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

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Big Jay
Posts: 14
Joined: Fri Jun 17, 2016 5:41 pm
Location: Baltimore, MD

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

Postby Big Jay » Thu Nov 17, 2016 11:35 am

I'd love to hear from other patients' experiences with the W&W strategy. I was one of the lucky ones to have a cCR and am interested in learning more about this option.

So far I've had all of my treatment, from DX until now, done at Johns Hopkins Hospital. When I met w/ my surgeon to plan the surgery I asked him about his thoughts on the cCR, how this would affect the surgical plan, and what he could tell me about "watch and wait." Much to my annoyance he had not even looked at the CT/MRI results that had come out four days earlier. He quickly skimmed them and said he wasn't going to change his surgical plan: a complete removal of my rectum to w/in a cm or two of the dentate line, with a TME and an anastomosis. I asked him why he'd remove nearly the entire rectum when the tumor had been 9cm from the anal verge. His response was that this way he didn't have to worry about the margins and I wouldn't miss those few extra centimeters worth of rectum. When asked about W&W he said that he didn't know much about it. He told me that if I wanted to know more I'd have to go read all the medical journals I could find and then I'd know as much as he did.

Challenge accepted: I spent my weekend reviewing every report I could find from Dr. Habr-Gama, OncLIve, ASCO, NIH, Lancet, Memorial Sloan Kettering, etc. With a December 2015 Lancet Oncology report in hand I then met with my Medical Oncologist and asked her about W&W. She said she hadn't seen the report, didn't know much about W&W, and that I was her first patient who's ever brought it up. Ugh.

Luckily my Radiation Oncologist is all over the idea and thinks I should definitely consider it.

The JHH tumor board met on Tuesday and, not surprisingly, says I should follow the surgeon's original plan.

So I've canceled my surgery that was scheduled for today and I'm making arrangements to visit MSK in NYC. They've had a W&W program since 2006 so they'll be able to answer my questions. If I end up deciding that the risk is too great, or if MSK thinks I'm not a good candidate for W&W, I think I may need to find a new surgeon. I found my guy's complete dismissal of my concerns about LARS, and sexual/urological nerve damage, frustrating. His "easier for him" near total rectal removal plan is also very disconcerting.
DX at 45yo 6/9/16
Mod diff Adenocarcinoma, MSS, 6/14/16
2.4cm tumor, 9cm from Anal Verge, 6/27/16
Clinical staging could be IIIC, CEA 3.1 7/1/16
30x Chemorad 8/5/16 - 9/16/16
CT/MRI/Scope = NED! AKA:CCR 11/1/16... Rolling the dice on Watch & Wait

prs
Posts: 77
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 Nov 20, 2016 5:33 pm

Big Jay, all I can tell you is It's been eighteen months since I finished radiation and almost a year since chemo and my body is just about back to normal. I had my quarterly exam and rectal MRI on Oct 31st and everything looked good. I am so glad I was lucky enough this option was available to me. I have to believe my QOL is much higher than it would have been if my rectum and sphincter were surgically removed.

My radiation oncologist told me they are seeing higher rates of complete clinical response although they have not changed their radiation procedures. I have to assume they are looking harder given they can now offer their patients "watch and wait" rather than automatically going to surgery. Also they may be waiting longer to make the call as I've read it can take eight weeks or more for the tumor to finish shrinking.

Watch and Wait is not an approved treatment for rectal cancer so I can understand why some Doctors are reluctant to go this route. However it's your body and you are entitled to make your own decision. My surgeon told me that in her 15 years experience before she introduced this program she'd had about a dozen patients who made their own decision to avoid surgery and go to watch and wait. To her knowledge only one of them suffered a recurrence.
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 2,000 mg Xeloda each 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 10/15
NED but still early days.

hawkowl
Posts: 43
Joined: Sun Dec 14, 2014 5:29 am
Location: MN/FL

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

Postby hawkowl » Mon Nov 21, 2016 12:59 am

I am a (now retired) physician with rectal cancer diagnosed in 2014 and also had a cCR to neoadjuvant FOLFOX followed by chemoradiation. I spent a lot of time researching w/w and my
oncologist would have supported me if I had opted out of surgery, but in the end I made my decision based on raw emotion and gut feelings rather than evidence based medicine.

