How soon is too soon to receive your first scan after treatment.

My friend just finished treatment - Started 10/8/11 3 weeks chemo (carboplatin, 5FU & Erbitux) followed by 40 IMRT with concurrent chemo.

He is doing amazingly well. His doctors ordered a pet scan for the end of April - but it was moved up to yesterday and has already been performed.

As anyone he is extremely nervous about the results.

From all I have read - this seems really early for a scan. He is still pretty raw from the radiation.

Is this normal protocol?

I am just trying to help him prepare for what the doctors might say.

He meets with them tomorrow for the results.

Thank you for any insight you can provide.

A follow up PET scan is usually done at about 3 months post treatment. My doc told me that anything sooner has higher false positives dues to the inflammation.

When did your friend finish chemo and rads?

Hi JDOC

the accuracy of the PET will also depend on where the cancer was located as well as how long since radiation finished. You are right that if the PET is done too soon, healing may interfere with the results giving your friend a "false positive"

Alex also had chemotherapy before chemoradiation and had his PET scan 12 weeks after radiation finished. Alex's cancer was on his tonsil and base of tongue (BOT) which is the bit down the throat.

The difficulty with PETs is that it is not specific to cancer and also picks up the healing process, scarring and infection. Obviously,this is all going on soon after radiation. The idea of doing the PET at 12 weeks is to allow time for the healing process to settle down so the doctors can determine what is going on with the tumour.

It might help if you could give us more information about your friends condition: where was the cancer, how big was it, did the cancer travel to the lymph nodes, what was the last day of radiation?

Will you or someone close be going to the appointment with your friend? That would be a very good thing to do if you can manage it.

Good luck
Karen

He finished 3/20/12

Its not the usual procedure for a PET to be done so closely with the end of radiation. Being post rads for 2 weeks is not enough time for any swelling to subside. Dont be surprised to see it come back positive. Is your friend being treated at a cancer center?

Sorry I thought that information was in my profile. His cancer was BOT Stage IV with lymph node on one side - those were removed.

Hi,
I had Stage IV tongue cancer as well, with surgery, radiation, and chemo over a 3 month period. I finished all of my treatments in August of 2009, and had my follow up PET scan in November of that year. Yes. Your friend's PET scan seems a bit soon.

His chemotherapy treatments were done at a cancer center at a regional hospital that uses/works with Sloan Kettering. His IMRT treatments were done at another hospital that works with the University of Michigan. Both his chemotherapy doctor and his RO worked together on his treatment.

There is a big difference with a hospital being associated with Sloan/Kettering and being treated at a major cancer center. A cancer center is one location which meets government criteria and where a team of specialists all work together as a team. They will meet weekly and discuss each patient's case working together to develop and implement a successful treatment plan. Bottom line is cancer centers offer the very best chance for a successful outcome.

Since your friend did not get treated at a cancer center it does NOT mean that he is not in good hands. Just that cancer centers treat hundreds of similar patients on a regular basis and have a proven track record of providing the best treatment outcome.

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This is very early for a PET, and makes me wonder what the doctors are thinking.

Make sure that they are prepared for the area of treatment to really light up, it is no doubt still in repair mode and the inflammation there is going to make the scan worthless in that area. However, if there was suspicion on the doctors part that there was an opportunity to this to have metastasized to a more remote area than the neck, then a PET which looks at everything from the top of your head to your groin would show activity in any other vital organ. Of course that begs the question; if you thought that this might be a possibility why didn't you check this out before beginning treatment? The treatment might have needed to be more definitive and involve different therapeutic agents and techniques to deal with the mets in addition to the primary.

Even in those more remote anatomical places, benign things other than cancer will cause a PET to light up the area, so residual issues related to chemo, as the liver and kidneys are still processing it etc. all could be collateral to his treatments and not disease. Even an infection in the patient's lungs will give you a false positive. So while I'm a big believer that PETs are highly useful, at this stage of the game you have to wonder - with what everyone knows about early PETs and false positives, why are they doing this.