SRS vs VATS for single lung nodule?
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SRS vs VATS for single lung nodule?

› Forums › Cutaneous Melanoma Community › SRS vs VATS for single lung nodule?

  • Post
    • November 1, 2012 at 3:06 pm
    dian in spokane
    Participant

    Hi,

    It's been a while since I was on here, so some of you newer folks won't recognise my name. Briefly, I have a very long history with melanoma, most of it was stage 1, but I advanced to stage 3B back in 2003, followed by high dose interferon and then to stage 4 in 08 with distant subcutaneous mets that were surgically resected, and followed with the MAC/VAC trial, which I completed in 2010 I've been in complete remission since then

    Hi,

    It's been a while since I was on here, so some of you newer folks won't recognise my name. Briefly, I have a very long history with melanoma, most of it was stage 1, but I advanced to stage 3B back in 2003, followed by high dose interferon and then to stage 4 in 08 with distant subcutaneous mets that were surgically resected, and followed with the MAC/VAC trial, which I completed in 2010 I've been in complete remission since then

    We've been following a single nodule in my lung since last year, which, although it has grown slowly from 8.8 mm to 13, has now increased in SUV to 10.1 My oncologist is virtually certain it is cancer and suggested SRS to treat it.

    I also have a long history of false alarms in my lungs too, so I'd like confirmation of what we are dealing with before treatment so I am scheduled to see my pulmonary doc for a possible biopsy.

    Back when I was studying such things obsessively, I think that radiation was not considered to be very successful foro melanoma treatment. Have things changed?

    I know that there's a chance that biopsy attempts will be unsuccessful, so I'm wondering if I shouldn't just get a thoracic surgeon consult and go directly for VATS..then at least we'd have material to biopsy afterwards

    I'd love any imput, particularly on any new types of biopsy options for lung mets, and/or input from anyone who has had SRS on the lungs.

    And..to forestall questions on the topic, I have never been BRAF tested, and don't think we'll be looking at either zelboraf of yervoy at this time. As long as it's a single nodule, I'll be saving that treatment for the future.

    thanks folks,

     

    dian in spokane

Viewing 17 reply threads
  • Replies
      • November 1, 2012 at 10:08 pm
      vivian
      Participant

      Hi Dian,

      You and I have the same questions, sorry to say.  I was diagnosed 3a in November 2010, progressed to 3c with a single sub-q in March 2012.  While doing the restaging scans, they saw two 5mm lung nodules.  Because they were so small, we just watched and rescanned every two months since.  Only one of the nodules has grown, but it has continued to increase in size up to 9mm, and the growth appears to be speeding up.  Everyone feels fairly sure it is cancer.  So…what to do?  The thoracic surgeon said the needle biopsy would be very difficult and possibly inconclusive because of the size and location, and he recommended VATS.  I talked with Dr. Wolchok at Sloan and my oncologist here about SRS, and they both felt removal is the better bet because of the probablility it is melanoma.  Dr. Wolchok made me feel pretty positive about the whole deal by saying some people just  go along for years and years with single melanomas popping up and being surgically removed. I am hoping to be one of those – not that I enjoy surgery , and I heard thoracic surgery is a bit painful!  My hesitation is in doing this at all right now – I feel fine.

       I am BRAF positive, which is good, but yervoy is not in the cards because I had a bone marrow transplant 10 years ago.  The docs fear yervoy would cause my body to reject my transplanted immune system.  In any case, no need to focus on that yet.  My surgery is scheduled for Nov. 19, and I have fingers crossed that it isn't mel at all!  

      Keep us posted as to what you decide.  I'm sending you positive thoughts and vibes!

