Experience with re-irradiating lymph nodes?

[tallguy2]

I have three small (8 mm or smaller) "common iliac chain" lymph nodes that still demonstrate metastatic disease (from the PET scan with Axumin) after chemotherapy.

These lymph nodes received 4680 Gy of IGRT in 2012.

It's been recommended that I have these re-irradiated with perhaps another 2500-3000 Gy. My question: have any men on the forum had their lymph nodes hit a second time? If so did you experience any major issues? I understand that a significant concern is injury to the bowels due to proximity. This is the first time I've hit the "pause" button and would appreciate your input.

Thanks, and Happy Thanksgiving everyone!

[Tall_Allen]

You can probably safely use SBRT just on the LNs that lit up, but I would be wary about retreating them all because of the possibility of serious bowel issues you mention. You might want to talk to an RO at a teaching hospital (rather than someone who is looking for money from treating you ) to address the safety issue. Those LNs may just be radioresistant - can you have one biopsied?

[tallguy2 in reply to Tall_Allen]

Thanks for your insight. The recommendation to pursue this came after my visit last week to MD Anderson so I am going to take it seriously, but with eyes wide open as to side effects. We didn’t talk about a biopsy for radio-resistance; thank you for that. I visited a local cancer center yesterday with PET scan in hand and was turned down because of the risk. I have to respect that oncologist for being honest with me. (And hence my question to the group about risk.).

So I am headed back where I was treated in 2012 as I trust that radiation oncologist. That appt is in 2 weeks.

BTW I asked about surgery to simply remove these three areas and was told the risk of lymphodema outweighs any potential benefit in my situation.

Happy Thanksgiving to you and your family.

[Hidden]

I was told in this situation to avoid the radiation if you are not experiencing pain. Radiation is not the best for prevention since there could come a time when you really need it and you will have already played your last card.

[tallguy2 in reply to Hidden]

Thanks for your reply. The recommendation to explore this option comes from my urologic oncologist so I will look into it, but with caution.