NSCLC adeno stage IV mets to hips, why radiation is only for addressing pain

Portal Forums Radiation Oncology General Radiation Oncology NSCLC adeno stage IV mets to hips, why radiation is only for addressing pain

This topic contains 7 replies, has 4 voices, and was last updated by  Dr. Ben Creelan 4 years, 6 months ago.

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May 22, 2013 at 5:50 pm  #1256647    

karenk

First time user….here goes my stats and questions|

7/2008 Right middle lobectomy stage 3 adeno
8/2008 cycsplastin and vp16 (sp?) AND radiation together
4/2012 biopsy to right lung – new growth and plueral eff with cancer cells
5/2012 positive for ALK, started Xalkori
11/2012 sigmoid colon resection – second primary colon cancer adeno no penetration thru colon wall – stage2
3/2013 pain to left hip
4/2013 pain in left hip
5/2013 PET showing mets to both hips…..now stage 4…still on Xalkori

I am scheduled to see radiation oncologist end of this month to start radiation for the purpose of pain relief.

A few questions:

1.) Why is radiation only for pain rather than killing all the cancer cells in my hips? Is the thought that the cancer is already in my blood to “travel” to my hip area and killing all the cancer cells in the hips will not impact length of life?

2.) I know there is a limit to how much radiation one area of your body can receive in a lifetime. Is there a total body amount of radiation limit?

3.) Would there be any benefits to using stereotactic body radiation vs. traditional radiation to my hips? A friend of a friend with my type cancer with mets to left hip went to Univ of Fla Proton Therapy Inst and SBRT was used.

Thank you for your time and insight!!!

Karen

May 22, 2013 at 8:24 pm  #1256656    
JimC Forum Moderator
JimC Forum Moderator

Hi Karen,

Welcome to GRACE. I’m sorry to hear of your diagnosis, progression and second diagnosis, but it’s good that you have found this site, where you will find much good information as well as support.

You pretty much answered your first question. Though the main purpose of radiation to bone mets is relief of pain or other symptoms, it is an attempt to kill as many cancer cells there as possible in order to accomplish that goal. But it’s not a case of killing the cells there in an attempt to eradicate all cancer in the body, precisely for the reason you mention – it is already in the bloodstream and can show up somewhere else.

There isn’t really a lifetime limit, but even if there were, the focused radiation directed to a particular part of the body targets such a small area that the local limit is much more significant.

Proton beam and SBRT are used in situations where extremely finely focused radiation is necessary to avoid damage to surrounding tissues. Standard radiation is more than adequate unless such conditions exist.

I hope your radiation brings rapid pain relief.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

May 22, 2013 at 10:35 pm  #1256665    
Dr West
Dr West

Jim provided a great answer to your questions, and I really don’t have anything to add to those great explanations. In particular, there is no added value to proton beam, SBRT, or very focal radiation therapy for palliative therapy for metastatic lesions, since standard radiation therapy does the job perfectly well.

-Dr. West

May 23, 2013 at 4:10 am  #1256675    

karenk

Dear Jim and Dr. West,

Thank you so much for your replies. I truly appreciate this site!!!!!

Karen

May 23, 2013 at 6:09 pm  #1256707    

karenk

Not sure if you will see this question… On my first writing above I mention a friend of a friend who had SBRT to the hip vs. traditional radiation. I learned today, it was actually SBRT for the mets cancer in lymph nodes in the hip area. (So not to the hip bone as I originally thought.)

Does that make a difference in your above feedback?

Thank you,
Karen

May 23, 2013 at 7:56 pm  #1256716    
Dr West
Dr West

No. Focal radiation really doesn’t have any clear place in treating mets, unless it’s for an area that was previously radiated, is in close proximity to some critical structure at risk for over-treatment with radiation, or some other extenuating circumstance. Sometimes these approaches are used a little gratuitously for financial reasons rather than for solid medical reasons.

-Dr. West

May 25, 2013 at 8:27 am  #1256739    

karenk

Dr. West, thank you again! This site is such a blessing! Navigating through all of this doctor/trearment/decisions etc. can be overwhelming for those of us not typically in the medical world and this sight certainly allows us to learn along the way and have more information!!! And truly appreciate your candor!

Hope you have a wonderful weekend.

Karen

May 28, 2013 at 6:03 pm  #1256832    

Dr. Ben Creelan

I agree with the above, and I would also add that excessive doses of pelvic radiation may impair your bone marrow’s reserve to handle traditional chemotherapy in the future. Now, I have heard of some investigators, like Dr Ross Camidge, use select high-dose radiation for a single bone met that appears after a long disease-free interval in ALK+ patients. There is no solid evidence for this, but it does make some scientific sense. The idea is that this is a single cell clone that is ALK-resistant, and just needs to be culled out. However, it sounds like your disease is on both sides of the pelvis. Most of the bone marrow in adults is in the hips, and so heavy doses of external beam radiation (>50 Gy) directly to this area can decrease your bone marrow reserve. It would be a shame if you could not tolerate chemotherapy in the future, simply because we zonked your bone marrow for a fanciful idea.
So without solid evidence, I would view the approach of ‘curative’ external beam radiation directly to the bilateral pelvic bones as short-sighted.

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