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10-31-03 CT scan. “Suspicious mass” in left upper lobe.

11-13-03 Bronchscopy – inconclusive

11-26-03 CT guided fine needle aspiration biopsy – non-diagnostic - pneumothorax

1-2-04 Upper left lobectomy. Dx NSCLC, stage 1B adenocarcinoma . 4x5 cm. No chemo. Smoked for 16 years between age of 24 and 40, then quit for 19 years, then got lung cancer.

8-6-04 CT scan. 9 mm nodule noted in remainder of left lung.

1-28-05 CT scan. Nodule noted at last scan is now 1.2 cm.

2-7-05 PET scan. Borderline uptake at nodule.

2-9-05 CT guided fine needle aspiration biopsy – non-diagnostic - pneumothorax

2-25-05. Surgery and pathology shows 1.2 cm nodule to be malignant. Lymph nodes clear. Completion left pneumonectomy. Dx stage 1A adenocarcinoma.

4-14-05 Started 4 rounds of gemcitabine/carboplatin

7-6-05 Finished chemo

8-30-05 CT scan. No evidence of recurrent or residual disease.

2-23-06 CT scan. 1.4 x 2.1 cm spiculated nodule at right upper lobe. Suspicious for recurrent or metastatic disease.

2-28-06 Brain MRI. My brain is "normal"

3-14-06 PET/CT scan. Uptake of 7.5 at nodule and is consistent with a malignancy. There is no sign of other malignancy.

3-27, 3-28 Consultations at Swedish Cancer Institute, Seattle, Wa. The medical team thinks it highly likely that the nodule is a secondary cancer. There will be no biopsy.

4-18-06 Begin 33 treatments of image guided radiation therapy at Swedish Cancer Institute, Seattle.

6-5-06 End radiation therapy

6-27-06 Begin 4 rounds of alimta in Aberdeen, WA clinic.

7-27-06 Bone scan...negative for mets

8-30-06 End chemo

9-7-06PET/CT scan. Uptake of 7.9 at site of tumor. Radiolgist interprets this to indicate live tumor. Radiation oncologist says that high suv is more likely caused by radiation inflammation. Tumor is the same size as last scan. No new disease. Next scan, mid December.

12-13-06 PET/CT scan results:local radiologist interprets high suv as a marked increase form 1 cm to 3.4 cm of the tumor. No new disease.

1-3-07 Bronchoscopy performed at Swedish Tumor Institute. Results inconclusive.

2-28-07 Begin 40 mg per day of prednisone.

3-11-07 Begin tapering off prednisone.

3-12-07 PET/CT scan. The results are no longer ambiguous. The tumor increased from 39 mm to 49 mm. SUV at 14.0. No new disease.

4-17-07 Cyberknife treatment approved by insurance.

5-17-07 Successful fiducial placement for Cyberknife using bronchoscopy.

5-25-07 MRI of chest without and with contrast. Tumor increased from 7.5 cm by 4.9 cm to 8.4 cm by 5.6 cm.

6-5 to 6-7-07 Cyberknife treatment at Swedish Tumor Institute. The radiation oncologist says that I cannot have a dose sufficient to kill the tumor because of the great risk of unacceptable pneumonitis and pneumonia. I have 3 doses instead of 5. The object is to stabilize or shrink the tumor.

8-31-07 PET/CT scan at Lacy, WA done by Western Washington Oncology. The radiologist reads it as progression to 5 by 10 cm, with cavitation at the center. A new 1cm nodule with uptake is seen at the apex, near the big tumor.

9-6-07 X-ray indicating post obstructive pneumonia. Developed an annoying cough that woke me up at night time.

9-7-07 Chest ct with contrast indicates pneumonia and pneumonitis from treatment. If inflammation is present, it obscures the tumor and makes it difficult to evaluate the tumor status. The new nodule could be a loculation of pleural fluid.

9-8-07 Prednisone started at 80 mg a day. I have much improvement from my cough and pneumonia after taking the prednisone and a course of antibiotics.

10-16-07 Chest ct with contrast indicates no significant change since last chest ct. The apical pleural loculation is referred to as a nodule now. Continuing prednisone and am at 50 mg, soon to drop to 40 mg a day.

11-29-07 PET/CT scan at Swedish Tumor Institute shows increase in mass compared to 9-7-07 and 10-16-07 scans to 9x7x6 cm. Still unclear what is inflammation and what is tumor. The apical nodule is unchanged. The difference in mass size compared to the 8-3-1-07 scan is due to use of a different scanner in Lacy. There is still a relative increase in size. I continue prednisone, but am unable to taper down on schedule and have been bouncing back and forth between 40 mg and 35 mg.

12-2-07 Consult with Dr West. He thinks I have progression, that the tumor is slow growing and recommends tarceva. Continue to use prednisone 40 mg.

1-10-08 Begin tarceva 150 mg

1-17-08 begin lexapro and occasional xanax

2-22-08 Pet/CT scan shows slight shrinkage of big tumor but 8 new small nodules are seen. The apical nodule is gone. Next scan 4-29-08

3-21-08 continue 150 mg tarceva,15 mg lexapro, occasional xanax, down to 30 mg on prednisone.

4-29-08 Chest ct scan shows 11 nodules and growth on older nodules. Tarceva is not working. Big tumor is stable due to prior ck treatment. Dr. West recommends taxotere.

6-10-08 Begin taxotere at local clinic. Continue lexapro at 20 mg. I am down to 20 mg of prednisone.

6-21-08 to 6-25-08 hospitalized for acute respiratory arrest

6-25-08 to 7-1-08 follow discharge instructions to taper off prednisone in one week. Inflammation comes back

7-8-08 taxotere infusion

7-24-08 Pulmonologist puts me on 60 mg prednisone and taper down more slowly. My lung function improves.

7-29-08 taxotere infusion #3.

8-12-08 Chest CT Scan...stable

8-19-08 taxotere infusion #4

8-24-08 spent night in hospital...low oxygen saturation, slightly dehydrated

8-27-08 Pulmonologist puts me back on 60 mg of prednisone and taper down more quickly to get to 40 mg as soon as possible then gradually get to 20 mg. There is a dramatic improvement with lung function upon taking the 60 mg.

9-2-08 Visit with oncologist. No more taxotere. I have got most of the benefit from the first 4 scans and it is not worth the risk of respiratory arrest to do the final 2 infusions.

Chemo break for 3 months and then rescan.

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