Sallysh Posted February 22, 2023 Share Posted February 22, 2023 I have stage IIIA Squamous cell cancer in my upper left lobe with one positive lymph node in the mediastinum close t the left lung. Because of that node my cancer was determined to be inoperable. I have had high dose radiation and chemotherapy (finishing chemo this week). Unofficial looks at the mini Ct scans done daily to ensure correct alignment show changes suggesting node is gone. My medical oncologist has referred me to a thoracic surgeon for preliminary evaluation and Ct. if no surgery immunotherapy with durvalumab. With all my questions and concerns, it hasn’t dawned on me to ask whwthe you can have immunotherapy AFTER surgery in my situation. I will certainly ask my growing team of doctors but wonder if anyone else has had this experience. If this is possible I would be able to get benefits of both, which has been a dilemma. Thanks Tom Galli 1 Quote Link to comment Share on other sites More sharing options...
LouT Posted February 22, 2023 Share Posted February 22, 2023 Sally, I'm glad to hear that the lymph node has shown such improvement. While my treatment was surgical only there are many different combinations or avenues of treatment available. I recommend that you take a few minutes to look at Treatment Options for Lung Cancer, it can be found here. It can help you understand some of the options while you wait for others here to respond. Again, I'm glad to hear that you can now move on with your treatment. Lou Tom Galli 1 Quote Link to comment Share on other sites More sharing options...
Karen_L Posted February 23, 2023 Share Posted February 23, 2023 That's a good question, which I hope you will ask your oncologist before you meet with the surgeon. My radiologist told me there's some data about optimal start of durva after chemo-rads. But durva also can have some side effects that might preclude surgery, i.e., pneumonitis, which I had a severe case of. I like Lou's suggestions about learning as much as you can so you can ask questions that help you make decisions you feel good about. K BridgetO, Sallysh, LouT and 1 other 4 Quote Link to comment Share on other sites More sharing options...
Sallysh Posted March 10, 2023 Author Share Posted March 10, 2023 Well the answer to my question is yes but. Now must make decision on surgery. When I was diagnosed nosed, the treatment plan was concurrent high dose radiation and chemotherapy- cisplatin (changed to carboplatin do to kidney issues) ans etoposide followed by durvumalab for a year. All explained thoroughly by my radiology oncologist, who shared studies, stats etc. my medical oncologist started bringing up surgery along the way. I agreed to go to a surgeon who bluntly said most surgeon would not do it because of the high dose radiation and my copd/€asthma but he was aggressive and would consider. Very many downsides for mewtith the only pro being that tumor would be gone. Of course recurrence still a possibility. I don’t get why the medical oncologist and my pulmonologist are pushing this and neither does my radiation oncologist. Very frustrating., especially as my tor has shrunk dramatically according to Ct. LouT 1 Quote Link to comment Share on other sites More sharing options...
LouT Posted March 10, 2023 Share Posted March 10, 2023 Hi Sally, I'm very glad to hear that your tumor has been shrinking. If you had a chance to see the readings I recommended to you in my last post there are times with a stage IIIa lung cancer when surgery may be performed after other treatments. I think you need to sit with your oncologist and ask all the questions you have regarding the potential therapy; Why do it now?; Why not just continue with radiation/chemo?; Do the surgery benefits outweigh the risks? You should not go into any treatment not believing it is necessary or that it is well-advised. Have the conversation with the oncologist (or any of the physicians you want) before you make a decision to take or not take the surgery route. Please keep us advised of what you learned. Lou Quote Link to comment Share on other sites More sharing options...
Tom Galli Posted March 10, 2023 Share Posted March 10, 2023 Sally, Welcome here. I've been following your forum discussion and thought I'd respond because your situation is precisely where I was 19 years ago. I also was diagnosed Stage IIIB NSCLC (squamous cell) and had only a single large tumor in the main stem bronchus of my right lung. Like you I had fractional radiation (60 treatments) paired with weekly Taxol and Carboplatin chemo. This combination effectively yielded a no evidence of disease (NED) scan. A thoracic surgeon removed my right lung, and ironically, a biopsy of the "dead" tumor showed cancer cells still alive. But the downside was the radiation treatment complicated post-surgical suture healing resulting in two subsequent thoracic surgeries and 4 rigid bronchoscopies to bolster sutures for my bronchus stump. After a year's worth of additional surgery and healing, cancer metastasized to my left lung, and in the early 2000's, conventional chemotherapy in the form of Taxol and Carboplatin were administered as my third and fourth line treatments. For me, surgery was the right call. First-line treatment did shrink but did not eliminate cancer. The surgery removed it. There is always the risk of a distant metastasis when dealing with lung cancer at any stage and I experienced one. There is no certainty in this disease. As a plus, you have immunotherapy as an effective treatment method should there be metastasis after surgery. I'm also noting differences of opinion on your treatment team. That is not unusual. Again, there is no certainty and my team had differing opinions. The surgeon's view is a very narrow one: can the tumor be removed? The pulmonologist perspective was also narrow: would I have enough lung function to live after surgery? I sided with my medical oncologist in deciding about surgery and further courses of treatment. Stay the course. Tom LouT 1 Quote Link to comment Share on other sites More sharing options...
Sallysh Posted March 11, 2023 Author Share Posted March 11, 2023 Thank you both. Lou, I did read the article you mentioned. In fact I’ve read it a few times! My treatment plan was exactly as described for IIIA. My radiation oncologist has shared others with me, none of which include surgery in the middle. My cancer was considered inoperable but suddenly it’s not? The only answer from my medical oncologist is that’s the only way to know it’s gone, while acknowledging recurrence. I am meeting with him Monday The radiation oncologist who I have the most faith in sees no benefit. Anyway I am having pulmonary function tests, conferring with surgeon and then will decide. My thinking has been a little fuzzy but I had a blood transfusion Thursday so am feeling better! I appreciate your thoughts and will be at peace with whatever I decide Although there may be some bumps until I do Tom Galli and LouT 2 Quote Link to comment Share on other sites More sharing options...
LouT Posted March 11, 2023 Share Posted March 11, 2023 Sally's, I'm glad that you found the information useful. If you decide to get the surgery please read the blog "Thoracic Surgery Tips and Tricks". It will provide advice for pre-surgery, in-hospital, and post-surgery situation and can be found here. Please continue to keep us updated. Lou LilyMir and Tom Galli 2 Quote Link to comment Share on other sites More sharing options...
Sallysh Posted April 13, 2023 Author Share Posted April 13, 2023 I decided not to go forward with surgery. After discussing with the surgeon, he agreed it was a very reasonable decision under the circumstances. I will be starting durvalumab, probably next week for a year. I have a PET CT scan tomorrow. Hopefully it will show even bett results than the Ct. Tom Galli, Scruboak and LouT 3 Quote Link to comment Share on other sites More sharing options...
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