Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

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NHMike
Posts: 539
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby NHMike » Sat Aug 19, 2017 8:29 pm

prs wrote:At Kaiser they wouldn't even give me an appointment until six weeks after radiation ended. I was told any earlier my rectum would be too swollen and inflamed from the radiation for them to make a good determination of the results. It was the longest six weeks of my life!! That appointment was a physical rectal exam with a scope and they took photos of the scar tissue remaining at the site of the tumor. It was here that I was told I'd had a complete clinical response. They did schedule an MRI to confirm that determination but it didn't happen until the 9th week. I started chemo at 10 weeks.

Mike, is your surgeon a board certified colorectal surgeon?


Dr. Melnitchouk received her medical degree from Albert Einstein College of Medicine. She completed her general surgery residency at Brigham and Women’s Hospital/Harvard Medical School. As a resident, she received the Rudolph Vollman Award for excellence in teaching and contributed to multiple HMS research projects on colon and rectal surgery procedures. She completed a colorectal surgery fellowship at the combined Memorial Sloan Kettering Cancer Center and New York Hospital/Weill Cornell Medical Center Colorectal Surgery Program. She is board certified in general surgery and Colon and Rectal Surgery.

Her research interests are in outcomes research and global health; colorectal cancer screening and surgery for colorectal cancer in low-to-middle income countries; gastrointestinal complications involving cardiac surgery patients with LVAD and heart transplant; and sphincter sparing surgery for rectal cancer. Her clinical interests include minimally invasive surgery (laparoscopic, robotic and combined endoscopic laparoscopic surgery), sphincter preserving/saving surgery in rectal cancer, colon and rectal cancer, inflammatory bowel disorders.


https://physiciandirectory.brighamandwo ... ails/12609

Brighams and Womens generally does the surgery for cancer patients at Dana Farber (Oncology and Radiation are done at Dana Farber, scans are done at B&W). My local oncologist told me that the quality of surgeons at Brighams and Womens is very high and I found that DFCI/BW is rated fourth in the country for cancer care. He also told me that Mass General could have slightly better surgeons for this area but I had already decided to go with DFCI. In retrospect, I think that I would have gone with MGH if I had known how hard the induction process was at DFCI. It seems to be a lot easier to get set up with MGH as DFCI is the big name draw in Boston for cancer. I had some questions on insurance coverage at Mass General as well which turned out to be a non-issue. DFCI just does an incredible amount of volume for cancer alone.
06/23/17: ER rectal bleeding; Colonoscopy+Biopsy
07/13/17: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm.
Xeloda 3,400 mg/day + radiation 07/31 - 09/08.
CEA 2.7; halfway through treatment: 1.9; after treatment: 1.8.
MSS, KRAS G12D
10/06/17: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV.
Surgery: 10/30/17 LAR, Temp Ileostomy

prs
Posts: 105
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Sat Aug 19, 2017 9:57 pm

For future reference here is the link to determine if a colorectal surgeon is board certified, for best results enter the last name only and click on Submit:

http://www.abcrs.org/verify-a-physician-2/

Mike yes, your surgeon is very well qualified.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

vlp
Posts: 1
Joined: Tue Aug 22, 2017 4:20 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby vlp » Tue Aug 22, 2017 5:15 pm

Hi,
I'm new to this forum, just wanted to check in since I also have had the diagnosis of colorectal cancer, stage 3 in Jan 2015. Quite large tumor, in my rectum. I discovered it and was scheduled for a colonoscopy which confirmed it, because I had blood appearing in my stool. This was despite regular occult blood lab tests over the years. So colonoscopies are really vital, in my opinion!

I found this site because I thought I'd google to see what is the latest news regarding treatments for colorectal cancer. I am totally blown away by this site. I don't know how to set up a profile with my cancer story for all to see, but I thought that my case and Peter's (prs) are so similar it is amazing. Hi Peter, we are the same age, and we had almost identical diagnoses, at the same time, and the same treatment...and I am also cancer free...now that is amazing! But...there is a big difference in how I was treated, also at Kaiser.

I did the Habr-Gama watch and wait method, BUT I had to literally fight (ok, argue strenuously) with my Kaiser doctors when I refused surgery. They acted like they had never, ever heard of this, and none of them said they would support it! This was at Kaiser, Folsom in Northern Calif. After about 6 months, post CRT, I was still refusing surgery, but they talked me into agreeing to a biopsy, where I was taken into the OR and put under anesthesia so they could do a very extensive biopsy, afterwards the surgeon didn't even call me to tell me they could find NOTHING, the tumor was completely gone. I had to call them myself, after about 3 weeks I thought it strange, so I called them and the surgeon very begrudgingly told me the news.

