Any information about de-escalated adjuvant radiation therapy (DART)

Keep_the_Faith1

This is a follow-on to an earlier topic that I started, but since this is focused on the de-escalated adjuvant radiation therapy (DART), I thought I would make this a new topic.

I was diagnosed with early stage HPV+ cancer on my right tonsil. After conferring with my surgery, chemo and radiation doctors it was recommended to have TORS surgery. The surgery went well, and fortunately the lymph nodes that were removed tested negative. But now the radiation doctor is recommending 5 weeks of "clean up" radiation because the margins were <3mm. However, my surgeon suggested that I did have a margin although <3mm, and NavDx blood results for HPV after surgery looked good and that in my particular case, radiation treatment (which comes with permanent side effects) was a personal choice that could go either way.

My radiation doctor recommended 50 Gy delivered over 5 weeks.

I was concerned about the side effects of radiation so I called the Mayo Clinic. They reviewed all of my medical records and offered me a de-escalated treatment called DART that only used 30 Gy along with docetaxel delivered over 2 weeks. The idea is that the lower dose radiation would greatly diminish possible long term side effects caused by radiation.

Does anyone have any information about this de-escalated adjuvant radiation therapy (DART)?

Has anyone received this treatment?

I believe that this might be considered a clinical trial but I was told that a phase III report would be published soon. Does anyone have an opinion about this clinical trial or clinical trials in general?

Any opinions on whether I should go with the 50 Gy or this lower dose DART method?

wbcgaruss

Hi, Keep_the_Faith1. I'm sorry, but it looks like you're not done with treatment yet. They are recommending follow-up radiation.

I have not had your kind of cancer nor your treatment modalities.

I would just like to comment on 30 vs 50 Gy radiation strength.

Radiation side effects are real but I don't think they are generally as severe as they were in the old days because of newer technologies that limit it hitting the wrong places, good tissue vs bad questionable area as much, I think they aim it much better. Still, no radiation is more desirable but can't be avoided in a lot of cases.

That being said the way I understand your situation is 50 Gy is recommended.

You got a second opinion from Mayo and they are offering 30Gy reduced from 50Gy

The 30 GY you say is a clinical trial.

In my mind a clinical trials are tests which is what they are.

Clinical trials are research studies that test how well new medical approaches work in people. 

https://www.cancer.gov/research/participate/clinical-trials/what-are-clinical-trials

What is the purpose of a clinical trial? 

Clinical trials test new ways to find, prevent, and treat cancer. They also help doctors improve the quality of life for people with cancer by testing ways to manage the side effects of cancer and its treatment. 

Your treatment situation is pretty good the way it is now with conventional treatment I would not recommend getting a clinical trial research study in your case.

My opinion is you are better off with the standard 50 Gy dose or standard treatment of some sort, no clinical trials or tests, and finish this up for yourself and be cancer-free. But it is your choice your choice.

WHY?

• To be sure you got the optimum treatment for your case leaving virtually no chance of surviving cancer cells
• You only want to do this once
• As my Radiation Oncologist told me "This is a One-Shot Deal"
• There are a lot of functions in the H&N area and the more treatments and operations you have in that area the more chance of malfunctions and permanent issues (You only want to do this cancer deal once and done) This is not something you want to risk revisiting if at all possible.
• No matter which method you choose make sure your care team verifies that this treatment will mop up the rest of your cancer and you will be cancer-free. Or as close to that as possible. I don't think they can guarantee anything with cancer but you want to be as sure as possible such as 99% sure.
• Take the surest route to be cancer-free.
• Did I say you want to be sure and only do this once?

Wishing You The Best

Take Care, God Bless

NEGU (Never Ever Give Up)

Russ

Keep_the_Faith1

Thank you very much Russ!

Keep_the_Faith1

Hi Russ,

As a follow-on, the paper on the Mayo treatment is called:

"De-escalated therapy improves quality of life following oropharynx cancer treatment"

I tried to copy the link in a previous post but was unsuccessful. The 2 week clinical trial includes 30 Gy accompanied by two radiosensitizing doses of the chemotherapy docetaxel.

I will likely still go with the standard 50 Gy as you recommended. "Once and done".

God Bless,

Frank

wbcgaruss

Very well Frank.

