Joined: 8/21/2009
Posts: 1
|
patient is a 57 year old female with a tobacco history, perianal squamous cell carcinoma (cured via chemo/radiation 2 years ago), copd/emphysema/chronic bronchitis, arthritis, high blood pressure.
here is the report from PET:
7/08/2009
in the left base of the tongue/tonsillar pillar region is an 18mm rounded mass with associated increased fluorodeoxyglucose uptake, SUV 3.9. the lesion is somewhat suspicious.
In addition, there is a 2.3 x 2.5 cm consolidated mass involving the left lung base with SUV as high as 6.2. This is pleural-based and wedge-shaped.
and the biopsy:
7/22/09
Gross exam:
the specimen is labeled left lower lobe lung mass and radiologically measures 4 x 2.5 cm. it consists of four H&E slides, four pap smears, and three core biopsies. A rapid smear was prepared and read by Dr. XXX as "large cell carcinoma."
Microscopic exam: AXN/JKG/RGA
Microscopic examination reveals foci of well-differentiated adenocarcinoma with bronchoalveolar features characterized by enlarged cells with hyperchromatic nuclei, somewhat prominent nucleoli, and mild to moderate amount of eosinophilic cytoplasm forming papillary and glandular structures. Foci of desmoplastic stromal reactions, as well as mild to moderate chronic inflammation, are present.
no lymph nodes, no spreading any other way.
breathing slightly diminished post lung and throat biopsy (post lung biopsy collapse). She said when they did the test she was still quite sore to breathe from these procedures so she held back.
the oncologist she is seeing was very excited to bring up CK, and spoke of getting her into the study based on the results of her throat biopsy (which was negative). This was at her first visit. At her second, he was not hopeful for CK and mentioned lobectomy. (she had quit smoking for 2 weeks).
if it is small, low and to the side, why not just do a resection if she will be cut? Why the whole lobe?
Why would the doctor change his mind about CK after stating if the tongue thing was malignant it would ruin her chances. It is not malignant so she should be a candidate.
She does not have a very good health insurance (medicaid). Would that hinder (payment from them are sometimes less than forthcoming we understand)? Assuming it would, and she is still stage I, why not enroll her in the study? Do her other health issues exclude her for CK?
Also, noting the size difference between the pet and the biopsy. Would her type really increase in size that much in a couple of weeks. Another doctor told her about a small node 2 years ago. She chose to ignore it (measuring in mm) while she went through treatment for the perianal cancer (which apparantly didn't touch the lung tumor?)
these questions as much as you can and any other pertinent information you can give will be greatly appreciated. Her oncologist said she shouldn't take more than 6 weeks to decide. TIA
Missie
|
Joined: 10/10/2008
Posts: 2346
|
I don't know why she could not be treated with CK, but then I have not seen the scans. I would hope that the Medicaid status would not change things.
Wedge resection is about 90% effective, CK about 93% (in our series), and lobectomy about 95%. Standard treatment wold be a lobectomy if she can tolerate that. CK would be a very reasonable alternative (and would be what I would choose for myself).
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
|
Joined: 10/11/2008
Posts: 928
|
Unfortunately some centers do not accept Medicaid for Cyberknife.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
|