Radiation or not post surgery

[helenv]

Dear all,

I write on behalf of my mother, who is receiving two opinions from her doctors regarding radiation therapy. The surgeon who removed the tumor does not recommend - this surgery took place abroad as my mother was visiting me when it occurred.

We would welcome comments.

From the doctor not recommending radiation: Her pathological finding was T3N0 with clear margins of more than 3 mm and without other risk factors. The only risk factor for her disease was perforation. For her disease, C/T could be prescribed to decrease recurrence. (Benefit : from 30% to 25% recurrence in 5 years with C/T). However the benefit of R/T is not so strong. You can read the guidelines in the NCCN Clinical Practice Guidelines in Oncology, Rectal Cancer 2010 - page 9, announcement m. It is difficult to decide whether your mother should receive R/T. The complications of R/T might interfere with her quality of life ( including stool leakage, frequent defecation, rectal bleeding, radiation enteritis.....) Therefore I did not recommend she receive R/T. Before R/T you could discuss with Virginia's Dr about the benefit and complications of R/T. Every treatment should balance both of these."

Her Drs. in the US believe that the benefits outweigh the complications.

Does anyone know how often complications arise in reality? Are there any studies that would predict the likelihood or the chance that one will have them? Is anyone familiar with statistics on those who opted to do radiation vs those who did not and their long term prognosis?

The report states that "the incremental benefit of R/T is likely to be small. Consider chemotherapy alone." Again, wondering if these issues have come up for anyone.

Other notes: she's doing chemo now.

Thanks so much and best wishes to you,
Katherine

[Terry]

Hi Katherine,

I think we need more information. Since they're even considering radiation it must be rectal cancer. Usually they do the radiation and chemo to shrink the tumor or better yet kill it all off and then remove it. I think I have seen those on here that have had to have emergency surgery and then went on to have radiation and hopefully they'll post. What is her age? That can make a difference on her complications with stool leakage, etc.

[SkiFletch]

Her pathological finding was T3N0 with clear margins of more than 3 mm and without other risk factors

Does this mean she's had surgery already? If that's the case I'm kind of surprised they're even considering radiation therapy. Usually as Terry said, RT is used before surgery to shrink the tumor, then surgery, then chemo, in that order. If your mom just had surgery already, I'd be pretty happy that it only turned up T3 with clear margins.

[helenv]

Hello Terry,

Many thanks for your note.
My mother is 63; yes, the tumor was in the rectal area. She had the surgery and they successfully removed it, did an ileostomy and a successful reversal. She is now doing the post surgery chemo and considering radiation. Yes, her situation was exactly that - rushed in to Emergency with severe abdominal pain. The xray revealed leakage in her abdomen, which they discovered was the tumor having perforated the colon/rectal wall.

Thanks again,
Katherine

[helenv]

Yes, she has had the surgery. Your response is in line with what her original surgeon recommended (as a recap - the surgery happened outside the USA.)

Her doctors here in the US recommend the radiation post surgery for these reasons:
"A perceived pelvic recurrence risk exceeding 25% based on the perforated tumor. In general, postoperative radiation decreases this risk by a relative benefit of half. The implications of a pelvic recurrence on quality of life are significant- and can lead to many problems.

We created an impressive IMRT treatment plan that does a great job protecting her bowel. In studies, surgery itself is the primary cause problems with defecation and incontinence, with radiation increasing this risk by about 10%."

Thank you for your response.
Katherine

[Joy]

I had radiation àfter`surgery.

My case was ùnusual..during my colonoscopy a `polyp`was bleeding and the biopsy came back as benign. Colon rectal surgeon decided that he didn`t want to take a risk and performed a LAR. Thank god he did because it turned out that I had a T3N1MO. Surgeon was surprised that I was classified as `rectal`because be thought it was high in the sigmoid. I took the radiation on the advice of the Oncology team .....better safe than sorry!!

The radiation has left lots of issues, I still have days where I`m chained to the toilet. I have learned to manage....cheese or any high fat is out of the question.

