To IMRT or Not to IMRT that is the question ?

Hi,

From the beginning of my treatment my Oncologist told me that IMRT was not
indicated for my type of lower tongue tumor (squamous cell carcinoma), and
neither was CyberKnife.

First he told me that because of the location of the tumor, and the fact
that the soft tissue could not be fixated (or immobilized), that it made it
impossible to get the benefits of the increased precision of focus and beam
placement of IMRT compared to 3D Conformal Mapping.

A second factor is that Chiang Mai has only had an IMRT facility for about
six months, and he was concerned the team was not "trained up" to the level
they should be yet.

That seemed reasonable to me. But lately I have read of several people here
with H&N cancer who seem to have had IMRT for tongue cancers. And I see
other stories like the one posted today by Matti Narkia on
sci.med.diseases.cancer :

"IMRT and preservation of salivary function in head and neck
squamous cell carcinoma"

A week ago my Oncologist mentioned that I did have the choice of IMRT or 3D
Conformal Mapping, but that he felt there was little benefit in my case in
going with IMRT (much more expensive). That he now mentioned it as an option
was a complete surprise.

I'd appreciate any opinions or thoughts on IMRT vs. 3D Conformal Mapping in
tongue or soft tissue.

thanks !

Uncle Sally

On Wed, 18 Apr 2007 17:36:23 GMT, "Uncle Sally"
<uncleSally@auldUncleSally.com> wrote:

>Hi,
>
>From the beginning of my treatment my Oncologist told me that IMRT was not
>indicated for my type of lower tongue tumor (squamous cell carcinoma), and
>neither was CyberKnife.
>
>First he told me that because of the location of the tumor, and the fact
>that the soft tissue could not be fixated (or immobilized), that it made it
>impossible to get the benefits of the increased precision of focus and beam
>placement of IMRT compared to 3D Conformal Mapping.
>
>A second factor is that Chiang Mai has only had an IMRT facility for about
>six months, and he was concerned the team was not "trained up" to the level
>they should be yet.
>
>That seemed reasonable to me. But lately I have read of several people here
>with H&N cancer who seem to have had IMRT for tongue cancers. And I see
>other stories like the one posted today by Matti Narkia on
>sci.med.diseases.cancer :
>
> "IMRT and preservation of salivary function in head and neck
>squamous cell carcinoma"
>
>A week ago my Oncologist mentioned that I did have the choice of IMRT or 3D
>Conformal Mapping, but that he felt there was little benefit in my case in
>going with IMRT (much more expensive). That he now mentioned it as an option
>was a complete surprise.
>
>I'd appreciate any opinions or thoughts on IMRT vs. 3D Conformal Mapping in
>tongue or soft tissue.
>
I'm a bit suspicious about their arguments, it sounds like that there
are other than medical reasons behind your oncologist's decision, such
as cost and low competence of IMRT crew. It would be nice if you could
get a second opinion from a competent radiation oncologist. Perhaps
Steph could give his opinion, if you ask nicely? ;-)


--
Matti Narkia

Uncle Sally wrote:

> From the beginning of my treatment my Oncologist told me that IMRT was not
> indicated for my type of lower tongue tumor (squamous cell carcinoma), and
> neither was CyberKnife.
>
> First he told me that because of the location of the tumor, and the fact
> that the soft tissue could not be fixated (or immobilized), that it made it
> impossible to get the benefits of the increased precision of focus and beam
> placement of IMRT compared to 3D Conformal Mapping.
>
> A second factor is that Chiang Mai has only had an IMRT facility for about
> six months, and he was concerned the team was not "trained up" to the level
> they should be yet.
>
> That seemed reasonable to me. But lately I have read of several people here
> with H&N cancer who seem to have had IMRT for tongue cancers. And I see
> other stories like the one posted today by Matti Narkia on
> sci.med.diseases.cancer :
>
> "IMRT and preservation of salivary function in head and neck
> squamous cell carcinoma"
>
> A week ago my Oncologist mentioned that I did have the choice of IMRT or 3D
> Conformal Mapping, but that he felt there was little benefit in my case in
> going with IMRT (much more expensive). That he now mentioned it as an option
> was a complete surprise.
>
> I'd appreciate any opinions or thoughts on IMRT vs. 3D Conformal Mapping in
> tongue or soft tissue.

