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Radiotherapy after Chemotherapy

vinslymphoma
Posts: 24
Joined: Feb 2014

Hi,

Did anyone here had chance of not having radiotherapy after chemotherapy? I have had 6 cycles of chemotherapy until end of May and in complete remission so far. Nobody says radiation is required or not as the original tumour has gone completely and therefore now have to decide whether i have to go for radiation or not. 

though its specific and may vary...did all of you here have radiotherapy after your chemo ? is it better to have this radiotherapy to reduce chances of relapse? radiotherapy may leave long term effects and also a possibility of relapse..how did you decide..or were you given the final decision to go for it with any recommendation or suggestion ??

i am seeking second opinion from experts but just thought to see whats the general feeling from our folks here :-)  thanks in advance 

 

Cheers

Vinoth

Rocquie's picture
Rocquie
Posts: 857
Joined: Mar 2013

Vinoth, Congratulations on your remission!

After I completed 8 treatments with R-CHOP, I was told my options were:

1. Do nothing. Watch and wait.

2. Have Radioimmunotherapy (Zevalin).

3. Have Rituxan Maintenance, one infusion every 8 weeks for 2 years.

My Oncologist, my husband, and I felt Rituxan maintenance was the best option. 

Good luck with seeking advice and opinions and I hope you can make a decision which provides you with the most confidence.

Cheers to you too,

Rocquie

 

vinslymphoma
Posts: 24
Joined: Feb 2014

Thanks Rocquie...whats this rituxan maintenance? is it again intravenous infusion of rituximab? i had rchop as well......sorry somehow just typed that word but now changed it :p 

 

cheers

Vinoth

Csimowitz
Posts: 3
Joined: Aug 2014

You didn't say if the doctor was recommending targeted radiation or whole brain radiation. Based on my research they are quite different. Do A LOT of research prior to agreeing to whole brain radiation. Remember, it is exactly as it sounds and many of the effects are permanent. Your age and status plays an important criteria in your progress. The younger you are, age 60 being some kind of magic ut oh , the better you probably will fare. Just research your options, I believe that you mentioned rituxin. This is not a chemo drug and enhances the chemo, letting it work better. I am all in favor of also the wait and see. Good luck.

 

vinslymphoma
Posts: 24
Joined: Feb 2014

hey...sorry its not brain radiation..its targeted radiation to upper left chest just above heart area...oncologist team suggests that there is no absolute need for radation but they say its standard..i had rituxin with my chop...not as maintenance..so bit confused..

Rocquie's picture
Rocquie
Posts: 857
Joined: Mar 2013

Vinoth, yes it certainly can all be confusing! 

I had rituxan as part of my R-CHOP treatment. Additionally, I am receiving rituxan alone, as a maintenance plan to help achieve a longer term, durable remission.

The zevalin radioimmunotherapy I mentioned, and trust me I am no expert on the subject, is I believe more of an injection of a monoclonal antibody (rituxan) with a radioisotope attached. So it is more systemic rather than a beam of radiation which targets a specific part of the body. 

It all depends on the type of lymphoma you have. So that is where trusting your Doctor comes in very handy.

Hugs,

Rocquie

 

Max Former Hodg...
Posts: 3705
Joined: May 2012

Vinoth,

I agree with pretty much everything the others have replied to you regarding getting/not getting radiation.

In your first post you asked the general question (which is obvioulsly limited to a discussion of lymphomas), "Has anoyone ever NOT gotten radiation after chemo?"  The answer to that is, Yes -- MOST people who do long term combination therapy do not seem to get radiation in most cases.  People who are earlier stage, and do fewer cycles Do more frequently have a combination of radiation and chemotherapy.  Patients who are very early stage sometimes get NO chemo, but ONLY radiation (for instance, if a scan could detect only one or a few nodes in a small area of the body). So, the answer is obviously all over the board.  In your bio you mention only one large mass, but you also did a fairly heavy chemo regimine.  To me (with no medical training at all, just reading) that confuses the issue somewhat.  The singula mass might suggest radiation, but the number of cycles suggests a later stage disease. Your clinical history is challanging, perhaps even for your doctor.

My own relatively rare form of Hodgkins, when it is late stage, virtually NEVER gets radiation as a treatment, either during or after chemo. The only exception might be if a single, huge node would not receed with the others.  I and two next door neighbors all three had extremelly advance, widespread lymphomas; mine was HL, they both had forms of NHL.  None of us three every even received a question about post-treatment radiation, or any other medications, for that matter.

If given a choice about post treatment drugs, if rituxan (rituxan is spelled numerous different ways) were one of the choices, it would be what I would take, since I have never heard of it harming anyone, except with allergic reactions, which are rare. The patient may feel fluish, but it is not going to damage any organs, or cause any secondary cancers.  It mostly kills CD-20 cells, so if that form of cell is not part of your strain of lymphoma, it would be useless.  I asked about getting rituxan myself, and the oncologist said it was worthless post-treatment for the type of disease I had experienced. Rituxan is also widly used for inflammatory arthritis.

In the most general, generic terms, if I had a choice of getting radiation post chemo or not getting it, and IF the doc said that there was no statistical benefit to receiving it, I would DECLINE receiving it, since very rarely mixing them can cause problems years later. This alsoo varies  with where the radiation is applied in the body.  But the specifics of your case you need to further research. You mentioned a second opinion from a doctor, and I definitely recommend that you do seek out another opinion. A doctor from OUTSIDE your own doctor's medical practice is usually better, since large group practices may have all or most of its internal doctors following the same insurance protocols, which might influence their thinking.

I hope you share what you learn and decide,

max

vinslymphoma
Posts: 24
Joined: Feb 2014

MAx - thank you very much for your post..really very helpful mail for me to introspect details...it seems somehow exactly as to what i have in my mind...i was told i was given rchop 6cycles because the size of the mass was 10.5cmxx which is big enough..had it been smaller <5cm...radiation would have been the primary treatment method.

yes my haematalogist team says they wouldnt recommend radiation and its upto me to decide as the tumour has disappeared totally n no activities after third cycle..i am just scared about the ill-effects of radiation n secondary risk whatsoever latest radiation method that we use these days..but then they say its like making sterile with radiotherapy cleaning up any existing undetected c-cells as the mass was very bulky..

also at the same time i feel...the side effects that we are talking now is not from the recent radiotherapy procedures/techniques which is very targetted and moreover i may be receiving only 30grays for 15days..so i am just thinking n everything n everyone around me now are waiting for this decision so that pending things can be turned around..i have a radiotherapy oncologist appt on thursday n hope to ask all these questions again...

i have asked second opinion from Advance Medical folks..so mostly will be knowing their opinion this week..

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