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Weekly Cisplatin Vs Standard Therapy of Three Weekly Cisplatin in Concurrent Chemotherapy of Head and Neck Cancer:

http://apocpcontrol.com/paper_file/issue_abs/Volume12_No5/1185-88%20c%204.1%20Fatih%20Kose.pdf

In this study, weekly cisplatin has slightly more toxicities than the three weekly cisplatin, but weekly had better overall survival.

To add to the above posts, a baseline eye exam, kidney function, and if there is any pins and needle sensations in the hands or feet to tell the doctor, which may be a sign of neuropathy, which may not be reversable if not dealt with. They may lower the speed of infusion, lower the dose, and in some cases, eliminate a chemo.

Oral care is important. DF should have a dental oncologist on their team to check you teeth. Any in need of repair should be done before trestment. If any are in disrepair they need to be extracted at least several weeks prior to treatment for adequate healing. Brushing, and rinsing after each meal, before bed, flossing too, if it doesnt cut the gum. The stanadrad rince is warm salted water mixed with baking soda. I used that, Biotene dry mouth rinse, no alcohol & Magic Mouthwash. They say rinsing with Gulatamine powder is also good for repair of the mucosal lining in the mouth, digestive tract and stomach, for the neuropathy too, if swallowed. They sell them in health food store or vatamin shops.

The RO will give instructions for care of your neck, and mouth too. I was told to use Aquaphor on my neck daily, but not before having radiation treatment. I used Cetaphil another time, and liked that. Some RO's do hydration infusions, if needed, mine did, and did a power spray cleaning of the mouth with I believe was a saline solution, not sure.

As Christine mentioned, adequate hydration is important, and also helps eliminate the chemo from the body.

The speech and swallow therapist will give instructions, exercises to help maintain chewing, swallowing, and range of motion

The nutritionist will advise how many calories to eat to maintain weight, and adequate nutrition, hydration.

There is plenty of other things, but he will find out as he goes along, and can ask.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Sep 2006
Posts: 8,311
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Patient Advocate (old timer, 2000 posts)
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Paul,

Thanks for pointing out that study which I had not read but reading their study and their conclusion they state:

"In conclusion, alternate schedule with weekly cisplatin
during radiotherapy is as effective as three weekly
cisplatin with respect total Overall Survival (OS), locoregional/systemic relapse
rates. Last but not least, we were
not able to show that alternate regimen was less toxic than
standard regimen (standard = the 3 Big Bag Method). However, our study did not include
whole toxicity parameters which would be needed to reach
firm conclusion about treatment toxicity."

They explained which toxicities they were not able to study as follows:

"However, we did not use
any parameter that was accepted as �cumulative high dose�
cisplatin toxicity such as frequency of marked nausea and
vomiting, peripheral neuropathy, and hearing loss in both
groups and treatment cessation rate due to mentioned
toxicities. This was the weakness of current study."

To me those are critical toxicities which when added to the rest of the problems associated with cisplatin (the ones they did compare) really need to be compared to form a total toxicity comparison.

When I mentioned that those on this site seemed to have fared better with the weekly regimen I did so with the total toxicity in mind. JM2C's


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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Patient Advocate (old timer, 2000 posts)
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I thought you would like the study or rather anaylsis since it does come up frequently, which to do, and does shed some light on some aspects. Easy to loose tract here with the A's and B's, and noted several things that stood out to me, that weekly infusions may be as good, maybe not so good in certain aspects.

Myelosupression more common in goup B, while grade lll-IV mucocitis was higher in froup A, grade l-ll was higher in group B.

Probability of Overall Survival. One, two year, and three year probabilty of survival were A 75% and B 65%, A 63% B 56% in two years, an A 63% and B 53% in three years, respectfully.

During follow-up period, 11 and 5 patients experienced relapse of disease in goups A 11 and and B 5.

4 patients in group A expeienced systemtic relapse and 7 in Group B

But our study suggested weekly cisplatin was as effective but not less toxic regimen than high dose Cisplatin, and then goes on to say, however............

This does seems kind of flawed with a lot of howevers lol. I don't know about any other studes or comparisons off hand. Just from this, I don't know which one I would do. Flip a coin, more likley go with what my doctor says.

Next is Carboplatun vs. Cisplatin lol. I do have one if you want.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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[quote]Next is Carboplatun vs. Cisplatin lol. I do have one if you want.[/quote]Hi Paul,
Carbo vs Cisplatin efficacy trials/studies during concurrent CRT is something I still never did get a solid hit on. Kind of moot for me as my last chemo was last Tuesday and last radiation treatment is this coming Monday.

