Hi Michael,
I don't think any of us on here are so sensitive that it hurts our feelings to have questions asked concerning one treatment VS another type of treatment. I think that most XRT recipients are just making sure that the poster realizes that some cancers HAVE to be treated with XRT, they don't have the option for IMRT. I didn't have IMRT, I had XRT as I had lymphnode involvement and my doctors wanted to cover all areas.
I also think everyone should push for IMRT if possible, but if it comes down to the fact that XRT is the only option it would be a shame for them to have a negative opinion of it. Plenty posters on here had XRT and are doing great. Of course we would like to have less side effects, but we're also very happy that it's been a few years after treatment and we are still cancer free! That's the important part.
Just wanted to make sure that all understand that no one is trying to say XRT is "better" or being protective of it. Some are just making sure that the idea isn't given that everyone CAN have IMRT. It's just not that simple.
Take care,
Minnie

I don't understand why lymph node involvement per se should preclude IMRT -- in fact it shouldn't really matter, the IMRT treatment should cover all the cancerous areas if it were planned correctly. IMRT just allows better targeting and avoidance of non-target tissues. It is replacing conventional XRT at most centers and hospitals, in fact, all our larger local hospitals here in Montgomery Co. MD use IMRT for prostate cancer and I would expect, for other cancers where important non-target organs or tissues lie close to the cancerous area (like HNC).

Barry has stage IV SCC (right tonsil --removed w/ some residual at base of tongue and two lymph nodes) and he is not only getting IMRT, he is getting tomotherapy IMRT at Hopkins because they want to avoid radiating his inner ears (he has some hearing loss) and want to maximize parotid gland sparing, which is easier to do with the more precise targeting of the tomo machine.

As everyone knows, the bottom line of treatment is the final outcome, and of that, the major issue is being cancer-free, but quality of life is also a vital concern. Cancer treatments are moving both to improve the first and the second, although there is still along way to go...

Gail

I had the same recollection as Minnie about Brian's post from awhile back on this topic. I think I found it -- under a thread topic "Really Scared" (the post is dated February 15, 2004).

Cathy

This is the post I was trying to explain from Brian. He, of course, says it much better then I do. My only desire is to keep it in the open that IMRT is not for everyone.

Brian Hill
OCF Founder
Member # 4

posted February 15, 2004 03:26 PM
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February 15, 2004 11:26 AM
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I wanted to weigh in on this one because it is such a great technology, but it is not for everyone. If you do a search here on the boards for IMRT you will see similar comments in the past. As great as it is, and as much reduction in after affects that it yields, IMRT isn't for everyone, especially late stage threes ands fours. Even if I had had the opportunity for IMRT 5 years ago, (which I did not) I would not have chosen it because with extensive bilateral neck mets, who know for sure how many occult small cancers cells were in the surrounding tissues, (muscle, fatty, and others) that would have come back to bite me a year later. It works best in areas where the typical cancers are very confined, brain cancers for instance, and as Gary mentioned prostate cancer. These cancers require precious pinpoint accuracy and are usually well defined. They do not typically spread out into the surrounding tissues and become diffused in those tissues like most oral cancers do. So while I am the biggest proponent for this technology in early oral cancers, and in sweeping the areas of known mets even if nothing appears there on MRI's, or CT's, this cancer can end up in the osseous (boney) tissues of your mouth, your spine, and numerous other regional areas in it's early metastasis that are not always obvious to scanning and diagnostic technologies that we use. So primary

Brian-
Thanks for your post. That was very informative and easy to understand. I am fairly new at being in this forum since my Mom was just diagnosed at the end of June. I spend endless hours trying to research this horrible disease and learn anything that I can to possibly help her. I had a few questions for you:

Is the IMRT the 3-D version of the Rad? And what do you mean by Cervical mets?

My Mom's ENT diagnosed the SCC tumor on the base of her tounge (left side) and the size was 2cm. This was after a surgical scope and biopsy. The CT scan led them to believe that it was stage one. After a PET Scan they found it in one node on the left side and a very small 2nd tumor on the right side of tonge base. She is getting 3d rad (4 weeks 1x day, 2 weeks 2x a day + 6 treatments of chemo/ docetaxel, ciplatin, and flurocil 5) This was all done without a 2nd opinion. I just find myself wondering every waking minute if this is the right treatment for my Mom. Especially after the 1st chemo run obliterated her and they now have post poned the rest of the chemo treatments for now. Any insight would be greatly appreciated.
Tami

Tami I would be best for you to start a new topic by clicking on the button "new topic" at the bottom of the page. Your questions won't get mixed up and lost in someone elses' post.

