Monday, August 9, 2010

Is neo-adjuvant chemotherapy the right thing to do?

After reading up on Cisplatin and other Chemotherapy's, I'm starting to question whether it's a good idea to do the chemo before surgery. According to what I've been reading, this stuff isn't as targeted as I thought. It kills any cell in the body that is actively dividing (it binds to DNA during cell division).

This article was one of the references listed on the Wikipedia site for Cisplatin (It's long winded but raises some good issues - at the beginning):
Anti-cancer Agents: A treatment of Cisplatin and their analogues

Cancer cells are really no different than other cells that are actively replenishing themselves as part of their (or their organ's) function like Bone marrow, nerves, intestine linings. It also attacks kidneys (big time) and inner ear and even eyes (and of course hair follicles).

My Oncologist argued that although chemo is a 'blanket bombing' sort of strategy it would be good insurance against the chance (perhaps small) that any cells have moved out of the bladder and gives us a leg up on attacking them if they have. This is an insurance policy, but like any insurance, there is a cost to reducing the risk. I thought it was interesting that he didn't want to start treatment that day because he was afraid that IF there were complications from chemo, I would feel like I had been pressured (hard sell) into chemo.

I'm just thinking I should talk again with my surgeon to see what he's seen and what he thinks. These guys are specialists and it seems like they are pretty tightly focused so it will come down to me in the end.

I've been talking with friends (on Facebook and others) who have known people who have gone through this and I don't remember hearing about pre-operative chemo.

In this case clinical studies don't seem to be much help. There's one study (10 years old) that showed a significant improvement with this strategy but they weren't using this same combination of chemicals.

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