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Confused about 4th chemo


Ellen B.

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Hi All,

Henk just finished his planned 3 chemo/28x radiation treatments. At least, that is what we thought. But now, to our amazement, the hospital is telling Henk that a 4th chemo is planned in 2 weeks.

We don't understand this. Beforehand docs told that he would have 3 chemo treatments and now, suddenly,a 4th treatment is planned.

Of course, we will ask the docs why this is. But I wonder. Is this usual?

When Henk had his third chemo, his doc said to Henk: "You still have too much strength. We are going to do something about that".

What is this? Isn't it a good sign to have strength? What does this mean?

Ellen.

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Hello, Henk and I are among the 1-3% of lung cancer patients who have a pancoast tumor. I know I had more than 3 rounds of chemo. I think I had that many over the course of about 6 weeks of radiation. Then I was able to have surgery . About 3 weeks after that I started more rounds of chemo. Wishing you and Henk well, keep us posted. See below

Concurrent Chemotherapy and Radiation Followed by Surgery

As stated previously, the role of chemotherapy has been clearly defined in the treatment of locally advanced non-small cell lung cancer and has been shown to be superior to radiation therapy alone. The phase II Southwestern Oncology Group (SWOG) 94-16 trial [37, 38] evaluated the role of concurrent cisplatin (Platinol®; Bristol-Myers Squibb) at a dose of 50 mg/m2 on days 1, 8, 29, and 36 and etoposide (Etopophos®; Bristol-Myers Squibb; Princeton, NJ) at a dose of 50 mg/m2 on days 1–5 and days 29–33 with 45 Gy of TRT over 5 weeks followed by two additional cycles of chemotherapy in mediastinoscopy-negative patients with superior sulcus tumors in a multi-institutional setting. Those authors demonstrated that this therapy was associated with acceptable morbidity and mortality, and that complete resection rates of 92% where obtainable with this regimen. Sixty-six percent of those who went on to surgery had pathologic complete responses (36%) or minimal microscopic disease (30%) on resection. Of the patients who completed induction therapy and went on to surgery, the 2-year survival rates were 55% for all patients and 70% for those who underwent complete resection [38, 39]. Updated results noted a 33-month median survival and a 5-year overall survival rate of 41% for the total cohort [39]. The Japan Clinical Oncology Group (JCOG) protocol 9806 is similar to the North American intergroup effort (Table 1) [38–40].

Wright et al. [41] from the Massachusetts General Hospital published a retrospective review of patients treated with different institutional protocols consisting of preoperative chemoradiation and radiation alone. The patients who received chemotherapy had a higher complete resection rate, higher pathologic complete response rate, lower local recurrence rate, and longer survival than patients treated with radiation alone. These results are consistent with current knowledge, but selection bias may have contributed to this result.

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It is not unusual to have 4 to 6 cycles of chemo. I imagine the onc started with 3, with the option in his mind that, if Henk handled it well, that there would be more cycles. That Henk handled it well is good and the fourth cycle may be a precaution or preventive move. As you said, asking the onc about it is the best plan. Don

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