Postby catstaff » Tue Sep 14, 2021 4:00 pm
He's still on Folfiri+bev and it does seem to have worked on the lymph node mets. It may well be working (slowly) on the bone met as well. I will need to discuss SBRT with his oncologist. The standard of care is they don't do it unless the met is painful (symptomatic) which his is not. There are risks to it, especially fracture, but I assume the fracture happens when a chunk of bone is hollowed out by the minimal support it's getting from the cancer collapsing. This one is so small I doubt that's a big risk for that. It is almost certainly still active since his CEA is 6.8 and the other mets appear to have been knocked down.
His energy and appetite have flagged with an increasing number of cycles but he's hanging in there. We are going to try Ritalin. I may consider ginseng, which seems to have some scientific support (not just folklore) for this type of fatigue, but it takes a while to work. He will probably go to maintenance after another cycle or two (after the current one).
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-