Why don't you trust him? You haven't had (as) bad side effects as others here.
J

On Wed, 18 Apr 2007 21:31:41 +0300, Matti Narkia <mna@mbnet.fi> wrote:

>On Wed, 18 Apr 2007 17:36:23 GMT, "Uncle Sally"
><uncleSally@auldUncleSally.com> wrote:
>
>>Hi,
>>
>>From the beginning of my treatment my Oncologist told me that IMRT was not
>>indicated for my type of lower tongue tumor (squamous cell carcinoma), and
>>neither was CyberKnife.
>>
>>First he told me that because of the location of the tumor, and the fact
>>that the soft tissue could not be fixated (or immobilized), that it made it
>>impossible to get the benefits of the increased precision of focus and beam
>>placement of IMRT compared to 3D Conformal Mapping.
>>
>>A second factor is that Chiang Mai has only had an IMRT facility for about
>>six months, and he was concerned the team was not "trained up" to the level
>>they should be yet.
>>
>>That seemed reasonable to me. But lately I have read of several people here
>>with H&N cancer who seem to have had IMRT for tongue cancers. And I see
>>other stories like the one posted today by Matti Narkia on
>>sci.med.diseases.cancer :
>>
>> "IMRT and preservation of salivary function in head and neck
>>squamous cell carcinoma"
>>
>>A week ago my Oncologist mentioned that I did have the choice of IMRT or 3D
>>Conformal Mapping, but that he felt there was little benefit in my case in
>>going with IMRT (much more expensive). That he now mentioned it as an option
>>was a complete surprise.
>>
>>I'd appreciate any opinions or thoughts on IMRT vs. 3D Conformal Mapping in
>>tongue or soft tissue.
>>
>I'm a bit suspicious about their arguments, it sounds like that there
>are other than medical reasons behind your oncologist's decision, such
>as cost and low competence of IMRT crew. It would be nice if you could
>get a second opinion from a competent radiation oncologist. Perhaps
>Steph could give his opinion, if you ask nicely? ;-)

On the other hand, if you are going to get your radiation therapy
there, and they cannot do IMRT properly yet as you hinted, perhaps
it's not so hot idea to try to force them to do something they are not
good at.




--
Matti Narkia

Uncle Sally wrote:
> First he told me that because of the location of the tumor, and the fact
> that the soft tissue could not be fixated (or immobilized), that it made it
> impossible to get the benefits of the increased precision of focus and beam
> placement of IMRT compared to 3D Conformal Mapping.

Think about what he's saying there. He can shoot IMRT at the spot, but
the spot isn't going to be where he's shooting the radiation. He could
fill your nasopharynx with concrete and immobilize the spot, then do the
necessary imaging to locate the spot and have the physicists calculate
the necessary parameters to do the IMRT, but in the few days that would
take, you might decide you liked it better when you could breathe.

There's no sense shooting fixed beams at a moving target.

--
Music hath charms to soothe the savage breast.
That's why stereo has two channels.

J wrote :

.... original post by Uncle Sally snipped for brevity ...

"Why don't you trust him ?"

It is not a lack of trust to want other opinions when you have received
different information at different times from your doc. In fact I think it's
always good to get (at least) a second opinion in any potentially
life-threatening or major illness and its treatment. In the case of my
Oncologist, he's extremely busy, with a case load that I guess is around 300
people; he's also frequently travelling outside the country to international
meetings, and involved in national level planning for Thailand's entire
oncology and radiation establishment. I do trust him, and can live with the
fact he may be too busy at times to be 100% 'on the beam' regarding my case
and what he's told me before.

I was hoping to hear directly from some folks here who have tongue or
soft-tissue H&N cancer treated with IMRT and know something about whether
they were given the option of 3D conformal mapping vs. IMRT.

"You haven't had (as) bad side effects as others here."

I'll take your word for that, although for me 35 pound weight loss, near
total inability to eat, nearly passing out every time I get up from lying
down or sitting down more than 5 minutes, fatigue, etc. are the worst I've
ever experienced. But you are right, there are other people here who have
gone (and are going through) so much more. I humbly respect their courage
and positive attitudes and helpfulness to others shown here ... and that
includes you.

best, Uncle Sally

On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:

>Uncle Sally wrote:
>> First he told me that because of the location of the tumor, and the fact
>> that the soft tissue could not be fixated (or immobilized), that it made it
>> impossible to get the benefits of the increased precision of focus and beam
>> placement of IMRT compared to 3D Conformal Mapping.
>
>Think about what he's saying there. He can shoot IMRT at the spot, but
>the spot isn't going to be where he's shooting the radiation. He could
>fill your nasopharynx with concrete and immobilize the spot, then do the
>necessary imaging to locate the spot and have the physicists calculate
>the necessary parameters to do the IMRT, but in the few days that would
>take, you might decide you liked it better when you could breathe.
>
I think that Uncle Sally has cancer in the lower tongue, which
according to my understanding is in the oropharynx, not in the
nasopharynx. I had cancer in oropharynx plus in many other places, and
I had IMRT.

