Can FOLFOX be curative? - 1265124

Wed, 07/23/2014 - 14:57

My dad underwent 3 months of mFOLFOX to treat 2 lymph nodes with metastatic duodenal adenocarcinoma that remained after a local resection. The lymph nodes were 3cm and 2cm in diameter, and were no longer visible on PET/CT or regular CT after treatment.
He just had a full Whipple to remove the nodes along with other tissue that was expected to have the disease, however the pathology report found none in the entire removed specimen including 17 lymph nodes.
I'm confused now. Is it possible for the FOLFOX to have completely removed the cancer in the lymph nodes, or is it likely the surgeons missed the 2 lymph nodes in question?

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Hi eil49, I hope your dad is doing well after surgery. I don't know if we'll be of much help but possibly a doctor will have an answer. As a lay person with lots of specific info about lung cancer it seems like it's more likely the chemo got rid of at least most of the cancer cells in the lymph nodes than the surgeon not finding the right lymph nodes. Previous CT scans will have pinpointed the lymph nodes for the surgeon, however I'm speaking from a thoracic surgery point of view.

I don't know how much info you've found on this type of cancer but I see it's quite rare. I did find this conversation on the UK's macmillan forum. I've really grown to like the site.…

All the best of luck,

Dr West

No, the idea is to "downstage" the cancer by eradicating some of the cancer, as much as possible. Having a good response by having no evidence of cancer in the lymph nodes is a good finding, as is having major shrinkage (and even sometimes complete eradication of all viable disease) in the main tumor. Not surprisingly, the best prognosis tends to be in the patients who have the best response to the chemotherapy preceding surgery when that strategy is pursued.

Good luck.

-Dr. West