Radiation: Question for Steph

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

My wife has just begun a course of radiation treatments
for brain metastases. Her oncologist has recommended 5
days a week for two weeks. Our consultant says half the
dose over 20 days has greater benefits and does less long-
term damage. Your thoughts would be greatly appreciated.
Thanks. - Tony Lima

The commonest regimes are 5 treatments or 10 treatments.
Your oncologist is correct that longer courses are not
indicated, not really because they are more toxic, but
because they are no more effective.

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

My wife has just begun a course of radiation treatments
for brain metastases. Her oncologist has recommended 5
days a week for two weeks. Our consultant says half the
dose over 20 days has greater benefits and does less long-
term damage. Your thoughts would be greatly appreciated.
Thanks. - Tony Lima

The commonest regimes are 5 treatments or 10 treatments.
Your oncologist is correct that longer courses are not
indicated, not really because they are more toxic, but
because they are no more effective.

Is there any evidence that smaller fractions cause less long-
term cognitive disfunction? - Tony

--
Tony Lima /"\ ASCII ribbon campaign \ / against HTML mail X
and postings / \

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

My wife has just begun a course of radiation treatments
for brain metastases. Her oncologist has recommended 5
days a week for two weeks. Our consultant says half the
dose over 20 days has greater benefits and does less long-
term damage. Your thoughts would be greatly appreciated.
Thanks. - Tony Lima

The commonest regimes are 5 treatments or 10 treatments.
Your oncologist is correct that longer courses are not
indicated, not really because they are more toxic, but
because they are no more effective.

Isn't chemo overkill? He's researching and planning for that
in combination. J

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

My wife has just begun a course of radiation treatments
for brain metastases. Her oncologist has recommended 5
days a week for two weeks. Our consultant says half the
dose over 20 days has greater benefits and does less
long-term damage. Your thoughts would be greatly
appreciated. Thanks. - Tony Lima

The commonest regimes are 5 treatments or 10 treatments.
Your oncologist is correct that longer courses are not
indicated, not

really

Quoted message said:

Quoted message said:

because they are more toxic, but because they are no more
effective.

Is there any evidence that smaller fractions cause less
long-term cognitive disfunction? - Tony

Tony, the median survival for patients with brain mets from
the common cancers is 12-16 weeks............ Long term
toxicity of treatment is not really an issue

Tony Lima said:

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

My wife has just begun a course of radiation treatments
for brain metastases. Her oncologist has recommended 5
days a week for two weeks. Our consultant says half the
dose over 20 days has greater benefits and does less
long-term damage. Your thoughts would be greatly
appreciated. Thanks. - Tony Lima

The commonest regimes are 5 treatments or 10 treatments.
Your oncologist is correct that longer courses are not
indicated, not really because they are more toxic, but
because they are no more effective.

Is there any evidence that smaller fractions cause less
long-term cognitive disfunction? - Tony

We've been through this before here. 4 or 5 fractions(or
even 1x 8Gy in the UK) are done not just because of the
poor prognosis but because of scarce machine time. If the
brain is 'full' of mets or the primary tumor is
radioresistant as in malignant melanoma these intensive
schedules also make sense. In countries with enough machine
time and the resources to take out up to 4 or 5 mets
stereotactically a lower fraction size over 2-3 weeks makes
sense as these patients live long enough to experience a
treatment-induced dementia.

--
madiba

madiba said:

Tony Lima said:

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...
> My wife has just begun a course of radiation
> treatments for brain metastases. Her oncologist has
> recommended 5 days a week for two weeks. Our
> consultant says half the dose over 20 days has
> greater benefits and does less long-term damage. Your
> thoughts would be greatly appreciated. Thanks. - Tony
> Lima
>

The commonest regimes are 5 treatments or 10
treatments. Your oncologist is correct that longer
courses are not indicated, not really because they are
more toxic, but because they are no more effective.

Is there any evidence that smaller fractions cause less
long-term cognitive disfunction? - Tony

We've been through this before here. 4 or 5 fractions(or
even 1x 8Gy in the UK) are done not just because of the
poor prognosis but because of scarce machine time. If the
brain is 'full' of mets or the primary tumor is
radioresistant as in malignant melanoma these intensive
schedules also make sense. In countries with enough
machine time and the resources to take out up to 4 or 5
mets stereotactically a lower fraction size over 2-3 weeks
makes sense as these patients live long enough to
experience a treatment-induced dementia.

