Lung Mets?

[Rob in PA]

I've had multiple lung mets over the years. Did the "wait and see" on them for two scans, then docs wanted to try SBRT. I did that and it eliminated them (two in one lung and one in the other). One year later they came back in one lung, did SBRT again (too close to artery for VATS), it eliminated it for one year. Then two came back again in a year and i qualified for VATS. I opted for VATS and NO chemo follow up. That was two years ago and I've been NED since (knock, knock). I also had a needle biopsy when PET lit up the first time to verify them. Had no problems with biopsy.

Best of luck to you. PM me if you have any questions.

Rob

I'd also like to add that while SBRT didn't necessarily help long term (reason being SBRT is so precise that it will miss small undetectable cancer nearby), because they kept coming back in nearby areas, it did buy me the time i needed to get in a position where i could safely have VATS and take out a reasonable buffer area around the active tumors.

[Sophy]

I had lung laser surgery in Germany and UK for my lung mets and am pleased with the results so far.

If you search here or google for Professor Rolle in Coswig or Mr George Ladas in London or 'lung laser' you will find lots of information and contact details.

Some American patients have had the cost paid by their health insurance.

Hope this help
Sophy

[CRguy]

Thank you all for the kind thoughts, information, and guidance. I have a PET scheduled for Oct 18th. I have been doing research on the types of treatment and options. I will get scheduled afterwards to see a thoracic surgeon.
My onc mentioned chemo but unsure if and when (too early). Oncs words were it "looks suspicious for a slow growing cancer." If PET likes up, needle biopsy may be considered but my old onc advised against it.

I like this plan .. 'cos it is exactly what I did in 2009 - 2010 for a single peripheral left side lung met.
-> found on survey Xray ( not a CT )
-> PET / CT scan + MRI done
-> thoracic surgeon consult. he said "Really no point because whatever it is, we want it out anyway " in reply to my question about doing a biopsy first.
-> VATS resection due to "easy" access
... BUTT a possible full thoracotomy if the in-surgery pathology revealed something other than a CRC met ( i.e. primary lung cancer )
-> follow up "pseudoadjuvant" chemo (FOLFOX)
-> here I am today 6+ years later

My comments :
my surgeon is head of thoracic surgery at a large hospital, runs his own department and teaches at the biggest university here ( turns out he was also my CRC surgeons professor ! ) I respected him and his opinion => so no biopsy done.

As a practicing vet for 35+ years I have done a shitload of biopsies for cancer and non malignant growths and never had any problems with seeding ... BUTT we made it a point to remove the needle biopsy tract during the actual open resection.
With a VATS, the biopsy tract would likely NOT be resected in the procedure = there IS a risk for seeding.

My Onc informed me there was no defined follow up for my situation and pseudoadjuvant chemo was controversial. I decided to do full FOLFOX, as I had done only Xeloda previously and wanted to "hit this as hard as possible" with the recurrence.

My preference matches my surgeons ".... we want it out anyway " in getting the met for further testing if required. "Zapping" technologies ( SBRT, laser, RFA etc.) won't recover the actual mass and may "require" a needle biopsy for confirmation ..... so the choices will vary.

I think you are on the right trajectory for your situation

Best wishes
CRguy on the Journey

[canadiandaughter]

I have multiple lung mets and am on my 4th round of vectibix
my cea is 16 from 34 and they say the mets are also shrinking
i have had no side effects

Takemeom, are you on Vectibix by itself? My dad is on this now, just had his 6th infusion and this past week, by supper time most nights he is so shaky and just wants to go to bed. His blood work has been good so far, magnesium was a wee bit low his last two infusions so they gave him a bolus to bring it up. He has some skin issues and rash, but nothing he can't handle. It is the constant fatigue that is the worst. He is also a bit nauseated at times, but we have that under control with one of his drugs from when he was on folfiri. He scans on Monday and we get the results on the 19th. In my mind and heart, I want him to stop and get some strength and QOL back but I am not sure what he will say. My other thought was to maybe see about the immunotherapy trial in Edmonton right now. BUt, if the side effects are going to be similar, not so sure it is worth it at his age. Our oncologist doesnt tell us his CEA numbers, I have asked at past appointments.

