I think maybe we had this conversation before, Glenn, but even if we did it seems worth saying that the research that shows chemo adds 10-15% effectiveness to radiation adds 10-15% more to local/regional control. That same research also shows no effect of that particular chemo (concurrent cisplatin) on the likelihood of metastatic cancer. So even if you had the chemo, Glenn, it may not have been effective in the way you would have liked. I just say this to try to keep the picture of the advantages of chemo a little more balanced--and also because it is still not receommended protocol for treatment for many early stage oral cancers.

I'm doing research right now (or trying to) on the potential benefits of chemo to IMRT that I'll begin in February. At this point there are no plans for chemo since there is no protocol for it with the adenocarcinoma (not same for squamous?) of the minor salivary gland that I have. Anyone with good info on this could help me or at least steer me to it! Mine is considered "low-grade" still even after this third bout since it is still localized. The theory told to us is that benefits are uncertain due to the localization (non-distant mets) of all three incidents and as Nelie said "early stage" consideration.

Ruth.... It is difficult for someone to find your NEW topic of discussion if it is attached to the end of someone else's topic on a different subject. Would you please copy and past it into a new topic so that you wil not get lost in the shuffle? After you have done that, I will delete it off the end of this thread.

Dear friends,

Thanks again for all the helpful/constructive comments. On the 6th I'll be seeing Arnold Markoe, chair of the department of radiation oncology at the University of Miami and presumably one of the best radiation oncologists in South Florida. Luckily, he also works at the Sylvester Cancer Center--a CCC. So, he is in close contact with many other doctors. Your posts have equipped me with many questions that I plan to ask him.

My first question will be about the prospect of including chemotherapy as part of my treatment. I will keep you guys posted.

regards,
Gino

Nelie,
what you are saying is the same thing. "Local/regional" odds improvement is the same as the benefit for a chemo adjunct to radiation (in others words - not in addition to). I have not seen any studies to indicate that chemo by itself has any benefit for local and regional controls for head & neck cancer. I have read that Cisplatin, combined with radiation at three week intervals will improve survival odds by as much as about 15%. I don't know what the numbers are for Carboplatin, a slightly less toxic relative of Cisplatin.

Glenn is speaking of an entirely different aspect which is one of distant metastesis. One of the sinister aspects of SCC is that the tumor sends out thousands of cancer cells daily into the blood stream so there is a possibility of new primary tumors occuring in distant locations such as the brain, kidneys, esophogus, liver and/or lungs. This is why many argue for regular PET/CT's, not so much for screening for H&N recurrence but the distant metastesis issue. Your H&N team typically will not order such a PET/CT as it isn't that useful for H&N screening post Tx because of the propensity for false positives. It is a true medical paradox.

The cancer cells will typically "stick" in places where transitions with the blood are happening, like the aforementioned organs. A healthy immune system can take out these rogue cells as well, so it is hardly an automatic thing to have a distant metastesis. The long term survivors here will testify to that.

Ruth, studies have already been done about the efficacy of using a chemotherapy adjunct (soecifically Cisplatin or Platinol) to radiation. I do not know whether it is cancer specific but I would hazard a guess that it is not. Cisplatin is an alkylating agent that enhances the oxygenation of the tissues and increases the efficacy of the radiation.

Thanks for the answer Glenn. I wish you had been given Chemo also. I didn't have any in 2003 and it keeps me a little nervous. Did it take long for your distant metastasis to show itself?

Gino rad therapy was the hardest thing I have ever been through but take every chance you have to beat this, no pain as they say!!
You may have side effects later that you don't expect or understand but ask away to as many people as you can it affects us all in different ways and someone here will have been there

good luck
take care
peter

Gary, Right, I'm aware that local regional IS the 15% benefit. What I was saying (or trying to anyway) is the same thing you just said--that distant metastasis is something different and I'm pretty sure those two huge clinical trials that showed the benefits of concurrent chemo found it did NOT have an effect on distant metastasis (although I don't have the articles in front of me).

Nelie

Thanks for the response, Peter. Based on everything I've read (including some of the comments that were posted here), I'm bracing myself for what might be an excruciating experience. I just hope it ends up being a lot better than what I'm anticipating.

You know, I don't think I've ever felt this close to a group of total strangers. It's
certainly empowering to be in touch with people who are fighting the same battle.

regards,
Gino

Gary and Nelie,

Let me make sure I've understood this. Chemo adds 15 percent to the effectiveness of radiation at the local/regional level. However, the rad/chemo combination doesn't do much in terms of decreasing the possibility of distant metastasis?

Gino