BTW Tony please don't recommend PET scans to look for brain
mets in breast cancer, the usual FDG-PET is not suitable for
this. CT and MRI are much more reliable. PET using amino
acid tracers is ok but its not available everywhere and is
still experimental.
--
madiba

madiba said:

Tony Lima said:

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...
> My wife has just begun a course of radiation
> treatments for brain metastases. Her oncologist has
> recommended 5 days a week for two weeks. Our
> consultant says half the dose over 20 days has
> greater benefits and does less long-term damage. Your
> thoughts would be greatly appreciated. Thanks. - Tony
> Lima
>

The commonest regimes are 5 treatments or 10
treatments. Your oncologist is correct that longer
courses are not indicated, not really because they are
more toxic, but because they are no more effective.

Is there any evidence that smaller fractions cause less
long-term cognitive disfunction? - Tony

We've been through this before here. 4 or 5 fractions(or
even 1x 8Gy in the UK) are done not just because of the
poor prognosis but because of scarce machine time. If the
brain is 'full' of mets or the primary tumor is
radioresistant as in malignant melanoma these intensive
schedules also make sense. In countries with enough
machine time and the resources to take out up to 4 or 5
mets stereotactically a lower fraction size over 2-3 weeks
makes sense as these patients live long enough to
experience a treatment-induced dementia.

--
madiba

She started "full dose" on Tuesday. breast cancer mets - 7
lesions in the brain, one met to the lung, looking into (or
starting) Temodar. Age unknown. As of June/03 "living with
breast cancer for 39 months" J

On Fri, 19 Mar 2004 19:30:11 +0100, [email hidden]

(madiba) said:

BTW Tony please don't recommend PET scans to look for brain
mets in breast cancer, the usual FDG-PET is not suitable
for this. CT and MRI are much more reliable. PET using
amino acid tracers is ok but its not available everywhere
and is still experimental.

I generally don't recommend anything. However it was a PET
scan that first picked up the two mets in Gloria's liver.
We had to fight like anything to get Kaiser to do it. Our
main medical consultant (yes, he's a real MD) pushed us to
push Kaiser.

Now perhaps PET doesn't work well with brain mets. I defer
to your superior knowledge on that subject. But I'm very
happy that we discovered the liver mets long before they
would have shown up on a routine CT scan. - Tony

--
Tony Lima /"\ ASCII ribbon campaign \ / against HTML mail X
and postings / \

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

On Fri, 19 Mar 2004 19:30:11 +0100, [email hidden]

(madiba) said:

BTW Tony please don't recommend PET scans to look for
brain mets in breast cancer, the usual FDG-PET is not
suitable for this. CT and MRI are much more reliable. PET
using amino acid tracers is ok but its not available
everywhere and is still experimental.

I generally don't recommend anything. However it was a PET
scan that first picked up the two mets in Gloria's liver.
We had to fight like anything to get Kaiser to do it. Our
main medical consultant (yes, he's a real MD) pushed us to
push Kaiser.

Now perhaps PET doesn't work well with brain mets. I defer
to your superior knowledge on that subject. But I'm very
happy that we discovered the liver mets long before they
would have shown up on a routine CT scan. - Tony

Tony, that begs the question, "Why"?

Tony Lima said:

On Fri, 19 Mar 2004 19:30:11 +0100, [email hidden]

(madiba) said:

BTW Tony please don't recommend PET scans to look for
brain mets in breast cancer, the usual FDG-PET is not
suitable for this. CT and MRI are much more reliable. PET
using amino acid tracers is ok but its not available
everywhere and is still experimental.

I generally don't recommend anything. However it was a PET
scan that first picked up the two mets in Gloria's liver.
We had to fight like anything to get Kaiser to do it. Our
main medical consultant (yes, he's a real MD) pushed us to
push Kaiser.

Now perhaps PET doesn't work well with brain mets. I defer
to your superior knowledge on that subject. But I'm very
happy that we discovered the liver mets long before they
would have shown up on a routine CT scan. - Tony

Don't get me wrong, PET is fantastic. But brain mets are a
problem because the brain uses so much glucose and FDG-PET
is a sugar- tracer. When people get brain mets and one can't
find where they are coming from PET is the best diagnostic
tool for finding those occult primaries.
--
madiba

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

On Fri, 19 Mar 2004 19:30:11 +0100, [email hidden]

(madiba) said:

BTW Tony please don't recommend PET scans to look for
brain mets in breast cancer, the usual FDG-PET is not
suitable for this. CT and MRI are much more reliable.
PET using amino acid tracers is ok but its not available
everywhere and is still experimental.

