Mom, Helen and I met with Dr. Gill Kirkpatrick, Mom's oncologist this morning. We came away from the meeting liking Dr. K very much. He is young, but seems very honest and direct, willing to listen and trade ideas. Mom very much liked the fact that he looked at her and made eye contact when he spoke, establishing a strong trust factor.
The three of us had time to meet briefly before the appointment and Mom went over her list of questions so nothing would be left out.
Dr. K was direct. He started with a description. It is a complex shape, 'multilobulated' is the secret word of the day. Two overlapping lobes starting from a common growth measuring roughly an inch and a quarter square in the upper left lobe of the lung draped around an airway making surgery impossible without removing too much lung. They did not get quite enough tissue with the biopsy to do genetic diagnosis, but he didn't think that would be an issue at this time. Dr. K said he did discuss cryo-treatment (freezing the tumor) with his colleagues, but they felt that there was not enough data to validate the efficacy of the treament at this time.
The ideal procedure would be to surgically cut the tumor out, but since that isn't an option, we need to look at some form of radiation. He recommends CyberKnife or stereotactical radiation and has referred us to Dr. Robert Timmerman, a Professor of Radiation Oncology at Southwestern Medical. Stereotactical Radiosurgery is a non-invasive means of precisely delivering a high level of lethal radiation directly on the mass with minimal effect on surrounding tissue. It would be done in two or three treatments and would involve no chemotherapy. Conventional external-beam radiation would involve daily treatments over a number of weeks with accompanying chemotherapy to enhance the effects of the radiation. Mom's PET scan showed low function in her left kidney (it was very slow to pass the dye) and her relatively high creatinine level indicating clearance issues also makes chemo a bad alternative, since the inability of her kidneys to clear the toxins would magnify the side effects. It seemed clear to us that the Radiosurgery is the way to go.
According to Dr. K, the main side effect is fatigue. There's not much discussion of side effects on the Cyberknife site. I suspect they are being undersold, especially for someone in Mom's fragile state. We should address side effects with Dr. Timmerman at the first appointment.
Dr. T is on the forefront on this technology and has been instrumental on developing the protocol. Here is a link to a PowerPoint presentation he uses to show the advantages of this treatment. It gets a little technical, but pretend you're a hospital administrator.... Advances in Image Guided Hypofractionated Radiation Therapy. (Hypofractionated means the treatment is broken into several sessions.)
For a look at how it works, here is a presentation (with a video) by Cyberknife: How Does CyberKnife Treat Lung Cancer? Keep in mind that CyberKnife is a trademarked name for a brand of stereotactical radiation equipment.
One point Dr. K emphasized is that radiation typically is not a cure. Frequently there are some cells which are resistant to radiation, or survive or mutate and grow back. But the time gained with high quality of life is significant.
Mom did ask Dr. K very directly, "What'll get me first, the emphysema or the lung cancer?"
Dr. K was taken aback and chuckled.
"Pneumonia or heart failure are the usual causes related to emphysema," he said.
After a pause, while he considered the proper euphemism, he finally grinned, "If I had to say, I guess the emphysema'll get ya first!"
Following her treatments, evaluation will be done with periodic imaging which will be monitored by Dr. K. The first appointment for follow up is Thursday, Sept 29 at 10:20am.
Mom has her first evaluative appointment with Dr. Timmerman next Thursday, Aug 4. We'll know more about her schedule then.