>There's no sense shooting fixed beams at a moving target.

Not with IMRT, but I think CyberKnife, which Uncle Sally also
mentioned, probably can do that at least to some ectent.

Well, we are not experts in this, but Steph is. I hope he has time
reply to Uncle Sally.


--
Matti Narkia

On Thu, 19 Apr 2007 00:15:00 +0300, Matti Narkia <mna@mbnet.fi> wrote:

>On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:
>
>>Uncle Sally wrote:
>>> First he told me that because of the location of the tumor, and the fact
>>> that the soft tissue could not be fixated (or immobilized), that it made it
>>> impossible to get the benefits of the increased precision of focus and beam
>>> placement of IMRT compared to 3D Conformal Mapping.
>>
>>Think about what he's saying there. He can shoot IMRT at the spot, but
>>the spot isn't going to be where he's shooting the radiation. He could
>>fill your nasopharynx with concrete and immobilize the spot, then do the
>>necessary imaging to locate the spot and have the physicists calculate
>>the necessary parameters to do the IMRT, but in the few days that would
>>take, you might decide you liked it better when you could breathe.
>>
>I think that Uncle Sally has cancer in the lower tongue, which
>according to my understanding is in the oropharynx, not in the
>nasopharynx. I had cancer in oropharynx plus in many other places, and
>I had IMRT.
>
Here some definitons:

Pharynx - Wikipedia, the free encyclopedia
<http://en.wikipedia.org/wiki/Pharynx>


--
Matti Narkia

On Thu, 19 Apr 2007 00:15:00 +0300, Matti Narkia <mna@mbnet.fi> wrote:

>On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:
>>
>>There's no sense shooting fixed beams at a moving target.
>
>Not with IMRT, but I think CyberKnife, which Uncle Sally also
>mentioned, probably can do that at least to some ectent.
>
Below some CyberKnife links:

CyberKnife® Stereotactic Radiosurgery System
<http://www.georgetownuniversityhospital.org/body.cfm?id=451>

"How is CyberKnife System Different from Other Stereotactic
Radiosurgery Systems?

The CyberKnife system uses the combination of a robotics and
image guidance to deliver concentrated and accurate beams of
radiation to intracranial and extracranial targets, many of
which are inoperable. The robotic arm is highly flexible,
allowing access to tumors in difficult-to-reach locations.

The CyberKnife, unlike other stereotactic radiosurgery systems,
is able to locate the position of the tumor without the use of
an invasive stereotactic head frame or stereotactic body frame.
The CyberKnife system compensates for patient movement during
treatment, constantly ensuring accurate targeting."

CyberKnife Society
<http://www.cksociety.org/>

CyberKnife® Patient Support Group
<http://www.cyberknifesupport.org/>

Accuray CyberKnife
<http://www.accuray.com/>


--
Matti Narkia

"Uncle Sally" <uncleSally@auldUncleSally.com> wrote in message
news:rGsVh.422365$8a4.115448@fe03.news.easynews.co m...
> Hi,
>
> From the beginning of my treatment my Oncologist told me that IMRT was not
> indicated for my type of lower tongue tumor (squamous cell carcinoma), and
> neither was CyberKnife.
>
> First he told me that because of the location of the tumor, and the fact
> that the soft tissue could not be fixated (or immobilized), that it made
> it
> impossible to get the benefits of the increased precision of focus and
> beam
> placement of IMRT compared to 3D Conformal Mapping.
>
> A second factor is that Chiang Mai has only had an IMRT facility for about
> six months, and he was concerned the team was not "trained up" to the
> level
> they should be yet.
>
> That seemed reasonable to me. But lately I have read of several people
> here
> with H&N cancer who seem to have had IMRT for tongue cancers. And I see
> other stories like the one posted today by Matti Narkia on
> sci.med.diseases.cancer :
>
> "IMRT and preservation of salivary function in head and neck
> squamous cell carcinoma"
>
> A week ago my Oncologist mentioned that I did have the choice of IMRT or
> 3D
> Conformal Mapping, but that he felt there was little benefit in my case in
> going with IMRT (much more expensive). That he now mentioned it as an
> option
> was a complete surprise.
>
> I'd appreciate any opinions or thoughts on IMRT vs. 3D Conformal Mapping
> in
> tongue or soft tissue.
>
> thanks !
>
> Uncle Sally
>
>

