the order of treatment
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Topic: the order of treatment
Posted By: puppi
Subject: the order of treatment
Date Posted: Aug 23 2009 at 10:24am
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biopsy from first surgery reported TN this week, we have a team
together another surgery is planned then a six week hiatus after which
the team recommends radiation then chemo. Monday an MRI is scheduled,
tuesday we meet the oncologist and radiation oncologist for the first
time. Question... does the order of the treatment make any difference.
for instance my husband and I read a result on web that having
chemo before the operation met with successful results. Has anyone
else heard this ???? or have thoughts on the order or treatment...making any significant difference |
Replies:
Posted By: trip2
Date Posted: Aug 23 2009 at 11:16am
Hi Puppi and welcome.
Most of us have radiation after chemo so not sure why they want to do it the other way.
http://www.breastcancer.org/symptoms/types/ask_expert/2008_07/question_21.jsp - http://www.breastcancer.org/symptoms/types/ask_expert/2008_07/question_21.jsp
The above is a website which if you look to the left you will see many links that will hopefully answer some of your questions.
http://www.cancernetwork.com/display/article/10165/1340727?verify=0 - http://www.cancernetwork.com/display/article/10165/1340727?verify=0
http://www.breastcancer.org/symptoms/diagnosis/trip_neg/treatment.jsp - http://www.breastcancer.org/symptoms/diagnosis/trip_neg/treatment.jsp
I'm so sorry you have been diagnosed by feel you are in a good place for answers and support.
Please feel free to jump in and don't forget to look into our News/Resource section for alot of good info.
Also I would suggest you go to http://www.facingourrisk.org - http://www.facingourrisk.org in regard to familial cancer. You can speak with a certified Counselor who will help you to decide if you should be tested. Many BRCA 1 women are TNBC while the reverse is not so.
Best wishes ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: puppi
Date Posted: Aug 23 2009 at 12:44pm
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thanks for info yes they have planned to do surgery, radiation, then chemo but have seen some NT studies where they do chemo before surgery "Because patients with TNBC often are treated with an anthracycline regimen and have poorer prognosis and overall survival, research is needed to evaluate new, more effective treatments. Trials are researching the use of bevacizumab before surgery, newer agents that interfere with certain cell signaling pathways, and platinum compounds (Reynolds, 2007). The Triple Negative Trial, a clinical trial directed at women with TNBC, is evaluating carboplatin and docetaxel in the United Kingdom (National Institutes of Health, 2008a). Ongoing chemotherapy trials, using agents such as gemcitabine and oxaliplatin; abraxane, bevacizumab, and carboplatin; weekly paclitaxel and carboplatin; cisplatin; gemzar and cisplatin; and erlotinib, are being conducted (National Institutes of Health, 2008b)." we will know more by the end of the week when they STAGE the cancer and meet with oncologist tuesday for the first time |
Posted By: trip2
Date Posted: Aug 23 2009 at 1:24pm
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Thanks puppi, let us know what you find out.
http://cme.medscape.com/viewarticle/569483 - http://cme.medscape.com/viewarticle/569483
http://www.curetoday.com/index.cfm/fuseaction/news.showNewsArticle/id/5/news_id/1067 - http://www.curetoday.com/index.cfm/fuseaction/news.showNewsArticle/id/5/news_id/1067
http://annonc.oxfordjournals.org/cgi/content/abstract/19/11/1847 - http://annonc.oxfordjournals.org/cgi/content/abstract/19/11/1847
http://www.breastcancer.org/treatment/chemotherapy/new_research/20071213b.jsp - http://www.breastcancer.org/treatment/chemotherapy/new_research/20071213b.jsp
http://www.breastcancer.org/treatment/chemotherapy/new_research/20090515b.jsp - http://www.breastcancer.org/treatment/chemotherapy/new_research/20090515b.jsp
http://www.medpagetoday.com/MeetingCoverage/ASCO/14458 - http://www.medpagetoday.com/MeetingCoverage/ASCO/14458
http://www.medicalnewstoday.com/articles/153316.php - http://www.medicalnewstoday.com/articles/153316.php
------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: unklezwifeonty
Date Posted: Aug 25 2009 at 2:31pm
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They usually do radiation after chemotherapy but I have read that there is not a significant different in prognosis from doing it the other way. Not sure why your oncologist is recommending you do radiation first. Ask them. ------------- Dx: Jul/09. Age: 37. Grade: High. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. Kicked from E5103 due to Taxol reaction. Now on AC->Abraxane. Zometa (S0307). |
Posted By: Roxie
Date Posted: Aug 27 2009 at 9:24pm
| You are not sure because you are not a doctor. |
Posted By: cg---
Date Posted: Aug 28 2009 at 9:51am
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Roxie,
Do not assume that people responding are not medical doctors.
