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Sandwich Treatment

Virgil90012's picture
Virgil90012
Posts: 34
Joined: Feb 2015

I had debulking surgery on April 19 for my recurrence.  My surgeons removed the vaginal lesion along with a lesion that was initially thought to be on the liver but instead was on the membrane that covered the diaphragm.  The PET scan that I had on 2/14 detected these two lit up areas and the CT scan only saw the one on the diaphragm.  My Gyn-Oncologist told me prior to the surgery that when they surgically remove the lesion on the diaphragm via robotic laparoscopy, he was going to look around to see if there were other lesions that were not detected.  He said that CT scans, although a great tool, does not always find small lesions.  Well, I must be very ”lucky” because in my post surgery appointment with him today, he told me that he found 5-6 other small lesions in my abdominal area (on the peritoneum) that were 0.6mm or smaller that were not surgically removed because it would have been a more intensive surgery which we had not discussed (removal of part of the vagina, removal of part of the membrane).  Instead, he said that because of the size, he feels that chemo will kill the cancer cells in the lesions.  

We discussed the next steps and he recommended the sandwich procedure (chemo, radiation, chemo).  The chemo would be with carbo and taxol and then brachytherapy/external radiation.  I am to meet with the radiation oncologist and chemo oncologist in the next couple of weeks.  Can anyone tell me what to expect with the sandwich procedure?  Is there any tips or precautions to watch out for?  I did not have any additional treatments when I was initially diagnosed in 2014 with Uterine cancer Stage 1a, grade 2 other than surgery.  

Thank you to all for your advice.

Cathy

MAbound
Posts: 829
Joined: Jun 2016

Any chance that they saved the removed tissue so you can have genomic testing on it? 

I didn't have the sandwich procedure. My oncologist felt that radiation damages blood vessels where you want chemo to get to the most, so he waited until I was done with chemo to send me for radiation. From what I've read since being here, the last three chemos are harder after radiation.

Don't forget to have what you need on hand to keep your hands and feet cold during infusions to prevent/minimize neuropathy.

So sorry to hear about your recurrence. The genomic testing might help you find out what all of your possible options are if you need more than what's currently being proposed in the future.

Virgil90012's picture
Virgil90012
Posts: 34
Joined: Feb 2015

Thank you.  I will ask about the genomic testing 

NoTimeForCancer's picture
NoTimeForCancer
Posts: 2544
Joined: Mar 2013

Cathy, I am so sorry to hear about your recurrence.  

I had the sandwich, and my first suggestion would be to take this one step at the time.  MAbound already mentioned how some women have successfully avoided/minimized neuropathy by icing their hands and feet.  My suggestions;

- chemo is constipating so get some Miralax

- make sure they have in your plan to step you down off of the steroids

- probiotics should help with the side effects of radiation 

- protein is going to help you make it through to the end

I did have a question on #5, got it in, and #6 was delayed a week.  

Virgil90012's picture
Virgil90012
Posts: 34
Joined: Feb 2015

Thank you

Armywife's picture
Armywife
Posts: 266
Joined: Feb 2018

So sorry to hear of your recurrence!  It sounds as if you have a wonderful surgeon/oncologist.  

Was your cancer endometriod endometrial adenocarcinoma, or one of the others?

I didn't have the sandwich treatment, but I did have chemo.  My tips for you would be to ice your hands and feet during every infusion.  It's not painful to do, and it saved me from neuropathy.  I was also able to do half the usual dose of steroids with no ill effects, for which I am really grateful.  Drink lots and lots of water during your weeks of treatment.  Hugs to you!

Virgil90012's picture
Virgil90012
Posts: 34
Joined: Feb 2015

My cancer is the endometriod adenocarcinoma (”the garden variety”)

zsazsa1
Posts: 290
Joined: Oct 2018

Start the probiotic (someone here recommended Culturelle) a week before starting radiation.  There is some evidence that it helps to protect the bowel.  It certainly made a difference for me when I started it two weeks into the radiation.  I take it after having had the radiation, each day.