We do IMRT for tongue base cancers all the time.
I don't buy that particular argument

"Matti Narkia" <mna@mbnet.fi> wrote in message
news:m12d23p4rtvqj9h07guongco3qjkugbhvh@4ax.com...
> On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:
>
>>Uncle Sally wrote:
>>> First he told me that because of the location of the tumor, and the fact
>>> that the soft tissue could not be fixated (or immobilized), that it made
>>> it
>>> impossible to get the benefits of the increased precision of focus and
>>> beam
>>> placement of IMRT compared to 3D Conformal Mapping.
>>
>>Think about what he's saying there. He can shoot IMRT at the spot, but
>>the spot isn't going to be where he's shooting the radiation. He could
>>fill your nasopharynx with concrete and immobilize the spot, then do the
>>necessary imaging to locate the spot and have the physicists calculate
>>the necessary parameters to do the IMRT, but in the few days that would
>>take, you might decide you liked it better when you could breathe.
>>
> I think that Uncle Sally has cancer in the lower tongue, which
> according to my understanding is in the oropharynx, not in the
> nasopharynx. I had cancer in oropharynx plus in many other places, and
> I had IMRT.
>
>>There's no sense shooting fixed beams at a moving target.
>
> Not with IMRT, but I think CyberKnife, which Uncle Sally also
> mentioned, probably can do that at least to some ectent.
>
> Well, we are not experts in this, but Steph is. I hope he has time
> reply to Uncle Sally.
>
>
> --
> Matti Narkia

If IMRT is unable to treat a cancer of the oropharynx because of "organ
movement", then cyberknife would be even worse........
But it's a silly argument. IMRT is perfectly good treatment for the tongue
base. Any concerns about organ movement are dealt with by defining the ptv
volume to treat. It's done all the time.

> I was hoping to hear directly from some folks here who have tongue or
> soft-tissue H&N cancer treated with IMRT and know something about whether
> they were given the option of 3D conformal mapping vs. IMRT.

Hi Uncle Sally,

I had 39 IMRT treatments for what was considered inoperable cancer
located on the back of my tongue. There were two spots one was
moderately invasive and the other minimally. In conjunction with the
radiation I had chemo in the form of Erbitux that occurred along with
the eight weeks of radiation at a rate of one infusion weekly. I
opted not to have a feeding tube and lost 40 lbs. going from #185 to
#145. My treatments were between June 26 and Aug. 22, 2006 and I now
weigh about #162. The weight loss bothered me less then my physicians
because I thought I was fat to begin with. I only stand close to 5'8"
and at 185 was pretty plump!

I was never given an option for any other type of radiation treatment
and was actually thrilled to be receiving the IMRT as it was
considered state of the art at the time. Other then attendant side
effects the only real negative thing that I experienced during the
eight weeks was the ineptness of the cyclotron techs to get me under
within the 30 min. half life of the Amifostine (chemo protectant for
salivary glands).

Subsequent to treatment I had about two weeks of exhilaration followed
by about 4-5 weeks of depression. The depression was soloved with
excercise but it took those weeks before I was told about the positive
results from excercise. My sex drive fell off dramatically but was
more stress related then anything. Since then Mr. Winky has returned.

As of today I don't seem to be suffering much in the way of residuals
beyond being careful to protect from the sun and having a change in
voice and glowing in the dark which my wife loves (just kidding!). I
have more "discomfort" from the left and right neck disections that
preceded (May '06) the radiation/chemo. Most recently (Tuesday) I
had a node removed from the left neck which at the moment (microscopic
tissue examination is occuring as I write) according to my Dr. appears
to have been a stitch that "went bad". I'll be posting when I have
the full results.

