Anyway I'm due to meet with a radio therapist specialist next week my neck dissection cleared the cancer and I have clear margins. However because this is the second time it's came back and I'm only 20 my consultant thinks its a good idea to have radiotherapy, I too also think its a good idea because if it comes back again I could end up having even worst operations that I have already had and wouldn't want to go through cancer ever again, so anyway I have to see my consultant next week and a radiotherapy specialist next week , and all I know so far is that it will be low does rads , that's all I know so far, and anyway just wondering as I have read a lot about side effect , and freaked myself out , if the dose of rads is lower gy and the weeks you have it over are less , are the side effect as bad as a higher dose? Thanks In advance

I don't recall your cancer, but if it's HNSCC, it usually takes 50Gy IMRT or more to kill the cancer. I guess you can have lesser IMRT, in conjunction other boost treatments, like brachytherapy, IORT, but that's radiation too, in a different form, and would add up go even more radiation. They both can be done alone, but more often as a boost.

After 5 weeks, or 25 treatments, IMRT's effectiveness becomes less each day, and that is worked into the treatment plan. so more is not better, and reason why they usually do treatments in 7-8 weeks, 2Gy a day. There are other different radiation treatments using 5, 6 weeks with accelerated radio delivery, other names I forget, that work to counter this decrease in effectiveness, tumor kill in an allotted time.

Side effects also depends on the fractions, usually between 1.8 to 2Gy, higher is usually unacceptable. Also the amount of time for each delivery. There is much more to it than that, and radiation treatment is very complicated to understand, explain, and say the dosimetrist is like the wizard of oz.

Another type, is photon treatment, which I'm not really familiar with to say, but has been mentioned recently on the board. That may be lesser than other radiation modalities.

Good luck.

[quote]the dosimetrist is like the wizard of oz.[/quote]True that. Of all the professionals involved with our cancer treatments, the folks behind the RO are the wizards. Even though I finished my radiation treatment, I am going to meet the dosimetrist and have them convey as much of their art and science as I can grasp.

My understanding is their main job is to work with the RO and rad techs to define the program for the accelerator. Each area to be radiated, at what dose, how often, what the contour is for each hot spot and the less critical areas. For example, I believe, in my case, even though there was no indication that cancer had cross the mid-line onto the left side, the RO made clear and showed me on the map that they still planned to cover the entire left side with 5300 grays.
This was in response to my comment/concern about trying to minimize the rads to the parotid glands in order to maintain spit. It has worked very well as being post 4 weeks, I have to chew chew sip only on a few things like a sandwich which possesses a lot of dry material.
I do believe very deeply that the best technology, both hardware and software, and a crack dosimetrist and RO can create a very effective radiation map while minimizing collateral damage to other organs and tissue.

Usually the parotid is spared or the dosage is between 26-30Gy with IMRT. Anything higher, and the gland is totally destroyed, and will not recover.

Hi Gemma. You are young and relatively healthy that should factor in to how you do overall. It may not hit you as badly. What are they looking at in terms of numbers? How many weeks? etc... Radiation therapy is not fun by any standard. Even at it's best it's hellious with long term effects. However - that said - you want to do whatever you can to prevent a recurrence. BTW what you had in the nodes really wasn't a recurrence... chances are it was there all along, a clear scan does not mean it's not there microscopically. An oncologist I know said there is really no such thing as a recurrence, particularly so shortly after treatment - it simply means they didn't get it all the first time out. Chances are your cancer seeded to the nodes and was dormant. Anyway.

the less radiation - the less damage, however - make sure the are giving you the recommended therapeutic dose otherwise your suffering will be for nothing.

hugs

if they applied 5300 to the entire side that showed no evidence of cancer just to be safe, then that seems to mean the parotids got that much as well. I'll have to look more closely at the rad map and see the effect of contouring and if all rad is applied a base of 5300. They told me there was 5300, 6400, and 7500, something like that. that is just what I understood.

They can dose paint. Check your cumulative dose volume histogram on your treatment plan, if you have it. I don't know if they do 53Gy to the parotid gland with IMRT, and read, they can spare, do lesser radistion due to the limited dose toxicity of 30Gy, but anything is possible. Mine looks like it started at 28Gy, but the histogram is somewhat difficult to figure out with the cGy, ratio of total structure volume%, and relative dose%. They also do lesser radiation than the primary for the right and left brachial plexus nerve, like 53Gy, brain stem 53Gy, larynx 35Gy, spinal cord 15Gy, and mandible 34Gy due to toxicity levels. I was turned down for radiation 2x, for two recurrences in level V, due to already receiving the max radiation to the left brachial plexus nerve, which area originally was given 53Gy-66Gy depending on the proximity to level lV. Check with the Wizard of Oz. lol.

It does appear 53gy is a recurring number for your dosage as well as lesser amounts to other organs. The Wizards are wizards as they guard their secrets well and only reveal what they have to when forced.

All I can do is be as armed with the verbiage and lingo to develop some cred with them and then maybe they show more of the kimono.

The treatment map images showed a lot of detail and between the fast talk and my glazing over the images, I am certain most went right by. I'll be more prepared next time.

What sorts of deliverables or work output are worth requesting of the RO and dosimetrist? Can I just ask for a copy of all the records they have collected up?
It seems the medical physicist participates at a level above individual cases and more focused on ensuring process, procedures, techniques, equipment, etc. are all constantly monitored and calibrated.

You can get a copy of everything, I do, except original pathology slides, but you may have to pay for it, depends on facility. My dosage to primary was 70Gy. As mentioned, it takes over 50Gy to kill SCC, and less may not work.

Thanks Paul,
I have copies of PET/CT on disc along with the image viewer program. Very impressive to zoom and rotate around your own neck. lol

Depending on the facility, sometimes I get them for free and sometimes a nominal fee.

As to minimum of 50 gY to kill SCC, that makes perfect sense why 5300 dosage was painted across the entire left side as a "mop up" meaning to KILL any stray or small, undetected cancers.

I feel very confident they killed any cancer in the HNC area. The thing still worrisome but not making me lose sleep or create any anxiety is what the lungs show this time on the upcoming scans. I have a couple undiagnosed spots that after much flapping about remain a bit of a mystery.

Since the induction chemo was very(near complete) effective in disintegrating all visible tumors and the spots in the lungs remained the logic goes it is likely something else. I see the logic but rather have direct rather than some deductive projection of what that is.

Other than that I really feel confident the C is dead but need a couple years under the belt to celebrate.