Aggressive Care Works for Lung Cancer SurvivorYou can’t tell by looking at him, but 74-year-old Patrick Diener has only one lung. The former marathon runner and retired teacher had his right lung removed seven years ago as part of his aggressive treatment for lung cancer.
A non-smoker (he quit more than 50 years ago), Patrick noticed one day how thin he was, and asked his doctor for a chest X-ray.
“I trained for a lot of marathons and I never got that thin,” he said. The X-ray showed a tumor “the size of an Irish potato,” Patrick recalled. That quickly led to further tests and a referral to Froedtert & The Medical College of Wisconsin. The Milwaukee resident was diagnosed with advanced lung cancer in 2005. In addition to the tumor, the cancer had spread to the lymph nodes in the center of his chest, but not beyond.
Patrick underwent carefully coordinated treatment including chemotherapy, radiation and surgery. His multidisciplinary team included Elizabeth Gore, MD, Medical College of Wisconsin radiation oncologist; Paul Ritch, MD, Medical College of Wisconsin medical oncologist; and Mario Gasparri, MD, Medical College of Wisconsin thoracic surgeon.
Before treatment, Patrick’s prognosis looked challenging, Dr. Ritch said, and the tumor was too big to remove surgically: “We discussed his case at our multidisciplinary tumor board, and decided to be very aggressive to achieve the goal of getting him to surgery.”
Patrick first received two cycles of chemotherapy alone over about seven weeks, followed by seven weeks of concurrent chemotherapy and radiation treatments. The plan was twofold: first, to kill any cancer cells present in the lymph nodes or elsewhere in his body, and second, to shrink the tumor to make it easier to remove surgically.
“He had the resilience to go through aggressive therapy, and he responded dramatically well,” Dr. Ritch explained. The tumor shrank enough to make surgery possible, and Patrick’s lymph nodes were clear of cancer, which was an important achievement.
“The hope is always to remove only a portion of the lung,” Dr. Gasparri said. “We want to preserve as much lung as possible. At the same time, we have to take out as much lung as is needed to eradicate the tumor.” Although the tumor was smaller after treatment, it was still large enough to warrant removing the entire lung.
Before deciding to remove a patient’s lung, Dr. Gasparri explained, the team runs extensive tests to ensure the patient can tolerate it. “We want to make sure the patient can still be active, maybe a step slower, but still be able to participate,” he said. “We select these patients very carefully.”
Patrick’s care was thoroughly coordinated from the beginning.
“Before radiation began, we understood Patrick might have his right lung removed,” Dr. Gore said. “Therefore, we knew it was vitally important that we minimize delivery of radiation to the left lung. The multidisciplinary approach for him was critical, and it was important for all of us to be part of management decisions for his care prior to starting therapy. We all have an academic and clinical focus in lung cancer,” she added. “This is vital for providing the highest level of carefully coordinated care for our patients.”
Not every patient would have tolerated treatment like Patrick’s. “There is a fair amount of controversy over how to treat patients with advanced lung cancer,” Dr. Gasparri said. “We tend to be very aggressive with these patients. Some other centers might have been reluctant to follow this course, but we’ve had very good results.”
For example, Dr. Gasparri explained, the reported mortality rates for an operation like Patrick’s can be as high as 20 percent. “Our numbers are in the 1 percent to 2 percent range. I think it’s because of our coordinated, multidisciplinary approach, and because we carefully select appropriate candidates,” he said.
While Patrick didn’t participate in a clinical trial, Dr. Gore said, clinical trials offer important options for lung cancer patients. “Current trials are evaluating exactly his situation to see if we can improve the response rate prior to surgery with new drugs. It’s important to give our patients those opportunities,” she said.
While he can’t run marathons anymore, Patrick stays active, going to the gym every day, gardening, and photographing Milwaukee’s east side, where he lives. In fact, some of his pictures were recently displayed at St. John’s Cathedral.
He’s grateful for the care he received. “Everyone looked after me, and if I wanted something special, they’d go out of their way to get it. The best care was here,” Patrick said.
“It’s a remarkable outcome for an aggressive disease,” Dr. Gasparri said. “Patrick was fit, and he was also very positive, with a strong support system. His outcome confirms that it’s worth doing everything possible in treating patients facing similar challenges.”
Author: Dustin Kehrmeyer
Date: Feb. 5, 2013