Brachytherapy

pjs62

Well we met with my drs Fri. for the 'game plan' on my recurrent cancer. Good news...tumor is smaller then last year by 3cm. (size is now 2-3cm)& about 3cm. inside 'anal canal'. Bad news...need surgery to remove then radiation. (& 10-12 days in the hospital! ugh)
So here's the plan (& am wondering if anyone has been this 'route' or knows about this):
Laser surgery to remove tumor & surrounding tissue. Next place 'catheter tubes' in rows to prepare for brachytherapy. I'll have radiation 2 times/day for 6 days (at the cancer center which is thankfully connected to the hosp!). I'll have to lay on my stomache during the stay, be on strict liquids, unable to get up much...not gonna like being idle! haha! And since its just over an hour from home (& hubby has to work) I'll only see him every couple days (there's a Care House for him to stay at overnt). (bummed won't see my kids/grandkids/pups!!)

If anyone has some input, it'd be greatly appriciated. My drs explained in detail what's going to happen but I'm still anxious scared nervous. They're 'stepping out of the box' on this one, but we have confidence in my medical team & the cancer center.
(if I'd gone to them last yr I may not be going thru this!) We learned to question & research everything. Kind of hard to believe my 'old drs' still haven't called to see what I decided or how I'm doing. They really care about the patient hahaha!!!

mp327

Hi pjs62!
I would suggest that you Google brachytherapy for anal cancer. I have looked into this before on the internet and there is information out there. I have only known of one person who underwent this type of treatment. It's my understanding that radioactive rods are inserted into the anal canal, which is probably the "tubes" you mentioned in your post. I really don't know much other than that. If you get more information, please let us know what you find out. As always, I wish you all the very best and will keep you in my thoughts and prayers.

z

pjs62
I am so glad you will be getting started to rid you of this cancer for once and all. I have no knowledge of brachytherapy for anal, but my friend had it for cervical, and she had the surgery (hysterectomy), and then the brachytherapy, and she is fine and that was over 5 years ago.

It sounds like a lot to go through but is much better than having the colostomy in my opinion and I would opt for this treatment for myself. It won't be fun to miss your family and pets, but hopefully it will go by quickly. I am also glad it is much smaller than last year, my cancer was 2-3 cm also.

Now, this may be ground breaking also, and they will find that the anal cancer patient should go this route before colostomy for recurrent anal cancer, I wish you well, and take your computer so you can update us. Lori

7243

www.rare-cancer.org/
I'm very excited to see they are trying another option prior to resorting to APR. I have seen research in Europe and/or Australia re; the approach your physicians are taking and I know this approach is being used here in the states for recurrence.

Frankly, this option was offered to me as an initial approach to treatment, similar to what they do for patients with cervical cancer. The radiation oncologist outlined 15 days of external beam radiation, followed by brachytherapy; insertion of rods in the anal canal under anesthesia with placement of the isotopes directly into the rods...less time, supposedly less damage to tissue, however I don't know about tissue damage with brachytherapy after previous external beam...something you would want to discuss with the physicians.

The radiation oncologist I consulted with felt for a young woman this would be the best approach as it offered the least radiation damage. I opted for the standard Nigro protocol as per NCCN guidelines given the long-standing evidence for cure of "initial" disease.

This approach sounds very reasonable and conservative for recurrence and an approach I would seek out prior to APR if I have to deal with local anal recurrence as you are. If I were you, I would ask how many times they've used this approach, what is their actual success rate, and what are the side effects possible complications so that you can move forward knowing what "could" happen. And do they know how patients treated with this approach across the states and in the international realm are doing? Will you go through chemotherapy again and what agents will they use?

I also suggest if you haven't registered at the rare cancer alliance, you may want to consider doing that. There are many, many anal cancer survivors there dealing with recurrence etc. ... perhaps someone there has had brachytherapy for recurrence.

Wishing you all the best ... please keep us informed and God Bless! xoxo

pjs62

7243 said:

www.rare-cancer.org/
I'm very excited to see they are trying another option prior to resorting to APR. I have seen research in Europe and/or Australia re; the approach your physicians are taking and I know this approach is being used here in the states for recurrence.

Frankly, this option was offered to me as an initial approach to treatment, similar to what they do for patients with cervical cancer. The radiation oncologist outlined 15 days of external beam radiation, followed by brachytherapy; insertion of rods in the anal canal under anesthesia with placement of the isotopes directly into the rods...less time, supposedly less damage to tissue, however I don't know about tissue damage with brachytherapy after previous external beam...something you would want to discuss with the physicians.

The radiation oncologist I consulted with felt for a young woman this would be the best approach as it offered the least radiation damage. I opted for the standard Nigro protocol as per NCCN guidelines given the long-standing evidence for cure of "initial" disease.

This approach sounds very reasonable and conservative for recurrence and an approach I would seek out prior to APR if I have to deal with local anal recurrence as you are. If I were you, I would ask how many times they've used this approach, what is their actual success rate, and what are the side effects possible complications so that you can move forward knowing what "could" happen. And do they know how patients treated with this approach across the states and in the international realm are doing? Will you go through chemotherapy again and what agents will they use?

