Some Comments re Radiation vs Chemo

[Guest guest]

Hi Jim and All,

Thought I would throw out a few ideas here to see what others may

think.

I have spinal metastasis to the L4 vertabrae...I guess size is 4 cm

or so. The size is not nearly so important as the physical location,

which for me is such that it is actually pressing on the

spinal column and causing " weakness " when I walk. So I have little

choice in deciding what to do - I must attempt some sort of

treatment SOON to stop/delay possible side effect of paralysis.

From all I have heard, surgery is not a " common " treatment for spinal

metastasis. Guess it is somewhat risky, and the likelihood of NEW

spinal mets arising kind of high. So they seem to avoid this route

if others are available (and I have not seriously pursued it).

According to the radiation oncologist, radiation is not as effective

against colon cancer tumors as it may be among solid tumors deriving

from different cancer types. She says the radiation I receive

will " likely HALT FURTHER deterioration of the L4 vertabrae " , but MAY

NOT reverse damage which has already occurred. For what it's worth,

she puts the probability of DAMAGE REVERSAL at around 60-70%.

So while I'll certainly do the radiation (in hopes it " works " better

than she claims - and what choice do I have?!), I did not regard this

as the most positive of news.

Were there a higher chance of reducing tumor size by chemotherapy

BEFORE doing radiation, for my own case it might make sense to

attempt that first. But my oncologist AND radiation oncologist both

agree that radiation would have a better chance of stopping/reversing

the existing damage - with the added advantage of finding out sooner

what it can do. If radiation is going to work,it will

be " immediate " (e.g. during the time it is given). Chemo seems to

take awhile longer to determine its actual effect (weeks, months?).

Plus, chemo is KNOWN NOT to " work " as well (e.g. reduce tumor size,

as opposed to stop tumor growth) for patients who have already had

some type of prior chemo. I have been on Xeloda for 3 cycles now,

which I do believe has stopped growth of several " large " tumors on my

back. So my only chemo option would be to add in Oxaliplatin to the

current regemin. I was hoping to delay this addition of Oxal until

later - when perhaps I could get Avastin to take along with it

(thereby improving its effectiveness). But that could be MONTHS,

which I do not have time to wait!

In your brother's case, the urgency does not sound as high as it does

for my own (due to my existing spinal damage). Am I correct in that

there is no current concern about spinal damage, and your brother's

met is NOT causing him " severe pain " ? If true, I can sort of see why

his oncologist might prefer to start treatment with chemo followed by

radiation if needed, rather than just radiation. If his current

chemo regimen is not working (seems to be the case if L4 tumor has

doubled in size), it would clearly be a good thing could they

discover a NEW chemo/trial to shrink his existing tumor and hopefully

halt/delay the progression of NEW tumors. But if he does radiation

first and it works, they will not let him into the clinical trial!

HOWEVER, going the chemo route, I would surely INSIST on a very

careful monitoring of tumor size to make sure things are not getting

out of hand. Once tumors grow, it does not appear " easy " to shrink

them again(!!!)

As we've noted here, the oncs all seem to have different ideas and

approaches, and it's difficult to always say what " should " be done.

The idea of " treating to the urgency " does make sense to me and might

be what is happening for your brother. Perhaps a " second opinion "

from a different oncologist (and directly from a radiation

oncologist!) might be in order and put your mind more at ease?

Hope this helps!

Best Wishes,

> Hello, I'm new to group but have been monitoring messages for some

> time now.

>

> My Brother (45) dx with colon cancer on 7/03, 13 out 13 lymph nodes

> involved, met to a nodal area near L4. He has went through 6 cylces

> of CPT-11 Xeloda. His CEA dropped from 20 prior to surgery down to

> 1.6 then his last CEA count went to 11.9, his last scans showed the

> tumor near the L4 has doubled in size (5cm), but no spread to liver

> or lungs. Onc wants to switch to phase III trail using oxaliplatin

> w/ 5FU, PTK787/ZK. Onc did not want to do radiation, until after

the

> oxaliplatin treatment. Has any one had experience with this? Can

> surgery remove his L4 tumor?

>

> Any response would be appreciated.

>

> Thanks,

> Jim

[Guest guest]

Hi Jim-

I just was reading your post and I got the impression that the

metastatic lesion was in the node next to L4 rather than in the

spine. In general, most surgeons feel that if tumor has spread to

nodes not immediately adjacent to the tumor, that the chances of

achieving a cure with surgery are small and therefore not worth the

debilitation that surgery may cause.

A while ago there was a discussion about whether, if there were only

a very few lymph nodes involved, whether an aggressive surgeon would

consider operating. I think it came up that had asked

Sugarbaker about this and from what I recall he said maybe in a few

selected cases it could be considerd? I developed lymph node

involvement along my spine after aggressive surgery by Dr. Sugarbaker

for peritoneal metastatic disease. Because multiple nodes were

involved, there was not a chance that I would have been a surgical

candidate, but, perhaps with one???

I had radiation therapy for my involved lymph nodes only because I

was in a great deal of pain because of them, and my oncologist was

convinced that I would not respond again to oxaliplatin, because the

lymph node involvement had recurred in so short an interval from when

I had previously had oxaliplatin. Radiation did control my pain

fairly quickly, but I developed more metastatic lesions outside the

radiation treatment field during my treatment.

I ended up going back on oxaliplatin again anyway and responded very

well, so, in hindsight, the radiation was probably not as appropriate

as it seemed at the time.

is right that radiation therapy is the way to go for spinal

metastasis with danger of nerve damage, because of the more certain

likelihood of quick reponse.

Best wishes,

Kris

> > Hello, I'm new to group but have been monitoring messages for

some

> > time now.

> >

> > My Brother (45) dx with colon cancer on 7/03, 13 out 13 lymph

nodes

> > involved, met to a nodal area near L4. He has went through 6

cylces

> > of CPT-11 Xeloda. His CEA dropped from 20 prior to surgery down

to

> > 1.6 then his last CEA count went to 11.9, his last scans showed

the

> > tumor near the L4 has doubled in size (5cm), but no spread to

liver

> > or lungs. Onc wants to switch to phase III trail using

oxaliplatin

> > w/ 5FU, PTK787/ZK. Onc did not want to do radiation, until after

> the

> > oxaliplatin treatment. Has any one had experience with this? Can

> > surgery remove his L4 tumor?

> >

> > Any response would be appreciated.

> >

> > Thanks,

> > Jim