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Chuck M Offline OP
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I am getting ready to start chemo and radiation and have an opportunity to check into Proton Beam. Does anyone know if this works on large areas? We are planning to heavy dose the tumors and wide range radiation to the whole neck area to hit the lymphatic system. Anyone have this type of treatment?


Diagnosed 9-30-08,Stage 4a scc, T2,N2b,M0 base of tongue, 2 lymph node tumors, 46 yo male. 4 tx Cisplatin, 35 tx IMRT 70gy total. Treatment ended 1-6-08
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The type of radiation you will most likely get and is now the standard is IMRT which stands for Intensity Modulated Radiation Therapy. This method allows a greater targeted area than IMPT (Proton Therapy) which is why it is deemed more suitable for H & N cancers where they want to make sure they kill as much, if not all, of the cancer present in your oral cavity. IMPT is more suitable for harder to reach cancers, like brain but one day may have applications for H & N patients. IMRT is better than it's predecessor, RT, in that it does less damage to your "good cells" and therefore leaves you with less side effects.

Have you been tested for HPV?

Are they discussing any surgery?

Were you a tobacco user?


David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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Chuck M Offline OP
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Yes, we are scheduled to start IMRT in a couple of weeks. I'm just trying to see if I can save the salivary glands by having the Proton Beam on the tumors and then the IMRT on the whole neck.
I have not been tested for HPV but my wife is positive. I was a smoker. Originally they were going to do surgery, but when my PET scan came back with base of tongue they said they no surgery.


Diagnosed 9-30-08,Stage 4a scc, T2,N2b,M0 base of tongue, 2 lymph node tumors, 46 yo male. 4 tx Cisplatin, 35 tx IMRT 70gy total. Treatment ended 1-6-08
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You do not necessarily destroy all your glands permanently with IMRT. What exactly gets nuked depends on radiation field and strength and the person. Although IMPT sounds great, if it delays the regular treatment for a long time it is not advisable. The other concern is how much data there is for such a complex combination treatment.
If you want to use IMRT on the whole neck you need a significant amount of radiation to get a desired effect, otherwise what was the point. In that case there will be radiation damage the severity again depending on the field/strength.

That said let us know what you are going to do and what your treatment plan is.

M


Partial glossectomy (25%) anterior tongue. 4/6/07/. IMRT start @5/24/07 (3x) Erbitux start/end@ 5/24/07. IMRT wider field (30x) start 6/5/07. Weekly cisplatin (2x30mg/m2), then weekly carbo- (5x180mg/m2). End of Tx 19 July 07.
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Loma Linda University Medical Center has a Proton Beam treatment center.

They indicated for Head and Neck they use Proton Beam in conjunction with IMRT.

http://www.protons.com/proton-therapy/conditions-treated/head-and-neck.html


Don
TXN2bM0 Stage IVa SCC-Occult Primary
FNA 6/6/08-SCC in node<2cm
PET/CT 6/19/08-SCC in 2nd node<1cm
HiRes CT 6/21/08
Exploratory,Tonsillectomy(benign),Right SND 6/23/08
PEG 7/3/08-11/6/08
35 TomoTherapy 7/16/08-9/04/08 No Chemo
Clear PET/CT 11/15/08, 5/15/09, 5/28/10, 7/8/11

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Be careful about using IMPT as there may be cancer cells "lurking" in or near the vicinity of the known tumors with emphasis on the word known and that is why IMRT is presently the standard for H & N as it will cover more area than the smart bomb type IMPT. Almost all of us in the last few years had IMRT and most of us have decent saliva post Tx. BTW, what good is saliva if you're not around to use it? The primary goal is to keep you alive.


David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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From what I read IMRT is the standard for H&N cancers. If they are using IPRT in conjunction with IMRT it must have something to do with hitting the tumor directly on. My RO basically told me the same thing that David said. My RO said a spot the size of a period can have millions of cancer cells present. A period!! . . . . . . . . <------Look! amazing.... I assume IPRT's are primarily used on tough to reach spots...maybe the prostate or the brain...I don't know. And I hope I don't ever have to find out..........

Last edited by Ray1971; 10-17-2008 08:05 AM.

7-16-08 age 37@Dx, T3N0M0 SCC 4.778cm tumor, left side of oral tongue, non smoker, casual drinker, I am the 4th in my family to have H&N cancer
8-13-08 left neck dissection and 40% of tongue removed, submandibular salivary gland & 14 nodes clean, no chemo, IMRTx35
11-4-08 Recovering & feeling better

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