Is a 2-week break between adjuvant radiotherapy & chemo okay?

Normally will a two weeks break in between a cycle will affect the curative intent for adjuvant chemotherapy ?

Hi @kslayer, that is a good question for your relative's cancer team. I'm tagging fellow members like @stageivsurvivor @gamaryanne @susanpmadigan @ncteacher @lfitz, who I believe have experience with chemoradiation and 5FU.

You may also be interested in this related discussion.
- Radiation and chemo for pancreatic cancer: Is it effective? https://connect.mayoclinic.org/discussion/tadiation/

I can't speak for your family member's specific situation, but it is not uncommon to patients to be offered "chemo holidays" to recover from side effects without decreasing the effectiveness of treatment. Sometimes a chemo session may be delayed if one's blood cell count is too low. Adjustments may also be made to the chemo drug mixture if one of the drugs is causing a specifically challenging side effect. For example, reducing the amount of cisplatin if there is concern about permanent peripheral nerve damage.

As you can see, there are a variety of possible options that can be discussed with the cancer team to make sure the option is best for your relative, the goal of treatment and quality of life/side effects. It is an individual choice made with the medical team who have all the medical records, history, etc.

What side effects is your relative finding challenging at this point?

kslayer,

I am not a medical professional - and, I don't know the specifics of your relative's diagnosis or current condition - nor where the surgery was performed.

I usually offer my opinion that one should be seen and treated at a center of excellence - for both CHT and CRT, as well as for the surgery. Pancreatic cancer is sneaky and hard to kill. Unless your relative was and is being treated at a center of excellence for PANCREATIC cancer, please consider contacting one for a consult - if you can them in, also please consider shifting their care to one of those centers.

I'm stage 4 and do not qualify for surgery or any type of radiation, so the only thing I can do is rely on chemo. @colleenyoung is right in that sometimes doctors recommend a chemo "holiday" to help the patient recover from earlier therapy and get prepared for upcoming therapy. Your relative's CA 19-9 level looks wonderful, which is encouraging. The issue, of course, is that every patient is different. That really seems to be the case with pancan! So it would be difficult to say whether a two-week break would cause problems. That's definitely a question for your MD. I agree that it would be helpful to know what kinds of side effects your relative has experienced and whether there's anything the doctor can do to alleviate those. I would encourage your relative to ask for frequent, regular CA 19-9 blood tests to keep track of that level.

Thank you very much for all the responses. Ca19.9 was taken every week during radiotherapy and the numbers have been 3x and 2x for throughout this month. Basically ca19.9 is done every other week during folfurinox. My relative appetite has been poor during the end of radiotherapy and he has been suffering from neuropathy ever since the 3rd cycle of adjuvant therapy. He is afraid if continuing folfuirinox rite after the week where radiotherapy ends will bring a large impact to his body as the radiotherapy side affects are still here and he needs to sleep most of the time with a low quality of life

I can't speak to radiation side effects. I haven't had radiation for pancan. I did have 16 rounds for a small DCIS (breast cancer) in winter 2022-23, but had no side effects. Re the neuropathy, have you talked to your MD about gabapentin? It is often prescribed to help with neuropathy. I've never taken it, so I don't know how effective it is or whether it has side effects as well. But it might be worth asking about. Another option might be discontinuing the oxaliplatin for a little while to give the nerves a chance to recuperate. That raises other questions of chemo effectiveness, so be sure to discuss this with your MD and weigh the options.

Re appetite, that's a tough one no matter what type of pancan treatment is being administered. In general, I've found smaller meals, more frequently, suit me better. In my early chemo days, when I was really struggling with loss of appetite and stomach upset, I relied a lot on bland, starchy foods, such as baked potatoes, rice, bread. Be sure that your relative stays hydrated. I never was able to manage sports drinks, but a lot of people on this board say they've had good success with them. Getting better nutrition and hydration should help with the fatigue, I hope.

@kslayer, ncteacher's response reminds me that I asked my med. onc.'s office for additional IV fluids a few weeks after surgery bc my general queasiness put me off not only food but beverages; I think I should have had more than one appt. for IV fluids, bc my recovery from surgery has been a little slow. Pls keep IV fluids in mind as an option for your relative, bc being dehydrated increases fatigue and general malaise. (I don't know whether your relative automatically receives additional IV fluids during FOLFIRINOX infusions.)

