roadrunner wrote:You and I are in a somewhat similar situation. I started with TNT, did 4 treatments of FOLFOX (one without Oxaliplatin), I had tons of bad side effects but achieved 70-80% reduction of the tumor. So jumped to CRT, 60Gy w/Capecitabine. Did extra cycles of Xeloda before and after RT. Was offered the other 4 FOLFOX treatments (of TNT’s 8 treatments) in the “interval” after CRT, was about to start, but deferred due to the pandemic. So went to MRI, which showed “near cCR,” then flex sig, which showed the same. There’s very little of anything left, but it’s not the smooth white scar W&W requires. Subsequent biopsy was negative, but my surgeon judges that there likely is some cancer still present (and that’s the best evidence). So now I am just about to finish off the FOLFOX as a last ditch effort at local control/way to get the full chemo in before surgery.
I’ve got a great team and have researched this a great deal. Here’s my understanding: cCRs and pCRs increase for up to 22 weeks after CRT. “Interval” chemo appears to increase the odds of pCR, but the effect is modest. A lot seems to depend on whether you were a “good responder” to CRT. If yes, delay is safer and more likely to work. Chemo during the interval would I think reduce risk of spread and may help a bit if you’ve got very little cancer left. But local control is mostly about radiation therapy and surgery. You said your response to CRT was “robust,” but not how much disease remained, which I think is important — if you’re really close to a cCR and short of 22 weeks out, you may achieve a cCR with or without chemo. Just my perspective, but while I will likely do the chemo with the *hope* that it will get me from a “near cCR” to a cCR, I understand that I’m likely just going to get the benefit of getting the recommended cycles in before surgery, thus avoiding systemic undertreatment for the most part. You may also want to discuss trans-anal excision with your surgeon. Or at least perioperative biopsy if you get to a resection. Those may provide alternatives to radical resection in some cases. Good luck!
Thank you for sharing and I really hope you get the ccr.
It was interesting and very encouraging to see what a dramatic effect 4 infusions of FOLFOX had on your tumor. I pray I respond as well.
The crt reduced the mass of the tumor by more than 50% and much of what remains is necrotic (dead or dying cancer cells. My doctors could not/would not say what % of what remains is active.
Unfortunately my tumor does involve the external anal sphincter, so for me it truly is an all or none scenario.
Ive been told there is no alternative to an APR (leaving me with a bag) should I not achieve ccr and I’m unwilling to go through and live like that.