Stage 3B

[Joe]

Has anyone on this forum been diagnosed with NCSLC Stage IIIB and beat their cancer back to remission? The statistics and doctors make it sound like it's impossible so I want to see what the real world has to say.

Also, has anyone who has been diagnosed with Stage IIIB ever had surgery? The statistics and doctors also say that isn't possible.

Thank you for your input.

Joe

[kimblanchard]

Joe

My NSCLC was declared stage III by one doctor and stage IV by another. So I'm not sure. Anyway, it was located in my upper right lobe and right top rib. They attempted surgery and closed me back up when they found a tumor in my lower right lobe.

I have had radiation and chemotherapy and have been stable/in remission for about one year. They have just now found mets to my liver.

Hope this helps.

Sue M

[Anniemac]

My husband was dx with what they thought was IIIA and they did chemo and radiation to shrink the tumor and then did surgery. The surgeon found the tumor was more extensive than they realized and called the oncologist from the operating room and was going to give up and close him back up. Our onc knew we wanted to be aggressive and that my husband was relatively young, so he told the surgeon to do what he could. He did and was able to remove it all, even though it had grown onto his pulmonary artery and they had to open his heart sack to get it off. They did restage him to IIIB and he is doing some follow-up chemo now to make sure that nothing is left.

Not quite remission yet, but we are hoping for it. The next scan is on 9/8 and we hope it will show nothing!

So, it is possible, with the right doctors, to have surgery. Staging is not very exact and there is a thin line between A and B. You would think that they would at least try! Maybe they could do something to shrink it first with the hope of surgery. Get 2nd and 3rd opinions.

Annie

[john]

Not sure where you live but you can check www.clinicaltrials.gov if you want to explore what trials may be available

--------------------------

Guidelines on treatment of stage IIIB non-small cell lung cancer.

Jett JR, Scott WJ, Rivera MP, Sause WT; American College of Chest Physicians.

Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. jett.james@mayo.edu

Stage IIIB includes patients with T4, any N, M0, and any T, N3, M0. Surgery may be indicated only for carefully selected T4N0M0 patients with or without neoadjuvant chemotherapy or chemoradiotherapy. Patients with N3 lymph node involvement are not considered as surgical candidates. For patients with unresectable disease, good performance score, and minimal weight loss, treatment with combined chemotherapy and radiotherapy has resulted in better survival than treatment with radiotherapy alone. Multiple daily fractions of radiotherapy have not resulted in improved survival compared with standard fractionation once daily. Concurrent chemoradiotherapy appears to be associated with improved survival compared with sequential chemotherapy and radiotherapy. Treatment of stage IIIB due to malignant pleural effusion is addressed in the section that deals with stage IV disease.

Publication Types:

Guideline

Practice Guideline

Review

Review, Academic

PMID: 12527581 [PubMed - indexed for MEDLINE]

This study shows 74 Gy may produce better results than 60 Gy. 60 Gy is the standard dose of radiation

High-dose conformal radiotherapy for treatment of stage IIIA/IIIB non-small-cell lung cancer: technical issues and results of a phase I/II trial.

Rosenman JG, Halle JS, Socinski MA, Deschesne K, Moore DT, Johnson H, Fraser R, Morris DE.

Department of Radiation Oncology, Lineberger Comprehensive Cancer Center of the University of North Carolina--University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA. rosenman@radonc.unc.edu

