how strict is the 1cm magic number?

[shabby]

So I have my post-chemo CT coming up at the end of the year (Merry Christmas, right?) and I'm curious about how strict the 1cm target is on whether I'd proceed with RPLND? What's the effective difference between a 0.9cm and 1.1cm node? Is there documented precedence on leaving a greater-than-but-close-to-1cm node alone or even on proceeding with surgery on a less-than-but-close-to-1cm node?

[Trekga]

I am not certain. With my son his nodes were all still over 2cm or 3cm post chemo so post chemo RPLND. I know IU says OVER 1cm. Goodluck.

[Ann]

Shabby - We are in the same boat as you. My son is at his post chemo scans right now. We meet with the Doctor next Tuesday to discuss the results. It's the first time I can see the fear in my son's eyes. He is scared that they are going to tell him he will need the RPLND. When he was in cycle 2 of BEP ended up in hospital with blood clots in the lungs and one exploded. x-rays from that we know the node was smaller (PA said emergency room does not even mention node in their notes, and usually they only mention anything over 1cm). Hopeful it's gone after cycle 3. I'm adding your to my prayers shabby, that we both get our Christmas wish this year

[Mike]

I am not sure that you are going to find detailed information in regard to 0.9 cm vs. 1.1 cm. I think one may take into consideration of the response of the node (how big it was before and after chemotherapy) and the timing of the CT (could the node continue to shrink). However, almost all the experts would agree that a post chemotherapy RPLND is recommended for nodes >1 cm with nonseminoma.

There was this fairly recent article on sub-centimeter nodes after chemotherapy that may help put things in comparison on risks, etc. and be of use for you and your doctors. https://academic.oup.com/annonc/article/25/2/331/191333

Mike

[biwi]

Mike is right on, the rest of the details (pathology, staging, timing of scans and treatment, etc) matter when it is right on the border.

FWIW, my signature has my details. I had a post-chemo 1.0cm lymph node. Went on surveillance on the recommendation of two oncologists. A few months later the node was enlarging. Quickly had an RPLND done once enlargement was confirmed, and it was determined to be teratoma. All clear since.

[shabby]

Thanks, everyone

[Ann]

We had our post Chemo apt today. Tumor markers normal. Lymph node is .7 cm. RPLND is recommend in about three months. It was stated that node could shrink further and very small possibility no surgery. Side note: My son did not take his lovenox shots for 4 or 5 days so ended up back in hospital with severe pain this past weekend and still has severe pain. The 3 month delay in surgery would give his lungs time to heal. Recommended surgeon Dr. Steven Campbell Cleveland Clinic. Does this sound like we are on the right path.

07/17 95% embryonal 5% yolk sac. rising markers. Stage 2A. Lymph node 2.1 x 2.0 cm.
09/17 AFP 133.7 Start 3x BEP
11/17 finish BEP AFP 5.9
12/17 Recommended RPLND AFP 4.6

[S P]

The standard of care is to do the RPLND surgery for residual masses (lymph nodes) over >1cm, but like Mike said, it depends on pathology, the degree of shrinkage of the nodes, and whether markers have normalized or not. Sloan-Kettering is known to be more aggressive about doing the RPLND surgery. Indiana University is more likely to favor surveillance, but it very much depends on specifics of the case as well.

[S P]

We had our post Chemo apt today. Tumor markers normal. Lymph node is .7 cm. RPLND is recommend in about three months. It was stated that node could shrink further and very small possibility no surgery. Side note: My son did not take his lovenox shots for 4 or 5 days so ended up back in hospital with severe pain this past weekend and still has severe pain. The 3 month delay in surgery would give his lungs time to heal. Recommended surgeon Dr. Steven Campbell Cleveland Clinic. Does this sound like we are on the right path.

07/17 95% embryonal 5% yolk sac. rising markers. Stage 2A. Lymph node 2.1 x 2.0 cm.
09/17 AFP 133.7 Start 3x BEP
11/17 finish BEP AFP 5.9
12/17 Recommended RPLND AFP 4.6

Surveillance is a perfectly viable option here. In another 3 months that residual mass might not even be there, and it's likely just necrotic (dead) tissue.

[Mike]

We had our post Chemo apt today. Tumor markers normal. Lymph node is .7 cm. RPLND is recommend in about three months. It was stated that node could shrink further and very small possibility no surgery. Side note: My son did not take his lovenox shots for 4 or 5 days so ended up back in hospital with severe pain this past weekend and still has severe pain. The 3 month delay in surgery would give his lungs time to heal. Recommended surgeon Dr. Steven Campbell Cleveland Clinic. Does this sound like we are on the right path.

07/17 95% embryonal 5% yolk sac. rising markers. Stage 2A. Lymph node 2.1 x 2.0 cm.
09/17 AFP 133.7 Start 3x BEP
11/17 finish BEP AFP 5.9
12/17 Recommended RPLND AFP 4.6

I am not all that familiar with Dr. Campbell (not that mean that much) but if it was me, I would just ask what the options are as far as RPLND surgeons at Cleveland Clinic. I am not sure who is doing the most procedures now but know that Dr. Klein is there, Dr. Stephenson is there and there are probably others as well. Dr. Campbell may very well be the one doing most of the cases now, I just don't know.

Mike

[StaticX]

Is the 1cm rule for non-Seminoma only? I had my post chemo scans today and I have 2 nodes (seminoma) still about 1.5cm each, but was told if they are under 3cm with normal markers to only do surveillance. Does this sound right, or is my oncologist clueless?

[shabby]

2.9cm. Referred to urology. Oh well. =/