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If Chemo leaves no cancer detected, why do radiation?

connieprice1's picture
connieprice1
Posts: 290
Joined: Oct 2010

My wife Connie just finished 2 rounds of induction chemotherapy. She was suppose to do 3 rounds but due to many side effects after the 2nd round and a month long stay in the hospital, her chemo oncologist told her she would not be doing anymore chemo. When she was in the hospital her chemo doctor ordered a CT Scan and the scan came back that their was no cancer detected. She is starting 7 weeks of radiation at the end of this month 33 total radiation treatments. My question is if the cancer is no longer detected why not save the radiation card in case the cancer returns rather than using all available treatments at once. Her cancer was HPV positive which is easier to treat. The radiation seems to cause so many side effects and in some cases these side effects linger for years, wouldn't it be nice to proceed without radiation and monitor closely. If the cancer returned then radiation would be a 1st option. Connie's husband, Homer Price

ratface's picture
ratface
Posts: 1232
Joined: Aug 2009

Homer , where was the primary and what stage was the cancer at? Any surgery?

ratface's picture
ratface
Posts: 1232
Joined: Aug 2009

chemo was used? Cisplatin, Erbitux, or a cocktail?

connieprice1's picture
connieprice1
Posts: 290
Joined: Oct 2010

1st week: Cisplatin, Docetaxel and Erbitux followed by 5FU injected by an infusion pump over the next 4 days
2nd week: Erbitux only
3rd: nothing
This treatment was suppose to be repeated 3 times for a total of 9 weeks

connieprice1's picture
connieprice1
Posts: 290
Joined: Oct 2010

Base of tongue that spread to 2 lymph nodes in the neck classified Stage IV. The tumors in the lymph nodes were too large (6cm) so surgery was not an option.

D Lewis's picture
D Lewis
Posts: 1518
Joined: Jan 2010

A cancer that returns is much harder to treat than is the initial cancer. And, typically, if a cancer returns, it does so in the form of a metastatic (is that the right word?) disease in the lungs or brain or pancreas or liver or some such place. For some folks, with very early cancer that has not spread, surgery may be enough. For other folks, maybe only chemo would follow the surgery, to ensure that any metastatic cancer would also be killed off. In your wife's case, she did not get all the way through the chemo, so now the radiation is the backup treatment to ensure it won't spread. In my case, my base of tongue cancer had already spread to lymph nodes on both sides of my neck, thus I got surgery, chemo and radiation. And, I was happy to receive it. I have no wish for the cancer to ever return. Side effects I can live with. The operative word here is LIVE.

Best of luck to you and your wife on her journey.

Deb

buzz99's picture
buzz99
Posts: 404
Joined: Sep 2010

Like your wife, Buzz had to omit the 3rd round of "induction chemo" after two hospitalizations after rounds 1 and 2. The purpose of the induction chemo is the shrink the tumor and make it easier to target with radiation. My understanding is that radiation really kills the cancer and there may be some cancer cells remaining after chemo. So Buzz had 7 weeks of radiation with concurrent Erbitux chemo. Your really need to complete the full treatment to hopefully be cured. Karen

DrMary's picture
DrMary
Posts: 527
Joined: Nov 2010

The instruments can't see below a certain size - as we know, all it takes is one cancer cell hanging out in a lymph node. How large was her primary tumor and how much did it shrink? My brother-in-law the doctor says this is one way they judge the effectiveness of the chemo.

In any case, you really do want to be safe rather than sorry. Radiation is a different kind of tough - the chemo caused Doug blood clots, low WBC and a loss of over 30 lbs, while radiation caused daily exhaustion, throat pain, dry mouth and nausea. Those were more easily handled - naps after radiation, magic mouthwash, salagen/caphasol/fluoride and timing the antinausea pills to kick in about 30 minutes after radiation. He was taking decadron for the nausea after his second chemo and I asked if we could keep him on it until after radiation was over - it seemed to help reduce the swelling in his throat and might have kept him swallowing better.

Doug also omitted the 3 chemo (cisplatin) but his chemo and radiation were concurrent. Now that it's over, we're glad we did both radiation and chemo - even so, we worry about not getting it all (don't we all).

kingcole42005's picture
kingcole42005
Posts: 177
Joined: Oct 2010

I met a woman who decided not to do radiation after doing chemo. She had breast cancer and thought exactly as you do. I met her 3 years after her first diagnosis I was undergoing radiation for my own cancer. She went against what the doctors recommended and figured the chemo and her own immune system would get the rest of the cancer. She was very wrong and she was very upset with herself for not listening to her doctors. Her cancer came back, worse. She is now undergoing radiation and her odds aren't as good. It is ultimately your choice, but if you trust your doctors and you are not a doctor yourself then you should listen to them. Shelly

Hondo's picture
Hondo
Posts: 5608
Joined: Apr 2009

It’s a good question, I am not sure I could give you a good answer; but this is my story. I did Radiation with out chemo for my first cancer NPC, I had a 98% chance of cure, I was clean for only about 11 months before it came back. The second time I did radiation with Chemo for NPC, I had only a 25% chance of cure and it still came back 14 months later. I was told I should have done the Radiation and Chemo the first time and killed it all then, so to me it is hard to say.

I do wish now that I would have done the radiation and Chemo the first treatment as it might have gave me a better chance of not coming back and saved me a lot of pain down the line.
Drill your doctor on the question and don’t be afraid to question his answer.

All the best to you both.
Hondo

Kent Cass's picture
Kent Cass
Posts: 1746
Joined: Nov 2009

This is C, Homer. Only way to error is on the side of the aggressive. That often means taking the patient to the limit of what they can tolerate. Again- this is C. I wish I could tell you just the Chemo would be enough, but from what I know, and with what you say she's diagnosed with- I think you would be foolish to disregard your Drs. advice. You might think the rads are ugly- but treating this half-aXXed is asking for it to get one heckuva lot uglier down the road, in my opinion. Even us, who've gotten all the Drs. can dish out, have a high risk of the C coming back, Homer. C don't just go away like an infection or virus.

