5-Treatment - High Dose Radiation ???

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kimmygarland
kimmygarland Member Posts: 312
in Head and Neck Cancer #1
I posted last week about my husband having recurrence. Likely he will have another surgery, chemo and re-radiation (it's been over 2 years, so they say he is 'eligible').

However, yesterday when we saw Radiation Oncologist, he mentioned a different type of radiation that is very high dose, targets the tumor specifically, and is done in 5 treatments. If they did this type radiation, there would be no surgery or chemo. The tumor board is meeting for a second time tomorrow to talk about my husband's case and he is going to bring it up with them.

We are of the opinion that our Medical Oncologist and ENT Oncologist will not go for this, as this is pretty much our last shot.

I've read about HDR brochyherapy, but I'm not sure if that is it, he didn't mention that term.

Anybody?

Note - on a good note - pet scan revealed local tumor only - no spread, thank God.

Comments

  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #2
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    I'm talking out of a cocked hat....
    So take what I have to say with a grain of salt. But I do understand radiation biology pretty well, though I've not run into this before.

    The reason we get individual 200rad sessions is that if the rads are given to sufficient depth dose at a faster rate, the complication rate goes way up. Way up. Even doubling down, which is done with ENT cancer, to treating twice a day instead of once a day give higher complication rates. This is why most of us go in once a day, five days a week, for six or seven weeks.

    The depth-dose required to treat a cancer of, say 3cm size is at least 5200 rads. That's 26 sessions from a proper modern source. More, if the tumor is larger, or more radioresistant.

    To achieve that kind of dose, the individual rad fractions would have to be at least a 1000 rads. This, IMO is unacceptably high. There used to be a type of surface radiation given many years ago, using the old orthovoltage machines, to control bleeding, delivering a very high surface dose of rads. Those were given in 1000rad fractions. One or two of those and bleeding stopped due to swelling of the vessels.

    I'd not fall for this in any way shape or form without much better justification for doing it. That justification needs to come from the experts. If you can't get adequate, HOW COME WOULD YOU DO tHIS? answers from the nuclear med doc, then ask pointed questions to the medical and ent oncologist. They will know exactly what the guy is thinking.

    I'm sorry I am not much help here. I'll do some asking and post again if I learn anything.

    Your point is you want a chance of CURE, if possible, and as few catastrophies along the way as they can possibly give you.

    Best to you.

    Pat
  • kimmygarland
    kimmygarland Member Posts: 312
    #3
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    longtermsurvivor said:

    I'm talking out of a cocked hat....
    So take what I have to say with a grain of salt. But I do understand radiation biology pretty well, though I've not run into this before.

    The reason we get individual 200rad sessions is that if the rads are given to sufficient depth dose at a faster rate, the complication rate goes way up. Way up. Even doubling down, which is done with ENT cancer, to treating twice a day instead of once a day give higher complication rates. This is why most of us go in once a day, five days a week, for six or seven weeks.

    The depth-dose required to treat a cancer of, say 3cm size is at least 5200 rads. That's 26 sessions from a proper modern source. More, if the tumor is larger, or more radioresistant.

    To achieve that kind of dose, the individual rad fractions would have to be at least a 1000 rads. This, IMO is unacceptably high. There used to be a type of surface radiation given many years ago, using the old orthovoltage machines, to control bleeding, delivering a very high surface dose of rads. Those were given in 1000rad fractions. One or two of those and bleeding stopped due to swelling of the vessels.

    I'd not fall for this in any way shape or form without much better justification for doing it. That justification needs to come from the experts. If you can't get adequate, HOW COME WOULD YOU DO tHIS? answers from the nuclear med doc, then ask pointed questions to the medical and ent oncologist. They will know exactly what the guy is thinking.

    I'm sorry I am not much help here. I'll do some asking and post again if I learn anything.

    Your point is you want a chance of CURE, if possible, and as few catastrophies along the way as they can possibly give you.

    Best to you.

    Pat

    Thanks Pat
    I'm pretty sure other docs are not going to go for this, but I was intrigued by the possibility. My husband is very leary to put it mildly. We are at a teaching hospital where they have a lot of cutting edge type bio medicine, etc.

    Appreciate the feedback.
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #4
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    longtermsurvivor said:

    I'm talking out of a cocked hat....
    So take what I have to say with a grain of salt. But I do understand radiation biology pretty well, though I've not run into this before.

    The reason we get individual 200rad sessions is that if the rads are given to sufficient depth dose at a faster rate, the complication rate goes way up. Way up. Even doubling down, which is done with ENT cancer, to treating twice a day instead of once a day give higher complication rates. This is why most of us go in once a day, five days a week, for six or seven weeks.

    The depth-dose required to treat a cancer of, say 3cm size is at least 5200 rads. That's 26 sessions from a proper modern source. More, if the tumor is larger, or more radioresistant.