I also suggest if you haven't registered at the rare cancer alliance, you may want to consider doing that. There are many, many anal cancer survivors there dealing with recurrence etc. ... perhaps someone there has had brachytherapy for recurrence.

Wishing you all the best ... please keep us informed and God Bless! xoxo

Thanks for the information. I checked out this website but didn't find too much regarding what I'll be going thru. But I'll check it out again.
My drs are confident that the surgery with brachytherapy will remove the tumor & treat surrounding tissue. No chemo needed, possible temp ostomy bag. They're 'stepping out of the box' so to speak on this but have done a few similar with success. (one was for cervical cancer) Yes normal treatment is the chemo & radiation which is usually successful I'm not sure if because my '1st drs' didn't have alot of experience with anal cancer is the reason I now have recurrent or not. (they're the ones who said I have no option but APR!) But we're happy we did alot of research & feel confident with our new drs at Goshen Cancer Center. My surgeon even practiced at MD Anderson, my radiologist at Chicago. They are very caring people at Goshen.

pjs62

mp327 said:

Hi pjs62!
I would suggest that you Google brachytherapy for anal cancer. I have looked into this before on the internet and there is information out there. I have only known of one person who underwent this type of treatment. It's my understanding that radioactive rods are inserted into the anal canal, which is probably the "tubes" you mentioned in your post. I really don't know much other than that. If you get more information, please let us know what you find out. As always, I wish you all the very best and will keep you in my thoughts and prayers.

Hi mp327!!
I have googled, web md, ask jeeves....whatever I can find! My radiologist was very informative but its still scary just thinking about it! (did see a picture of the 'rods' inserted & yea well...hmmm!!) My hubby said he's taking a picture to post! Not gonna happen!! haha!! I gotta laugh or I'll cry...got about 2 wks of waiting for the 'big day' & my emotions are all over the place.
Thanks for your prayers....its great having a 'sounding board'.

pjs62

z said:

pjs62
I am so glad you will be getting started to rid you of this cancer for once and all. I have no knowledge of brachytherapy for anal, but my friend had it for cervical, and she had the surgery (hysterectomy), and then the brachytherapy, and she is fine and that was over 5 years ago.

It sounds like a lot to go through but is much better than having the colostomy in my opinion and I would opt for this treatment for myself. It won't be fun to miss your family and pets, but hopefully it will go by quickly. I am also glad it is much smaller than last year, my cancer was 2-3 cm also.

Now, this may be ground breaking also, and they will find that the anal cancer patient should go this route before colostomy for recurrent anal cancer, I wish you well, and take your computer so you can update us. Lori

Hi Lori!!
Yes I feel like I'm the 'experiment' on this treatment. But its all good coz I won't have to go thru APR (at this time at least). We feel my medical team will take good care of me. I hope after all this I'll be able to help others in similar situations. It helps having a supportive 'sounding board'. I'm so thankful my son discovered this board for me.

P.S. I will definately have my computer with me! Gonna me idle & need stuff to do!! haha!
BTW...hope you're getting some rest & starting to feel better.

7243

pjs62 said:

Thanks for the information. I checked out this website but didn't find too much regarding what I'll be going thru. But I'll check it out again.
My drs are confident that the surgery with brachytherapy will remove the tumor & treat surrounding tissue. No chemo needed, possible temp ostomy bag. They're 'stepping out of the box' so to speak on this but have done a few similar with success. (one was for cervical cancer) Yes normal treatment is the chemo & radiation which is usually successful I'm not sure if because my '1st drs' didn't have alot of experience with anal cancer is the reason I now have recurrent or not. (they're the ones who said I have no option but APR!) But we're happy we did alot of research & feel confident with our new drs at Goshen Cancer Center. My surgeon even practiced at MD Anderson, my radiologist at Chicago. They are very caring people at Goshen.

wonderful
PJS...wonderful. Like I said, I would seek this approach if faced with local recurrence. It's hard to say why recurrence occurs ... but fortunately you have a plan you understand and physician's you trust and are moving forward ... great news! This is the best news. PLEASE keep us informed. xoxo

endcancer

HDR Brachytherapy
So sorry to hear about the recurrence. Best of luck to you on the Brachytherapy and surgery. My mother has recurrent anal cancer HPV 16 positive and had HDR Brachytherapy for the first recurrence. Would be happy to fill you in about it. FYI her treatment with HDR Brachytherapy was different than yours. No catheters. Once a week for three weeks on an outpatient basis. Is yours LDR (low dose rate)?

Am looking for doctors who will step out of the box for my mother's persistent disease as well. Could you please let me know which cancer center/medical team you are using now? Thanks.

Good luck and feel free to contact me for additional info about my mother's treatment. FYI we were warned in advance that it in a worst case scenario it could cause problems- fistulas etc. While there may be a small fistula developing now, it's been over a year and no major problems to date. The rad onc used a small dosage. As it turned out, probably not enough to cure the cancer. The cancer is still there. It was hiding in scar tissue that they were tracking.