Are you basing the C being gone on a Cat Scan? You shouldn't. She has to get a Pet Scan to get a good opinion on if it is, or isn't, gone. That's the way it is with all of us.

kcass

connieprice1's picture
connieprice1
Posts: 290
Joined: Oct 2010

I appreciate everyone taking the time to respond. I want what is best for my wife and I guess it looks like 33 rounds of radiation is the surest thing at this point. It has already been a rough road and we are only half way through treatment not counting recovery after treatment. Man, I tell ya "CANCER REALLY SUCKS" I do sometimes wonder, when the drug companies are behind so many of the clinical trials why they would be motivated to cure cancer if it would make their cancer drug obsolete. Just think, if cancer were like polio and an absolute cure was possible with a vaccine would anyone really come forward with it knowing that doctors who study cancer for years could be out of work, or cancer hospitals would have to start over trying to cure some other disease. My mother got lymphatic cancer in 1978 and she did chemotherapy 33 years ago. She fought the disease hard for 5 years and the day finally came when the doctors told her their was nothing more that they could do for her. I remember when I went home to see her for the last time how betrayed she felt because she had done everything that they had asked her to do and that they had given up on her. I realize that their has been many break throughs with chemotherapy since 1978 but my wife did 5FU recently and this chemo drug was invented in the 1950's. I pray that GOD will provide someone to come up with the cure for cancer, possibly gene therapy or stem cell research but it is discouraging to me that over the past 40 years that the big 3 in cancer is surgery, radiation and chemo.

ekdennie's picture
ekdennie
Posts: 231
Joined: Aug 2010

that is true that the names of the treatments haven't changed much, but the methodology has changed so much. 5 years ago they would have had to remove my nose to get to my cancer...if they would have even bothered. 5 years ago I would have had to have standard radiation which would have caused severe side effects. instead I had my tumor removed using a scope through my nostril with a section being removed from my mouth, when they removed my hard palate (that was where my tumor grew from). then I had IMRT...they were able to target the tumor so well that they could "block out" my thyroid, brain, and eyes. before the invention of IMRT,those would have all be affected. plus I was able to use some incredible lotions for my skin, an oral rinse that they wouldn't have bothered with, and i was able ot be at home for my recovery time. just a few years ago, that would not have been possible. there have been huge leaps even in the last 7 years...that was when my grandmother died from liver cancer...they didn't do PET scans then to see if a tumor had spread...by the time they found her tumor, it was too late. she had already battled leukemia, only to be taken out by a hidden tumor. a PET scan would have shown a tumor. there is still hope that new advances will develop a cure...and an affordable one then!

Kent Cass's picture
Kent Cass
Posts: 1746
Joined: Nov 2009

would really, REALLY, like for there to be a cure. Not sure it's possible, though, with C being as it is.

As for the drug companies being part of the trials- the only reason for the trials are new drugs, or combinations. A co-worker's wife recently was diagnosed with NH Lymphoma. I started doing research for them, and lo and behold there's a company I'm invested in called Spectrum Pharmaceuticals that has a new drug, Zevalin, which might replace Rituxan, which is a harsh standard in Lympho treatment. This new drug apparently shows equal positives in regards to the C fighting with a Stage-2 human trial, and the side-effects are far less, and the cost savings are Bigtime, as one only takes this once, instead of the three Rituxan doses. So, one would think the FDA will put this on the fast-track. Not necessarily so- this just means a wider Stage-3 human trial begins. And the market? Biggest hurdle will be the marketing of Zevalin, as the Roche and Genetech giants control Rituxan, and that's a lotta clout. All I can find on the net says Zevalin is a major improvement on Rituxan in every way, including cost, and this is great news to every NH Lympho patient, but apparently the FDA doesn't have the same priorities as the patients with this C. And that is wrong.

Please keep us informed on how things go, Homer. You are here, now, so you are family to every one of us. Any questions or concerns- the answers we can provide, or attempt to, is what makes our day. Your wife, Connie, will win this battle for a long life with you. That's the fact that trumps all which comes her way with treatment. The road can get very rough, but she will survive.

Believe

kcass

connieprice1's picture
connieprice1
Posts: 290
Joined: Oct 2010

I considerate it an honor to be part of this courageous family and I appreciate all the kind replys. Someday I would like to meet all the fine people on this website and yes I believe we are all brothers and sisters dealing with a sneaky disease.

ekdennie's picture
ekdennie
Posts: 231
Joined: Aug 2010

ditto what everyone else said! the side effects far out weighed not doing it for me!
best of luck and hugs to you both!

ratface's picture
ratface
Posts: 1232
Joined: Aug 2009

It seemed a valid concern initially as radiation brings it's own host of side effects. I commend you for being such an advocate for your wife. If the cancer had been 'In Situ" small tumor, low grade, I think your question had merit. My personal opinion is that Erbitux will someday become the new gold standard and your wife is evidence of that with such a great response. Although they still use chemo, radiation, and surgery as in the 1950's they have all evolved significantly. Erbitux is a mono clonal antibody targeted therapy that is revolutionary in the treatment of cancer. It seks out and destroys individual cancer cells leaving healthy cells alone. Radiation has come from cobalt to now proton and surgery is now using the Da Vinci robot. I think it would be criminal to radiate someone without a target ( although it was used for the treatment of acne once) and what your doctor is proposing is in line with the standard of treatment for your wife's stage of cancer. Looks like you are off to a good start in a crappy situation.

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