Postby roadrunner » Sat Nov 07, 2020 10:20 am
I am by no means saying it’s an option for you — that’s up to you and your doctors), but there is a treatment approach called TNT (“total neoadjuvant therapy”) in which 8 cycles of chemo (usually FOLFOX) and long-course radiation are delivered before surgery is considered. Studies have shown that up to 30% of patients with a Stage 3 diagnosis can achieve a “complete clinical response” or “cCR,” and then enter a “watch-and-wait” protocol, avoiding surgery in the absence of recurrence. Since you are facing a permanent colostomy, this may well be worth researching.
I should note that some patients who pursue a more traditional approach (chemorad, surgery, chemo) also achieve “watch and wait,” but it is a lower %. Also, your doctors must be willing to do “watch and wait” — my oncologists are with a cancer center that won’t do it, but I was able to get them to work with a surgeon at another center who was a pioneer. There is a thread on this site that you may wish to read. Two notes: This approach is not for everyone, and even if you want it your body may not cooperate (I am so far right on the line — my tumor is gone, I’ve got a negative MRI and biopsy, but some clinical observations are still iffy). Short course RT can induce a cCR, but I think it is less likely than long-course. I don’t know how many centers are doing long-course in the pandemic environment, so that may also be a complication. But the idea may be worth research.
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
Switched to neoadjuvant chemorad in 11/19 (Xeloda and approx. IMRT, 60 Gy, 33 fractions)
Trying to achieve cCR.