[kimmercans]

I had radiation after surgery. All indicators pointed toward stage 1 but I ended up stage 2A. I was too numb from the diagnosis initially to study up on the risks vs benefits before I underwent therapy. That being said, I would probably do it again. Radiation for me was not bad except for extreme fatigue. I was taking chemotherapy at the same time. I did not suffer burns or vaginal stenosis. I did have loose frequent stools but remained continent. I do have chronic coccyx pain and my surgeon says my colon is "glued" to my sacrum due to scar tissue. Did the surgery or the radiation cause the scar tissue? Probably a combination. I take Celebrex daily to manage the pain and it works well. Knowing how radiation works in concert with chemotherapy, it can sterilize the field of any stubborn cancer cells left after surgery. I think I remember seeing stats that stated without any adjuvant radiation, odds of recurrence were around 35%...with it closer to 20%. Thats a significant benefit, much higher than with chemo alone.

[Joy]

I forgot to say.....would I do it again? YES!! Radiation has shown to Up the odds of recurrence and that was all I needed to hear!!!

[RDM]

If the tumor perforated the colon wall it would be a T4. Typically chemo and or radiation is given before ileostomy takedown. One does not have to deal with bowel issues that often develop and potential radiation damage to reconnect area (this depends on the type of surgery done). Adjuvant radiation used to be the norm, studies show neoadjuvant lessens the chance of local recurrence, a small but statistically significant advantage. In emergency surgery one has no choice. I would be very careful with radiation now as it could easily damage bowel function.

[PGLGreg]

If the tumor perforated the colon wall it would be a T4.

I don't think so. T4 means cancer is found outside the colon/rectum wall; with T3 it has penetrated the wall. However, I'm not sure what the implications of "perforation" are for staging.

My rectal cancer seems very similar to your mother's. I was 63 also, the tumor was T3N0M0, margins were 3mm, and I did not have radiation before surgery. A difference is that I did not have an ileostomy, or any ostomy. The reason I did not have neo-adjuvant radiation (which is given customarily) is that it seemed from my colonoscopy that my tumor was probably in my colon, not rectum. But the surgeon found it in my rectum.

I was told after my LAR surgery that radiation was considered obligatory for my case and gave a substantial survival benefit, and chemotherapy was optional (though my oncologist strongly recommended chemo, in addition to radiation).

I did have radiation after my surgery, and a mild form of chemotherapy also. Individual cases prove little, and I know you asked for statistics (as you should), but I'll tell you that my own side effects from radiation were minimal, at the time of the therapy and now, 4 years later. I eat what I want, I have no issues with continence or diarrhea. And my cancer has not recurred.

[RDM]

I suppose it could technically be a T3 if it didnt GROW through the wall of the rectum but the perforation was caused by weakness due to the tumor.

T1: The cancer has grown through the muscularis mucosa and extends into the submucosa.

T2: The cancer has grown through the submucosa and extends into the muscularis propria (thick outer muscle layer).

T3: The cancer has grown through the muscularis propria and into the outermost layers of the colon or rectum but not through them. It has not reached any nearby organs or tissues.

T4a: The cancer has grown through the serosa (also known as the visceral peritoneum), the outermost lining of the intestines.

T4b: The cancer has grown through the wall of the colon or rectum and is attached to or invades into nearby tissues or organs.

[lorrainem]

Helen,

You've come to the right place. You will receive scores of information and opinions. So here are my two cents:

My tumor was T3 and found prior to surgery via colonoscopy when I presented with bowel trouble. Surgical stage II. It was in the rectal/sigmoid junction so I was treated as rectal. I received radiation and chemo pre op and chemo post op. I would do it again, even though my only noted problem is vaginal stenosis. Other side effects can be caused by chemo or radiation, so not determined which was the culprit. Again, my opinion, at 63 your mom has the possibility of many years of life; I don't think her age is the biggest factor, her overall health should be considered.

Having said that, Jaynee is the most well versed member on radiation. She researched very thoroughly and opted out. Her information is invaluable either way, so look for her to hopefully respond to this.

Good luck and best wishes to you both.

[helenv]

Dear All,

Our great thanks for your input. It comes at a critical point as my mother is still in the middle of deciding. She feels like her body is saying no....we will meet with the doctors again to discuss. We'd love to be in touch with Jaynee as you mentioned.

Again, thank you.
Katherine