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Suggest Treatment For Leiomyosarcoma On Right Lung With Mediastinal Lymphadenopathy

Posted on Thu, 29 Jan 2015

Question: Hi Doctor, Recently I have come to know as my father has "Leiomyosarcoma on Right Lung with mediastinal lymphadenopathy". Please help me in this regard, I can send all the reports taken so far, if an email is provided. He doesnot smoke or drink alcohol.

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
Need to confirm the diagnosis

Detailed Answer:
Hi

Thanks for your query. I am sorry to know about your father.

I have gone through all the reports.

I have a few observations/suggestions..

1. This is a very rare diagnosis. Hence it is better to re-confirm the diagnosis from any other pathology lab of good repute.

2. Even if this is sarcoma, a sarcoma in lung is more often due to spread from other source than primarily arising from the lung. Hence a whole body PET-CT to search for other source would have been preferred. I do note that MRI of abdomen has been done.

3. Regarding the treatment, concurrent chemo and radiotherapy, that too with cisplatin is not something I would have preferred. Probably I would consider chemotherapy with doxorubicin and/or ifosfamide followed by RT or even no RT.

4. Unfortunately a lung sarcoma which has spread to the mediastinal nodes is not curable hence we only try to control it for as long as possible.

Hope I have answered your query. I will be available to answer further followup queries, if any.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Indranil Ghosh (43 minutes later)

Hi doctor, thank you for the response.

Yesterday, we have had a PET-CT scan. Even though current doctor did not do that, based on suggestions from my friends, I have did it, and I have just gotthe report.

I am attaching the reports. Please have a look doctor.

Please help me in this regard.Thank You very much.
XXXX

I have uploaded the PET-CT of whole body just now doctor. Please let me know if they are not clear, so that I can do a fresh scan and upload. Thank You much Doctor. Awaiting eagerly for your response.

Answered by Dr. Indranil Ghosh (13 minutes later)

Brief Answer:
please refer below

Detailed Answer:
Thanks for follow-up.

Given this report, I would strongly consider 2-3 cycles of chemotherapy (after reconfirming the diagnosis), followed by another PET-CT to decide on further course.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Indranil Ghosh (25 minutes later)

Hi doctor,

Thanks a lot for quick responses.

Doctor, can you please let me know what does reconfirming diagnosis mean, (sorry, being a layman I am asking the question, please dont mind). We have already had biopsy, CT Scans, MRI Scans and PET-CT scan now. Do you think we have to do anything else to make it more confirmed.

What does 2-3 Cycles mean doctor, does it mean 3 times.

What do you think about current drug used Cisplatin 50mg doctor.

Thank You,
XXXX

Answered by Dr. Indranil Ghosh (25 minutes later)

Brief Answer:
please refer below

Detailed Answer:
Sorry I should have explained that.

By reconfirming I mean submitting the biopsy blocks and slides to another good pathology lab and taking their opinion.

Chemotherapy for sarcoma is usually with doxorubicin and/or ifosfamide. Cisplatin is usually not preferred for sarcoma.

I wanted to mean 2 or 3 courses at 21 day interval of above mentioned drugs (and only chemo, not with RT).

Hope this helps
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Indranil Ghosh (20 hours later)

Just one more question doctor, given the present situation and size - based on PET-CT scan, do you think if Surgery is possible?

Answered by Dr. Indranil Ghosh (2 hours later)

Brief Answer:
probably after few cycles of chemo

Detailed Answer:
Though I am not a surgeon, the size of the tumor and its proximity to vital organs, especially the esophagus or food pipe makes me believe that surgery is not feasible now.

We can consider it if there is a good response to chemo.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar