Thanks Cathy. I am putting together the "up to now" part of my blog, "The Road to Remission", and hopefully can get it started this weekend. A very good friend, who is a photographer, took one of his pictures of a curve in a road, and photoshopped a road sign into it with the curve and Remission below it. I wish we had the ability to upload pictures, it is fantastic!

Congradulations Bill on making your decision...

So far, I think that is one of the hardest parts.

(Of course, I haven't had the Chemoradiation yet:)

Be strong. And keep you inquisitive nature, it just may be the thing that makes the difference.

- Michael

To hell with "remission" - I'll take "complete response" (CR) thank you. This isn't leukemia or Hodgkins disease.

Same thing basically my doc said Bill so I got the max with XRT. Good luck tomorrow. I wish you the best. It will start out slow but when it ends you will wonder how the time went by so fast.

Blessings,
Barb~

Hi Bill, to give you further encouragement and support, I am the one who received XRT together with chemo to treat my T2N3M0 tonsil cancer 4 years ago.No surgery, no feeding tube. In fact I was never given the option of IMRT or was I even aware of its existence. I have always been an ignorant and obedient patient who seldom argued with doctors ( good or bad? it depends!)Dry mouth problem is really frustrating but is not intolerable.With a bottle of water around, I can go anywhere and eat anything. In fact I usually still have half of the bottle full when I return home.
So far, I have no regret that I was not an IMRT patient and as Brian said, not everyone is a suitable candidate. I have been in remission for 4 years and everything is back to normal, almost 100%.
Sorry, Gary, 'remission' is the term my oncologist used to describe my status and he refused to declare me fully recovered at this stage and I obediently accept his words.

Karen

All I will add to the discussion at this time is this is not what the ROs at Johns Hopkins told us -- they said properly planned IMRT was the best approach even for Stage IV HNC, which my husband has. In fact they are putting him on the tomo IMRT to better facilitate the radiation targeting and improve results. They do give what they term "prophylactic doses" outside the primary target areas to catch undetected cancer cells.

I will ask the radiation physicist Monday when we meet again to address the issue -- I am not sure if they even do conventional XRT (by which I assume everyone is speaking of 3-D conformal) any more for HNC.

Will report what he says....

Gail

I would be interested to hear if John Hopkins is not doing XRT radiation any longer, or conventional as it is sometimes called. That would seem like a huge step for any hopital to take. Are there any studies done yet showing the success of IMRT, long term?? It sounds like the choice of treatment if it shares the success rate of conventional.
Possibly IMRT is being paired up with conventional?? A weaker, less damaging dose, is being given to surrounding areas??
There has to be a reason why any doctor would say that IMRT can be used on any HNC, at least a doc at a top 50 place.
Any thoughts?

As I understand the technology IMRT is delivering the same amount of energy to the target. The issue is whether the target is everything or something less than everything. I read here (by non profesionals) what amounts to guesswork. None of us know what the specific maping layout is for any patient here. For us to question specific treatments is out of line. We are not trained on the myriad details of radiation therapy. IMO, There is no reason to believe that properly planned IMRT is less effective than XRT. I would love to have a RO speak here to resolve any questions we have.

Also I do not believe XRT is the same as 3D conformal.

3D conformal is an earlier version of IMRT. It can definitely be used in a prophylatic sense as well. Most of us have had bilateral irradiation as well as lymph node targeting, etc. It's been said many times here that one must be a candidate for IMRT and meet certain diagnostic criteria. A lot of the treatment programming IS educated guesswork - that is why it is best to be treated at a comprehensive cancer center. IMRT is a standard of care now. In over 10 years of usage it have proven itself efficacious and almost all of the RO treatment centers have retrofitted or purchased new machines with it (the life span of the typical LINAC is about 5 years).


XRT is not going away - for certain types of tumors and conditions it will remain the treatment of choice. IMRT machines can be readily converted back to XRT by unsnapping the multi-leaf collimator (MLC). In fact when you get the weekly x-ray, they take off the MLC. There is virtually no difference in the ionizing radiation source between the two, only in the targeting methodology.

Interestingly, Proton Beam Therapy (PBT) is SO accurate that they use it in conjunction with IMRT for the marginal areas. I have never heard of a multimodality treatment with both XRT and IMRT.

As I said, I will ask our rad physicist (who is the person responsible for bringing the tomo therapy IMRT to Hopkins) about these issues and post what he says. At the least, it will be interesting to hear his perspective from the technical side.

Btw, I also had heard (as Gary said) that IMRT can be used to deliver more conventional radiotherapy by modifying the delivery system. Remember until a month ago my perspective has only been from the prostate cancer end (I am a SPORE advocate for Hopkins' PC program) and not fro m HNC side.

Gail