Can chemo/radiation alone work for EC?

I was Diagnosed in May 2012 T3N1Mo Stage 3B Cancer.  Doctors at MD Anderson thought mine might be staged wrong so they did an Endoscopic Mucosal Resection.  Took an endoscope and removed some of the tumor.  They hoped to remove it all but it was actually deeper into the esophogus wall and could not get it all.  I was upset about it afterward because I always believed cutting on the tumor before chemo and radiation would make it spread (No scientific fact but just something I thought).

They did 5 1/2 weeks of combined Chemo and Proton Radiation on me. After healing and before the surgery I had been given the option of the chemo/radiation getting it all or going ahead with the esophogectomy to possibly increase the success. I wanted to give myself the greatest hope and elected to have the surgery.  When they did my surgery all the pathology reports came back negative which I felt said the Combined chemo and radiation killed the cancer.  Would it return without the surgery?  Was the surgery needed?  Will my cancer return even though I had the surgery?  I can't answer these questions about my own cancer and we are all unique and different.  You'll hear many on here say we are a Statistic of One.  Some without surgery survive and others that have had the surgery end up with a recurrence. 

I do recommend that if surgery is something that you feel strongly about then get a second or third opinion and don't give up the fight. 

regel said:

Treatment

 

Hi Ricky, I had chemo and proton treatment in Aug and Sept. 2012.  Had the surgery on 11-15-12.  Three days after surgery I caught pneumonia and was in a coma for 3 weeks.  I finally got out of hospital on 1-3-2013.  I’m still on a feeding tube.  I had a dilation of my esophagus 5 weeks ago since it had on 1/4" opening so I could not eat.  This made it a 1/2" opening but then I had another one done 3 weeks ago since it had shrunk.  I'm having another scope and dilation done next week plus a CAT scan.  This is difficult since we have a 6-hour drive to MDA plus the cost of hotel stay.  Did you need to have a dilation done?  The doctor says he does not know how many I will need.   Do you have this problem?

Dad’sfight,

I think the surgery is a catch 22 and only the patient can decide if it’s right for them.  A catch 22 in regard to the fact that if the pathology on the resected esophagus and nodes are cancer free that means the patient had a complete response to chemo/radiation and one could argue the surgery was not needed.  On the other hand if cancer is found during pathology the patient is told he did not have a good response to chemo/radiation and his prognosis is not so good, and one could argue the surgery was perhaps a waste of time.  Personally looking back I wish I had never had the surgery.  Again, this is my personal feeling and other people’s opinion will certainly differ.  In my case I had a clean pathology (complete response) and still suffered a recurrence and many problems as a result of the surgery.  There is little doubt in my mind that if I had skipped the surgery I’d be in the same place I am today with the recurrence minus the complications from the surgery.  During my initial meeting with my oncologist at Dana Farber in Boston I was told that there is some debate on the actual value of surgery.  Because of pressure from my wife and children I agreed to the surgery.  The problem is the patient is in a no win situation when it comes to looking out for himself and satisfying others interests.  Sorry for the ramble but to answer your question, I do believe chemo & radiation can be as effective as the trimodal approach.  If I can give any advice it would be to treat your dad with respect and not pressure him into things that you may both regret down the road.

Best regards,

Dad'sfight said:

Please don't apologize for

Please don't apologize for the ramble, I so appreciate your response. I've seen a lot of people that have had great success with surgery, but I also wanted someones perspective that had surgery and it re-occurred. What you've said is exactly how he feels, It's a no win situation.  The oncologist's wanted us to celebrate that he had a response to chemo/radiation, but then they tell you the chances of reoccurance and limited treatment options he'll have especially with radiation. Sorry, but  we didn't feel like celebrating. Did you have chemo/radiation before surgery? I'm so sorry to hear that it has re-occured after surgery, how are they treating the re-occurance?  I'm sure your children and wife were thinking the same thing I was, he'll have a better chance with surgery.  Selfish on my part, no doubt, I just want to keep him around as long as possible. I'm curious if your doing chemo again, and if you think it has affected your quality of life?

I'm definently taking your advice and will not pressure my father into anything. He looks to me for an opinion, probably because I've worked in the healthcare field since graduating high school.  My goal is to make sure he knows the WHOLE TRUTH wether he does surgery or not. Was your oncologist pretty direct with you about survival, sometimes I feel like they give him false hope.

Since meeting everyone on here, I've been writing down names so that I can remember everyone for prayer. You will be added . Thanks again for taking the time to respond.

Pre MIE surgery I had six weekly rounds of carboplatin and taxol with 28 rounds of concurrent radiation.  The recurrence was discovered eight months post-surgery (distant node).  The node was resected and I started six rounds of EOX but do to an allergic reaction I had to stop after two rounds (definitely impacted QOL).  We’re now just keeping an eye on some distant nodes that are enlarged and have slight uptake on the PET.  I’ve opted out of any additional treatment but agreed to continue with a PET/CT scan every few months.  My doctors were honest with me in regard to five year survival rate of less than 20%. 

Joel