Dilemma: choose radiation or second lobe surgery removal.

[Muriel]

Welcome Guillermo. My situation was somewhat similar to yours. In June 2003 I had surgery to remove the upper lobe of my right lung. The tumor was 3.1 cm. and the path. dx. was T2N0M0. In the fall I had chemo - Carboplatin and Taxol once every three weeks for a total of 4 treatments. Nov 4, 2004 was our "bleak" day. A CT showed something in the upper lobe of my left lung. The PET scan "lit up like a Christmas tree" according to my pulmonologist. I had that lobe removed on Nov 26th. The recovery was slower than from the first surgery. I had chemo again. This time it was cisplatin and Gemzar. I had a little more trouble with that, also. Now, three years later, I still get short of breath at times, but I don't need oxygen. I celebrated my 66th birthday two days after the surgery. When I was faced with your options (surgery or chemo/radiation), it was an easy decision. I felt that I had a better chance of surviving longer if I had surgery. I'm not saying that surgery would be the best choice for you. But, in my case, I think it was the right thing to do.

Good luck making a decision and with the results. Do let us know what you decide.

Muriel

[Don M]

I just want to welcome you Guillermo. I already gave you my comments in LUNG-NSCLC@LISTSERV.

Don M

[john]

I just read that radiation can be given for "curative intent".

You might also want to ask about Tarceva since you are a non-smoker.

One thing to consider would be what Dr has the best reputation and with whom do you feel comfortable?

Radiation can cause fibrosis so both options (I think) can affect lung function.

Take care.

Surgery for Recurrent Lung Cancer?

Question

A 58-year-old female quit smoking 12 years ago. She has now developed a 1-cm recurrence in the opposite lung 22 months after aggressive surgery, aggressive radiotherapy, and chemotherapy for the initial tumor. The pathologist believes that this is a recurrence rather than a new primary. No other disease has been found. The performance status is 0 with an excellent pulmonary reserve. Is there any indication for surgical resection?

Response from Corey J. Langer, MD

Associate Professor, Temple University, Philadelphia, Pennsylvania; Medical Director, Thoracic Oncology, FCCC Oncology Department, Temple University, Philadelphia, Pennsylvania

If feasible, an isolated recurrence of previously resected pulmonary lung cancer merits re-resection.[1] In this instance, the patient's performance status is excellent, and her metastatic survey, presumably, has proved negative. At the very least, given the stakes, it would be prudent to proceed with PET scan or, if PET scan is not available, CT scans of the chest and upper abdomen and CT or MRI of the brain. If there is any indication of metastases, then planned surgery should be aborted.

In questionable instances, we will often treat patients with systemic therapy initially for 2-4 cycles, then resect. We do this for 2 reasons: to determine the sensitivity of relapsed disease to cytotoxic therapy, and to rule out the intercurrent development of early, treatment-resistant metastases, which would otherwise preclude resection.

If pulmonary reserve is limited, then wedge resection may be preferable to lobectomy. However, if the patient is sufficiently fit, anatomic resection is indicated. There are ample data in treatment-naive patients to show that proper anatomic resection of stage 1 non-small-cell lung cancer results in a lower incidence of local recurrences and improved survival. In an LCSG study, the local regional recurrence rate with limited resection was 15%, compared with only 5% for anatomic resection.[2]

By quitting smoking, this patient has demonstrated a commitment to good health practice. In addition, her commitment may translate into a decreased perioperative morbidity.

It should be noted that the final pathology will likely arbitrate between metastasis and a new primary. Even though the initial biopsies suggest a metastasis, immunohistochemistry of the final surgical specimen may potentially dispute this finding. Regardless, the new lung mass should be resected.

[mary colleen]

Guillermo,

Welcome.

I agree with Ry that you should get over to Onctalk and

correspond with Dr. West.

For what it's worth, my husband had most of his right lung removed (2B, T2, N1) and has very little pulmonary difficulty.

Please keep us posted.

Mary Colleen

[Patti B]

Guillermo-

Unfortunately I cannot help you with any of your wuestions - just wanted to say welcome to the board. You will find a lot of help here.

Stay strong - Patti B.

[john]

Good to hear your lung function is good. The SUV is the standardized uptake value. It is a value that indicates how much glucose is "consumed" by the area.

An SUV of < 4 is supposed to be less likely cancer from what I understand or at least *might* indicate a less aggressive cancer.

I am not positive about the this but you might want to ask the Dr

Good luck