Postby roadrunner » Sun Dec 11, 2022 11:05 am
Mark: Thanks, that does clear things up. It sounds like the 2 and 3 cm sizes are just the “impact zones” or met-plus-margin zones from the SABR, with any remaining cancer likely a much smaller area. That definitely threw me off; seemed like there was a lot of growth of the nodules themselves. I would also note that perhaps your signature contains a typo, as it shows about a year between the thoracotomy and the SABR.
In any case, my remaining questions are: (1) Can you repeat the SABR on the two mets? This is usually doable and often successful (based on my review of the literature) if there wasn’t too much toxicity the first time, though central location (if there in your case) could cause some hesitation. (2) More a comment, but I’d discuss the untreated nodules very specifically with them. My guess is that your folks aren’t focused on them because *for the purposes of the trial they don’t exist* (since not confirmed as mets or for other reasons related to the trial). But as you say, the nodules’ prior behavior is highly suggestive, so for you, those nodules may be very important as to how the drug is doing. With trials IMO, it’s always very important to consider the team’s mindset and incentives carefully, because those can differ from those in ordinary care, as they are influenced, and often driven, by the trial goals and parameters. Still, your team should IMO give you information on the untreated nodules. In the final analysis, those nodules should at least be watched carefully regardless of how the drug is doing/the trial, because you need to address them optimally going forward (whether surgically, with ablation, or with systemic therapy).
At least, that’s my read. Again, could be off given incomplete info. Hope this helps, at least in terms of brainstorming.
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
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)