comparative impact of rad before vs. after surgery??

[jaycey60]

I'd appreciate personal advice, stories, and links to published research on the comparative effects on survival and recurrence of radiation before vs after surgery in Stage IV rectal.

We're at the point where FLOX has decreased size of main rectal tumor (mid-rectum) and of most of the lymph node tumors (no mets in other organs). Our onc told us the surgeon and radiologist are arguing over whether to do radiation before or after tumor and lymph node resection. Apparently the surgeon finds it harder to remove the lymph nodes after rad because the texture of them changes and they are harder to resect (or something like that).

Any wisdom?

Thanks for being here, and being your own irascible selves!

[jaycey60]

Reposting this as got no replies - hope I didn't offend you kind people or something!

We're at the point where FLOX has decreased size of main rectal tumor (mid-rectum) and of most of the lymph node tumors (no mets in other organs). Our onc told us the surgeon and radiologist are arguing over whether to do radiation before or after tumor and lymph node resection. Apparently the surgeon finds it harder to remove the lymph nodes after rad because the texture of them changes and they are harder to resect (or something like that). But rad-onc wants radiation before surgery to reduce likelihood of local recurrence.

I'd really appreciate personal advice, stories, and/or links to published research on the comparative effects on survival and recurrence of radiation before vs after surgery in Stage IV rectal

Any wisdom?

Thanks for being here, and being your own wise caring selves

[weisssoccermom]

I don't know if there are specific studies that pertain to stage IV rectal cancer. However, I do remember that studies showed that preoperative chemoradiation was better than adjuvant chemoradiation.....and, as I recall, the differences weren't all that much....somewhere around, perhaps 8 - 10%....and both showed a significant benefit to the treatments.

Honestly, sometimes you just have to go by what the surgeon feels is best, regardless of the studies. All the studies in the world won't mean anything if the surgeon doesn't feel that he can adequately resect due to radiation 'damage'. That being said, are you dealing with a board certified COLORECTAL surgeon, as opposed to a board certified general surgeon? Here is a link to check out the credentials of the surgeon you are thinking of utilizing.
http://www.abcrs.org/verify-a-physician-2/

Even if this surgeon is board certified in colon/rectal surgery, you might think about getting a second opinion. Obviously, none of us know the specifics of your situation, but it is fairly routine/common to have the chemoradiation prior to surgery so I don't quite understand the comment about the lymph nodes. The lymph nodes are contained in the perirectal fat and they aren't removed independently.....it is all removed together.

Good luck with whatever decision you make.

[jaycey60]

Thanks so much for your reply, which was very reassuring. I'll post more separately, but it turns out it will be surgery first, very good doc, and a trial (tho I don't know if we'll end up in the treatment arm). In any case, thank you again!