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Ask The Expert Archive

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Radiation Oncology Archive Questions

Below are Dr. Feigenberg’s answers to Radiation Oncology questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 16.

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Q : 1

My mother-in-law underwent a lumpectomy and needs to start radiation therapy. She is specifically interested in the prone radiation therapy. Do you offer that as an option for breast cancer radiation?

We do offer prone radiotherapy for those whom we feel it is appropriate. The greatest benefit is seen in patients who have a large breast size with a lot of skin folds. Additionally, the tumor bed needs to be away from the chest wall and the patient needs to be node negative.

Q : 2

Is there a maximum number of brain mets that can be treated using the RapidArc?

If the patient already had failed whole brain RapidArc--which is a method to deliver IMRT more swiftly--RapidArc can be used to just treat the tumors. I have treated a few patients with this approach who had more than 20 metastases.

Q : 3

What is the frequency for treatment with EBRT using the Calypso platform? How long is each session?

Typically it is a 5 day per week treatment and each treatment is between 5 to 20 minutes. Depending on the complexity of your specific anatomy or the type of radiation planning used, you are in the office for approximately 30 minutes a day. The number of treatments is around 40 sessions.

Q : 4

Can you explain the loss of taste after treatment? How long does it take to come back?

Taking zinc two times a day works for some patients, but it can take some time and it may not completely return depending on the dose and what areas of the tongue received the treatment. Cancers of the oral tongue (the movable tongue) can be the worst because it hits all four senses. Taste can also change permanently as a result of changes in saliva production. I often warn patients that their favorite foods may change.

Q : 5

Is it safe to get the lymph nodes radiated with radiation therapy for prostate cancer if the nodes don't show swollen on the CT scan? Will it cause a problem if it does?

Treating the lymph nodes with radiation does increase the side effect profile by increasing the dose to the small and large bowel. The side effects are very different from facility to facility depending on their technique and experience. Using some of the fancier techniques such as Intensity modulated radiotherapy(IMRT), image guidance (IGRT) and using new particles such as protons, allows oncologists to give dose to the nodes safely.

Q : 6

Is it possible to have blisters and "burning" of the skin after only one radiation treatment for breast cancer?

It is possible - but extremely unlikely - I would be worried more about an infection OR much lower risk of a problem in the amount of radiation dose calculated.

Q : 7

Gold or carbon markers and Calypso for radiation treatments: my current understanding is markers permit accurate aiming assuming no body movement during radiation. Calypso implants allow "tracking" the prostate during treatment. Questions: What radiation machines are used with markers? Why wouldn't the Calypso systems be the number one choice for prostate radiation treatments?

You are right the mark. Gold markers (aka fiducials) can be used with any radiation machine - but are only good for the split second it takes to obtain the film, it doesn't tell you what happens during treatment. Calypso is the only system that can track tumors in real time and actually tell you where the tumor is. It is only FDA-approved for patients already diagnosed with prostate cancer. I agree with you - I think it is the number one choice for patients who receive external beam radiation using IMRT. I have been using it for approximately 6 years. However, this unit is not perfect. It requires the placement of 3 beacons (larger than conventional gold fiducials), the technology doesn't work if you are heavy around the abdomen, and it is not useful with use of other radiation including high or low dose rate brachytherapy.

Q : 8

Can a woman's heart be damaged from radiation from breast cancer treatment?

Yes. If a woman's tumor is on the left side, the heart can be in close proximity to the target requiring radiation therapy. Although it doesn't manifest for several years (but clearly women can have other risk factors as well), certain chemotherapy (adriamycin, herceptin), other medical conditions (diabetes, high blood pressure) as well as certain habits (smoking being the biggest culprit) can cause problems. This used to be much more concerning based on techniques from 1980 and earlier. Now with modern radiation therapy, almost all radiation centers make the effort to reduce this risk as much as possible by using CT scans for planning to help delineate where the heart is in relation to the target and by utilizing some novel approaches such as breath holding techniques (which i use). Intensity modulation can sometimes work and monitoring breathing during treatment to minimize daily errors (techniques using vision rt) is another option.

Q : 9

I have been reading about the RapidArc/Trilogy radiation therapy. I had a full allotment of radiation for stage 4 esophageal cancer (half in 2007 and half in 2009). Could I be a candidate for RapidArc?

It depends on how much of the disease is still present. A technique called stereotactic body radiotherapy can sometimes be applied if the disease is limited and not near specific critical structures. If it is in the area that already has received a full dose of radiation twice, it would be difficult to offer any further radiation.

Q : 10

Do you have experience in nasopharnx carsinoma cases? My brother (62) has been diagnosed with this. We are told this is rare. It is in advanced stage. What would you suggest we do?

I am very familiar with this type of cancer. It is most present at a locally advanced state (meaning spread to lymph nodes in the neck), but still very curable. However, treatment can be very difficult to go through. Patients usually need daily radiation therapy for 7 weeks most times with chemotherapy which is given during radiation and afterward. It is very important to go to a facility that treats a lot of these types of cancers because you only have one chance to beat it.

Q : 11

Is the RapidArc effective for breast cancer?

There is no benefit for conventional breast cancer treatment, unless partial breast radiation was indicated. Even then, other approaches are available. If the tumor were to have spread, it is a good treatment for select metastases that require stereotactic radiotherapy.

Q : 12

I have stage IV non-small cell lung cancer and just finished with six months of chemotherapy. Could I be a candidate for SBRT to eradicate the remaining tumors?

It depends on the extent of metastatic disease and what the response was to chemotherapy, but it could be a possibility. Sometimes if everything is responding but only a few tumors are growing (ie < 4), SBRT could be used as alternative to changing chemotherapy.

Q : 13

Can you give me some idea of the likely side-effects of SBRT please? Everyone is being kind of vague.

The side effects depend on what is being treated and what critical structures the tumor is adjacent to. Radiation oncologists who use this technique often identify very few symptoms as side effects. This is most likely due to appropriate patient selection. However, larger tumors and tumors close to certain structures (i.e. esophagus or small bowel) may be at a higher risk for complications. I apologize for also being vague, but location is very important for predicting potential side effects. For lung cancer in general, the most common complaint is fatigue and, rarely, a cough during treatment. In the weeks following treatment, there is a small risk for radiation pneumonitis (a cough or shortness of breath) that 3 to 7 percent of the time needs treatment with steroids or the use of oxygen. Depending on the number of treatments (related to the radiation each treatment) and the technique used and the size of the tumor, there can be a risk of chest wall pain due to injury of the nerve or development of fibrosis compressing the nerve (if tumor very close to chest wall).

Q : 14

My husband has nerve damage from radiation for the prostate and palladium seeds that was done 2.5 years ago. Do you think hyperbaric oxygen chamber therapy could help repair the nerve damage? He has a terrible burning pain in his rectum immediately after urinating. His scans and cystoscope showed inflammation of the prostate and urethra.

Hyperbaric oxygen chamber therapy may work, but if his symptoms have been present for an extended period of time, it probably won't be effective. Another option for treatment may be the use of pain medication that works on neuropathic related pain such as Elavil or Neurontin.

Q : 15

I have tenesmus due to radiation therapy for colon cancer. How can I get the pain under control? What can I do to help the painful episodes?

One thing you can do is increase the amount of fiber in your diet to decrease the pressure/friction you experience when you go to the bathroom. Also, decreasing the amount of fatty and spicy foods you consume will help.

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