Surveillance Protocol After Chemo and RPLND

[jim]

In my review of the posts on this site, I haven’t seen much on people’s surveillance protocol following chemotherapy and RPLND. My Onc just laid out his plan for me and I was curious to see if it was similar to other people’s surveillance who had undergone both chemo and an RPLND. I also wanted to be sure that my surveillance plan was adequate as we all know how important it is to catch any potential relapses early.

Here is a brief summary of my treatment and planned surveillance:

August 5, 2005 – Right Orchiectomy (shows seminoma and teritoma)
October 21, 2005 – 4xEP ends
November 9, 2005 – CT scan taken and shows residual mass in retroperitoneum
November 29, 2005 – Full Bilateral RPLND (residual mass was teritoma)
February 13, 2006 – Surveillance CT planned plus tumor markers
After February 13, 2006 – chest x-rays and tumor markers every 8 weeks (during the 1st year –not sure of 2nd year yet) and CT scans once a year going forward.

Notice that three months go by between my CT on Nov 9th, 2005 and the planned CT on Feb 13th, 2006 and there is no chest x-ray planned during this period. Is it ok to let 3 months go by without any x-ray or CT?

Is the CT on February 13, 2006 an appropriate time following my RPLND (the CT will be 11 weeks after the RPLND)? I had heard that if a CT is taken too early after RPLND it can show abnormalities caused on by the healing surgery.

Any other specifics on other people’s surveillance who had chemo and RPLND would be appreciated. I am sure it would also be a good resource to have in one place for all viewers to be sure everyone is followed adequately by their physicians.

Thanks to all for your help.

[justinsmom]

I am curious about others' follow-up protocols also. Justin had his last CT scan Oct. 17 then his full-bilateral RPLND Nov. 21. He had tumor markers done Dec. 13 and his next appt. with the oncologist is Jan 10, so that will be almost 3 months. His Dr. is talking about CT scans every other month 1st year, every 3 months 2nd yr, 4 months 3rd yr....& blood work every month for the 1st yr....Justin's was intermediate risk because of the large abdominal teratoma....

[Martin]

I have bloodwork done every month, CT Scan every other. Once I hit the 1 year mark it'll be a quarterly CT-Scan, bloodwork still monthly. After that it'll go a little easier.

I have been discussing the use of CT-Scan vs. Chest X-Ray with my oncologist several times - she feels rather strongly about going that way and I have to say I will trust her on that. My cancer spread rather agressively in a short time period and should it ever show it's ugly face again I want to be right there with the big stick. Nonetheless, I will bring it up again when we hit that 1 year mark.
My Cancer Center is also affiliated with the Dana-Farber-Institute in Boston, which is not the worst of resources to have, though maybe not leading on TC.

She did point me to a resource page she is consulting (one for oncologists regardless of specialty), but unfortunately I cannot remember the URL. My next appointment is about 2 weeks away, so I will try to get it again from her.

- Martin

[Chris'Mom]

Sloan has Chris getting a cat scan almost six months since RPLND and chemo.....now I am hearing all of you having one sooner...did anyone else wait about five months for cat after RPLND.....he has blood and chest every month though.....Mary Ellen

[jdbob]

I've been following the schedule in tcrc - Whatnow for Path stage 2 nonseminoma which is basically blood tests and chest X-ray. I had a scare almost a year ago where I was getting some "adenopathy" showing up in my chest X-ray, in which case we followed up with CT scans. It turned out to be caused by poorly treated asthma and a lung infection.

[Martin]

.....now I am hearing all of you having one sooner...

I think it's safe to say that Sloan will do the right thing. My CT-Scan schedule is likely overkill (boy, do I hate to have 'kill' in a word in that context), but, as mentioned earlier, my oncologist feels it's the right thing to do.
Normally, chest x-rays are sufficient because the chances of a recurrence after all that prior treatment are very low.

- Martin

[jim]

Thanks for all the responses so far. Hope everyone is doing great on their surveillance. Any other thoughts from others on their surveillance protocals is still appreciated.