PURPOSE: We completed a Phase I/II clinical trial (Lineberger Comprehensive Cancer Center 9603), in which we treated 62 Stage IIIA/IIIB inoperable non-small-cell lung cancer (NSCLC) patients with two cycles of induction carboplatin/paclitaxel chemotherapy, followed by concurrent weekly carboplatin/paclitaxel with radiation doses escalated from 60 to 74 Gy. The median survival of 24 months, 3-year survival rate of 38%, and the high dose of radiation used justified a critical analysis of the technical and clinical components of this trial. METHODS AND MATERIALS: Between 1996 and 1999, 62 sequential patients with inoperable Stage IIIA/IIIB NSCLC were enrolled and treated with two cycles of induction carboplatin (area under the concentration curve = 6 using the Calvert equation) and paclitaxel (225 mg/m(2)), followed by an escalating radiation dose of 60-74 Gy with concurrent carboplatin weekly (area under the concentration curve = 2) and paclitaxel weekly (45 mg/m(2)). The goals of the trial were to determine whether 74 Gy of radiation could be safely delivered under these circumstances and whether patients could potentially benefit in terms of survival. The radiation treatment plans for all 62 patients were reviewed to determine the prechemotherapy and postchemotherapy tumor volume, as well as the dose-volume histograms of the normal lung and esophagus. RESULTS: Of the 62 patients who entered the trial, 48 completed the entire course of treatment. At last follow-up, 20 patients were alive (crude survival rate 32%). With a median follow-up of 43 months, the median survival was 24 months. The survival rate was 50% at 2 years and 38% at 3 years. Cox regression analysis showed that survival was best predicted by whether the patient had received radiotherapy (finished the trial), performance status, disease stage, and log postchemotherapy tumor volume. The 3-year survival rate for the 48 patients finishing the trial was 45%. Eight patients (13%) suffered locoregional relapse as the only site of failure. Only 1 patient had Grade 2 radiation pneumonitis. Five patients (8%) had Radiation Therapy Oncology Group Grade 3 or 4 esophagitis; 40 (65%) had a Grade 1 or 2 esophagitis. Esophageal toxicity could be predicted by the length of esophagus receiving 40 or 60 Gy. CONCLUSION: Radiation doses of 74 Gy, when given under the guidelines of the Lineberger Comprehensive Cancer Center 9603, appear to be safe and may possibly contribute to increased survival in patients with inoperable Stage IIIA/IIIB NSCLC.

Publication Types:

Clinical Trial

Clinical Trial, Phase I

Clinical Trial, Phase II

Multicenter Study

[BarbaraL]

Hi Joe,

I'm relatively new to these boards and have Stage IIIB disease. The bare statistics are pretty grim, but NO ONE knows how any single individual will respond to treatment. Statistics are just collections of numbers.

I've had 4 rounds of chemo so far, my CT scan after 3 treatments showed 50% reduction in the volume of my primary tumor. And, I've had few side effects from the treatment either. All my blood counts are still high, so my immune system remains in good order.

Tell your dad to drink a ton of water. Also, if his diet is less than optimum, he's got to change it. Lots of fish, skinless poultry, beans/legumes, fresh vegetables and fruit. There are quite a few good books out there--I really liked "What to Eat if You Have Cancer."

Good luck!

Barbara

[Hebbie]

Barbara -- I love that book too! (and it made me feel good when my hospital nutritionist told me it was one of her favorites as well!)

It was so easy to read and the way they have the foods broken down with the suggested servings each day is so easy to follow. That is what I need -- break it down for me and tell me EXACTLY what to eat and I can follow it like a trained pet!

[Guest kjdenver]

Joe, thanks for your post. My dad was diagnosed with stage III NSCLC about a week ago, but he didn't remember whether it was IIIa or IIIb. I am anxious to know. I suspect it is IIIb because it has spread to both lungs, although I'm told it hasn't spread to other organs. My dad is older than yours, he is 80 and weak from unrelated recent operations. Notheless he is a good sport about his treatments. I've come home for his first week of radiation and chemo treatments. He seems upbeat, but is bracing for tougher times ahead. He's resolved not to push for surgery, but if he were younger we'd be all over it. Hope you find good information and have good results from whatever treatment you pursue.

[JudyB]

Joe,

I was pegged IIIB, but fought to have surgery even tho the surgeon said it would not be successful. Well, it WAS successful, much to his surprise and also to my oncologist. Each case is singular. You also have to know that reading films is very subjective, and 2 radiologists can come to different conclusions.

JudyB

[Hebbie]

Joe, my "phone buddy" through ALCASE was Stage IIIB -- during surgery, they saw lymphnode involvement and almost closed her back up, but her surgeon was aggressive and continued. They followed her up with radiation and chemo. That was in 1998. She just celebrated her 5 year survival mark. She never had a recurrence and is such a motivation/inspiration to me I wish I could call her every day!!!