Steph had two good posts for you. If there is anything else I can
tell you please ask, I am not sure what you are looking for
specifically so I tried to give you an olio of experience. Remember,
we are all in this together and the longer we write the older we get!
ipunty

On Thu, 19 Apr 2007 07:53:34 GMT, "Steph" <steph@vancouvers.island>
wrote:
>
>"Matti Narkia" <mna@mbnet.fi> wrote in message
>news:m12d23p4rtvqj9h07guongco3qjkugbhvh@4ax.com.. .
>> On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:
>>
>>>Uncle Sally wrote:
>>>> First he told me that because of the location of the tumor, and the fact
>>>> that the soft tissue could not be fixated (or immobilized), that it made
>>>> it
>>>> impossible to get the benefits of the increased precision of focus and
>>>> beam
>>>> placement of IMRT compared to 3D Conformal Mapping.
>>>
>>>Think about what he's saying there. He can shoot IMRT at the spot, but
>>>the spot isn't going to be where he's shooting the radiation. He could
>>>fill your nasopharynx with concrete and immobilize the spot, then do the
>>>necessary imaging to locate the spot and have the physicists calculate
>>>the necessary parameters to do the IMRT, but in the few days that would
>>>take, you might decide you liked it better when you could breathe.
>>>
>> I think that Uncle Sally has cancer in the lower tongue, which
>> according to my understanding is in the oropharynx, not in the
>> nasopharynx. I had cancer in oropharynx plus in many other places, and
>> I had IMRT.
>>
>>>There's no sense shooting fixed beams at a moving target.
>>
>> Not with IMRT, but I think CyberKnife, which Uncle Sally also
>> mentioned, probably can do that at least to some ectent.
>>
>> Well, we are not experts in this, but Steph is. I hope he has time
>> reply to Uncle Sally.
>>
>>
>> --
>> Matti Narkia
>
>If IMRT is unable to treat a cancer of the oropharynx because of "organ
>movement", then cyberknife would be even worse........

Are you sure you don't mean GammaKnife? Personally I have no
experience about CyberKnife, but according to the following quote it
can handle also at least somewhat mobile target:

CyberKnife® Stereotactic Radiosurgery System
<http://www.georgetownuniversityhospital.org/body.cfm?id=451>

"How is CyberKnife System Different from Other Stereotactic
Radiosurgery Systems?

The CyberKnife system uses the combination of a robotics and
image guidance to deliver concentrated and accurate beams of
radiation to intracranial and extracranial targets, many of
which are inoperable. The robotic arm is highly flexible,
allowing access to tumors in difficult-to-reach locations.

The CyberKnife, unlike other stereotactic radiosurgery systems,
is able to locate the position of the tumor without the use of
an invasive stereotactic head frame or stereotactic body frame.
The CyberKnife system compensates for patient movement during
treatment, constantly ensuring accurate targeting."

>But it's a silly argument. IMRT is perfectly good treatment for the tongue
>base. Any concerns about organ movement are dealt with by defining the ptv
>volume to treat. It's done all the time.
>
That's what I thought, too. Thanks.




--
Matti Narkia

Uncle Sally wrote:

>
> I was hoping to hear directly from some folks here who have tongue or
> soft-tissue H&N cancer treated with IMRT and know something about whether
> they were given the option of 3D conformal mapping vs. IMRT.

I had IMRT for tongue cancer. They also radiated the neck and other
nearby areas to kill any microscopic cancer cells that may have been
hiding. My tumor was surgically removed.

I was not offered an alternative form of radiation. I went to a major
cancer center expecting them to know what they were doing and what was
going to be the best treatment for me.

I did have a stent which I had to place in my mouth before each
radiation treatment. I assumed it was just to protect some areas of my
mouth and salivary glands (which it did) but it could have also been to
stabilize my tongue so it would not move during treatment.

--
Janet Wilder
Bad spelling. Bad punctuation
Good Friends. Good Life

"Matti Narkia" <mna@mbnet.fi> wrote in message
news:73re23p47bbjblslbma6v14vq0e8u508g9@4ax.com...
> On Thu, 19 Apr 2007 07:53:34 GMT, "Steph" <steph@vancouvers.island>
> wrote:
>>
>>"Matti Narkia" <mna@mbnet.fi> wrote in message
>>news:m12d23p4rtvqj9h07guongco3qjkugbhvh@4ax.com. ..
>>> On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:
>>>
>>>>Uncle Sally wrote:
>>>>> First he told me that because of the location of the tumor, and the
>>>>> fact
>>>>> that the soft tissue could not be fixated (or immobilized), that it
>>>>> made
>>>>> it
>>>>> impossible to get the benefits of the increased precision of focus and
>>>>> beam
>>>>> placement of IMRT compared to 3D Conformal Mapping.
>>>>
>>>>Think about what he's saying there. He can shoot IMRT at the spot, but
>>>>the spot isn't going to be where he's shooting the radiation. He could
>>>>fill your nasopharynx with concrete and immobilize the spot, then do the
>>>>necessary imaging to locate the spot and have the physicists calculate
>>>>the necessary parameters to do the IMRT, but in the few days that would
>>>>take, you might decide you liked it better when you could breathe.
>>>>
>>> I think that Uncle Sally has cancer in the lower tongue, which
>>> according to my understanding is in the oropharynx, not in the
>>> nasopharynx. I had cancer in oropharynx plus in many other places, and
>>> I had IMRT.
>>>
>>>>There's no sense shooting fixed beams at a moving target.
>>>
>>> Not with IMRT, but I think CyberKnife, which Uncle Sally also
>>> mentioned, probably can do that at least to some ectent.
>>>
>>> Well, we are not experts in this, but Steph is. I hope he has time
>>> reply to Uncle Sally.
>>>
>>>
>>> --
>>> Matti Narkia
>>
>>If IMRT is unable to treat a cancer of the oropharynx because of "organ
>>movement", then cyberknife would be even worse........
>
>

