› Forums › General Melanoma Community › Any thoughts on surgery then systematic treatment?
- This topic has 30 replies, 6 voices, and was last updated 12 years, 4 months ago by
MariaH.
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- November 28, 2011 at 12:58 pm
I am wondering if it would make more sense to do a "debulking" of tumors prior to systematic treatment. It seems to me that the smaller the tumor burden, the better the chance for a durable response.
I realize that by removing tumors via surgery there is always the residual disease, but even if you can't remove all of them, wouldn't it make sense to get the majority out?
Just throwing this out there –
I am wondering if it would make more sense to do a "debulking" of tumors prior to systematic treatment. It seems to me that the smaller the tumor burden, the better the chance for a durable response.
I realize that by removing tumors via surgery there is always the residual disease, but even if you can't remove all of them, wouldn't it make sense to get the majority out?
Just throwing this out there –
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- November 28, 2011 at 1:33 pm
Maria, I feel that if the tumour burden can be reduced by surgical resection then this
would give systemic treatments a better chance of success. You would need to consult a
surgical oncologist about this. See:
http://journals.lww.com/melanomaresearch/Fulltext/2008/02000/Evidence_and_interdisciplinary_consensus_based.10.aspxTake care
Frank from Australia
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- November 28, 2011 at 1:33 pm
Maria, I feel that if the tumour burden can be reduced by surgical resection then this
would give systemic treatments a better chance of success. You would need to consult a
surgical oncologist about this. See:
http://journals.lww.com/melanomaresearch/Fulltext/2008/02000/Evidence_and_interdisciplinary_consensus_based.10.aspxTake care
Frank from Australia
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- November 28, 2011 at 1:33 pm
Maria, I feel that if the tumour burden can be reduced by surgical resection then this
would give systemic treatments a better chance of success. You would need to consult a
surgical oncologist about this. See:
http://journals.lww.com/melanomaresearch/Fulltext/2008/02000/Evidence_and_interdisciplinary_consensus_based.10.aspxTake care
Frank from Australia
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- November 28, 2011 at 4:46 pm
I agree that it makes sense to reduce tumor burden. I thought the same thing about removing or reducing my lung mets. My oncologist, Dr. L. Flaherty, Karmanos, Detroit, felt that it was not appropriate for me. There was no evidence that reduced tumor burden made systemic treatments work better and the recovery period from a thoracotomy would delay the start of other treatments. Perhaps it's different for different mets locations and sizes. Just make sure that you're consulting a melanoma specialist for advice.
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- November 28, 2011 at 4:46 pm
I agree that it makes sense to reduce tumor burden. I thought the same thing about removing or reducing my lung mets. My oncologist, Dr. L. Flaherty, Karmanos, Detroit, felt that it was not appropriate for me. There was no evidence that reduced tumor burden made systemic treatments work better and the recovery period from a thoracotomy would delay the start of other treatments. Perhaps it's different for different mets locations and sizes. Just make sure that you're consulting a melanoma specialist for advice.
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- November 28, 2011 at 4:46 pm
I agree that it makes sense to reduce tumor burden. I thought the same thing about removing or reducing my lung mets. My oncologist, Dr. L. Flaherty, Karmanos, Detroit, felt that it was not appropriate for me. There was no evidence that reduced tumor burden made systemic treatments work better and the recovery period from a thoracotomy would delay the start of other treatments. Perhaps it's different for different mets locations and sizes. Just make sure that you're consulting a melanoma specialist for advice.
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- November 28, 2011 at 10:57 pm
I am thinking of debulking, and I am seeing a oncology surgeon next week. I saw a Doc at Angeles Clinic and he thought it was a good idea. My regular oncologist thinks so too.
Terri
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- November 28, 2011 at 10:57 pm
I am thinking of debulking, and I am seeing a oncology surgeon next week. I saw a Doc at Angeles Clinic and he thought it was a good idea. My regular oncologist thinks so too.
Terri
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- November 28, 2011 at 10:57 pm
I am thinking of debulking, and I am seeing a oncology surgeon next week. I saw a Doc at Angeles Clinic and he thought it was a good idea. My regular oncologist thinks so too.
Terri
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- November 29, 2011 at 11:37 am
Actually Lynn, your story and others have been what got me thinking. Terri, keep us posted on how it goes next week with your oncologist. I got ahold of Sloan Kettering about their MDX1106/IPI combo trial. There doesn't appear to be anything that would disqualify him so the head research nurse will be calling me today. The nurse did say something about accrual being on hold though, for whatever reason (she thinks it's an internal issue). He has until December 28 to make a decision, but we want to stay one step ahead of the game.
I just wish his tumor burden wasn't so large.
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- November 29, 2011 at 11:37 am
Actually Lynn, your story and others have been what got me thinking. Terri, keep us posted on how it goes next week with your oncologist. I got ahold of Sloan Kettering about their MDX1106/IPI combo trial. There doesn't appear to be anything that would disqualify him so the head research nurse will be calling me today. The nurse did say something about accrual being on hold though, for whatever reason (she thinks it's an internal issue). He has until December 28 to make a decision, but we want to stay one step ahead of the game.
