Vats for lung nodules

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catstaff
Posts: 140
Joined: Wed Mar 03, 2021 11:37 am

Re: Vats for lung nodules

Postby catstaff » Tue Sep 14, 2021 12:26 pm

Thank you, IsmailMehdi, but I am not sure what they'll be willing to do about the L5 met. It is small (11mm), didn't grow during the chemo and the onc thinks it may have shrunk a bit, with lytic tumor being replaced by sclerotic bone around the outer boundary. The conundrum is that because it's small and asymptomatic they will likely not want to do anything about it, yet because it's small the odds of a successful and relatively low-risk treatment with something like SBRT are probably good. I am pretty sure that it's the source of all or at least most of the residual over-normal CEA. His CEA dropped in a near-perfect exponential decay from 40 to 8.6 over 5 treatments. We had to start partially over after he missed a cycle and it's been going down much more slowly (8, 7.6, 7.3, now 6.8 ). Bone mets are hard to kill but the onc seems to want to try to keep grinding it (and him) down with the treatments as long as possible. Maybe if he goes on maintenance after another cycle or two they'll consider other options if it seems to start to grow a bit.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

IsmailMehdi
Posts: 36
Joined: Sun May 02, 2021 5:52 pm

Re: Vats for lung nodules

Postby IsmailMehdi » Tue Sep 14, 2021 2:44 pm

is radiation an option ? SBRT for sure would kill it. FOLFIRI worked on the other met and managed to stop this one, is he still on it ?
I imagine no biopsy possible there, if you go in, might as well get it. Do they even know if it is active ? Could be dead.

We messaged about the skipped chemo cycles, it takes a bit but works again.
How is his energy and appetite ? I finished my 8 cycles and seriously need to come off prednisone and control my glucose, the weight i put back on has my at my correct BMI, so i'll try to ride the CRT train a little longer with corticosteroids.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 signet ring-cell carcinoma
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27

catstaff
Posts: 140
Joined: Wed Mar 03, 2021 11:37 am

Re: Vats for lung nodules

Postby catstaff » Tue Sep 14, 2021 4:00 pm

He's still on Folfiri+bev and it does seem to have worked on the lymph node mets. It may well be working (slowly) on the bone met as well. I will need to discuss SBRT with his oncologist. The standard of care is they don't do it unless the met is painful (symptomatic) which his is not. There are risks to it, especially fracture, but I assume the fracture happens when a chunk of bone is hollowed out by the minimal support it's getting from the cancer collapsing. This one is so small I doubt that's a big risk for that. It is almost certainly still active since his CEA is 6.8 and the other mets appear to have been knocked down.

His energy and appetite have flagged with an increasing number of cycles but he's hanging in there. We are going to try Ritalin. I may consider ginseng, which seems to have some scientific support (not just folklore) for this type of fatigue, but it takes a while to work. He will probably go to maintenance after another cycle or two (after the current one).
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-


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