Percentage That Have A Complete Clinical Response To Chemo/Radiation

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Deep
Posts: 16
Joined: Thu Nov 01, 2018 6:10 pm

Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby Deep » Wed Dec 19, 2018 8:08 pm

Does anyone know what percentage of people who go through chemoradiation for rectal cancer before surgery experience a "complete clinical response"? My radiation oncologist told me that it was near 30%, and that seems a bit high to me? Thanks
11/29/18 Diagnosed T3N1 Rectal Cancer (Age 39, Male, no family history)

Phillypatient
Posts: 23
Joined: Sun Aug 05, 2018 11:28 am

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby Phillypatient » Wed Dec 19, 2018 10:11 pm

https://clinicaltrials.gov/ct2/show/NCT03565029

That sounds about right and what the doctors said to me.

https://www.mskcc.org/clinical-updates/ ... ut-surgery

The above link is one of the doctors leading the study.
Really do what you can to get there, because the surgery is awful.

Good luck and always ask questions
Male 48, dx 10/16 rectal cancer t3n1m0
Chemorad Dec 16
Xelox Mar 17-Jul 17
Lar Sept 17
Reversal Dec 17

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susie0915
Posts: 891
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Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby susie0915 » Thu Dec 20, 2018 9:37 am

I had a complete clinical response. After chemo/rad my surgeon did a sigmoid and said all that was left was scar tissue, and a pet scan showed no sign of cancer. He did not really seem surprised, and said depending what pathology shows after surgery I may not have to do chemo. The pathology after surgery did show minimal residual cancer cells, clear margins and 0/24 lymph nodes. Chemo was recommended and I went ahead and did 6 rounds of Xelox. My tumor was 2 cm about 4-5 cm from the anal verge.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/only scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, 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
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change
11/18 CEA .6

Punky44
Posts: 168
Joined: Mon Oct 01, 2018 4:29 pm

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby Punky44 » Thu Dec 20, 2018 5:49 pm

We’ve been told 25%-30%.
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17
MRI/CT/PET puts staging at T3N2M0
Trying total neoadjuvant therapy—chemo first, then short course radiation, then surgery
11/5/18 started Folfox—6 down, 2 to go!

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

mozart13
Posts: 141
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby mozart13 » Thu Dec 20, 2018 6:29 pm

depend's on the stage:
"Patients with stage II tumors had a higher complete response rate of 54 percent (23 of 43 patients) compared to 33 percent (87 of 265 patients) with clinical stage III tumors. Pathological complete response rates were in line with previous results from a multicenter study led by MSK and published in The Lancet, which ranged from 25 to 38 percent."
https://www.mskcc.org/clinical-updates/ ... alResearch

Talking here about Total Neoadjuvant Therapy.

Radiation peak is about 15-17 weeks,page 7/53:
http://www.iwwd.org/wp-content/uploads/ ... 015-NF.pdf
55 year at the time of diagnosis, male
Diagnosed with T1,T2 N0 M0 rectal cancer
Total neoadjuvant therapy or TNT (chemoradiation followed by systemic chemotherapy)
Negative since Feb. '17
No surgery
Watch&Wait approach 8)
I don’t come much to forum , so if this is not updated it means I remain negative!
Wish good luck to all!

CF_69
Posts: 9
Joined: Sat Dec 22, 2018 9:44 pm

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby CF_69 » Sat Dec 22, 2018 10:12 pm

That is a very interesting article.

I’m newly diagnosed myself. T3 N1 adenocarcinoma in the sigmoid right at the rectosigmoid junction. I believe I’m being treated as rectal since I am on Xeloda and getting radiation for 5 weeks.

I’m supposed to have surgery after and then possibly 4 months of chemo afterwards, depending on what they find.

I’m curious about this TNT idea. I will see what my onco thinks about it next time I see him.

A little about me, I’m 47 years old, male, no family history. The only symptom I had was occasional blood that got progressively worse, and in fact about 2-3 weeks before my colonoscopy the doctor sent me home with a dismissive tone and a tube of Preparation H.

