4/13 stable

Hi Lembird, I'm so sorry the cancer has started rearing it's ugly head. I've pasted your profile above for the doctors' reference. I imagine you've read most if not all of these but I wanted to make sure you've got the reference points we have to offer. From last year is your thread where Dr. West states, "There really are no data on stereotactic radiation in multifocal BAC," http://cancergrace.org/topic/results-of-latest-scan
But Dr. West does suggest in his algorithm for treating BAC that for focal growth radiation is an appropriate approach while multifocal growth is systemically treated. http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

This is the latest information on radiation in lung cancer including stereotactic ablation. This series of videos are each fairly short. http://cancergrace.org/radiation/2012/12/02/mehta-podcast-series-refine…

I hope this is helpful,
Janine

Reply # - November 5, 2013, 12:25 PM

lembird
Posts: 58

Thank you Janine....
I didn't know what happened to my profile, happy to see it again.

I guess I will look at my profile and figure out how to get it back there so I can update it.

This information on radiation is good and I will look at each of the podcasts with very interested eyes now that I have recurrence.

I was hopeful that there might be new information on the RFA also so will see if any of the doctors weigh in.

Otherwise, I appreciate the information you have provided, it will be very helpful to me going forward.

Sincerely,
Lembird

Reply # - November 5, 2013, 08:33 PM

Dr West
Posts: 4735

Lembird,

There are absolutely no studies, not even a hint of evidence, because this concept of the "lead runner" is just what I'd consider to be good clinical judgment, not a textbook approach. There is simply no textbook approach that fits indolent BAC/minimally invasive adenocarcinoma well.

There is really no more information on RFA that I have seen, and my impression is that it probably poses more risk than any slow-growing BAC. It doesn't rank among options I've ever given 10 milliseconds of consideration to in this setting.

I really think that cyberknife/stereotactic body radiation therapy (SBRT) for these lesions is at least as compelling, and probably more so, than repeated surgeries. The main advantage in my mind is that if you're going out on a limb doing local therapy for slow-growing multifocal disease, you'd be wise to do the treatment that poses the least risk and does the least damage, because you run a very real risk of causing more harm than good.

To be honest, I think the most appropriate randomized trial should be local therapy with something like SBRT vs. using Adobe Photoshop to remove the lesions from the CT images and make doctors and patients lose the temptation to just treat images that pose a very low risk over the next several years, perhaps longer than that.

-Dr. West

Reply # - November 6, 2013, 06:05 AM

lembird
Posts: 58

Dr West,

You made me laugh with your analogy of SBRT vs Adobe photoshop. You have a way of making things very clear.

I was a little confused when I was at Mayo as to why there is any interest in treating this lesion since although it did grow from 1cm to 1.3cm in the last 6 months it is still small and I have no symptoms. My first thought was to change my scan schedule from 6 months to maybe 3 or 4 months to watch things but then I also thought it might be best to keep it at 6 months to avoid additional radiation.

I know you do not answer specific questions but if you had a patient with my profile .... how large would a lead runner have to be in order for you to feel comfortable with SBRT to take it out. Is there a time when with all things being stable, except one, would it be the size of the GGO or would it be possible clinical symptoms that would govern when you would go ahead and treat it locally.

Thank you....
Lembird

Reply # - November 6, 2013, 08:46 PM

Dr West
Posts: 4735

Honestly, I don't mean to be evasive, but I really need to see it and know the context of the health, age of the patient, their level of anxiety, etc. There just isn't any threshold that I use. I don't mean for it too sound too squishy, but I just think it's not just the variable of the size of the lesion as much as the pace of change over time and the backdrop of the patient in whom that lesion is being managed.

-Dr. West

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