That too

On Thu, 19 Apr 2007 14:58:19 GMT, "Steph" <steph@vancouvers.island>
wrote:

>
>"Matti Narkia" <mna@mbnet.fi> wrote in message
>news:73re23p47bbjblslbma6v14vq0e8u508g9@4ax.com.. .
>> On Thu, 19 Apr 2007 07:53:34 GMT, "Steph" <steph@vancouvers.island>
>> wrote:
>>>
>>>"Matti Narkia" <mna@mbnet.fi> wrote in message
>>>news:m12d23p4rtvqj9h07guongco3qjkugbhvh@4ax.com ...
>>>> On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:
>>>>
>>>>>Uncle Sally wrote:
>>>>>> First he told me that because of the location of the tumor, and the
>>>>>> fact
>>>>>> that the soft tissue could not be fixated (or immobilized), that it
>>>>>> made
>>>>>> it
>>>>>> impossible to get the benefits of the increased precision of focus and
>>>>>> beam
>>>>>> placement of IMRT compared to 3D Conformal Mapping.
>>>>>
>>>>>Think about what he's saying there. He can shoot IMRT at the spot, but
>>>>>the spot isn't going to be where he's shooting the radiation. He could
>>>>>fill your nasopharynx with concrete and immobilize the spot, then do the
>>>>>necessary imaging to locate the spot and have the physicists calculate
>>>>>the necessary parameters to do the IMRT, but in the few days that would
>>>>>take, you might decide you liked it better when you could breathe.
>>>>>
>>>> I think that Uncle Sally has cancer in the lower tongue, which
>>>> according to my understanding is in the oropharynx, not in the
>>>> nasopharynx. I had cancer in oropharynx plus in many other places, and
>>>> I had IMRT.
>>>>
>>>>>There's no sense shooting fixed beams at a moving target.
>>>>
>>>> Not with IMRT, but I think CyberKnife, which Uncle Sally also
>>>> mentioned, probably can do that at least to some ectent.
>>>>
>>>> Well, we are not experts in this, but Steph is. I hope he has time
>>>> reply to Uncle Sally.
>>>>
>>>>
>>>> --
>>>> Matti Narkia
>>>
>>>If IMRT is unable to treat a cancer of the oropharynx because of "organ
>>>movement", then cyberknife would be even worse........
>>
>>
>
>That too
>
Sometimes you replies are a bit cryptic :-). Could you elaborate a
little? Do you mean that CyperKnife has failed to function the way my
quote from the Georgetown University Hospital's web page says it can
do?


--
Matti Narkia

I appreciate the advice, the shared experiences, the support very much !

I am inclined to go with my doctor's recommendation for 3D Conformal Mapping
instead of IMRT with my tumor just based on trust and his knowledge of the
capabilities and skills of the hospital facilities and staff at this time.
He has had broad experience for many years treating thousands of patients.
And he is an active researcher, professor, as well as practicing clinician.
His "number two" is a Stanford, Harvard Medical School, Johns Hopkins,
trained Thai woman.

My guess is that it would be very difficult to ... for a specific individual
tumor ... estimate the potential benefits of IMRT over 3D Conformal Mapping,
but that over a wide spectrum of cases (probably with significant
improvements for certain types of tumors) there is a general quantifiable
improvement.

I probably should have mentioned in my original post that a friend of mine
knows Dr. Brady (inventor of the CyberKnife) in the US and talked to him
about my tumor, and Dr. Brady said CyberKnife was not indicated for such
tumors of soft tissue.

