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Metastatic to sacrum
GSub
Posted: Friday, April 18, 2014 1:37 PM
Joined: 4/18/2014
Posts: 4


My father was cancer free for two years until this past September when his CEA levels increased. A CT-guided biopsy to the left sacrum in the S5 region confirmed its colorectal adenocarcinoma origin; the cancer metastasized to his presacral area.  Bone scan and standard CT were negative.  Pain was increasing earlier this year and he elected for stereotactic radiation at Kaiser Permanente in Southern California, where they don't have CK and use a body cast and straps to fix the body in position for 30 minute doses.  He received 30 Gy in 5 sessions, pain subsided after 2-3 weeks from stereotactic radiation.  Just a couple a weeks ago the pain has returned in the sacral area. Radiation oncologist has mentioned no further treatment is possible in the same area and that cancer cells are radiation resistant, only resolution is pain medication and a nerve block.  This is without performing anymore scans to see if the cancer returned in the same area or adjacent location.  Based on scans done in Feb, cancer has not spread to any other location and chemo is not recommended due to age.  Some questions:
1) Can CK be used for treatment in this case?  If so, how many sessions and radiation dosage is usually done?
2) Since this would be an out of pocket, out of network expense, has anyone had experience getting CK done in a foreign country with lower treatment costs?
Thanks, George


radsrus
Posted: Friday, April 18, 2014 2:25 PM
Joined: 10/10/2008
Posts: 4435


Scanning needs to be performed to see whether there is a recurrence of the cancer or another cause for the pain. If it is recurrent cancer, then it is unlikely that CK will be of value since further treatment would carry substantial risk. There could be exceptions, so it would be worth getting someone else to look at the scans and records.

 

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

 


GSub
Posted: Friday, April 18, 2014 3:01 PM
Joined: 4/18/2014
Posts: 4


Thank you Doctor, we'll get a 2nd opinion at a CK center nearby.


GSub
Posted: Wednesday, April 23, 2014 8:14 PM
Joined: 4/18/2014
Posts: 4


Dr. Medbery,
  You mentioned that further treatment would carry substantial risk. Is this risk of myelopathy or neuropathy?  The tumor location in the presacral area shows it to be bone pain thus far instead of nerve pain, it is low enough in the S5 area that its avoiding sacral nerves thus far.
Thanks,
 -George

radsrus
Posted: Thursday, April 24, 2014 3:04 AM
Joined: 10/10/2008
Posts: 4435


This is well below the spinal cord, so I meant neuropathy. I have not seen the scans, but it is hard to imagine that there are not any nerves there that could be damaged. Also you will further weaken the bone. But see what the CK center thinks. They will have all the data to assess.

 

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

 


GSub
Posted: Friday, April 25, 2014 9:45 AM
Joined: 4/18/2014
Posts: 4


Thanks Dr. Medbery, the CK center radiation oncologist mentioned this tumor is treatable with CK, yet a newer PET-CT scan needs to be done to confirm that the tumor is well-defined and localized for CK to be effective (pervious PET-CT was 7 months ago). A diffusive tumor will be hard to target and could impact healthy cells/nerve/tissue that was already radiated with the Varion Trilogy SBRT that included a margin around the tumor volume (margin was needed since it doesn't provide real-time tumor localization like CK does).

radsrus
Posted: Saturday, April 26, 2014 9:55 AM
Joined: 10/10/2008
Posts: 4435


Good. I hope they can still treat.

 

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

 


 

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