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Is Chemotherapy Necessary After Removing Tumor Through Lung Surgery?
Question: Hi doctor, on 20th of this January 2015 ( its been 23 days by today) my father has undergone lung surgery ( Right Lateral Thoracotomy + Right Lobectomy) for Leiomyosaracoma of Right lung. Can you please suggest me what should be his further treatment.(Attaching the "surgery discharge summary + Histopathology lab report for removed tumor + IHC markers report).
After consulting a doctor, we were advised to start chemotherapy (attaching the prescription for drugs suggested) . Please let us know your opinion.
Before undergoing Surgery, he just had one dose (one time on one day) of Cisplatin 50mg (AND) 5 days of Radiaition, prior to 4 weeks of surgery (on 23rd december). Where we discontinued it and went for surgery as per the advice of a doctor from different hospital. (Attaching all earlier reports and scans)
Please let me know if you require any other reports to be uploaded.
Also, can you please let me know the chemotherapy drugs suggested by the doctor in the prescription. Sorry, I am unable to understand it - And I could not recollect the names mentioned by doctor when asked about.
After consulting a doctor, we were advised to start chemotherapy (attaching the prescription for drugs suggested) . Please let us know your opinion.
Before undergoing Surgery, he just had one dose (one time on one day) of Cisplatin 50mg (AND) 5 days of Radiaition, prior to 4 weeks of surgery (on 23rd december). Where we discontinued it and went for surgery as per the advice of a doctor from different hospital. (Attaching all earlier reports and scans)
Please let me know if you require any other reports to be uploaded.
Also, can you please let me know the chemotherapy drugs suggested by the doctor in the prescription. Sorry, I am unable to understand it - And I could not recollect the names mentioned by doctor when asked about.
Brief Answer:
Yes, I think chemo should be given
Detailed Answer:
Hi
Thanks for getting back.
I remember your dad's case. Some time back I had reviewed the reports and had opined against the radiation + cisplatin.
So it seems he his back on track. The surgery seems to have been successful. However, it is a large tumor with only a single lymph gland removed which was involved with tumor. There may be other lymph glands left in the chest which may harbor the disease. Hence further chemo is required.
Dr XXXXXXX has prescribed a combination of ifosfamide and adriamycin (doxorubicin), same as I had suggested in my initial opinion.
Please let me know if you want to know anything else.
All the best.
Regards
Yes, I think chemo should be given
Detailed Answer:
Hi
Thanks for getting back.
I remember your dad's case. Some time back I had reviewed the reports and had opined against the radiation + cisplatin.
So it seems he his back on track. The surgery seems to have been successful. However, it is a large tumor with only a single lymph gland removed which was involved with tumor. There may be other lymph glands left in the chest which may harbor the disease. Hence further chemo is required.
Dr XXXXXXX has prescribed a combination of ifosfamide and adriamycin (doxorubicin), same as I had suggested in my initial opinion.
Please let me know if you want to know anything else.
All the best.
Regards
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you very much for the response doctor !
True, I had already reached you. In fact, I tried reaching you again today by trying to open the earlier discussion we had, but I could not do so in this tool. Thank you & happy to see reply from you doctor.
I have few doubts regarding chemotherapy doctor - please forgive me, if my questions are not to the mark doctor. I was actually going through the site – “http://www.leiomyosarcoma.info/chemo10therapy.htm”
1) It’s been only 23 days now after surgery , how soon do you think we have to go for this chemotherapy treatment.
2) I am worried about de-differentiation concept, mentioning the chances of tumors getting more active – because of chemotherapy. Also, caution while using multiple drugs like “Ifosfamide + adriamycin(doxorubicin)” - to choose only it is really must in the situation present.
Please help me in understanding the same.
Thank You,
XXXX
In fact you response was one of the major reason for going to a second opinion and having surgery as advised doctor.
True, I had already reached you. In fact, I tried reaching you again today by trying to open the earlier discussion we had, but I could not do so in this tool. Thank you & happy to see reply from you doctor.
