Imrt best practices?

[Blaguy]

Hello. So I am to start imrt next week and tend to think my dr. Is just winging it on protocol. He says to stop vitamin c and e. Also to cut out any flatulent causing foods like whole grains for the duration. Also drink 32 ounces of water prior to treatment. I have tried to find the best advice but to no avail. Please tell me your experience. Thanks

[pjoshea13]

Most cancer treatments, including radiation, generate ROS (reactive oxygen species). The fear is that antioxidants might rescue cancer cells from destruction. I have discussed this with two radiologists who dismissed the idea.

But maybe your guy has better data?

It is no hardship to give up C & E until 1 month after the final session. In any case, oral C has no effect on PCa, & the most common E supplement might drive down the most useful forms.

Water is recommended, but basically, the 8 x 8oz portions daily that is always trotted out. There is no basis for that 64oz number, & big men need more than small men.

He wants you fully hydrated before the sessions, but, from what I have read, you should avoid dehydration at any point, up until several weeks after treatment.

-Patrick

[ng27868168]

Both vitamin C and E have been found to possibly have a negative effect on the radiation therapy.

[cpcohen]

Just on "theoretical grounds":

. . . If you're gassy, your internal organs will be in _slightly_ different positions than

. . . if you're not gassy.

Unless you're in a real-time-monitoring MRI-integrated radiation device, that movement will be enough to put the radiation beam where it doesn't belong.

So his recommendation to avoid whole-grain foods is probably a good one! There are some anti-gas pills available (I've forgotten the name) -- ask a pharmacist, and ask your doc if he advises taking them.

I can't speak to "stop vitamin C".

. Charles

[AlanMeyer Moderator]

I also have seen the Vitamin C antioxidant theory that Patrick and ng27868168 referred to. Not knowing any better, I always assumed it was true. It "stands to reason" as we often say. The question now is, do the radiation oncologists who promote the theory believe it merely because it "stands to reason" or because they have evidence. Ditto for the ones who don't believe it.

I searched Google for ( does vitamin C reduce radiation damage ). The top hit was:

ncbi.nlm.nih.gov/pubmed/190...

The authors of that article tested the theory on rats and found, that for the cell types they tested with the dosages of radiation and vitamin C that they applied, the vitamin C WAS protective. Note also the "Similar articles" column on the right side of the screen that discuss curcumin and L-carnitine.

As with anything health related, Google searches will produce piles of garbage along with the possible gems. So I tried the same search in Pubmed. Most of what I got back concerned damage from UV rays, i.e., sunburn, for which vitamin C is said to have some protective effect. I also saw this article that mght be more specifically applicable:

ncbi.nlm.nih.gov/pubmed/128...

And this one that specifically studied DNA damage - a principal goal of radiation oncology:

ncbi.nlm.nih.gov/pubmed/259...

Full text is available free for that last one.

I noted that the last citation was to a study that tested a number of anti-oxidants and described the amount of protection that each provided against radiation. Very significant, I thought, was the statement that "The combination of different antioxidants did not have an additive effect." I take it that that means that if vitamin C has a 25% protective effect and vitamin E has a 12% protective effect, unless you get rid of both supplements, eliminating vitamin C will only give you 13% reduced protection of the tumor cells. Vitamin C was actually the second strongest protector. The strongest was N-acetyl-L-cysteine (NAC).

It's possible to drive ourselves nuts with these kinds of things, but in this case I'm thinking it's worthwhile because eliminating vitamin C (and a few other supplements) is super easy to do, probably has no significant side effects, and looks like it could measurably improve the outcome of radiation treatment.

Of course all of that assumes that I understood what I read and that the people who wrote the articles knew whereof they wrote. There isn't a lot of certainty in medicine, is there?

Alan

[Blaguy in reply to AlanMeyer]

Thanks for the reply. It's the idea we have to search around that bothers me. There should be a current best practices page for doctors as well as patients to refer to. I tried NCI to no avail. What set me off is that my dr. recommended the anti flatulent diet which not so current research has said works in theory but the opposite is true in practice and he should have known that. You have given me a lot to look at, thank you

[Blaguy in reply to AlanMeyer]

Second reply. There is no doubt that antioxidants protect the healthy cells. The question is does it protect cancer cells from radiation.

[Hidden]

If your urine is clear, I believe that that is an indication that you have sufficient water. If it is yellow, try drinking more water.

[Blaguy in reply to Hidden]

The theory is that if your bladder is full it pushes the prostate gland away and helps avert damage to other organs. Truth or fiction.

[Hidden in reply to Blaguy]

Ah. Or "immobilizes" the tissue around there. ? Pushing the prostate away means the bladder is pushed up against the prostate. But you want to keep the bladder away from the radiation.