I ate a fairly clean diet, worked out pretty regularly since high school. I definitely took several months off here and there over the years as I also have a bad back. I do have a weakness for Big Mac’s and I was a heavy beer drinker.

All scans looking for spread have come back clear. I’m in otherwise good health.

Anyway, not intending to turn this into my diary or anything. Just this article caught my attention so was a good spot to finally jump in to the water, so to speak.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N1M0
CEA 1.9
Xeloda / radiation x 25

weisssoccermom
Posts: 5892
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby weisssoccermom » Mon Dec 24, 2018 2:26 am

I was one of the lucky ones that had a complete clinical response. While I did not have the LAR afterwards ....instead I had a full thickness transanal excision.....I am 11+ years out from surgery (a little more than 12 from diagnosis). It is possible.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby lakeswim » Sun Jan 06, 2019 8:27 pm

weisssoccermom wrote:I was one of the lucky ones that had a complete clinical response. While I did not have the LAR afterwards ....instead I had a full thickness transanal excision.....I am 11+ years out from surgery (a little more than 12 from diagnosis). It is possible.


Where was your tumor? I was told transanal is not an option for me.
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby lakeswim » Sun Jan 06, 2019 8:30 pm

mozart13 wrote:depend's on the stage:
"Patients with stage II tumors had a higher complete response rate of 54 percent (23 of 43 patients) compared to 33 percent (87 of 265 patients) with clinical stage III tumors. Pathological complete response rates were in line with previous results from a multicenter study led by MSK and published in The Lancet, which ranged from 25 to 38 percent."
https://www.mskcc.org/clinical-updates/ ... alResearch

Talking here about Total Neoadjuvant Therapy.

Radiation peak is about 15-17 weeks,page 7/53:
http://www.iwwd.org/wp-content/uploads/ ... 015-NF.pdf


The radiation peak is the frustrating thing for me right now. They just did my post-TNT scans at around (only!) 8 weeks and I asked why we can't wait longer and surgeon said the few weeks more wouldn't make much of a difference!
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby lakeswim » Sun Jan 06, 2019 8:32 pm

CF_69 wrote:That is a very interesting article.

I’m newly diagnosed myself. T3 N1 adenocarcinoma in the sigmoid right at the rectosigmoid junction. I believe I’m being treated as rectal since I am on Xeloda and getting radiation for 5 weeks.

I’m supposed to have surgery after and then possibly 4 months of chemo afterwards, depending on what they find.

I’m curious about this TNT idea. I will see what my onco thinks about it next time I see him.

A little about me, I’m 47 years old, male, no family history. The only symptom I had was occasional blood that got progressively worse, and in fact about 2-3 weeks before my colonoscopy the doctor sent me home with a dismissive tone and a tube of Preparation H.

I ate a fairly clean diet, worked out pretty regularly since high school. I definitely took several months off here and there over the years as I also have a bad back. I do have a weakness for Big Mac’s and I was a heavy beer drinker.

All scans looking for spread have come back clear. I’m in otherwise good health.

Anyway, not intending to turn this into my diary or anything. Just this article caught my attention so was a good spot to finally jump in to the water, so to speak.


CF69 - I'm with you. I was the picture of health and young too. Athletic/fit my whole life, nearly vegetarian, not a drinker. It's bizarre. Good luck to you! (This is a great resource! But you may want to consider creating a signature .)
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

weisssoccermom
Posts: 5892
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby weisssoccermom » Sun Jan 06, 2019 10:09 pm

The first surgeon measured my tumor at 3 cm in however, he was way off. My tumor was actually located between 7 - 8 cm up and initially it had grown downwards which is why the first surgeon thought it was at 3 cm. Transanal is possible with tumors higher up (but there is a limit) particularly when the surgeon has access to the equipment for TEM (not to be confused with TME). TEM stands for transanal endoscopic microsurgery.

