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Sacral Tumor
floyd
Posted: Sunday, August 15, 2010 5:11 AM
Joined: 8/15/2010
Posts: 11


Hi there,

In Dec 2009 my father had Cyberknife on his inoperable sacral tumor. He also had 6 months of Folfiri with Avastin. Around 2 weeks after finishing Cyberknife he was pain free. After 6 months his CEA went from 33 to 7.7.

He has now finished Chemo and his pain is starting to return. As the tumor is located in the S1 and S2 nerve root he was told it would be impossible to remove the tumor without him losing the ability to walk (he can barely walk anyway) and he would lose control of his bladder and bowel.

He latest Pet scan showed a mild decrease in the degree of FDG uptake  and size involving the soft tissue mass and assosiated left sacral bone involvement.

As we live in Australia and had to go overseas for cyberknife I thought I would ask a couple of questions on this forum.

Is this tumor permanently controlled? Is it possible to have cyberknife again on the same tumor? We would like to have another go to control the pain... Also, would it be a good idea to surgically remove whatever portion of the tumor is possible and then cyberknife the residual cancer?

Please note this is a recurrent rectal cancer tumor. His primary tumor was removed 12 years prior and this is a solitary met.

Thanks in advance for your help.

x

 

 

 

 


radsrus
Posted: Sunday, August 15, 2010 6:46 AM
Joined: 10/10/2008
Posts: 4435


1. It does not sound like it is permanently controlled, but it is difficult to say for sure. 2. It is possible to re-treat, but there are risks to the nerves from that also, although probably not as much risk as surgical removal. However, with surgical removal you lose function. With radiation neural damage you can get pain and function loss. With surgery the loss is immediate, with radiation it is usually gradual over many months. 3. The decision about doing surgery with such consequences is a tough one and one that would need to be made by your father in consultation with surgeons. It is true that less tumor would be easier to control with radiation.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Sunday, August 15, 2010 7:07 AM
Joined: 8/15/2010
Posts: 11


Thanks so much for responding, and so quickly. It has definately given food for thought, and I will discuss with my Father and Oncologist and Surgeon indepth this week when we are decision making.

x


floyd
Posted: Saturday, August 28, 2010 1:32 AM
Joined: 8/15/2010
Posts: 11


Just one last question... I was under the belief that cyberknife would make his ability to walk a little easier, rather than worse. Which is true?

Many thanks:)


radsrus
Posted: Saturday, August 28, 2010 11:27 AM
Joined: 10/10/2008
Posts: 4435


If it gets rid of the tumor and does not cause nerve damage, it would make things better. If it causes nerve damage, it will make them worse. In re-treatment, that is the trade-off that must be managed.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Monday, August 30, 2010 4:08 AM
Joined: 8/15/2010
Posts: 11


I see... I swear last question... can cyberknife be curative when there is bony involvement?
radsrus
Posted: Monday, August 30, 2010 5:32 AM
Joined: 10/10/2008
Posts: 4435


Yes...and no. THere is a new paper out showing that there are about 25% long-term disease-free survivors when you treat patients who have small numbers of metastatic tumors, usually defined as 1-3. So some patients with bony metastatic disease may indeed be curable. It is a very young field onf inquiry right now. If the bony involvement is merely local extension, then the odds get much better.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Julie G
Posted: Tuesday, September 07, 2010 11:54 AM
Joined: 9/1/2009
Posts: 20


Dr. Medbery, can you post either a link to this new paper you mentioned, or perhaps the PMID number so that I can look up the abstract? I have bone-only disease and would like to discuss these findings with my radiation oncologist. Thanks so much. Best, Julie G
radsrus
Posted: Tuesday, September 07, 2010 1:33 PM
Joined: 10/10/2008
Posts: 4435


I can't immediately put my hands on it. It may have been in one of the online journals or not yet be published. However, if you do a google search on oligometastatic cancer you can find a lot of references.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Friday, November 05, 2010 5:36 AM
Joined: 8/15/2010
Posts: 11


Hi Dr Medbery,

So we took the punt and have just come back from the Wijaya medical centre in Malaysia were my father has now been treated twice for his sacral tumor.