      Lear

      • November 1, 2012 at 10:08 pm
      vivian
      Participant

      Hi Dian,

      You and I have the same questions, sorry to say.  I was diagnosed 3a in November 2010, progressed to 3c with a single sub-q in March 2012.  While doing the restaging scans, they saw two 5mm lung nodules.  Because they were so small, we just watched and rescanned every two months since.  Only one of the nodules has grown, but it has continued to increase in size up to 9mm, and the growth appears to be speeding up.  Everyone feels fairly sure it is cancer.  So…what to do?  The thoracic surgeon said the needle biopsy would be very difficult and possibly inconclusive because of the size and location, and he recommended VATS.  I talked with Dr. Wolchok at Sloan and my oncologist here about SRS, and they both felt removal is the better bet because of the probablility it is melanoma.  Dr. Wolchok made me feel pretty positive about the whole deal by saying some people just  go along for years and years with single melanomas popping up and being surgically removed. I am hoping to be one of those – not that I enjoy surgery , and I heard thoracic surgery is a bit painful!  My hesitation is in doing this at all right now – I feel fine.

       I am BRAF positive, which is good, but yervoy is not in the cards because I had a bone marrow transplant 10 years ago.  The docs fear yervoy would cause my body to reject my transplanted immune system.  In any case, no need to focus on that yet.  My surgery is scheduled for Nov. 19, and I have fingers crossed that it isn't mel at all!  

      Keep us posted as to what you decide.  I'm sending you positive thoughts and vibes!

      Lear

      • November 1, 2012 at 10:08 pm
      vivian
      Participant

      Hi Dian,

      You and I have the same questions, sorry to say.  I was diagnosed 3a in November 2010, progressed to 3c with a single sub-q in March 2012.  While doing the restaging scans, they saw two 5mm lung nodules.  Because they were so small, we just watched and rescanned every two months since.  Only one of the nodules has grown, but it has continued to increase in size up to 9mm, and the growth appears to be speeding up.  Everyone feels fairly sure it is cancer.  So…what to do?  The thoracic surgeon said the needle biopsy would be very difficult and possibly inconclusive because of the size and location, and he recommended VATS.  I talked with Dr. Wolchok at Sloan and my oncologist here about SRS, and they both felt removal is the better bet because of the probablility it is melanoma.  Dr. Wolchok made me feel pretty positive about the whole deal by saying some people just  go along for years and years with single melanomas popping up and being surgically removed. I am hoping to be one of those – not that I enjoy surgery , and I heard thoracic surgery is a bit painful!  My hesitation is in doing this at all right now – I feel fine.

       I am BRAF positive, which is good, but yervoy is not in the cards because I had a bone marrow transplant 10 years ago.  The docs fear yervoy would cause my body to reject my transplanted immune system.  In any case, no need to focus on that yet.  My surgery is scheduled for Nov. 19, and I have fingers crossed that it isn't mel at all!  

      Keep us posted as to what you decide.  I'm sending you positive thoughts and vibes!

      Lear

      • November 1, 2012 at 11:26 pm
      akls
      Participant

      Dian,

       

      Just wanted to say I'm sorry about the lung nodule.  My mom had a primary lung cancer last fall that they removed by VATS.  She has been doing well since and it was a pretty easy recovery.  I know it's not exactly the same situation, but the surgery is the same.  She had the nodule biopsied first.  They were able to tell her the day of the biopsy that it was a primary lung cancer and not a met from her earlier endometrial cancer.  They were wrong about the type of lung cancer though.  It ended up being a less invasive form which was discovered during her surgery. 

      Good luck with whatever you decide.

      Amy S. in Michigan

      • November 1, 2012 at 11:26 pm
      akls
      Participant

      Dian,

       

      Just wanted to say I'm sorry about the lung nodule.  My mom had a primary lung cancer last fall that they removed by VATS.  She has been doing well since and it was a pretty easy recovery.  I know it's not exactly the same situation, but the surgery is the same.  She had the nodule biopsied first.  They were able to tell her the day of the biopsy that it was a primary lung cancer and not a met from her earlier endometrial cancer.  They were wrong about the type of lung cancer though.  It ended up being a less invasive form which was discovered during her surgery. 

      Good luck with whatever you decide.

