Postby roadrunner » Wed Aug 10, 2022 5:13 pm
I’ve seen many studies that use 120 days as the top end for VDT of pulmonary CRC mets. I’ve also seen individual reports where it was as much as 139. Keeping in mind that as inter-observer variability can be as much as 1.7mm, and there are other variables, there is some “play” here (especially given the small size), I think, but no growth in a year off chemo at 4-7mm initial measurement seems quite promising. Multiplying diameter by .26 is a decent surrogate for doubling in volume, so 4mm, for example, “should be” 8.4mm doubling at VDT=120 days over a year.
I’d be interested in (1) why your team thought these were mets—were any resected (I seem to recall you had something done, but you have no signature)? (2) Is there a plausible alternative explanation (e.g., are you a smoker?)? (3) what are they saying now that it’s been a year with no change?
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