Rectal Cancer and Folfox - 8 or 12 treatments?

[SynD]

My oncologist has recommended going beyond the 8 standard Folfox treatments for rectal cancer stating that "if my body can handle it, we should push toward 12".

Those of you with RC, what did or are you doing?

[Joy]

28 5FU + radiation ...."8" round of FOLFOX.

I was 59 at the time of diagnosis, just celebrated by 65 birthday last December

With me 8 was enuf

[RayGirl]

Did the 12 rounds after surgery (plus the 28 Xeloda). Onc never even discuss 8 being an option. It seems really regional whether 8 or 12 is standard when I've seen threads on this before.

[Surroundedbylove]

Do you mean the adjuvant treatment time or total chemo? For my post I'm talking in terms of weeks so it is easy to convert between FOLFOX and XELOX treatments.

I had 6 weeks of XELOX with radiation neoadjuvantly and that counted as "8 weeks" of chemo (because you don't have the week long breaks). Then I had 18 weeks of XELOX (Xeloda only at the end because of neuropathy). My onc said that given my prognostic factors (all pretty good) that this was enough and also that the 6 weeks of neoadjuvant counted toward the total recommendation of 6 months. 6 months in oncology world is 24 weeks total and when he combined the neoadjuvant and the adjuvant, I had the 24 weeks total.

So, to come back to your question - 12 treatments of FOLFOX is 24 weeks of chemo if you have the normal breaks. Did you have neoadjuvant chemo? If so and you also have had 8 treatements (16 weeks) of adjuvant, then he seems to be recommending more than the norm. Is this because of poor prognostic factors? (mucinous component to the tumor, poor differentiation, depth of tumor invasion, vessel/vascular invasion, etc.) Is it because of a study showing at your stage that longer chemo treatment is better? Is this because your dosage of FOLFOX each cycle has been a little lower so he wants you to do it longer to get the "full" dosage?

I ask these questions to give you questions to ask your onc.

[SynD]

Good questions.

(mucinous component to the tumor, poor differentiation, depth of tumor invasion, vessel/vascular invasion, etc.)

I don't believe it was due to any of these. I have had the full dose so far. I also had neoadjuvant continuous 5-FU during radiation.

Is it because of a study showing at your stage that longer chemo treatment is better?

Could be. I'll have to ask him about this. I did tell him I wanted to treat it aggressively and not leave anything to chance, so it could have been based on that.

[RayGirl]

I still think it's very regional on whether the oncs count the chemo during radiation or not. I know most in the Houston area don't. Good luck it's a hard decision on how long to poison yourself.

[Surroundedbylove]

My onc counted the neoaadjuvant time - but admittedly I also had oxi during that time - not just Xeloda. I realize Xeloda is the heavy hitter but I did have the triple whammy of Xeloda, oxaliplatin, and radiation.

Also, forgotten to mention above - the recommendation could also be based on your patholigical response to the neoadjuvant treatment - complete response, near complete response, partial response, very little response?

In my case with near complete response (and almost a complete response because all the cancer they found were a few minute cells), and all of the other prognostic factors were good, he may have gone with the studies he quoted me that said that 4 1/2 months post surgery was all that was needed. He said 3 months was the minimum post surgery so everything after that was the "extra boost."

[janeandrea]

I had 4 weeks (was supposed to be 5, but I had an adverse reaction to the radiation I was having at the same time that led to temp ileo surgery, so my chemo was cut short) of Folfox (5 days a week, 24 hrs a day), then 12 treatments of adjuvant chemo (48 hrs every two weeks) of 5FU and Oxaliplatin. My understanding is that this is the standard of care.

[TheBurn]

I didn't do neo because of my ulcerative colitis, so the plan has always been 24 weeks and onc wants the 6 weeks of chemo-rad after. It started as Folfox 6, then we changed to Xelox, then to just Xeloda - but still 24 weeks regardless of the regimen.

[Bill5107]

Huh... 6 months (12 rounds, 2 weeks each, of FOLFOX) was the plan and what I did. I had 42 days of Xeloda during my 6 weeks (30 treatments) of radiation, then a break, then surgery, then a break, then FOLFOX.

In my case, my path reports showed aggressive (poorly differentiated) cells, and after surgery even my surgeon called my path report "ugly"(active cancer in tumor and 10/18 nodes X-p). So I suppose I may have got the aggressive schedule by default. I haven't heard this debate/difference in treatments before. I guess one learns something new everyday if they want to, eh? Either way, I made it pretty clear I'm up for what I can tolerate, and I tolerated my full dose of xeloda well to begin with (so long as I stayed on my nausea meds!).

[laxmom3]

My story was a little funky since the GI that initially dx my cancer said that it was colon not rectal- so I didn't have chemo/rad prior to having surgery- my surgeon found the tumor in my rectum after doing a colonoscopy while I was on the OR table. Anyway, I ended up doing 6 rounds of adjuvent chemo 5 FU and eloxy, then 5 weeks of radiation with xeloda, 3 week break, then finished off with 6 rounds of xeloda and eloxy. All in all it took 8 months. My oncologist said the standard was 12 rounds of chemo, with the 5 weeks of chemo/radiation. I did like taking the pills better, since I wasn't hooked up to a pump for days- had lots of problems with the pump- but also ended up with hand and foot pain from the pills, but it was short lived.

lisa

[RayGirl]

I was told I would do 12 treatments FOLFOX when I went for my first exams with the 2 different onc 1 and 2 days after my scope. Final path report wasn't even back and the only info we had was the colonoscopy report. Maybe if everything had come back more favorably they would have cut it back to eight, who knows? Both docs had ties to MD Anderson system, but that was the only thing they had in common. Of the few other patients I've known in the MD A system, none have been able shortened their FOLFOX sentence with the chemo during radiation. I seem to recall that Hopkins and Mayo do give you credit for time served, can't remember about others, so who knows which center is right?!?! If the experts can't agree, then all you can do is trust your docs and your own heart.

[Polarprincess]

i had all 12, just because my doctor felt we should do all we could. my coworker who is stage IIIc is getting 12 as well. i should say that i didnt get all 12 with the oxaliplatin. i think the last 3 were without.

[jjlist]

my onc scheduled 12. i stopped her after 10 cause of neuropathy. onc put a couple of timeouts during the 10 and cut my dosage to the lowest effective one (according to her) around treatment 5 or 6 i dont remember. I told her no more and she did not say a word to me about trying to finish.

[dtrujillo]

Diagnosed with rectal/sigmoid cancer last 12/11, had tumor removed, am now Stage III, T1, cancer found in one/seventeen nodes. Had one onc consider me 'cured' with surgery, and two more recommended Folfox 4 for 12 treatments. Don't know why 12 but its for Adjuvant therapy to lessen reoccurance.