Postponing chemo because of radiation?

[Jdhanoa]

Hi all,

My dads first radiation has been sheduled for June 21st. However his 3rd chemo is set for June 26th. When briefly speaking with his RO he mentioned that chemo would be postponed in order to do radiation.

This confused a me a little bit as from my understanding the radiation would be for pain (my dad is stage 4 metastasized to the bones) and the chemo is for killing the cancer cells (he is currently on triplet therapy). Therefore, wouldn’t it make more sense to prioritize the chemo before the radiation? Please let me know your thoughts on this. Thanks

[Junenight]

I had triplet therapy (docetaxel, 1 infusion every 21 days, 6 infusions total), followed by radiation to my prostate My oncologist and radiation oncologist had me do the chemo first, and then waited some time after my last infusion before doing the radiation. They are top notch, I think, with Northwestern Hospital/University in Chicago.

[AlvinSD]

I also did triplet therapy. Started Eligard / Nubeqa (darolutamide) last spring. I was on that for about 6-8 weeks then started chemo. (6 cycles of Docetaxel). My RO had me wait until after chemo (about six weeks) then we did radiation. (He even said I could push it out longer but I wanted to get it done.) His rationale for doing the radiation last was to allow time for the ADT and chemo to work then hit it hard with radiation. (I had no pain or other symptoms besides an elevated PSA.). My RO is at UC San Diego.

[Jewelrylady in reply to AlvinSD]

Would you mind sharing who your radiologist is. What type of radiation did you get?

[AlvinSD in reply to Jewelrylady]

I saw Dr Brent Rose who is outstanding. UCSD was wonderful.

[dougnola]

hi jdhanoa,

I, too, was stage 4 w bone metastises almost 7 years ago. For me, they did the radiation to my neck and spine prior to all my rounds of chemo (taxotere and carboplatin). The logic for that timing in my case was the intense pain those tumors were causing to my arms (pressing against nerves) and the risk of vertebrate integrity. This was done with close consult of my oncologist, radiologist, and neurologist. The radiation shrunk those tumors quickly so I was out of pain so then I could do the whole chemo/ADT adventure that lie ahead. So far so good…I’ve been pain free and with an undetectable psa since 8/18! Best wishes for your journey 🤞

[Shams_Vjean]

I’ve not had radiation, but in my experience with a de novo stage 4 metastatic bone only diagnosis and triplet therapy, the triplet therapy resolved all of my bone pain not long after chemotherapy (6 rounds docetaxal) was completed.

Is low bone density an issue? or severe pain indicating nerve impingement by mets? Unless the bone metastases are a risk for causing nerve damage or fractures near term, I not sure why radiation would be pushed ahead of completing the chemo?

Are you able to get a 2nd opinion? Not sure how Canada NHS works with that.

[Jdhanoa in reply to Shams_Vjean]

He doesn't have any pain from the mets - almost all pain went away after zoladex injection. Maybe will need to get a second opinion regarding radiation

[Shams_Vjean in reply to Jdhanoa]

If it was me, I’d be wanting to know specifically why it is important to postpone chemotherapy in favor of radiation? And was the Zoladex administered more as palliative care to relieve pain from mets? Or more for suppression of testosterone?

You didn’t indicate how long the chemo would be delayed by radiation treatment. If only for a week or few I’d consider it less significant than a delay more than a month.

I’m not a Dr. , so my opinion should not be considered equal to one. Rather my observations are based on limited personal experience and information gleaned from reading and listening to both professionals and forums such as this.

I do strongly believe it’s every patient’s right to advocate for themself; which can be best accomplished when healthcare professionals fully explain why the treatment protocols being promoted are the best fit for the situation.

Wishing you all the best in getting the answers that will satisfy your need to feel confident that your dad is receiving the best possible care.