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Chances for relapse after 4xchemo and PC-RPLND??

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  • Chances for relapse after 4xchemo and PC-RPLND??

    Hi to everybody!
    Some of you may already know about my story. In brief, my husband has been diagnosed with TC IIIB 100% EC back in 3/2016. He had two huge masses one in his left retroperitoneal area and one right retrocrural. He finished his chemo (2xBEP 2xVIP) in 6/2016 and his markers were normalized since the end of his second round. In 9/2016 he had his PC-RPLND. They remove only the left retroperitoneal mass and the biopsy showed only necrosis. The biopsy from retrocrural mass showed necrosis too, so the doc said that it was not necessary to be resected.
    Unfortunately sometimes I feel that I can't manage this situation and I am afraid of a possible relapse. Surveillance makes me really anxious. Please let me know about your opinion regarding the chances of relapse?? Are the chances for cure good in that case?
    Thanks a lot.

  • #2
    Only time will tell for sure, but the early results seem to be positive, so I think his odds are pretty good.

    Fingers crossed!

    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP


    • #3
      Thanks Dave for your response! I am wondering if anyone else has seen a research or more specific information about this matter.
      Thanks a lot!
      Last edited by Vaan; 01-05-17, 06:37 PM.


      • #4
        Realistically, stage III is fairly rare, and stage III with his particular types of growth even more so. I would be surprised if there were any statistically significant studies matching his case. I could be wrong.That he is 6 months out of chemo, markers normal after 2 rounds, & had surgery confirming no active cancer is all very encouraging. hoping the good news continues.

        Last edited by Davepet; 01-07-17, 04:38 AM.
        Jan, 1975: Right I/O, followed by RPLND
        Dec, 2009: Left I/O, followed by 3xBEP


        • #5
          Thanks Dave. I also hope so!
          Last edited by Vaan; 01-07-17, 06:29 AM.


          • #6
            Hey vaan,

            Indeed, I would be also surprised if the medical literature will gave us an answer on this question. I searched a little and found not so much interesting data. There are so much different presentations, IGCCCG group presentation, histology of the tumor type, etc.

            With pure EC, some authors report as much as 90 % of complete response to chemo. MSKCC in New York found a 7 % presence of teratoma after chemo with pure EC. Still, those case reports are for stage II and III, so they maybe not representative of stage IIIB TC alone.

            But my gut feeling says that with only necrosis found, maybe the greatest risk of "relapse", although not a relapse, is the 2 - 5 % risk of having a new TC in the controlateral testis.

            December 15, 2015 : Right I/O. Markers normal.
            December 24, 2015 : Merry Christmas ! 100 % pure EC, no LVI.
            January 7, 2016 : CT scan : 2 RPLN of 8 and 9 mm
            February 2016 : Markers normal.
            March 2016 : Markers normal.
            April 2016 : Abnormal B-HCG (43). 14 mm (from 8) and 10 mm (from 9) lymph nodes.
            April 25, 2016 : Happy birthday ! Relapsed confirmed.
            May 2, 2016 : BEP x 3 begins.
            July 3, 2016 : BEP x 3 ends.
            July 2016 : Serum tumor markers normal. 10 mm (from 14) and 6 mm (from 10) lymph nodes. Back on surveillance !
            December 23, 2016 : Merry Christmas ! Serum tumor markers normal. 6.8 mm (from 10) and no more visible (from 6) lymph nodes. Surveillance continues.
            June 2017 : Serum tumor markers normal. 4 mm (from 7 mm) lymph node. Surveillance continues.


            • #7
              Hello to everybody!
              Yesterday my husband had his follow up scans and blood markers! Unfortunately the radiologist saw an increase in his remaining mass (about 5 mm). He had two masses one in the left and one in the right. During his PC-RPLND they remove only the left mass since the quick biopsy from both masses shown only necrotic tissue. His markers are still negative. Could this increase indicate a relapse??


              • #8
                What size was the node before this scan ? What size is it now ?

                Markers being negative are a good sign.

                - Matt
                March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
                March 13th: Left IO 100% Classic Seminoma
                6.3 x 5.1 x 3.8 cm, no invasion of anything
                LDH never fully normalized
                Stage: IS
                Watchful Waiting
                May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
                May 12th: started 3xBEP
                Neupogen during Cycle 2 and 3
                July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
                August 4th: Post Chemo CT/PET scan
                September 4th: Port removed
                Jan 9th 2019: 4.5 YEARS ALL CLEAR !


                • #9
                  The size of the mass was about 4x4 cm.


                  • #10
                    Originally posted by Vaan View Post
                    The size of the mass was about 4x4 cm.
                    Is that the original size when the surgery was done or the new size at this scan. It seems odd to me that they didn't go ahead & take it out while they had him open.

                    Jan, 1975: Right I/O, followed by RPLND
                    Dec, 2009: Left I/O, followed by 3xBEP


                    • #11
                      That was the original size. In the previous scan was slightly smaller and now is approximately 5x4,7. if the biopsy of one mass shows necrotic tissue they don't remove the other. I had the confirmation of D E for this practice so I don't have doubts that they do the right procedure, taking into account and the effects of bilateral RPLND and the difficulty of the procedure.
                      But now it makes me really upset the fact that the mass is getting bigger!! They also did a quick biopsy in the remaining mass during the surgery which shows only necrotic tissue.
                      Any ideas??


                      • #12
                        If it is surgically possible, I'd tell your surgeon to take that node out. Surely, there may be some other risks involved as to why they didn't do this in the first place, but given the size increase and the original size itself, why would you want to take a chance? This will also ease your mind and allow to get back to your normal life faster. IMHO.
                        Jan '11 - Stage IIIc, Mets in lungs and liver, abdo 7*7, pulmonary embolism
                        Right I/O AFP 13,000, bHCG 110, Scrotal Hematoma, IVC Filter
                        4*BEP AFP 20 end of 4*BEP
                        May '11 - RPLND @ Indiana U - inferior vena cava dissected, necrosis, AFP<5
                        Surveillance (blood & X rays) and all clear for 24 months
                        April '13 - AFP 26 , went up to 46 in a week, Negative CT Scan, Ultrasound and head MRI
                        4xTIP - almost normal AFP, but started rising again
                        2 x HDC with Autologous Stem Cell Transplant - AFP almost normal but started rising again
                        Lost kidneys, damaged liver, chirhosis, ascites 2 liters per day, dialysis 3 times per week, disabled
                        2 Lung Wedge Resections -


                        • #13
                          Hi Tark!
                          Thanks for your comment. His surgeon who is very experienced working for an Europian reference center in RPLND in Cologne saw the images and compared to the previous. His answer was that this is only a slight increase and only if the totals increase is more than 25% we should worry. I trust him and taking into account that dr E also agree with this procedure I don't worry. Maybe, if I had to decide I would prefer to the it out.. just for peace of mind! But I don't want to tell my husband something that it will make him anxious since the experts haven't mention it yet.