Postby wdt » Wed Jul 01, 2009 3:11 pm
EBMJ - in response to your question I believe the decision for surgery hinged more on the fact that the CT and PET only showed the one small 11mm nodule and the one hilar node. They found the other node and other nodule during surgery; both were too small to show up on either CT or PET. So, it looked like he was a good surgical candidate when they decided to operate. From what I have read, the gold standard for a single metastatic nodule is surgery to remove it. The treatment is different when multiple nodules are present, or for situations where nodules are present in both lungs. The decision to take the rest of the lung was made while he was on "the table". If they had known this on the front end, they most likely would have just offered chemo and not done the surgery. Hindsight is 20/20....always a risk. My husband had a nodule show up located in his thyroid on his staging PET and they removed it and the pathology ended up being benign. Lesson= CT's and PETs are not 100% accurate. Also, his CEA was only mildly evelvated (around 4) and had hovered there for months before any nodule showed up. Had it shot up, they probably would have initiated chemo earlier. Also, the nodule did not show up until he had been off chemo for about a year, so that always factors into the treatment decisions as well. Meaning, he did not "progress" while on chemo.
I found out that his onc has been in contact with someone at MD Anderson and asked them about the drug regimen that they would recommend. He was tested for the microsatelite instability prior to his adjuvant chemo, but I don't believe they tested for KRAS at that time because he was stage III and only on a two drug regimen - Xeloda and oxaliplantin - no EGFR's. I feel confident that our onc will send for the KRAS testing now before he proceeds with this next round of chemo because it will include Avastin this time, but I plan to ask him to confirm. He has to heal from the lung surgery and won't start chemo for about a month.
I am praying that going back on chemo will keep this disease at bay and prevent other mets from surfacing, since he cant afford to loose any more lung tissue! You are correct that RFA is always an option, however.
Thank you all for your responses and keep them coming. I need all the help I can get!
Hubby diag Nov 2006 at 43 Stage III rectal cancer, 3/12 nodes T2N1M0
LAR 12/07 Radiation and chemo Xeloda and Oxaliplatin (finished 10/07)
06/2009 lung mets; 2 lobes of rt lung removed,
11/2009 Oxaliplatin reaction; on to Irenotecan