[behconsult]

I had my PET and it showed 3 nodules light up in right upper lung, 1 in the lower right lung and 1 in the lower left-total is 5. She reports they are slow growing. Largest is 1.3 CM, next is 9 mm. SUV was 9 and 10. I have a consult with a thoracic surgeon. My onc wants to do chemo of 5fu and Avastin. She did not want to treat aggressively with Folfiri (sp). Not sure why she didn't want to treat aggressively unless she thinks it is going to be a chronic condition? She wants to treat with chemo and shrink. I also had an area light up at the perotid gland and may see a head and neck cancer specialist.

I have a second opinion at the Cleveland Clinic and will check on their recommendations. This does suck. Any pearls appreciated. Thank you for those that responded. Rob, I may take you up on your offer here in the future as this is a lot to digest.


Bob

[mypinkheaven]

I had my PET and it showed 3 nodules light up in right upper lung, 1 in the lower right lung and 1 in the lower left-total is 5. She reports they are slow growing. Largest is 1.3 CM, next is 9 mm. SUV was 9 and 10. I have a consult with a thoracic surgeon. My onc wants to do chemo of 5fu and Avastin. She did not want to treat aggressively with Folfiri (sp). Not sure why she didn't want to treat aggressively unless she thinks it is going to be a chronic condition? She wants to treat with chemo and shrink. I also had an area light up at the perotid gland and may see a head and neck cancer specialist.

I have a second opinion at the Cleveland Clinic and will check on their recommendations. This does suck. Any pearls appreciated. Thank you for those that responded. Rob, I may take you up on your offer here in the future as this is a lot to digest.


Bob

So, you started out with 2 nodules and now there are 5? Were the 3 others too small to be picked up on the CT scans, but lit up with the PET? Are they sure the 3 "new" ones are mets?

I don't quite understand "not treating aggressively with Folfiri", unless she is concerned about side effects from the Irinotecan.

I would certainly meet up with the thoracic surgeon and get his/her opinion. And get the second opinion. I had an email consult with the head of oncology surgery @ Moores Cancer Center and also DK37's oncologist. Because my CT scan report stated several mets, they both suggested systemic chemo first, then local treatment like SBRT or VATS. Same suggestion was given to someone getting a 2nd opinion at MD Anderson, backing up Dr. Kemeny's plan. So, that's what your thoracic surgeon and the 2nd opinion may also recommend to you. But unless those nodules disappear, I'd be assertive about getting the local treatment after chemo.

I know that it's sometimes hard to do at the time, but always try to ask you oncologist "Why?" if there's anything you don't understand. I've emailed my previous oncologist several times to get a clarification of something he said during the consult. No need for you to worry if her non-aggressive treatment means a chronic condition.

[behconsult]

Yes, you are correct, They saw two on the CT scan and have been a watch and wait, and now saw there are 5 on PET light up. I think I may need to go to needle biopsy. I agree you with you on that overall approach. PET had false positives and who knows what is what with some of the light up nodules.

[takemeom]

Hello
Yes I am on vectibix only, along with antibiotics prophylactically, which I am glad someone suggested (not my doc)
My biggest complaint is my eyebrow, eyelashes and general facial hair is growing very rapidly...the eyes hurt.
I am reading that its vectibix for life, or until it doesn't work and then they add on, or switch it up.
I have been on chemo and xeloda and now vectibix, starting september 2012, and its worn me down socially,
forget about working, I can't focus long enough to be productive.
Also, my big toe nail just got inflamed, which is predictable after 14 weeks of treatment. I hope to heal it.
Cleveland Clinic...my original colorectal surgery was done by emina huang, who is fabulous and heads up the gastro dept there,
they also do mailing second opinions. which also johns hopkins does mail in second opinions
takemeom