Week 167: radiation surprise

Written by Lars Haakon Soraas
04
Nov

Week 167 in the war on lung cancer has passed. Here are highlights:

  • As mentioned in last week’s post, we have been planning to radiate a lymph node conglomerate in the hilus of the right lung. It turned out, however, that radiating this area was more difficult than initially anticipated. The reason is that Dyanne in September 2015 received radiation to an area very close by. And the bronchus at that point in time received a quite high dose of radiation. And as there are strict limits on how much radiation the bronchus can receive, the radiation dose that can be delivered now is much less than the dose that normally would have been used. The dose that now will be used is 2.8 Gy x 3 to the part of the lesion that is closest to the bronchus, and then 6 Gy x 3 to the part of the lesion that is furthest away from the bronchus. Will the low dose of 2.8 Gy x 3 be enough to stop these cancer cells? That is a big question.
  • One other metastasis, which is in the left lung and measures 9×8 mm, will also be radiated. This will receive 6 Gy x 3, which is more of an acceptable dose.
  • We have investigated whether other approaches to local treatments could be employed instead. Microwave and radiofrequency ablation (MWA and RFA) is not possible due to the proximity of large blood vessels. Surgery also appears impossible to do. Irreversible electroporation (also known as NanoKnife) also does not seem promising, as shown by this article. The only methods we have found could be possible, is transarterial chemoperfusion (TACP) and transpulmonary chemoembolization (TPCE). The latter concept is described in this article. These approaches are experimental, but seems to be low risk. The benefit is, however, also uncertain. We have not made a final decision yet, and may still opt for this. However, first we will do radiation, which will take place this coming week.
  • We have sent some of the tumor tissue that was extracted in the biopsy done 2 weeks ago to a Cegat GmbH. Cegat will do whole exome sequencing as well as RNA sequencing of the tumor tissue. They will also check extra carefully for mutations in a panel of 700 or so genes related to cancer. They have also received a blood sample and will look for cancer mutations in the blood. The results can be used to make a new cancer vaccine, and, depending on what is found, may also direct choice of further treatment.
  • Dyanne has been in ok shape, but has had some fatigue.

If anyone has suggestions for how to best treat cancer in the right hilus, then please do let us know (my email is, as always, larshaakon@gmail.com).

Hope everyone has had a good weekend.

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