Spread into Peritoneal

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Rock_Robster
Posts: 399
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
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
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 & (01/20) stoma reversal

nzjez
Posts: 18
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 4c (T3N2bM1c 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
2019-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery 3 peri mets removed.

Rock_Robster
Posts: 399
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
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
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 & (01/20) stoma reversal

nzjez
Posts: 18
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Sat Nov 23, 2019 4:52 pm

Hi all
So all went well enough for my Cytoreductive surgery with HIPEC on the 9th Nov. My surgery was an open surgery (there was mention initially of laparoscopic being possible), and took under 6 hours (including the HIPEC).
They found the original metastasis had grown and was starting to move in towards a tricky spot, but luckily they got in before it got there. They also found 2 more small ones in the omentum, and as per usual removed the omentum. My gallbladder was also removed. My adhesions from my previous hemicolectomy was quite extensive, so they opened up those as much as possible to explore in there.
I had Mitomycin C (MMC) HIPEC for 90 minutes.
I had a great recovery, and was not as bad as I was expecting. I guess it can be a tough one to recover from, but I was lucky enough to have my epidural work really well. They phased in my pain pump before they took out the epidural so it overlapped well, and only felt rough for about half a day when the epidural was removed. I was discharged after 9 days.
The only negative is the surgeon mentioned he would recommend I follow up with an oncologist - as he would recommend chemotherapy. I don't know why, and what type it would be? I was kind of hoping to avoid that stuff again, as my peripheral neuropathy is annoying and don't want it to worsen.
Does anyone have experience with what adjuvant chemotherapy would follow CRS/HIPEC for colon primary??? Surely it wouldn't be the regular CAPOX/FOLFOX as it doesn't usually help with peritoneal involvement?
I haven't had the details from the histology report yet.
It's now 2 weeks after the surgery and I'm feeling good, and managing to do most things. Feel lucky to have had this as an option, and now crossing my fingers I will be one of the few who beats the odds.
Anyone with info/advice for what to do after this procedure would be appreciated :)
Male, Dx 39
Stage 4c (T3N2bM1c 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
2019-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery 3 peri mets removed.

tcross
Posts: 5
Joined: Mon Mar 26, 2018 6:42 pm
Facebook Username: Tadd L Crosslin

Re: Spread into Peritoneal

Postby tcross » Sun Nov 24, 2019 10:26 pm

nzjez,

I’m glad to see your CRS/HIPEC went well. I still lack one more round of FOLFOXFIRI and then a month off prior to my CRS/HIPEC. I will have completed 8 treatments prior and will do 4 after as
Mop up. My CEA has gone down from 31 to 16 after six treatments and my MRI at four treatments showed two spots were reduced to half the size.
I would definitely seek the opinion of an oncologist on chemo afterwards. What’s your CEA? Is it a reliable indicator for you?

Trying
Posts: 185
Joined: Sun May 13, 2018 10:11 pm

Re: Spread into Peritoneal

Postby Trying » Sun Nov 24, 2019 10:31 pm

Im so happy to hear you had the surgery and it went well.

Nicole
38 yr old single mom of almost 2 yr old.
Colon cancer stage IV 10 liver mets and peri metApril 2018
Folfox as of June 2018
Down to 2 mets in liver dec 2018.

nzjez
Posts: 18
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Sat Nov 30, 2019 9:41 pm

tcross wrote:nzjez,

I’m glad to see your CRS/HIPEC went well. I still lack one more round of FOLFOXFIRI and then a month off prior to my CRS/HIPEC. I will have completed 8 treatments prior and will do 4 after as
Mop up. My CEA has gone down from 31 to 16 after six treatments and my MRI at four treatments showed two spots were reduced to half the size.
I would definitely seek the opinion of an oncologist on chemo afterwards. What’s your CEA? Is it a reliable indicator for you?