For those with initial recurrences, look into proton therapy (Oklahoma City did first anal cancer patient summer 2010) and PDT (photo dynamic therapy). I looked into both for my mother following persistent disease post HDR (high dose rate) brachytherapy. Neither were an option once she had the brachytherapy on top of IMRT/Nigro Protocol. They said maximum radiation to that area had been received.

Hope to hear your treatment works and you are NED for good!

pjs62

endcancer said:

HDR Brachytherapy
So sorry to hear about the recurrence. Best of luck to you on the Brachytherapy and surgery. My mother has recurrent anal cancer HPV 16 positive and had HDR Brachytherapy for the first recurrence. Would be happy to fill you in about it. FYI her treatment with HDR Brachytherapy was different than yours. No catheters. Once a week for three weeks on an outpatient basis. Is yours LDR (low dose rate)?

Am looking for doctors who will step out of the box for my mother's persistent disease as well. Could you please let me know which cancer center/medical team you are using now? Thanks.

Good luck and feel free to contact me for additional info about my mother's treatment. FYI we were warned in advance that it in a worst case scenario it could cause problems- fistulas etc. While there may be a small fistula developing now, it's been over a year and no major problems to date. The rad onc used a small dosage. As it turned out, probably not enough to cure the cancer. The cancer is still there. It was hiding in scar tissue that they were tracking.

For those with initial recurrences, look into proton therapy (Oklahoma City did first anal cancer patient summer 2010) and PDT (photo dynamic therapy). I looked into both for my mother following persistent disease post HDR (high dose rate) brachytherapy. Neither were an option once she had the brachytherapy on top of IMRT/Nigro Protocol. They said maximum radiation to that area had been received.

Hope to hear your treatment works and you are NED for good!

end cancer
Hi there...
I'm going to Goshen Cancer Center in Indiana. (www.cancermidwest.com) My medical team is very informative & most come from the bigger hospitals. I'm happy we did more research & went for a 2nd opinion at Goshen. (plz let me know if you need my dr's names)
I'm not sure if mine will be LDR. I do know 2 times/day for 6 days. My recurrent is smaller then a yr ago (was 6cm & now 2cm). Drs feel hopeful this treatment will work. After the treatment I'll be going for monthly checkups at first then every 3 months or so. Did your mom have 'traditional' (external rad/chemo)treatment when she was first diagnosed? Last yr I had that treatment but guess my cancer was too stubburn. So hope things work out better this time...tired of this mess!
With the brachytherapy did she have any side effects, like you may have with external rad/chemo? How is she feeling?
Hope things get better for your mom.

z

pjs62 said:

end cancer
Hi there...
I'm going to Goshen Cancer Center in Indiana. (www.cancermidwest.com) My medical team is very informative & most come from the bigger hospitals. I'm happy we did more research & went for a 2nd opinion at Goshen. (plz let me know if you need my dr's names)
I'm not sure if mine will be LDR. I do know 2 times/day for 6 days. My recurrent is smaller then a yr ago (was 6cm & now 2cm). Drs feel hopeful this treatment will work. After the treatment I'll be going for monthly checkups at first then every 3 months or so. Did your mom have 'traditional' (external rad/chemo)treatment when she was first diagnosed? Last yr I had that treatment but guess my cancer was too stubburn. So hope things work out better this time...tired of this mess!
With the brachytherapy did she have any side effects, like you may have with external rad/chemo? How is she feeling?
Hope things get better for your mom.

bump
Bump for lilly

pjs62

appt set
So as an update...
Nov. 15th (Tues.) is set for surgery & inserting the 'rods' (for brachytherapy). Then on Nov. 16th (Wed.) begins the radiation (twice a day for 6 days). So rad for 3 days then weekend off then 3 more days (& home in time for tureky day! haha). Being in the hospital the entire time won't be fun but worth it to be rid of this 'c-stuff'! Thankfully there's a Caring Home by the hospital so we can stay the day before (easier to be so close when doing colon prep),then hubby will stay an extra 2 days.
I'm so anxious to get this over with! I've been in more pain lately & alittle more tired. I'm still working part time & after 6-8 hrs on my feet, can't wait to get home & drop! But it helps to keep somewhat busy.

mp327

pjs62 said:

appt set
So as an update...
Nov. 15th (Tues.) is set for surgery & inserting the 'rods' (for brachytherapy). Then on Nov. 16th (Wed.) begins the radiation (twice a day for 6 days). So rad for 3 days then weekend off then 3 more days (& home in time for tureky day! haha). Being in the hospital the entire time won't be fun but worth it to be rid of this 'c-stuff'! Thankfully there's a Caring Home by the hospital so we can stay the day before (easier to be so close when doing colon prep),then hubby will stay an extra 2 days.
I'm so anxious to get this over with! I've been in more pain lately & alittle more tired. I'm still working part time & after 6-8 hrs on my feet, can't wait to get home & drop! But it helps to keep somewhat busy.

Thanks for the update!
I'm glad you now have your treatment dates scheduled and everything is proceeding nicely. I know you are anxious to do this and have it done and over with and my prayers for you are that it all goes well and results in being cancer-free! Take care and update again when you can.