NSCLC Tough choice - radiation or surgery?

Posted by kkckkjm @kkckkjm, Sep 14 6:23pm

Hello, I had a right lung lobectomy at the end of June. Recovered pretty well. I have now been diagnosed with a NSCLC nodule next to my heart. Radiation or surgery with some targeted therapy are recommended treatments. Can anyone comment if they had this unfortunate choice to make, and how they made it? I really don't want to do anything for at least 8 weeks and am getting pushback about that.

Interested in more discussions like this? Go to the Lung Cancer group.

You mentioned a targeted therapy, has your biomarker testing shown a gene mutation; EGFR, KRAS, ALK, etc? The targeted therapies for some of those types of mutations can be very effective, with minimal side effects.
Sorry that you need to make this decision, they are never easy and rarely straight forward. Do you have a good team? I would be looking for thoracic specialist, at a major medical center. Best of luck to you, take care, Lisa

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@lls8000

You mentioned a targeted therapy, has your biomarker testing shown a gene mutation; EGFR, KRAS, ALK, etc? The targeted therapies for some of those types of mutations can be very effective, with minimal side effects.
Sorry that you need to make this decision, they are never easy and rarely straight forward. Do you have a good team? I would be looking for thoracic specialist, at a major medical center. Best of luck to you, take care, Lisa

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I agree with lls8000 I would go to a cardiologist and then make my decision—-Did you
have a Biopsy yet? if so did they have to go through your back?

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@kkckkjm, I hope you saw the helpful suggestions that @lls8000 and @marcia115 offered. Marcia mentioned getting a cardiologist involved, which tipped me off to let you know about cardio-oncology.

Mayo Clinic offers expertise in addressing heart problems (called cardio-oncology), potential or current issues. The Cardio-Oncology Clinic (https://www.mayoclinic.org/departments-centers/cardio-oncology-clinic/overview/ovc-20442193) evaluates people prior to cancer treatment and patients who have experienced side effects due their treatment.

Might they have a cardio-oncology specialist where you receive care? Did you make your decision in the meantime?

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@colleenyoung

@kkckkjm, I hope you saw the helpful suggestions that @lls8000 and @marcia115 offered. Marcia mentioned getting a cardiologist involved, which tipped me off to let you know about cardio-oncology.

Mayo Clinic offers expertise in addressing heart problems (called cardio-oncology), potential or current issues. The Cardio-Oncology Clinic (https://www.mayoclinic.org/departments-centers/cardio-oncology-clinic/overview/ovc-20442193) evaluates people prior to cancer treatment and patients who have experienced side effects due their treatment.

Might they have a cardio-oncology specialist where you receive care? Did you make your decision in the meantime?

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Hello and thank you all for your comments. I did already have a biopsy done but the tissue sample, while confirming malignancy, was to small to make a biomarker analysis. The removed right lobe had EFGR but that doesn't mean (I've been told) the same cancer is in the left lung. I have switched to Mayo and another national cancer center for 2nd and 3rd opinions from that of my original team. Three centers, 3 different perspectives and recommendations. I have narrowed it down to 2. Radiation is off the table. Surgery (wedge resection rather than lobectomy) is 1 option, then determine type of cancer with all the tissue. The second option is do another navigational bronchoscopy to attempt to get more nodule tissue to type the cancer, and also sample lymph nodes for spread. It was a difficult navigational situation the first time so I'm not so inclined to do that procedure again as it is risky with uncertain results. Or I could just start targeted therapy under an assumption it is the same EFGR cancer and see if the medication reduces the nodule size. It is alot to consider.

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@kkckkjm

Hello and thank you all for your comments. I did already have a biopsy done but the tissue sample, while confirming malignancy, was to small to make a biomarker analysis. The removed right lobe had EFGR but that doesn't mean (I've been told) the same cancer is in the left lung. I have switched to Mayo and another national cancer center for 2nd and 3rd opinions from that of my original team. Three centers, 3 different perspectives and recommendations. I have narrowed it down to 2. Radiation is off the table. Surgery (wedge resection rather than lobectomy) is 1 option, then determine type of cancer with all the tissue. The second option is do another navigational bronchoscopy to attempt to get more nodule tissue to type the cancer, and also sample lymph nodes for spread. It was a difficult navigational situation the first time so I'm not so inclined to do that procedure again as it is risky with uncertain results. Or I could just start targeted therapy under an assumption it is the same EFGR cancer and see if the medication reduces the nodule size. It is alot to consider.

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Those are great options but very difficult decisions.
I can only offer my experience. I have ALK positive lung cancer, a similar mutation, stage IV, so I only had the choice of the targeted therapy, not surgery. The pills have worked wonders for me. Within days of starting the drug I was feeling better and knew it was working. Within 6 months I was declared ‘no evidence of disease’ on scans. My cancer will never be cured and it will reoccur, but the targeted therapy has allowed me extra time. I am two years post diagnosis, and I know that I wouldn’t be here without it.
Wishing you well with your difficult decision ahead, Lisa

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Thank you for that glimpse into your experience. The information makes me feel even more hopeful.

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@kkckkjm

Thank you for that glimpse into your experience. The information makes me feel even more hopeful.

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An update: I am scheduled for surgery next week at Mayo. There were several reasons I chose this path. As previously mentioned, there were several approaches put forth to deal with this nodule. One treatment plan assumed the cancer type was the same as that in my removed right lung lobe. Clarification yo determine this was EBUS and another navigational bronchoscopy. However, my MRI, Petscan, and CT showed no spread and all lymph nodes taken from my right lung were clear. I'm hopeful this indicates my left nodule cancer is NOT the same as the EFGR right lung so I am proceeding with surgery,

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@kkckkjm

An update: I am scheduled for surgery next week at Mayo. There were several reasons I chose this path. As previously mentioned, there were several approaches put forth to deal with this nodule. One treatment plan assumed the cancer type was the same as that in my removed right lung lobe. Clarification yo determine this was EBUS and another navigational bronchoscopy. However, my MRI, Petscan, and CT showed no spread and all lymph nodes taken from my right lung were clear. I'm hopeful this indicates my left nodule cancer is NOT the same as the EFGR right lung so I am proceeding with surgery,

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You'll be in good hands at Mayo.

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