I will say that I have no QOL issues due to my APR/colostomy (it doesn't limit me one bit); I do have a lot of trouble with neuropathy from my FOLFOX and cystitis and prostatic fibrosis from my pelvic radiation. I am happy with my decision and although it is not clear it will have any positive impact on my long term survival, the surgery has also had no impact on my ability to enjoy life (I travel to remote corners of the world, swim, ride my bike...any limitations I have are due to my neuropathy).

Good luck with this difficult decision!!
Dx 12/2014 T3N2MX (iliac nodes) low rectal
12/2014-4/2015: FOLFOX (8 cycles)
4/2015-6/2015: 28 cycles of chemoradiation with xeloda
8/2015: Robotic APR with iliac node dissection; path showed ypT0,ypN0 (complete pathological response).
11/2015 scans clear, CEA 2.1
11/2015 parastomal hernia repair
3/2016 CEA 1.7

Ajane
Posts: 427
Joined: Tue Jul 23, 2013 3:03 am

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

Postby Ajane » Mon Nov 21, 2016 12:10 pm

I wish all of you the very best possible outcome.
My advise is to always go with your gut. This needs to be your decision alone and then no looking back or second guessing yourselves later on. But just know, anything can happen.
Compared to most CRC patients here, I've had a fairly easy go of it for the past 40 months. Although I "graduated" from stage 1 to 4 eighteen months ago, I live a pretty normal life. The thoractomy remains sore and the oxali induced peripheral neuropathy slows me down a little, but life is still quite good.
My journey was not limited to clinical response watch and wait. We took it a step further and did the Transanal Endoscopic Microsurgery (TEM) at 12 weeks post chemorad. It proved the six weeks of concurrent chemorad had achieved a complete pathological response. And 40 months later, I've not had any local recurrences. But unfortunately, in the past 18 months I've had two distant ones.
In hindsight, I still would not change my course..except to insist on adjuvant chemo after the TEM surgery (stage 1 was deemed unneccessary, even though my tumor was ultra-low and grade 3). Don't know that it would have changed things, but that I would have liked to have done!
A year ago, through Guardant 360 testing, I learned I carry the tp53 mutation, among 4 others. The existing chemo protocols are ineffective against these mutations. If my latest met carries any of those mutations, I'll be limited to trials.
I wanted to share my story so you'll know it doesn't work out for everyone, keeping in mind that I did have a couple of negative indicators that put me at greater risk for recurrence with the route I chose...but I'm still here fighting! It's the risk I took. Jane
7/13, T2, G3, Ultra-low. CEA 5.7 KRAS Wild, MSS
8-9/13 6 wks Xeloda/radiation
12/13 TEM pCR NED
5/15 CEA 4.6 PET 1.5 cm met, UL Lobectomy
6-10/15: Rounds 1-2 Xelox+Avastin; 3-8 Folfox+Avastin
10/15-4/16: 12 rounds Avastin
9/2016 CEA 4.2, 12 mm AP node
11/2016 CEA 4.3. PET/CT. 16mm AP nodal met removed
4 wks chemorad
2/2017 NED CEA 2.4
Carafate to tx esophageal ulcers caused by rad
Avastin maintenance postponed

2 Corinthians 12:9

mozart13
Posts: 48
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

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

Postby mozart13 » Fri Dec 09, 2016 8:02 pm

PRS wrote:A year ago I was diagnosed with a very low rectal tumor that had progressed thru the rectum wall and into the sphincter muscles. The three local Drs I saw all told me straight out that treatment would involve an APR and include removal of my sphincter. Fortunately my health care provider did not have a local colorectal surgeon and I was offered and accepted a referral for treatment at Kaiser Permanente's huge medical center in Los Angeles. A year later I am NED and still have a fully functioning sphincter, in fact I have had no surgery whatsoever. I thought I should share my story here and detail exactly what happened.

