Radiation FAQ

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Mohrfamily
Posts: 106
Joined: Tue May 22, 2018 4:04 pm

Radiation FAQ

Postby Mohrfamily » Thu Mar 28, 2019 4:44 am

As I mentally prepare for April 3rd I realize I have no idea what to expect with radiation. Granted its not guaranteed that we'll be approved for it but I'm curious about it. DHs oncologist seemed excited to refer is to an in house radiation Doc even though she was told it was a tricky case and needed to consult other doctors beforehand.

What's the most common side effects, is it/can it be as debilitating as chemo, what should we expect before, during, and after.....

Tell me everything you can
DH dx officially stage IV with liver mets largest measuring 6x6.4 cm
Colonoscopy/endoscopy/port place 5/29
4cm long mass in splenic flexure
1st round FolFox 5/30
08/2018 new CT no new lesions, clear lungs, slight decrease in colon.
3/2019 PET scan shows greater than 6-7 liver mets largest measuring 3x3 cm. No growth nothing new.
4/3/19 consult radiologist for possible radiation treatment.

Pyro
Posts: 230
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Radiation FAQ

Postby Pyro » Thu Mar 28, 2019 8:05 am

What are they radiating?
Aug 2015- Diag Stage 4 CC with mets to liver (38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not a surgery candidate for liver
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery, Dr. Vauthey
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda, CEA @36, treatment failure

Mohrfamily
Posts: 106
Joined: Tue May 22, 2018 4:04 pm

Re: Radiation FAQ

Postby Mohrfamily » Thu Mar 28, 2019 10:11 am

Pyro wrote:What are they radiating?


The bigger spots on his liver.
DH dx officially stage IV with liver mets largest measuring 6x6.4 cm
Colonoscopy/endoscopy/port place 5/29
4cm long mass in splenic flexure
1st round FolFox 5/30
08/2018 new CT no new lesions, clear lungs, slight decrease in colon.
3/2019 PET scan shows greater than 6-7 liver mets largest measuring 3x3 cm. No growth nothing new.
4/3/19 consult radiologist for possible radiation treatment.

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O Stoma Mia
Posts: 1600
Joined: Sat Jun 22, 2013 6:29 am

Re: Radiation FAQ

Postby O Stoma Mia » Thu Mar 28, 2019 10:15 am

What type of radiation are you talking about? If it is some kind of internal radiation therapy (e.g, brachytherapy), then you can read about it and its effects in the first article below. if it is a different kind of radiation therapy, then you can click on one of the other links on the left-hand side of the page of this article:

https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/internal-radiation-therapy-brachytherapy.html


https://www.macmillan.org.uk/information-and-support/treating/radiotherapy/internal-radiotherapy-explained/brachytherapy.html

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ginabeewell
Posts: 196
Joined: Wed Oct 24, 2018 10:30 am

Re: Radiation FAQ

Postby ginabeewell » Thu Mar 28, 2019 11:31 am

My doctor told me that the HAI pump would not be an option for me if I did radiation. Have you asked about that? It’s practically only by chance that we found out!
45 year old mom of twins (7) and lucky stepmom of 13 and 16 year olds
9/17/18 DX stage 4 CRC w inoperable liver mets (largest 11 cm)
9/20/18 CEA 931
10/1/18 FOLFOX + Vectibix planned 12 rounds
12/12/18 Routine scan showed typhlitis (7 days in hospital) but largest met down to 5 cm. Chemo holiday.
12/26/18 CEA 4.6
1/14/18 Resume chemo (#6-8)
3/27/19 Surgery: HAI pump placement / colon resection
4/8/19 Resume chemo (#9-12) FOLFOX (no OX) + Vectibix
5/20/19 CEA 1.3
Late summer: liver resection hopefully

User avatar
texmexflute
Posts: 9
Joined: Mon Dec 31, 2018 9:59 pm
Location: Dallas, Texas

