We were very happy 3 months ago, when my brother was discharged from a cancer hospital with very favorable prognosis. Despite huge weight loss, eating and swallowing difficulty, he dared joined his work back.

But, a couple week ago, we had a major setback. he had terrible headache. they did CT nothing in there so they assumed neuralgia and rxed Lyrica and some other pain meds. a few days after that, he developed left eye ptosis. We consulted a neurophysicain. He ordered MRI.

Findings of the MRI are devastating. it says that they see a lesion on exterior wall of nasopharyngeal wall extending to few more places also edema around optic nerve (likely metastatic). we asked for Biopsy but his current drs are adamant that it is not possible. they have advised 10 days RT. Should we approach other Dr.?

Im very sorry to hear about your brothers possible recurrence.

It is always a good idea to have a second opinion. Recurrences can be fast moving so do not let any time waste before getting this taken care of.

Good luck!!!

Cancer can only be confirmed by biopsy. None of the diagnostic tests are 100% accurate, except FNAB, which is very close. They are probably right, based on CT, MRI, experience, but I would like to get a 2nd opinion, if I could, to proceed further. Why can't they do a biopsy, under anesthesia, on the nasopharyngeal wall? 10 days radiation? Type of radiation? Surgery? Alternative treatment? It takes over 50Grays to kill SCC, certain areas lower due to max toxicity levels, previous radiation, and the optic nerve probably has a lower toxicity level, maybe nasopharyngeal wall also. Sometimes for reiirdation in certain area they do a flap. No chemo planned as a radio sensitizer? This is really the best shot for a cure now to avoid another rcurrence. My last recurrence, my 5th, my consulting RO said 50Gy IMRT would not work, so I left my treatment center, had a different treatment at his institution.

Good luck with everything.

Thank you Christine and Paula for Prompt response.

Is it ok, to do RT without CT in recurrence? I spoke to an Oncologist here, and he said Erbitux for lifetime is your best shot to prevent future recurrence.

thanks

Erbitux can be given long term. I know they give this for palliative care too. and my local onvologist suggested putting me on long term Erbitux, due to my recurrences, but never happened since she was not my treatment doctor. Tarceva, also called Eroltinib, is used as chemo prevention too..Dr Dong Moon Shin, from Emory University, did some studies with this for chemo prevention with Tarceva and a Cox-2 Inhibitor. Are they seeking a cure with treatment.

http://clincancerres.aacrjournals.org/content/early/2013/02/12/1078-0432.CCR-12-3149.abstract

I think your question is can they do radiation without chemo? Yes they can, I did, due to my condition, but chemo can improve radiation by 5-20 or 30 percent, depending on chemo. I forget what Erbitux is. Dr James A Bonner, an expert with Erbitux, also called Cetuximad, did a study or several, if you look him up. If I find, I'll attach.

http://www.docguide.com/adding-erbi...ents-head-and-neck-cancer-presented-asco

I had Erbitux my last recurrence, along with Taxotere. I read a report from MSKCC, adding Cisplatin was disappointing, plus I could not have it due to my kidneys, maybe carboplatin instead said one doctor. The biggest side effect is the rash, can be managed by antibiotics.

Time is always of the essence if you are facing a recurrence but how do you know it's a recurrence if they haven't biopsied? admittedly it if they are going in to biopsy it would make sense that they go in with the intent of taking it all, but they are radiating a sensitive area without confirmation it is a cancer. I am sure they are experienced but that's a tad scary. I wouldn't do anything that would slow the process, but do look into it further to make sure they are experienced at this. Take care and best of luck... you are at a CCC right?

Thank you Cheryl and Paula.

We went to another Cancer hospital today and they opined that surgery or biopsy is not possible because of location of the tumor. MRI findings are: "an intensely enhancing ill-defined lesion involving left lateral wall of nasopharynx with involvement of left parasellar and cavernous region extending to orbital apex through orbital fissure with subtle bony erosion, edematous left optic nerve sheath near apex and adjacent extra-ocular muscle with left retro-orbital fat haziness. in given clinical settings possibility of metastasis appears most likely."

They would start Radiation from Friday. No chemo yet. I am flying back home to be with him. Prayers please.

Hey Cheryl,

Is CCC a hospital? if yes, then we are not at CCC but at HCG cancer hospital in Ahmedabad, India.

Thanks,

[quote=pmb]Is CCC a hospital? [/quote]
CCC is an abbreviation for "comprehensive cancer center," meaning a medical facility where a cancer patient's case is considered from the outset by a team of specialists representing different areas (surgery, chemo, radiation and other specialties depending on the type of cancer) -- taking a "comprehensive" approach to treatment, as opposed to the patient having to find a surgeon, a chemo doc, a radiation doc etc. on his/her own and then hope that they talk to each other.

HCG is a CCC in Ahmedabad - Private institute but has some decent reputation.

All the best for treatment, RT is going to be terrible! Erbitux is an option but it will be an expensive one in India. Rather than RT, Proton Beam Therapy may be more effective in this setting, discuss with oncologist and locate a center (I do not think we have one in India yet) where your brother can have it done.