    To achieve that kind of dose, the individual rad fractions would have to be at least a 1000 rads. This, IMO is unacceptably high. There used to be a type of surface radiation given many years ago, using the old orthovoltage machines, to control bleeding, delivering a very high surface dose of rads. Those were given in 1000rad fractions. One or two of those and bleeding stopped due to swelling of the vessels.

    I'd not fall for this in any way shape or form without much better justification for doing it. That justification needs to come from the experts. If you can't get adequate, HOW COME WOULD YOU DO tHIS? answers from the nuclear med doc, then ask pointed questions to the medical and ent oncologist. They will know exactly what the guy is thinking.

    I'm sorry I am not much help here. I'll do some asking and post again if I learn anything.

    Your point is you want a chance of CURE, if possible, and as few catastrophies along the way as they can possibly give you.

    Best to you.

    Pat

    EXCEPTION
    to what I just said. Hey, if you are in one of those centers that has GAMMA KNIFE experience for these tough cases, that's a whole different enchillada. Start by reading this: http://www.empowher.com/cancer/content/new-gamma-knife-technology-treat-head-and-neck-cancers

    Does this sound like what they talked to you about? If so, this needs considered in your special circumstances. Call back and get the proper label on what exactly type of treatment this guy was talking about. Its the only way your going to sort this out.

    Sorry for the earlier, I'm brain dead today.

    Best.
  • Skiffin16
    Skiffin16 Member Posts: 8,305 Member
    #5
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    longtermsurvivor said:

    EXCEPTION
    to what I just said. Hey, if you are in one of those centers that has GAMMA KNIFE experience for these tough cases, that's a whole different enchillada. Start by reading this: http://www.empowher.com/cancer/content/new-gamma-knife-technology-treat-head-and-neck-cancers

    Does this sound like what they talked to you about? If so, this needs considered in your special circumstances. Call back and get the proper label on what exactly type of treatment this guy was talking about. Its the only way your going to sort this out.

    Sorry for the earlier, I'm brain dead today.

    Best.

    Gamma Knife - Cyber Knife...
    Same thing...just asking?

    Like you, I had 6000rads or grays on the non-tumor side and 7000 on the infected side...

    JG
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #6
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    Skiffin16 said:

    Gamma Knife - Cyber Knife...
    Same thing...just asking?

    Like you, I had 6000rads or grays on the non-tumor side and 7000 on the infected side...

    JG

    Yup
    I just have no idea how this fits. Not in my experience. It is used occasionally, in certain centers. If I were offered this, I guess I'd have to have some idea what the risks of recurrance/ benefits of tight beam control ratio did to my survival odds. At least in theory, cyberknife is better for very discreet, confined cancers. The beam fall-off is huge outside the target area. So if you have a tumor, and 1cm over from the tumor there is a single cancer cell waiting to grow, you miss it. The advantage of traditional therapies, including IMRT is that you kill that other cell too.

    OTOH, if I remember the original discription of his cancer, it is in a very tight spot. This may be why the discussion came up to begin with.

    PS Just reread Kimmys first post. Anatomically the tumor is in the same location, not necessarily in an anatomically tight spot (like close to spine or carotid artery), so I'm not certain cyberknife is a must to effect high enough rad dose for cure. Kimmy, I'd simply slow them down for a complete discussion of why this option works in your case. Unless otherwise proven, modern standard IMRT is generally going to be preferrable. The cyberknife may offer some advantages, as well as some disadvantages, but they need to prove this to you. This would include some rough idea of how successful for CURE they think they can be with the two modalities.

    Sorry I'm so scattered today.
  • Marty36
    Marty36 Member Posts: 84
    #7
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    longtermsurvivor said:

    EXCEPTION
    to what I just said. Hey, if you are in one of those centers that has GAMMA KNIFE experience for these tough cases, that's a whole different enchillada. Start by reading this: http://www.empowher.com/cancer/content/new-gamma-knife-technology-treat-head-and-neck-cancers

    Does this sound like what they talked to you about? If so, this needs considered in your special circumstances. Call back and get the proper label on what exactly type of treatment this guy was talking about. Its the only way your going to sort this out.

    Sorry for the earlier, I'm brain dead today.

    Best.

    Sounds like Cyberknife
    or Gamma Knife

    I start Cyberknife tomorrow. Different set of circumstances (radiation six months ago near same area, no tumor, adjunctive therapy) but it is 5 days with chemo. The goal is to give concentrated, high-dose radiation to area where tumors have been removed in case there is more cancer cells lurking. There is not a lot of information out there on the procedure for HNC and I'm having it done at one of the facilities in the country that does a significant amount of procedures. There's been some good research put out by Georgetown on their experience with it and the success rates.
  • kimmygarland
    kimmygarland Member Posts: 312
    #8
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    Marty36 said:

    Sounds like Cyberknife
    or Gamma Knife

    I start Cyberknife tomorrow. Different set of circumstances (radiation six months ago near same area, no tumor, adjunctive therapy) but it is 5 days with chemo. The goal is to give concentrated, high-dose radiation to area where tumors have been removed in case there is more cancer cells lurking. There is not a lot of information out there on the procedure for HNC and I'm having it done at one of the facilities in the country that does a significant amount of procedures. There's been some good research put out by Georgetown on their experience with it and the success rates.

