My husband was offered the option of getting his chemo in weekly increments or in 3 doses (1st week, 4th week and 7th week) with radiation. Additionally, he was offered to get a jump start on his chemo 2 weeks before radiation.

We're questioning if this is the right thing to do by jump-starting treatments before radiation begins. We can't seem to find information on how chemo is given and the overall outcome and adverse reactions to either/or.

Thank you for your help.

What chemo drug would he be getting?

To answer your question, my husband was offered the same options by his medical oncologist (MO). He got carboplatin (only). He opted for 7 weekly small doses as the MO felt that this would probably cause him fewer side effects such as nausea. When he met with his chemo nurse (before starting treatment) she concurred that the patients getting 6-7 small doses seemed to do better re handling the drug, and she has treated 100s of patients. Barry had the 7 dose regimen, and as far as he was concerned, the chemo was a "non-event" -- far less difficult than either the radiation or the amifostine he took every day.

As for induction chemo, that is usually given when the tumor is large and they are trying to shrink it before starting radiation, to allow a smaller area of the head/throat to be radiated. However, a number of studies have found no long-term survival advantage to induction chemo in most cases. For my husband, who had a T3N2MO primary right tonsil (which had been removed) with extension to base of tongue, the MO did not recommend induction chemotherapy while another patient, with an extensive unresectable tumor invading the soft palate and affecting his physical ability to swallow, induction was very helpful as his tumor shrank about 30% in two weeks.

By the way, you must ask to meet with your medical oncologist or his/her nurse and find out about how the chemo is to be given and the expected side effects. Hopkins (where my husband was treated) gives a "chemotherapy class" for all new cancer patients but they just started doing this a year or so ago when they found too many people didn't know what to expect or what to watch out for as they went through treatment.

Never be afraid to ask questions, and if you do not understand, keep asking!

Gail

Dear V, while I can't address the chemo part of your question, I can encourage you to follow Gail's advice about asking questions-lots of questions-even questions that you think might be dumb -in order to get your minds wrapped around the things that may crop up during treatment. This is not to scare you, but to eliminate fears. The more you know ahead, the less fearful you are if a side effect happens and the more prepared you are to deal with it, realizing that many folks have experienced that one and got through it. This forum has done more to educated me as a caregiver that any of the Medical people we have dealt with over the last 14 months. So keep reading and keep asking. And Best Luck to you both. Amy

Dear V,
My father received Erbitux(only) and received it in weekly doses for 8 weeks. This drug is started one week prior to beginning radiation. The first dose is twice as much as the next seven. He had already had surgery prior to beginning treatments. His main side effect was an acne like rash on the face and head. He also experienced severe headaches but only for the first two weeks and then they subsided. His MO gave him antibiotics about 3 weeks in when the acne rash got pretty bad. He took 10 days worth of the antibiotics and the rash didn't reappear until about a week after treatments were over. He did not experience any nausea. The radiation had the worst side effects and we are still dealing with those. I agree totally with Amy keep asking questions. Kim(used to be Sue1215)

Each medical oncologist do things a little different than the other. Six to one, half dozen the other. I, like Jam, received Taxol with carboplatin, others received other drugs. They are all recommended for head and neck cancer. I can tell you, that the doses of chemo received in initial are small and rarely cause side effects. I am currently on Taxotere and Cisplatin for metatastic disease and the doses are massive and side effects are devestating but my tumor is responding.....Chemotherapy in initial treatment is a preventative measure to help prevent metatastic disease due to endocrinic involvement. Bottom line, relax and enjoy the ride and like the lady said, NEVER BE AFRAID TO ASK QUESTIONS OF YOUR CAREGIVERS....
DARRELL

I had cisplatinum, with the 3 doses (1st, 4th and 7th week). Or it was supposed to be 3 doses. But the cisplatin massacred my white blood cell count (and my red blood cell count, actually, despite taking Procrit to help prevent that) and so the second dose was 4 days into the 4th week because they wouldn't give it when my WBC was below a certain number so I had to wait for it to creep up a little, and for the third dose both blood counts were so low, and then I got a fever indicating some kind of infection, and so it never happened at all.

I wasn't offered any other options but if I had it to do over again (thank God I don't) I'd ask if I could do smaller doses every week and I'd ask about some of the alternatives to cisplatin.

