radiation therapy vs chemotherapy

[Alex_G]

I came accross this website with ineresting information.

http://patient.cancerconsultants.com/testicular_cancer_treatment.aspx?id=1006

Two studies evaluating adjuvant radiation therapy indicated improved survival after treatment with adjuvant radiation therapy. One of these clinical studies involved 81 patients with stage I seminoma who were treated with adjuvant radiation therapy. The results indicated that only 5 (6%) patients relapsed an average of 7 months after radiation. Three of these 5 patients were subsequently cured with chemotherapy, for an overall cure rate of 98%. Another clinical study conducted in Italy involved 299 patients with stage I seminoma who were treated with adjuvant radiation therapy between 1969 and 1989. The 5-year survival rate was 99% and the 10-year cancer-free survival rate was 96%. The recurrence rate was only 2.3% and no patient relapsed in the radiated field. The chance of serious complications from radiation was 1.3%, occurring 6-27 years after treatment. Nine patients developed new cancers that were probably a result of the radiation.


May it's better to go with chemo than radioation- you will have lower chances for another cancer?

[keysi]

In my opinion both treatments are acceptable, chances of getting a second cancer are there anyway either with chemo or RT, I think that although is necessary to take in consideration the long-term effects of treatment (radiation or chemo) the choice of either one is correct, because the real future of each individual does not depend on treatment's side effects, I believe is up to GOD, you can choose the one that statistics shows less risk and die in a car accident, I don't know, that's just the way I see it, I know there are some people that do not believe in GOD and prefer to base their beliefs in stats it all depends, but the way I see it, I think we should all stop worrying about long-term effects because is not healthy, I used t do that and it was driving me crazy, I was basing everything on statistics, and I realized that our future does not depend on clinical trials.... I agree that we should consider every single option, but that's it, if you haven't decide yet, think about it, if you already have...stop thinking about it and just take care of yourself, doing exercise and eating well, but anyway, I believe both should work fine...Radiation and Chemo....

[Pilgrim]

Good Q to ask

I am asking similar questions, in doing my research. (I see an oncologist tomorrow for the first time, had surgery last week).

If you are at stage 1 it is worth assessing with your specialist options including:

1) Surveillance only - with chemo if something develops later
2) Radiotherapy
3) Single dose chemo

My reading of recent research suggests to me that survival rates from (3) and (2) are the same, but the health consequences are diffierent.

You need to weigh it up for yourself, and ensure your specialist is taccessing the latest research in giving you the options.

[Sans rt1]

You can drive yourself crazy with trying to figure that one out. When I did my research, I found you could come to either conclusion, depending on which study you believed. I assume you are talking about the single-dose carboplatin chemo. I chose RT because there seemed to be equivalent kinds of risks and benefits to each. Others have come to other decisions looking at the same information.

I can't recall if any of your other postings gave your staging and if you had vascular invasion. If you didn't, then surveillence is an option - if you are the type that can deal with that kind of odds, and will be diligent with your frequent follow-ups. Sounds like you have decided that treatment is needed. If you do RT, you will need to decide between the dogleg and para-aortic pattern. If you do the para-aortic, which does not treat the pelvic lymph nodes (and uses less dosage with less bowel problems), then make sure your follow-up protocol includes yearly pelvic CT.

As far as the chemo goes, your whole body gets treated, so the pelvic nodes are not missed. I did not find any studies on the two doses of carboplatin vs. single dose - as to whether it has any better results or much greater risk, but some have done that. My oncologist did not want to recommend the double dose at all as he had not seen studies that showed the second dose was worth the risk, and just what that risk was. He seemed at the time to be pushing the single-dose, but later told me he was happy with my choice of RT.

Ultimately, the choice is yours. Are you consulting with a medical oncologist?

[Alex_G]

I have classical seminoma with vascular invasion. CT scan found something less than 1 cm in pelvic and my urologist told me that I have to go for radiation and surveillance is not an option for me.
I'm currently in process finding oncologist. I just want to know the subject before we are going to discuss my treatment.
I live in Chicago area. Does any one know good oncologist with TC experience or I just can go to hospital in my neighborhood and find the doctor there? I have heard that it’s a good hospital however I have no clue about oncologist and his experience with TC.
I just know that he graduated from Harvard medical school in 1995. That’s all that I found on the internet about him.

[Sans rt1]

I guess I had not seen your staging and the enlarged lymph node. You need to get the right oncology opinions. From what I have read, radiation would probably do it, and sounds like dogleg is required to catch the enlarged lymph node. I am not sure the effectiveness of the single dose carboplatin if there is the chance it has visibly spread (vs. just the chance of microscopic spreading).

So, based on the fact you have a marginal enlarge lymph node, definitely seek out an oncologist that has experience with seminoma to get a good opinion as to the best treatment specific to your case. I think another poster had given you a link to one of the TC resources sites where there are oncologist and medical center information for most areas of the country - that would be a good place to start. I would also recommend that when your oncologist gives you his recommendation, that you make sure he has consulted with Dr. Lawrence Einhorn (Indiana University) confirm your treatment plan based on your staging and the fact that an enlarged lymph node is detected.

Sounds like you are working your way through this all - definetly asking the right questions. I am still amazed that a urologist could not recommend radiation oncologist - I know TC is relatively rare and he may only see a case or two a year, but how many prostate cancer patients does he have? Oh well.

[Sans rt1]

Here is a link to the TCRC experts page, there is one urologist listed in the Chicago area, he might be a place to start in finding a qualified oncolgist, and radiation oncologist in your area. Otherwise there are some in nearby areas on the list.

http://tcrc.acor.org/experts.html

Hmmm, none of my doctors are on the list. Well, at least my oncologist consulted with the best - he fired off an e-mail to Dr. Einhorn and within 24 hours he had confirmation from the expert that the treatment plan he proposed was reasonable.

[Alex_G]

Thanks for the advice and link.
I have a feeling that procedure for TC treatment is the same.
1. Ultrasound – if something found then surgery and then treatment.
depends of type of cancer.
I think experience needed when reading CT scan. And again I guess doctors don’t like risk – they will prescribe you chemo for non seminoma and radiation for seminoma just in case. I’m not telling it is wrong way to go but I don’t really see a lot of different options for doctors especially urologist.
I might we wrong but that’s my feeling lately.
I have strong feeling that doctors are oldest but least knowledgeable profession on the earth.

[IowaBrian]

Don't drive yourself too crazy until you talk to the ONC today they will give you the odds and they are all in your favor so that is the great news.
Write down your questions so you don't forget any and take someone with you to help out. Plan on spending a couple hours there as it can take some time for the doctor to explain all that is going on and your options.
Don't be surprised if they order more test.
Good Luck
Brian