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.