      Amy S. in Michigan

      • November 1, 2012 at 11:26 pm
      akls
      Participant

      Dian,

       

      Just wanted to say I'm sorry about the lung nodule.  My mom had a primary lung cancer last fall that they removed by VATS.  She has been doing well since and it was a pretty easy recovery.  I know it's not exactly the same situation, but the surgery is the same.  She had the nodule biopsied first.  They were able to tell her the day of the biopsy that it was a primary lung cancer and not a met from her earlier endometrial cancer.  They were wrong about the type of lung cancer though.  It ended up being a less invasive form which was discovered during her surgery. 

      Good luck with whatever you decide.

      Amy S. in Michigan

      • November 2, 2012 at 2:46 am
      Harry in Fair Oaks
      Participant

      Get it taken out by VATS, with good margins if possible.  I had an 11 mm nodule taken out in 2000.  I bought me almost 11 years of NED.  Melanoma can be resistant to radiation – surgical removal, where possible, is more certain.

      Best wishes,

      Harry

      • November 2, 2012 at 2:46 am
      Harry in Fair Oaks
      Participant

      Get it taken out by VATS, with good margins if possible.  I had an 11 mm nodule taken out in 2000.  I bought me almost 11 years of NED.  Melanoma can be resistant to radiation – surgical removal, where possible, is more certain.

      Best wishes,

      Harry

      • November 2, 2012 at 2:46 am
      Harry in Fair Oaks
      Participant

      Get it taken out by VATS, with good margins if possible.  I had an 11 mm nodule taken out in 2000.  I bought me almost 11 years of NED.  Melanoma can be resistant to radiation – surgical removal, where possible, is more certain.

      Best wishes,

      Harry

      • November 2, 2012 at 4:12 am
      MaryD
      Participant

      Hi Dian,

      Well I recognize you because I'm an "old timer" on this board too 🙂    Sorry to hear the nodule has grown but would have to say that I vote for VATS too.   Five years ago I had VATS for a solitary nodule on my lung and have had no recurrences in the lung since.   At the time it had skipped the lymph nodes and gone to the lung so one year after the lung nodule was removed, it did show up in one lymph node while I was on Ipi (for resected melanoma) and had a complete LND.  Since then I've been NED for 4 years now.

      I was very happy I did the VATs surgery and I was only in the hospital for two days.  Recovery is pretty quick – most of the post-op pain related to the three little incisions where they went in between the ribs.  That was well controlled with pain meds.

      Keep us posted on what you decide and wishing you to be NED very soon!

      Mary

      • November 2, 2012 at 4:12 am
      MaryD
      Participant

      Hi Dian,

      Well I recognize you because I'm an "old timer" on this board too 🙂    Sorry to hear the nodule has grown but would have to say that I vote for VATS too.   Five years ago I had VATS for a solitary nodule on my lung and have had no recurrences in the lung since.   At the time it had skipped the lymph nodes and gone to the lung so one year after the lung nodule was removed, it did show up in one lymph node while I was on Ipi (for resected melanoma) and had a complete LND.  Since then I've been NED for 4 years now.

      I was very happy I did the VATs surgery and I was only in the hospital for two days.  Recovery is pretty quick – most of the post-op pain related to the three little incisions where they went in between the ribs.  That was well controlled with pain meds.

      Keep us posted on what you decide and wishing you to be NED very soon!

      Mary

        • November 2, 2012 at 7:02 pm
        dian in spokane
        Participant

        thanks to all of you for your input. Can you tell me, those of you who had VATS, was the melanoma in your lungs confirmed by biopsy before the VATS? and if so..how was the biopsy done?

         

        dian

        • November 2, 2012 at 7:02 pm
        dian in spokane
        Participant

        thanks to all of you for your input. Can you tell me, those of you who had VATS, was the melanoma in your lungs confirmed by biopsy before the VATS? and if so..how was the biopsy done?

