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chemoradiation - the added benefit of the chemo.

Larry M
Posted by
I was diagnosed with stage II colorectal cancer last December at age 72. Tumor was removed with 34 lymph nodes in late February. Margins were clear. Turned out to be stage III. One of the 34 nodes was involved. I began FOLFOX treatments in April. After the 8th and final FOLFOX treatment, I was diagnosed with deep vein thrombosis and three pulmonary embolisms and am now getting Lovenox injections twice a day. 
The question:
Now I am facing five weeks of proton radiation therapy. I will need to take capecitabine (5 tabs 5 days a week for 5 weeks). However, I have the choice of not doing the chemo part. I am wondering how much less effective the radiation will be without the chemo. 
LarryMars - LAR, 8 FOLFOX treatments, 5 weeks of Proton radiation therapy
Linda - Macmillan
Posted by

Hi Larry M,

Thanks for your post, making decisions is never easy. But it is important to be as informed as you can be to understand the benefits and risk associated with your treatment.

When specialists recommend one treatment over another it is because there is a known additional benefit. When they offer a choice it may be because the advantage is not clearly understood for you. Given your history of blood clots it’s important to consider the risk of further clots against the benefits that these options may give you.

The benefit with combining chemotherapy and radiotherapy compared to radiotherapy alone was established in the 1980’s/90’s with improved local disease control, longer disease-free periods and improved survival outcomes. This is because the capecitabine makes the cancer cells more sensitive to the radiotherapy.

It’s difficult to say how the combination of chemoradiation vs. radiotherapy alone will benefit you. This is because you have already had chemotherapy and studies comparing these treatments haven’t included this as a factor.

We would recommend speaking with your oncologist before making your decisions. They should be able to give further guidance based on their experience. You can ask them if they can offer statistics about the potential benefit of both treatments.

I hope you are able get some clarity over your situation, and if we can help further please stay in touch.

Best wishes, Linda (Cancer Information Nurse Specialist)

Larry M
Posted by

Thank you for your insightful answer. The surgeon did what he though was best for stage ii cancer. His misdiagnosis seemed to put me in a whole new category. And, there was ambiguity as to the exact location of the tumor - rectum vs. colon. (Surgery was done in Southern California and the oncology is being done in Seattle WA.)

The protocol for stage iii rectal cancer was chosen. I asked a lot of questions for which there were no answers. I was skeptical even of the radiation, but when I was offered proton rather than x-ray, I decided to get the radiation. Friday I get a preliminary CT and later this month I will start radiation treatments. I opted out of the chemo. According to the oncologist I'll have a 15% chance of recurrence rather than a 10% chance. I am praying that the side effects for radiation alone will be more tolerable than with  the capecitabine.

LarryMars - LAR, 8 FOLFOX treatments, 5 weeks of Proton radiation therapy