Radiation: Question for Steph

Discussion in 'Health and medical' started by Tony Lima, Mar 17, 2004.

  1. Tony Lima

    Tony Lima Guest

    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
     
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  2. Steph

    Steph Guest

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

    Tony Lima Guest

    On Wed, 17 Mar 2004 05:16:30 GMT, "Steph"
    <[email protected]> wrote:

    >
    >"Tony Lima" <[email protected]> wrote in message
    >news:[email protected]...
    >> 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 / \
     
  4. J

    J Guest

    Steph wrote:

    > "Tony Lima" <[email protected]> wrote in message
    > news:[email protected]...
    > > 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
     
  5. Steph

    Steph Guest

    "Tony Lima" <[email protected]> wrote in message
    news:[email protected]...
    > On Wed, 17 Mar 2004 05:16:30 GMT, "Steph"
    > <[email protected]> wrote:
    >
    > >
    > >"Tony Lima" <[email protected]> wrote in message
    > >news:[email protected]...
    > >> 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, 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
     
  6. Madiba

    Madiba Guest

    Tony Lima <[email protected]> wrote:

    > On Wed, 17 Mar 2004 05:16:30 GMT, "Steph"
    > <[email protected]> wrote:
    >
    > >
    > >"Tony Lima" <[email protected]> wrote in message
    > >news:[email protected]...
    > >> 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
     
  7. Madiba

    Madiba Guest

    madiba <[email protected]> wrote:

    > Tony Lima <[email protected]> wrote:
    >
    > > On Wed, 17 Mar 2004 05:16:30 GMT, "Steph"
    > > <[email protected]> wrote:
    > >
    > > >
    > > >"Tony Lima" <[email protected]> wrote in message
    > > >news:[email protected]...
    > > >> 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
     
  8. J

    J Guest

    madiba wrote:

    > Tony Lima <[email protected]> wrote:
    >
    > > On Wed, 17 Mar 2004 05:16:30 GMT, "Steph"
    > > <[email protected]> wrote:
    > >
    > > >
    > > >"Tony Lima" <[email protected]> wrote in message
    > > >news:[email protected]...
    > > >> 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
     
  9. Tony Lima

    Tony Lima Guest

    On Fri, 19 Mar 2004 19:30:11 +0100, [email protected]
    (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 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 / \
     
  10. Steph

    Steph Guest

    "Tony Lima" <[email protected]> wrote in message
    news:[email protected]...
    > On Fri, 19 Mar 2004 19:30:11 +0100, [email protected]
    > (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 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"?
     
  11. Madiba

    Madiba Guest

    Tony Lima <[email protected]> wrote:

    > On Fri, 19 Mar 2004 19:30:11 +0100, [email protected]
    > (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 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
     
  12. Tony Lima

    Tony Lima Guest

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

    >
    >"Tony Lima" <[email protected]> wrote in message
    >news:[email protected]...
    >> On Fri, 19 Mar 2004 19:30:11 +0100, [email protected]
    >> (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 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 / \
     
  13. Steph

    Steph Guest

    "Tony Lima" <[email protected]> wrote in message
    news:[email protected]...
    > On Sat, 20 Mar 2004 03:17:02 GMT, "Steph"
    > <[email protected]> wrote:
    >
    > >
    > >"Tony Lima" <[email protected]> wrote in message
    > >news:[email protected]...
    > >> On Fri, 19 Mar 2004 19:30:11 +0100, [email protected]
    > >> (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
    > >> >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?
     
  14. Tony Lima

    Tony Lima Guest

    On Sun, 21 Mar 2004 00:09:09 GMT, "Steph"
    <[email protected]> wrote:

    >
    >"Tony Lima" <[email protected]> wrote in message
    >news:[email protected]...
    >> On Sat, 20 Mar 2004 03:17:02 GMT, "Steph"
    >> <[email protected]> wrote:
    >>
    >> >
    >> >"Tony Lima" <[email protected]> wrote in message
    >> >news:[email protected]...
    >> >> On Fri, 19 Mar 2004 19:30:11 +0100, [email protected]
    >> >> (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
    >> >> >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 / \
     
  15. Steph

    Steph Guest

    "Tony Lima" <[email protected]> wrote in message
    news:[email protected]...
    > On Sun, 21 Mar 2004 00:09:09 GMT, "Steph"
    > <[email protected]> wrote:
    >
    > >
    > >"Tony Lima" <[email protected]> wrote in message
    > >news:[email protected]...
    > >> On Sat, 20 Mar 2004 03:17:02 GMT, "Steph"
    > >> <[email protected]> wrote:
    > >>
    > >> >
    > >> >"Tony Lima" <[email protected]> wrote in message
    > >> >news:[email protected]...
    > >> >> On Fri, 19 Mar 2004 19:30:11 +0100,
    > >> >> [email protected] (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
    > >> >> >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
     
  16. Tony Lima

    Tony Lima Guest

    On Sun, 21 Mar 2004 05:29:43 GMT, "Steph"
    <[email protected]> wrote:

    >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 / \
     
  17. Tony Lima

    Tony Lima Guest

    On Sun, 21 Mar 2004 18:54:32 +0100, [email protected]
    (madiba) wrote:

    >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

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

    Tony Lima Guest

    On Sun, 21 Mar 2004 23:38:32 +0100, [email protected]
    (madiba) wrote:

    >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

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

    Steph Guest

    "Tony Lima" <[email protected]> wrote in message
    news:[email protected]...
    > On Sun, 21 Mar 2004 05:29:43 GMT, "Steph"
    > <[email protected]> wrote:
    >
    > >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.
     
  20. Madiba

    Madiba Guest

    Steph <[email protected]> wrote:

    > "Tony Lima" <[email protected]> wrote in message
    > news:[email protected]...
    > > On Sun, 21 Mar 2004 05:29:43 GMT, "Steph"
    > > <[email protected]> wrote:
    > >
    > > >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.

    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
     
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