I was just curious, which is more... 24 Gy over 3 fractions (his first dose of cyberknife) or 25 Gy over 5 fractions (his second dose of cyberknife). Can the second time perhaps finish off killing all the cancer cells the first one didn't?

Thanks for your time.

 

 

 


radsrus
Posted: Friday, November 05, 2010 5:51 AM
Joined: 10/10/2008
Posts: 4435


24 Gy is a higher biologic dose. Hard to say about the chances of control.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Friday, November 05, 2010 6:01 AM
Joined: 8/15/2010
Posts: 11


Thankyou:)

x


floyd
Posted: Tuesday, November 16, 2010 4:27 AM
Joined: 8/15/2010
Posts: 11


Hi Dr Medbury,

As there have been 12 years from my father's initial NED status to recurrence, does this mean that his tumor would be slower growing compared to someone who had, let's say, 2 years till time of recurrence? Also, would this recurrent tumor have been growing slowly for those 12 years? Is it harder for radiation to kill cancer cells of stubborn, slow growing tumors?

Thanks in advance:)

xx

 

 


radsrus
Posted: Tuesday, November 16, 2010 1:18 PM
Joined: 10/10/2008
Posts: 4435


Taking longer to reappear certainly implies a tumor that is growing more slowly. With the doses of radiation we use, I am not certain that there are major differences in response from tumor to tumor.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Tuesday, December 21, 2010 6:21 AM
Joined: 8/15/2010
Posts: 11


Hi there,

Just wanted to post a follow up as I realised after going through so many posts on these boards that we don't often see what happens after the person has been treated, which I believe is an absolute necessity for anyone who is interested in cyberknife.

It has now been nearly 2 months since my father's 2nd lot of cyberknife on his sacral metastasis and before treatment he was experiencing chronic pain. His meds were oxycodone, fentanyl patches and lyrica and he still had such shocking pain he would be in tears.

He is now absolutely pain free and is off all meds, he doesn't even need a parecetamol!!! His CEA is the lowest it has been since his recurrence over a year ago!! It's seriously like a miracle has happened... He was practically bedridden and is now starting to enjoy his life again....

Dr Medbery, thank you for taking the time to answer my questions, isn't it unreal that a few moments of your time has helped a man so immensely:)

On that note, Merry Christmas!

x

 

 


radsrus
Posted: Wednesday, December 22, 2010 4:01 AM
Joined: 10/10/2008
Posts: 4435


Always good to hear positive stories this time of year.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Sunday, July 03, 2011 4:46 AM
Joined: 8/15/2010
Posts: 11


I'm back! Everything is going well with my father at the moment. It would seem that this second lot of cyberknife has controlled his sacral met longer than the first try. I was just wondering, if his sacral met were to start growing again, would it be out of the question to try cyberknife for a third time? Has this been tried before?
radsrus
Posted: Sunday, July 03, 2011 6:13 AM
Joined: 10/10/2008
Posts: 4435


It would be possible to treat the sacrum again, but I personally would only do it if it were not the same spot.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Monday, July 04, 2011 4:13 AM
Joined: 8/15/2010
Posts: 11


Why so? Higher chance of bowel perforation? Has anyone ever been treated in the same area three times?
radsrus
Posted: Monday, July 04, 2011 5:29 AM
Joined: 10/10/2008
Posts: 4435


I would worry more about severe nerve damage. I don't know if anyone has been treated three times.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


floyd
Posted: Wednesday, October 05, 2011 6:02 AM
Joined: 8/15/2010
Posts: 11


Just a follow up.... It is now almost a year since the second lot of cyberknife on my father's sacral tumour and he is now in a complete remission! No evidence of disease!!!! The doctor did say with this type of tumour it is likely to recur, however he is enjoying this time in his life... JUST BRILLIANT!!!
swheeler
Posted: Friday, July 26, 2013 8:59 AM
Joined: 7/25/2013
Posts: 2


Arm yourself with as much information as possible before using addictive medications medication mistakes prescription addiction what to do for an overdose prescription narcotic abuse
 

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