I have few doubts regarding chemotherapy doctor - please forgive me, if my questions are not to the mark doctor. I was actually going through the site – “http://www.leiomyosarcoma.info/chemo10therapy.htm”
1) It’s been only 23 days now after surgery , how soon do you think we have to go for this chemotherapy treatment.
2) I am worried about de-differentiation concept, mentioning the chances of tumors getting more active – because of chemotherapy. Also, caution while using multiple drugs like “Ifosfamide + adriamycin(doxorubicin)” - to choose only it is really must in the situation present.
Please help me in understanding the same.
Thank You,
XXXX
In fact you response was one of the major reason for going to a second opinion and having surgery as advised doctor.
Brief Answer:
Please refer below
Detailed Answer:
Thanks. My answers
1. Ideal time to start chemo after surgery is 3-4 weeks but if the recovery from surgery is delayed then we can extend it upto 6 weeks
2. No, this concept is not right. Tumors don't get more active because of chemo. But it may happen that even if chemo destroys most of the cancer cells, some cells are resistant and later they proliferate and cause a relapse. This would have happened anyway, and not due to chemo.
3. Yes, multi drug vs single drug is still an open question. In fact in my original reply I had said one drug +/- the other. If the patient is fit enough we sometimes give 2 drug combination. Otherwise single drug.
Regards
Please refer below
Detailed Answer:
Thanks. My answers
1. Ideal time to start chemo after surgery is 3-4 weeks but if the recovery from surgery is delayed then we can extend it upto 6 weeks
2. No, this concept is not right. Tumors don't get more active because of chemo. But it may happen that even if chemo destroys most of the cancer cells, some cells are resistant and later they proliferate and cause a relapse. This would have happened anyway, and not due to chemo.
3. Yes, multi drug vs single drug is still an open question. In fact in my original reply I had said one drug +/- the other. If the patient is fit enough we sometimes give 2 drug combination. Otherwise single drug.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you much for response doctor !
Is there any way through some test, we can find out the if still the cancerous cells are present in the body after the current surgery doctor. If so, based on it can we take the call of - whether current chemo is really required or not.
Sorry doctor, my dad is very much reluctant to the further treatment - especially chemo, before taking the challenge of convincing him once more, I wanted to know if this chemo we are going is absolutely necessary in the current situation/stage.
Thank You,
XXXX
Is there any way through some test, we can find out the if still the cancerous cells are present in the body after the current surgery doctor. If so, based on it can we take the call of - whether current chemo is really required or not.
Sorry doctor, my dad is very much reluctant to the further treatment - especially chemo, before taking the challenge of convincing him once more, I wanted to know if this chemo we are going is absolutely necessary in the current situation/stage.
Thank You,
XXXX
Brief Answer:
unfortunately there is no such test
Detailed Answer:
These cells are in the microscopic level and not detectable by any scan. PET scan has Already been done.
But we have to remember that there are more than 50 lymph glands in the chest. One has been examined and it is involved by cancer. So other ones can be involved as well. That's why chemo is being recommended.
Now the benefit of chemo is not 100%. Even after chemo disease may come back. Hence patient choice is also important.
unfortunately there is no such test
Detailed Answer:
These cells are in the microscopic level and not detectable by any scan. PET scan has Already been done.
But we have to remember that there are more than 50 lymph glands in the chest. One has been examined and it is involved by cancer. So other ones can be involved as well. That's why chemo is being recommended.
Now the benefit of chemo is not 100%. Even after chemo disease may come back. Hence patient choice is also important.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you much for your prompt and quick responses doctor !
So I understand that there is a large possibility of having these cells in the other lymph nodes, and it is advisable to go for the treatment ( even though this does not guarantee of removal of all such cells).
Generally, when can we see the impact of current present cells doctor on patient. And do we have any disadvantage of earlier chemo done at that point.
Thank You,
XXXX.
So I understand that there is a large possibility of having these cells in the other lymph nodes, and it is advisable to go for the treatment ( even though this does not guarantee of removal of all such cells).
