My father is aged 55years, never smoked tobacco, diagnosed with T2 N2 Adenocarcinoma of the lung (Pathological staging) with a solitary asymptomatic left temporal lobe ring enhancing lesion measuring 5mm.
28th Feb 2013: Right sided lobulated mass on CT
17th April 2013: Given tissue diagnosis of adenocarcinoma. Delay with diagnosis& surgery due to tissue diagnostic delay &SUV uptake for neck/spine on PET investigations were negative for cancer.
7th May 2013: Underwent right pneumonectomy. (Planned RUL lobectomy but peri-operatively tumour was crossing the horizontal fissure). Unfortunately 1-2mm pleural seeding resection biopsy +ve for adenocarcinoma
19th June 2013: Commenced chemotherapy (4 cycles) carboplatin/pemetrexed
27th June 2013: Contrast CT of thorax/abdomen revealed no new disease. However repeat cranial MRI showed an increase in size of the left temporal lobe lesion to 11.2mm & a further speck of a signal in the cerebellum which was not visible on previous MRI- but too small to report a size.
2nd July 2013: EGFR status for the tumour is NEGATIVE.
30th July 2013 – Due a repeat PET scan
My concern is that the temporal lobe lesion has doubled in size over 3 months.
Further PET arranged 13 days’ time &then to discuss the case in an MDT (multidisciplinary team) before deciding stereotactic brain surgery or WBRT and whether or not to give radiotherapy to the chest.
My questions are:
1. Should we request stereotactic radiosurgery for the brain ASAP (mid-chemotherapy?)
2. Can a solitary brain metastasis send further seeds of brain metastases?
3. Should we wait until the chemotherapy is completed as hopefully the pemetrexed could shrink the metastasis and then proceed to radiosurgery?
I am very grateful to Dr West and his team for the GRACE online service that you have provided. I practice as a primary care physician in the UK, however oncology itself is a rapidly developing specialty itself and I am grateful for your views and opinions on