Malignant Pleural Effusion and Radiation/Chemo

[BarbaraL]

Has anyone experience and/or information about using radiation in conjunction with chemo for Stage IIIB and MPE?

From all my scientific readings, people in my situation (see signature) are often considered Stage IV by many in terms of treatment, yet I've often read of people here getting both rad/chemo. To quote my situation as it existed on 5/13/03 according to my bronchosopic surgeon: "Excellent visibility… Massive pleural effusion… 2.5 liters of fluid drained …pleural studding throughout the chest including the chest wall, diaphragm and mediastinum. On the surface of the lung, there were alsomultiple nodules evenly distributed throughout the three

lobes."

The pathology report on the removed pleura indicated T4NxMx. DUH! MPE is T4 by definition!

I had bone and brain scans (negative) and CT scans with contrast to the pelvis and abdomen (with inconclusive results). I *do not* have confirmed mets outside the thoracic area, although a suspicious small area on the liver was never confirmed either way. I never asked that the liver area be pursued at the time, since I realized it would not affect the first-line treatment I received.

In reviewing my various test results, a suspicious adrenal lesion turned out to be a non-obstructing stone, and on the other adrenal the radiologist saw little reasons to be concerned and recommended "watchful waiting"--another scan in 6 or so months.

Any advice? I really like my onc, who has had very satisfying answers to my most complicated questions at the tip of his tongue. I'm strongly considering a second opinion, which can't hurt, for sure.

Guidance on my specific situation or anything written above is most welcome!

Love,

Barb

PS: I had my fifth chemo of MTD carbo/taxol today, and it's the usual feeling of being from Mars. My side effects have been few, and easily dealt with. How can I not be a candidate for even more aggressive treatment?

[judysdaughter]

I don't have any direct experience with what you're asking (I get lost in all of the technical language). I can tell you that my mom and chemo and radiaiton together. She started at stage 4 and went to 3b. It sounds like you feel comfortable with your doctor. Maybe you could sit down and ask and ask and ask, until you understand it better. Of course a second opinion is good too. Feeling comfortable with a doctor is half the battle so maybe you should just press him or her and let them know what you're considering. Just a thought. Warm thoughts your way.

[Marlon]

Barbara,

I too have heard some people do receive chemo and radiation with a malignant pleural effusion, but it is very rare. My mom had no tumors, but her doctors decided against radiation, saying that any radiation would cause too much irreparable damage.

My mom also had a small spot on her liver. In the beginning they assumed it was a mets, but after months of observation it turned out to be a hemangioma(sp??), just some swelling, not a malignancy at all.

My mom went thru a surgery to repair her collapsed lung when the fluid started testing negative for any more cancer cells. The surgically removed tissue also tested negative for cancer cells, so hopefully she has this thing licked. She's doing ok now and it's been a year and 2 months. To this day no one knows whether she was stage IIIB or IV.

[Keith]

You look young in your picture - and therefore, like me, they shold be going after it w/ maximal aggression. I am queued for 50 to 60 greys of radiation to run over 5 to 6 weeks in conjunction w/ aggressive chemo. I will keep you update on my radiation progress - I would certainly like to know of yours.

I recieved a second Onc. opinion yesterday and we addressed exactly what you are talking about - Sure sounds to me that it should be agressive even if "protocall" calls for something different. I also noticed in my research and had confirmed by my onc. that taxotere/cysplatin may have a slightly better efficacy. Kinda depends on where in the country you are what is the most popular chemo combo.

my prayers are with you

Keith

[luvmydog2]

I did not have any fluid involved so therefore my situation may be slightly different than yours. I had chemo and radiation at the same time and did not have any side effects to speak of. I did get tired some but I did that before treatment so I can't say that was really a side effect. The treatments were given in hopes of shrinking 7cm tumer. It shrunk to 1 cm and then I was able to have my surgery. Good Luck.

[BarbaraL]

Thanks for everyone's replies!

Yes, Keith, I *am* young -- 45. And, I had heard the same thing that you did regarding the Cisplatin/Taxotere regimen having slightly better results, but I had a severe allergic reaction to the Taxotere. So Carbo/Taxol was our second choice. It was weird, since I had heard that Taxotere was generally more easily tolerated, and they've often switched patients to it when they couldn't withstand the Taxol. Aside from losing *all* my hair, I'm doing very well with the chemo. Showering has become a very quick task!

I'm having a second opinion on Monday at the Cancer Institute of New Jersey, one of 39 comprehensive cancer care center in the country as designated by NIH. They have a group dedicated to Thoracic Oncology, so I figure these folks are as up-to-date as can be, including very plugged-in with clinical trials.

I'll post on Monday after my consultation. Meanwhile, if anyone has any specific suggestions of things to discuss with these doctors, I'm all ears. I'm basically going to tell them how well I've tolerated treatment so far, and how I'm looking to be as aggressive as possible with further treatment.

Barb