"Curative intent" chemotherapy at Stage IVa, possible?

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Ibbey
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Joined: Sun Jun 30, 2013 10:36 pm

"Curative intent" chemotherapy at Stage IVa, possible?

Postby Ibbey » Sat Jan 10, 2015 12:14 pm

My wife recently had a second lung met removed. That makes 2 recurrences in two years following colon resection and Folfox. While there is currently no evidence of cancer, these recurrences show that her initial chemotherapy didn't get all the cancer cells. The oncologist is recommending 12 cycles of Folfiri to be given with "curative intent". He estimates that the chance of recurrence can be reduced from 70+% to 10% or less with chemo. However, her pulmonary surgeon, while also advocating more chemo, stated categorically that chemo given at this stage is for control and is not "curative". He went on to add that the chemo could possibly add years to survival. So, we're confused. What does it mean to pursue chemo treatment for "curative intent" when chemo is not considered curative in any case? Getting more chemo with a significant chance of cure would make risking the side-effects worthwhile. Any suggestions/clarifications?
Wife dx'd cc and colon resection 10/11
Originally Stage III C (T3,N2,M0), later revised to Stage IVa
FOLFOX 12 cycles completed 6/12
Lung met & VATS resection 6/13
Observation
2nd lung met & lobectomy 12/14

KWT
Posts: 3214
Joined: Thu Jul 11, 2013 7:22 pm

Re: "Curative intent" chemotherapy at Stage IVa, possible?

Postby KWT » Sat Jan 10, 2015 12:25 pm

I don't think I would bother with anymore lung procedures without a chemo plan following shortly after. Both time they messed with my lungs it came back rather quickly. Hell I'd go with the onc in this situation.

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CRguy
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Joined: Sun Feb 10, 2008 6:00 pm

Re: "Curative intent" chemotherapy at Stage IVa, possible?

Postby CRguy » Sat Jan 10, 2015 1:40 pm

Any suggestions/clarifications?

Clarification :Pseudoadjuvant chemo is controversial ( given after IVa diagnosis or after a recurrence ) and is spoken of as being "curative" all things being equal.
Exactly what I had in 2010 and termed "with curative intent" not palliative.
So far so good.

Suggestion : don't take chemo advice from a surgeon and don't take surgical advice from a medical oncologist. Each has their own expertise and experiences to draw from and will often be in disagreement, as yours are, albeit in a more minor "definition / intent" sense rather than a wholesale "Do it / don't do it " sense.

I took my medical Oncs advice after a "clean" VATS surgery, and as I said .... so far so good.

Best wishes
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

ams5796
Posts: 2298
Joined: Fri Feb 06, 2009 10:07 am

Re: "Curative intent" chemotherapy at Stage IVa, possible?

Postby ams5796 » Sat Jan 10, 2015 2:53 pm

As you can see from my signature I have had VATS twice and SBRT once and have not had chemo after these procedures. I did have Xeloda for eight months before the first VATS and of course, I had FOLFOX the first year. My oncologist believes in "saving" the chemo for a possible time down the road when I really need it since I am currently NED.



Ann
Stage 3C (or 4?) Rectal Cancer 01/07
2/10 lung mets
3/11 VATS
6/11 VATS
7/13 lung met
2/14 SBRT
NED 8/14
5/17 scan and MRI found treated spine met

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Voxx66
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Joined: Wed Jul 24, 2013 10:22 pm
Facebook Username: Michael Void Ward

Re: "Curative intent" chemotherapy at Stage IVa, possible?

Postby Voxx66 » Sat Jan 10, 2015 6:07 pm

CRguy has it right I think. Stick to your oncologist when asking about chemo.
DX and resect 10/2012 age 46
Stage IIa CRC
liver mets both lobes 8/2013
CEA 28
FOLFOX + Avastin 8/26/13 3 rounds
Folfox only 3 rds + rd 8
platelets low round 7,9,10 5FU only
1/14 CEA 1.0 y90
5fu
10/14 mets lung and peri
1/15 Folfiri

vancouver eve
Posts: 1507
Joined: Fri Jan 18, 2008 3:04 pm
Location: Vancouver

Re: "Curative intent" chemotherapy at Stage IVa, possible?

Postby vancouver eve » Mon Jan 12, 2015 3:21 am

I am confused about the staging. I was informed by the Onc. I have now that a spread to the liver is a stage 4A, while a spread to the lungs is a 4B. Can anyone give the answer as to why the Onc. informed me of this staging method?

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dianetavegia
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Joined: Sat May 16, 2009 8:47 pm
Facebook Username: Diane Weldy Tavegia
Location: Villa Rica, Georgia

Re: "Curative intent" chemotherapy at Stage IVa, possible?

Postby dianetavegia » Mon Jan 12, 2015 8:32 am

Different cancers have different meanings of IVa, IVb and IVc. For CRC see the quote below:
Stage IVB is when there is spread to more than on distant organ.

Stage IVA is spread to one organ.
Stage IV colon cancer is divided into stage IVA and stage IVB.

Stage IVA: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes. Cancer has spread to one organ that is not near the colon, such as the liver, lung, or ovary, or to a distant lymph node.
Stage IVB: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes. Cancer has spread to more than one organ that is not near the colon or into the lining of the abdominal wall.
http://www.cancer.gov/cancertopics/pdq/ ... ages/Print
Stage III cc surgery 1/7/09. 12 tx FOLFOX
Stage IV PET = 1.5cm liver met. HR 4/11/12

14 years since dx and 11 years post liver resection.
Pronounced CURED and discharged by onc

“O Lord my God, I cried out to You, And You healed me.” Psalms 30:2


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