Can radiation be used on partly solid nodules close to an airway?

Hi @lijda, While I don't have personal experience with radiation. Others in the group have had radiation near the esophagus. You may want to ask your oncologist for clarification on why they are saying 'No'. There may be reasons specific to your case that make radiation to that area too risky. The side effects can be difficult to manage, but when there are no other options, it may be a possibility.
Here's a link to another similar post:
https://connect.mayoclinic.org/comment/1010141/

If you have multiple nodules, have you been diagnosed with multifocal lung cancer?
I have multifocal lung cancer and have had two video-assisted lung surgeries for two nodules, and then one SBRT series (3 sessions) for another nodule. With multiple nodules, there must be a treatment strategy in place because as the radiation oncologist told me "Radiation makes Swiss cheese out of lungs."

I have been diagnosed with multifocal lung cancer by my surgeon; and with metastatic lung cancer by my oncologist. My pulmonologist says it's hard to diagnose which. A summary pathology report from the second lobectomy states that "The main tumor and two additional tumor nodules are morphologically similar to each other and are suggestive of intrapulmonary metastases." It also states that "two additional nodules are morphologically different from the main tumor and from each other and may represent separate primaries." The tumor in the first lobectomy, some but not all growths in the second lobectomy, and the three nodules removed in the bronchoscopy were all EGFR-positive. Not all EGFR-positive growths have the same (or the same number of) co-mutations. Two growths from the second lobectomy were varieties of KRAS.

My oncologist's treatment strategy is Tagrisso (osimertinib) as monotherapy; I want to at least have considered other options (including other drugs and drugs in combination with chemo, as well as radiation and even surgery) because of worse response with EGFR TKIs (not only Tagrisso) when there is a TP53 co-mutation. (For example, progression-free survival and overall survival can be shorter with some co-mutations.) Radiation interests me because all of the nodules are still slow-growing but one cluster is of concern because of its position. I wouldn’t expect radiation to be a treatment strategy for all nodules. I have 20 to 30 nodules (Swiss cheese indeed).

I have an appointment scheduled with my surgeon and with a pulmonologist and I expect to talk to a radiation oncologist also.

Yesterday I found a study from Korea, published online on March 21, 2023, that states the following, based on analysis of patients from 2016-2021 at a single institution:

"SBRT is a safe and effective treatment for patients with GGO-predominant lung cancer lesions and is likely to be considered as an alternative to surgery."

The title of the article is "Clinical Outcome of Stereotactic Body Radiotherapy in Patients with Early-Stage Lung Cancer with Ground-Glass Opacity Predominant Lesions: A Single Institution Experience." Full link is https://www.e-crt.org/m/journal/view.php?number=3474#:~:text=SBRT%20is%20a%20safe%20and,as%20an%20alternative%20to%20surgery.&text=Based%20on%20the%20National%20Lung,has%20increased%20worldwide%20%5B1%5D

20-30 nodules is a lot. I have been told that I am in the upper range for number of nodules, but I do not have that many.
I know it is not possible to diagnose from "outside" which are primary lung cancers and which can be metastasis. As mentioned I had two wedge resections and lobes not removed so can't say if there is metastasis except based on PET scans, cancer only in lungs.
My last VAT pathology report detected STAS - spread through air spaces. Not much is known about this new way to spread.
I had one series of SBRT and two months later had radiation-induced pneumonitis. They said I can't have immunotherapy now because it could trigger another episode.

Following as I am stage 4 (biomarkers not tested in 2010 at dx), and have several GGOs becoming solid. Due to damage from previous radiation I'm not a candidate for resection.

I had SBRT radiation (EGFR exon 19) for a 4mm ground glass opacity that they suspected might be cancer on my right lung after having an ULL lobectomy a month earlier with one lymph node in that surgery testing positive. At my follow up from my first scan after treatment last month, I learned I also have another nodule in my middle right lung that wasn’t mentioned before but Rad Onc says was definitely there from the beginning. They are watching that one. I’m hoping Tagrisso kills it.

I just added a response to this thread but couldn't find this reply that I wanted to respond to: I see two different variations of this post.

Anyway, I apologize for taking so long to respond but I did want to say that the nodules, even when small, can be tested for biomarkers via a bronchoscopy. My nodules had to be tested for mutations to identify the EGFR (and other) mutations; they couldn't use the analysis from the growths removed in the lobectomies, because there's no guarantee the mutations are the same (and I did have a variety of mutations). An interventional pulmonologist can get samples of nodules if the nodules are large enough. Actually, "large enough" doesn't have to be terribly large if the pulmnologist is very good. My pulmonologist took "samples of two subpleural nodules positive for adenocarcinoma (0.5 cm each)" that were large enough for full molecular analysis.

Do talk to a pulmonologist about whether the nodules are large enough for sampling. If they aren't now, they will be soon unless of course they are very indolent, in which case you don't yet need their molecular analysis.

Thank you. My pulmonologist and oncologist are not in favor of a bronchoscope. I've found a pulmonologist in Chicago who I will be seeing if there are any changes in size when I have my next CT.

Was your bronchoscope done at Mayo?

No, it was done at Memorial Sloan Kettering by Dr. Mohit Chawla, an interventional pulmonologist, which is a fairly new field in pulmonology.