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Judy M.

SBRT

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Had my first SBRT treatment for the 3 tumors in my lungs. The way they are doing it seems unusual possibly and interesting so thought I'd share. They are treating all 3 tumors each session consecutively. This involves laying perfectly still with my arms stretch above my head for about 1 1/2 hours. This is a bit uncomfortable since I have a hinky left shoulder and had a port place in my upper left chest a couple of days ago, but it is doable. They will do 5 treatments spaced 2 or 3 days apart to give me a bit of a rest. Has anyone else had multiple consecutive SBRT treatments. I'm thankful I can have these since they do seem to have a good success rate as far as eliminating existing tumors. I do wonder why chemo was not done first to try to stop any spread though. They seem to be looking at it as get rid of the lung tumors then do chemo as a sort of mop up of anything left now. My plan seems to have sort of evolved between the 2 Radiology Oncologists and the Medical Oncologist over the last 6 weeks as it kept changing.

Judy M

 

 

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Judy,

Our experience has some similarities. I only had 1 tumor to treat. My treatment was administered 3 consecutive days but the treatment cycle was about 30 minutes a session. So 3 tumors @ 30 minutes each yields your 1.5 hour treatment time. 

I think your doctors are considering your SBRT as a surgical procedure. The point of after surgical chemo, as I understand it, is to eliminate cells dislodged during surgery. SBRT does excite the tumor and perhaps cells can be discharged from this treatment, thus the post treatment rational. Better answer, ask you doc. 

I'm excited you have this opportunity. I've often wondered why SBRT has not been used in circumstances like yours. I wish you success. SBRT worked for me!

Stay the course. 

Tom

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Thank you, Tom. I'm glad for this opportunity also. I hadn't realized SBRT could excite the tumor. Before my port placement and first treatment I'd felt perfectly healthy. The only symptom I had was an occasional cough. Since I've had some soreness in my neck, dizziness at times, and a little more tired than usual. Nothing major, just not as perky as I was before. By exciting the tumor do you mean this could actually cause the cancer to spread?
Judy M

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Judy,

To your question, does excitement (my word) cause the tumor to spread. I don't know. I don't know if a radio oncologist would agree with the word excite as a descriptor for gamma ray bombardment. I used the term because the radiation actually destroys the cancer cells by applying vast amounts of energy. I don't know enough about how the cells die but at the molecular level, fundamental physics suggests increased cell activity as it absorbs and reacts to gamma ray energy. So I thought the word excite would substitute for the previous long winded explanation.  A good question for your radiation oncology would be to explain the mechanics of cell activity to radiation.

I know post surgical chemo is a precautionary treatment. It is done to kill cells in the blood stream be they caused by surgery or normal metabolic or metastatic activity.  I believe your SBRT is considered to be a surgery equivalent procedure. Thus they are following treatment protocol. 

Stay the course. 

Tom. 

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Thanks Tom. The physicist who was involved in planning my SBRT was actually present at my last treatment and I got to meet him. And I see one of my Radiation Oncologists each week. I may ask the question just to see what they have to say. It's an odd thing. I've been told by doctors that questions are good. But I've also seen doctors look irritated by my many questions. My Medical Oncologist's A.P.N. told me the last time I saw her that those in medicine need to be challenged. or they won't grow. I like that idea.
Judy M

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Tom,
Just had 2nd SBRT treatment. My physicist says he'll be present for all of my treatments, and he's very happy to answer questions so I ask away. As far as SBRT exciting the tumor he says no, it won't. The reason being because the fractionations are so high. Pretty much the little devils just don't stand a chance. But he said, on the other hand, if I was having standard radiation it would be bad if I missed a treatment because the tumor knows it's being threatened and will quickly develop radiation resistance. I also now know that Gy stands for a gray and is sort of like a degree on a thermometer except it's a particle of ionized radiation. And, like you, he calls that energy. I'm receiving 10 Gy from 5 separate angles on each tumor for each treatment for a total of 50 Gy to each tumor for each treatment. Being you, you probably already knew most of this. But you're so good to answer all our questions that I wanted to pass on what I could. Thomas, my physicist, is great to talk to if you have anything else you want me to run by him
Judy M

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Judy,

Thank you for the explanation. 

Take good notes on your treatment. Your's is a unique treatment experience. Perhaps you could write a blog about your treatment in the blog section of our forum so we can all learn from your experience. 

So glad things are going well...and...

Stay the course. 

