Re-post recent article about lung mets & surgical removal, please?

[jml]

Hi Friends~
Can someone repost or direct me to the post about resecting lung nodule mets?

Just got scan results - sort of.
Not good. Just had scans yesterday morning and have been waiting for results, so I called today - twice.
My NP just called me back & said scans not good - lungs have progressed.
Don't know details, but going to cancer center right now to discusss results and so she can listen to my lungs/chest.
Today is her day off.
I've had a lingering cough, that's changed a bit over the past six months & then have been feeling increasingly SOB the past week, but thought it could be severe anemia. Fortunately labs are holding steady, low H&H, but ultimately not the source of SOB.
Oh God.
There's nothing left for me. Don't know how I could tolerate anything else if there were.
But maybe, just maybe, if I remember the article correctly, lung nodule metastectomy could be an option?

Desperately Keeping the Faith~

Jessica
Dx-5/17/02 - 33 yo; Stage IV - L IDC w/single liver met
1) Herceptin + Navelbine x 8 weeks - No response; progress to innumerable,immeasureable liver mets
2) ISIS 2504 + Herceptin - 6 mos, partial response
3) Taxol + Herceptin x 13 weeks to NED!
NED for 1 year
9/04 - Single liver lesion recurrence
Taxol + Herceptin - on/off to beat back lesion
12/05 - R Hepatectomy; Liver NED until 2009
3/06- Local recurrence - Left breast, IDC & DCIS, but holding treatment while continue to heal from Hepatectomy.
12/06 - L mastectomy + reconstruction through 8/07
10/07 - Recurrence - supraclav nodes
4) Gemzar + Herceptin - on/off controlling nodes thru
9/08 - 7wks Rads to supraclav nodes
10/08 - Acute Renal Failure - nodes in belly stricturing kidneys. placed permanent ureteral stents
Back on Gemzar + Herceptin, but no longer responding.
5) 05/09 - Tykerb + Xeloda - partial response x 5 mos
6) 10/09 - Xeloda + Herceptin - no response, disease progresses
7) 2/10- Ixempra + Herceptin - partial response x 12 wks.
Discovered single brain lesion x 4mm & liver lesions growing while screening for TDM1 + PI3Kinase study.
6/10 - Novalis to treat brain met - SUCCESSFUL!
8) 6/10 - Chemo-embo w/Adriamyacin to de-bulk liver lesion.
9) 8/10 - Screened & Started TDM1 EAP
Immediate response, disease in belly responds dramatically.
2/11- questionable progression of lung nodules
Discontinue TDM1
10) 3/11 - PI3Kinase + Herceptin - intial good response in 1st 6 weeks but LFT's elevated.
11) 7/11-Discontinue PI3Kinase + Herceptin study;
Disease progression - 2 small lesions in colon – docs have never seen this before in BC
11) 8/11 –Start new combo Halaven+Herceptin
10/14/11 -Completed 3 cycles (9 wks)Halaven+Herceptin...
10/18/11 - Scanxiety time -1st scans since starting this regimen
Good interval response, continue on H+H!
10/25/11 – new 2mm questionable spot in brain? Due to Novalis or new disease?
Re-scan in 8 weeks.
1/3/12- Disease progression; 50%increase size & SUV-R lung, middle lobe 6cm lesion.
R supraclav node multiple, miscellaneous nodes in belly. Colon lesions fired up.
12) Herceptin+ metronomic Cytoxan + Methotrexate.
…on a hope & a prayer. Only chemo I haven’t been on is Taxotere.
Hurry up Pertuzumab & TDM1!
Follow Up Brain Scan on 1/18/12…pleasepleaseplease be okay. I can’t take much more.
1/18/2012- 8 new spots in 8 weeks since last Brain MRI
one 2cm spot in brain stem, one 2cm spot in R temporal lobe.
No symptoms, THANK GOD!
1/25/12 – Start WBR x 15 rounds
2/10/12 – Oral Cytoxan WORKING! Melted supraclav node & undetectable by US!
2/14/12 – FINISH 15 rounds WBR
6/12/12- Continuing on oral Methotrexate BID & Cytoxan qpm, but on chemo break
for 3rd week due to low counts.
6/15/12 – Yay! Resume chemoJ
6/25/12 – Chemo break again due to low counts L
6/28/12 – PET Scan & Brain MRI this week…
NED IS BACK!!! NED in the HEAD, NED in the BODY!
10/26/12 – Still NED in the HEAD, but single troublesome node in chest, precariously close
to superior vena cava/heart. Not a perfect scan, but pretty darn good.
Maintain current treatment and Echocardiogram on 11/1 to keep an eye on node.
11/1/12 –echo shows normal cardiac function  & node non-threating,
but experiencing symptoms of Superior Vena Cava Syndrome (obstruction/compression)
12/3 - hold cytoxan & methotrexate bc counts too low.
12/13-moved up PET scan due to increased SVC symptoms
12/14 –No more NED node progression causing increased SVC symptoms
12/17 – repeat echo & new chest mri for closer look…
Radiation to chest node recommended, change of systemic treatment pending
12/20/12 – 1/10/13 -14 rounds of rads to chest for mass causingSVCS
1/17/2013 – Started Pertuzumab, Herceptin, Taxotere
1/26-1/30/2013 – Surprise hospital stay for severe dehydration, dangerously low counts & blood born staph.
3/2013 – PET/CT shows almost complete resolution of chest mass & SVCS resolved. Still NED in HEAD!
Continue with PHT, but very hard on me.
Chronically anemic, requiring transfusions more frequently
Completed 5 cycles of PHT, now scan time 5/23.

