SBRT to C2 and hilar lymph node

[Drandma]

We’ve met with the radiation oncologist and have had multiple MRIs, Ct scans. The doctor wants to SBRT the bone Mets on the C2 in 5 treatments. Yesterday, a head and shoulders cage was made which my husband will be wearing as he is strapped to the table during radiation. The doctor has cautioned my husband against lifting weights or using the rowing machine at the gym as his bone integrity at the C2 is very compromised. My questions are: Will radiation further compromise the bone integrity? Is there anything that can be done to strengthen the bone? Will the zytiga, prednisone and Eliguard further damage the bone? Anyone else had radiation to the C2? Feeling very apprehensive. The doctor also wants to radiate the hilar and para aortic lymph nodes when he is finished with the C2. Thank you for your responses.

[NRH_Beach]

I had SBRT radiation to (3)vertebrae - including the C2 - in 2019. It was successful in neutralizing all the tumors

I did need a Kyphoplasty procedure on two of those vertebrae about a year later. (Day surgery reinforcing the veribreae with cement). I am still careful about lifting heavy loads, but I have my full range of motion for yoga and bicycling.

Best

[Drandma in reply to NRH_Beach]

Thank you, this is encouraging! The best to you! Looking at your bio and you and my husband started on this journey at the same age around the same time.

[nobaday]

I had stereotactic radiation around 50 greats to C2 in 2018. I have had tumours at C2 and T8 to T-2 and was on Abi prednisone followed by Abi Dexamethasone for 4 1/2 years, and Zoladex ADT, Then C2 was found growing again and eroding C2 and I had to have 2 rods and 7 screws in C1 to C6 to support C2 in June 2022. I was then able to get on a Lu177 trial and had 5 out of 6 infusions of Lu177. T8 to T12 tumours remained stable but C2 tumour started growing again. and just yesterday I finished a second five stereotactic radiations of another total 50 grays. at C2.

No side effect in either set of 5 radiations of 50 grays total . I did get some dry mouth from C2 surgery and Lu177 infusions and loss of taste. But no blisters. I was told by the radiation oncologist this time around I might get a sore throat over the next 2 to 3 weeks and if I do to contact his office to get a ‘special mouthwash’ maybe similar to what you have been given. No sore throat the first time around of C2 radiations and nothing yet this time. The first time it did stop/ zap / slow growth at C2 as indicated by loss of any pain at C2 for a couple of years or so.

Your husband has tumour(s) growing at C2 and if ithey grows too much they can push against the spine or one of the blood vessels to the brain which would be a BIGGER problem. Yes the bone integrity can be further weakened over time by radiation and C2 might need to be supported, by cement or rods/ screws. I had severe pain in my neck as the tumour ate away some C2 bone , pain so bad I had to lie down as my neck could no longer support the weight of my head!

In your case the immediate priority is stoping/ slowing the growth of tumour at C2 which hopefully the radiation will have done. And if you get pain in your neck the priority will be to support/ stabilize C2.

Hope that helps!

[Drandma in reply to nobaday]

You have been through a lot! I’m so sorry! Thank you for the encouraging words. I am surprised that the tumor on the C2 came back though. I was under the assumption that the radiation would prevent this from happening. I don’t think I’ll share that but of information with my husband. Sometimes ignorance is bliss! Good luck to you!

[nobaday in reply to Drandma]

if you don’t zap every bit of tumour and they have to minimize radiation close to the spine then will grow back slowly as prostate cancer does. I think on my first stereotactic radiation I had hoped it would zap it all. The same with Lu177 but that might have worked just some non avid PSMA cells that have grown back as a non avid PSMA tumour prostate cancer often finds a way around , that’s why Abi prednisone fails although for some people it is weeks, some it’s months and for some it’s many years.

[Kayakbob]

Ask about Zometa infusions (it's a bisphosphonate) to rebuild bone structure after radiation. I had mets at L2, caused a fracture and quite a bit of back pain. After SBRT to zap the mets, and a year of monthly (if I remember correctly) Zometa infusions, scans showed new bone growth had replaced the cancer area, and back pain had stopped.

[Drandma in reply to Kayakbob]

Thanks for the information. We will be sure to ask about that.