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Need advice on a decision

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  • Need advice on a decision

    I'm looking for advice, other's experiences etc., to help make a decision. I had a orchiectomy on 9/20 and now need to make a decision on whether to do chemo (4 cycles of Etoposide Cisplatin) or radiation. They have diagnosed me as stage T2A, with inlarged lymph nodes in my lower abdomen that need treated. I've been told that both Chemo and Radiation will take care of the issue, that the decision is mine as far as which route to go. I'm having a hard time making a decision. I understand the differences in time commitment for treatment, but I'm wondering which might have less side effects, and which has more significant long term risks? Any advice, and or personal experiences would be appreciated. I need to make a decision in the next couple of days. Thanks...

  • #2
    A good place to start is by reading the NCCN Treatment Guidelines. . Can you tell us anything about more about you type of tc or the results of your blood work and scans/xrays?
    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.


    • #3
      Hi Trent,

      Welcome to the Forum. My guess is that since you have been given a choice between chemo and radiation, you have pure seminoma, right? If you have any non-seminomatous components in your pathology, then radiation is never an option. I just want to make sure we're on the same page here.

      As far as the treatment options are concerned, traditionally, patients with stage II seminoma were treated with high dose radiation (35-40 Gy); however, the trend now is to treat with chemo instead (either 3xBEP or 4xEP) -that's what is used here at Dana-Farber, and I recall a recent post where even Larry Einhorn himself has prescribed this regimen to one of our members for a seminoma relapse at stage II. Both methods have their pros and cons. With radiation, there's a risk for developing a secondary malignancy in the long run. This has been documented for cases in which adjuvant radiation was used to treat stage I patients, who usually receive only 20-25 Gy. Since you have confirmed mets, you would need the higher dose. With chemo you have stronger side effects, and if you go the 4xEP route, the cisplatin could cause cumulative ototoxicity and possibly peripheral neuropathy. There is also a long term risk of developing leukemia, but this risk is smaller than that of the secondary malignancies due to high dose radiation.

      You should rest assured, though, that both methods carry extremely high cure rates. The decision in the end will be your own. Just make sure you weigh the advantages and disadvantages of each one.
      "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
      11.22.06 -Dx the day before Thanksgiving
      12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.


      • #4
        Sorry, didn't provide a lot of information. It is pure seminoma, and based on the NCCN treatment guidelines they are prescribing exactly what was listed there. The tumor was 8cm. Blood work showed tumor markers (HCG) of 46.0 before surgery, 3.0 a week later, and 0.9 two weeks later. I've had the test done again, but do not know the latest results. A bone scan and CT scan showed no additional growths, only the enlarged lymph nodes.


        • #5
          Gosh Trent, hard choice to make and it is easy for me to sit here and say I feel one way or another when I don't actually have to do any of the treatment myself. When the doctor explained chemo to us the idea made sense. Why just kill the cancer we can see when we have a chance to kill the cancer we can see and the microscopic cancer we may not be able to see?

          He explained it was like scrubbing a dirty spot on the bathroom floor or with chemo, pouring bleach on the entire floor and killing the germs/dirt we also could not see.

          The best news is, either can provide a cure, and YOU being cured is the most important thing.

          Co-survivor with husband Boyce, Diagnosed 7-11-06, orchiectomy right testicle on 7-12-06- Stage 3A: Mixed germ cell tumor with inguinal seminomatous and kartotypic carcinoma. One tumor over 10 cm, second tumor 4 cm, Chemo 4xBEP: Bi-lateral RPLND Dec 2006, nerve sparing but left sterile.
          Current DVT
          Current testosterone replacement therapy, Testim.

          "You must abandon the life you planned, to live the life that was meant for you" ~wisdom I have learned from my family on this forum