I only knew about Habr-Gama from my own research, extensive research about my ailment. With no support from the doctors, I had to really believe it would work to insist on taking this chance...and now I read that this is not uncommon, and in fact, Kaiser in So. Calif. offers it as a choice!! I cannot tell you how shaken I am by this news. But there is more, also.

I also took oral Xeloda, but that's not what they had prescribed. Instead, they prescribed IV fluorouracil...to be administered with a surgically implanted catheter in my thoracic artery that I was supposed to take home with me and live with--a beeping, red light flashing box attached to a tube in my chest!! So again, I researched intensively, read all the literature, found that oral capecitabine (Xeloda), which is a form of flurouracil, was at least as effective as the IV, with much less patient discomfort!! Again, I had to demand that I get that instead, and the oncologist was actually pretty much OK with that although she was surprised and a little taken aback that I would ask for it.

So I must ask, WHAT is going on here? The same organization--Kaiser Permanente--but two drastically different ways of treating patients with colorectal cancer. To say that I am shocked is an understatement.

But I am here to tell you all that I am indeed cancer free, and my only residual problem is an occasionally sore coccyx (tail bone), if I have to sit for long periods of time. I hope and pray that this isn't a cancer brewing at the site of the radiation, because that is exactly where it was aimed. But, I also lost 40 pounds, a lot of it in my rear end, but not due to the treatment. I lost a lot of weight because I was also practicing intermittent fasting, and I changed my diet to a vegan, whole foods way of eating, so as to give my body the best chance possible to fight cancer should it try to return. As a result, I am so healthy now it is amazing. I have ideal blood panels, blood pressure, etc. and I am fit and lean. SO...the sore coccyx is very likely due to the fact that I have lost all my butt fat, which I am very sad about, but it is better than being too fat.

I hope this gives hope to some of you out there. If you can, and you really, really want to be as healthy and long-lived as you can be, switch now to a whole foods, plant-based diet. Especially restrict your protein drastically, radically, that is the best recommendation I can give you (besides refusing surgery a la Habr-Gama) if you want to remain cancer free. Cancer is so very, very much tied to our modern way of eating, but like heart disease, it is very unlikely to occur if you change the way you eat. You will be so much healthier, happier, and you will be helping to save the planet as well as billions of animals that suffer horribly due to the animal livestock industry. You can learn the most about this from Dr. Greger's website, it's all non-profit and free, nothing to sell, at http://www.NutritionFacts.org. To your health and best wishes to all. Vivian

skb
Posts: 23
Joined: Tue Mar 28, 2017 2:00 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby skb » Wed Aug 23, 2017 1:29 pm

Vivian,
Your post gives me hope. Because I am also on Habr-Gama.
Could you please tell us how long has it been since your diagnosis and the completion of neoadjuvant chemotherapy? How long have you been cancer-free?

It is not uncommon for treatment plans to vary within the same hospital. It varies from oncologist to oncologist. They do collaborate but the ultimate decision as t o how to treat a patient falls on the primary oncologist for that patient. Also it is possible that your case happened before Peter's and Habr-Gama was not adopted at Kaiser at that time.

Also I liked the way you used the word 'begrudgingly" :D :lol: My biopsy results were not shared with me for about two weeks until after the biopsy and I had to call in to get the result (University of Minnesota) just like you. Some of the delay might be due to the time taken to test the sample, confirm the results etc. but I hope the care team realizes that we the patients are on tenterhooks during this process.

I am surprised and happy you got away with oral Xeloda as the adjuvant chemo (mop-up). I did not fight the doc on it. I had the chest port implant last Thursday and infusion started the same afternoon. I am suffering from peripheral neuropathy (finger tingling), sensitivity to cold, throat constriction, nausea . I am putting up with all of it in the hope that this strong medicine will kill any remaining cancer cells (if any) in my body.

I completely agree with you on plant diet. I grew up on such a diet and it changed dramatically after I started living in this part of the world. (US) about 20 years ago. It is only logical to believe that what we eat affects the health of our gut. It is plain and simple. However the doctors here tell me , "Eat whatever you want although you have cancer". Why is the relation between cancer and foods not researched? The highest per capita colorectal cancer is in Korea. It is natural to wonder if it has to do with spicy food like Kimchi. There is definitely good correlation with read meat consumption.