Generally, when can we see the impact of current present cells doctor on patient. And do we have any disadvantage of earlier chemo done at that point.
Thank You,
XXXX.
Brief Answer:
very difficult to predict
Detailed Answer:
It may take 6 months to few years for these cells to manifest.
Giving chemo now may prolong this interval but not totally prevent relapse. Hence, giving chemo only when disease comes back is also one option. No strong recommendation for one versus another approach can be given at this time because of want of evidence.
Much depends on the patient, whether he wants to take the therapy now to have longer disease free interval or wants to take chemo only when disease is proven.
This type of sarcoma (in lung) is a rare disease and that compounds the problem in decision-making.
very difficult to predict
Detailed Answer:
It may take 6 months to few years for these cells to manifest.
Giving chemo now may prolong this interval but not totally prevent relapse. Hence, giving chemo only when disease comes back is also one option. No strong recommendation for one versus another approach can be given at this time because of want of evidence.
Much depends on the patient, whether he wants to take the therapy now to have longer disease free interval or wants to take chemo only when disease is proven.
This type of sarcoma (in lung) is a rare disease and that compounds the problem in decision-making.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you much doctor.
If you have to suggest me as my personal doctor - what do you say doctor, is it better to do now or wait. I know this a very tough question and needs to be taken by patient, but please tell your opinion.
One more final question doctor - if PET-CT is the only scan which can tell about the presence of microscopic cancerous cells... when can this scan is preferable after going through surgery..
And is it possible, all the lymph nodes affected got removed in the surgery performed, as the lab report just talks about largest lymph node.
I extremely apologize for the flooding questions - but PLEASE try to undertsnad my situation. THANK YOU MUCH FOR YOUR SUPPORT.
If you have to suggest me as my personal doctor - what do you say doctor, is it better to do now or wait. I know this a very tough question and needs to be taken by patient, but please tell your opinion.
One more final question doctor - if PET-CT is the only scan which can tell about the presence of microscopic cancerous cells... when can this scan is preferable after going through surgery..
And is it possible, all the lymph nodes affected got removed in the surgery performed, as the lab report just talks about largest lymph node.
I extremely apologize for the flooding questions - but PLEASE try to undertsnad my situation. THANK YOU MUCH FOR YOUR SUPPORT.
Brief Answer:
my answers below
Detailed Answer:
1. I feel that if patient is fit, to start chemo now rather than later
2. PET-Ct can't really detect microscopic disease but it can detect cancer which is not picked up by conventional CT. However, if we do it now, so early after surgery, it may give false results. At least 2-3 months should elapse after surgery.
3. That is unlikely. In that case they would have reported say " 10 nodes found of which one is involved"
my answers below
Detailed Answer:
1. I feel that if patient is fit, to start chemo now rather than later
2. PET-Ct can't really detect microscopic disease but it can detect cancer which is not picked up by conventional CT. However, if we do it now, so early after surgery, it may give false results. At least 2-3 months should elapse after surgery.
3. That is unlikely. In that case they would have reported say " 10 nodes found of which one is involved"
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you much Doctor!
I really thank you and appreciate the patience you show towards your patients. I will definitely be in touch with you going forward. Please let me know, if there is any way I can get in contact with you on a regular basis apart from this tool, so that I would be happy to be in contact . I am from XXXXXXX
Thank you doctor.
XXXX
I really thank you and appreciate the patience you show towards your patients. I will definitely be in touch with you going forward. Please let me know, if there is any way I can get in contact with you on a regular basis apart from this tool, so that I would be happy to be in contact . I am from XXXXXXX
Thank you doctor.
XXXX
Brief Answer:
You are welcome
Detailed Answer:
All the best to you. I will be happy to help whenever required.
As we are based in different cities, I think this site is the best way to get in touch with me. You can always post a direct query so that it comes to me only.
Warm regards
You are welcome
Detailed Answer:
All the best to you. I will be happy to help whenever required.
As we are based in different cities, I think this site is the best way to get in touch with me. You can always post a direct query so that it comes to me only.
Warm regards
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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