Again many thanks for your time and good energy

best, Uncle Sally

On Thu, 19 Apr 2007 17:22:32 GMT, "Uncle Sally"
<uncleSally@auldUncleSally.com> wrote:

>I appreciate the advice, the shared experiences, the support very much !
>
>I am inclined to go with my doctor's recommendation for 3D Conformal Mapping
>instead of IMRT with my tumor just based on trust and his knowledge of the
>capabilities and skills of the hospital facilities and staff at this time.
>He has had broad experience for many years treating thousands of patients.
>And he is an active researcher, professor, as well as practicing clinician.
>His "number two" is a Stanford, Harvard Medical School, Johns Hopkins,
>trained Thai woman.
>
I think taht you are making the right decision in choosing the
treatment they can do best. Is 3D Conformal Mapping same or similar
than the treatment known as 3D-CRT?. If it is, it's also fairly modern
technique, and according to some reviews, actually not much less
accurate than IMRT.

>My guess is that it would be very difficult to ... for a specific individual
>tumor ... estimate the potential benefits of IMRT over 3D Conformal Mapping,
>but that over a wide spectrum of cases (probably with significant
>improvements for certain types of tumors) there is a general quantifiable
>improvement.
>
That's the view I also got just now after reading a few abstracts.

>I probably should have mentioned in my original post that a friend of mine
>knows Dr. Brady (inventor of the CyberKnife) in the US and talked to him
>about my tumor, and Dr. Brady said CyberKnife was not indicated for such
>tumors of soft tissue.
>
Now you lost me. In my mind all the tissue except for the bone is
"soft tissue". Surely CyberKnife was not designed for bone cancers
only. Please clarify. From Georgetown University Hospital's web page
I got an impression that CyberKnife can treat almost any kind of
cancer (there are of course some obvious exclusions), but it serves
best, when used treat cancers, which are difficult or impossible to be
treated with other radiation techniques. The Georgetown University
Hospital's web page

<http://www.georgetownuniversityhospital.org/body.cfm?id=451#5>

tells what kind of cancers are treated with CyberKnife:

"What will the CyberKnife Treat?

The following are some of the conditions that will be treated by
CyberKnife at Georgetown:

* Intracranial tumors and lesions
* Extracranial tumors and lesions
* Spine cancer and spinal cord tumors
* Malignant tumors (primary & metastases)
* Benign Tumors
* Acoustic Neuromas
* Schwannomas
* Meningiomas
* Pituitary Adenomas
* Arterial Venous Malformations
* Functional Disorders (Trigeminal Neuralgia)

New Soft Tumor Treatment for CyberKnife - Called Synchrony

Two years after its installation, Georgetown’s CyberKnife
continues to prove its mettle and versatility in battling hard-
to-treat tumors and lesions. While two-thirds of cases involve
the central nervous system – the original focus for the
stereotactic radiosurgical device – Georgetown’s physicians and
researchers are also among the most experienced in the world at
using CyberKnife to ablate soft-tissue tumors, treating more
than 50 lung, pancreas and liver lesions to date. But because
such tumors may move with the patient’s every breath, they pose
special operational challenges.

Enter Synchrony Software , CyberKnife’s latest advancement and,
according to manufacturer Accuray, the first technology in the
world capable of accurately delivering dynamic radiosurgery to
tumors that are affected by the respiratory cycle. As such, it
is particularly well suited for use with lung, liver, kidney
and pancreatic tumors.

Synchrony uses a complex system of cameras, motion tracking
software, fiber optic sensing technology, infrared emitters and
a special formfitting, highly elastic patient garment to do its
job. In conjunction with CyberKnife, the system identifies,
updates and then correlates external body surface movement with
movement of the internal tumor fiducials. Throughout the
procedure, Synchrony is monitoring the target and readjusting
its calibrations to assure that it is locked on the tumor. The
result is that physicians know exactly where the tumor is in
real time, and can use maximum radiation without fear of
harming surrounding healthy tissues.

While treatment by traditional radiotherapy can be effective,
it is also limited and associated with serious side effects – a
particular concern with lung cancer patients who already have
compromised health and diminished capacity due to years of
smoking. By contrast, Synchrony reduces radiation "scatter,"
allowing for ablative tumor doses with much improved toxicity.
It is also faster and more accurate, making it easier on the
patient.

Lung cancer treatment with Synchrony is a team effort, relying
upon the expertise and experience of a thoracic surgeon,
radiation oncologist and physicist. Prior to the procedure, the
patient undergoes a series of tests and measurements to allow
the team to plot out the most appropriate treatment plan.
Treatment usually requires three sessions of one to two hours
each, spread out over the course of two weeks."


