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Re: Chemo and Radiation

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Hi :

When my mom was first diagnosed and radiation was discussed she was

advised that Camptosar and radiation could not be given concurrently

and that radiation would hold up the chemo " a bit " . If she had been

a candidate I would have preferred the radiation option, but as it

turned out the area was too large and too close to healthy remaining

bowel for her to be considered a candidate at that time. So I can't

really help you with any info on that front.

Camptosar is the drug my mom is on with Leucovorin and 5FU. For some

it can be rough, causing diarrhea and vomiting. Often diarrhea can

be controlled if Immodium is taken with the first loose stool, and

then as directed afterward. My mom's onc said that the percentage of

people experiencing very difficult side effects was about ten

percent, and rough side effects were more serious in the above 70

population, according to research.

My mom, knock on wood, has been able to maintain a very good quality

of life so far on Camptosar. She was to take it for four weeks on

and two off, but because of blood counts (low white blood counts) the

onc decided to move her to a one week, one off regime. Not exactly

standard protocol, and to tell the truth, I do worry she is getting

less medication this way, but she is tolerating her treatments quite

well. And because she is Stage 4 her quality of life is so

important, so we're reluctant to mess with what seems to be a good

thing.

I do not have much to add on Oxaliplatin. There are so many here who

have posted on it.

I'm happy to hear that your dad is planning to go for more aggressive

treatment. Some physicians still recommend only leucovorin and 5FU

with Stage III, but from all accounts I've read, more aggressive

treatment results in better overall outcome. You have lots of good

reason to be very hopeful! I know posted quite a bit on this

topic in the past. Have you checked the archives? If not, I'll

have a look back for specific articles for you.

I wish your dad and your family all the best with these decisions.

He's so lucky to have you looking after his interests. Keep the

faith.

Warm regards,

Laurie

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- As others have said, radiation therapy only is useful for

treatment of tumor within the radiation " field " . The area treated is

usually a fairly small, because radiation can damage normal tissue

as well as tumor tissue. Normal tissue usually can repair the damage

more efficiently that tumor tissue, but there are limits to this.

Some organs such as intestines are more easily damaged than others.

That is why radiation oncologists go to such pains to tailor the area

radiated so that as little normal tissue as possible is included.

That is where the technique that Cliff describes comes in. Varian is

the name of a brand of radiation therapy machine. Some of the newer

models of this brand, when used in conjunction with more

sophisticated computer treatment planning systems, allow the area

radiated to be more precisely regulated to spare more normal tissue

than previously available equipment. This is sometimes called

IMRT, short for Intensity Modulated Radiotherapy. There are other

brands of machines that have similar capabilities.

Although 5-FU is a chemotherapy drug that can kill cancer cells on

its own, it has been used in conjunction with radiation therapy for a

number of years because it also acts as a radiosensitizer. This

means that it enhances the damage that radiation does to the tumor.

CPT-11 also is a bit of a radiosensitizer, but I don't believe that

the degree of effect is as well known since it is a newer drug. I

believe the reluctance to treat when this is given as well, since

normal tissues may also be sensitized by these drugs.

They do radiation therapy on rectal carcinomas, because there is less

normal intestine in the pelvis, and radiation can shrink a rectal

tumor so that surgeons can more easily remove it in the tight

confines of the pelvis.

When I received pre-op radiation therapy for my rectal Ca, my

radiation oncologist told me that there was a 5% chance of developing

a stricture of small intestine that might get in the radiation

treatment field. I developed a stricture that was eventually

surgically removed. Whether it was because I was recieving CPT 11 as

well as 5-FU, or bad luck, or because I had difficulty having a full

urinary bladder during radiation therapy because of the CPT 11

induced diarrhea is uncertain. (They ask you to come in with a full

urinary bladder for radiation of the rectal region, because the full

bladder displaces small intestine further from the radiation treated

area. The urinary bladder is not as likely to be damaged by the

radiation as the small intestine. )

Hope this helps answer some questions.

Best wishes for a sucessful treatment,

Kris

> Hi again :

>

> Interesting that others note they did do the radiation along with

the

> chemo. I specifically remember that my mom was advised that

> radiation would hold up her chemo. Maybe 5-FU doesn't hold it up

> (Xeloda is the oral form of it), but Camptosar does. Or maybe its

> just that in this fine balance, every case is looked at

individually.

>

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Cliff,

Would you please be so kind as to tell me the name and location of

the radiologist who said he COULD do radiation to lymph nodes. My

sister has node metastasis and I am having extreme difficulty in

finding any doctor willing to treat it. I would really appreciate

if you could tell us who this wonderful radiologist is.

Thanks so much,

Deb

> I asked my wonderful radiation doctor if they can do the "

newer "

> radiation to lymph nodes and he replied that they could. I had the

> Varian radiation done in the spring of 2000 for inoperable liver

mets.

> It is three years for my friend who had the same treatment for a

15 cm

> ...small grapefruit size liver met. She had no chemo afterwards

and we

> both had no side effects. I would ask your onc about this newer

> radiation and chemo. We all respond differently to chemo and

radiation.

> It's good to get as many different options as possible. Hope this

helps.

> Take care and God bless. Cliff . . " It is not because things are

> difficult that we do not dare; it is because we do not dare that

they

> are difficult. " Lucius eus Seneca . . " ALL things are

possible.

> Pass it on. "

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Cliff,

Would you please be so kind as to tell me the name and location of

the radiologist who said he COULD do radiation to lymph nodes. My

sister has node metastasis and I am having extreme difficulty in

finding any doctor willing to treat it. I would really appreciate

if you could tell us who this wonderful radiologist is.

Thanks so much,

Deb

> I asked my wonderful radiation doctor if they can do the "

newer "

> radiation to lymph nodes and he replied that they could. I had the

> Varian radiation done in the spring of 2000 for inoperable liver

mets.

> It is three years for my friend who had the same treatment for a

15 cm

> ...small grapefruit size liver met. She had no chemo afterwards

and we

> both had no side effects. I would ask your onc about this newer

> radiation and chemo. We all respond differently to chemo and

radiation.

> It's good to get as many different options as possible. Hope this

helps.

> Take care and God bless. Cliff . . " It is not because things are

> difficult that we do not dare; it is because we do not dare that

they

> are difficult. " Lucius eus Seneca . . " ALL things are

possible.

> Pass it on. "

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