YAG laser qualifying criteria questions - Germany

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Rock_Robster
Posts: 1017
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

YAG laser qualifying criteria questions - Germany

Postby Rock_Robster » Fri Jan 12, 2024 9:10 pm

Hi all,

I know there’s been a lot of posts on this recently and I’ve tried to research back as much as I can, but I’m also aware the mood on this stuff can change on a dime too as practices evolve.

So my questions with gratitude are…

1. Can anyone please inform me on the key qualifying criteria for YAG laser lung therapy in Coswig, Germany with Dr Rolles’ practice - particularly as it relates to extra-thoracic disease? (Eg liver, distant nodes, etc).

2. Is systemic control of lung (or all) disease needed prior?

3. Is really good lung function is needed going into this, or do they accept some cough issues from mets (and hence the need for treatment…).

Many thanks as always,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev

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Sophy
Posts: 261
Joined: Fri May 27, 2011 2:46 am
Location: New Zealand

Re: YAG laser qualifying criteria questions - Germany

Postby Sophy » Fri Jan 12, 2024 9:40 pm

Hi from New Zealand, Rob

My experience may be out of date now but when I had this surgery back in January 2014 I was told that the surgery is only considered feasible when there is no disease except for in the lungs. It doesn't matter if the nodules are causing symptoms so long as they are all inside the lungs.

The surgeon explained this is because after any surgery the body is flooded with growth hormones to heal the damage. This causes mets left outside the lungs to grow faster and makes the situation worse than it would be without surgery. This is also why the second lung needs to be operated on as soon as possible if there are mets in both lungs.

Some other people have had their liver mets and other mets removed prior to the laser lung surgery and have gone on to become long term NED.

There is such a tiny amount of lung tissue removed (even with multiple mets) that there is minimal difference in lung capacity after the surgery. Dr Rolle told me that this is why he developed the laser - he hated opening up a lung to do traditional surgery and only be able to remove a maximum of 5 mets so that if he found there were more he would just have to sew the person back up and leave them with the additional mets still in the lung. The laser can remove 100 mets from a lung and still leave enough tissue for the patient to be able to breathe.

Of course, things may have changed in the last 10 years, so I hope that anyone who has had this surgery or has contacted Coswig more recently can give you up to date info.

All the best
Sophy
dx T3N1M0 Feb 2011 when children age 11, 7 and 2
Xeloda/rad March 11, LAR June 11 temp ileo
Xelox 6 rounds, NED
Lung mets Oct 13
Laser surgery Germany Jan 14. 3 mets left lung.
Laser surgery UK Jun and Aug 14 one met each lung, NED
Aug 14 Started Xeloda and Celebrex (ADAPT)
June 20 CT shows nodule, bronchoscopy confirms is scar tissue, still NED
Dec 20 stopping Xeloda continue celebrex, cimetedine
Aug 21,March 23 scans show still NED
March 2023 CURED - discharged from Oncology, no more scans or follow up

Rock_Robster
Posts: 1017
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: YAG laser qualifying criteria questions - Germany

Postby Rock_Robster » Fri Jan 12, 2024 11:07 pm

Thank you Sophy, that’s all really helpful - appreciate your feedback.

Cheers,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev

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beach sunrise
Posts: 1023
Joined: Thu Mar 05, 2020 7:14 pm

Re: YAG laser qualifying criteria questions - Germany

Postby beach sunrise » Fri Jan 12, 2024 11:23 pm

Are you a candiate for liver and lymph removal?
Maybe send scan with questions to Dr. Kern and Dr. Plones to see what it takes to be a candidate?
Couldn't hurt.
The lung function test is hard. They put the mask on you to read the carbon dioxide I think you are producing and it makes it hard to breath while you are peddling away with all those electrodes stuck everywhere on chest and sides.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

Rock_Robster
Posts: 1017
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: YAG laser qualifying criteria questions - Germany

Postby Rock_Robster » Fri Jan 12, 2024 11:37 pm

beach sunrise wrote:Are you a candiate for liver and lymph removal?
Maybe send scan with questions to Dr. Kern and Dr. Plones to see what it takes to be a candidate?
Couldn't hurt.
The lung function test is hard. They put the mask on you to read the carbon dioxide I think you are producing and it makes it hard to breath while you are peddling away with all those electrodes stuck everywhere on chest and sides.