I generally don't recommend anything. However it was a
PET scan that first picked up the two mets in Gloria's
liver. We had to fight like anything to get Kaiser to do
it. Our main medical consultant (yes, he's a real MD)
pushed us to push Kaiser.

Now perhaps PET doesn't work well with brain mets. I
defer to your superior knowledge on that subject. But I'm
very happy that we discovered the liver mets long before
they would have shown up on a routine CT scan. - Tony

Tony, that begs the question, "Why"?

Because I love my wife and want to keep her around a while,
OK? - Tony

--
Tony Lima /"\ ASCII ribbon campaign \ / against HTML mail X
and postings / \

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

On Fri, 19 Mar 2004 19:30:11 +0100, [email hidden]
(madiba) wrote:

>BTW Tony please don't recommend PET scans to look for
>brain mets in breast cancer, the usual FDG-PET is not
>suitable for this. CT and MRI are much more reliable.
>PET using amino acid tracers is ok but its

not

Quoted message said:

Quoted message said:

Quoted message said:

>available everywhere and is still experimental.

I generally don't recommend anything. However it was a
PET scan that first picked up the two mets in Gloria's
liver. We had to fight like anything to get Kaiser to
do it. Our main medical consultant (yes, he's a real
MD) pushed us to push Kaiser.

Now perhaps PET doesn't work well with brain mets. I
defer to your superior knowledge on that subject. But
I'm very happy that we discovered the liver mets long
before they would have shown up on a routine CT scan.
- Tony

Tony, that begs the question, "Why"?

Because I love my wife and want to keep her around a
while, OK? - Tony

I appreciate that. But do you think that early diagnosis of
brain mets affects prognosis?

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...
> On Fri, 19 Mar 2004 19:30:11 +0100, [email hidden]
> (madiba) wrote:
>
> >BTW Tony please don't recommend PET scans to look for
> >brain mets in breast cancer, the usual FDG-PET is not
> >suitable for this. CT and MRI are much more reliable.
> >PET using amino acid tracers is ok but its

not

Quoted message said:

Quoted message said:

> >available everywhere and is still experimental.
>
> I generally don't recommend anything. However it was a
> PET scan that first picked up the two mets in Gloria's
> liver. We had to fight like anything to get Kaiser to
> do it. Our main medical consultant (yes, he's a real
> MD) pushed us to push Kaiser.
>
> Now perhaps PET doesn't work well with brain mets. I
> defer to your superior knowledge on that subject. But
> I'm very happy that we discovered the liver mets long
> before they would have shown up on a routine CT scan.
> - Tony
>

Tony, that begs the question, "Why"?

Because I love my wife and want to keep her around a
while, OK? - Tony

I appreciate that. But do you think that early diagnosis of
brain mets affects prognosis?

I'm sorry for not being clear. I was talking about the PET
scan that found her liver mets. And, yes, I think early
diagnosis was helpful controlling them. - Tony

--
Tony Lima /"\ ASCII ribbon campaign \ / against HTML mail X
and postings / \

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

On Sat, 20 Mar 2004 03:17:02 GMT, "Steph"
<[email hidden]> wrote:

>
>"Tony Lima" <[email hidden]> wrote in message
>"]news:[email hidden]...
>> On Fri, 19 Mar 2004 19:30:11 +0100,
>> [email hidden] (madiba) wrote:
>>
>> >BTW Tony please don't recommend PET scans to look
>> >for brain mets in breast cancer, the usual FDG-PET
>> >is not suitable for this. CT and

MRI

Quoted message said:

Quoted message said:

Quoted message said:

>> >are much more reliable. PET using amino acid
>> >tracers is ok but its

not

Quoted message said:

>> >available everywhere and is still experimental.
>>
>> I generally don't recommend anything. However it was
>> a PET scan that first picked up the two mets in
>> Gloria's liver. We had to fight like anything to get
>> Kaiser to do it. Our main medical consultant (yes,
>> he's a real MD) pushed us to push Kaiser.
>>
>> Now perhaps PET doesn't work well with brain mets. I
>> defer to your superior knowledge on that subject.
>> But I'm very happy that we discovered the liver mets
>> long before they would have shown up on a routine CT
>> scan. - Tony
>>
>
>Tony, that begs the question, "Why"?

