Anyone chosen to SBRT radiation over surgery for stage 1 lung cancer?

Hello JoJo, In 2023 I was told I had stage one lung cancer and that it was slow growing. I also have COPD due to being a smoker up until 8 years ago. Other than that my health was good. Due to the COPD, they thought that SBRT was the best way for me to go. I had 5 radiation treatments, and they got it! I am also 76 years old. The treatments were like getting a typical scan, no big deal. I felt great, and fortunate. A few months went by and I started having sciatica nerve pain down my opposite leg from treatment. I did a short stint in therapy, and it cleared up. Two years later a scan picked I had broken the 7th rib. Three months later a check up x-ray showed that now the 6th and 7th ribs were broken as # 7 had not yet healed. I wish I could say that was the end of it but three months later the 5th rib also showed a fracture. So now it is 3 years post treatment and I have 3 broken ribs. I just had another x ray and I have not gotten the results yet. This has been pretty painful and my whole life has been disrupted. I can't even sweep the floor due to the movement.
You can do a search on SBRT treatment and rib fractures to get an answer that may help you choose which way to go. My ribs may never heal properly, and the doctor says it is going to take lot's of patience and time.
The oseoporosis I have actually throws a wrench into the whole healing process also. Here is the reward, no cancer, it's gone at this time, 3 years later.
I can't compare it to surgery which I did not have, but at this point despite all that I have and am going through I think I still would do the same treatment at my age. God Bless and help you make the right choice for your needs.

@jojo99, I'm sorry to hear that you're struggling with these options. I was originally diagnosed with stage 2b EGFR Exon 19 mutation in my upper right lung. I had a lobectomy but they didn't get all the cancer. So that was followed by 33 rounds of radiation and four rounds of chemo. The chemo was because once they had the lobe out they could see that the cancer had already traveled to a nearby lymph node. That was in 2018 when I was 58 years old. I recovered from the surgery in a couple of months. The pain was minimal. The radiation just made me tired. 8 years later I have never had a recurrence in that area.

Personally, I get annoyed when my doctors tell me to make a medical decision. Inside my head, I tell them that I have a Bachelor's degree in Mechanical Engineering, a Masters degree in Applied Mathematics, a PhD in Applied Mathematics, and over 30 years of Mechanical and Systems Engineering experience -- NONE of which qualifies me to make a medical decision!

Even inside my head that sounds a bit snarky, so instead I let them know my desired outcome and my concerns and ask them to choose a medical treatment that will best get me there. My primary oncologist is now at MD Anderson, and I faced treatment options for recurrence in my brain. Being a geek, I formulated my three desires:

1. I want to live forever.
2. I want to remain me as much as possible, mentally first, physically second. If there's ever a conflict between the two we should have a discussion.
3. Favor long term benefits over short term solutions.

Based on those guidelines, the neurosurgeon chose full open brain surgery over the much less invasive LITT. I had that surgery in January.

I'm not suggesting that you need to write down your own guidelines. but I do encourage you to think about what your desired outcome is, and what your concerns are. Formulate those ideas in some detail, take them to your oncologist, and let him or her make the medical decision. After all that's what they get paid for.

I wish you all the best. Let us know what you and your oncologists decide. There's a large group of supportive people here.

I was diagnosed in 2022 with Stage 1 NSCLC in right lobe. Surgery was not an option due to the location of the nodule and I was not a good candidate for chemo (not sure why). I had 5 sessions of SBRT and, to-date, no recurrent growth in that nodule, although due to COPD and emphysema on top of everything else, every time I get my 3 month CT scan, they see something "suspicious", and I am constantly battling pneumonia. I have just been diagnosed with MAC disease, a serious bacterial infection in the lungs for which I am on 3 antibiotics a day and will be for at least a year. I live in Daytona Beach and can't even go to the beach for fear of breathing in the bacteria in the sand, and have to wear a mask when I work in the yard. Due to overwhelming fatigue after the SBRT, the anemia I have got progressively worse, so my oncologist ordered a bone marrow biopsy which resulting in a diagnosis of Myelodysplastic Syndrome, or MDS, which is blood cancer and if not treated can lead to full blown leukemia. If my hemoglobin continues to drop, then I have to go on chemo and the only "cure" would be a stem cell transplant. I'm doomed there because I don't have a donor - my son is adopted and my sister is not in good health. So, for me, it's all in God's hands and I take it one day at a time. I'm a widow, 77 years old, work full time (because I want to) and live alone with my little dog. I thank God every day for my blessings. My motto - "It is what it is!" I will keep you in my prayers. God bless.