What Gale said about educating yourself about chemo is very important. I wasn't sent to a class but everyone at my MO's office who gets chemo first meets for a good hal hour or longer with a nurse practitioner there who has been an oncology nurse for decades and seen it all. She was VERY thorough in telling me what to expect, what serious things to watch for, and managed to do it without scaring me or making me expect the worse (in fact, she had me expecting it could go really easily although, for me, it turned out to actually have some pretty severe effects--but I'm glad I was not led to expect the worst but was nonetheless prepared for the worst by her).

Ask lots of questions of your MO and also feel free to ask more here.

Nelie

Darrell,
you wear me out constantly having to correct you. Cisplatin is typically administered at three week intervals beginning with the first day of radiation. It is still considered "front line" standard of care, in conjunction with, and as an adjunct to radiation therapy. This is the pharmacuetical manufacturer's recommendation for greatest efficacy. On rare occasions they will modify the infusion rates for patients with compromised livers or kidneys and give smaller doses at more frequent intervals. Cisplatin is very toxic. Cisplatin has actually been in use for quite a while and is very effective when used with radiation. Carboplatin is an alternative and not quite as effective but won't cause deafness and the nephrotoxicity issues aren't as severe. Some studies have suggested as much as 13% higher survival rate with the Cisplatin/Radiation combination, so I wouldn't be kicking myself too hard about not choosing something else.

Erbitux, taxotere, F5U, etc., are not "front line", but "second line" treatments and the doctors will fiddle with the infusion intervals with them since they are more in the experimental category. To date ct, by itself, has not shown to be a front line method of treatment.

I have noticed a trend to offer Erbitux, post rad, but I would speculate that they gathering data for efficacy studies. It just got cleared by the FDA for H&N application.

All of this stuff I mention is related to primary care - not for treatment of
metastatic disease. There are "no hold's barred" for recurrence or metastatic treatments. Taxol, for instance, is typically indicated and administered for breast cancer.

Just to add to Gary's comments....
Because Cisplatin is so toxic it is usually administered during a hospital stay for at least 5 days. The reason according to my husbands MO is that it is so hard on the kidneys that renal failure is a very real and dangerous side affect. You stay in the hospital so that they can measure your intake and outgoing fluids to monitor the kidney function.

My husband was treated with 37 rad txs that were 40 minutes each. He started the chemo the day before rad. His chemo was a 2 hour drip of Cisplatin once every 28 days and had 4 treatments. The 5fu was a 96 hour slow drip, They usually started the 5fu when we checked into the hospital and ran the Cisplatin the next morning. The rad txs were so long because they shot him in 2 different areas to make sure they weren't missing something.

The cisplatin is very hard on the body. Harry was violently sick within the first 12 hours after receiving it the first time.

But let me say that in a matter of 2 weeks from now Harry will be cancer free post treatment for a year. His side effects since tx have been very mild. He can eat almost anything that tastes ok to him. He has been the textbook patient as far as the doctors are concerned and no surgery.

The docs explained that with the concomitant rad and chemo and NO surgery they are getting results that are equal to or better than surgery so they opted not to operate.

My advice about the chemo txs.....

Choose your doc wisely and make sure you are informed and then you have to put your faith in that doc. I know that sounds not much like what you were looking for in ways of advice but what I know is that each patient is different and their cancers are unique to them. The really good docs know and understand this and they will recommend the txs based on the records and knowledge they have of the individual patient. At least that is what ours did and we just put our faith in them to do the right thing. It was all we really could do and for us it was successful.

Best to you,
Cindy

It seems that what is typical to most people here doesn't apply to me. I had 4 shots of cisplatin on a weekly basis together with the radiation. I was not sure about the dosage and only remember that I had a blood test to confirm my white blood cell count was at a satisfactory level prior to the shot. I stayed in a room with some other patients receiving chemo treatment and it was a 2-hour drip too. Afterwards I could just walk away for lunch and returned for radiation in the afternoon. Chemo drugs are of course toxic and cisplatin is no exception. I suffered from nausea 2 days after each shot and the anti-nausea medicine was a great help to me. I only threw up twice during the whole treatment.
When I finished all the chemo shots, I suffered from high fever and a drastic drop of white blood cell count. I had to be hospitalised because of this for closer observation and medication. Everyone has different reaction to the treatment and I just want to share my own experience.

Karen

Cindy,
I know of only a few patients who have required a hospital stay for infusion of Cisplatin. For most of us it was an outpatient peocedure that took about 3-4 hours at most.

Yes is it very toxic and vital to maintain adequate hydration.

Here's a link to the latest guidelines for ct
http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf

Here's a link for Cisplatin (from NZ) which is actually a nice short, easy to comprehend, description
http://www.medsafe.govt.nz/Profs/Datasheet/c/Cisplatininj.htm