The Colon Club

I’m really struggling with making a decision on adjuvant chemotherapy, I’m 43 with Stage 1 rectal cancer (T2 tumor) did Xeloda/radiation for 6 weeks prior to surgery to shrink tumor it went down about 50 % and pathology showed clear margins T2 tumor removed and 30 lymph nodes clean. Oncologist is recommending 12 cycles of oxaliplatin/5fu via port. I asked about doing just Xeloda and he said we could but he recommends being more aggressive.
Has anyone done just Xeloda for adjuvant Chemo and have a good result?

12 cycles seems like a lot for stage 1. I’m stage 3 and only doing six. That’s because of the recent IDEA study that came out showing that three months of treatment is just about as effective as six. Maybe mention this study to your Onc? I don’t have experience with Xeloda only but it seems like it would be fine for stage 1. But I’m not an onc.

I'm a bit surprised that you had a recommendation for Oxaliplatin at Stage 1 but your oncologist knows more about your case than I do. Are you at a major cancer center? If not, perhaps you could go for a second opinion at a major cancer center.

Recent papers have two points:
1. For lower stage patients with no special risk factors, 3-4 months adjuvant chemo may be about as good as 6 months but oncologists are cautious about this;
2. For curative resections, chemo intensity counts, like you're trying to burn out a few cells.

One might increase Xeloda dose 10-25% (European dosage) by carefully avoiding folic acid in enriched flours, bread, and oldstyle multivitamins. Just don't over do the chemo. Natural folate rich foods help prevent some related side effects. Especially if your CA199 is over 20, I would look at cimetidine. There are other adjuncts that might be useful. Possibly consult outside advisors like naturopaths or Life Extension.

We deal with stage 4 mCRC where utter continuity of chemo, without cycles, can have advantages. There we use many strategies to increase the intensity of chemo activity and yet reduce the side effects over the years.

kal74 wrote:I’m really struggling with making a decision on adjuvant chemotherapy, I’m 43 with Stage 1 rectal cancer (T2 tumor) did Xeloda/radiation for 6 weeks prior to surgery to shrink tumor it went down about 50 % and pathology showed clear margins T2 tumor removed and 30 lymph nodes clean. Oncologist is recommending 12 cycles of oxaliplatin/5fu via port. I asked about doing just Xeloda and he said we could but he recommends being more aggressive.
Has anyone done just Xeloda for adjuvant Chemo and have a good result?

I was stage 3 and did Chemo/Rad, Surgery, then Chemo. I did 6 cycles of XelOx (Xeloda + Oxali). My Onc gave me credit for the chemo I did with radiation. I would do Xeloda every time over 5-FU, I can't imagine being hooked up to a pump.

Oncs can be conservative as they're not the once getting the poison. In my opinion the best shoot at cure is for the surgeon to have removed all of the cancer. I'm not sure I'd count on the Chemo it's more to clean up and small stragglers. With that said at stage 3 with a couple positive nodes for me Chemo is a no brainer. At stage 1 there's more of a question. One way to think about it may be, if you have a recurrence and didn't do the full XelOx how would you feel about that?

There's no question I'd chose Xeloda over 5-FU. The standard XelOx program it 8, three week cycles. Maybe do 6 cycles of XelOx as a compromise and get the benefit of Oxali.

Question with respect to your story.
You state that you had about 50% shrinkage with neoadjuvant chemoradiation and the tumor (after radiation) was a T2. What was the 'T' designation BEFORE radiation?
That is important.

First of all, it's not usual for a patient to have chemoradiation with a stage I diagnosis. Not saying that it can't happen BUT....it's not common. What was your clinical staging?

Are you saying you are a stage 1 AFTER chemoradiation or were you classified as a stage I PRIOR to chemoradiation? If you had a 50% shrinkage and your pathology still showed a T2 tumor, it sounds as though the initial tumor was larger.....perhaps a T3? If so, then you wouldn't have been a stage I.

Can you please elaborate as to what your initial staging was....based on the EUS/MRI/PET, etc.?

Yes I was staged T2 prior to chemo/rad and again T2 after via CT and surgery so the size of the tumor shrunk but not the invasion. I asked oncologist about this and he said not uncommon but I do wonder if maybe it was a T3

I did 6 rounds of Xelox and was stage 2A. All that remained of tumor was scar tissue after chemo/radiation and pet scan before surgery showed no cancer. My surgeon said depending on pathology after surgery may not need chemo. Even though lymph nodes were not affected, margins were clear, there were minimal residual cancer cells detected where the tumor was. My oncologist initially recommended 7 rounds giving me credit for chemo/radiation but I did 6. My son was getting married and I wanted to have a month to recover before traveling for the wedding. She agreed that 6 was fine, as I told her I would do the 7th if she felt it was necessary. Her comment to me was even though chance of recurrence was low don't want to wonder "what if" if it recurred, so I went ahead. She also could not guarantee cancer cells did not get into the blood stream. It's a tough decision, as stage 2a can also be a grey area when it comes to chemo after surgery. But I don't regret doing it.
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