I just wish his tumor burden wasn't so large.
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- November 29, 2011 at 11:37 am
Actually Lynn, your story and others have been what got me thinking. Terri, keep us posted on how it goes next week with your oncologist. I got ahold of Sloan Kettering about their MDX1106/IPI combo trial. There doesn't appear to be anything that would disqualify him so the head research nurse will be calling me today. The nurse did say something about accrual being on hold though, for whatever reason (she thinks it's an internal issue). He has until December 28 to make a decision, but we want to stay one step ahead of the game.
I just wish his tumor burden wasn't so large.
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- November 30, 2011 at 1:14 am
Historically,surgery has been a first line defense and offense to address melanoma.
To me, it still is with some caveats.
First to debunk the naysayers about debulking. There has been the suggestion that slicing in or around a tumor is like puncturing a plastic bag that allows melanoma to flow through the body is just really not supported by the science. Yes, there are narrow opinions that say otherwise, but really, that opinion is not supported by science……………….for ANY cancer.
It is only a ideological opinion, again not supported by science, that systemic treatments are more or less effective following surgery.
Yes it is true that surgery is an insult to the body and the degree and extent of surgery can make one immuno-suppressed.
So the caveats would be about how much surgery would physically knock you down. It is known that the better the overall health of the patient, the better the ability to tolerate treatments.
From a common sense approach, there is certainly credence that the fewer tumors any given treatment has to deal with, the better.
So to sum up, if one can do tumor debulking via surgery that has a relative quick rebound; it makes sense.
A complex surgery with a long recovery time is another matter. There is also the matter of just how much "measurable disease" the chosen doc may want.
Only an opinion…………..but also an opinion of experience. Numerous of my dozen or so surgeries have been for the precise purpose of reducing tumor burden prior to adjuvant therapy. But that is only me.
The risk to benefit ratio is very personal, but it belongs in the conversation about chances and choice and should be explored during the treatment decision making process.
Cheers,
Charlie S
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- November 30, 2011 at 1:14 am
Historically,surgery has been a first line defense and offense to address melanoma.
To me, it still is with some caveats.
First to debunk the naysayers about debulking. There has been the suggestion that slicing in or around a tumor is like puncturing a plastic bag that allows melanoma to flow through the body is just really not supported by the science. Yes, there are narrow opinions that say otherwise, but really, that opinion is not supported by science……………….for ANY cancer.
It is only a ideological opinion, again not supported by science, that systemic treatments are more or less effective following surgery.
Yes it is true that surgery is an insult to the body and the degree and extent of surgery can make one immuno-suppressed.
So the caveats would be about how much surgery would physically knock you down. It is known that the better the overall health of the patient, the better the ability to tolerate treatments.
From a common sense approach, there is certainly credence that the fewer tumors any given treatment has to deal with, the better.
So to sum up, if one can do tumor debulking via surgery that has a relative quick rebound; it makes sense.
A complex surgery with a long recovery time is another matter. There is also the matter of just how much "measurable disease" the chosen doc may want.
Only an opinion…………..but also an opinion of experience. Numerous of my dozen or so surgeries have been for the precise purpose of reducing tumor burden prior to adjuvant therapy. But that is only me.
The risk to benefit ratio is very personal, but it belongs in the conversation about chances and choice and should be explored during the treatment decision making process.
Cheers,
Charlie S
-
- November 30, 2011 at 1:14 am
Historically,surgery has been a first line defense and offense to address melanoma.
To me, it still is with some caveats.
First to debunk the naysayers about debulking. There has been the suggestion that slicing in or around a tumor is like puncturing a plastic bag that allows melanoma to flow through the body is just really not supported by the science. Yes, there are narrow opinions that say otherwise, but really, that opinion is not supported by science……………….for ANY cancer.
It is only a ideological opinion, again not supported by science, that systemic treatments are more or less effective following surgery.
Yes it is true that surgery is an insult to the body and the degree and extent of surgery can make one immuno-suppressed.
So the caveats would be about how much surgery would physically knock you down. It is known that the better the overall health of the patient, the better the ability to tolerate treatments.
From a common sense approach, there is certainly credence that the fewer tumors any given treatment has to deal with, the better.
So to sum up, if one can do tumor debulking via surgery that has a relative quick rebound; it makes sense.
A complex surgery with a long recovery time is another matter. There is also the matter of just how much "measurable disease" the chosen doc may want.
Only an opinion…………..but also an opinion of experience. Numerous of my dozen or so surgeries have been for the precise purpose of reducing tumor burden prior to adjuvant therapy. But that is only me.
The risk to benefit ratio is very personal, but it belongs in the conversation about chances and choice and should be explored during the treatment decision making process.
Cheers,
Charlie S
-
- November 30, 2011 at 1:17 am
Historically,surgery has been a first line defense and offense to address melanoma.