It turns out that this cancer center had just introduced the Habr-Gama "Watch and Wait" strategy with no surgery for those patients who had a complete clinical response to chemoradiation, and I was fortunate enough to be one of the 20% or so of patients who have a complete response. My colorectal surgeon explained that the Habr-Gama strategy had been around for a number of years but was only now gaining acceptance because new studies have shown that when patients on watch and wait do have a recurrence they can undergo "salvage" surgery and the outcomes of this surgery were just as good as if they had had surgery in the first place.

To sum up if you are lucky enough to qualify for watch and wait the odds are good that you'll never have a recurrence of the disease, but if you do have a recurrence then you get "salvage" surgery and the chances of a good outcome are the same as if you had surgery in the first place. To me this seems like a no-lose proposition.

My surgeon explained that the "salvage" surgery info is very new and it's really only colorectal surgeons who keep up with the literature and attend conferences who know about it. She said it was unlikely that the info had yet gotten thru to oncolgists or general surgeons. I asked her if she was the only colorectal surgeon implementing this strategy and she replied that she knew of a number of centers thruout the US that were implementing it. She indicated they were mostly teaching hospitals because the Drs at those centers were usually most up to date. I asked about Kaiser's position on this and she implied it had been blessed by the powers that be but they were leaving the decision to implement up to the colorectal surgeons at each facility. She indicated it was spreading rapidly thru Kaiser's facilities in Southern California.

Dr Angelita Habr-Gama is perhaps the most famous and recognised colorectal surgeon in the world, She is based in Brazil, is probably close to 80 years old, and has had an amazing career breaking thru many glass ceilings in a profession dominated by men. She's definitely worth a Google.

I can provide more detail on this Habr-Gama strategy if anyone is interested.

Hi,
I am gonna start chemoradiation in couple of weeks,
have T1,T2 rectal cancer
Will have 25 sessions , xeloda 1750 twice a day, and 50gy radiation.
Could you please tell me what was your dose of chemo post initial treatment.
I am hopeing for same result, my surgeon is not trilled with idea, but will do whatever I want.
Thx!
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 Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, started folfox 10 rounds, every second week

mozart13
Posts: 48
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

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

Postby mozart13 » Fri Dec 09, 2016 9:31 pm

Congrats, that's great news.
PRS could you please provide me more info on Habr-Gama strategy.
I am about to start the same treatment.
Thx!
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 Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, started folfox 10 rounds, every second week

prs
Posts: 77
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 Dec 10, 2016 6:02 pm

During chemoradiation my Xeloda dose was set at 1,000 mg twice per day, with weekends off. This dose was much lower than the 2,300 mg twice per day recommended dose based on my body surface area, I don't know why my onc set it this low, but it worked fine for me and I didn't get any of the Xeloda side effects often discussed on this forum.

A word of warning; I took my first Xeloda dose on an empty stomach and without food. An hour later I just about passed out in a supermarket parking lot. From then on I always took it towards the end of breakfast and dinner. I didn't worry about these being exactly 12 hours apart, usually breakfast was about 8 am and dinner at 6 pm.

During the six months of mop up Xelox chemo my Xeloda dose was initially set at 1,500 mg twice per day for 14 continuous days at the beginning of each 21 day cycle, with the last week of each cycle off. However towards the end of the third cycle I developed severe diarrhea and the fourth cycle had to be delayed a week. My Xeloda dose was then reduced to 1,000 mg twice per day for the remaining five cycles and the diarrhea issue never returned. In my case the oxaliplatin infusions caused much more severe side effects than the Xeloda, but again this is likely because of the relatively low dose I was taking.

I am certainly not advocating anyone take lower doses of Xeloda, but my experience suggests that if the side effects become so great you are tempted to quit treatment, then taking a lower dose might be an option.
Last edited by prs on Mon Mar 20, 2017 12:15 am, edited 1 time in total.
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 2,000 mg Xeloda each 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 10/15
NED but still early days.

mozart13
Posts: 48
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

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

Postby mozart13 » Sat Dec 10, 2016 10:46 pm

Not an easy road, thank you for sharing your experience.
Haven't mention this to my oncologist yet, will do on next appointment.
I don't think they have this approach at my place, but they can always learn.
You waited 3 months before starting 8 cycles of chemo, right.
Did you receive oxaliplatin infusions every day of xeloda therapy?
My oncology radiation doc said they gonna focus radiation on lymph nodes, that's where the problems are usually hidden.


