From: "Dr. D. Kossove" <doctordee@telkomsa.net>
Subject: Neil on Pet questions
Date: Thursday, November 06, 2003 8:57 PM

Date:    Tue, 4 Nov 2003 20:19:31 -0800
From:    Neil Sandow <neil@Q3.COM>
Subject: Re: PET Questions

Dana Singleton wrote:
>1.  My husband had a PET scan that showed increased metabolic activity in a
>node in the left mediastinal.  One of the docs (the one who ordered the PET)
>says PETs are very reliable and extremely sensitive, but our LMS doctor
>says he
>doesn't even order them for his patients because they are so full of errors.
>Any ideas?  Should we be concerned?  All but one of the tumors in his lungs
>have disappeared after the five rounds of chemo, so it's strange that this
>would
>show up now, even though otherwise he's NED.  Any chance this is an incorrect
>result?

Dana,

THE FOLLOWING COMMENTS ASSUME THAT TOM'S CANCER IS HIGH GRADE
(METABOLICALLY VERY ACTIVE)

Bev's medical oncologist pooh-poohed PET scans 'cuz "there are too many
false positives."

Nonetheless, we insisted on quarterly PET scans concurrently with quarterly
CT scans. We have seen "false positives" (in the sense that they were not
mets) such as post-surgical inflammation. One was large and looked
malignant to the PET radiologist but didn't look as worrisome on the CT
scan. So we just watched and waited and on the next PET scan it was gone.
Three months ago PET showed two suspicious hot spots in Bev's good lung;
they were gone in the new scan last week.

If Tom's tumor is high-grade, even small mets will show up clearly on PET
and will help you make a judgment about whether a "suspicious" lesion that
shows up on a CT scan is a met or not.

In the case of the node perhaps it's merely inflamed or, worst case, it's a
new met that's resistant to Tom's current chemo. What does it look like to
the radiologist who's reading Tom's CT's (and have you given him a copy of
the PET report so he can pay particular attention to the node)?

Also, another advantage of PET is that it may identify tumor necrosis from
chemo long before shrinkage shows up on a CT.

We love PET.

Cordially, Neil Sandow (Bev's husband), Santa Cruz, CA

Beverly: 74, Dx'd uterine LMS following TAH/BSO 09/00. R lung RFAs (08/01 &
01/02) for 2 lung mets ultimately failed. Successful lobectomy and
bronchial sleeve resection of recurrence 05/02. Brain met found 10/04/02
and resected 10/14/02. All subsequent brain MRI's clear. PET scan 02/03
found 12 cm intensely hypermetabolic new met near L kidney. After 5 rounds
of Gemzar/Taxotere tumor no longer visible on 07/07/03 PET scan and
confirmed necrotic on 07/28/03 CT scan following final 6th round of chemo.
Still NED and necrotic tumor still shrinking on 10/20/03 PET and 10/28/03 CT.


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