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  • PC-RPLND Adjuvant Cycles of EPx2

    I was curious whether anyone has done the 2xEP post pc-rplnd? The 4xBEP hit me pretty hard so I am expecting a rough go on these next rounds but maybe it won't be as bad without the bleo. And I've had a couple of months to recover.

    My pc-rplnd pathology, though mostly teratoma was up in the air for the first pathologist who looked at it but then my oncologist sent it to the most seasoned guy in the department at upenn and he concluded a minute focus of viable tumor. I didn't know that you could have anything but a 100% certain result on a pathology report but there it is. I sort of wonder whether maybe they found something they couldn't explain or whether my sample was just too mutilated after the rplnd and of course they have to err on the conservative side. I've been really impressed by the physicians and nurses at univ of penn and my onc said that if he had any doubts he would have sent the sample to Sloan or IU.

    For anyone about to go into a pc-rplnd, I was quite fearful but it turned out not to be as bad as I expected. The most difficult part so far was going without food for 9 days or whatever it was. They say I had complications, with a particularly tricky bit of tumor that was stuck to the vena cava where they had to cut out more than they wanted so the procedure was about 5.5 hrs. But they brought in a vascular surgeon to patch that and honestly I don't feel any the worse. The NG tube gave me laringitis (sp?) for a few weeks. Also, it kinda feels like someone stuck a spoon in my guts and stirred things up down there because it definitely doesn't feel the same as it used to, just the way things move down there. But I am regular and aside from crampy pains especially at night, I'm doing ok. Pain wasn't much of an issue. The epidural worked like a charm and they gave me some diloded after that. but the diloded made me feel crazy so I have just been on ibuprofen since they took out the epidural, but there wasn't close to the pain I expected. Also couldn't get much rest in the hospital, but as soon as the bowels woke up, I went home and things improved fast! Still walk around kinda hunched like an old man but I had cabin fever and returned to the office 2 weeks after the procedure. My docs didn't recommend any of the non-fat diet but I did a low-fat diet for the first two weeks. Does anyone know whether Sloan recommends continued low-fat after that or just the nuts and popcorn thing? If anyone is about to do this, I am happy to share any of my experience up to this point.

    PS I'm more of a reader than a poster on here especially when I'm feeling yuck but I have followed many experiences since my diag and besides my appreciation for other experiences, many have my thoughts and prayers even when it doesn't get typed here.
    Diag: 05/30/07, Stage 3 treatment at Upenn
    I/O: 06/04/07
    4 Rounds BEP ended 08/22/07
    RPLND: 10/12/07 Upenn
    2 Rounds EP ended 12/06/07
    2nd RPLND 07/08 Sheinfeld

  • #2
    Originally posted by nskene
    I was curious whether anyone has done the 2xEP post pc-rplnd? The 4xBEP hit me pretty hard so I am expecting a rough go on these next rounds but maybe it won't be as bad without the bleo. And I've had a couple of months to recover.

    My pc-rplnd pathology, though mostly teratoma was up in the air for the first pathologist who looked at it but then my oncologist sent it to the most seasoned guy in the department at upenn and he concluded a minute focus of viable tumor. I didn't know that you could have anything but a 100% certain result on a pathology report but there it is. I sort of wonder whether maybe they found something they couldn't explain or whether my sample was just too mutilated after the rplnd and of course they have to err on the conservative side. I've been really impressed by the physicians and nurses at univ of penn and my onc said that if he had any doubts he would have sent the sample to Sloan or IU.

    For anyone about to go into a pc-rplnd, I was quite fearful but it turned out not to be as bad as I expected. The most difficult part so far was going without food for 9 days or whatever it was. They say I had complications, with a particularly tricky bit of tumor that was stuck to the vena cava where they had to cut out more than they wanted so the procedure was about 5.5 hrs. But they brought in a vascular surgeon to patch that and honestly I don't feel any the worse. The NG tube gave me laringitis (sp?) for a few weeks. Also, it kinda feels like someone stuck a spoon in my guts and stirred things up down there because it definitely doesn't feel the same as it used to, just the way things move down there. But I am regular and aside from crampy pains especially at night, I'm doing ok. Pain wasn't much of an issue. The epidural worked like a charm and they gave me some diloded after that. but the diloded made me feel crazy so I have just been on ibuprofen since they took out the epidural, but there wasn't close to the pain I expected. Also couldn't get much rest in the hospital, but as soon as the bowels woke up, I went home and things improved fast! Still walk around kinda hunched like an old man but I had cabin fever and returned to the office 2 weeks after the procedure. My docs didn't recommend any of the non-fat diet but I did a low-fat diet for the first two weeks. Does anyone know whether Sloan recommends continued low-fat after that or just the nuts and popcorn thing? If anyone is about to do this, I am happy to share any of my experience up to this point.