thank you again!
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 Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, started folfox 10 rounds, every second week

prs
Posts: 77
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 Dec 11, 2016 2:14 am

My colorectal surgeon determined my complete clinical response about six weeks after I finished radiation treatment. She recommended I start mop up chemo asap, and I did so the following week. The oxaliplatin infusions are on the first day of each three week cycle, I didn't feel too bad after the first one but the side effects got worse after each infusion. After the sixth infusion my blood counts went really low and my onc was so concerned about the low platelet count that he postponed the seventh infusion. After three weeks the counts were still not back up to safe levels, so he had me finish the last two cycles on Xeloda only.

My initial staging mentioned two suspicious lymph nodes. The IMRT radiation did specifically target my tumor, but I was told they were also radiating my entire pelvis to make sure they got all the lymph nodes
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 2,000 mg Xeloda each 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 10/15
NED but still early days.

mozart13
Posts: 48
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 Dec 11, 2016 9:30 am

thank you for detailed explanation.
Could you please provide me with name of Hospital, than I will have my guys to look into it, if you can't post it, can you send me message.
Thx!
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 Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, started folfox 10 rounds, every second week

prs
Posts: 77
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 Dec 11, 2016 10:48 pm

I was treated at the Kaiser Permanente Medical Center on Sunset Blvd in Los Angeles.
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 2,000 mg Xeloda each 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 10/15
NED but still early days.

mozart13
Posts: 48
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 Dec 12, 2016 10:18 am

thank you!
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 Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, started folfox 10 rounds, every second week

Garycee
Posts: 5
Joined: Mon Dec 12, 2016 12:30 pm

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

Postby Garycee » Mon Dec 12, 2016 2:06 pm

weisssoccermom wrote:9.5 years ago, when I was diagnosed with rectal cancer, I actually spoke (via email) with Dr. Habr-Gama and a surgeon in Pittsburgh (Dr. David Medich) who were collaborating on a similar idea. Instead of watch and wait....they were taking patients who had a complete clinical response, offering them an excision (either transanal or the newer transanal endoscopic microsurgery), seeing what the biopsy results from that showed and then proceeded with either a modified 'watch and wait' or the more radical surgery.

The studies done on over 2000+ specimens from patients who underwent the LAR procedure indicated that there was a strong correlation between a pathological complete response and any nodes affected. Obviously nothing is guaranteed but the results were strong. My excised specimen showed no cancer cells, all my pre-treatment tests (EUS, CT) indicated that no nodes were affected so I was comfortable with having the chemoradiation, excision and then follow up chemo. The excision isn't an open surgery, causes little to no bowel issues as the amount of tissue removed is miniscule and the rectum is able to heal itself. Personally, I feel better knowing that I had the excision and was able to get a pathology report on it indicating that in my case...no cancer cells were found.

In my mind, the problem with the 'watch and wait' strategy as a whole is simple. You have no way of knowing whether or not microscopic cancer cells are remaining in the radiated area of the rectum. I'm glad to see, at least, that chemotherapy was offered. Not to do mop up chemo would, IMO, be reckless. I know how hard I fought to have the excision and how nervous I was to find out the pathology report from my excision surgery. If I had to do it all over again, I would still opt for the excision as a biopsy tool (if nothing else). It was a relatively simple procedure....spent the night in the hospital only because of an unrelated complication and overall, I have excellent function and lead a relatively 'normal' life.

I am happy to see that in the last almost 9 years since my surgery, that surgeons and the medical community are warily starting to accept alternatives to the accepted 'standard of care' protocol. Hopefully this approach and or some modification of it will gain acceptance in the medical community that there ARE other ways to treat a specific subset of patients rather than just utilizing the more radical surgical approach. I remember reading a paper where one surgeon made an analogy to breast cancer surgery and rectal cancer surgery. The gist of it was that in breast cancer surgery we have evolved from the more radical surgery (radical mastectomy) to a less invasive surgery (lumpectomy...in some cases) while at the same time utilizing other medical treatments such as chemo and/or radiation. The author pointed out that with rectal cancer just the opposite has transpired. We've gone from excisions (without radiation and/or chemo) to the more radical surgery and have not bothered to look at potentially reversing that trend while at the same time utilizing the radiation and/or chemo to achieve similar results. I'm probably not explaining it very well but it has stuck with me and it is true. I'm not knocking the LAR procedure....there is no denying that it has improved survival rates, etc. but it does come at a cost.....one that I was very concerned about. Without surgeons who are willing to push the boundaries and without patients who are willing to participate in these 'trials', nothing will ever change.

