Sandwich of chemo then radiation then chemo

Teresa_Wingfield

Any experience/info on this approach? I have uterine carcinosarcoma stage 3, so looking to help the odds. Thank you!

cmb

A cancer diagnosis is always shocking, especially when it's a later stage, aggressive variety. There are some women who have had the sandwich method, but that isn't as common as the chemo first, followed by radiation approach. Hopefully other members who had the sandwich treatment will comment here.

I was diagnosed with Stage 3B carcinosarcoma five years ago this month. Although I did not have the sandwich treatment, I have not had a recurrence yet. You can click on my user name and select "View Profile" to read about the chemo regimen I had, with radiation later. You'll see that my medical oncologist used a two-phase chemo approach. This isn't a combination that I've seen on this board or on an older forum that was dedicated to carcinosarcoma. But as I'm still NED (no evidence of disease) one or more of the chemo drugs must have been effective for me.

Did you have any genetic testing done on your tumor? That is much more common now than it was in the past. The results from that testing can be helpful when the oncologist is selecting which chemo drugs to use, although Paclitaxel/Carboplatin are typically used in front line treatment today.

Please ask any other questions you might have. We want to support you while you're going through treatment.

Teresa_Wingfield

https://csn.cancer.org/discussion/comment/1691644#Comment_1691644

Thank you so much for your kind response. I reallyappreciate it. My doctor is recommending 6 cycles of carboplatin plus paclitaxel. I can't help but wonder if the more diverse chemo that you had is more advantageous as you obviously responded positively to something. I will definitely check into this. There are a few smaller studies showing the chemo, radiation, chemo work better than chemo and then radiation. I have an appt with my current oncologist Monday and am getting a second opinion on Wednesday. It's great to have options to ask about and I am grateful that you have given me one. Oh and Merry Christmas!

JMJforever1989

I have stage one carsinosarcoma. It was a major shock, especially the way I found out. My lab results came back in my online chart before the OBGYN could call me and tell me. I was diagnosed two months ago. I have had a total hysterectomy and two courses of Taxotere and Carboplatin. Originally they tried the Taxol but I had a severe allergic reaction to it. Had to have the Taxotere slowly administered in the hospital the first time and I will have to do that one more time before they will let me have it in the infusion center. I have my bracheatherapy radiation simulation this upcoming week. They are planning on doing it during the chemo I believe. There will be a total of 6 chemo infusions and 3 bracheatherapy treatments. I know that this cancer is aggressive and tends to pop back up again, but I choose to believe that it is already completely gone and will never return. I have great admiration and heartfelt love for Cancer patients. There is much suffering, anxiety and so many questions and future unknowns. However there is also the gift of Faith, Hope and Trust and learning to live each day the best that you can. I appreciate each person's perspective and thoughts.

NoTimeForCancer

Teresa, I had the 'sandwich' (3 rounds carbo/toxol - 25 external/3 brachy - 3 rounds carbo/taxol). I noticed from the discussion on this board that a lot of women are not getting that anymore and when I recently saw my oncologist on the annual follow up I asked her about that. She told me some places have switched away from the 'sandwich' to all chemo and then the radiation. (I was Stage 1A UPSC)

To read cmb's profile where she posted her treatment is good to be able to see. I definitely think it is worth asking about.

As JMJ pointed out, taxol can cause allergic reactions which is why they watch you closely during those infusions and will switch it out.

Teresa_Wingfield

https://csn.cancer.org/discussion/comment/1691665#Comment_1691665

Thank you for sharing and best wishes. Yes, this is a tough one, but we are stronger!

Teresa_Wingfield

https://csn.cancer.org/discussion/comment/1691667#Comment_1691667

Thank you. My oncologist had also mentioned that the sandwich approach has fallen out of favor. I will try to find out more in my appt in a few hours.

cmb

The discussion about the sandwich method is interesting because when I met with the gynecological oncologist a couple of weeks after surgery to explain my pathology results, he mentioned the sandwich method. But unlike many of the women here, he did not manage my chemo process.

My hospital had a separate group of medical oncologists and one of them devised and managed my chemo treatment. The medical oncologist didn't mention the sandwich approach when we discussed the two-phase chemo plan. What he did say was that Phase 1 (Paclitaxel/Carboplatin) would be easier on my system than Phase 2 (Ifosfamide/Doxorubicin) - which was absolutely true.

I didn't get the neurotoxity from Ifosfamide or heart damage from the Doxorubicin (two of the worst side effects from those drugs) but I felt so weak and unable to eat after infusions that I could barely move. Only extra fluids and antiemetics the week after the infusions kept me functioning, albeit at a very low level. Fortunately, once I was done with that phase, I did recover within a month or so.

But I still remember being almost in tears talking with the nurse when I called to say that I just couldn't make it in for my weekly checkup after the first infusion because I felt so horrible. She persuaded me to come in and then delivered the fluids and antiemetics that did make me feel better. After that, the oncologist changed up the supportive drugs I would get on the last day of the infusions and a couple of days thereafter. That helped, as did the once or twice weekly fluids and antiemetics I then routinely scheduled for the week after treatment.

But it was a really tough regimen, nonetheless. The severity of the side effects these two drugs can cause is one of the reasons why Paclitaxel/Carboplatin have become the recommended first-line chemo instead for carcinosarcoma. 

Teresa_Wingfield

https://csn.cancer.org/discussion/comment/1691688#Comment_1691688

Thank you. I believe there’s a trade off between toxicity and efficacy. Taking to folks this week.

Teresa_Wingfield

https://csn.cancer.org/discussion/comment/1691665#Comment_1691665

Thank you and best wishes. At least you caught this early! Teresa

BluebirdOne

https://csn.cancer.org/discussion/comment/1691665#Comment_1691665

Welcome JMJforever1989,

We are glad that you found us. It must have been a terrible shock to find out that way, I hope you have been reading the old threads about chemo, icing, etc. to help you along. There are threads about brachytherapy if you would like to see what others have reported. Allergic reactions to the chemo are also very common, I am allergic to the iodine given for CT scans so they have to give me premeds, drink lots of water, and be observed. Still very scary to go through. So welcome and remember we are here for you.

xxoo

Denise

Teresa_Wingfield

https://csn.cancer.org/discussion/comment/1691693#Comment_1691693

Thank you Denise! Glad to be here.

BluebirdOne

Theresa, I am glad to welcome all of our new folks, whether they comment our not. Lots of "readers" out there. (I think the term "lurker" is passe, thankfully)

Denise

SpringerSpanielMom

I was told the sandwich method was out of favor too. MDA and my local gyn onc did not do it, supposedly. But I ended up getting exactly that. I was part way into my chemo (carbo taxol, 6 rds) and 4/5 of my docs said I should get brachytherapy. My radiation oncologists said there was absolutely no need to wait until after chemo, and one pointed out as it was December (of '21), my deductibles and out of pockets would already be satisfied. Went back to my gyn onc and said: "Then why wait?" She said--"Just logistics". So I went ahead and did my 5 brachytherapies over two weeks between Chemos 3 & 4, with zero delays for #4. Was I then exhausted? Yes, but I'm so glad I got it over with, and I felt, absent a real medical reason to delay, the sooner the better. No problems from brachytherapy except for some short-lived urethral spasms (sort of like the day before a UTI), and of course, the dreaded dilators forever to prevent stenosis.