Brian,

I would be most interested to hear what you find out. ANother RO we are considering gave us different advice than the one we are now considering. To clarify my main questions again were:

1. Does IMRT ever work well in combination with hyperfractionation/altered fractionation? (doc 1 said it doesn't).
2. Does altered fractionation work more effectovely in treating tongue lesion? (doc 1 said it doesn't).
3. Hence, for treating OT is IMRT/hyperfractionation the best combo?

BTW I went to Niguel Hills middle school and was the best female body boarder at Salt Creek back in the late 80s. Dude.

Thanks and god bless,
Tasha

I would think another consideration (not that this should necessarilly be a determining factor)is if a patient wanted to use amifostine (ethyol) to protect their salivary glands somehwat against the effects of radiation, I would think that would be nearly impossible to do if you are getting fractionated radiation. With IMRT, it depends on the radaition plan how much there is a need for salagen and usually some salivary function can be spared anyway so it' somewhat less ofan issue but in my case amifostine was recommended anyway and I do think it did help preserve a little of my salivary function.

But the amifostine has to be given exactly half and hour before radiation, give or take a few minutes, it doesn't last long in the system and it creates enoiugh nausea that you would NOT want to get it twice a day.

Nelie

Nelie your point is well taken.

It will be interesting to see what Brian comes up with.

Radiation (and surgery) are both local therapies and therefore rely on the cancer being local. Also, platinum drugs sensitize cancer cells to radiation and in addition are systemic and can eliminate or at the very least reduce the number"stray" cells. This in my mind seems more attractive than a more aggressive local therapy.

What are the numbers??
Hyper fractionation vs regular IMRT with weekly cis/carboplatin or Erbitux for that matter.
In which case do you get more local failure and which has more distant failure?

M

Nelie -- I couldn't agree with you more. I would get off the radiation table, go up the elevator, walk down the hall about 50 yards, take a right toward the parking garage, and WHAM, the nausea would hit. You could set your watch by it.

Markus -- I agree those numbers would be great to see. The problem as I see it is that there are so many variables -- location (oral cavity, BOT, tonsil, parotid, etc.), T Stage, N Stage, tumor grade, extracapsular spread, patient age, comorbidities, neck dissection status, etc., that it is tough to find a study that definitively addresses it. In theory, an ideal study would involve a cohort, for example, of patients with SCC of the tonsil, T2, N1, neck dissection, no extracapsular spread, well differentiated, no comorbidities, and of approximately the same age. If you treated some of them with hyperfraction and some without, your results would likely be pretty meaningful if the stats were significantly different. However, the more you vary from a true control set of paramenters, the less controlling the data becomes.

Study dollars are so precious, that few researchers can afford such narrowly tailored studies. Thus, they have a primary goal of the study, and then seek trends in the subsets of other characteristics.

However... you need clear and convincing numbers about the benefit of HF, otherwise what is the basis for deciding to go with it?
What is driving the use. Is there a clear benefit for the patient or is is just a benefit for he facility (I ASSUME they get to charge more for HF vs regular IMRT)?
I personally still like the idea of a concurrent chemo component that provides both enhanced local activity and some distant protection. {Disclaimer: If this (chemo) can be tolerated and if it is indicated, i.e. talk with your RO, who hopefully has up do date knowledge}

M

I agree, Markus. HF was conceived in the XRT environment, nor IMRT, and the studies of which I am aware in the HF arena do not involve IMRT. I also agree with the benefits of concurrent chemo, the benefits of which are pretty clear in the studies. I personally would not expect to see dramatic differences between regular IMRT and HF IMRT, but the results would be intriguing.

Hi Brian, were you able to get a hold of the doc this week?

Been away at a conference. Hope he will return call next week. But no one should put off making any decisions waiting for this comment. You have to go with the doctors that have actually seen what's what first hand.

hi brian, your info will be very important for the forum and its members, and i know that it might not be a fina; answer on things, but i have time before papa's pathology comes out and his Tx begins. I will need to be prepared in advance inc ase we have to pick up and move for a few months. for example the only tomotherapy center in India is in mumbai,which is on the other side of the country. i am going to make every possible research into this that i can before making a decision. your help is appreciated and i won't forget this forum when it's all over; ill come back to help other members in whatever way i can. and i apologize for the poor grammar but it's a lack of time to proofread that makes me post it like this. looking forward to your info. god bless you and take care.