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Pet scan shows multiple lung nodules. Had a surgery of removal of tumor. Now what should be done?

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Practicing since : 2004
Answered : 1213 Questions
dear sir.,this quiery is particulary to Dr Indranil XXXXXXX of kolcutta as i have already got an opininon from i had sent you all the reports of my neice XXXXXXX 13yrs on sat 15th sep 2012.just a brief reminder.,PNET diagnoised in XXXXXXX 2011.,primary tumour at vulva and second tumouir at right occipital region.,primary tumour removed to the maximum extent by surgery.17 cycles of CT as per IESS-III protocl was given and also RT given to both the sites.last CT was given on 31st AUG 2012.the latest pet scan shows multiple lung nodules eventhough no tumour on those sites that were diagnoised ibnitially.(had sent you reports last time) and also requested the healthcare WWW.WWWW.WW to attach those reports today aswell.i got your reply about salvage chemotherapy.the same has been prescribed by the TMH.,TOPOTECAN 1000mg 1x 5 days.,cyclophosphamide 350mg 1 x 5 days (totally 4 cycles) plus a tablet of TAMOXIFEN
twice daily.and LUNG BATH after 4 cycles if at all there is a response to the CT.doctors have told to review with a pet scan after 4 cycles.but regarding stemcell transplant the doctors there are not possitive and are almost ruling out that now my question to you is 1)i haerd at st.judes a lot of clinical trials are going on with various drugs particularly for Ewing sarcoma.will taking my child there going to help in any way better than TMH. 2)in the website of st judes they have mentioned that stemcell tgransplant is also one of the option for metastatic E there any successfull case of survival of E SARCOMA PATIENTS treated with stemcell transplant.if so where was that done.3)when i tried to contact st judes they informed us that i should approach them through a doctor., so can you arrange for an appointment with them if we enroll our child at your centre.presently she is on the first cycle of the salvage CT but she is fit to travel anywhere as she is quite active doing her routine work.its like now or never situation for kindly help me with these queries as we want to save our child at any cost and are ready to take her anywhere in the world.
Posted Wed, 7 Nov 2012 in Cancer
Answered by Dr. Indranil Ghosh 1 hour later

Thanks for followup.

My answers to your queries--

1. Enrolment is some trial may surely benefit her but I am not sure whether any trial suitable for her is currently on. Even if not in a trial, they can certainly explore the options of transplant.

2. Transplant has been done for many patients of Ewing but only a few of them are long term survivors.
You can contact Dr XXXXXXX Bakhshi at AIIMS as he has done many transplants for Ewing.

3. You can contact Dr F Navid at St Jude's. If she wants a referral I can write an email to her.

Above answer was peer-reviewed by
Follow-up: Pet scan shows multiple lung nodules. Had a surgery of removal of tumor. Now what should be done? 12 days later
Dear doctor indrnil XXXXXXX this is in continuation of my quiry dated 2nd OCT(Ewings sarcoma-rakshanda jain-13y mentioned to XXXXXXX Dr XXXXXXX bakshi in AIIMS regarding stemcell transplant.i would like to inform you that even at TMH we wanted to XXXXXXX Dr. XXXXXXX khatri but they directed us to the medical oncologist who almost ruled out the posiibility of kindly inform me whether we can directly XXXXXXX a stem cell transplant specialist or we should always go through an medical oncologist.can we XXXXXXX Dr Bakshi directly and discuss the possibilities of a transplant in our case.also doctor as already mentioned she is currently on chemo cycles with TOPOTECAN & CYCLOPHOSPHAMIDE plus tab Tamoxifen..i want to know is this the best available option presently for her condition.have they worked in ewings patients earlier.?lastly one cancer hospital by name modern cancer hospital in guangzhou china has replied after seeing her reports that they plan to give her chemo drugs interventionally(directly to the tumours) along with immunotherapy.i want to know is there any treatment like that.i mean can that be real because that hospital is of
some reputation in china. doctor kindly put more light on these quiries.
warm regards XXXXXXX XXXXXXX
Answered by Dr. Indranil Ghosh 20 hours later

You can certainly XXXXXXX Dr XXXXXXX Bakhshi directly as he only takes care of ewings there.
Regarding the China treatment it is an experimental therapy and does not help in lung mets. It may help in tumors localised to limb.
As of now this therapy seems reasonable to me with expected responses of 40-50%.
Above answer was peer-reviewed by
Follow-up: Pet scan shows multiple lung nodules. Had a surgery of removal of tumor. Now what should be done? 12 hours later
Thanks for your reply doctor...i want to know whether stemcell transplant can be considered only if the tumours respond to the current salvage chemotherapy..or can it be considered even without response from the current therapy..because as i have understood autologus transplant is considered as the last option when the diesease fail to respond to regular chemo regime..otherwise why would one opt for such a harsh & risky treatment..also how would we know if any trial is going on for ewing any where..i mean is there anyway we can know about trials.kindly give clarification regarding my quiry.
Answered by Dr. Indranil Ghosh 17 minutes later
1. Transplant can be done even if there is good response to salvage chemo to improve the chances of cure. Results are actually better if there is a good response to salvage chemo.

2. I am not sure about any trials in India. Regarding worldwide trials you can search at WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: Pet scan shows multiple lung nodules. Had a surgery of removal of tumor. Now what should be done? 4 days later
Doctor its regarding rakshanda 13 (PNET).after first cycle of salvage chemo with topotecan snd cyclophosphamide after 15 days one of her lungs got filled with fluid and she had dry ichy cough drained the liquid which looked like blood.cytology report said HAEMORAGIC PLEURAL FLUID SHOWING SMALL ROUND SARCOMA CELLS.doctors at tmh indicated that its the sign of progressive diesease and told us that may be topotecan has not worked and instead of waiting till second cycle they instantly changed the drug to GEMCITABINE & has to be given in two lots first day & 8th day of the cycle.of which 1st day dose has already been the meanwhile i came and met dr XXXXXXX bakshi at aiims.he said that if he were the treating doctor he would have given ICE chemo(ifosfamide & carboplatin with etoposid).he told that neither topotecan nor gemcetabine we are literally in dielama as to what to my question to you iz is yhat really is the sign of drug not working..and how long it would take for us to atleast notice any differenence in symptoms with gemcitabine.i mean she is complaing abt pain in chest & bacj if we have to change TO ICE CHEMOTHERAPY do we need to wait till 21 days as we have only goven one part of gemcetabine of 1st day.can we change to ICE CHEMO.also is ICE CHEMO more effective than gemcitabine..also let me inform..Of the ICE CHEMO DRUGS, ifosfamide and etoposide has already been given during first line of treatment.only carboplatin is not given. Dicyor kindly put your valuable thoughts into this at your earliest.
Answered by Dr. Indranil Ghosh 3 hours later

I am afraid that she is rapidly progressing on salvage chemotherapy. There is very little chance that it would response to any other chemo. Gemcitabine docetaxel may be tried but chances are less. As you said rightly that in ICE, she has already received two drugs and immediately after completion she had recurred. Hence by adding just carboplatin there is little chance of any response.

It may happen that soon she becomes chemo-refractory and in that scenario we can only offer end-of-life care.


Above answer was peer-reviewed by
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