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Joined: 7/2/2009
Posts: 2
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My father is 79 and was treated with Cyberknife in Shanghai in Jan 19-22,
2009. The tumor size was 3*4.5 in cm before the CK, in his left lung.
The size effect for my Dad is shingles. He is 90% healed from that
now. Other than that he has felt normal.
He started taking Tacevar in February. Has not stopped since. He
has never had chemotherapy.
The follow up CT scan in May showed that the tumor has shrunk to 1.7*2.3 in
cm. He has had two follow ups one June and the other yesterday, and the tumor
has stayed in the same size.
The blood test result this months starts to show a little bit increase in CEA
(from 5- 13, was over 100 at its highest, right after CK treatment),
CA125 (from 37 -6), CA 19-9 (from 25 -47), CA 15-3 (from 22-31) and
CYFRA21-1 (from 2.4 - 3). even though the tumor has not grown. CA 72-4
decreased from 20-9.8. We are getting a little bit concerned that this
might indicate the cancer is making a come back.
What would be the best line of action here?
Option 1: Should we wait more to see whether the tumor will start shrinking
again? Is it likely?
Option 2: start Chemotherapy
Option 3: retreat the tumor with CK. The doctor at CK center said we
could retreat the tumor with CK because he reduced the dosage on my Dad's
treatment as he was suspecting metastases in lymph nodes at the time. But
the recent month follow ups seem to have convinced him otherwise.
Thank you so much for your help!
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Joined: 10/10/2008
Posts: 2347
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4. Get a PET scan if possible. That should help answer the question. I wouldnot re-treat a tumor that is not growing unless it was getting hotter on PET scan or was biopsy proven to be still tumor.
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: 7/2/2009
Posts: 2
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Thanks for your response Dr. Medbery. I have been waiting for my father to have a PET scan to update this post. This is the lastest update on 10/23/09:
PET scan was taken on 10/21/09, the result as follows:
- tumor size 2.8*2.3cm, was 4.5*3cm back in Jan 09 before CK.
- SUV for the tumor is between 3.7 -5.7, was 12.6 in Jan.
- SUV for the lymph nodes is 2.8, was 5.8 in Jan.
The doctor at the CK center reduced the dosage on the treatment back in Jan. because they suspected some lymph nodes involvement. I believe the dose was 26Gy.
Other information:
- My father has been taking regular CT scan every month between April 09 - Sept. 09. The tumor size has remained the same: 2.3*1.7CM. (Somehow PET scan shows larger size, could it be the margin of error or difference in measurement?)
- He has been taking Tarceva 150mg daily since March. Never had chemo.
- He has been having blood test every month. They were trending down in general. For September test, CEA was 8.94. All the other tumor marks were within normal range with one exception, C-214, was 26.68. He has not had the blood test this month.
Our question is:
- should we go back to CK center to get the tumor re-treated because of the still high
SUV value?
- Would there be additional side effect to have the CK treatment for the second time
on the same spot? My father got shingles after the Jan. treatment, should we
expect to happen again? Any way we could prevent it?
- What would you suggest the dose would be for this time, if possible?
- what is your opinion on the lymph nodes involvement? The doctor at CK center
seems to rule it out now because it has never been treated but has been staying
stable for the past 9 month.
Thank you so much for your help!
sydney
IT consultant, Fairfax VA
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Joined: 10/10/2008
Posts: 2347
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You should talk to the CK center. I would probably favor getting a biopsy because I am not at all convinced that this is persistent tumor, although it may be. I would not expect shingles again.
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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