footlooseinflorida, Please know I will keep you in my prayers. You sure have been through the ropes. I started a garden last year thinking it would be like therapy. Not!!! When I went to pull weeds was when I heard one of the ribs pop. Not to mention that it has been announced that we now have ticks in our area. I think of the story of Job quite often. I can't seem to arrive at the same patience, but constantly feel shot down before I start. I have not heard anything concerning the last chest ex-ray and I was up at 2:00 Am due to the pain. Can't lay down because of it.
My cousins husband has been going through a process something of what you are enduring. His was from Agent Orange in Viet Nam. When I was first told I had cancer stage 1, the doctor told me if he had to tell anyone they had cancer, he would hope it would be this one. Three years later...my hope barely hangs on from one difficulty to the next. I honestly think that I had this strange idea that it was all going to go back to normal.
Yet I do look forward in faith that " this too shall pass." God Bless you and help you daily and always through this pilgrims progress.

In Dec 2021 I was diagnosed with bilateral multifocal lung cancer. I was 80 years old. I had VAT wedge resection and not a lobectomy ...wedge resection preserves more lung. It was easy. You are careful on what side you sleep, you are careful on activities for some weeks, but I was driving my car a week later. I had another VAT wedge resection in May 2023 to a different lobe and that time a rib was cracked so it was more painful, but I still did well. With surgery they take it out and know what it is.
Then three months later I had photon SBRT to two nodules. Easy, you lay down on table and after you get up.....BUT 6-8 weeks later I had big shortness of breath = radiation induced pneumonitis. I was put on Prednisone for 8 weeks and that helped. Several months later I repeated my pulmonary function tests and they had dropped and I was diagnosed with pulmonary fibrosis and now on Oxygen for exertion and sleep, Since I have multiple cancer nodules developing, I now am limited in my treatment options. Radiation comes with risks.
You mention both photon and proton. There is a big difference. Photon is the one given the most because there are only about 50 places in the country that offer it. Doctors need to justify giving you proton over photon or your insurance will not cover it because it is much more expensive. Proton is much more precise and does not damage the surrounding tissue like photon does. I had proton last year because I can no longer do photon radiation because of my fibrosis and limited lung function. And with the proton beam therapy I developed chest pain some 4 months later, It hurt to breathe ...but it has gotten much better now ....personally I would choose VAT wedge resection over radiation given my experience.

Vic83, thank you for sharring. I am sorry to hear what you are going through. Actually I can't tell you how much this has been on my mind. I am pleased you shared the fullness of your treatment for consideration. I am right now very concerned that my situation is going to end up the same from the SBRT treatments. I suppose I could add that is what is so great about this site. It gives JoJo a deeper understanding of what can happen. I can't stand the constant pain. My oxy has stayed the same, but I feel exhausted all the time because I really can't get up and do things as I would like. I have also started having a productive cough that I believe is connected to what is going on with the ribs. I guess if it is pneumonitis, I will just have to deal with it. I have two other solid nodules but they really are not concerned about that at this time. Thank you for sharing and adding to content. God Bless you!

Hello @jojo99, These decisions are never easy. We can only weigh the information given to us by our doctors, and hope we make the best choice.
Have you decided on radiation vs. surgery? How are you feeling about the upcoming treatment?

You may find this article to be helpful. It can help to focus on feeling empowered to be able to make the decision, rather than burdened.
https://connect.mayoclinic.org/blog/cancer-education-center/newsfeed-post/one-size-does-not-fit-all-in-cancer-care/

I will be getting radiation have not decided which type yet. Waiting to speak to the radiologist.
Thanks