Can radiation be given between finishing chemo and having Whipple?

Posted by steveron @steveron, Jun 10 2:04pm

Our oncologist and surgeon say radiation is not needed or recommended between finishing chemo and having Whipple. It seems logical that any therapy which could shrink the tumor is something to consider. Has anybody had radiation therapy between finishing chemo and having Whipple?

Thanks.

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marienewland | @mnewland99 | Jun 12 8:09am

In reply to @ashley2235 "Hi. I don't have any genetic mutations that they have found." + (show)

Forgive my ignorance, I’m probably not understanding the term correctly of no evidence of tumor at survey, but what did they remove then? Did you mean after they removed the dead tumor and tested it?

ashley2235 | @ashley2235 | Jun 12 8:50am

In reply to @mnewland99 "Forgive my ignorance, I’m probably not understanding the term correctly of no evidence of tumor at..." + (show)

So during surgery there was no tumor there anymore. Just the tumor bed, where it had been. Chemo and radiation had obliterated the entire thing. Every day while I was on the radiaton table I visualized the tumor being blasted into oblivion. And I guess that's what happened. My CA19 had normalized 5 months prior to radiation, as well as no PET activity. So it was essentially dead and gone.

ashley2235 | @ashley2235 | Jun 13 5:45am

In reply to @gamaryanne "I would add only that one should discuss radiation with several sources. And do ask about..." + (show)

This is very true regarding CA19 in normal range. Mine has gone from 16 to 22 to 23 and Mayo isn't concerned because it's "normal". Yet I am documenting the trend and anxiously awaiting my next scans and labs.

mayoconnectuser1 | @mayoconnectuser1 | Jun 13 7:39am

Here's a good summary of CA 19-9 ... https://pancan.org/facing-pancreatic-cancer/diagnosis/ca19-9/

What isn't clear is whether an increase from say 10, to 14, is considered as representative of anything, given that both are in the normal range.

beckyshops | @beckyshops | Jun 20 9:04am

In reply to @ashley2235 "I am a patient of Dr Mark Truty at Mayo, and he definitely is a fan..." + (show)

Hi - I am working through the Mayo clinic in Phoenix and have requested referral to Dr. Truty in Rochester as I have tumor in pancreas head but with a few arteries wrapped >180. Did radiation start while you were still getting Gemcitabine infusions, or was there a break? I had 4 Folfirinox infusions followed by blood test & CT at Mayo Phoenix and it's shown almost no response. ca19-9 stays in the same general range (mid-400s) so they are starting me today on the Gem-abraxine chemo. I'm eager to hear back from Truty's office, but thinking maybe they'll want to wait for a couple cycles of this chemo before evaluating me.
Anyway, just wondering about the chemo-radiation schedule. Thanks and congrats on your progress!!

ashley2235 | @ashley2235 | Jun 20 9:14am

In reply to @beckyshops "Hi - I am working through the Mayo clinic in Phoenix and have requested referral to..." + (show)

I did 3 rounds of Folfirinox with poor response (CA19 increased from 174 to 440). Switched to Gem/Abrax and my CA plummeted to 75 after the first round! I am hopeful you will see the same results!
I did 4 rounds Gem/Abrax, then took a couple weeks off before radiation started. I did not get in with Dr Truty until after I had completed radiation, but that is just how the timing went with fighting my insurance.
I did weekly Gemcitabine infusion (no abraxane) during my 4 weeks of radiation. Then after radiation and meeting with Truty, I continued Gem/Abrax for another 2 rounds followed by a few weeks off, prior to surgery.

ashley2235 | @ashley2235 | Jun 20 9:15am

In reply to @beckyshops "Hi - I am working through the Mayo clinic in Phoenix and have requested referral to..." + (show)

Also wanted to add that the first appointments with Dr Truty take a few days and are VERY in depth. He does labs, PET/MRI, and peritoneal washing to see if you are a surgical candidate. He is extremely thorough and the absolute best in my opinion. I owe him my life at this point!!

beckyshops | @beckyshops | Jun 20 2:01pm

In reply to @ashley2235 "Also wanted to add that the first appointments with Dr Truty take a few days and..." + (show)

Thanks so much for your replies! Was your oncologist (overseeing the chemo
& radiation) with Mayo also or elsewhere? Nearby or a travel-distance? I'm
hoping I can continue to coordinate keeping chemo at closeby MDAnderson
facility and get radiation at local Mayo, then surgery in Rochester.
Just had my 1st Gem/abrax chemo; what a breeze compared to the
Folfirinox...THIS I can do!

*Becky*

ashley2235 | @ashley2235 | Jun 20 2:37pm

In reply to @beckyshops "Thanks so much for your replies! Was your oncologist (overseeing the chemo & radiation) with Mayo..." + (show)

I am in Atlanta and did chemo and radiation here. There should be no issue at all doing treatment locally. I hated to be away from home so often and for so long (6 weeks last summer!), but I knew I would get the best outcomes by going to Mayo Rochester in my particular case.

And yes, Gem/Abrax was smooth sailing! Other than the complete hair loss. haha. Small price to pay.

beckyshops | @beckyshops | Jun 20 3:23pm

In reply to @ashley2235 "I am in Atlanta and did chemo and radiation here. There should be no issue at..." + (show)

Thanks again. This is so helpful. Rochester will be kind of sweet for me because I just moved from the Twin Cities to AZ about 1+1/2 years ago. I'd actually get to see a lot of old friends, not far away...Would just miss my pup here.
I'm getting prepared for hair loss; I think I'm picking a date next week for a head-shave!
Stay well!