--
Matti Narkia

"Matti Narkia" <mna@mbnet.fi> wrote in message
news:6f2f231gqqfe9ogi433duv33jc0hfc6737@4ax.com...
> On Thu, 19 Apr 2007 14:58:19 GMT, "Steph" <steph@vancouvers.island>
> wrote:
>
>>
>>"Matti Narkia" <mna@mbnet.fi> wrote in message
>>news:73re23p47bbjblslbma6v14vq0e8u508g9@4ax.com. ..
>>> On Thu, 19 Apr 2007 07:53:34 GMT, "Steph" <steph@vancouvers.island>
>>> wrote:
>>>>
>>>>"Matti Narkia" <mna@mbnet.fi> wrote in message
>>>>news:m12d23p4rtvqj9h07guongco3qjkugbhvh@4ax.co m...
>>>>> On Wed, 18 Apr 2007 14:54:59 -0500, clifto <clifto@gmail.com> wrote:
>>>>>
>>>>>>Uncle Sally wrote:
>>>>>>> First he told me that because of the location of the tumor, and the
>>>>>>> fact
>>>>>>> that the soft tissue could not be fixated (or immobilized), that it
>>>>>>> made
>>>>>>> it
>>>>>>> impossible to get the benefits of the increased precision of focus
>>>>>>> and
>>>>>>> beam
>>>>>>> placement of IMRT compared to 3D Conformal Mapping.
>>>>>>
>>>>>>Think about what he's saying there. He can shoot IMRT at the spot, but
>>>>>>the spot isn't going to be where he's shooting the radiation. He could
>>>>>>fill your nasopharynx with concrete and immobilize the spot, then do
>>>>>>the
>>>>>>necessary imaging to locate the spot and have the physicists calculate
>>>>>>the necessary parameters to do the IMRT, but in the few days that
>>>>>>would
>>>>>>take, you might decide you liked it better when you could breathe.
>>>>>>
>>>>> I think that Uncle Sally has cancer in the lower tongue, which
>>>>> according to my understanding is in the oropharynx, not in the
>>>>> nasopharynx. I had cancer in oropharynx plus in many other places, and
>>>>> I had IMRT.
>>>>>
>>>>>>There's no sense shooting fixed beams at a moving target.
>>>>>
>>>>> Not with IMRT, but I think CyberKnife, which Uncle Sally also
>>>>> mentioned, probably can do that at least to some ectent.
>>>>>
>>>>> Well, we are not experts in this, but Steph is. I hope he has time
>>>>> reply to Uncle Sally.
>>>>>
>>>>>
>>>>> --
>>>>> Matti Narkia
>>>>
>>>>If IMRT is unable to treat a cancer of the oropharynx because of "organ
>>>>movement", then cyberknife would be even worse........
>>>
>>>
>>
>>That too
>>
> Sometimes you replies are a bit cryptic :-). Could you elaborate a
> little? Do you mean that CyperKnife has failed to function the way my
> quote from the Georgetown University Hospital's web page says it can
> do?
>
>
> --
> Matti Narkia

No, I mean you can use most sophisticated instruments to do most jobs.

"Uncle Sally" <uncleSally@auldUncleSally.com> wrote in message
news:szNVh.466325$rN.348875@fe09.news.easynews.com ...
>I appreciate the advice, the shared experiences, the support very much !
>
> I am inclined to go with my doctor's recommendation for 3D Conformal
> Mapping
> instead of IMRT with my tumor just based on trust and his knowledge of the
> capabilities and skills of the hospital facilities and staff at this time.
> He has had broad experience for many years treating thousands of patients.
> And he is an active researcher, professor, as well as practicing
> clinician.
> His "number two" is a Stanford, Harvard Medical School, Johns Hopkins,
> trained Thai woman.
>
> My guess is that it would be very difficult to ... for a specific
> individual
> tumor ... estimate the potential benefits of IMRT over 3D Conformal
> Mapping,
> but that over a wide spectrum of cases (probably with significant
> improvements for certain types of tumors) there is a general quantifiable
> improvement.
>
> I probably should have mentioned in my original post that a friend of mine
> knows Dr. Brady (inventor of the CyberKnife) in the US and talked to him
> about my tumor, and Dr. Brady said CyberKnife was not indicated for such
> tumors of soft tissue.
>
> Again many thanks for your time and good energy
>
> best, Uncle Sally
>
>

I'm a great supporter of trusting your oncologist