Postby roadrunner » Mon Aug 16, 2021 1:50 pm
You are the captain of your own ship, so I’ll step back on this, but I feel compelled to give this last cautionary note on the subject:
Cavitation can show central necrosis, and you’re right that it can appear (at least according to one study) as a treatment effect. However, it also appears to have vascular causes unrelated to treatment, at least in some cases (basically, the structures in place can’t support the tumor), and at least some tumors that show cavitation appear to retain viability. Furthermore, even if the cavitation is prognostically significant for some mets in your case, some nodules are showing it and others aren’t. And I think it’s likely a bridge too far to go from a finding of cavitation in some lesions to the conclusion that alternative treatments are working and will eventually eradicate disease.
So it appears you have a significant metastatic disease burden, and even if cavitation is positive in your case, failing to treat that disease now could very well have adverse consequences. For example, while it was traditionally believed that pulmonary metastases of CRC do not themselves metastasize, animal studies, and current views, on this are equivocal. Systemic chemotherapy and/or other treatment might address that issue, and/or might buy you significant time (and thus potentially other options), even if it isn’t curative right away. Additionally, such therapy might address other preexisting, occult disease.
For these reasons, I think another period of waiting may not be a good idea. Especially if your team counsels against it.
I well understand how hard it is to dive back into treatment when you feel fine. But I would try as hard as possible to drop that psychological factor from my calculus. You still have legitimate, potentially productive (and even curative, particularly in stages, down the line) chemotherapeutic (and immunotherapy) options, potential laser surgery, etc.
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