Topic: Treatment options post whipple???

My Dad, Alan C, from Rhode Island went for his initial meeting with oncologist post whipple today.  He is very discouraged. Thought this might be a little easier than it sounds, but.....
   The Dr., Dr. Howard Safran, from Miriam Hospital has a protocol with 12 weeks of gemcitibine 3 weeks on 1 week off with 28 radiation treatments following the chemo.
     His tumor was 1 inch at the distal end of the common bile duct, was focal, with 1/18  lymph nodes positive.  No mets, the surgeon staged it 2B.
    My question to all of you is does this sound appropriate???  Any and all advice is welcomed and appreciated! Thank you in advance!

Re: Treatment options post whipple???

How old is your dad?

Do you know the status of the surgical margins? (negative / microscopically positive / macroscopically positive)

My wife had Whipple two years ago at the age of 44. Extrahepatic CC, Stage 2B. 2/15 positive nodes. Microscopically positive margins where they reconnected the common bile duct.

She had radiation for 28 days combined with 5FU chemo around the clock.

Followed by: 6 cycles of Gemcitabine/Cisplatin chemo. 2 weeks on, 1 week off. 12 trips to the chemo chair in total.

To answer your question, your dad's treatments sound appropriate, but that depends a lot on his age and general state of his health. Positive node is a big risk factor. Note that I'm not a doctor.

Take a look at NCCN Treatment Guidelines for Hepatobiliary Cancers. You will need to register for a free account to see the PDF. … iliary.pdf

The document describes the current standard of care for CC. Slide #30 (labelled EXTRA-2) is the one you should be looking at. It shows the treatment protocols post Whipple.

Given that your dad is very discouraged, it's a good idea to go for a second opinion at a major cancer center that sees many CC patients.

Re: Treatment options post whipple???

Thank you Eli for your response and advice,  my Dad just turned 70 this past May and is in overall good health with the exception of a pacemaker for  heart rhythm  abnormality.  The only margin report I am aware of is the"clean margins with the first cut", post whipple. Something I might have to learn more about!

Re: Treatment options post whipple???

Pacemaker? He *must* seek a second opinion from his cardiologist. The proposed treatments are very tough on the body, including heart. My wife had some issues with irregular hearbeats during her treatments. She was in great shape before she got diagnosed (and much younger than your dad). I don't want to scare you... just pointing out that you have to be mindful of his heart condition.

Re margins: do you have a copy of the full pathology report post Whipple? It should note the status of the surgical margins. If all margins are clean, I would seek a second opinion from another oncologist about radiation.

Re: Treatment options post whipple???

The Dr. Stated that my Dads chance of reoccurrence is 50/50 at this point , but with chemo and radiation it decreases the risk by only 10-15%. This scares my Dad, thinking that 4 months of chemo and 28 days of radiation and such minimal decrease in it worth it???  I  personally think it is because I want my Dad to be with us for as long as possible!!  But it has to be his choice, no regrets!  I'm looking for any feelings of pro or con treatment to help me understand my Dads  dilemma......please....thank you
.....also if anyone out there has a first line protocol with better stats please let me know

Re: Treatment options post whipple???

Peggy...this link reflects one study re: aduvant therapy
Like you I believe like you that ultimately it should be up to your Dad to make the decision re: chemo.  It is not a piece of cake however; some do quite well.    This study is currently underway in the UK: … allbladder
Basically, at this point it is still the decision of the individual practitioner to either recommend or not to recommend adjuvant therapy.
It is for this reason and for some others that we like to obtain several, professional opinions.