SBRT vs Cryo for lung mets & Maint schedule

Please feel free to read, share your thoughts, your stories and connect with others!
behconsult
Posts: 245
Joined: Fri Jul 04, 2014 4:53 pm

SBRT vs Cryo for lung mets & Maint schedule

Postby behconsult » Tue Mar 26, 2019 8:49 am

Hello everyone,

A couple of nodules on my lungs have grown. I previously had cryo and got two years of time out of the procedure. The PET sees some avidity with one met having a higher SUV then before. I was thinking about cryo again but a second opinion doc weighed in that radiation seems to work better on the lungs, I liked that cryo did not alter my pulmonary function however that radiation will do that. Thoughts?
Which one is better for disease free status?

My second opinion onc proposed a new xeloda schedule in Europe of 2 tablets daily M-F and off weekends. This is continuous. He reports it works well in Europe and not as well in American. No reason why. I have been on 10 tablets of Xeloda a day and avastin and recently reduced to 8 a day. My primary has been gone for 5 years. Any knowledge of this cycle? Thank you for any details you can share as I have to figure my game plan soon. Bob
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT

User avatar
LPL
Posts: 651
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: SBRT vs Cryo for lung mets & Maint schedule

Postby LPL » Tue Mar 26, 2019 1:41 pm

behconsult wrote:Hello everyone,

A couple of nodules on my lungs have grown. I previously had cryo and got two years of time out of the procedure. The PET sees some avidity with one met having a higher SUV then before. I was thinking about cryo again but a second opinion doc weighed in that radiation seems to work better on the lungs, I liked that cryo did not alter my pulmonary function however that radiation will do that. Thoughts?
Which one is better for disease free status?

My second opinion onc proposed a new xeloda schedule in Europe of 2 tablets daily M-F and off weekends. This is continuous. He reports it works well in Europe and not as well in American. No reason why. I have been on 10 tablets of Xeloda a day and avastin and recently reduced to 8 a day. My primary has been gone for 5 years. Any knowledge of this cycle? Thank you for any details you can share as I have to figure my game plan soon. Bob

Following.
I’m guessing you do not have a link to reseach from Europe regarding this? (I live in Europe). Can I ask what kind of Suv #s you have experienced? You say: “hugher SUV then before”. Hubby had a RFA of one lung ‘thing’ but there was another smaller lung ‘thing’ that also had SUV# but they did not do anything with that one.. wondering if it had to do with the SUV#? (Next PETscan for him will be at the end if May)
I wich you all the best with your treatment.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung NED again Oct-19 :)
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets

behconsult
Posts: 245
Joined: Fri Jul 04, 2014 4:53 pm

Re: SBRT vs Cryo for lung mets & Maint schedule

Postby behconsult » Tue Mar 26, 2019 2:16 pm

LPL wrote:
behconsult wrote:Hello everyone,

A couple of nodules on my lungs have grown. I previously had cryo and got two years of time out of the procedure. The PET sees some avidity with one met having a higher SUV then before. I was thinking about cryo again but a second opinion doc weighed in that radiation seems to work better on the lungs, I liked that cryo did not alter my pulmonary function however that radiation will do that. Thoughts?
Which one is better for disease free status?

My second opinion onc proposed a new xeloda schedule in Europe of 2 tablets daily M-F and off weekends. This is continuous. He reports it works well in Europe and not as well in American. No reason why. I have been on 10 tablets of Xeloda a day and avastin and recently reduced to 8 a day. My primary has been gone for 5 years. Any knowledge of this cycle? Thank you for any details you can share as I have to figure my game plan soon. Bob

Following.
I’m guessing you do not have a link to reseach from Europe regarding this? (I live in Europe). Can I ask what kind of Suv #s you have experienced? You say: “hugher SUV then before”. Hubby had a RFA of one lung ‘thing’ but there was another smaller lung ‘thing’ that also had SUV# but they did not do anything with that one.. wondering if it had to do with the SUV#? (Next PETscan for him will be at the end if May)
I wich you all the best with your treatment.


I assume it was the Cairo 3 study with respect to the Xeloda/Avastin. I didn't notice a weekend off in the article. As for PET and SUV much depends on how who much of a change and also the shape of what the avidity is; complete rim, partial, solid, etc. If the only did the one they likely were concerned about the other. My SUV more than doubled.
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT

User avatar
betsydoglover
Posts: 973
Joined: Mon Aug 14, 2006 2:31 pm
Facebook Username: Betsy Lindh Williams
Location: Maryland - outside DC

Re: SBRT vs Cryo for lung mets & Maint schedule

Postby betsydoglover » Tue Mar 26, 2019 3:08 pm

I have had Xeloda twice, first after diagnosis along with oxy and Avastin. When I had a lung recurrence 3+ years later, I had removal of met via VATS (easy surgery - is this not an option for you?). I did Xeloda + Avastin for 6 rounds and then Avastin for almost another 2 years. So technically my Xeloda the first time was first line treatment and adjuvant with respect to the lung recurrence the second time. The dose was the same each time (2000mg twice a day).

