By Fred Hutch staff

Art Chandler, 68, was enjoying his retirement when he received his fourth cancer diagnosis: lung cancer. It was January 2023, and about a month after he’d had back surgery to alleviate pinched nerves, when he suddenly started having breathing problems. Art’s general practitioner referred him to a pulmonologist, who performed “about a million” tests, according to Art, and determined that his diaphragm was elevated causing a partial collapse of his left lung.

The collapse may have been caused by two small tumors on the phrenic nerve, which controls the diaphragm. Unfortunately, they were extremely close to his heart, and surgery to remove them was not an option. Not only that, but with his breathing issues, Art couldn’t afford to lose any of his healthy lung tissue.

The diagnosis didn’t come as a complete surprise to Art. He had been a long-time smoker.

“At least now I knew what the problem was and could do something about it,” he said.

His pulmonologist referred him to Fred Hutchinson Cancer Center, where a tumor board — a group of specialists who consult on medical cases and come up with the best treatment strategy — agreed that Art should pursue proton therapy along with chemotherapy and followed by immunotherapy. Proton therapy was the only radiation option because it could precisely target the tumors and spare radiation dose to the heart. In addition, it would minimize damage to his healthy lung tissue.

“Art’s tumors were abutting his left ventricle, which is the heart chamber responsible for pumping blood throughout the body, and close to the coronary arteries supplying blood to the left ventricle,” said his radiation oncologist, John Kang, MD, PhD.

“We first performed a 4D simulation scan which allowed us to visualize the tumors as they moved when Art was breathing and his heart was pumping. The scan allowed us to plan to target the tumors accurately, even as they moved. Using protons, we were able to minimize the dose to the left ventricle, the left anterior descending artery, and the left circumflex artery compared to a traditional radiation treatment plan.”

“Dr. Kang was great throughout my proton therapy. He listened to what I had to say and took as much time as we needed so that I understood how everything would work. The calm way he explained things helped take the stress out of what can be a difficult time.”

Despite this complicated treatment, during proton therapy “the worst part was the drive back and forth from my home in Kent,” Art said. “The treatment caused a little bit of temporary ‘sunburn,’ too.”

Art was treated from two different angles. His damaged phrenic nerve was still impacting his back pain, so while waiting on his back on a hard surface as the machine repositioned between angles and the beam could be delivered was uncomfortable.

“I would get very sore, but the radiation therapists were so helpful and would do anything they could to alleviate the situation. I can’t say enough good things about them,” he said.

During his recent follow-up CT scan, Art received positive news. The images showed that his tumors have been reduced to less than half their original size and the damage to surrounding tissue was minimal. However, his breathing issues have not improved. It might take surgery in the future to “tack down” the diaphragm and create lung space.

“I’ll do what needs to be done,” he said. “This is my fourth bout with cancer. It was lymphoma the three previous times and treatment has always helped. My advice for others is, ‘Go ahead and try and get better. Treatment might seem intimidating, but if it works, it’s worth it. You never know what will happen.’”

Now, his immediate plans are to finish immunotherapy, have the diaphragm surgery and then travel. He and his wife, Catherine, love to take the long way on road trips to any destination — be it Las Vegas, San Diego or Minnesota. They also love the area around Lake Cushman above Hood Canal, where they met and have enjoyed many vacations with their kids and grandkids. Art looks forward to continuing these travels in the future — for a real retirement!

This article was originally published October 18, 2023, by Fred Hutch News Service. It is republished with permission.