Postby roadrunner » Tue Mar 14, 2023 12:52 pm
Mark: Your situation is obviously pretty complicated, and this decision depends in great part on your subjective preferences and perspective, so I’m not going to try to advise, but instead list a few questions that I would want to be able to answer before I made it:
1. Apart from your trial oncologists and the surgeon who’s offering surgery, have you talked to others familiar with your history to get their views on the likelihood of follow-on disease? What are the opinions? Odds? Likely timing?
2. Since surgeons can find additional disease when they “go in” and palpate the lung, have you discussed your surgeon’s approach in that regard?
3. What specific surgical procedures are being offered (wedge v. segmentectomy v. lobectomy) and how much tissue would be taken/remain? Will the surgeon make the call once he’s in?
4. Since you’ve had minimal-to-low growth on the trial, do the trial oncologists think that will continue, or do they have a reasonable hope that increased doses will do better? Do they think the drugs are restraining metastasis at present? What do your non-trial oncs think of that?
5. If the drugs appear to be having a stabilizing effect that might improve, can you just delay the surgery a bit?
6. Have you considered other, non-surgical options? (I know that SBRT failed, but it can generally be repeated (including by a different provider), and there are other ablation techniques that may preserve more tissue).
That’s what I can think of for now. Hope it helps.
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.)