Newly diagnosed

sephie said:

slight difference in tx protocol

as i said , various hospitals and docs have different ideas.... my tx was 2009,,,, one year or so , i think , after yours.... so MD anderson  has learned more and more....perhaps now for my stage of cancer and with all the burning of tissue that i had ( really bad after one week), and being in intensive care,  they have changed and do not feel the same way about not interrupting the radiation for longer than a weekend..... glad we both have made it this far.... my hope is for others to have info and to know that they can make it through this......sephie

My radiation oncologist would not allow a break.  He had warned me in advance that I would want one, but in his opiniont would effect the tx in negative way.

pializ said:

Break in treatment

my understanding is that a break in treatment is not advisable if possible. Of course, some patients have problems in tolerating treatment for a variety of reasons, & unfortunately they have no choice. I understand that the research indicates a better outcome if treatment is completed within a specific timeframe (sorry, but I can't remember either timeframe or source of information now)

This is verbatum from the most recent update of the NCCN guidelines for the treatment of anal cancer, which can be found on page MS-10,11 of the document:

RADIATION THERAPY

"The optimal dose and schedule of RT for anal carcinoma also continues to be explored, and has been evaluated in a number of nonrandomized studies.  In one study of patients with early-stage (T1 or Tis) anal canal cancer, most patients were effectively treated with RT doses of 40 to 50 Gy for Tis lesions and 50-60 Gy for T1 lesions.  In another study, in which the majority of patients had stage II/III anal canal cancer, local control of disease was higher in patients who received RT doses greater than 50 Gy than in those who received lower doses (86.5% vs. 34%, P = .012).  In a third study of patients with T3, T4 or lymph node-positive tumors, RT doses of >54 Gy administered with limited treatment breaks (less than 60 days) were associated with increased local control.  The effect of further escalation of radiation dose was assessed in the ACCORD 03 trial, with the primary endpoint of colostomy-free survival at 3 years.  No benefit was seen with the higher dose of radiation.  These results are supported by much earlier results from the RTOG-92-08 trial and suggest that doses of >59 Gy provide no additional benefit to patients with anal cancer.

There is evidence that treatment interruptions, either planned or required by treatment-related toxicity, can compromise the effectiveness of treatment.  In the phase II RTOG-92-08 trial, a planned 2-week treatment break in the delivery of chemo/RT to patients with anal cancer was associated with increased locoregional failure rates and lower colostomy-free survival rates when compared to patients who only had treatment breaks for severe skin toxicity, although the trial was not designed for that particular comparison.  In addition, the absence of a planned treatment break in the ACT II trial was considered to be at least partially responsible for the high colostomy-free survival rates observed in that study (74% at 3 years).  Although results of these and other studies have supported the benefit of delivery of chemo/RT over shorter time periods, treatment breaks in the delivery of chemo/RT are required in up to 80% of patients since chemo/RT-related toxicities are common.  For example, it has been reported that one-third of patients receiving primary chemo/RT for anal carcinoma at RT doses of 30 Gy in 3 weeks develop acute anoproctitis and perineal dermatitis, increasing to one-half to two-thirds of patients when RT doses of 54 to 60 Gy are administered in 6 to 7 weeks."

I hope this answers everyone's questions regarding treatment breaks.  And forgive me if this sounds a bit like a rant, but all of you have access to this same information if you will just register on the website for the National Comprehensive Cancer Network--www.NCCN.org.  It is simple and will give you access to the above information and so much more, as regards the diagnosis, staging, treatment and follow-up of anal cancer.  I highly recommend that you all do this. 