I have given up alcohol and all meat since my diagnosis. I still eat fish. I enjoy it. I do not miss alcohol or meat, I lived without them for the first half of my life.

Please do post more and share valuable information with us.
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge, slightly into internal sphincters
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy per day
6/28/17: biopsy from where tumor used to be reveals no invasive adenocarcinoma
8/09/17: MRI reveals no primary tumor left
8/11/17: placed in wait and watch at Univ of Minn. Masonic Cancer Center
8/17/17: started mop-up chemo with Folfox and oxaliplatin (IV infusion), every other week for about 4 to 5 months

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susie0915
Posts: 435
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby susie0915 » Wed Aug 23, 2017 2:07 pm

My story is quite the same except I didn't have the option of watching and waiting. After chemoradiation, surgeon told me all that was left was scar tissue. His good news was that I may not need chemo after surgery, in which I was elated. He said surgery was necessary because may not know for sure if lymph nodes were affected until they sample them. After surgery, clean margins, no nodes affected I was told I should do chemo as there were dead cancer cells in specimen. I wish I would've known about watch and wait, as I may have tried to fight for that too. I recovered from chemoradiation pretty well, my surgery, complications, and clean up chemo not as well. Good Luck to you guys as you are paving the road for many of those to follow. Here's praying all follow up testing continues to be positive. :D
58 yr old mother of 3 Dx @ 55
5/15 DX T3N0MO/ 2A
6/15 5 wks of chemo/rad
7/15 sigmoidoscopy/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. 3 1/2 weeks in hospital,early ileo rev since
surgery to repair blockage. c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod onc thinks scar tissue
monitored for autoimmune disorder/interstitial lung disease
7/17 no change lung nodule
10/17 Clear CT

prs
Posts: 105
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Wed Aug 23, 2017 3:15 pm

Hi vip, I think the various Kaiser regions are somewhat autonomous. I know for sure the only reason I'm on W&W is because my colorectal surgeon at Kaiser Sunset got permission from the powers that be to introduce it at that facility. Given it's not an approved treatment I understand Kaiser Southern California left it up to the individual surgeons to determine if they wanted to introduce it. The Kaiser Sunset facility is the regional cancer center for Southern California so they see a lot of patients and have some great Doctors.

I wasn't told about W&W ahead of time, it was only when I had the complete clinical response that my surgeon told me about it and offered the option. That was a happy day!!!

I could tell just by their reaction that some of the other Drs I was involved with, particularly the older ones, were not too thrilled about W&W, however as time has passed I think they have all come around and now support the program.

We all look forward to reading more details of your journey. To enter your signature click on your user name at the top right of the page, then click on "User Control Panel", then click on the "Profile" tab, and then click on "Edit signature"
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

mozart13
Posts: 97
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Sun Aug 27, 2017 2:56 pm

How much chemo is enough has been ongoing disscussion.
Here is the the link on the study comparing 3 months vs 6 months of chemo, there was also difference in staging, 3 months cases were lower stages vs 6 months higher stages, and the difference is 12% in beneffits of 6 months, regardless of higher stage:

"The primary endpoint was DFS, defined as the earliest date of relapse, secondary colorectal primary tumor, or death due to all causes. To demonstrate noninferiority, the investigators reached consensus that a 12% relative risk increase in DFS in the 3-month arm compared with the 6-month arm was acceptable. This required a noninferiority margin of 1.12 for the DFS hazard ratio (HR)."

https://am.asco.org/risk-based-approach ... lon-cancer
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Chemo/rad finished end of January 2017, focus was on lymph nodes
Tumor erased, CCR, negative mri, ct, scope, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

prs
Posts: 105
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Sun Aug 27, 2017 4:34 pm

mozart13, hope all is well. How are you holding up to the chemo?
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

mozart13
Posts: 97
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Sun Aug 27, 2017 7:14 pm

prs wrote:mozart13, hope all is well. How are you holding up to the chemo?

Tough, had 8 rounds so far, neuropathy is there all the time, trying to talk myself to last 10 rounds, you can see on my posting what I am struglling with, had 4 delays, lab results were in boots, but my weight goes opposite way, each time heavier and heavier, not as active as used to be.
Each round is harder and harder.
Had CT last week, every thing was negative, thats excelent news, will have MRI soon.

