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suv max increased 3 month after treatment
zvi1
Posted: Saturday, December 07, 2013 8:53 PM
Joined: 12/7/2013
Posts: 2


an update My husband had 4 lessions in lung (osteosarcoma) that had been treated last year. 3 (54gyX3fr) completly gone. 1 in r up lobe got 50gyX5 fr (size 3.5) got smaller (2 cm) then grew up after 6m since radition to 6.5 cm suv max was around 3.2. our doc "sbrt" it again 60gyX3fr now 3 months later tumor shrinked to 4 cm. a l-o-t of fibrosis near the area and suv max increased (not sure how much but more then 3.2, highest in the fibrosis area where there was no tumor and in the bottom of what left from the tumor) beside that two new nudles 0.5 cm and 1.8cm doing "sbrt" again suggested to do more chemo. my questions: 1. Is the result of the suv suggest a failure,(based on the fact that the other tumors suv got down quite fast) or is it a normal occurance in this stage (3 monts) and we should only look at the size that got down (doc says its ok but need more follow up beacuse of the mass that in the bottom)? 2. Is there a conection to such a mass of fibrosis and increase suv level and the fact that it was a second sbrt? (rp signs?) 3. In your opnion, is 60gyX3 for 6.5cm tumor usually enough or would you do 66X3 or 72X3? taking to consideration that its a second time in 6m to tumor that responds well at the beginning even to 50X5, periperial with no blood vessels, airways and such - stuck to side, up in the back) , In the research of zimrman at el. they gave to T1 tumors 60X3 and to T2 66X3 and got 95% lc, but it was first sbrt and not second and toxicety grade was quite high. I know it is an "after" question but your opnion is important to us, since if you have seen similar cases with failures, we may take some steps to improve the outcome(such as chemo, rfa etc) if you says the doses werent enough. 4. as a continue for my third question: is it an option to give another dose 54 or less (third time) of sbrt to the same tumor after 3m, even though we are not sure it faild, to make sure it wont grow back (Im talking about the area where there is still a mass and high uptake)? is it an option at all to give sbrt a third time in case of a future failure? 5. last - is chemo right after sbrt improve sbrt result? (of course, not right away but in the safe 4-6 weeks distance) would you recomend chemo now, before we are doing the sbrt to the two new noudles, to improve the result of the reiradiated tumor? again, thank you for your answers so far. you have been great help to us.
radsrus
Posted: Sunday, December 08, 2013 4:41 AM
Joined: 10/10/2008
Posts: 4435


1. Just have to follow to find out 2. The suv value can be somewhat variable after treatment. 3. 20 Gy x3 (total 60 Gy) is as high as we have gone, although we have exceed that several times by re-treating, as was done in this case 4. We have treated a third time once, and it was safe, but I would not do it without clear sign of active tumor 5. Not clear whether chemo imiproves the results of SBRT

 

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

 


zvi1
Posted: Sunday, December 08, 2013 10:52 PM
Joined: 12/7/2013
Posts: 2


thank you, your answer gave us so much (it was based on your answer that the doc decided to give 60X3 the second time around) about side effects for second time treatment: he is having the following symptoms: heartburn (severe - no medicine helps), chest wall pain (not so bad) and a very tender feeling in the airway which cause him to cough a lot (though, no mucus), the doctors here are good with sbrt, but it doesnt seem they have a lot of expirience with side effect treatment, and we arent sure the heartburn isnt due to other mediction he takes. thank you again for your answers
radsrus
Posted: Monday, December 09, 2013 2:46 AM
Joined: 10/10/2008
Posts: 4435


Depending on tumor location, these could all be due to the treatment. You can use viscous lidocaine (prescription) for the heartburn along with Prilosec OTC taken one hour before supper if he is not already on a similar drug. The chest wall pain usually responds to anti-inflammatories, such as Alleve if he can take those safely. Probably the most effective cough suppressant is Tussionex Suspension (prescription)

 

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

 


zvi
Posted: Sunday, January 19, 2014 11:47 AM
Joined: 2/18/2013
Posts: 15


seem I was worng about the suv. result are as written: tumor in rul is with no change, no uptake (hope its the right word) could be found. 1. Is it feasble to do rfa (ablation) after we have done sbrt (twice)? although result look encouraging we would like not to take the risk since its a big tumor (6 cm) and we already sbrt it twice 2. Is there a rule in general for the amount of times a preson can have sbrt not to the same tumor? and p.s. many many thanks for your advice on symptoms mediction. It helped us greatly
radsrus
Posted: Monday, January 20, 2014 2:48 AM
Joined: 10/10/2008
Posts: 4435


You can't just keep on re-treating the same place. What is the SUV now? RFA would be difficult and somewhat hazardous

 

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

 


zvi
Posted: Monday, January 20, 2014 4:58 AM
Joined: 2/18/2013
Posts: 15


doc only said it seems very good and got smaller but there is small mass in the corner that need following (most of it looks like ground glass mass), and paper result says: no uptake could be dedacted. we consult our rfa doctor and she said that if his condition is well (lung function, blood count etc) there is realy no problem since the tomor is stuck to corner and there are no blood vessel airways and such
 

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