To me, it still is with some caveats.
First to debunk the naysayers about debulking. There has been the suggestion that slicing in or around a tumor is like puncturing a plastic bag that allows melanoma to flow through the body is just really not supported by the science. Yes, there are narrow opinions that say otherwise, but really, that opinion is not supported by science……………….for ANY cancer.
It is only a ideological opinion, again not supported by science, that systemic treatments are more or less effective following surgery.
Yes it is true that surgery is an insult to the body and the degree and extent of surgery can make one immuno-suppressed.
So the caveats would be about how much surgery would physically knock you down. It is known that the better the overall health of the patient, the better the ability to tolerate treatments.
From a common sense approach, there is certainly credence that the fewer tumors any given treatment has to deal with, the better.
So to sum up, if one can do tumor debulking via surgery that has a relative quick rebound; it makes sense.
A complex surgery with a long recovery time is another matter. There is also the matter of just how much "measurable disease" the chosen doc may want.
Only an opinion…………..but also an opinion of experience. Numerous of my dozen or so surgeries have been for the precise purpose of reducing tumor burden prior to adjuvant therapy. But that is only me.
The risk to benefit ratio is very personal, but it belongs in the conversation about chances and choice and should be explored during the treatment decision making process.
Cheers,
Charlie S
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- December 1, 2011 at 12:17 pm
Hi Charlie,
I agree. I seems to me, after following the board, that the long term stage IV's out there had either caught the disease early, or had resections of some type.
Just one more path that Dave can look into – finding a surgeon willing to do it should be a treat.
Decisions, decisions,
Maria
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- December 1, 2011 at 12:17 pm
Hi Charlie,
I agree. I seems to me, after following the board, that the long term stage IV's out there had either caught the disease early, or had resections of some type.
Just one more path that Dave can look into – finding a surgeon willing to do it should be a treat.
Decisions, decisions,
Maria
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- December 1, 2011 at 12:17 pm
Hi Charlie,
I agree. I seems to me, after following the board, that the long term stage IV's out there had either caught the disease early, or had resections of some type.
Just one more path that Dave can look into – finding a surgeon willing to do it should be a treat.
Decisions, decisions,
Maria
-
- November 30, 2011 at 1:17 am
Historically,surgery has been a first line defense and offense to address melanoma.
To me, it still is with some caveats.
First to debunk the naysayers about debulking. There has been the suggestion that slicing in or around a tumor is like puncturing a plastic bag that allows melanoma to flow through the body is just really not supported by the science. Yes, there are narrow opinions that say otherwise, but really, that opinion is not supported by science……………….for ANY cancer.
It is only a ideological opinion, again not supported by science, that systemic treatments are more or less effective following surgery.
Yes it is true that surgery is an insult to the body and the degree and extent of surgery can make one immuno-suppressed.
So the caveats would be about how much surgery would physically knock you down. It is known that the better the overall health of the patient, the better the ability to tolerate treatments.
From a common sense approach, there is certainly credence that the fewer tumors any given treatment has to deal with, the better.
So to sum up, if one can do tumor debulking via surgery that has a relative quick rebound; it makes sense.
A complex surgery with a long recovery time is another matter. There is also the matter of just how much "measurable disease" the chosen doc may want.
Only an opinion…………..but also an opinion of experience. Numerous of my dozen or so surgeries have been for the precise purpose of reducing tumor burden prior to adjuvant therapy. But that is only me.
The risk to benefit ratio is very personal, but it belongs in the conversation about chances and choice and should be explored during the treatment decision making process.
Cheers,
Charlie S
-
- November 30, 2011 at 1:17 am
Historically,surgery has been a first line defense and offense to address melanoma.
To me, it still is with some caveats.
First to debunk the naysayers about debulking. There has been the suggestion that slicing in or around a tumor is like puncturing a plastic bag that allows melanoma to flow through the body is just really not supported by the science. Yes, there are narrow opinions that say otherwise, but really, that opinion is not supported by science……………….for ANY cancer.
It is only a ideological opinion, again not supported by science, that systemic treatments are more or less effective following surgery.
Yes it is true that surgery is an insult to the body and the degree and extent of surgery can make one immuno-suppressed.
So the caveats would be about how much surgery would physically knock you down. It is known that the better the overall health of the patient, the better the ability to tolerate treatments.
From a common sense approach, there is certainly credence that the fewer tumors any given treatment has to deal with, the better.
So to sum up, if one can do tumor debulking via surgery that has a relative quick rebound; it makes sense.
A complex surgery with a long recovery time is another matter. There is also the matter of just how much "measurable disease" the chosen doc may want.
Only an opinion…………..but also an opinion of experience. Numerous of my dozen or so surgeries have been for the precise purpose of reducing tumor burden prior to adjuvant therapy. But that is only me.
The risk to benefit ratio is very personal, but it belongs in the conversation about chances and choice and should be explored during the treatment decision making process.
Cheers,
Charlie S
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