Spread into Peritoneal

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Rock_Robster
Posts: 375
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Spread into Peritoneal

Postby Rock_Robster » Sat Sep 21, 2019 8:36 pm

nzjez wrote:
Rock_Robster wrote:One other comment on the PRODIGE 7 trial results - this trial used oxaliplatin as the HIPEC drug. I’ve seen inconsistent results between this and mitomycin-C (MMC), some research suggests Oxaliplatin has the edge, but some more recent studies indicate significantly better results from MMC. Might also be a topic for discussion with whomever is planning the surgery.

Cheers
Rob

Hi Rob
Thanks for all your advice and input. I really appreciate everything you've said, and your though into it.
Definitely will chat about the type of HIPEC, and any reasoning the surgeon/ oncologist has as to their choice esp with recent study finding. Even whether HIPEC is recommend? Maybe CRS on its own to reduce morbidity?
The pelvic Exenteration surgery ive also been suggested does also sound like and option, but I'm really hoping they can make CRS a good feasible choice. PE sounds such a drastic terrible surgery.

No problem at all, sounds like you’re heading down the right path with regard to the conversations.

Just out of interest, am I right in assuming from your username you’re in NZ?

I agree re PE surgery - whilst these are all big procedures, this is another level again. I haven’t heard of PE used for peri mets so much; here it’s more used for complex local recurrence of rectal cancer that can’t be managed with a more localised resection. If they believe they can remove all macroscopic disease with CRS then I’m sure this would be preferable.

I’ve seen a few people here comment that if they had their time again they would do CRS without HIPEC. I can also understand that based on the research so far. I guess the question will be, given you’re having major surgery anyway, does adding HIPEC materially increase your risk of complications - and if not and may add a few % of survival benefit, then perhaps there’s an argument for it. Maybe others who’ve had this procedure can weigh in here.

Good luck, let us know how you go.

Cheers
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

nzjez
Posts: 15
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Fri Nov 01, 2019 6:46 pm

Rock_Robster wrote:
nzjez wrote:
Rock_Robster wrote:One other comment on the PRODIGE 7 trial results - this trial used oxaliplatin as the HIPEC drug. I’ve seen inconsistent results between this and mitomycin-C (MMC), some research suggests Oxaliplatin has the edge, but some more recent studies indicate significantly better results from MMC. Might also be a topic for discussion with whomever is planning the surgery.

Cheers
Rob

Hi Rob
Thanks for all your advice and input. I really appreciate everything you've said, and your though into it.
Definitely will chat about the type of HIPEC, and any reasoning the surgeon/ oncologist has as to their choice esp with recent study finding. Even whether HIPEC is recommend? Maybe CRS on its own to reduce morbidity?
The pelvic Exenteration surgery ive also been suggested does also sound like and option, but I'm really hoping they can make CRS a good feasible choice. PE sounds such a drastic terrible surgery.

No problem at all, sounds like you’re heading down the right path with regard to the conversations.

Just out of interest, am I right in assuming from your username you’re in NZ?

I agree re PE surgery - whilst these are all big procedures, this is another level again. I haven’t heard of PE used for peri mets so much; here it’s more used for complex local recurrence of rectal cancer that can’t be managed with a more localised resection. If they believe they can remove all macroscopic disease with CRS then I’m sure this would be preferable.

I’ve seen a few people here comment that if they had their time again they would do CRS without HIPEC. I can also understand that based on the research so far. I guess the question will be, given you’re having major surgery anyway, does adding HIPEC materially increase your risk of complications - and if not and may add a few % of survival benefit, then perhaps there’s an argument for it. Maybe others who’ve had this procedure can weigh in here.

Good luck, let us know how you go.

Cheers
Rob


Hey Rob
Yeah NZ based. Live down in Queenstown. You're Oz based?
You're onto it with what's going on mate. The PE was due to them thinking it could've been a local recurrence in the lower bowel. Must have been a hard read on the PET scan, but was checked and confirmed unfortunately peri.
Over the last few weeks I have arranged a diagnostic laparoscopy, and confirmed a single met at the time. I now have a surgery confirmed (yesterday) for next Saturday for CRS/HIPEC with MMC as my hot chemo. So only a little time to plan, as have to move the family to the north island next mid next week.
Exciting times!
Male, Dx 39
Stage 4 (T3N2bM1 21/47 LNs)
2018-11 - Colon resection
2018-12 - CAPOX Chemo started
2019-03 Clear CT
CEA 7/19 0.8
2019-09 PET/CT found metastasis in peritoneal
2018-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery

Rock_Robster
Posts: 375
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Spread into Peritoneal

Postby Rock_Robster » Fri Nov 01, 2019 7:19 pm

Awesome - Queenstown is definitely my favourite place in NZ. Amazing mountains and such good food.

Yep I’m in Melbourne, moved back here about a year ago for treatment. Was in Europe before that.

Great that it’s only a single peri met - I think the outcomes for that after surgery can be good. Fantastic that they’ve got onto it so quickly too - bummer you have to move north but it’ll all be worth it no doubt!

Good luck for the move and Saturday! Keep us updated :-)

Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal


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