Chemo recommended 6 weeks after thoracotemy - 1241703

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joppette
Chemo recommended 6 weeks after thoracotemy - 1241703

Here's a brief overview as is in my signature at Lungevity: 6/07 DX NSCLC, Left Upper Lobe wedge resection: Stage 2.3/4, (2B?) Adenocarcinoma, measures 2.5x1.5x1.1cm. Involving visceral pleura but not through it. 6 months chemo, carboplatin and Taxol.
9/07, 1/08, 7/08, 6/09, 1/10, 6/10 CT Scan - NED. 1/11 3.5 mm node found. 10/11 CT scan reveals node now 8 mm, and new 6 mm node. 11/11 CT Pet shows slight uptake. 1/4/12 Biopsy - Pneumothorax complication. 1/14/12 Lobectomy of upper rt. lobe.
NSCLC Adenocarcinoma in situ, nonmucinous (bronchioloalveolar carcinoma) 1.4cm involves pulmonary parenchyma. 3 nodes discovered.

This is my second thoracotemy in four and a half years. Both cancers were staged IIB with chemotherapy recommended both times. Last surgery was January 14, 2012. I meet with doctors on 2/21 to discuss recommended chemotherapy (ies). When I met with the surgeon last week for the normal post-op follow up, he wanted me to understand that chemo is going to be recommended again. He said that it was important for me to decide quickly because "chemotherapy needs to begin within six weeks after the surgery." I vaguely seem to remember something like that the last time.

ANYWAY, what is the significance of six weeks? I asked to move my appointment out from early Feb. because my pain was so significant, and I wanted to be further along in healing before going down this chemotherapy road. Now I'm being told about this six week thing, and I don't understand. No one mentioned this before. Please help if you can! Thank you so much.

catdander
Reply To: Chemo recommended 6 weeks after thoracotemy

Joppette, welcome to Grace. I'm so sorry you're going through this again! but I'm glad for you that you have posted on Grace. I'm not going to try to discuss your question with any kind of authority; I'll let the experts handle that.
I hope too you are getting your pain managed; there should be no reason that can't happen now. You may need to ring the surgeons office a bit more but don't be shy asking for pain medication.
Again welcome to Grace. I know you will get answers here that will help with your understanding.
Janine

Dr Pennell
Reply To: Chemo recommended 6 weeks after thoracotemy

Hi Joppette, welcome to GRACE.

The reason we use 6 weeks or so as the timeframe to start adjuvant chemotherapy is simply because that is the way it was given in the trials that showed a survival benefit from adjuvant chemo. The concept is that chemotherapy can eradicate microscopic metastatic disease (scattered cancer cells) before they set up shop and start to form macroscopic (visible on scans) metastatic disease which is not curable.

No one actually know how long you can wait after surgery and still have the chemotherapy be beneficial. The cutoff I usually use is 3 months. After that I assume that either patient is either cured already anyway or the cancer is no longer curable with adjuvant therapy. Could it be OK to give it later? I suppose, but there is no data to guide us so I would rather spare the patient the toxicity of chemo if it wasn't proven to help.

Every patient is different after surgery. Some are ready to start chemo one month post-op, while some need much longer. If a patient is still not fit enough 3 months post-op, though, something is usually significantly wrong and chemo is not as big a priority.

laya d.
Reply To: Chemo recommended 6 weeks after thoracotemy

Joppette:

In my Mom's case, her adjuvent chemo started 7 weeks after her right pneumonectomy. My Mom's Med. Onc. told us that her general rule is to start adjuvent chemo 6 to 8 weeks post surgery - - but, that there are exceptions. Like Dr. Pennell, she also does not go outside of the 12 week post-surgery mark for adjuvent chemo.

Best of luck to you,
Laya