Hi all, so far my treatment is going well (successful liver resection! Am thrilled), so thought I’d turn to the experts here once again for thoughts on sequencing my next treatment steps.
I completed 6 rounds of neoadjuvant FOLFOX before my liver resection. The plan now is that I do 5 weeks chemoradiation (with Xeloda), have an 8 week break, then surgery on the primary rectal tumour (ULAR). I expressed concern about the total time off systemic chemo here, and my oncologist suggested I do 2 more rounds of FOLFOX during the 8 week radiation recovery period (still leaving a 4 week recovery before surgery). I like this idea as it greatly reduces the time off full chemo, and accelerates the overall treatment plan. My surgeon thinks it’s a good idea as well.
In total he wants me to do 12 rounds of chemo during my treatment, but only 8-9 rounds with oxaliplatin to try to avoid too much permanent neuropathy. This would only leave *maybe* one more round with oxy to be done after the rectal surgery (then 3-4 rounds of just 5FU). I am concerned based on my understanding that the point of adjuvant chemo was to ‘clean up’ any residual micro-level cells or metastases that may remain after surgery, and that this true adjuvant regime may not be sufficient for this. He was of the view that the most important thing was to get the full FOLFOX course done, minimising time off chemo, and that the trend is toward giving more chemo earlier to try to stay ahead of any spread.
Any perspectives on the above? I know I could always push to do 12 rounds with oxaliplatin (as many have), but also don’t want to risk leaving myself without any adjuvant options if toxicity gets too great.
I also realise standard protocol is to wait until after all surgeries to do adjuvant chemo, but this sounds like a potentially good optimisation - my onc is sharp (and very research-oriented) and I don’t want to miss an opportunity to get a better outcome.
Thanks for any input.