On 6/29/2009
sajbs1 wrote:
My wife was diagnosed with stage II rectal cancer (T3, N0, M0) in Feb.of this year. She has already undergone surgery to remove the tumor and has undergone adjuvant radiation and oral chemo.
We are now considering whether she should continue with i.v. chemo (port and pump) - whether the decrease in recurrence rates will be enough to offset the additional pain and suffering involved.
Her oncologist put recurrence rates with nothing except surgery at 40% and with everything (radiation, oral and i.v chemo) at 20%. He also said that "if you only choose one or the other, radiation is the most important part" and so we assume that she would only see less than a 10% improvement in the odds if she continued with the i.v. treatments. But we really would like to find some reliable statistics.
Can anyone help?
I'm not sure where your onc is getting his figures from. It is true that rectal cancer has a higher LOCAL recurrence rate than colon cancer. In addtion, it is also true that neoadjuvant chemoradiation offers better statistical (by a few percentage points) advantage over adjuvant chemoradiation. Which brings me to the question. Why with a T3 tumor (this should have been clinically staged prior to surgery) didn't your onc recommend chemoradiation prior to surgery??
As to the other points in your post. Those statistics that your onc quoted are from a long time ago and are no longer accurate with the newer techniques in surgery. The TME (total mesorectal excision) has drastically improved the odds in patients. Again, however, I wonder why chemoradiation was not done first to shrink the tumor and to help with local control.
Unless you have some negative prognostic factors, such as: mucinous or signet cell adenocarcinoma, poorly differentiated tumor, vascular invasion, etc. I would recommend adjuvant chemo HOWEVER, there is no need to do the full blown chemo with a stage IIA with no negative prognositic factors. Furthermore, the pump/port is also not necessary. The oral chemo, Xeloda, has been proven to be just as effective and most studies actually show it to be significantly MORE effective than 5FU.leucovorin via infusion. The addition of oxi to the protocol is not warranted (again assuming no negative prognositic factors) for stage IIA patients as it only adds 1 -2 percent to an already high (85-88% NOT the figures he gave you) statistical survival benefit. Remember that oxi also has long term and even permanent side effects and the patient needs to weigh the risks of side effects against the potential benefit it might give him/her.
The choice is up to you. Personally I had the following protocol with a stage IIA (there was some discrepancy as to whether or not my tumor truly was a T3 or a T2 on the clinical ERUS exam) rectal cancer diagnosis. 5-6 weeks of chemoradiation with Xeloda (tried the pump for one week and got off of that thing soooo quickly!), 5 more months of Xeloda only, full thickness transanal excision. I was diagnosed in 6/06, had my surgery in 4/07 and am still NED.
Remember that this is YOUR decision not the oncs. The decision to follow up with more chemo does not have to follow his plan either. If you want more chemo and you feel that you can tolerate Xeloda, insist that you be given that instead of the infused 5FU/leucovorin. There is no reason why you shouldn't take it but be prepared for some potential arguments. Although I would like to say it doesn't happen, oncs are more apt to want to Rx the infusion vs oral simply for monetary reasons. Sometime go to the colonclub.com and read what others have said on this issue.
You must be a decision making partner in your care and ultimately you have the sole discretionary power to say yes or no to any decisions regarding your care. Since it sounds like you don't have a port, I would tell the onc you want the Xeloda to avoid that minor surgery, then you can still go on with the chemo and know that you have done the 'standard of care' (FOLFOX is NOT standard of care for stage IIA with no negative prognostic factors) for your stage.
Jaynee