Please, make sure you stay on top of your follow ups. I know I wasn't a fan of the every three month exams...either an EUS or a mini flex sig....but I faithfully had them done, along with a CT and bloodwork. As time passed, those exams were able to be spread out and now I am done with them, except obviously for my full blown colonoscopies. It's super important with this procedure that you stay on top of everything and IF a recurrence happens or even if you develop another polyp (which, btw, is very common in patients who have had pelvic radiation) that it is taken care of immediately.
Age 64
Colorectal diag 09/16. Mets to liver solitary tumor.
One tumor in colon/rectum 4 CM.
11/16 liver resection tumor which has shrunk to a shadow after 4 session if folfixi chemo.
Post op recovery now. 4 weeks out and starting to fee normal. Liver completely clean
Now back to chemo regimen for 6-8 sessions and then look at colon tumor. Radiation and surgery
I'm 64. One surgeon said that rectal tumor has "shrunk back" into Colon and because it's shrunk so much from chemo maybe just radiate

Garycee
Posts: 5
Joined: Mon Dec 12, 2016 12:30 pm

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

Postby Garycee » Wed Dec 14, 2016 4:28 pm

Question
I dx crc with mets to liver (solitary tumor)
After 4 rounds chemo liver tumor shrunk to shadow so had liver resection. Result was clean liver. I've been off chemo for 6 weeks. Due to restart. What is usual "downtime" before chemo resumes. I have tumor in lower colon/rectum which had shrunk after first four rounds of chemo.
Any thoughts or experiences would be appreciated
Thank you
Last edited by Garycee on Wed Dec 14, 2016 9:42 pm, edited 1 time in total.
Age 64
Colorectal diag 09/16. Mets to liver solitary tumor.
One tumor in colon/rectum 4 CM.
11/16 liver resection tumor which has shrunk to a shadow after 4 session if folfixi chemo.
Post op recovery now. 4 weeks out and starting to fee normal. Liver completely clean
Now back to chemo regimen for 6-8 sessions and then look at colon tumor. Radiation and surgery
I'm 64. One surgeon said that rectal tumor has "shrunk back" into Colon and because it's shrunk so much from chemo maybe just radiate

User avatar
Nik Colon
Posts: 5210
Joined: Thu Jan 08, 2015 3:35 pm
Location: MN

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

Postby Nik Colon » Wed Dec 14, 2016 9:23 pm

Garycee wrote:Question
I dx crc with mets to liver (solitary tumor)
After 4 rounds chemo liver tumor shrunk to shadow so had liver resection. Result was clean liver. I've been off chemo for 6 weeks. Due to restart. What is usual "downtime" before chemo resumes. I have tumor in lower colon/rectum which had shrunk after first four rounds of chemo.
Any thoughts or experiences would be appreciated
Thank you

6 weeks is average time after surgery, some say a month, I would also say it has to do with how you are doing, I think mine was around 6 weeks.

Ps, you may want to post this as a new post to get more answers.

Best wishes
KRAS-mut G12V,MSS
Stage IVa Sig CC 2 lvr mets 1/12 Ln
(3, =<3 lng spots at dx til 5/16)
=T3N1aM1a 4cmX4mm (lng not included)
dx 12/2014 at age 39
CEA 1/15-4.9, 12/16-4.9 again
neoadj FOLFOX 1/15-3/15 (4tx, 3w/1wo oxi)
Col/Lvr surg 4/23/15 NED
adj FOLFIRI start 6/15-9/15 (8tx, 5w/3wo iri)
1 sml lvr spot/cyst
12/6/16 multi lung spots/mets?
No longer NED :(
My tx ongoing-start 1/20/15
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