And, adding to ncteacher's thoughts on food when one is queasy / has no appetite: low-sodium sliced turkey and plain chicken were / are helpful for me, as were / are instant mashed potatoes (I have no energy to cook), corn flakes, and unsweetened applesauce. Very diluted apple juice is sometimes more palatable to me than water, meaning that I drink more, as is undiluted ginger ale.

Also, I also recommend Bolthouse Farms protein shakes, diluted with lots of dairy milk or soy milk (to reduce the amount of sugar, which I can't tolerate these days). I prefer Bolthouse to Ensure bc the former have fewer lab chemicals and less sugar.

Just FYI: Our observation in my Bride’s 5th cycle of Folfirinox was that extra Infusion Hydration has made a huge reduction in side effects. My Bride drinks as much 50/50 Water-Gatorade Zero as she can throughout the day but can’t apparently get the internal hydration state which she gets from the infusions (via a Bard port). We have worked out in a 14 day running cycle of chemo, where she gets the extra hydrations on Days 3, 8, & 13. The nurses have all said anecdotally that many cancer patients seem to benefit from the extra hydration. It took us a couple of cycles to figure this out for her and we had to sort of pull it out of the oncology team. We created a daily Chemo Misery Index chart for them which showed the effects. Hoping this experience might help someone else on their journey!

ncteacher I haven’t seen any posts from you for awhile now. How are you? I just noticed this post today and thought I would throw in my 2 cents since this is my issue now. In late June and early July my CA19-9 climbed 2 points from 17 each session (ie 19, then 21). I also had a CT but not MRI (I have liver lesions and abdominal nodules). That CT showed decrease in size of my lesions. I also started to have some occasional sharp pains in my left side. This small increase had me concerned. My oncologist (not pancreatic) at infusion center seemed almost annoyed with me for being concerned as they congratulated me on my CT. I did have a small hernia which they said was new, but of no concern to them. I happened to also be experiencing some cardiac arrhythmias at this time. My birthday was also after mid July so my infusion oncologist put me on a chemo vacation for 1 week but I asked for 2 weeks because I was having some extended birthday celebrations. I feel this was a huge mistake as when I returned my CA19-9 was now 97 (from 21). I had another infusion the following week and my CA19-9 was now 197. It took a bit convincing by me for my infusion oncology to admit that “changes are occurring”. He tried to offer that CA19-9 tests can have different upper limits! Yes, 34 or 37! So now I’m getting imagine next week (PET and MRI) and will meet with my pancreatic oncologist following those imaging results to see if there is a next step for me. So yes, everyone is different, but the first question I would ask myself is has the CA19-9 been a good indicator of your cancer status? For me it always was. Also, there can not only be growth of existing tumors or lesions, but appearances of new modules, lesions, etc. which might have caused that increase in CA19-9.

Hello! You're kind to inquire after me. I check into the board daily, but backed off from posting for a few reasons, including health. I'm hanging in there. I've had a rough summer, no thanks to a gastric output obstruction. I could consume and digest food, but the blockage kept it from moving into my small intestine. A duodenal stent didn't help; as it turns out, the pinch point was below the stent. Anyway, since the beginning of June, I've had two surgeries (duodenal stent and replacing the ureteral stent), 15 days of higher-dose radiation to shrink the blockage, a short hospital stay for TPN, and reduced nutrition and hydration, all of which have left me weaker than I was in May. I'm getting fluids twice a week, and I received 2 units of blood on Wednesday because my hemoglobin stays too low.

The radiation did help, as my stomach is better and I'm eating solid food. (Thank heavens--I couldn't tolerate the "full liquid" diet, AKA mush.) But the problem hasn't been permanently solved, of course, so we're going to consult with an HPB surgeon next week to discuss options. My oncologist is campaigning for a GJ (gastric-jejunum) bypass, in which the bottom of the stomach would connect to the jejunum (small intestine), bypassing the duodenum and pinch point below it. Meanwhile, chemo (Folfiri) is set to resume on Tuesday 8/27, and I hope we get a good response. My CA 19-9 is up to 217, in part due to inflammation from radiation, so I'd like to knock it down again for a while. My brain wants to do things--the library reading tutor program starts next month, for example, and I'd love to volunteer--but my bod just hasn't been cooperative. I'm hoping for better days ahead. Or, to quote my blood type, B positive--that is, be positive!