Recurrence of rectal cancer

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naturalna
Posts: 2
Joined: Sun Dec 04, 2022 7:08 pm

Recurrence of rectal cancer

Postby naturalna » Sun Dec 04, 2022 7:14 pm

My colonoscopy in 2021 found rectal cancer, spread to my liver
8 cycles of FOLFOXIRI - 4 of which were with Erbitux
Hepatic artery infusion pump placement in April 2022 - 3 cycles of FUDR to my liver, 7 cycles of FOLFIRI
Liver clear since May scans. Rectal clear since Dec 2021 scans. I was on wait and watch for the rectal.
Nov 18 shows return of rectal cancer - hazelnut size - MRI shows no spread
Recommendation is to do Xeloda with radiation
Researching radiation vs. proton therapy
Any other protocols you've heard of and followed that worked?
Surgery is not recommended at this time
Thank you
Ania

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Recurrence of rectal cancer

Postby Rock_Robster » Sun Dec 04, 2022 8:44 pm

Sorry to hear the news. Why is surgery not recommended? This would usually be the gold standard for dealing with a rectal primary, although being recurrent could make it more complex if it’s not a common presentation.

My understanding is that PBR doesn’t have a lot of clinical advantage over VMAT/IMRT for rectal cancer if that’s an option (and is a lot more expensive and potentially harder to access), but it’s a good question for a rad onc.
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Recurrence of rectal cancer

Postby roadrunner » Sun Dec 04, 2022 8:56 pm

Three questions: (1) How was your initial rectal tumor staged? (2) What was your treatment for the initial tumor? Your post discloses chemo only (w/o radiation), which is likely not SOC, but perhaps occurred because of your initial presentation as Stage IV with liver metastases? (3) Rock Robster’s question—Why no surgical option now? If you are NED, as it seems, it would appear that a TME or at least an excision would be called for, though perhaps what you are saying is that they didn’t do radiation the first time and thus won’t operate now until they do. That *might* make sense if they intend to do an excision, I guess, but I don’t understand it if they are going to remove your rectum. Though I may be missing something.

Finally, if you had a rectal tumor and went on Watch & Wait with no chemoradiation beforehand (as part of TNT), that would raise questions for me. But without the initial staging even that is unclear, at least for me. Can you provide the requested details?
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

naturalna
Posts: 2
Joined: Sun Dec 04, 2022 7:08 pm

Re: Recurrence of rectal cancer

Postby naturalna » Sun Dec 04, 2022 10:14 pm

My initial rectal tumor was staged IV because it spread to my liver. FOLFOXIRI took care of the rectal cancer and reduced lesions on my liver from 20 to 7. No radiation was ever given. My colorectal surgeon suggests radiation first and leave surgery until absolutely necessary.
I love him for that. Looking at that first before taking out next ammunition.
I'm new here and a lot of abbreviations are not clear to me. SOC, TME, etc....
I have access to proton therapy - local and covered by insurance....

User avatar
Peregrine
Posts: 255
Joined: Tue Mar 01, 2022 1:18 am

Re: Recurrence of rectal cancer

Postby Peregrine » Sun Dec 04, 2022 10:50 pm

Naturalna -

The questions posed by both roadrunner and Rock_Robster are very good, in my opinion. This is because, in the U.S., the NCCN now lists Total Neoadjuvant Therapy (TNT) as the recommended strategy for treating rectal cancers. At least that is my understanding.

Under TNT, all chemo and radiation treatment is done before surgery, and the rectal surgery is usually performed a month or two after the TNT treatment is completely finished.

Thus, there is no Wait & Watch under TNT, as I understand it. The rectal surgery is done as soon as the patient has recovered well enough from the earlier treatments and is physically fit enough for surgery.

The post below shows my earlier view on the matter:

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=66167&p=512290#p512290

In your case, they wanted to do the liver treatment before finishing the TNT regimen. There may have been other considerations involved, though. For example, if your rectal tumor was a T4b tumor invading nearby organs, they may not have been able to do a clean Total Mesorectal Excision (TME).

Anyway, these are just my thoughts at the moment. I might have misinterpreted or misunderstood something.


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