Thanks Tadd
Your results from chemo sound fantastic! Nice one mate!
I never had chemo suggested prior to surgery, maybe because I never had an oncologist assigned??? Or maybe because I had only finished chemo in late May from after my Primary hemicolectomy surgery?
However, after my operation the surgeon has said he would recommend chemotherapy.
Hope your chemo cycles are going smoothly. Is it FOLFOXIRI , or FOLFOXFIRI? Are you on oxaliplatin/irenotecan/leucovin/5FU pump? Do you have a targeted therapy like bevacizumab added in?
I have annoying peripheral neuropathy from my previous chemo so I'm not so keen on Oxipilatin again. But I guess I'll do what it takes to try and get through it all.
My CEA has never been an indicator for me. Last year just prior to my emergency hemicolectomy it was normal. Also, I had a score of 0.8 just before they found my Peri mets.
I am now just 3 weeks after this major surgery, and I feel great. Havent had to take a pain killer for about a week or more.
I wish you the best for your upcoming op, and keep in touch if you ever want to chat about things.
Cheers
Jeremy
Male, Dx 39
Stage 4c (T3N2bM1c 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
2019-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery 3 peri mets removed.

nzjez
Posts: 18
Joined: Sat Jan 19, 2019 12:23 pm
Facebook Username: Jeremy Macgillivray

Re: Spread into Peritoneal

Postby nzjez » Sat Nov 30, 2019 9:46 pm

Trying wrote:Im so happy to hear you had the surgery and it went well.

Nicole

Thanks Nicole
I hope things are improving for you, and the chemo keeps shrinking that bad stuff!
Jeremy :)
Male, Dx 39
Stage 4c (T3N2bM1c 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
2019-10 Laparoscopy found a single peri met, CRS/HIPEC option offered.
2019-11 CRS/HIPEC surgery 3 peri mets removed.

tcross
Posts: 5
Joined: Mon Mar 26, 2018 6:42 pm
Facebook Username: Tadd L Crosslin

Re: Spread into Peritoneal

Postby tcross » Mon Dec 09, 2019 8:28 pm

nzjez wrote:
tcross wrote:nzjez,

I’m glad to see your CRS/HIPEC went well. I still lack one more round of FOLFOXFIRI and then a month off prior to my CRS/HIPEC. I will have completed 8 treatments prior and will do 4 after as
Mop up. My CEA has gone down from 31 to 16 after six treatments and my MRI at four treatments showed two spots were reduced to half the size.
I would definitely seek the opinion of an oncologist on chemo afterwards. What’s your CEA? Is it a reliable indicator for you?


Thanks Tadd
Your results from chemo sound fantastic! Nice one mate!
I never had chemo suggested prior to surgery, maybe because I never had an oncologist assigned??? Or maybe because I had only finished chemo in late May from after my Primary hemicolectomy surgery?
However, after my operation the surgeon has said he would recommend chemotherapy.
Hope your chemo cycles are going smoothly. Is it FOLFOXIRI , or FOLFOXFIRI? Are you on oxaliplatin/irenotecan/leucovin/5FU pump? Do you have a targeted therapy like bevacizumab added in?
I have annoying peripheral neuropathy from my previous chemo so I'm not so keen on Oxipilatin again. But I guess I'll do what it takes to try and get through it all.
My CEA has never been an indicator for me. Last year just prior to my emergency hemicolectomy it was normal. Also, I had a score of 0.8 just before they found my Peri mets.
I am now just 3 weeks after this major surgery, and I feel great. Havent had to take a pain killer for about a week or more.
I wish you the best for your upcoming op, and keep in touch if you ever want to chat about things.
Cheers
Jeremy


I’m hopeful my surgery will go as smooth as yours. I just finished round 8 of FOLFOXFIRI. Oxaliplatin, Irinotecan and 5FU pump...no targeted therapy as the genetic testing showed no benefit for my mutation.

I’m currently on a one month break to recover from chemo prior to surgery. My oncologist at my last appointment stated we will wait to see results from the surgery prior to performing more chemo. If CEA, MRI/CT, and liquid biopsies reveal nothing we may take a wait and see approach.

If CEA is not a good indicator have you considered a liquid biopsy/CTDNA test?


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