Tom

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Tom
I haven't found a blog section. And I wouldn't have any idea how to write a blog. But will try to share what I learn along the way. Although maybe not so much. As you've probably guess I talk a lot. Lol.
Judy M

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Hi Everyone,

Finished with S.B.R.T. to the 3 tumors. Received50Gy/5 Fractions with treatments being every 323rd or 4th day. Don't know why the 2 or 3 says between except that Radiology Oncologist says it was to give my normal tissues time to heal. And I'd had standard radiation less than a Year ago. Perhaps that made a difference. At the conclusion 1 tumor was disintegrating and they thought the other 2 had shrunk, but hard to tell because of scar tissue. So we wait and see. The B.E.D. for the radiation was 1000. Hoping Tom knows what that means as far as standard S.B.R.T. goes. Chemo has been changed from Cisplatin/Taxol to Cisplatin/Alinta. Tom, you were right. They are treating this as though I've had surgery on the 3 tumors. Medical Oncologist said as much. The reason he gave for the switch in chemo is interesting. He said 5 years ago they weren't very sophisticated and gave the same chemo for every type of lung cancer. But now they have the chemo more fine tuned. Cisplatin is still given but they've learned that Alinta doesn't work well for squamous cell, but works very well for Adenocarcinoma. Will have 2 treatments 3 weeks apart, then scan. If all looks good that's it. If not 2 more rounds of chemo. Good news is I won't lose my hair with the Alinta. Both Radiology Oncologist and Medical Oncologist think I have a good chance with this treatment and the day things have gone so far. Just updating since my treatment continues to be rather unique and I have no idea how do start a blog.

Judy M

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Sorry about all the errors in the above. Have a new phone that likes to try to think for me. The chemo drug is Alimta. And hope it doesn't change it yet again when I post this.

Judy M

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Judy,

BED means biologically effective dose. I don't know what the number 1,000 means in relationship to a BED. 

I bet the other two tumors are fried also. It is hard to hide from SBRT. 

Let us about your chemo after your first infusion. 

Stay the course. 

Tom

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Hi Tom, do you know if the radio is good for pleural mets? Do you know some One?? Thanks

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Ale,

Yes. In the states, some radiation oncologists are getting aggressive treating multiple tumors with stereotactic radiation. This thread with Judy is but one example of this change in approach.

Stay the course.

Tom

Translation: Sì. Negli stati, alcuni oncologi delle radiazioni stanno diventando aggressivi nel trattamento di tumori multipli con radiazioni stereotassiche. Questa discussione con Judy non è che un esempio di questo cambiamento di approccio.

Mantenere la rotta.

 

 

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Alla mia mamma l'ospedale ha proposto la tomoterapia, non so se è lo stesso tipo di radiazioni di cui tu parli; vogliono aspettare novembre per fare un'altra PET e vedere dove c'è malattia e dove tessuto cicatrizzato penso per evitare inutili radiazioni. Questo per la pleura, dove si vedono poche zone con basso assorbimento ma ancora malate; per il nodulo primario, che capta di più,  invece il radioterapista dice che è possibile intervenire anche più volte vista la posizione apicale. Secondo te la procedura può funzionare sulla pleura in maniera definitiva? Purtroppo ogni oncologo con cui ho parlato mi ha detto che la pleura è un punto molto delicato ed il suo interessamento è sempre un indice prognostico negativo... però sembra che Tarceva e qualche integratore abbiano comunque lavorato meglio sulla pleura che sul nodulo polmonare, quindi spero molto nella radioterapia!! Inoltre tu che senso dai al marker CEA? Alcuni lo considerano importante per vedere l'andamento della malattia... cioè anticipa la progressione se si alza; mamma ha 5 nelle ultime analisi (quasi nella norma...). Anche se inoperabile vorrei tanto avere speranza che la malattia di mamma possa essere debellata secondo l'attuale quadro... spero altresì che il tuo controllo di ieri sia andato bene!! In bocca al lupo.... Ciao e grazie mille!!!!

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Ale,

The English Translation of your Post is: my mother the hospital proposed tomotherapy, I don't know if it's the same kind of radiation you are talking about; they want to wait until November to do another PET and see where there is disease and where scar tissue I think to avoid unnecessary radiation. This for the pleura, where few areas with low absorption but still sick are seen; for the primary nodule, which captures more, instead the radiotherapist says that it is possible to intervene even more times given the apical position. Do you think the procedure can work on the pleura in a definitive way? Unfortunately, every oncologist I spoke to told me that the pleura is a very delicate point and his involvement is always a negative prognostic index ... but it seems that Tarceva and some supplements have worked better on the pleura than on the pulmonary nodule, so I hope very much in radiotherapy !! Also, what's the point of giving the CEA marker? Some consider it important to see the progress of the disease ... that is, it anticipates progression if it rises; mom has 5 in the last analysis (almost normal ...). Even if inoperable I would very much like to have hope that mother's illness can be eradicated according to the current framework ... I also hope that your control of yesterday went well !! Good luck .... Hello and thank you so much !!!!

Tomotherapy is a well recognized form of precision radiation. It produces less ionizing energy than other methods but has a very precise focus so treatment should be effective without the danger of excess radiation. I understand another PET will be performed in November before tomotherapy is started.  Is this correct? I'm confused about your low absorption discussion for the pleura. Do you mean the pleura displayed less uptake during the PET, while the primary tumor showed higher uptake? In the US, we don't normally use CEA markers as a predictor for lung cancer, and I don't know much information about CEAs. So I can't offer a comment about if or how CEA markers predict progression. I think adding tomotherapy for the primary lung tumor and continuing with Tarceva for the pleura and to control progression are good approaches for your mother.

Stay the course.

