Why not targeted radiation?

Portal Forums Radiation Oncology Brain Metastases / PCI Why not targeted radiation?

This topic contains 10 replies, has 5 voices, and was last updated by  knic 2 years, 8 months ago.

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March 5, 2015 at 9:33 am  #1268737    

knic

Well dads spread to brain is confirmed. He has 2 mets one smaller and one larger. They are treating with whole brain radiation I don’t understand why not targeted radiation?

He has squamous nsclc and is going to be treated with 5 wbr that doesn’t seen much?

March 5, 2015 at 1:05 pm  #1268743    
catdander forum moderator
catdander forum moderator

Hi knic,

It’s not possible for our faculty to guess about someone’s oncologist’s decision making process.

Dr. Loiselle wrote an informative post on the subject that starts, “For non-small cell lung cancer patients with multiple brain metastases, the standard approach of whole brain radiotherapy is not necessarily standard for each and every patient. Each patient’s specific situation may sometimes be best approached with various combinations of surgery, radiation, medical/systemic therapy, and non-cancer directed treatment.

The best course of treatment depends on many factors. Key aspects of a patient’s situation include age, how well the patient is doing in general, whether they have other sites of metastasis other than the brain (and whether those sites harbor active cancer), how extensive the brain metastases are in size and number, and whether they are experiencing symptoms” http://cancergrace.org/lung/2011/09/11/brain-metastases-in-lung-cancer-still-room-to-personalize-care/

The best way to know what the oncologist is thinking is to ask him/her personally. If your not comfortable after that a second opinion at a major teaching hospital may be in order. However brain mets can cause difficult symptoms and care sooner than later may also be important.

All best,
Janine

March 6, 2015 at 9:49 am  #1268755    

knic

Thank you for your reply. I know you cannot give information or speculate on my dads situation but I was wondering if anyone knew about the dose of WBR? Is it possible to have more then one of this in the future? 5 doses seems a very small amount considering what I have researched and was wondering why sometimes smaller doses are given and if it would even be beneficial.

March 6, 2015 at 11:19 am  #1268758    

cards7up

knic,you didn’t mention that dosage amounts or sizes here as you did on Inspire. This might be helpful.
Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

March 6, 2015 at 12:43 pm  #1268763    

knic

Thank you Judy I didn’t even realise x

The 2 mets appear to be one acorn size and one a small dot like a pen mark. They are treating over 5 days so I assume only 5 sessions.

March 6, 2015 at 1:40 pm  #1268764    
catdander forum moderator
catdander forum moderator

knic, I’ve got word out for our radiation onc to comment but as you can imagine he’s very busy and not unusual to take a day or more to respond. Radiation dose measurement are given in “Grays” or GY and different amounts can be given at one session.

Further reading to help understand what’s happening (and maybe help explain what’s happening in your dad’s case can be found in the links below. The second link being the one also posted in the first link.

http://cancergrace.org/radiation/2013/05/05/dr-scott-on-wbrt/

http://cancergrace.org/radiation/files/2013/05/WBRT-review-from-Scott.pdf

Janine

March 7, 2015 at 10:34 am  #1268777    
catdander forum moderator
catdander forum moderator

knic, Just checking in to see if you’ve spoken to your dad’s radiation oncologist or had a second opinion. I’m pretty sure we can have Dr. West comment today.

All best,
Janine

March 7, 2015 at 10:51 am  #1268778    

knic

Hi Janine

No have not been able to seem any advice or clarity needed. Dr wests opinion would be very much appreciated and I really am greatful for your help.

March 7, 2015 at 5:12 pm  #1268783    
JimC Forum Moderator
JimC Forum Moderator

Hi knic,

Just to clarify: whole brain radiation can be given in varying numbers of sessions at larger or smaller doses per session. For example, 5 sessions of 9 GY (or “Gray”) each is the same total amount of radiation as 15 sessions of 3 GY each. In Europe it is not unusual to see WBR given over the shorter time period, but that doesn’t necessarily mean a lower amount of radiation.

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

March 7, 2015 at 9:42 pm  #1268784    
Dr West
Dr West

Right. What Jim is describing is the concept of “biologically equivalent dose” (BED) in radiation, which is a product of both the number of treatment sessions, or “fractions”, and the dose per fraction. In fact, when treatment is given over fewer fractions, a lower absolute dose is used to reach an equivalent BED. So it’s actually not that you give 6 Gray (the basic unit of dosing radiation, abbreviated Gy) x 5 fractions to get the same BED as 3 Gy each x 15 fractions, but rather maybe 5 fractions x 3 Gy per fraction to equal the BED of 15 fractions of 2 Gy each.

As Jim indicated, the practice differs in different health care systems. WBR administered over 10-15 fractions is common (especially 15 fractions, 3 weeks of Mon to Fri) in the US, but in Europe as well as Canada, it’s pretty standard to give WBR over just 5 fractions in a single week. There’s a higher risk of acute side effects like headache, fatigue, and perhaps transient cognitive problems, but efficacy is more similar than different across the different common schedules.

You can learn more about brain radiation in this podcast:

http://cancergrace.org/radiation/2011/04/29/dr-minesh-mehta-radiation-oncologist-on-prevention-treatment-of-brain-metastases/

Good luck.

-Dr. West

March 8, 2015 at 11:49 pm  #1268818    

knic

Thank you all for taking the time to help.

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