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Postchemo RPLND

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  • Postchemo RPLND

    I'm based in the UK and nearing completion of my 3xBEP for a 3 cm RP mass.

    In 3 weeks I have a repeat CT scan to determine the effect of the chemo on my RP nodes.

    From what I've gathered so far, a group of very experienced oncologists and the surgeon will sit down and review all data such as response to chemo, primary tumour make-up, before/after CT scans and use all previous TC experience to determine the requirment for a postchemo RPLND.

    Although they take all this into account, it seems that they'll operate if there's anything left greater than 1 cm. I was told they're definitely more agressive about taking the residual mass out than they used to be.

    If you have any experiences, I'd be very interested to know how the criteria for postchemo RPLND varies in the specialist TC centres in US and Europe.

    Diagnosed March 2006, Stage IIB, 3cm RP mass
    10% Seminoma, 90% Non-Seminoma (Embryonal, and a tiny amount of choriocarcinoma and teratoma)
    Prechemo bHCG-2648, AFP-582
    3xBEP March-June, markers normalised
    3 months postchemo - 1.2cm residual RP mass
    RPLND September 2006 - mostly necrotic tissue plus tiny amount of well differentiated teratoma
    June 2009 - TRT commenced to help out my lefty
    May 2011 - check-up, all clear

  • #2
    Hi Davie,

    I live in Canada,and was told by my Oncologist pretty much what you were told.Anything remaining post-chemo 1cm or larger would have to be removed.

    Fortunately for me, it wasn't neccesary ! Hoping the same for you,mate!

    Best Wishes
    Dec/04-Right I/O-nonseminoma (95%E/C),Stage 1, surveillance
    Nov/05- 2.2 cm lymph node= Stage II A
    Nov/05 -Jan/06-3 x BEP
    Jan/06 -Surveillance



    • #3
      I would strongly urge you to question your doctor about scar tissue. Sometimes, a lot of times, there is some residual scar tissue that may or may not eventually continue to dissolve after chemo is finished. Our onco. took the approach of watching this to see what happened and did not want to put my husband through a surgery that wasn't necessary. We have been almost a year post chemo with two spots that appear to be scar tissue. April
      Wesley's TC
      90% Embryonal 10% Seminoma
      Stage IIIa
      Treatment: Left I/O 4/11/05
      4XBEP 4/25/05
      08/05 -Surveillance & Many Scans/X-rays


      • #4
        Sloan Kettering is very agressive when it comes to an RPLND. If there is anything left after chemo iT's surgery for you. They won't take a chance that the scar tissue could be teratoma.
        Last edited by dadmo; 05-18-06, 11:44 AM.
        Son Jason diagnosed 4/30/04, stage III. Right I/O 4/30/04. Graduated College 5/13/04. 4XEP 6/7/04 - 8/13/04. Full open RPLND 10/13/04. All Clear since.

        Treated by Dr. Rakowski of Midland Park, NJ. Visited Sloan Kettering for protocol advice. RPLND done at Sloan Kettering.


        • #5
          Hi Davie, I'm in a similar position to you - I have my post-chemo CT scan results next week in the UK. My original CT scan showed a single, 1.4 cm enlarged lymph-node - so the chances are I will be a borderline case in terms of having the RPLND. I'll post on here what my results are and the actions my oncologist is recommending, as I guess our onclogists will have to follow the same UK 'NICE' guidelines for RPLND referral.


          • #6
            Hi Davie,
            I had my chemo at the IU med center completing 3XBEP on 11/30/05. Original retroperitoneal mass was softball sized and shrunk down to 9.7cm x 8 x 6cm. during chemo. Both my HCG and AFP tumor markers were elevated to 48 prior to chemo and normalized by the end of the sessions. My oncologist then wanted me to do a PET scan to determine if any of the mass would light up indicative of residual post chemo cancer. He waited till the end of February to be sure the chemo was done doing its thing, and to reduce the chances of a false positive. Sure enough, it did light up, and I had the RPLND on 3/29/06. My big mass was all scar tissue and the surgeon told me that my PET scan was a classic false positive. The PET scan was 9,800.00 and my insurance only paid $5,000.00 as it is considered experimental. All things considered, I am glad to have the damn thing out of my back anyway, and while I don't begrudge the $5K out of pocket, I would have preferred skipping the whole PET ordeal. The needle they stick in your arm is the size of Rhode Island and was by far the most painful procedure I had done during the whole process. Good luck and God bless you.
            Brian, [email protected]
            left inguinal orchiectomy 9/21/2005 > seminoma, stage IIC 12cm x 12cm retroperitoneal mass> 3XBEP completed 11/30/2005 > residual 9cm x 7cm mass removed 3/29/06. All necrotic tissue found > Surveillance