    Thanks guys - Will keep you posted
    Bob is seeing his medical oncologist today for a brief discussion on this and a couple of other things. Tumor board is meeting today and they will discuss. I don't think this will be their recommendation (high dose rads) - I think they will recommend standard treatment, which in this case would be surgery/chemo/IMRT rads. But what do I know, lol.
  • adventurebob
    adventurebob Member Posts: 691
    #9
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    Got it
    Hi Kimmy,

    I received HDR back in September for a recurrence in my hip. Originally they were going to do 10 sessions but decided on doing 10 sessions worth in 2. Apparently new research shows that the complications are very minimal, the radiation more effective and the biggest benefit to us is less time under the linear accelerator and less time at the docs. I discussed it with my Chinese Medicine Man who is more up to date on evidence based research than any of my docs and he confirmed that is does have the evidence to back it up. It worked well for me in that it cleared up the horrible hip pain within a week and I got a clean PET a few months later. No noticeable side effects or complications. I was very happy to only be under the zapper for 2 days in a row as opposed to 10. Interesting that your Med oncologist would not support your Rad oncologist. Mine always support and defer to the other in their respective areas of expertise.
    Whatever happens for you guys next; may it be exactly what is needed for freedom, health and peace.

    AB
  • kimmygarland
    kimmygarland Member Posts: 312
    #10
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    adventurebob said:

    Got it
    Hi Kimmy,

    I received HDR back in September for a recurrence in my hip. Originally they were going to do 10 sessions but decided on doing 10 sessions worth in 2. Apparently new research shows that the complications are very minimal, the radiation more effective and the biggest benefit to us is less time under the linear accelerator and less time at the docs. I discussed it with my Chinese Medicine Man who is more up to date on evidence based research than any of my docs and he confirmed that is does have the evidence to back it up. It worked well for me in that it cleared up the horrible hip pain within a week and I got a clean PET a few months later. No noticeable side effects or complications. I was very happy to only be under the zapper for 2 days in a row as opposed to 10. Interesting that your Med oncologist would not support your Rad oncologist. Mine always support and defer to the other in their respective areas of expertise.
    Whatever happens for you guys next; may it be exactly what is needed for freedom, health and peace.

    AB

    Med Oncologist Opinion
    Much to my surprise, the med oncologist said this may be an option. The tumor board met this afternoon and we should hear something tomorrow or Friday. (Hurry up and wait)

    Thanks for the thoughts.

    AdventureBob - glad to hear you've had a good outcome.
  • hislove40
    hislove40 Member Posts: 51
    #11
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    kimmygarland said:

    Med Oncologist Opinion
    Much to my surprise, the med oncologist said this may be an option. The tumor board met this afternoon and we should hear something tomorrow or Friday. (Hurry up and wait)

    Thanks for the thoughts.

    AdventureBob - glad to hear you've had a good outcome.

    High Dose instead of surgery - cyberknife?
    This morning when I met with the radiation oncologist, she said that I would be getting a total of 37 treatments - 30 - 32 all along the left side of the face and neck and then very high dose radiation in 5 treatments in my preauricular lymph node at the end I believe she said. I'm just learning about everything. This is my second go round as I've had nearly 6 weeks on Monday to my left temple - easy and no real issues but it spread apparently to my lymph node.
  • kimmygarland
    kimmygarland Member Posts: 312
    #12
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    hislove40 said:

    High Dose instead of surgery - cyberknife?
    This morning when I met with the radiation oncologist, she said that I would be getting a total of 37 treatments - 30 - 32 all along the left side of the face and neck and then very high dose radiation in 5 treatments in my preauricular lymph node at the end I believe she said. I'm just learning about everything. This is my second go round as I've had nearly 6 weeks on Monday to my left temple - easy and no real issues but it spread apparently to my lymph node.

    Decided on Surgery
    They've decided on surgery for my husband, then decision will be made on chemo and radiation or just chemo, after recovery from surgery. Hopefully they can get clean margins with the surgery. They really don't want to radiate him again, doc said, but will take watch and wait for now. Surgery is Monday.
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #13
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    kimmygarland said:

    Decided on Surgery
    They've decided on surgery for my husband, then decision will be made on chemo and radiation or just chemo, after recovery from surgery. Hopefully they can get clean margins with the surgery. They really don't want to radiate him again, doc said, but will take watch and wait for now. Surgery is Monday.

    In for a penny
    It makes sense the way you just stated it. good luck to him (and you). Keep coming back.

    Pat

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