It can be done!!!!

Heather

[mhutch1366]

Joe,

I was diagnosed in april '00 with a pancoast tumor of the left upper lobe measuring 14 x 9 x 5 cm, with involvement of the nerves/vessels near the heart, it had consumed 5 ribs and was encroaching on my spine. It had extended up my neck on the left side almost to my earlobe. It had become a palpable mass on top of my left shoulder.

I received concurrent radiation (25 x = 5k rad maximum, total) with cisplatin/vp-16, followed by a 7 week hiatus awaiting surgery. I had two primary thoracic surgeons and a neurosurgeon. They had to go in from the front and dissect away the major nerves and blood vessels (that's where I lost my collarbone) where he literally held my heart in his hand, and THEN go in from the back and pull out the tumor, intact, which weighed 13 1/2 pounds. The surgery took over 14 hours. They had to rebuild my chest wall. Follow up was two more 6day rounds of chemo a month apart.

Last month I received an "all clear" on my 3 year post surgical ct/mri scans. I have some trouble breathing, both obstructive and restrictive pulmonary disease, from the radiation and the remodelling of the chest wall. However, I am not on oxygen, and I can do a brisk 2 mph when I put my mind to it, and carry my own groceries in from the car. I can camp with my kids, and I can ferry them back and forth to activities and be an active supporter there. Also work full time, and live independently, if you don't check the corners with a white glove.

Be proactive -- find a surgeon who will do it. If I hadn't had surgery at NIH, my private thoracic surgeon would have been willing to give it a go. He had been suggesting the chemo and radiation and surgery as a package, whle NIH was just suggesting palliative tumor removal. Then the radiation oncologist found a phase ii protocol that was ready for immediate implementation, and they recognized this would soon be the common treatment for this tumor type -- it was apancoast, which I think refers more to the way the tumor grows than to the type, which was nsclc.

HOWEVER I am here, to shout about it, and can recommend.---

don't stop looking for someone who is willing to go for the surgery, if that's what you want. Persistence pays. Be a vocal advocate on yourown behalf -- proactive. Write things down in a journal, or have someone keep one for you. Explore all your options, talk to all the doctors at the major cancer centers. Chances are someone would be able to point you in a positive direction if they can't help there. Go for it!!

God bless you, and know you are not alone....

You're in our prayers.

MaryAnn

[mhutch1366]

Dear Joe,

I should also remark I was stage III almost b, if that makes any sense. The tumor was that close to my spine.

I had involvement of my upper left lobe only, besides the massive invasion of my chest wall and neck.

I was afraid to look at the statistics, I didn't want to know. I knew I was a statistic of 100 or 0, so I wasn't going to pay that any mind. I couldn't ask how big the tumor was for over a year, or do the research on the prognosis, or on the clinical trials which only had results to 12 months.

I took one step at a time, literally, from one treatment to the next, from one appointment to the next, from one physical therapy appointment to the next. Took lots of naps, said a lot of prayers, read a lot of books. Wept some too. Sometimes just hung on by my teeth. But I hung on.

I didn't give up. I couldn't give up -- that wasn't in the program. Keep fighting until you find a doctor who says, sure, we can do that!!!!

When I got to 1 year, and looked around, saw I was still here, and thought, well, now what?.... I guess now I can go get that dental work done, and get new glasses.... and think about tomorrow.

Good luck to you, Joe, and keep looking... you'll find a doctor you can work with. I know this. They are out there. Just keep trying.

Love and prayers,

MaryAnn

[mhutch1366]

PS I forgot to add that not only did the tumor shrink pre surgery, that when they removed it (whole) the darn thing was DEAD. The double chemo/radiation simultaneously knocked the cra* out of the tumor.

Miracles do happen, every day!!

Good luck to you and your dad. He's relatively "young" too, in this scheme of things.

MaryAnn

Sorry I keep remembering things I should add... this is IT!..