Tuesday the family spent the whole day at Moffitt Cancer Center to hear about options. Options such as surgery, more radition and results.
Good news: The tumor is now 90% smaller than it's original 15 cm it was back in November. They aren't sure is this is active cancer or dying residual cancer but, they were very impressed with my dad's reaction to the chemo and radiation. They gave him the most aggressive kind possible. After the PET and CAT scan, the radiologist and surgeous discussed the next steps. My dad, mom and sisters were in the office and I listened in on the phone while at work.
Dr. Meredith, the surgeon, is a strong proponent for surgery. He deems my dad healthy enough. They woul do a pulmonary and nutritional test to identify his strength beforehand. The surgery is an esophagectomy - completely removing his esophagus, which is where the tumor was. They said this is the only way to completely CURE the cancer. Dr. Meredith declared my dad at a moderate risk for this surgery. He would be on a feeding tube for a few weeks afterward. He even said right after the surgery that he would have so many tubes in him he'd look he stepped out of a horror film. During the surgery they would need to collapse a lung. He said some patients recover and go through a McDonalds drive thru not long after and some take up to 6 months. There's no saying how my dad would react.
Dr. Shradir is concerned because he severely radiated my dad's right lung during radiation to treat the tumor. He is afraid his lungs won't make it through surgery or won't inflate properly afterward. There is also a risk of pnuemonia and other complications. He said that my dad would be the most high risk patient he'd submit to surgery.
Brachy therapy is another option - but results aren't always as favorable. This where they would do direct radiation hits on the esophagus zapping the tumor away.
Things to consider - quality of life after surgery? Just sit and let things happen? Reaction to brachy therapy? Complications during and after surgery?
My dad was 135 lbs a few weeks ago. He's 5'11''. He looks like a Holocaust victim, but the doctors aren't as concered about he weight as we are. I weigh more than my daddy. We're just not used to seeing him like this. I was going through old pictures and it's so apparent how much weight my dad as lost.
Here's my dad and at I at my sorority's father's day weekend Sophomore year, 2006:
And here we are during Easter this year:
Livestrong Daddy
Below is some research we found online on this procedure:
Cancer Society.
National Cancer Institute: http://www.cancer.gov/
American Cancer Society: http://www.cancer.org/
I love you!
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Ann Surg Oncol. 2010 Apr;17(4):1159-67. Epub 2010 Feb 6.
Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer.
Meredith KL, Weber JM, Turaga KK, Siegel EM, McLoughlin J, Hoffe S, Marcovalerio M, Shah N, Kelley S, Karl R.
Source
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA. kenneth.meredith@moffitt.org
Abstract
BACKGROUND:
Esophageal cancer remains a malignancy with high morbidity and mortality despite improvements to diagnosis, staging, chemotherapy, radiation, and surgery. Neoadjuvant therapy (NT) may improve oncologic outcome in many patients, however the degree to which patients benefit remains unclear. We examined the relationship between pathologic response to NT and magnitude of benefit in patients with esophageal cancer.
METHODS:
Using a comprehensive esophageal cancer database, we identified patients who underwent esophagectomy between 1994 and 2008. Pathologic response was denoted as complete (pCR), partial (pPR), and nonresponse (NR). Clinical and pathologic data were compared using Fisher's exact and chi-square when appropriate, while Kaplan-Meier estimates were used for survival analysis.
RESULTS:
We identified 347 patients who underwent esophagectomy, and 262 (75.5%) were treated with NT. The median age was 66 years (28-86 years) with median follow-up of 20 months (1-177 months). There were 106 (40.5%) patients exhibiting pCR, 95 (36.3%) with pPR, and 61 (23.3%) with NR. The rate of R0 resections was higher amongst pCR (100%) compared with 94.7% in pPR (P = 0.02) and 87.5% in NR (P = 0.0007). There were 15 (14.2%) recurrences in pCR, 22 (23.7%) in pPR, and 17 (28.8%) in NR (P = 0.04). Patients achieving pCR had 5-year disease-free survival (DFS) and overall survival (OS) of 52% and 52%, respectively, compared with 36% and 38% in pPR and 22% and 19% in NR (P < 0.0001, P < 0.0001).
CONCLUSIONS:
Esophageal cancer patients frequently succumb to their disease. However, patients treated with neoadjuvant therapy who achieve pCR have a higher rate of R0 resections, fewer recurrences, and improved 5-year OS and DFS.PMID: 20140529 [PubMed - indexed for MEDLINE]
