Postby roadrunner » Wed Nov 08, 2023 1:28 am
Ok, that’s helpful. I just did four cycles of FOLFIRI in April/May, so I know how tough it can be. I lost a lot of hair just in 4. It was tolerable otherwise for me, though. But I just did 4.
For your Mayo appt., I would definitely ask about your original oncologist’s view that resection and or ablation (curative or otherwise) is irresponsible. (You didn’t mention ablation or radiation, but these are potabtial options with or without surgery.) Beach Sunrise just had several nodules resected in Germany using an established laser technique, and that thread might be a useful read. Also, you should at least consider/ask about ablation/radiation/combos. It’s def bad luck that these are in 4/5 lobes, but I’m not certain that that alone means that only systemic therapy is possible.They are all still very small. And subpleural nodules are often easy VATS wedges.
You should be aware that there is a school of thought that believes that no pulmonary met should be resected (an argument is made that because they are generally slow-growing, OS is not greatly increased with resection). However, this is not a majority view, and there are folks just on this forum who have had pulmonary metasectomies and are close to or beyond recurrence-free survival of 10 years. I think you still have what is called oligometastatic disease, a concept you might want to familiarize yourself with (and more so because at least 1-2 of these might not be mets). Plus, I’d ask Mayo about doubling times, as yours seem on the quicker side, which might influence strategy. From what you’ve related, even if these are all metastases I don’t think cure is completely off the table, nor should metasectomy and or ablation/radiation be. At least not without thorough discussion. Another important point is whether to resect one of these to test for mutations. That might optimize any systemic therapy. Of course, all this depends on your preference as well. But now is the time to consider all this.
Sorrry this is a bit rambling. If this is all stuff you know, then you’re in good shape to prepare a question list for Mayo. If not, I’d look into these topics before you go in there. Finally, this looks like it might be a very important decision-point. Even getting a third opinion would not be crazy here.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23