Re: Radiation FAQ

Postby texmexflute » Thu Mar 28, 2019 11:39 am

I had SBRT to 2 liver mets in January. The tumor board thought this was a better way to get to the mets that were deep and tricky. They were around 2.5 cm each. The easiest to reach was done in one session that lasted about an hour and a half. The other had a different approach so they did in 3 fractions with a lower dose. The challenge during treatment for most with this is that you breathe in, hold for 20-30 sec. then breathe out. I'm a musician (flutist) so this was no big deal. Afterwards there weren't really side effects other than tiredness and a little nausea. I also didn't really want to eat, but I was still coming off of liver resection the month before and had not yet regained my appetite.
62 yo Male (polio survivor) DX 2-2018
2-18 right hemi-colectomy (robotic/minimally invasive)
Stage 3b - T4N1Mx
3-18 thru 8-18 xeloda
9-18 scans indicate 4 liver mets
and possibly in omentum/peritoneum
Upgraded to stage 4
9-18 thru 11-18 4 rounds Folfiri + Avastin, 2 rounds Folfiri only
12-26-18 3 liver mets removed (robotic/minimally invasive) + omentum biopsy (no cancer)
1-19 SBRT remaining 2 liver mets that were hard to reach
2-19 begin 6 rounds of mop-up chemo but folfox this time

Pyro
Posts: 230
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Radiation FAQ

Postby Pyro » Thu Mar 28, 2019 11:57 am

Is HIPEC worth it? It’s been around long enough now to be studied.

https://www.onclive.com/conference-cove ... vanced-crc
Aug 2015- Diag Stage 4 CC with mets to liver (38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not a surgery candidate for liver
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery, Dr. Vauthey
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda, CEA @36, treatment failure

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juliej
Posts: 2974
Joined: Thu Aug 05, 2010 12:59 pm

Re: Radiation FAQ

Postby juliej » Thu Mar 28, 2019 3:42 pm

ginabeewell wrote:My doctor told me that the HAI pump would not be an option for me if I did radiation. Have you asked about that? It’s practically only by chance that we found out!

Agree with Gina! Radiation could eliminate the possibility of getting HAI treatment, so I'd think long and hard about that.

Intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) are two types of radiation performed on liver tumors. IMRT is used when the tumors are close to critical organs or tissue. First they map your tumor in 3-D, then you have multiple sessions of radiation (commonly, five days a week for several weeks). With IMRT the radiation beam is shaped to the exact dimensions of your tumor so there's less collateral damage to the surrounding healthy tissue.

Stereotactic body radiation therapy (SBRT) combines IMRT and image-guided radiotherapy. They implant tiny markers into your tumor and use a CT scanner to guide the radiation to the tumor site. SBRT takes fewer sessions than IMRT (usually five or less).

texmexflute is right - SBRT requires "respiratory gating" - which is a fancy term for delivering radiation only at certain points in your breathing cycle. Holding your breath keeps the tumor from moving around when you're receiving radiation to minimize exposure to healthy tissue.

Have they mentioned RFA? Or is the tumor too large for it? RFA doesn't involve radiation so it leaves open the possibility of an HAI pump later on if he needs it.

Hope this helps!
Juliej
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 3/18/2019, CEA<1

Mohrfamily
Posts: 106
Joined: Tue May 22, 2018 4:04 pm

Re: Radiation FAQ

Postby Mohrfamily » Fri Mar 29, 2019 4:49 am

All good information. Julie you really got specific which I'm grateful for. We don't know what if there even are radiation options yet so I can't be sure what the "plan" is per say but its given me a lot of questions to ask.
DH dx officially stage IV with liver mets largest measuring 6x6.4 cm
Colonoscopy/endoscopy/port place 5/29
4cm long mass in splenic flexure
1st round FolFox 5/30
08/2018 new CT no new lesions, clear lungs, slight decrease in colon.
3/2019 PET scan shows greater than 6-7 liver mets largest measuring 3x3 cm. No growth nothing new.
4/3/19 consult radiologist for possible radiation treatment.


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