Connie
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Posted By: The Texas Woman
Date Posted: Sep 07 2009 at 8:37am
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I have not started treatment as yet but my onc at MDAnderson plans for me to do three months of FAC and then four months of taxol BEFORE surgery. I have IDCTN with node involvement. Doctor is Barry Feig. Hope that helps. Cher |
Posted By: TexasGal
Date Posted: Sep 07 2009 at 6:52pm
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I also go to MDAnderson and my Onc had me do Taxol x 12 ( 1 x weekly) , then FAC x 4 ( 1 x every 3 weeks) PRIOR to surgery. This is called neoadjuvant therapy. This method allows them to determine if the chemo is
shrinking the tumor prior to surgery. I personally feel there is a great benefit
to this method. I will be honest, I have NEVER heard of someone having radiation prior to the chemo ( not saying it hasn't happened) but I would be MOST INTERESTED to know why this course of action is recommended?
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Posted By: unklez
Date Posted: Sep 08 2009 at 6:11pm
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TexasGirl,
Curious - was the Taxol given first or was the FAC given first? Regards, Unkle ------------- Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads. |
Posted By: unklez
Date Posted: Sep 08 2009 at 6:37pm
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Dear Puppi,
The most common treatment plan is surgery followed by chemo followed by radiation. I've not heard of radiation before chemo (except in clinical trials; but does not mean it is not done) nor of radiation before surgery in early stage breast cancers. But yes, chemo before surgery is done quite often. It is called neoadjuvant chemotherapy. It helps in some ways: 1. You can observe the tumor shrink indicating the efficacy of the chemo. The jury is still out on whether the shrinkage raises false hope or is really indicative of long term prognosis. 2. It increases the chances that lumpectomy would become viable if it was initially not viable due to tumor size. 3. In a certain % of cases, the tumor gets completely killed by chemo. This is called pCR or Pathologic Complete Response. However, surgery is still needed to remove the tissue and margins from where the tumor used to be. 4. Peace of mind that metastatic disease, the real danger, is being addressed first. It also has some down sides: 1. When the chemo is done, the tumor cells on the periphery die in patches so when the tumor is removed, it may become very hard for the pathologist to be sure that the margins are negative even if they are indicated to be negative. 2. The body takes longer to recover from chemo to be ready for surgery than the other way. 3. I'm not sure that Dose Dense chemo has been studied in neo setting, so the chemo may take longer. 4. Biopsy results and staging can become skewed if the biopsy is done after chemo. This is why sometimes they still do the sentinel node biopsy upfront before doing the chemo. This means you will need surgery 3 times, a tumor biopsy, sentinel node biopsy (and axillary node dissection if needed) and lumpectomy. If surgery is done before chemo, you go into OR 2 times, once for tumor biopsy and second time for lumpectomy sentinel node biopsy (and axillary node dissection if needed). 5. There is a belief that Taxane based regimens in Neo setting actually lead to breakaway cancer cells to enter bloodstream and increase chances of future more vengeaful metastatis. Hope this helps. Regards, Unklez ------------- Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads. |
Posted By: TexasGal
Date Posted: Sep 27 2009 at 1:36pm
| Taxol was given first, Unklez |
Posted By: TexasGal
Date Posted: Sep 27 2009 at 1:47pm
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Puppi,
I go to mdanderson and they are huge on neoadjuvant chemo. If you would like more details please feel free to PM me.
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