         

        dian

        • November 2, 2012 at 7:02 pm
        dian in spokane
        Participant

        thanks to all of you for your input. Can you tell me, those of you who had VATS, was the melanoma in your lungs confirmed by biopsy before the VATS? and if so..how was the biopsy done?

         

        dian

        • November 2, 2012 at 11:40 pm
        kylez
        Participant
        Dian, for me VATS was the biopsy and confirmation. The suspicious lesions They were seeing in both my lungs were all less than 1 cm, and were considered too difficult to do a needle biopsy on, and also suspicious enough to justify the VATS (suspicious because I had had 2 stage 1 primaries, and the 8 suspicious lung lesions grew slightly during 3 month wait and watch period.)
        • November 2, 2012 at 11:40 pm
        kylez
        Participant
        Dian, for me VATS was the biopsy and confirmation. The suspicious lesions They were seeing in both my lungs were all less than 1 cm, and were considered too difficult to do a needle biopsy on, and also suspicious enough to justify the VATS (suspicious because I had had 2 stage 1 primaries, and the 8 suspicious lung lesions grew slightly during 3 month wait and watch period.)
        • November 2, 2012 at 11:40 pm
        kylez
        Participant
        Dian, for me VATS was the biopsy and confirmation. The suspicious lesions They were seeing in both my lungs were all less than 1 cm, and were considered too difficult to do a needle biopsy on, and also suspicious enough to justify the VATS (suspicious because I had had 2 stage 1 primaries, and the 8 suspicious lung lesions grew slightly during 3 month wait and watch period.)
        • November 5, 2012 at 8:31 pm
        MaryD
        Participant

        No – I didn't do a biospsy because I felt it was small and could be inconclusive.   The fact that it had grown from 3mm to 8mm was enought for me to just move forward with the VATS.

        Mary

        • November 5, 2012 at 8:31 pm
        MaryD
        Participant

        No – I didn't do a biospsy because I felt it was small and could be inconclusive.   The fact that it had grown from 3mm to 8mm was enought for me to just move forward with the VATS.

        Mary

        • November 5, 2012 at 8:31 pm
        MaryD
        Participant

        No – I didn't do a biospsy because I felt it was small and could be inconclusive.   The fact that it had grown from 3mm to 8mm was enought for me to just move forward with the VATS.

        Mary

      • November 2, 2012 at 4:12 am
      MaryD
      Participant

      Hi Dian,

      Well I recognize you because I'm an "old timer" on this board too 🙂    Sorry to hear the nodule has grown but would have to say that I vote for VATS too.   Five years ago I had VATS for a solitary nodule on my lung and have had no recurrences in the lung since.   At the time it had skipped the lymph nodes and gone to the lung so one year after the lung nodule was removed, it did show up in one lymph node while I was on Ipi (for resected melanoma) and had a complete LND.  Since then I've been NED for 4 years now.

      I was very happy I did the VATs surgery and I was only in the hospital for two days.  Recovery is pretty quick – most of the post-op pain related to the three little incisions where they went in between the ribs.  That was well controlled with pain meds.

      Keep us posted on what you decide and wishing you to be NED very soon!

      Mary

      • November 6, 2012 at 3:36 am
      DonW
      Participant

      Dian — I don't think the decision of VATS vs SRS is one of effectiveness. They both would probably be effective. General radiation is not very effective against melanoma, but SRS is targeted and is effective. Gamma Knife, for example, is a type of SRS and is very effective for brain mets. The drawback would be that there's no confirmation that it was melanoma. I think you probably want to know that for sure. What about the broncoscope? Have you ruled that out?

      I also think a visit to Dr. Byrd would be a good idea. I could meet you there and we could also visit the bar down the street:-)

      • November 6, 2012 at 3:36 am
      DonW
      Participant

      Dian — I don't think the decision of VATS vs SRS is one of effectiveness. They both would probably be effective. General radiation is not very effective against melanoma, but SRS is targeted and is effective. Gamma Knife, for example, is a type of SRS and is very effective for brain mets. The drawback would be that there's no confirmation that it was melanoma. I think you probably want to know that for sure. What about the broncoscope? Have you ruled that out?

