Radiation for Bone Metastases

[yucca13]

How do radiation oncologists determine how many treatments to give someone with bone metastases? I started out being told I needed 13 treatments and now they want to change it to 17. As far as I know they are not able to measure the results except by how I am feeling. Anyone else experienced this?

[Tall_Allen]

They are making money off of you. In ASTRO's "Choosing wisely" campaign in 2013, it issued the following guideline:

"Don’t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases. Studies suggest equivalent pain relief following 30 Gy in 10 fractions, 20 Gy in 5 fractions, or a single 8 Gy fraction. A single treatment is more convenient but may be associated with a slightly higher rate of retreatment to the same site. Strong consideration should be given to a single 8 Gy fraction for patients with a limited prognosis or with transportation difficulties. "

In general, start with one zap and add another if needed.

[yucca13 in reply to Tall_Allen]

Thanks, Allen, for your reply. Just spoke with one of the radiation doctors - my doc is on vacation. He implied that because I have so many metastases, it would influence the number of treatments. It seems pretty plain in the ASTRO guidelines that they should not routinely use more than recommended but it seems as if the radiation oncologist will try to convince you that you are in need of more. This doctor mentioned troubling swallowing ahead which I wasn't told about. In my case, I have to keep working to keep my no-copay insurance. I don't have the money to pay a 20% co-pay. The doc did say I can take a break if I want to. The fatigue at this point, 6 fractions = 13.50 is starting to be concerning.

[Tall_Allen in reply to yucca13]

It would be unusual to suffer fatigue from 6 treatments. More likely causes are stress or the cancer itself. They should be able to zap all the mets in one session. Swallowing is only an issue when radiation is given to the head or cervical vertebrae.

[Ian2017 in reply to Tall_Allen]

Fatigue is not that unusual. I had 5 treatments to my spine over a week in July last year. Took about a week for the fatigue to kick in but thereafter it knocked me quite heavily for about a month.

[Firespook]

How do they know where to “zap” you. And what was your PSA when discovered ?

[yucca13 in reply to Firespook]

I had robotic prostate surgery in May, 2016. Gleason 9. A PET scan a few months later showed a suspicious area in my right third rib. They wanted to do radiation right away but I hesitated because I have to keep working (at 67 I cannot afford to collect my social security because I would give up the 20% that is covered by Medicaid which when based on "unearned Income", SS, makes it too high and a Medicare Advantage plan won't accept me.

In September, they did a bone scan and it showed areas in my right scapula, anterior aspect of the left fourth rib, right iliac wing, sacrum and T4 and T11, The pain became unbearable around that time even with three different pain meds. I. My o. doctor is on vacation and I won't see him until Tuesday. I'm sure he will give me lots of reasons to continue but QOL is very important to me and if it won't make a difference in fracture, etc., I don't want to risk the side effects.

[Saydeebugz]

Thank you for posting this question AND all of the responses... following closely. My husband has completed 10 rounds of chemo, still on Zytiga n Lupron inject every 3mos (psa at 0.04, w/pelvic bone mets). He will now be doing 6mo treatment w/Radium 223, meeting w/RO today for first consult and his plan. I am thinking that he is very fortunate to NOT have to go under beam...

[JimVanHorn]

So they gave me 30 radiations when I found out my PCa had metastasized.

[AlanMeyer]

If you think that your radiation oncologist is not giving first priority to helping you, you might consider getting a second opinion. I always recommend the teaching and research hospitals listed in the National Cancer Institute's list of Designated Cancer Centers. See: cancer.gov/research/nci-rol...

I also suggest that you start bringing a family member with you to your appointments and discussing the cost and possible overtreatment issues at the meetings. I think it's useful to try to get through to a doctor on a personal level if you can and lead him to see that you are a human being in need of help and that you have a family that depends on you. A lot of appointments are terribly short and the patients feel like they are on an assembly line. It's hard to overcome that.

Best of luck.

Alan

[j-o-h-n]

As usual I defer to Mr. Tall_Allen's response/advice, cause I don't know shit from shinola and he know everything about Pca.

Good Luck and Good Health.

j-o-h-n Thursday 10/18/2018 5:07 PM EDT