Chemotherapy before or after surgery

sandwich2000

Hi, I am new here. My father was recently diagnosed with NSCLC. It’s at least stage 2b. We have seen two oncologists in Northern Virginia. One suggested to have surgery now and do systemic treatment after. The other oncologist suggested chemo and immunotherapy before the surgery. Given my dad is 80 and qualify of life is most important factor to concern, I am thinking to go with surgery first. I am scared that I will lose him and also scared that I am making wrong decision for him. Any help please? Thank you!

eDivebuddy

Not to muddy the waters more but I would discuss neoadjuvant or adjuvant immunotherapy with stereotactic body radiotherapy instead of surgery. Not quite as effective as surgery but a heck of a lot easier.

sandwich2000

Thank you so much for the reply! We did talk to radiologist about SBRT and Proton therapy. Unfortunately my dad has one positive lymph node near the mass, so any radiation therapy need to combine with Chemotherapy. Doctors said immunotherapy need to go with chemo too, and no target therapy for him. I researched and found even among healthy young patients, the rate to have grade 3 or above chemo related adverse effects will be 40-50%. That’s really high in my opinion. It seems no guidance of systematic treatment for older patients yet. Hope his surgery goes well!

eDivebuddy

Do you know his PD-L1 or tumor mutation burden numbers?

sandwich2000

https://csn.cancer.org/discussion/comment/1718953#Comment_1718953

For some reason, his biopsy results do not show PD-L1 level. I asked his surgeon and I was told that particular result takes time. I am wondering maybe doctor didn’t order this test when doing his biopsy. His surgeon promised PD-L1 will be analyzed from his surgery results.

eDivebuddy

Yeah that should be know before doing anything. If he had 100% PD-L1 he could quite easily get away with immunotherapy only which I've done over 4 years for stage 4b

sandwich2000

Wow! That’s very encouraging! Thanks for sharing the information. I guess it’s too late to ask his pulmonologist to order PD-L1 test now since the biopsy was done almost 3 weeks ago. Just hope his surgeon won’t miss this important test. Where can I find survivors network who are treated by the same doctors/facilities to share experiences? I feel that would be very helpful.

eDivebuddy

It can takesl about 4 weeks for all the genetic testing to come back. Check with the cancer center for local support groups.

https://forums.lungevity.org/

https://www.inspire.com

https://m.facebook.com/groups/986284055480932/

sandwich2000

https://csn.cancer.org/discussion/comment/1718964#Comment_1718964

Thank you so much!

BrendaHenry

https://csn.cancer.org/discussion/328678/chemotherapy-before-or-after-surgery

How much do you know about the side effects of immunotherapy? I began my lung treatments with chemo immunotherapy in October of 2023. In May of 2024, I was hospitalized with pneumonia. I am 68 years old and I had much difficulty overcoming the pneumonia. Prior to pneumonia and other complications from it, I had never been on oxygen. After pneumonia and as of this date, I began and am still using oxygen. After pneumonia, I had to regain strength for walking and to learn to use a walker. After my bout with pneumonia, I learned that immunotherapy can and does cause pneumonia in some cases. As I said, I am 68. You said your father is 80. Make sure that you know everything there is to know about immunotherapy and how it may affect your father's quality of life if this is the route that you choose to go for him.