I urgently ask for your advice, experience or input regarding what my mom Should do. She is 60 y. And very fresh in body and mind.
She was dx with nsclc ardenocarcinoma Dec 12 2012 with mets to lymf, liver, brain. She had surgery early feb. Where she had a large tumor in the brain surgically removed. The 9 other mets she has in the brain are tiny, but they where not there in Dec. So they have progressed over the last two months... They are spread in various locations in the brain, 1 of them relatively close to the hippocampus.
I asked about hippocampus sparring but there is no hospital in denmark using the needed technology - linac based IMRT or helical tomotherapy. With the available technical wbr equipment, the hospital could avoid hippocampus but only if they would avoid quite a big surrounding area of the hippocampus... but one of the mets is in that exact avoidance zone..! So, not really an option...
The original plan was to do 30 GY over ten treatmens, but the doctor I spoke with today now suggest 30GY but spread over 18 tretaments over a 4 weeks span. In this way, he can lower the dose a bit given to the hippocampus.
My questions and concerns;
Is 30 GY spread over 18 treatments less or more efficient than 10 treatments or is the effectiveness the same?
She just only started chemo two weeks ago, carbo and vinorelbine, but now she has stopped treatment because she is advised not to take chemo while she is given wbr.
How Will it effect her lung cancer not having chemo for another month??
Why is chemo not advised during radiation?
She is overall doing well, no symptoms from the brain mets. Aft she started chemo two weeks ago she has been caughing sooo badly and with a lot of pflegm. Good or bad sign???
Oh, I really hope you can help me with my concerns. Just want to choose whats best for mom and with the highest likelihood of getting through this alive!
Kindest regards
Magdalena
Reply # - March 8, 2013, 05:40 AM
Reply To: Wbr effectiveness and chemo break consequence
The standard treatment for lung cancer spread to the brain is radiation. Real estate in the brain is very tight and the brain tolerates masses more poorly than any other spot in the body. So, controlling cancer in the brain is typically more urgent than the rest of the body and typically takes priority.
Hippocampal sparing radiation is a new idea in brain radiation to lower the incidence of neurocognitive problems from the radiation. While promising, I don't think that it's considered a proven new mandatory standard of care.
Generally, the brain is one of the "easier" spots to radiate from a technical perspective. I've never seen any good data to convince me that one brain fractionation is superior to another for efficacy.
Chemotherapy can sensitive cancer cells to die from radiation--that's why we intentionally give chemo at the same time as radiation in stage III lung cancer. Chemotherapy can also sensitize non cancer cells to die from radiation, so it can also increase radiation side effects. The current standard of care is to consider giving chemo with radiation when the radiation is potentially curative, but (usually) to avoid doing so when the radiation is not.
Reply # - March 8, 2013, 06:33 AM
Reply To: Wbr effectiveness and chemo break consequence
Magdalena,
There is no significant difference in the efficacy of the WBR given over 10 vs. 18 fractions. The role of hippocampal sparing is also not established, and this is not a standard approach, so I don't think you should fret that this isn't being done.
We can't say what the effect will be for holding chemotherapy during brain radiation, but that's definitively how most oncologists would proceed. The reason chemo is held is that chemotherapy can potentiate the efficacy of radiation wherever it's given, and there's a real concern that increasing the effect of the radiation in the brain could lead to cognitive side effects that we don't want to see.
Unfortunately, it's not possible for us to say what the coughing means. No clear rule here.
I think it could be important for you to read some of the information here about what treatment for metastatic lung cancer can achieve. It can be very hard to have expectations that our treatments simply can't achieve. Specifically, none of these interventions can realistically be expected to be curative, I'm sorry to say. This is really because lung cancer that has spread to multiple sites in the brain can't be eradicated with any of the treatments we know of today. Our treatments can prolong survival and ideally also reduce cancer-related symptoms, but I think it's important to know what our treatments can and can't do, so that people can make truly informed decisions about how to proceed.
Good luck.
-Dr. West
Reply # - March 8, 2013, 10:55 AM
Reply To: Wbr effectiveness and chemo break consequence
Hi Magdalena, Welcome to Grace. I'm so sorry your mom is going through this. I know how difficult it must be. As Dr. West suggested reading what's on this site will give you an excellent understanding. We have an extensive library of expert discussion on almost any topic you can think of in the realm of lung cancer. Spend some time clicking around and don't hesitate to ask for help finding information.
Our search feature is excellent though depending on your browser you may need to log out first.
There's no need to post the same question twice. We read new posts as they are added. If we don't get back to you within a day bump it up to the top by adding a post under your question, we sometimes do miss things.
I hope your mom does well for a long while,
Janine
forum moderator