Martha

mp327 said:

Treatment Breaks as per NCCN Guidelines Version 2.2015

This is verbatum from the most recent update of the NCCN guidelines for the treatment of anal cancer, which can be found on page MS-10,11 of the document:

RADIATION THERAPY

"The optimal dose and schedule of RT for anal carcinoma also continues to be explored, and has been evaluated in a number of nonrandomized studies.  In one study of patients with early-stage (T1 or Tis) anal canal cancer, most patients were effectively treated with RT doses of 40 to 50 Gy for Tis lesions and 50-60 Gy for T1 lesions.  In another study, in which the majority of patients had stage II/III anal canal cancer, local control of disease was higher in patients who received RT doses greater than 50 Gy than in those who received lower doses (86.5% vs. 34%, P = .012).  In a third study of patients with T3, T4 or lymph node-positive tumors, RT doses of >54 Gy administered with limited treatment breaks (less than 60 days) were associated with increased local control.  The effect of further escalation of radiation dose was assessed in the ACCORD 03 trial, with the primary endpoint of colostomy-free survival at 3 years.  No benefit was seen with the higher dose of radiation.  These results are supported by much earlier results from the RTOG-92-08 trial and suggest that doses of >59 Gy provide no additional benefit to patients with anal cancer.

There is evidence that treatment interruptions, either planned or required by treatment-related toxicity, can compromise the effectiveness of treatment.  In the phase II RTOG-92-08 trial, a planned 2-week treatment break in the delivery of chemo/RT to patients with anal cancer was associated with increased locoregional failure rates and lower colostomy-free survival rates when compared to patients who only had treatment breaks for severe skin toxicity, although the trial was not designed for that particular comparison.  In addition, the absence of a planned treatment break in the ACT II trial was considered to be at least partially responsible for the high colostomy-free survival rates observed in that study (74% at 3 years).  Although results of these and other studies have supported the benefit of delivery of chemo/RT over shorter time periods, treatment breaks in the delivery of chemo/RT are required in up to 80% of patients since chemo/RT-related toxicities are common.  For example, it has been reported that one-third of patients receiving primary chemo/RT for anal carcinoma at RT doses of 30 Gy in 3 weeks develop acute anoproctitis and perineal dermatitis, increasing to one-half to two-thirds of patients when RT doses of 54 to 60 Gy are administered in 6 to 7 weeks."

I hope this answers everyone's questions regarding treatment breaks.  And forgive me if this sounds a bit like a rant, but all of you have access to this same information if you will just register on the website for the National Comprehensive Cancer Network--www.NCCN.org.  It is simple and will give you access to the above information and so much more, as regards the diagnosis, staging, treatment and follow-up of anal cancer.  I highly recommend that you all do this. 

Martha

 

 

yes, martha ,  thanks so much.....sephie

middleduck said:

breaks

My treatment started before Thanks Giving, Christmas and New year. I had those breaks because the staff had those days off. And of course maybe a day before or after as well, plus the weekend too.

I feel now that was a good thing a chance to heal sores in mouth, which by the way another treatment I found is to swish mouth with organic coconut oil,it is a natural way to heal. Be sure to spit out in trash not in sink or swallow. It collects bacteria. Coconut oil also heals blisters almost over night. I found that you can't have the oil on skin while radiation treatment,it blocks the radiation. So need to bathe before treatment real good. OR WAIT UNTIL AFTER TREATMENT IS DONE.

I had some diahrrea too which Imodium came in handy but found it needs to be taken on empty stomach or it takes forever to react.

I hope those breaks were ok, sure will find out in March PET scan. I feel real good. I had some emotional days but it was not my about my health.

Congrats on completing treatment!

Very interesting about the coconut oil healing the mouth sores.  I wish I would have know that when I went through treatment.  I had them really bad and salt water was about the only thing that eased them for me until the ran their course (7-10 days).

Kat7 said:

Countdown

Hi All,

I haven't checked in for a bit because still in the throes of testing and staging. Good news is I am Stage II , T2N0M0. I was so happy to receive that news. I have my port a cath in and do my pre-chemo blood draw on Saturday and start treatment on Monday. Still scared s-less ( so many puns, so little time) about it all but will be glad to get started and get it done!

I will continue to post here when I can to check in with you all.

Thanks again for being here, I found this quote which speaks to me as I begin my treatment:

"When the Japanese mend broken objects, they aggrandize the damage by filling the cracks with gold. They believe that when something’s suffered damage and has a history it becomes more beautiful." ~Barbara Bloom

 

Kat

I'll be thinking of you as you start your journey throught treatment.

Janet