Seeking advice on adjuvant chemotherapy or just regular scans after lobectomy.

[StephenS]

In June I was diagnosed with Adenocarcinoma 2A that was 4.3cm in size. Five weeks ago I had the top right lobe removed, together with associated lymph nodes. Scans show that the rest my body is clear. I also had a cancerous prostate removed 3 years ago and bypass surgery 17 years ago.

According to my oncologist, because of the size of my cancer, I’m a borderline case for needing chemotherapy and he wants me to decide. The chemotherapy would be three sessions per month for 3 months, with unknown potions.

I’m 74 years old, never smoked, fitter than average, below average weight, no other health conditions and bald, so hair loss is not a problem.  

[TJM]

Welcome Stephen. Sounds like your lobectomy went well and it's great news that it had not spread. Whether to get Chemo? That's a tough call. All I can do is let you know what I decided.

Prior to a diagnosis change (long story) I was staged at 2A as well and my tumor was about the same size. I knew that a decision around adjunctive Chemo was going to be coming so did some research, soul searching and getting input from this awesome group of people here on Lungevity.org. I decided that if given the opportunity I WOULD do the adjunctive Chemo.

As it turned out I really didnt have much of a choice because my tumor was found to be Large Cell. I will tell you that the Chemo (like the surgery) was not nearly as bad as I had feared. I was 58 at the time and in good health.

Which ever way you go I wish you the very best. I am sure you will be hearing from others shortly. I will be curious what input they have.

Peace

Tom

Edit: The bald comment made me chuckle out loud and disturbed my sleeping pup!

[LexieCat]

Hi, Stephen, and welcome.

I had a tiny nodule removed via lobectomy, Stage 1b. It was b, rather than a, because the pathologist believed it had invaded the pleural lining; my surgeon disagreed. I, too, was deemed "borderline" and opted to skip the adjuvant chemo. 

Three years later to the month I was diagnosed with Stage IV cancer. Despite scans every six months, I developed cancer in the other lung and a PET CT showed metastasis to a bone.

Nobody can tell me whether this was a spread from the original cancer or whether it was a completely separate one, and I'll never know whether having adjuvant chemo would have helped. My Stage IV cancer did progress after chemo for that--I'm doing well now after treatment in a clinical trial. If I had it to do over again, knowing what I know now, I think I would have opted for the chemo.

Good luck in whatever you decide. Incidentally, was a sample of your tumor sent out for molecular/genetic testing? If not, I'd definitely push for that. It might give you other options down the road if you should have a recurrence.

[Deb W]

Hi Stephen,

My experience was similar to Lexie's.  I had 1B - adjuvant therapy was not offered because the margins were clear and there was no lymph node involvement.  I didn't know enough at that time or I would have asked for it.  One year to the date of the 1B diagnosis - I was diagnosed with Stage IV.  Even though I had regular follow-up scans.  I was told it was micrometastasis and could not be seen.  If I had it to do over and knew what I know now,I would have demanded chemo.  Currently I am not having any treatment due to a systemic inflammatory response.  My last scan showed remission.  Tomorrow is a big day for me as I will be having a PET scan because of all of the side effects I've been experiencing.

Good luck to you.

[Judy M2]

At Stage IIIB, I wasn't a candidate for surgery and had chemo and radiation first, then started on targeted therapy for my EGFR mutation. Not gonna lie, chemo and radiation were rough, and I probably could have just gone straight to targeted therapy. But I have no evidence of disease today and I attribute that to all of the treatments. 

I agree with Lexie, press for biomarker testing. These days targeted therapy can begin after surgery. 

[Tom Galli]

Stephen,

Tough question. Let's let data help provide an answer. Read this (and sorry about the baseball analogy but there may be a rough equivalent with Cricket). Recurrence makes lung cancer dangerous. The cited study suggests a 66-percent probability of recurrence given a successfully treated stage IIA diagnosis. I've had 5 recurrences in my treatment history and would do everything I could to reduce the probability of recurrence. Moreover, consider that the strength of post surgical chemo dose is normally less than when chemo is attacking solid tumors. This adjuvant treatment is designed to sweep the lymphatic and blood systems of cancer cells. Side effects at adjuvant does levels may not even produce side effects. You might not even lose your hair!

Stay the course.

Tom