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#87514 01-07-2009 07:48 PM
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CherylR Offline OP
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Husband diagnosed 12/19/08 with SCC BOT T4N2cM0. Met with treatment team today. Treatment plan is radiation and chemo as soon as teeth extracted. We were told if we traveled to major city treatment would be 6 1/2 weeks, first 18 treatments once per day, after that treatments would be twice a day. they want to pursue aggressively. Alternative is to receive treatment in our hometown but likely the treatments would be 8 weeks with 1 treatment daily. Anyone know the pros or cons of this? Our initial reaction is to go to major city as it sounds like more aggressive treatment.


CG to H with SCC BOT T4N2cM0 dx 12/19/08, teeth removed pre-tx; Erbitux & RT-done 3/12/09, PEG 2/9/09-7/14/09; ND 6/16. Pet 6/12-no mets except lymph node in neck removed on 6/16. Chyle leak,2nd surg to repair. Dilate esophagus 4/15/10. Clear PET 12/17/10
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Cherly,

If possible get to a CCC (comprehensive cancer center), I'm not sure of the closest one to you. You probably should get a 2nd opinion there. There used to be a link from the main page that listed them.

Why are they extracting his teeth? Are they in bad shape? There are many here, including myself, that didn't have any extractions. We must be vigilant about our dental hygeine, but that is a small doable for me.

Are the radiation treatments IMRT? My treatments were 33 once a day treatments with the weekends off. There are several here who had a similar to schedule to what is planned for your husband. Chemo was once every 21 days. Many get chemo weekly, what is your husband's chemo schedule?

Hope this helps a little
tim

Last edited by Stoj; 01-07-2009 08:09 PM.

Tim Stoj
60 yr old. Dx Jun 06 with BOT Stage IV. Neck dissesction on 19 Jun 06. Started Tx on 21 Aug 06/completed 33 IMRTs and 3 CT (2 Cisplat & 1 Carboplat) on 5 Oct 06.
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This is called fractionated radiotherapy. It varies from place to place, but it is the standard. Actually just the once a day 5 days a week is a fractionated delivery in itself. Gary will hopefully post to this thread since he is the radiation expert around here.


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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Cheryl:

Welcome to OCF. Best place for treatments would be a CCC as Tim mentioned. I traveled 45 minutes each way for my treatments to go to a better center. Where would your husband receive the best care? Where are you both more comfortable with? Is either facility listed as a top cancer center? Are you able to travel for treatments? There is a list on the main OCF pages of the top hospitals.

As far as teeth go. There are some dentists on the forum who hopefully will be able to help answer questions about that. Personally, Ive suffered from not having my teeth all removed prior to treatments. Now Ive had to go thru alot and struggled with eating due to not having them removed first. If teeth are questionable, then its best to take care of it now before treatments and possible complications arise later.

Best of luck with your decisions.



Christine
SCC 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 smile
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CherylR Offline OP
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Thanks all for the fast replies. We won't know the full plan until next week. We are in east central Indiana - after reviewing the CCC's posted - we aren't close to any. Our option is treatment in our hometown of approximately 40,000 or to go to Indianapolis (1 1/2 hr. away - read more specialists/better hospitals) We'll make the drive. H's teeth are in bad shape. We weren't surprised that they need extraction first. Treatments will be 5 days on, 2 off. Don't know any more than that about the plan at this point except for the two treatments each day during last half of course of treatment. I just had never heard of two treatments in one day before. The big push seems to be that this has moved slowly right after diagnosis due to the holidays .