And yes, make sure to ice your hands and feet throughout the Taxol infusion, and if possible, have them dial down the steroid as you progress through chemo without an allergic reaction.

Virgil90012's picture
Virgil90012
Posts: 34
Joined: Feb 2015

Thank you

zsazsa1
Posts: 290
Joined: Oct 2018

Yes, drink a TON of water, starting right before the infusion, and for at least three days afterwards.  It made a big difference for me, washing the chemo rapidly through my kidneys and bladder.  The first time I didn't, and it burned my bladder and kidneys.

Virgil90012's picture
Virgil90012
Posts: 34
Joined: Feb 2015

Thank you for the advice.

Northwoodsgirl
Posts: 506
Joined: Oct 2009

I too am sorry to hear of your reoccurrence. I had the sandwich protocol 10 years ago. Others have given you great suggestions. I highly recommend having a port-a-cath vascular access device implanted to protect your veins in your arms and to make it less painful and easier to draw your labs. 

Another suggestion is after your first infusion of chemo you will notice your hair falling out. At that time get your hair cut short or shaved off. Go online and buy some cotton head covers or pretty cotton scarves. You can find the scarves or head covers easily on google- search chemo caps. Some of us bought wigs - I did and only wore it once.

If you are not Medicare recipient be sure to call your health insurance company to make sure all the providers are in network including whomever is going to be your anasthesiologist and radiology group. Find out now who the radiation oncologist will be. 

Just know that the next six months while you are going through treatment your “sisters” on this board will answer your questions based on our personal experiences and literature we have researched. Please try to stay in the present moment and not worry too much about the unknown. Personally I listened to guided imagery by Bellaruth Naperstak (sp?) and it helped me. Your gyn/Onc should also prescribe two different anti-nausea meds and also valium or ativan in case your anxiety keeps you from sleeping. Please keep us posted. I will keep you in my prayers as you make your way through the treatment. 

((Hug))

Lori

Virgil90012's picture
Virgil90012
Posts: 34
Joined: Feb 2015

Thank you for all the info.  I keep reminding myself to take one day at a time but it is sometimes hard.  I appreciate all the support that I have getting from the sisters on this site.  

With the sandwich protocol, did you have to wait for the first three rounds of chemo to be gone from your body before they start on the radiation?  How long did you have to wait from your first three rounds of chemo to the beginning of radiation?  Did your oncologist say why the sandwich was better than the regular protocol of finish 6 rounds of chemo and then radiation?

barnyardgal
Posts: 198
Joined: Oct 2017

My Dr had me wait 6 weeks in between chemo and radiation. I actually wasn't originally supposed to get the sandwich treatment. I was scheduled for 8 rounds of adriamyacin and carboplatin as I was allergic to Taxol and couldn't desensitize. After round 6 my counts were so low and I couldn't stop getting sick. So I had radiation after the 6 weeks break, then round 7 of chemo three weeks after radiation ended. 

NoTimeForCancer's picture
NoTimeForCancer
Posts: 2544
Joined: Mar 2013

Virgil, I kept notes so I went and grabbed them.  For me, my first 3 chemos, which was one every three weeks (I think that is pretty typical)  My last chemo was on 7/12 and I had a 'planning' CT and had the first external (IMRT) on 8/7.  Because of some travel and machine down, last external was 9/13.  I had the brachy, and that was one a week (9/20, 9/27, and 10/4) my next "round" of chemo (the 4th of the 6) was started on 10/31.  

Take a breath.  We got you.

zsazsa1
Posts: 290
Joined: Oct 2018

From what I have read, there really have not been enough studies done that directly compared chemo and radiation, or compared the timing of them.  If radiation were more effective, one would want to have it first, and vice versa.  So it seems as if the sandwich protocol is a compromise to get some of each in the best possible timing.

I wound up having 6 rounds of chemo, then external beam, just because it took me so long to determine that external beam seemed the best choice for me.  But that meant that I did not start radiation until slightly over six months from diagnosis, because of having surgery and chemo first.

I had to wait for my counts to come back up after the last round of chemo, before they would start radiation.

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