I'm still highly interested to know if anything was proven out showing weekly carbo was as effective as 3-bay Cisplatin as a radiosynthesizer.

don


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
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Besides Induction chemo, I don't think this old battle was ever finalized. You don't see many studies with H&N cancer. Seen others like lung, nasopharyngeal cancer, and did see one for solid tumors, which involves our cancer too.

Congratulations on completing. You're the man!


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Posts: 24
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Heading to Dana Farber to start Chemo and radiation in the morning. His pain is so so bad - even with constant morphine and codeine. HE can't/won't talk and can barely eat. We are actually looking forward to the feeding tube. He is so scared and I think the pain combined with the fear is creating a vicious cycle - feeding off each other. He is loaded with meditation tapes and advice. But he just walks around moaning all the time.

We are moving to Boston today - Dana Farber has a free place for people going through treatment. I will be staying in a hotel.

Anyway, thanks for your support and I will keep updating.


AWW, Brother of Dave, 60
Pre-canc 10 years ago
Biopsy Dentist 10/12
Stage 2 SCC 2.5cm
no action
5/13 to DanaFarber
Examined by Surgeon, MO, RO
PET, CAT
Stage T4, 4.5cm, no METs, or lymph nds
Started treatment 6/17 - RT 5x/wk, Csptn 1/wk, for 7 wks - will end 8/5
PEG since his first week.
Treatment ended 8/5
Scans scheduled for 10/30, with FU appointment 11/6
11/1 - Treatments didn;t work. Tumor continues to grow.
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Sending prayers and hugs your way wink


Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan
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Good luck with the radiation. Maybe they can increase the pain dosage or switch to another, everyone reacts differently to them. His symptoms don't sound that unusual. It's tough treatment to go through, and was like that myself my last round, and was by myself. All I can say is keep the doctors abreast, to treat what you can, since he is being hit all around by several means, and conditions, like the mucocitus by brushing the teeth after each meal, rinsing, flossing. Some like a water pic, treat bacterial, viral and fungal infections, like thrush, but can also be a combination of either, dry mouth. Adequate nutrition, hydration, sleep, which is all I wanted to do, which is not a bad thing to do, neuropathy from chemo. Some radiation facilities spray your mouth to cleanse it out, daily, and hydrate you with IV fluids.

They say, you can have the best medical care in the world, but more importantly is the support you have, during, after treatment that matters, which seems like you are doing a good job with.

Hang in there, all this shall soon pass.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Sep 2006
Posts: 8,311
Senior Patient Advocate
Patient Advocate (old timer, 2000 posts)
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He hasn't gotten/started to use the PEG yet?


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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So week one down. And a tough one. Not so much the chemo/radiation (yet) but rather from the fact that his pain got too intense to eat or speak - this is from the tumor. So he was literally starving to death and was dehydrated. So he was a walking zombie. We started two liters of fluid by IV every day after radiation, but that still had him dragging. On Thursday, the nausea hit - they were able to get that under control pretty quickly while he was on the IV - kit him with zofran, dexamethazone and pepcid. The kept him of the dexa for two more days, Now they have him on Zofran three times a day (until the chemo starts again when they give him the Aloxi and dexa by IV) and he is taking olanzapine every night. It seems to really work. They are pretty confident they can keep that under control.

On the pain side, they moved him to Fentynl patches and that did the trick. He was able to stop the morphine but he still uses oxycodone breakthrough.

They finally did the PEG yesterday (I got it moved up a week) and he is like a new person already. Taking food and water like crazy. He really recovered fast.

I also got him started on Celexa yesterday and am hoping that will give him a little more fight.

And this is the guy who never saw a doctor, swore he would not see a doctor and wouldnt take meds. What a trip for him. I am way proud of how far he has come.

So here we are - pain under control, nourishment and water going in. Finally where I wanted to get him when I first flew out to meet him. I am hoping he gets a week or so of respite before the side0effects of the RAD and chemo really kick in. He has been in pain from the tumor for so long, he really needs a mental break from pain for a week before it all starts up again from the sores.

Personally, I got myself a hotel nearby and am staying with him and his wife for the whole 7+ weeks. My wife and kids will join when they can. I am going to see this through with him!


AWW, Brother of Dave, 60
Pre-canc 10 years ago
Biopsy Dentist 10/12
Stage 2 SCC 2.5cm
no action
5/13 to DanaFarber
Examined by Surgeon, MO, RO
PET, CAT
Stage T4, 4.5cm, no METs, or lymph nds
Started treatment 6/17 - RT 5x/wk, Csptn 1/wk, for 7 wks - will end 8/5
PEG since his first week.
Treatment ended 8/5
Scans scheduled for 10/30, with FU appointment 11/6
11/1 - Treatments didn;t work. Tumor continues to grow.
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