Appointment today with ONC and he is suggesting a couple of chest X-Rays between every 6 month CT scan in order to monitor the lung nodules between scans. I questioned if that was safe due to more radiation exposure, and he says x-rays would provide him valuable information between scans and that it is minimal radiation impact. I wonder is that a common practice with other lung cancer patients?
Wife 64 never smoker 12/11-DX NSCLC Aden, small left pleural eff
12/9/2011-CT scans-3cm mass left lung,”innumerable nodules in both lungs under 5mm”
12/20/2011-PET scan 3cm lower left lung mass, mets both lungs, extensive osseous mets
12/14/2011-biopsy-neg for EFGR,ALK,KRAS,BRAF mutations
12/2021-Begin Alimta(pemetrexed) 3 wk intervals
2/2012-MRI brain,2 lessions 2.5mm&2.0mm,not appear to be brain mets
3/2012-7/2012- 4 chest x-rays,left lung mass sig reduced,”tiny nodules both lungs”,no pl eff
9/2012 – Brain MRI - Clear
12/2011-10/20/12-blood serum markers CEA 403.7 to 7.1,CA-19 5,210 to 27
12/2011-10/2012-14 sessions of pemetrexed in 3 wk intervals (with three 4 wk & one 5 wk interval)
1/7/2012 – CT Scan - Stable
2/18/13 - CEA increased from 7.1 to 20.5
10/17/2012 – Present – Break from chemo
Reply # - February 20, 2013, 10:00 PM
Reply To: X-Rays between CT Scans
Most lung cancer specialist don't use xrays and feel they don't offer any extra information. However many oncs do use them. My husband's did for some time.
Dr West stated," I don't know of any actual data on this. The amount of radiation in a modern chest x-ray is very minimal -- you get more from flying across the country, and living at a high altitude is also associated with radiation that is comparable to a few chest x-rays per year, I believe. " http://cancergrace.org/forums/index.php?topic=9548.0 You may find more info on the subject by doing a search using the Grace search function. It's very good, though you may need to log off first depending on your browser.
CT scans are many many x rays put together so one or 2 extra x rays between CT scans won't be detrimental to her health.
I'm glad to hear your wife is on break from chemo. My husband is also, after 3 years. I hope they both get to enjoy it for a long time.
Janine
Reply # - February 20, 2013, 11:18 PM
Reply To: X-Rays between CT Scans
The radiation risk from a chest x-ray to be exceptionally minimal. Honestly, the risk from that in the setting of an existing advanced lung cancer is about a billionth the level of risk vs. that posed by the cancer itself. It would be like worrying about getting a melanoma by ever leaving your home during daylight hours.
The real problem is that the value of a chest x-ray to assess anything other than striking differences over time is similarly minimal. A chest CT, even perhaps a "low dose", screening chest CT can provide incredibly greater information with a little more radiation exposure but would actually provide remarkably greater information about the status of the disease than a chest x-ray, which is perhaps minimally more effective than just asking her whether she thinks her nodules are bigger.
-Dr. West
Reply # - February 21, 2013, 10:29 AM
Reply To: X-Rays between CT Scans
Thank you both Dr. West and Janine. I am on GRACE almost evey night and I suspected what your answer would be and I completely agree. The x-rays taken in the past really have given very little insight into any progression or regression but only to confirm that the lung nodules exist and possibly the general size. We already knew that (and much more) from the 6 month CT scans. Our ONC is very knowledgable and intelligent but doesn't appear to have treated very many lung cancer patients. I pushed back a little yesterday and he just kept saying "valuable information" so since the radiation exposure is minimal we will probably have the x-rays done. Thanks again for your replys.
Wife 64 never smoker 12/11-DX NSCLC Aden, small left pleural eff
12/9/2011-CT scans-3cm mass left lung,”innumerable nodules in both lungs under 5mm”
12/20/2011-PET scan 3cm lower left lung mass, mets both lungs, extensive osseous mets
12/14/2011-biopsy-neg for EFGR,ALK,KRAS,BRAF mutations
12/2021-Begin Alimta(pemetrexed) 3 wk intervals
2/2012-MRI brain,2 lessions 2.5mm&2.0mm,not appear to be brain mets
3/2012-7/2012- 4 chest x-rays,left lung mass sig reduced,”tiny nodules both lungs”,no pl eff
9/2012 – Brain MRI - Clear
12/2011-20/2012-blood serum markers CEA 403.7 to 7.1,CA-19 5,210 to 27
12/2011-10/2012-14 sessions of pemetrexed in 3 wk intervals (with three 4 wk & one 5 wk interval)
10/17/2012 – Present – Break from chemo
1/7/2012 – CT Scan - Stable
Reply # - February 21, 2013, 02:24 PM
Reply To: X-Rays between CT Scans
fides, it sounds a bit like my husband's situation. I have suspicion that the doctors do these scans out of habit as much for the institution as for the the belief that it's actually helpful. But it seems like just another brick in the wall of a system that needs tearing down not building up. But like you said it's not doing harm to our loved ones. Too the cost is minimal (the $86 charged to us isn't minimal but to the system in general). After my and D's questioning our ability to pay he quit ordering the x rays. I wouldn't have complained about the cost if I thought it was helpful.
Like so many things in life, we pick the battles. I agree, x rays aren't necessarily one of them.
Reply # - February 21, 2013, 05:34 PM
Reply To: X-Rays between CT Scans
Janine, I really appreciate you sharing your experiences with your husband since it really helps dealing with my wife’s situation. I sincerely hope that your husband remains stable for a very loooooong time. I would also like to take this opportunity to say that we who are in the GRACE community are extremely fortunate to have you as a moderator. Your knowledge, wisdom, and extremely hard work are very valuable to this forum. Of course, it goes without saying that are also very blessed to have our Docs. Steve
Wife 64 never smoker 12/11-DX NSCLC Aden, small left pleural eff
12/9/2011-CT scans-3cm mass left lung,”innumerable nodules in both lungs under 5mm”
12/20/2011-PET scan 3cm lower left lung mass, mets both lungs, extensive osseous mets
12/14/2011-biopsy-neg for EFGR,ALK,KRAS,BRAF mutations
12/2021-Begin Alimta(pemetrexed) 3 wk intervals
2/2012-MRI brain,2 lessions 2.5mm&2.0mm,not appear to be brain mets
3/2012-7/2012- 4 chest x-rays,left lung mass sig reduced,”tiny nodules both lungs”,no pl eff
9/2012 – Brain MRI - Clear
12/2011-20/2012-blood serum markers CEA 403.7 to 7.1,CA-19 5,210 to 27
12/2011-10/2012-14 sessions of pemetrexed in 3 wk intervals (with three 4 wk & one 5 wk interval)
10/17/2012 – Present – Break from chemo
1/7/2012 – CT Scan - Stable