Postby NHMike » Sat Jul 28, 2018 9:30 pm
Hocks wrote:Thanks. I am from Singapore.
My wife is Singaporean and she was there for a few months earlier this year.
The document on recommended CRC treatment in Singapore is at
http://www.annals.edu.sg/pdf/44VolNo10O ... 10p379.pdf (I do not know if there is a newer version of this). They basically took the US (NCCN), European and UK treatment approaches but they recommend the NCCN guidelines overall. Neo-Adjuvant (Pre-surgical) chemo and radiation are recommended for Stage 3 and riskier Stage 2 patients.
Neoadjuvant/adjuvant therapy of clinical stage II (T3-4, node-negative disease with tumour penetration through the muscle wall) or stage III (node positive disease without distant metastasis) rectal cancer often includes locoregional treatment due to the relatively high risk of locoregional recurrence. A total of approximately 6 months of 5-FU-based perioperative treatment is preferred. Preoperative chemoradiotherapy showed fewer local recurrences (relative risk, 0.46; 95% CI 0.26 to 0.82; from 6% to 13%) and less acute and late toxicities.Patients, with resected stage II or III rectal cancer, who have not received preoperative radiotherapy should be offered postoperative therapy with concurrent chemoradiotherapy in addition to fluoropyrimidine-based chemotherapy. It is recommended that the total duration for perioperative therapy be approximately 6 months. http://www.annals.edu.sg/pdf/44VolNo10O ... 10p379.pdfIn the US, the standard procedure is Neo-Adjuvant Chemo + Radiation. The Radiation is 28 days, same as the chemo. There have been clinical trials with Total Neoadjuvant Therapy (a lot of chemo and radiation up front to possibly avoid surgery). I'm not sure if this is a standard option.
It appears that you weren't offered Neo-Adjuvant Chemo/Radiation before surgery so it's offered after surgery. I actually wanted my doctors to just cut out the tumor right away but I couldn't get surgeons to do that over here without the neo-adjuvant therapy.
I would guess that there's a moderate amount of research or Big Data analysis on the Neo-Adjuvant/Surgery/Adjuvant approach in the US. It would take some digging around to see what the results of six months of chemo vs four months of chemo + two months of radiation looks like - if the data is available.
Last edited by
NHMike on Sat Jul 28, 2018 10:06 pm, edited 2 times in total.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT