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Joined: 10/11/2009
Posts: 2
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My father (52) was diagnosed pancreatic cancer stage 4 on Oct 8th 2009 based on CT scan and blood test result.
He
had received one chemotherapy on Oct 8th 2009 of gemcitabine &
capecitabine plus the Tarceva. He is going to have the 2nd chemo on Oct
15th 2009.
After taking the chemo, he feels much better. He didn't feel pain
anymore in his stomach (he had pain in his upper abdomen before,
especially after eating & drinking) His apetite is normal, and he
has been eating lots of vegetables, fruits since then. He also
decreases the consumption of red meat & fatty food.
Based on the following info, what suggestion do you have for my father?
Can Cyberknife help him? How can he benefit from cyberknife?
Thank you in advance
His CT scan findings are like these:
There is a persistently hypodense irregular mass measuring 1.6 x 1.6 cm in the neck of the pancreas.
Although it lies adjacent to the proximal portal vein, there is no evidence of vascular invasion or thrombosis.
The pancreatic duct in the body and tail appears slightly prominent.
No other pancreatic lesions are seen.
Small volume peripancreatic lymphadenopathy is seen.
CBD is not dilated.
Multiple ring enhancing hypodense lesions are noted scattered
throughout both hepatic lobes, consistent with metastatic deposits.
Gallbladder is collapsed with suggestion of calculi but cannot be further evaluated.
Biliary tree is not dilated.
No splenic or adrenal lesions are identified.
Both kidneys enhance normally and symmetrically, with no suspicious solid lesions or hydronephrosis seen.
The visualised bowel appears unremarkable.
No upper abdominal ascites is seen.
The lung bases are clear.
No suspicious bony erosions are detected. Degenerative change is noted at L5-S1 level incidentally.
Conclusion:
The multiple ring enhancing hypodense lesions in the liver are consistent with metastatic deposits.
The primary lesion appears to rise from the neck of the pancreas. There
is no evidence of local invasion or vascular involvement on this study.
Small volume peripancreatic lymph nodes are present. Mild dilatation of
the distal pancreatic duct is also noted.
The cardiac and mediastinal outlines are within normal limits. No active lung lesion is seen
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Joined: 10/11/2008
Posts: 928
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Based upon this information, CK would have little to offer at this point in the face of multiple liver metastases. There might be a later role for CK if the pancreatic mass enlarges and produces symptoms or if a dominant liver lesion were symptomatic and needed to be controlled.
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
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Joined: 10/11/2009
Posts: 2
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Thank you for the reply Dr. Spunberg.
Why would my father not benefited from CK at this point? Can we use CK to destroy or control the mass in his pancreas now? Why should we wait until the mass enlarges, isn't it more dangerous?
I'm afraid his body condition will be dropped & not fit for CK if the cancer cell keep growing.
What prognosis do you advise for my dad?
Thanks again
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Joined: 10/10/2008
Posts: 2347
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The liver disease is more threatening, and treatment of the pancreas mass won't offer any real advantage.
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
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Joined: 10/11/2008
Posts: 928
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In the overall picture, the liver is the more immediate problem.
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
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