Hello everyone,

It has been years since I posted here and unfortunately I am back. My mom had a recurrence last September that required surgery and another earlier this month. Earlier this month, a small lump appeared on the left side of her neck area and quickly grew into the size of a golf ball. This was on the opposite side of the original jaw reconstruction. Was operated on last Friday with removal of lymph nodes. Question is can she undergo more radiation/chemo considering she went through 30 and 5 sessions in 2008?

Nick, in some cases a patient can get radiation more than once. Ive seen several OC patients go thru it twice. I personally know of 5 patients who have done it 3 times. This all comes down to a case by case basis. So many variables makes it difficult to predict if someone would be a candidate to get rads again, or even for a third time. Im sure size and location of the tumor would play key roles in determining if it was a possibility. Chemo doesnt have the same limitations as rads. But, I would think the type of chemo should get changed if it didnt work as expected with a previous round of OC. By itself chemo is used alone in patients who are terminal to extend their lifespan.

I suggest getting a second opinion at one of the top CCCs.

It is as Christine stated.

I'm in that "terminal" group because I had have 5 distant outbreaks of tumors; 4 sets in my liver, and one lymph node midway between the bottom of the liver and the stomach. Last Monday, I got my final radiation treatment to that node.

But about that "terminal" bit; let's get real here for a moment. Every living thing is born with an inevitably terminal condition called "Life." No one has survived it yet. Every treatment we have available only extends the time we have to walk this planet, that we would otherwise not have without the treatment. That is no guarantee that we won't be in a fatal car crash when we leave the treatment facility.

So relax. Enjoy this moment, it is truly all we are assured of; don't waste it in worry about things we can't do anything about.

I went to the gym today, but I lost 8 lbs during the past three weeks due to nausea limiting my ability to ingest (and maintain) sufficient calories. That was all muscle, so after having to quit the stair-master at the 22 min mark (instead of my goal of 30 min), I called it a day and will go again Wednesday.

You may be interested to know that there is another method of radiation treatment; it is snaking a tube up through the femoral artery (enter at the groin) and into the liver. Once there, branch arteries to other organs are blocked off and the two lobes of the liver are filled with SIRIspheres, small plastic beads (1/3 the diameter of the human hair), each with a tiny hunk of Yttrium-90 (an active Beta-particle emitter) and left in place permanently.

I had that done last November, it successfully knocked down the two sets of tumors that were active in my liver (recurrences #3 and #4) at the time. We discovered the active lymph node when we discovered that the Xeloda was no longer effective and made the decision to go the SIRIspheres route, but we let it (the lymph node) ride until the SIRIspheres were in place and had some time to "cool down." (Yttrium-90 has a short half-life.)

Six weeks or so later, we attacked the node with the focused-beam radiation - which I had 8 weeks of when I was initially treated, back in late ;09 - and found that the node had grown from 0.2 cm to 4 cm in the interim.

My MO thinks that since that growth was the only change in that time (as opposed to more of them showing "hot,") there's a good chance that I could be free of new mets for as much as a year now (my longest period since the first recurrence has been the 90 day wait after the end of treatment PET.

So, yes, even though you've had your "lifetime" radiation allowance, you can easily have more.

Yes, it can be done in certain cases, and is being done more often these days. Like Bart, we probably had more recurrences, more radiation than most here...I had 7 recurrences, 5 neck dissections same side, 5 different radiation treatments, over 192Gy, with three different types, IMRT, HD-IORT and Proton Therapy, and three chemo treatments with 5 different chemo's.

There is really no legal limit to the amount of radiation that can be given, morally or ethically, yes. Although there are limits on the amount of radiation exposure to workers. As mentioned, other factors come to play if radiation can or cannot be done again, and also depends on the time between radiation, the toxicity level to the structure or nearby structures, if part of an area was radiated as opposed to the whole area, the fractions, type of radiation, etc. Somewhere I read the lifetime BID is 137Gy, but haven't been able to re-confirm this or find out what BID means. Radiation is very complex, that's why it takes 2-3 weeks to come up with a radiation plan.

They removed my carotid artery last October, due to cancer involvement, and so I can get more radiation, 10Gy HD-IORT during surgery, which is really 3 times that amount in IMRT, and then 50Gy Proton therapy. To kill HNSCCC the amount usually has to be above 50Gy, really more, otherwise it won't work.

Reirridation tends to be more specific, so they may be able to squeeze in more. I just finished Proton Therapy, and seen patients in thier 80's. Chemo or targeted therapy can be given again, depending on other physical conditions, blood work, kidey, liver function, but they tend to change them since you can become resistant to the ones given, plus if it is a recurrence, apparently didn't work well.

I hope this helps, and good luck.

You've heard from the most knowledgeable who've lived through multiple recurrences. The answer is yes. Particularly in your mother's case as it's on a different side. Chances are it was in the radiation spray radius, but not directly in the line of fire.

best of luck

You are the living proof that multiple rads can be survivable and effective. As you say, radiation is very complex but in general it seems the broader and harsh therapies such as high dose systemic chemo and rads to broader areas are much more difficult to engage on recurrent tumors.

Proton is very targeted so it seems like it can be used more extensively in repeat situations.

Just speculation of course.

I haven't asked about reirridation with Proton Therapy. Something I consideted, but I didn't want to ask the doctors right now, and probably difficult to answer without any calculations, and other than that, I would assume yes, if it's not the same area as before. The types of chemo's, trials are limited for me due to my kidney and other issues, so yes, after a harsh treatment like Induction chemo, if it effects the organs, it may effect future chemo treatments. I was denied chemo three times, radiation twice in the past, but things change with change of health, different doctors, hospitals with thier experience, different techniques, and new technology.

One of my RO's said I'm probably one of a handfull of patients in the country that had HD-IORT and Proton Radiation as a course of treatment.