    PS I'm more of a reader than a poster on here especially when I'm feeling yuck but I have followed many experiences since my diag and besides my appreciation for other experiences, many have my thoughts and prayers even when it doesn't get typed here.
    Hi nskene,

    I had to respond to this because your case sounds to much like my sons.
    His initial therapy was 4XEP from Jan to April-

    Then he had RPLND in June, and the pathology was 80% mature teratoma 20%yolk sac.

    His doctors wanted him to have more chemo too, but I asked Dr. Einhorn about what to do and he said No to chemo. He said to do the RPLND and hope that it would cure him. (NOTE: We already knew he has residual disease, because his AFP started increasing before the rplnd)

    He advised us to just "observe" after rplnd and ..
    If his AFP failed to normalise, or if it started to increase again, he said then he would need HDC (tandem transplant) Apparently HDC has a higher success rate when used as second line chemo.

    I don't know what type of tumor you had, or any of your other details, (I'll search through your older posts to see if they are posted) OR if it would make much difference, but you may just want to email doctor Einhorn, give him your stats, and see what his opinion is. Or, ask your doctor to contact him for his opinion.

    It has been the standard to treat with more chemo post rplnd when disease is found, apparently not all the time.

    My son had his RPLND June 8th, 2007, and so far there is no evidence of disease.

    Another note: I am not trying to say that adj. chemo would not be a good way to go, as it may still be fine treatment. I would want the very best chance of complete success,(as everyone does) with the best treatment for relapse reserved incase of problems down the road.

    Oh and by the way, my sons renal vein was cut during rplnd too, and a vascular surgeon had to come in to repair it. Your case sounds so much like my sons!

    Best of luck in whatever you do-

    Tammy
    Last edited by mstlyn; 10-31-07, 02:12 PM.

    Son Anthony DX 12/11/06
    L/O 12/20/06 Stage IIIA, 95% EC, 5% Yolk Sac
    4XEP 1/29-4/6/ 07
    AFP started increasing3 wks later
    Residual abdominal mass found on CT
    RPLND 6/8/07
    Cancer in pathology-
    80% mature teratoma, 20% Yolk Sac. --
    No adjuvent chemo and
    AFP normalised

    July 22, 2010 ---- 3 years all clear!

    Comment


    • #3
      Thanks for the reply, it does sound very similar. I'll have to think about asking my doc to run this by IU. I do have a lot of confidence in him and believe he is one of the most reputable for TC in Philadelphia. I'll bet if he had any doubt he wouldn't hesitate to run the case by Einhorn since I believe he mentioned in the past that he is acquainted. As for the viable part of my tumor, they actually couldn't even tell what it was. I don't know if it was too small or maybe a bad sample? My initial tumor was mixed with 5% seminoma.

      Edit: I've also read somewhere that the success of the RPLND is much more important than any adjuvant chemotherapy in long term outcome. Did Einhorn believe more chemotherapy could harm him or just didn't believe it would have additional benefit?
      Diag: 05/30/07, Stage 3 treatment at Upenn
      I/O: 06/04/07
      4 Rounds BEP ended 08/22/07
      RPLND: 10/12/07 Upenn
      2 Rounds EP ended 12/06/07
      2nd RPLND 07/08 Sheinfeld

      Comment


      • #4
        Originally posted by nskene
        Edit: I've also read somewhere that the success of the RPLND is much more important than any adjuvant chemotherapy in long term outcome. Did Einhorn believe more chemotherapy could harm him or just didn't believe it would have additional benefit?
        I am posting his message to me, and directly below is a reference to a recent study done by Einhorn that may answer your questions. A link to a commentary on the article is linked (Medscape registration is required).

        Dr. Einhorn: "Basically, with the rising AFP, this means that he has persistent yolk sac tumor. If his disease is limited to the abdomen, we would proceed with the RPLND and hope the surgery is curative. Therefore would repeat abdominal and chest CT scan and perhaps head CT scan as well.If he relapses again or if surgery is not feasible he would then need salvage chemo which would entail high dose chemotherapy for 2 courses (tandem transplant)"

        STUDY:
        Metastatic Germ-Cell Tumors Potentially Curable With High-Dose Chemotherapy
        News Author: Roxanne Nelson
        CME Author: Désirée Lie, MD, MSEd
        Last edited by Fed; 11-03-07, 01:18 PM. Reason: Linked to abstract and commentary; moderator edits are in italics

        Son Anthony DX 12/11/06
        L/O 12/20/06 Stage IIIA, 95% EC, 5% Yolk Sac
        4XEP 1/29-4/6/ 07
        AFP started increasing3 wks later
        Residual abdominal mass found on CT
        RPLND 6/8/07
        Cancer in pathology-
        80% mature teratoma, 20% Yolk Sac. --
        No adjuvent chemo and
        AFP normalised

        July 22, 2010 ---- 3 years all clear!

        Comment


        • #5
          Ah thanks for posting that.
          Diag: 05/30/07, Stage 3 treatment at Upenn
          I/O: 06/04/07
          4 Rounds BEP ended 08/22/07
          RPLND: 10/12/07 Upenn
          2 Rounds EP ended 12/06/07
          2nd RPLND 07/08 Sheinfeld

          Comment

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