Because I love my wife and want to keep her around a
while, OK? - Tony

I appreciate that. But do you think that early diagnosis
of brain mets affects prognosis?

I'm sorry for not being clear. I was talking about the PET
scan that found her liver mets. And, yes, I think early
diagnosis was helpful controlling them. - Tony

I'm glad you think that. But there isn't too much evidence
that it's true, unfortunately

Steph said:

I'm glad you think that. But there isn't too much evidence
that it's true, unfortunately

Steph, I think you should review your statistical
methodology texts. Any of them will discuss the fallacy of
projecting from population data to individual experience. In
our case detecting the mets earlier helped. It might not for
others. But we can say the same thing for virtually every
treatment that deals with any aspect of this disease.

My wife actually likes Taxol. Most people don't feel that
way. They like Gemzar. My wife had a very bad reaction to
it. Population averages don't nearly tell the whole story.
- Tony

--
Tony Lima /"\ ASCII ribbon campaign \ / against HTML mail X
and postings / \

On Sun, 21 Mar 2004 18:54:32 +0100, [email hidden]

(madiba) said:

This is a case in point, the PET scan caught the liver mets
and missed the brain mets. Prognosis goes downhill when all
sit back and feel safe because of high-tech diagnostics..

The PET scan was well over a year ago. The brain mets are
much more recent. - Tony

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On Sun, 21 Mar 2004 23:38:32 +0100, [email hidden]

(madiba) said:

Ok, maybe the brain mets were not there yet. More likely a
connection to her recent lung mets. Good luck with the RT
+ Temodar.

Thank you. I spent the day today learning about high-dosage
tamoxifen treatment and some interesting possibilities with
megase. - Tony

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and postings / \

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Steph said:

I'm glad you think that. But there isn't too much
evidence that it's true, unfortunately

Steph, I think you should review your statistical
methodology texts. Any of them will discuss the fallacy of
projecting from population data to individual experience.
In our case detecting the mets earlier helped. It might
not for others. But we can say the same thing for
virtually every treatment that deals with any aspect of
this disease.

My wife actually likes Taxol. Most people don't feel that
way. They like Gemzar. My wife had a very bad reaction to
it. Population averages don't nearly tell the whole
story.
- Tony

The point I was trying to make is that finding metastatic
disease early, even at an asymptomatic stage, makes no
difference to survival for most common cancers. Find mets
early, and start treatment: some patients will live longer
than the median, some shorter, but there is no way you can
know if this is anything to do with treatment. Some patients
will die from the side-effects of treatment, in fact, so
they certainly don't benefit.

I see and hear people clamouring for PET scans and other
expensive tests all the time, because there is a deep-seated
belief in most of us that fining recurrent or metastatic
disease "early" confers some benefit. Generally, it doesn't.

Steph said:

"Tony Lima" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Steph said:

I'm glad you think that. But there isn't too much
evidence that it's true, unfortunately

Steph, I think you should review your statistical
methodology texts. Any of them will discuss the fallacy
of projecting from population data to individual
experience. In our case detecting the mets earlier
helped. It might not for others. But we can say the same
thing for virtually every treatment that deals with any
aspect of this disease.

My wife actually likes Taxol. Most people don't feel
that way. They like Gemzar. My wife had a very bad
reaction to
it. Population averages don't nearly tell the whole
story.
- Tony

Quoted message said:

The point I was trying to make is that finding metastatic
disease early, even at an asymptomatic stage, makes no
difference to survival for most common cancers. Find mets
early, and start treatment: some patients will live longer
than the median, some shorter, but there is no way you can
know if this is anything to do with treatment. Some
patients will die from the side-effects of treatment, in
fact, so they certainly don't benefit.

I see and hear people clamouring for PET scans and other
expensive tests all the time, because there is a deep-
seated belief in most of us that fining recurrent or
metastatic disease "early" confers some benefit.
Generally, it doesn't.

This is a case in point, the PET scan caught the liver mets
and missed the brain mets. Prognosis goes downhill when all
sit back and feel safe because of high-tech diagnostics..

--
madiba