Cervical Mets refer to cancer-containing lymph nodes of the neck. In latin cervix means neck (and in females the cervix is locted in a neck like part of the uterus.) mets is short for metastatic (or cancer spread)

more on the cervical nodes can be found here: http://www.emedicine.com/ent/topic306.htm and here: http://anatomy.uams.edu/anatomyhtml/lymph_head&neck.html

3d Conformal or 3D radiation is not quite the same as IMRT although IMRT is a 3D process. Both types are computer "guided" but IMRT is more complex. Which type your mother receives is partly what is available and partly what will do the best job for her.

thanks Mark
Tami

Well, a new day brings with it a new plan. One that I can live with and I am comfortable with, even if not what I had preferred.

I called my RO's office today and left word for him that my preference was to have IMRT. I also inquired as to whether or not he planned to do a PET scan.

About an hour later he called and we spent about 45 minutes on the phone. The PET scan is scheduled for Friday morning. That was the easy part. We then began discussing my preference for IMRT. He reiterated that he would do whichever treatment I wanted, however my choice was not his preference. In the end, I deferred to his expertise and will be having XRT.

My initial decision was made without taking a most important possability into consideration and was flawed. When asked why I preferred the IMRT I told him that from what I had read that I stood as good a chance of having the tumor eradicated with it and that it would also, in my mind, give me a better chance of not losing all of my salivary glands. In and by itself this was a basically correct impression. However, I left out one real important consideration.

My MRI did not show any spread anywhere. The PET scan has yet to be done, and in my uneducated mind I thought that it would only be looking for renegade cells elsewhere in my body. I also did not realize that even the PET scan will not pick up anything should there be a microscopic cell lurking somewhere.

He asked me what I wanted out of the treatment. I told him I wanted my best shot, with the tumor gone and with the IMRT treatment a better chance that at least some of the salivary glands intact. This would then give me a better chance at a better quality of life after treatment.

Dr. G told me that he wanted me cancer free, and to have a better chance to live, even if that meant a slightly lower quality of life due to the dry mouth problem. He told me that in many cases drugs can be used to help with that problem. He also told me that there could well be some microscopic cells in the vicinity, unseen by even the PET scan that would still be there after the IMRT treatment, but not there if XRT were done. With that additional piece of the puzzle put in place there was no more indecision. I'll send him a Christmas card in 2010 and thank him for explaining that to me.

Hi Bill,
I u know this was a difficult decision for you and I'm glad you're comfortable with the decision even though you were hoping for a different outcome.
Dry mouth is no fun, I won't even try to gloss it over. I am two years out and now it doesn't seem so bad, I feel like my saliva is better then it was 6 months ago. I was lucky that one salivary gland on my noncancerous side was spared. Be sure to ask your doctor if that is a possibility for you.
I can eat anything I want to, but choose not to eat some things as it requires to much work. The things I have given up that I used to LOVE is potatoe chips, just to much work BUT alot of that is due to the fact that I am still having many problems with my teeth and do not have a good chewing surface. I suspect that when I get my implants, I will be back to eating my chips. I eat bread alot, and I still make sandwhiches. I eat any type of meat but prefer steak with cheese on it. Pasta is great. As I said, I eat everything and with some of it just take an extra drink in the middle. I do not have huge issues swallowing, although I have noticed a tiny, tiny difference in my swallowing lately when compared to a year ago.
I wish you well with treatment and keep hold of the thought that it will pass and you will survive it and survive it WELL and cancer free.
Minnie

Bill,

I'm glad you were able to get a more complete explanation from your RO than what you apparently got in your previous discussion with him. Going into something as daunting as cancer treatment, it's really important to understand the "why" of what your doctors are recommending. There were times after my surgery when I was hearing from my medical team that I needed to go ahead with radiation, and at first I didn't see the reason for ANY radiation because the surgery came out with clean margins and no lymph node involvement. It was my doctors' concern about those microscopic, undetectable cancer cells that caused them to argue so strenuously for the aggressive approach they had mapped out.

I hope all goes well for you during your treatment and that it does the job getting rid of your cancer for good. Please keep us updated as you go along.

Cathy