jvanraalte
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Posts:2
I am 76 years old and have bad arthritis in both hips; surgeons recommend hip replacement - bilateral or twice unilateral. I am also a stage 4 lung cancer survivor (2 1/2 years; the last two years in "remission" with ongoing chemo - Alimta and Avastin every three weeks. For other reasons (protein in the urine) the Avastin was stopped a month ago and this seems like an ideal "window" to consider surgery.
My oncologist is opposed to surgery because of the risks (infection, blood clots, . .) and I can't find any relevant statistics. What is your recommendation? Any relevant experience? Relative risks in my case?
John vR
Forums
Reply # - October 29, 2014, 07:21 AM
Hi John,
Hi John,
You're not likely to find any relevant statistics, because each situation is different - the general health/concurrent medical conditions of the patient, the complexity of the surgery and the effect that chemo is having on the patient's blood counts. Dr. West wrote about the issues involved here:
"Obviously, the surgeon needs to be well-informed and there needs to be good coordination between the oncologist and the surgeon. The leading issue is ensuring that the patient's blood counts aren't low enough that it would lead to a higher risk of significant complications. Blood counts drop with the vast majority of chemo regimens, and this can lead to anemia (remedied with transfusions if the hematocrit needs to be increased quickly), increased risk of bleeding if platelet counts are very low (also can be treated with a platelet transfusion, but platelets usually recover over a matter of days or a week or two, and increased risk of infection if white blood cell counts are low (increase with time, also can be treated with white blood cell stimulant like G-CSF, and risk can be minimized with low white blood cell count by giving antibiotics). If surgery isn't emergent, we usually time chemo to end a month or more before proceeding to surgery, so counts will have recovered into a safe range." - http://cancergrace.org/forums/index.php?topic=5102.msg31474#msg31474
Of course, there's no way to know in advance what will happen if you hold chemo for a significant period of time before and after surgery; it's the unanswerable question of whether the chemo you've been receiving is necessary to keep your cancer under control. If there is no evidence of cancer on your recent scans, it's possible that you don't need chemo. Unfortunately the only way to find out is to stop chemo and see what happens.
JimC
Forum moderator
Reply # - October 29, 2014, 07:43 AM
We generally favor waiting at
We generally favor waiting at least 2 or 3 half-lives, or about 6-9 weeks, after stopping Avastin (bevacizumab), to really significantly reduce the risk of bleeding/wound healing process. The bigger question, at the risk of seeming too morbid, is whether your survival will be favorable enough to justify the short-term challenges of the surgery and recovery vs. the time to benefit from it. Most patients with advanced NSCLC aren't likely to benefit from a significant surgery, but then most patients aren't in "remission" for a year or more, which suggests that yours is not a typical trajectory (good for you!).
Good luck.
-Dr. West