[NEDenise]

Jessica,
Keeping the faith right along with you. Praying like crazy for exactly what you need...whatever that may end up being.

Keep us posted.
with love...
Denise

[Lani]

was this it?

Ann Thorac Surg. 2013 Apr;95(4):1170-80. doi: 10.1016/j.athoracsur.2012.11.043. Epub 2013 Feb 4.
Prolonged overall survival after pulmonary metastasectomy in patients with breast cancer.
Meimarakis G, Rüttinger D, Stemmler J, Crispin A, Weidenhagen R, Angele M, Fertmann J, Hatz RA, Winter H.
Source
Department of Surgery, Grosshadern-Medical-Center, Ludwig-Maximilians-University, Munich, Germany. meimarakis@med.uni-muenchen.de
Abstract
BACKGROUND:
We investigated whether overall survival (OS) in patients with primary breast cancer (BC) is prolonged by pulmonary metastasectomy and which prognostic criteria may facilitate the decision in favor of thoracic surgical intervention.
METHODS:
We assessed the median OS of 81 women after resection of pulmonary primary BC metastases by means of Kaplan-Meier estimators. Statistical interferences regarding prognostic factors were based on univariate log-rank tests and multivariate Cox proportional hazards regression. Matched patients who had not undergone resection from the Munich Tumor Registry served as controls.
RESULTS:
Between 1982 and 2007, 81 patients were recruited prospectively. In 81.5% of the patients R0 resection was achieved, which was associated with significantly longer median OS than occurred after R1 or R2 resection (103.4 months versus 23.6 months versus 20.2 months, respectively; p<0.001). Multivariate analysis revealed R0 resection, number (n≥2), size (≥3 cm), and estrogen receptor (ER) and/or progesterone receptor (PR) positivity of metastases as independent prognostic factors for long-term survival. Presence of metastases in mediastinal and hilar lymph nodes correlated with decreased survival only in the univariate analysis (32.1 versus 103.4 months; p=0.095). Matched pair analysis confirmed that pulmonary metastasectomy significantly improved survival.
CONCLUSIONS:
OS in patients with isolated pulmonary primary BC metastasis is prolonged by metastasectomy. Patients with multiple pulmonary lesions or metastases with negative hormone receptor (HR) status are at greater risk of disease relapse and should be followed closely. Moreover, additive treatment tailored to the biological subtype defined by HR expression should be considered for this group.
Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Comment in
Invited commentary. [Ann Thorac Surg. 2013]
PMID: 23391172 [PubMed - indexed for MEDLINE]

[michka]

Jessica I found a post by Joan M on April 17th about cryoablation of lung mets. She had herself a RFA for a lung met in 2008. Maybe you should PM her. I hope this is an option. Hugs. Michka


News on Cryoablation
Here is a news story from MedPage Today on using cryoablation for lung metastases. I wonder what would have happened if patients didn't have "few remaining treatment options," as the story noted.

In 2008, I had an RFA of the lung, which is also a minimally invasive, interventional radiology treatment. Cryoablation is freezing a tumor, while RFA is burning it.

IR procedures are an option for women with oligometastatic disease, or limited metastatic disease. They are also an alternative to surgery: they are minimally invasive and could be tried before surgery (however, a surgeon probably wouldn't agree with that).

Also, IR procedures are exactly like chemo in outcome: They work well for some survivors but not others.

I had a discussion yesterday with my onc while getting treatment. For women with oligometastatic disease, he first gives chemotherapy. If the patient's tumor(s) has shrinkage but not a complete response, he will then remove the tumor(s), because he realizes that he's not going to get more shrinkage with that drug. He said that he prefers to get out the tumor(s) on the upside. That is, when the patient is having a response, and not waiting until the downside when several lines of chemotherapy have failed and the situation is starting to get out of control. I like him because he's open, logical, and reasonable in his thinking. Why be dogmatic?

As to evidence based medicine based on clinical trial results, how do we know that that model fits in every situation. Often an onc will say that there's no evidence that a local procedure works. However anecdotal evidence (that's from a patient's perspective) and case studies (which is the same anectodal evidence, but from an onc's perspective) have shown that some patients do do well. Should we not use them just because up to now phase III clinical trials have not yet been conducted? But that is changing.