I don't know anything about a maintenance dose - obviously your suggested dose is much lower than the typical non-maintenance dose. But, regarding the 5 days on / 2 days off, this protocol was an early one used by Dr. John Marshall (either George Washington or Georgetown medical - can't remember). (You can search "John Marshall capecitabine and hopefully find more info.) On my second use of Xeloda, we tried this 5/2 protocol one round due to my side effects. I loved the weekends off, but overall, for me, the 1 entire week off after 2 weeks on was better for me re: side effects. So, we went back to that. With a lower maintenance dose, you might find the 5/2 more tolerable - it's all so individual, and it can always be changed.

Take care, (P.S. - if you do look at John Marshall papers etc, you may think he is arrogant because he says things like "my protocol is the best" or "I am the best GI onc there is". My oncologist tells me that he loves to talk this way and they (oncs) all love him - just mentioning in case you read any of his stuff.)

.
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 06/18

rp1954
Posts: 1523
Joined: Mon Jun 13, 2011 1:13 am

Re: SBRT vs Cryo for lung mets & Maint schedule

Postby rp1954 » Tue Mar 26, 2019 6:28 pm

The folks I've seen with SBRT tore up a lot of real estate and didn't gain as much as other methods of removal might have.

We favor oral chemo extended by mild adjuncts. Daily versions of Xeloda can be enhanced by various nicer adjuncts, with less side effects, guided by MCV and other bloodwork. You can even cycle different kinds of adjuncts to burn down heterogeneity, watch and whack them. There are several ways to use MCV, where John Marshall mentioned he liked to use MCV as a chemo guidance tool, too.

Below thresholds of chemo side effects, more of other blood work stays good too. Since you are BRAF mutant, IV vitamin C added to several adjuncts to Xeloda, might have the double benefit of better inhibition and fewer chemo side effects, MCV and bloodwork guided.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

behconsult
Posts: 245
Joined: Fri Jul 04, 2014 4:53 pm

Re: SBRT vs Cryo for lung mets & Maint schedule

Postby behconsult » Tue Mar 26, 2019 7:55 pm

rp1954 wrote:The folks I've seen with SBRT tore up a lot of real estate and didn't gain as much as other methods of removal might have.

We favor oral chemo extended by mild adjuncts. Daily versions of Xeloda can be enhanced by various nicer adjuncts, with less side effects, guided by MCV and other bloodwork. You can even cycle different kinds of adjuncts to burn down heterogeneity, watch and whack them. There are several ways to use MCV, where John Marshall mentioned he liked to use MCV as a chemo guidance tool, too.

Below thresholds of chemo side effects, more of other blood work stays good too. Since you are BRAF mutant, IV vitamin C added to several adjuncts to Xeloda, might have the double benefit of better inhibition and fewer chemo side effects, MCV and bloodwork guided.


Thank you. What is "MCV".
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT

rp1954
Posts: 1523
Joined: Mon Jun 13, 2011 1:13 am

Re: SBRT vs Cryo for lung mets & Maint schedule

Postby rp1954 » Tue Mar 26, 2019 8:03 pm

MCV, Mean Corpuscular Volume, is a panel from the CBC with differentials lab, one of the most basic blood tests. A series of MCV results take on extra meaning with chemo on many cancers. Basically, a slowly lagging indicator of chemo activity if is working and on the rise to a new level, perhaps much faster to decline when chemo activity declines.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

User avatar
juliej
Posts: 3049
Joined: Thu Aug 05, 2010 12:59 pm

Re: SBRT vs Cryo for lung mets & Maint schedule

Postby juliej » Wed Mar 27, 2019 5:14 pm

rp1954 wrote:The folks I've seen with SBRT tore up a lot of real estate and didn't gain as much as other methods of removal might have.

Agree. There's considerable collateral damage from SBRT. Sometimes they fail to mention that. RFA is a better alternative.

rp1954 wrote:There are several ways to use MCV, where John Marshall mentioned he liked to use MCV as a chemo guidance tool, too.

When I was on Xeloda my MCV was tracked to see if I was getting a therapeutic dose. It's an easy way to make sure you're getting the right amount.
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 9/23/2019, CEA<1


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: AmyG, Ehut and 48 guests