Radiation Ends

Today was my last day of radiation. The nurses wanted to know what I was doing to celebrate and I replied that I would be going to work, just like I do every day, and then going home to spend time with my lovely wife. I will celebrate when I feel like myself again.

I have had a lot of good feedback from the Lung Cancer Alliance Survivor Community. I put a description of my diagnosis on the website and asked other patients with a similar diagnosis and treatment to tell me what their experience after chemo radiation has been. I got four responses...all of which were very positive. Essentially the answer came back...more chemo. The only question really is what drugs to use. It was suggested that I be tested for the EFGR mutation and that, if the mutation existed, I might be a good candidate for tyrosine kinase inhibitors such as erlotinib/tarceva. I asked Dr. Lunin if the EFGR test has been done....and, of course, he had already ordered the test and it had come back negative for the EFGR mutation. I am going to pursue this a bit more with Scott.

At the end of my radiation today I met with Dave Rice, my radiation oncologist. I asked him how many lung cancer patients he has treated. He estimated that he has treated 10 per month for the past 100 months, since he has been in practice. That would be 1000 patients or so. I asked Dave, in his experience, what amount of shrinkage he would expect to get from the treatment I had just finished. His reply was that there are really two issues -- the absolute size of the tumor, and the metastatic activity of the tumor. In terms of size, he said the issue is the volume size of the tumor. Tumor might shrink in size by say 50%....but the VOLUME of the tumor could be significantly more than that....say 75% or even 80%. Even with such shrinkage, the real issue is how active the remaining cells are. This is measured by the SUV value, or how much sugar the remaining active cells absorb or take up. The higher the SUV value, the more active the cells, the faster they replicate etc.... At least that is my layman's understanding of it.

Dave seem to feel that I had a good chance of being "cured" with my current treatment and he seemed optimistic that my response to the treatment just completed would be good because it was uninterrupted for seven weeks, etc. Anyway, Dave seemed very positive that the outcome would be favorable. He expects the next step will be consolidation chemo. He did not think that the next "phase" would necessarily be worst that this first round of treatment. I hope he is right. In Dave's opinion, I will probably end up NED (no evidence of disease) after consolidation treatment. The question after that will be...does cancer show up somewhere else.... Time will tell.