Cyberknife for a weak patient

[krikkku]

Hi,

I am based in Bangalore, my mother had hysterectory and then the cancer spread to the lymph node. There is a SINGLE enlarged para-aortic node (7.3 x 8.8cm) which is close to Aorta and the backbone. Surgery is ruled out as it is very close to the backbone and my mother is very weak.

Can Cyberknife help? Will it help in stopping the progress of cancer, and say even reduce/remove the node? The node seems to be a clump of nearby nodes fused into a large mass and the size is increasing at an alarming rate. Size: Jan 2009 (2.6cm), Mar 2009 (5.5cm), May 2009 (8.5cm).

Finally, how do I find some one in Bangalore who will do this procedure?

thanks,

- KK

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
The imaging reports suggest that the nodal mass is increasing in size at a fairly rapid rate. At this point chemotherapy would be the treatment of choice to cause shrinkage of the growth. Further treatment would depend upon the response to chemotherapy.
If there is a fairly good response to chemotherapy, further treatment with surgery/radiation can be planned. However it can only be administered if the patient’s general condition permits. If chemotherapy cannot be given or the patient refuses it, radiation therapy can result in tumor shrinkage and symptom relief but is unlikely to cure the disease.
I suggest that you discuss with your oncologist the pros and cons of chemotherapy. Please go with an open mind; do not have a "mental block" against chemotharapy. With advances in anti-emetic therapy and supportive medical care, chemo can now be administered much more smoothly than in the olden days.
At this point of time, perhaps the most promising treatment option for her is chemotherapy.
All the best!

[Kamal S Saini, MD, MRCP (UK), DM]

One additional caveat to my answer above:

It may be necessary to reduce the size of the tumor (8.8 cm is a very large tumor) with chemotherapy before attempting CK.  

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,

CyberKnife can potentially be used in your mothers case. Of course, the final decision would be based on a review of the latest scans to assess the technical feasibility of the procedure. What was the histopathological report? Where was the primary tumor?

The CyberKnife facility in Bangalore is presently only available at the Bangalore Institute of Oncology. You could call the reception and set up an appointment with me.

All the best, and God Bless!

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Good luck!

[krikkku]

I had called yesterday and was told that for Cyberknife referral, I have to meet
Dr. Kumaraswamy. We met him today and he went through the case and
suggested IMRT treatment instead of Cyberknife.

Thank you very much for all the details you have given, it helped during my appointment with him.

thanks,

- KK

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Yes, that time is suitable for me. We can discuss in detail.
Best Regards.

[krikkku]

Can we get an appointment with you on Wednesday 2pm or so? I can come with all the scans and reports for a consultation. Please let me know what time will work for you.

thanks,

- KK

[krikkku]

Thanks for your comments. So are you saying that Cyberknife is not possible? Or that Chemo + Cyberknife can be used as a cure? Or that this is terminal no matter what?

Could you please clarify as I am really confused?

thanks,

- KK

[krikkku]

Dear Dr Saini,

I forgot to add, the USG report was for Retroperitoneum, this was done 2 days back.

A CT was done in Dec, the report says: "Multiple enlarged lymph nodes with areas of necrosis within seen in upper paraaortic area with slight encasement of aorta"

Another CT report done in Manipal in Mar says: "Significant increase in the size of the left para-aortic lymphnodes, which now measures 5 x 5.2 x 6.7 (TR x AP x SI). It is a heterogeneously enhancing necrotic node extending from the level of renal hilum to the aortic bifurcation. The left upper ureter traverses in close contact with its lateral margin and is probably involved, with significant dilation of the left pelvicalyceal system. The mass also erodes the anterior surface of L3 vertebral body as it extends into the prevertebral space displacing the aorta anteriorly. No change in the cysts in the both lobes of liver. These may represent simply cysts. Mild dilation of the small bowel loops in the lower abdomen".

The situation is becoming critical as the aorta is getting blocked - in Dec, it was mentioned as slight encasement of aorta, and 2 days back when we did the USG, radiologist said that the tumor is pushing quite a bit onto the aorta.

Thanks once again,

- KK

[krikkku]

Dear Dr Saini,

Thanks for your replies.

The pathology report says: "Sections shows fragments of a neoplasm composed of cells arranged in iiregular papillary and glandular pattern. The tumor cells are columnar with vesicular nucleus with nucleolus and moderate eosinophilic cytoplasm". The "HPR" (hopefully this is what you are asking for when you said "histopathological report" says: "Well differentiated Endometroid Adnocarcinoma (Stage 1C Grade 1) (Size 5 x 4cm) - the tumor has infiltrated more than half of myometrium. Serosal surface, cervix, tubes and ovaries are free from tumor".

The USG for the latest measurement says: "Shows a large irregular marginated solid mass with mixed echotexture adjacent to the aorta measuring 87x73mm in size. Mass noticed extending to the left renal foss laterally and posterior to the aorta causing anteriorly displaced abdominal aorta".

We are very much against chemotherapy. Will that be an issue with the above situation?

thanks once again for your patient response.

- KK