#78188 08-06-2008 07:11 AM | Joined: Jun 2008 Posts: 309 Platinum Member (300+ posts) | OP  Platinum Member (300+ posts)
Joined: Jun 2008 Posts: 309 | Dr told me yesterday that his plan is surgery then radiation.
I am hopeful this would change if he gets clear margins, as he spoke of when I first met with him, but now he makes me wonder ...
but anyways ... Then I read the article someone on the forum list mentioned and it said about leaving radiation therapy as a future option for reoccurence and so I wonder if he uses that option now, is this a one time shot? Is his plan the normal one then?
Rita - Age 44
wife, mother of 4 - ages 3,16,21,24 & grandma to 1
(R upper) Maxillectomy 8/8/08 - UW / Seattle, WA.
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"Those who think by the inch and speak by the yard, should be kicked by the foot."
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Joined: Sep 2006 Posts: 8,311 | It used to be a one time shot because we were told we were getting our lifetime allotment of radiation and a second shot would do unrepairable damage to our blood vessels and basically we would bleed out. Lately I have read where doctors are radiating twice in some circumstances but you are jumping WAY ahead of yourself here.
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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Joined: Jun 2008 Posts: 309 | thanks david  i know i am jumping ahead of the game, i was just surprised that he went from a 'maybe' to a 'yes' on radiation before doing surgery and wondered whether or not to question his reasoning on it if it was a one time shot, so i am not left wondering why or left without recourse if needed later... mind you i am hoping this is a one time shot like they tell me it should be. (?)
Rita - Age 44
wife, mother of 4 - ages 3,16,21,24 & grandma to 1
(R upper) Maxillectomy 8/8/08 - UW / Seattle, WA.
===============================
"Those who think by the inch and speak by the yard, should be kicked by the foot."
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Joined: Mar 2002 Posts: 4,912 Likes: 52 | Radiation is accumulative in your body. Every bit you get adds up. Every bit of sunshine, dental x rays, CT scans, and of course the big gun, treatment, all adds to a total tolerable number before it begins to do damage of its own. We learned much about this from survivors of Hiroshima who developed various cancers later in life after their radiation exposure from "Little Boy" and those at Nagasaki who dealt with "Fat Man." At some point enough radiation will cause its own malignancies as it degrades the stability and mutates cellular DNA. Those of us that have had 72 grays are at risk, in about year 10, of osteosarcomas (bone cancer) in the mandible caused by the radiation exposure of the bone. The gift that keeps on giving......
Holding radiation is "reserve" is said too often for my own liking, especially now in the days of IMRT radiation, that delivers about half the dose that I got, with the same impact. Incomplete primary treatment, whether surgical oncologists like to admit it or not, is in the minds of many, a contributing factor to recurrences in about year 1.5 to 2.5 post treatment, when remaining non visible micro mets finally prosper in some area surrounding the original primary or in more remote areas far from the primary like the cervical nodes. Having said that, complete treatment without radiation as the safety net would be ideal because of the long term QOL issues with radiotherapy.
Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
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Joined: Sep 2006 Posts: 8,311 | Brian,
Funny you say that because I had IMRT and I was told I got 70 Grays so what does that mean?
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.
| | | | | Joined: Jun 2007 Posts: 10,507 Likes: 6 Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) | | Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 10,507 Likes: 6 | Thats what I was going to ask my rad. doc about next month. I also have a hard time understanding the radiation info. My concern is that I was a devoted sun worshiper for about 25 years. I tried to read several articles on the main pages but they were too technical for me to understand. Are there any articles on here that explain it very simply?
ChristineSCC 6/15/07 L chk & by L molar both Stag I, age44 2x cispltn-35 IMRT end 9/27/07 -65 lbs in 2 mo, no caregvr Clear PET 1/08 4/4/08 recur L chk Stag I surg 4/16/08 clr marg 215 HBO dives 3/09 teeth out, trismus 7/2/09 recur, Stg IV 8/24/09 trach, ND, mandiblctmy 3wks medicly inducd coma 2 mo xtended hospital stay, ICU & burn unit PICC line IV antibx 8 mo 10/4/10, 2/14/11 reconst surg OC 3x in 3 years very happy to be alive | | | | | Joined: May 2007 Posts: 666 "Above & Beyond" Member (500+ posts) | | "Above & Beyond" Member (500+ posts)
Joined: May 2007 Posts: 666 | David, you asked....
We have to distinguish between dose (radation/kg) and total amount of radiation
One Gray is the radiation energy absorbed per kilogram of matter. So this is a dose.
Assume your irradiated volume is 1 liter (about 1kg of tissue).
If you get 70 gray this means that you get a total of 70 Joules. Also with IMRT this should be delivered mainly to the tumor sparing surrounding structures (incl bones if possible)
In the old style radiation you also wanted to get around 70 gray max dose for your tumor tissue, however since the radiated volume could not be a neatly selected you ended up getting more radiation (still 70 gray but twice the amount of tissue in example 140 Joule)
If you get 70 gray total body exposure and if you are 75kg then you get a total amount of radiation of 5250 Joules. Even a 6-20 Gray whole body exposure (500-1500 Joules) can be fatal.
The other issue is localization, for example I would be very careful about exposure of the neck to excessive sunlight.
UV radiation also causes damage and this is on top of the damage caused (and hopefully mostly repaired) by the x-rays.
I would be less concerned about tanning your legs after H&N IMRT. Still, it is probably a good idea not to bake in the sun anyway. If you had cancer that means that your DNA repair system already screwed up once. Also, H&N IMRT should not be a problem for subsequent prostate RT (as an example)
Markus
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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Joined: Jun 2007 Posts: 10,507 Likes: 6 | Markus:
You must be a genius to understand that stuff. To me its still clear as mud. From my understanding, now I need to avoid the sun and use sunscreen. Having 25 summers of tanning should make for a higher number of grays. What about xrays? I just need to know how to ask my radiation doc next month, so I dont sound like a complete idiot. Thank you.
ChristineSCC 6/15/07 L chk & by L molar both Stag I, age44 2x cispltn-35 IMRT end 9/27/07 -65 lbs in 2 mo, no caregvr Clear PET 1/08 4/4/08 recur L chk Stag I surg 4/16/08 clr marg 215 HBO dives 3/09 teeth out, trismus 7/2/09 recur, Stg IV 8/24/09 trach, ND, mandiblctmy 3wks medicly inducd coma 2 mo xtended hospital stay, ICU & burn unit PICC line IV antibx 8 mo 10/4/10, 2/14/11 reconst surg OC 3x in 3 years very happy to be alive | | | | | Joined: Mar 2002 Posts: 4,912 Likes: 52 OCF Founder Patient Advocate (old timer, 2000 posts) | | OCF Founder Patient Advocate (old timer, 2000 posts)
Joined: Mar 2002 Posts: 4,912 Likes: 52 | Markus perhaps you should reveal to the others what your background is and what you do.
Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | Markus,
Thanks, that's exactly what I wanted.
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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