Tom

Italian Translation:  La tomoterapia è una forma ben nota di radiazione di precisione. Produce meno energia ionizzante rispetto ad altri metodi ma ha un focus molto preciso, quindi il trattamento dovrebbe essere efficace senza il pericolo di radiazioni in eccesso. Capisco che un altro PET verrà eseguito a novembre prima dell'inizio della tomoterapia. È corretto? Sono confuso sulla tua discussione a basso assorbimento per la pleura. Vuoi dire che la pleura ha mostrato un minore assorbimento durante la PET, mentre il tumore primario ha mostrato un assorbimento più elevato? Negli Stati Uniti, normalmente non utilizziamo i marcatori CEA come fattore predittivo per il cancro del polmone e non conosco molte informazioni sui CEA. Quindi non posso offrire un commento su se o come i marcatori CEA prevedono la progressione. Penso che aggiungere tomoterapia per il tumore polmonare primario e continuare con Tarceva per la pleura e controllare la progressione siano buoni approcci per tua madre.

Mantenere la rotta.

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L'ultima Pet di luglio rileva una risposta parziale rispetto a quella di ottobre scorso (prima del talcaggio) a seguito dei seguenti rilevamenti:

- nella pleura alcune zone che prima captavano sono scomparse (tessuto cicatrizzato?) mentre altre piccole aree hanno un assorbimento basso

- il nodulo primario capta meno di ottobre ma è comunque più attivo della pleura;

In base a questi risultati a novembre faranno una nuova Pet alla mamma per eventualmente programmare la radioterapia che prima menzionato, pensi risulti efficace in una situazione così? Come dicevo spero tanto di distruggere tutte le cellule malate... Grazie ancora... Ciao

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Ale,

Your post translated to English: The last Pet in July noted a partial response compared to last October (before the talc) following the following findings: - in the pleura some areas that were previously found have disappeared (scar tissue?) while other small areas have low absorption - the primary nodule captures less than October but is however more active than the pleura; Based on these results, in November they will make a new Pet to the mother to eventually program the radiotherapy that previously mentioned, do you think is effective in such a situation? As I said so much I hope to destroy all the sick cells ... Thanks again ... Hello

I do believe that the combination of precision radiation and Tarceva can be effective in achieving no evidence of disease (NED) for your mother.

Stay the course.

Tom

My answer translated to Italian: Credo che la combinazione di radiazioni di precisione e Tarceva possa essere efficace nel raggiungere nessuna evidenza di malattia (NED) per tua madre. Mantenere la rotta.

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Innanzitutto sono molto contento che i risultati del tuo controllo sono andati bene, evviva!! Inoltre ti chiedo ancora una piccola delucidazione sul trattamento radioterapico: come dicevo non dovrebbero esserci problemi sul nodulo primario mentre è sulla pleura che sono preoccupato in quanto sembra un'area delicata... secondo te, quindi, la tomoterapia può essere efficace sulle zone malate della pleura? Su tutte contemporaneamente? Quante sedute dovrebbe avere? Grazie un abbraccio!!

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Scusami ancora, se non dovessimo debellare tutto sulla pleura sarà possibile in futuro fare un altro giro di radiazioni sempre sulla pleura e dopo quanto tempo?? Grazie mille!! Ciao

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Ale,

Your two posts translated: "First of all I am very happy that the results of your control went well, cheers !! I also ask you for a little clarification on radiotherapy treatment: as I said there should be no problems on the primary nodule while it is on the pleura that I am worried because it looks like a delicate area ... according to you, therefore, tomotherapy can be effective on diseased areas of the pleura? On all of them at the same time? How many sessions should you have? Thanks a hug !!"

"Excuse me again, if we were not to eradicate everything on the pleura it will be possible in the future to do another round of radiation always on the pleura and after how long? Thanks a lot!! Good buy."

My response: Your question is beyond my knowledge and ability to answer, except in general terms. I was thinking your mom's primary tumor was the one with PET uptake and that the primary would be the target of tomotherapy. Lung cancer in the pleura can be defuse -- spread over an area and not concentrated into a single tumor. If so, it is a difficult target for tomotherapy. The number of radiation sessions results from a very technical calculation that is performed in the US by both the radiation oncologist and a physicist. So I wouldn't be able to answer how many sessions she might have.

Will it be possible to do another round of radiation to the pleura? Generally no, however this is also a question that is beyond my ability to answer. 

Stay the course.

Tom

Translation to Italian: La tua domanda va oltre la mia conoscenza e capacità di risposta, tranne in termini generali. Pensavo che il tumore primario di tua madre fosse quello con assorbimento di PET e che il primario sarebbe stato l'obiettivo della tomoterapia. Il carcinoma polmonare nella pleura può essere disinnescato, diffuso su un'area e non concentrato in un singolo tumore. In tal caso, è un obiettivo difficile per la tomoterapia. Il numero di sessioni di radiazioni deriva da un calcolo molto tecnico che viene eseguito negli Stati Uniti sia dall'oncologo che dal fisico. Quindi non sarei in grado di rispondere a quante sessioni potrebbe avere.

Sarà possibile fare un altro giro di radiazioni sulla pleura? Generalmente no, tuttavia questa è anche una domanda che va oltre la mia capacità di rispondere.

Mantenere la rotta.

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