My onc recently treated a friend of mine with surgery for mets to the skin in the chest area. She had been treated at the same citadel in NYC that I was treated at for about a year, until I got hip and got out (even though I had my brain surgery and radiation there and managed to get the RFA of my lung there, as well). In general, the breast service there is very much against local procedures, even though I can't speak for each individual onc. My friend had been taking Herceptin and Xeloda, and even though her skin looked pretty good, a biopsy showed bc cells. The skin was removed with clear margins, and I'm praying for NED for her. My friend will be continuing on her treatment for a while and hopefully she will be able to eventually take only Herceptin.

Yes, I know that I go on and on about IR, but it's my bc soapbox. For others it could be supplements or something else. I think there's a natural tendency to want to push for what has worked pretty well for each of us.

Joan

Freezing Lung Metastases Helps, Early Trial Shows

By Todd Neale, Senior Staff Writer, MedPage Today

Published: April 15, 2013

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

NEW ORLEANS -- CT-guided cryoablation of lung metastases may provide some benefit to patients with few remaining treatment options, a phase I study suggested.

In patients with small-to-medium metastases in one or both lungs, the minimally invasive procedure resulted in a 100% response rate -- no patients had worsening disease -- at 3 months and a 95% response rate at 6 months, according to David Woodrum, MD, PhD, of the Mayo Clinic in Rochester, Minn.

In addition, there was a low complication rate and most of the adverse events were minor, he reported at the Society of Interventional Radiology meeting here.

These "preliminary, short-term results offer promising local tumor control," Woodrum said.

Cryoablation "adds value to the patient in that we're able to treat patients who may not have been surgical candidates and we can treat them in a way that decreases their time necessary in the hospital," he said on a conference call in advance of the meeting.

He acknowledged, however, that larger and longer studies will be needed to evaluate the technique, and, in particular, whether the local tumor control has an effect on survival.

Woodrum reported preliminary results from the ECLIPSE study, a prospective, single-arm study conducted at three centers in the U.S. and one in France to assess the feasibility of using cryoablation for local tumor control in patients with pulmonary metastatic disease.

The study included 40 patients (mean age 63; 60% male) who had up to five lung metastases no bigger than 3.5 cm, and no more than three on one side. The study excluded patients with primary non-small cell lung cancer, those who couldn't lie flat or those with respiratory distress at rest, and those with uncontrolled coagulopathy or bleeding disorders.

The most common primary cancer diagnoses were colon cancer (40%) and kidney cancer (23%) and the average size of the metastases was 1.4 cm.

The patients were considered for the study because their disease was progressing despite the use of chemotherapy, according to Woodrum. Generally, chemotherapy was stopped for about 2 weeks before cryoablation and then restarted after the procedure.

Most patients (80%) had tumors in one lung only. The total number of cryoablation procedures was 48.

The procedure involved placement of cryoablation probes into the tumors using CT guidance, at which point freezing began. CT also ensured that the ice ball completely engulfed the tumor. The procedure lasted 1.5 hours on average.

The side effects that occurred were mostly minor, Woodrum said. The most common were pneumothorax (50%), pleural effusion (21%), pain in the chest or back (13%), hemorrhage (8%), and cough (6%).

There were only three grade 3 events, including one case each of noncardiac chest pain, pneumothorax requiring video-assisted thoracoscopic surgery, and arteriovenous fistula thrombosis requiring thrombectomy.

By 3 months, no patients had a local failure, 80% had stable disease, and the rest had a partial or complete response.

By 6 months, there was one local failure, with the rest of the patients having stable disease or a partial or complete response.

Only two patients have reached the 12-month follow-up so far, one with a complete response and one with a partial response.

Those results are promising, Woodrum said.

The study has a planned follow-up duration of 5 years, and other factors the researchers will be examining include overall and disease-specific survival, the time to disease recurrence or progression, and the patients' physical function and quality of life.

Before cryoablation for local control of pulmonary metastases gains acceptance in the clinic, Woodrum said, the complication rate would need to stay low and tumor control would need to remain good over the longer term.

Cryoablation of metastases is not a cure for the cancer, he said, noting that new metastases may pop up.

"But hopefully by treating the disease that we can see, we can prolong their fight with the cancer and prolong their good lifestyle," he said. "Hopefully we've made their quality of life better."
Last edited by Joan M; 04-17-2013 at 06:21 PM..

['lizbeth]

Jessica,

I don't have anything to add on treatment. Just wanted to pipe up and am sending my prayers and support to you.

[Laurel]

In your corner, Jessica. Praying

[Mandamoo]

Hope you find something to help. Sending you much love. Xxx

[CoolBreeze]

Scary news, I know. I had a liver resection (as I see you did too) and they would not do it on me without seeing regression first, but lung may be very different, I don't know.

I don't see in your signature that you did Doxil or Abraxane. Abraxane is another form of Taxol but might be worth a shot. Are you on Perjeta?

I'm about to have SBRT for my stubborn liver met, maybe that's something you can look into as well?

Good luck, this whole thing just sucks.