CG to H with SCC BOT T4N2cM0 dx 12/19/08, teeth removed pre-tx; Erbitux & RT-done 3/12/09, PEG 2/9/09-7/14/09; ND 6/16. Pet 6/12-no mets except lymph node in neck removed on 6/16. Chyle leak,2nd surg to repair. Dilate esophagus 4/15/10. Clear PET 12/17/10
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Obviously cancer is not to be taken lightly. But you would be surprised at the number of people that I talk to every week that are near major NCI comprehensive cancer centers (within 2 hour drive), and choose to go to some small regional hospital because it is closer to home. Letting geography dictate your treatment center is a huge mistake. This is something that, within your abilities to be seen by them, you want to be with the best of the best, in a multidisciplinary dedicated cancer center. Cancer usually only gives you one chance to beat it. Here is link to the top 50 cancer centers in the US. Link



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Brian is right, go to the best treatment facility and Drs you can. I drove 70 miles every day for 7 weeks, to go to a top 10 facility and almost went to Houston (1,000 miles). Would have gone anywhere to increse my odds for survival. Most people on this site went for second opinions. I did Rad once a day for 35 days (5 on/off 2).


Bill Van Horn-53 ex-smoker, social drinker, Biopsy 8/24, Diagnosed 8/30/07 BOT T2N2-B MX Stage IV. Started treatments 10/1/07. IMRT 35 x, Cisplatin - 3 cycles - completed treatment 11/16/07. CT Scans on 1/15/08 all clear Selective neck dissection 1/28/08. All nodes clear.
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Check out #34 on the list, it's in Indianapolis. I live in GA and traveled to TX. Wasn't easy, but as Brian said you mostly only get one shot...

Last edited by Stoj; 01-07-2009 09:08 PM.

Tim Stoj
60 yr old. Dx Jun 06 with BOT Stage IV. Neck dissesction on 19 Jun 06. Started Tx on 21 Aug 06/completed 33 IMRTs and 3 CT (2 Cisplat & 1 Carboplat) on 5 Oct 06.
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Cheryl,
Radiation is given in fractions for 2 reasons: 1. A total dose (like 70Gy), all at once, would be fatal and 2. to allow the bodys normal cells time to recover and repair themselves.

A typical presciption for RT (radiation therapy) would be somewhere in the neighborhood of 60-70 Gy for H&N cancer. This would be broken up into fractions of 1.8-2.0 Grays (Gy)/day. Some treatment protocols call for twice daily treatments. One in the morning and one in the afternoon would be typical. Combined they still would not exceed the maximum of 1.8-2.0 Gy. You can roughly calculate the number of days in treatment by dividing the total number of Gy by 2. It will not change the number of days whether you opt for daily full fraction or daily X2 1/2 fraction. The latest NCCN oncology practice guidelines recommend the twice a day plan for many H&N cancers. 2 treatments per day is becoming more common and it's efficacy has been proven. Others here have had twice daily treatments.

This is a primary treatment plan and if it were me, and I had a T4N2cM0 staging I would go to a CCC or NCI Cancer Center as others have suggested. You need to hit this with the best treatment and expertise you can, particularly with a coordinated medical team. Others here have forgone treatment at a CCC for the convenience of not having to travel and they died. Some CCC's can arrange housing for you. I traveled 60 miles a day to go to a CCC in horrific bay Area traffic (some of the worst in the US).

I am not trying to frighten you but this is an aggressive, ruthless cancer and you don't get many chances to combat it. Radiation Oncology is like any other specialty and some are better than others. H&N cancers are relatively rare, in the scheme of things, and that's why your odds will be substantially better at a CCC where they see a lot of H&N cases. I sometimes use the analogy would you bring your BMW to a Toyota dealership for service?

Incidentally, the extractions need to heal first before they will start treatment. It was almost 2 months from my original Dx to when I actually started treatment- and they fast tracked all of my labs and scans.


Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
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"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)
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CherylR Offline OP
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woo hoo! The hospital we are using IS #34 on the link Brian posted (ty Brian!) and thanks Gary for the scoop on the radiation. We, like so many others, are newbies at this and it is my nature to read everything I can get my hands on and question endlessly. Thanks again - you guys rock!


CG to H with SCC BOT T4N2cM0 dx 12/19/08, teeth removed pre-tx; Erbitux & RT-done 3/12/09, PEG 2/9/09-7/14/09; ND 6/16. Pet 6/12-no mets except lymph node in neck removed on 6/16. Chyle leak,2nd surg to repair. Dilate esophagus 4/15/10. Clear PET 12/17/10
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