Ok - I typically pride myself on being rather intelligent and self-sufficient, but search on this forum makes my head spin around like in the Exorcist . I have tried going through advanced and using quotes and +, etc. but it never fails I get 8 - 15 pages each time and they aren't about what I am looking for. Most recent example - I am looking for others who have had the radiation boost at the end. So tonight I tried searching for IMRT boost or radiation boost, then I tried it with quotes, then with the +. I don't get anywhere on a couple of the ways and the other ways I need another hour+ to read them all.

I think this may be why so many people re-ask the question(s) rather than utilize the search.

Anyway - maybe a brief education post in the FAQ section on searching would be helpful.

Or it could just be that I have Dan's chemo brain

Michelle:

Starting with about the last 10 radiation treatments the time was increased. When we got to the last 5 it was 45 minutes on the table. Starting out it was 20 minutes. All that for probably only a couple minutes of being zapped. Maybe it was a gradual build up but I didnt notice it til the last 2 weeks. Or maybe its cuz I was feeling the worst then and it was such a struggle to go for tx.

It's a tough subject to find and has never been properly defined. Here are some links"

http://www.ro-journal.com/content/1/1/40
http://linkinghub.elsevier.com/retrieve/pii/S0196070900202433

"Acceleration of Radiation Dose: Another strategy in the treatment of head and neck cancers is to administer radiation therapy at more frequent and intensive doses. Patients with cancer of the head and neck may benefit from higher doses of radiation therapy that are administered twice daily compared to standard therapy consisting of lower doses administered once a day. However the current standard therapy is to administer radiation only once a day.

One of the largest clinical trials of the past 2 decades involving the treatment of head and neck cancer showed that the risk of a local cancer recurrence may be reduced in patients with locally advanced head and neck cancer by using increased frequency and doses of radiation therapy. In this study, over 1,000 patients with locally advanced head and neck cancer received radiation therapy either once daily or twice daily. Higher doses of radiation were delivered to the group of patients receiving treatment twice daily, whereas standard doses of radiation were delivered to the group of patients receiving treatment once daily. Two years following treatment, 56% of patients receiving radiation treatment twice daily were free of cancer recurrence, compared with 46% of patients who received radiation once daily.

(please note some in many cases the radiation dose frequency is simply done by adding a few more days and /or increasing the daily fractionalized dose rate higher then 1.8 Gy - my comments)

Research indicates that accelerated boost radiation therapy can also be effective in elderly patients with cancer of the head and neck who are healthy enough to tolerate this more aggressive treatment. In one study, accelerated boost radiation therapy was administered to 45 patients, age 70 or older, with cancer of the mouth, throat, or larynx. The results were compared to a similar group of patients who were younger than 70 years of age. Among the older patients, 68% lived 3 years or longer after treatment, compared to 62% for the younger patients. The local cancer was controlled in 73% of the older patients and 68% of the younger patients."

Full link:
http://patient.cancerconsultants.com/CancerTreatment_Head_and_Neck_Cancer.aspx?LinkId=53927

Another link:
http://www.medscape.com/viewarticle/518831

The last link has some interesting onformation on Amofostine as well.

Please note that some of these links are a few years old.

There is no substitute for going to a Comprehensive Cancer Center.

This whole subject will make your head spin!

Michelle,

Not sure I know what you mean by boost? Most of us that got the rad, got close to or the max amount of rad which I was told is about 70 Gy. Now as Gary points out some CCC's are trying different ways to reach that max by doing twice dailys the whole time or the last few weeks or only on Fridays or even cutting the delivery weeks in half. At Moffitt, almost 2 years ago (yeah), I just got a pretty much even dose each day but the last few weeks they spent all of the rad time on the 2 most potential areas. When I taught the class with Dr Trotti (my RO)a few months ago at Moffitt I know he spent a while telling the med students that they were beginning to use different accelerated radiation methods on H & N patients.

Thanks for all that effort Gary - I'm going to have to take a minute and absorb all that in.

David - my use of the word "boost" means that the last 10 treatments Dan will receive are to be targeted directly at the tumor area and not in the broad area he has been having. Does that make sense?

I'm just worried if he is getting 1.8 per day and it's being spread around a large field - if he gets that in a small field does that mean much more intensity to that area?

My curiousness is related to a)does this different way help with success and b)does this mean his burns are going to get that much worse in that area?

Oh - our MO said Amifostine wouldn't be used in our case because it is primarily used to protect salivary glands and we're trying to "kill" the salivary gland because that's where Dan's cancer is. He said there are no studies that show how it works with salivary gland patients so he didn't want to try it.

IMRT is never spread around a large area - it is always specifically targeted. at midpoint they will often take a CT and make adjustments to the treatment plan programming. They will also target known areas of interest, nodes, other tonsil (AKA bilateral radiation - if applicable of course), etc. In Dan's case they will hit the area without the clear margins for sure. We don't see much adenocarcinoma around here, mostly SCC and a very few melanoma cases so your RO is still the best person to ask.

It's all a little mysterious honestly. My tumor had completely vanished at the 3 week point and they radiated me for the full time anyway.

I guess what I mean by a large field is his whole neck and right side. Whereas if I understand the last treatments will be even more focused.

It is mysterious!!! I've got it on my list to ask the RO tomorrow.

Robin had conventional (radiotherapy) not IMRT and for the first 5 weeks he had both sides of his neck/mouth targeted,and th floor of his mouth/throat.At the end of week five he was recalibrated,had anothe simulator session and a new mask as he had lost so much weight,and then started a round of punishing booster sessions which were accompanied by some sort of electrodes attached as well.Theses sessions lasted for much longer (15 mins instead of 6 mins),and they absolutely floored him,which wasn't that hard as the first 20 sesions pretty well burned him to a crisp and fried the inside of his mouth as well.

My understanding was that they pinpointed the actual tumour sites and concentrated the treatment for a short while,rather than just zapping the whole area.

it was tough but like everything else sweetie you will get through it

love liz

Thanks Liz!! I know you've been keepin a low-profile lately and you have been in my daily thoughts. Thank you for taking a few minutes to send me some info and encouragement.

Michelle,

As I said or at least attempted to, my rad Tx plan called for targeting 5 areas at first and by the last 2 weeks the beam was only directed at 2 spots, those being the BOT where my primary was fond and the left side of my neck where I had at least 2 positive nodes. By your definition I guess that's a boost.

Michele

Everyone's case is different, but when they "boosted" my IMRT (to get me up to 7200 GY max), the damage to my neck and face skin also increased. So monitor that (I ended up using Vigilon a skin/gel dressing for burns twice a day) But it did the trick and I did not need a neck dissection even though two lymph nodes had shown up as infected in the diagnostic CAT and PET scans. The MRI two months after treatment showed all clean. Next PET is Mid May.
Good Luck
Tom