I have a question for your and your signature. It says T4N0M0 and you call that a stage 3a...however, stage 3 has some positive nodes. I recognize that the staging has changed somewhat but I just looked at the ACS and it still has all stage 3's having some form of lymph node involvement. Did the surgeon tell you this was your staging?
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

lakeswim
Posts: 146
Joined: Sat Mar 31, 2018 9:37 am

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby lakeswim » Wed Jan 09, 2019 8:35 pm

weisssoccermom wrote:The first surgeon measured my tumor at 3 cm in however, he was way off. My tumor was actually located between 7 - 8 cm up and initially it had grown downwards which is why the first surgeon thought it was at 3 cm. Transanal is possible with tumors higher up (but there is a limit) particularly when the surgeon has access to the equipment for TEM (not to be confused with TME). TEM stands for transanal endoscopic microsurgery.

I have a question for your and your signature. It says T4N0M0 and you call that a stage 3a...however, stage 3 has some positive nodes. I recognize that the staging has changed somewhat but I just looked at the ACS and it still has all stage 3's having some form of lymph node involvement. Did the surgeon tell you this was your staging?



HI weisssoccermom. Sorry for delay. Your question about lymph nodes is a good one. It's unclear to me and something I should probably ask more questions about.

My rectal tumor grew (is growing? Monday's sigmoidoscopy shows it's gone!) on the wall closest to my uterus. On the original scans (last May), they had trouble seeing any fat plane between the two organs so, (I believe) to be careful, they staged me Stage 3. (I believe) they were unsure at the time about lymph involvement or didn't think there was any.

How do they usually determine lymph involvement???

After 4 months of chemo (I did TNT), the post-chemo MRI showed a "significant' decrease (again, this was BEFORE chemo/radiation) in the size of my tumor. Apparently, some lymph nodes were smaller too. The surgeon said that this *may* suggest they were involved or they could have been enlarged for another reason to begin with (I honestly don't remember her reason here, but it sounded good to me at the time). They honestly haven't discussed nodes much so I haven't worried about that part.

Please let me know if it sounds like I'm missing something or getting something wrong or should ask more questions. I find this learning curve to be STEEP. I used to think I was fairly smart, but so many people on this board can digest an enormous amount of technical info and make real sense of it at a very anxious time in their lives. I am not succeeding at doing that. I come on here and get overwhelmed - get enough info to be dangerous (and more anxious) - and come back again later for more. I would love to know how long it takes most to get up to speed on all of this and how they do it. It's really like a bunch of medical school classes!

Thanks.
50 - F
Mom to 2 teens
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Jan 19 - MRI and Flex Sig shows tumor "completely gone"
Indistinct fat plane btwn uterus & rectum - the one thing in the way of a cCR - surgery next :(

weisssoccermom
Posts: 5892
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Percentage That Have A Complete Clinical Response To Chemo/Radiation

Postby weisssoccermom » Wed Jan 09, 2019 9:20 pm

It's common for the medical community to err on the side of caution. If they believe that nodes 'may' have been involved, they will assume that they are.....if there's enough evidence of involvement. However, when they do that, they would say something like N1 or N2, etc. They wouldn't say N0 and yet stage you as a stage III.

The doctors determine lymph node involvement from various tests. I'm assuming that after diagnosis, you had either a rectal MRI or a rectal ultrasound AND a CT or PET scan. Determining local lymph node involvement from a CT gives about a 75% accuracy with the rectal MRI (not just a regular MRI) or a rectal ultrasound having a better accuracy rate of closer to 90%. Remember that nothing is foolproof.

Yes, other things 'can' make lymph nodes appear larger, however, when dealing with cancer and particularly with local pelvic lymph nodes, the oncs/radiologists are almost always going to assume that enlarged lymph nodes are suspicious for cancer and will stage a patient accordingly. You can also have DISTANT lymph nodes (for example, in your chest/abdominal area) that are picked up by a CT or PET scan.

If it were me, I would be asking why they have staged me as a stage III and yet have not 'staged' you as being positive for local lymph nodes. You need to have the correct answers and all the information in order to make the best decisions.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness


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