When we get cancer and never had it before we have no knowledge and have to learn so much so quickly.

Also, there is so much information to digest and decisions to make.

It is not an easy time but you will get through it, many before you have.

Keep us updated.

Wishing You The Best

Take Care, God Bless

Russ

Keep_the_Faith1

Thank you so very much Russ,

The DART regimen consists of 30 Gy over two weeks with two radiosensitizing doses of the chemotherapy docetaxel. A link to a document about this is below:

https://www.mayoclinic.org/medical-professionals/cancer/news/de-escalated-therapy-improves-quality-of-life-following-oropharynx-cancer-treatment/mac-20538563

I agree with your advice that "you only want to do this once". I am probably going to stay safe and go with the standard 50 Gy (which is lower than some 60 Gy that I have also seen).

I always appreciate your feedback on this forum.

God Bless You,

Keep the Faith1

p.s. Is there a way to send a private message on this forum?

Keep_the_Faith1

Hi Russ,

The DART regimen treats select patients after surgery to 30 or 36 Gy over two weeks with two radiosensitizing doses of the chemotherapy docetaxel. Below is a link to a paper that discusses DART.

https://www.mayoclinic.org/medical-professionals/cancer/news/de-escalated-therapy-improves-quality-of-life-following-oropharynx-cancer-treatment/mac-20538563

I agree with your statement "you only want to do this once". I plan to go with the safe and standard of 50 Gy.

God Bless,

Keep the Faith1

goffrey

https://csn.cancer.org/discussion/comment/1719646#Comment_1719646

The DART regimen has fantastic results. Mayo has been doing this regimine for YEARS. I wish I could have qualified for it.

Keep_the_Faith1

Thank you for your feedback Goffrey,

I am now actually seriously considering the DART regimen. My main goal is to minimize the possibility of log term effects due to mop up radiation without compromising effective treatment. I would think that the difference between 30Gy and 50Gy could make a significant difference between having mild vs major long term side effects. I also believe that this DART regimen is the mayo Clinic standard treatment for patients that qualify.

I will let you know how it goes and thank you again for your feedback,

Keep_the_Faith1

Keep_the_Faith1

First of all, THANK YOU RUSS and GOFFREY! I am grateful for your feedback and support.

After a lot of praying and contemplating, I decided to travel over 200 miles to get the DART treatment at Mayo. I believe that this was one of the best decisions that I have ever made. I have never been treated better at any medical facility than at Mayo. I think that DART is actually their standard of treatment for patients that qualify, and many doctors think that this will become more common in the future. The de-escalated treatment of 30Gy was completed in 2 weeks. I finished my last radiation treatment 3 months ago. I still had the usual side effects of radiation, but I did not lose saliva, and the doctor is not expecting any long term jaw bone, teeth or thyroid problems. I still have not gotton all of my taste back, but it is expected to get better in the next few months. Last week was my first PET scan since treatment, and so far all looks good.

This forum is wonderful. If anyone has any questions about the DART treatment, let me know. I am happy to give back and contribute to this forum.

Special thanks again to Russ and Goffrey!

God Bless,

Keep_the_Faith1

wbcgaruss

Keep_the_Faith1, congratulations on finishing the de-escalated treatment and on your first post-PET Scan being all clear.

What we call NED here (No Evidence of Disease) or some of the docs call "Unremarkable".

I am sure it was a difficult decision for you considering the 200-mile drive.

But as it turns out, it is working out to be the best decision for you.

The reduced treatment will pay off, especially down the road. As we age, things become less flexible, including our larynx and other head and neck parts.

I thank and praise God for how he got you through it all safely and in good shape.

May all your scans ahead show NED, and "Unremarkable"

I am so thankful when I see success stories like yours on the forum, this is what we are striving for.

Wishing You The Best

Take Care, God Bless

Russ

I celebrate with you...

goffrey

https://csn.cancer.org/discussion/comment/1722525#Comment_1722525

https://csn.cancer.org/discussion/comment/1722525#Comment_1722525

https://csn.cancer.org/discussion/comment/1722525#Comment_1722525

Glad you opted for that route! Mayo is where I went and they are amazing! This is the standard protocol for them for cases that are not too far advanced. I was not able to quality due to the staging but I wish it would have been an option for me!