Thanks, theoretically the liver is likely treatable (surgery or ablation), and lymph nodes could likely be SABR’d. But with so many sites involved now including inoperable lungs, it’s very difficult to convince any individual surgeon to operate (you know the story), particularly while we’re still also grappling with systemic control and achieving stability.

My SpO2 and RR on room air is all fine, I’m just not running any hillclimbs any time soon, and have a chronic dry cough.

Thanks for the thoughts as always Beach.
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev

Markdale
Posts: 103
Joined: Wed Dec 02, 2020 4:45 pm

Re: YAG laser qualifying criteria questions - Germany

Postby Markdale » Sat Jan 13, 2024 2:33 am

Hi Rob. i was operated on at st Vincent’s public, they have an accomplished thoracic team. The surgeon that operated on me has a great reputation and works in the St Vincent private hospital aswell and uses the da Vinci robot. They have been known to take on challenging cases.
09/20:Diagnosed after colonoscopy for bleeding.
MRI and ct scan confirmed tumor at rectosigmoid junction aswell as lung nodules in RLL (1X1.2cm) and RUL (3X.5cm)
10/20: LAR tumour t3n2m1 4/24 lymph nodes.
11/20: pet scan confirmed Mets
11/20: folfoxiri - 10/6/21. 12 rounds in total
1/1/21 thoracotomy 1 met removed
2/2022 sabr to 2 lung nodule
09/22 PET scan progression of sabr’d nodules
10/22 phase 1 trial bispecific antibody
9/23 added pd1 blocker
12/23 bilateral VATS all visible (7) lesions removed

Rock_Robster
Posts: 1017
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: YAG laser qualifying criteria questions - Germany

Postby Rock_Robster » Sat Jan 13, 2024 4:14 am

Markdale wrote:Hi Rob. i was operated on at st Vincent’s public, they have an accomplished thoracic team. The surgeon that operated on me has a great reputation and works in the St Vincent private hospital aswell and uses the da Vinci robot. They have been known to take on challenging cases.

Thanks mate, appreciate the info. St Vincent’s is indeed
A great hospital and I love the Da Vinci - he did my rectal resection too!
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev

rp1954
Posts: 1847
Joined: Mon Jun 13, 2011 1:13 am

Re: YAG laser qualifying criteria questions - Germany

Postby rp1954 » Thu Jan 18, 2024 7:52 am

Sophy wrote:...back in January 2014 I was told that the surgery is only considered feasible when there is no disease except for in the lungs. It doesn't matter if the nodules are causing symptoms so long as they are all inside the lungs.

The surgeon explained this is because after any surgery the body is flooded with growth hormones to heal the damage. This causes mets left outside the lungs to grow faster and makes the situation worse than it would be without surgery. This is also why the second lung needs to be operated on as soon as possible if there are mets in both lungs.

So sad that the medical profession can't pull its collective head out of its rear end on simple nutrients and other anti-inflammatories for surgical inflammation, for old tech that has been simply ignored for 25 - 75 years.
I am so thankful I was aware of the long running Life Extension Foundation cancer articles with substantial coverage on this area, as well as other integrative efforts.
Peri-operative cimetidine is 30+ years old. CA199-CSLEX1 targeted cimetidine is 20+ years old.
Niacin/niacinamide has been known as an anti-inflammatory for ca 75 years. Likewise the pleiotropic benefits of higher vitamin D3 doses and cofactors.
I think Klenner first salvaged someone's botched surgery with IV vitamin C circa late 1940s. The options include continuous drips for several days, and daily infusions for 1-4 hours, for up to a week on so, depending on inflammation, injuries and infection loads.


Some other people have had their liver mets and other mets removed prior to the laser lung surgery and have gone on to become long term NED.

Yep, you have to find some dr to help break the ice and get the ball rolling on a better personalized multimodal plan.
Very important to not get discouraged and to keep moving forward when you encounter Dr. No(s).
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements


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