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Is radiotherapy ok for mediastinic lymph nodes?


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In May 2013 my dad (who will be 82 in Dec- diabetic, never smoked) had a Tc scan as a part of the follow up tests for his colon cancer (diagnosed and treated with emicolectomy + chemo in 2010) and it showed two target lesions in his liver. One of them has been biopsied and it was TTF-1 positive. So the oncologist said he has a primary cancer in his lung too. Actually, a speculate mass has been found in his lung by a Tc scan in fall 2010, but a Tc guided biopsy revealed it was a benign (antracotic-fibrotic) nodule.
My dad has always been ok, he tolerated well hischemo rounds (carbo+alimta and other drugs for colon cancer).

His follow up ct scan of a few weeks ago showed enlarged lymph nodes in the mediastinum. The bigger group is in the aortic-lung window (42x29 mm). He also has a little basal pleural effusion and his markers are higher.
So, his oncologist wants my dad to see a radiotherapist to see if he can have radiotherapy to reduce the lymph nodes in the mediastinum.

(he also has enlarged lymph nodes near the liver,but I don't know if they come from the colon cancer)

Is it radiotherapy the best choice for my dad now? Or is better chemo again? Carbo+ alimta again or other drugs?

He stopped bevacizumab+capecitabine (he had 35 round of this for colon cancer) past July because of severe tiredness and weight loss, but now his conditions are better. He gained 3 kgs (6.61 lbs), he has more appetite, sleeps and breaths well. He just keeps on walking slowly (with no cane).

I and my mom, old and fragile, are so awfully scared and sad, so any advice is welcome. 
Thank you for your attention and your work and support on this wonderful website.
Best greetings and wishes to all.

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I'm not a doctor so keep that in mind as I answer your question.  Is radiotherapy the best choice for treating lymph nodes in the mediastinum? I wouldn't know what the best choice is given his current state of health and other chronic conditions.  Radiotherapy alone can be a good choice, especially given advances in radiation techniques.  Here is a good summary of the different types of radiation used to treat lung cancer. Click on What are the different types of external beam radiation therapies (EBRTs)?

A common advanced stage non-surgical lung cancer treatment approach is combination therapy.  That is radiation combined with chemotherapy.  Perhaps your dad's doctors are concerned he is exhibiting both colon cancer and lung cancer concurrently or are mindful of his last chemotherapy effect on his health.

But, having said that, radiation therapy is certainly capable of addressing mediastinum lymph node involvement alone.

Stay the course.


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Thank you Tom for your prompt reply and for the link about the types of radiation. It has been useful to me also the part regarding the side effects of this therapy.

I hope I can talk to the oncologist to get further information about my dad's situation...

I'll keep you all informed. Bye for now and thanks again.




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