      I also think a visit to Dr. Byrd would be a good idea. I could meet you there and we could also visit the bar down the street:-)

      • November 6, 2012 at 3:36 am
      DonW
      Participant

      Dian — I don't think the decision of VATS vs SRS is one of effectiveness. They both would probably be effective. General radiation is not very effective against melanoma, but SRS is targeted and is effective. Gamma Knife, for example, is a type of SRS and is very effective for brain mets. The drawback would be that there's no confirmation that it was melanoma. I think you probably want to know that for sure. What about the broncoscope? Have you ruled that out?

      I also think a visit to Dr. Byrd would be a good idea. I could meet you there and we could also visit the bar down the street:-)

        • November 7, 2012 at 8:01 pm
        dian in spokane
        Participant

        Don,

        Bronchoscopy has been ruled out, I'm having a ct guided fine needle biopsy tomorrow morning.

        So.. I think both my med onc and my pulmonary doc are against the idea of surgery if it's melanoma..saying they can't be sure there is not more of it. So maybe if SRS IS effective, that's what I need to look at?

        I'll know more soon tommorrow

        • November 8, 2012 at 6:03 pm
        killmel
        Participant

        Hi Diane,

         

        I hope that your biospy turned out to be negative.

        However, if the biospy comes back mel, based on your doctors thinking that surgery is not a good idea because there might be more, I think that you should consider systemic treatment.

        Right now, you would be able to get into trials because you have measureable disease. If you do SRS, then you would have to wait to see if it is effective & the clock is ticking if there is more cancer cells in you.

        That is my 2 cents. GoodLuck with your decision.

        • November 8, 2012 at 6:03 pm
        killmel
        Participant

        Hi Diane,

         

        I hope that your biospy turned out to be negative.

        However, if the biospy comes back mel, based on your doctors thinking that surgery is not a good idea because there might be more, I think that you should consider systemic treatment.

        Right now, you would be able to get into trials because you have measureable disease. If you do SRS, then you would have to wait to see if it is effective & the clock is ticking if there is more cancer cells in you.

        That is my 2 cents. GoodLuck with your decision.

        • November 8, 2012 at 6:03 pm
        killmel
        Participant

        Hi Diane,

         

        I hope that your biospy turned out to be negative.

        However, if the biospy comes back mel, based on your doctors thinking that surgery is not a good idea because there might be more, I think that you should consider systemic treatment.

        Right now, you would be able to get into trials because you have measureable disease. If you do SRS, then you would have to wait to see if it is effective & the clock is ticking if there is more cancer cells in you.

        That is my 2 cents. GoodLuck with your decision.

        • November 7, 2012 at 8:01 pm
        dian in spokane
        Participant

        Don,

        Bronchoscopy has been ruled out, I'm having a ct guided fine needle biopsy tomorrow morning.

        So.. I think both my med onc and my pulmonary doc are against the idea of surgery if it's melanoma..saying they can't be sure there is not more of it. So maybe if SRS IS effective, that's what I need to look at?

        I'll know more soon tommorrow

        • November 7, 2012 at 8:01 pm
        dian in spokane
        Participant

        Don,

        Bronchoscopy has been ruled out, I'm having a ct guided fine needle biopsy tomorrow morning.

        So.. I think both my med onc and my pulmonary doc are against the idea of surgery if it's melanoma..saying they can't be sure there is not more of it. So maybe if SRS IS effective, that's what I need to look at?

        I'll know more soon tommorrow

      • November 8, 2012 at 9:30 pm
      killmel
      Participant

      Please let us know the results your biopsy. Our prayers are with you & we care about you.

      • November 8, 2012 at 9:30 pm
      killmel
      Participant

      Please let us know the results your biopsy. Our prayers are with you & we care about you.

      • November 8, 2012 at 9:30 pm
      killmel
      Participant

      Please let us know the results your biopsy. Our prayers are with you & we care about you.

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