Thx prs for asking, I will try to push myself to complete chemo, this time I ask for 3 weeks between, my oncologist agreed, should make life a bit easier.
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Chemo/rad finished end of January 2017, focus was on lymph nodes
Tumor erased, CCR, negative mri, ct, scope, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

NHMike
Posts: 539
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby NHMike » Sun Aug 27, 2017 7:37 pm

mozart13 wrote:
prs wrote:mozart13, hope all is well. How are you holding up to the chemo?

Tough, had 8 rounds so far, neuropathy is there all the time, trying to talk myself to last 10 rounds, you can see on my posting what I am struglling with, had 4 delays, lab results were in boots, but my weight goes opposite way, each time heavier and heavier, not as active as used to be.
Each round is harder and harder.
Had CT last week, every thing was negative, thats excelent news, will have MRI soon.

Thx prs for asking, I will try to push myself to complete chemo, this time I ask for 3 weeks between, my oncologist agreed, should make life a bit easier.


Best wishes on completion. I'm feeling the same way about my remaining two weeks of radiation therapy. I wish I could take a week off.

I'll be doing the Folfox after surgery too so may need a few encouraging words down the road.
06/23/17: ER rectal bleeding; Colonoscopy+Biopsy
07/13/17: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm.
Xeloda 3,400 mg/day + radiation 07/31 - 09/08.
CEA 2.7; halfway through treatment: 1.9; after treatment: 1.8.
MSS, KRAS G12D
10/06/17: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV.
Surgery: 10/30/17 LAR, Temp Ileostomy

prs
Posts: 105
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Sun Aug 27, 2017 9:33 pm

mozart13 wrote:Thx prs for asking, I will try to push myself to complete chemo, this time I ask for 3 weeks between, my oncologist agreed, should make life a bit easier.

I did 18 weeks of Xelox and then was put on hold because of low blood counts. After three weeks delay the blood counts were still too low so my onc had me skip the last two oxi infusions and finish out on Xeloda only.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

mozart13
Posts: 97
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Mon Aug 28, 2017 9:46 am

Thx guys, will keep in touch.
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Chemo/rad finished end of January 2017, focus was on lymph nodes
Tumor erased, CCR, negative mri, ct, scope, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

skb
Posts: 23
Joined: Tue Mar 28, 2017 2:00 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby skb » Tue Sep 05, 2017 11:22 am

My second chemo infusion (post 'complete response') that was scheduled for Friday 9/1/17 had to be rescheduled to the next Friday due to low neutrophil count. The oncologist has reduced the dose for 5FU for all subsequent infusions by 25%!!

That is a dramatic reduction.

When there is a reduction in chemo dosage like that, would it increase the number of infusions? Does anyone know?
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge, slightly into internal sphincters
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy per day
6/28/17: biopsy from where tumor used to be reveals no invasive adenocarcinoma
8/09/17: MRI reveals no primary tumor left
8/11/17: placed in wait and watch at Univ of Minn. Masonic Cancer Center
8/17/17: started mop-up chemo with Folfox and oxaliplatin (IV infusion), every other week for about 4 to 5 months

User avatar
susie0915
Posts: 435
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby susie0915 » Tue Sep 05, 2017 12:51 pm

I had reductions due to diarrhea and weight loss. Not sure of the % but my xeloda was reduced by 1000mg/day. Not sure about the oxi but that was reduced also. I did the same amount of infusions.
58 yr old mother of 3 Dx @ 55
5/15 DX T3N0MO/ 2A
6/15 5 wks of chemo/rad
7/15 sigmoidoscopy/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. 3 1/2 weeks in hospital,early ileo rev since
surgery to repair blockage. c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod onc thinks scar tissue
monitored for autoimmune disorder/interstitial lung disease
7/17 no change lung nodule
10/17 Clear CT

skb
Posts: 23
Joined: Tue Mar 28, 2017 2:00 pm

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby skb » Tue Sep 05, 2017 1:02 pm

Thank you Susan for the quick response. :)
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge, slightly into internal sphincters
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy per day
6/28/17: biopsy from where tumor used to be reveals no invasive adenocarcinoma
8/09/17: MRI reveals no primary tumor left
8/11/17: placed in wait and watch at Univ of Minn. Masonic Cancer Center
8/17/17: started mop-up chemo with Folfox and oxaliplatin (IV infusion), every other week for about 4 to 5 months


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