Types of radiation therapy and chemo therapy combinations

Posted by maeono @maeono, Nov 9, 2023

Hello - my brother was just diagnosed with HPV cancer and had removal of lymphs nodes through right neck dissection and removal of right tonsil. He is 56 and otherwise healthy and very active. There was cancer in only 1 or 30 lymph nodes but it was large and the cancer was outside the lymph node (extra nodal extension). They did not find cancer in the tonsil and he is now scheduled to go back for the TORS surgery to remove the lingual tonsil. They are unsure if they will find cancer in the other tonsil and think there is chance they will not find the primary site. He is told he will need radiation for 6-7 weeks and likely chemotherapy as well.
My questions;
I've been reading about Proton therapy radiation and it seems like it is better tolerated with less side effects. He is at Dana Farber and they seem to have an excellent Head and Neck program but I don't see on their website they offer Proton therapy. What can people tell me about proton therapy vs. traditional radiation and is worth seeking out a 2nd opinion at a center with proton therapy? I've also read about DART and wondering if others have chosen that?

Chemotherapy was discussed but there was no mention of immunotherapy. Wondering if others have been offered immunotherapy? The doctor seemed to indicate that although
he was leaning towards recommending chemo that it would be reasonable for my brother to decide not to choose chemotherapy as the research is limited. My brother has hearing loss in one ear already and I've read that one of the side effects of the chemo used for HPV is hearing loss so this is of course a concern.

Thank you ahead of time for any thoughts, suggestions or recommendations to further research and discuss with his team. My best to you all!

Interested in more discussions like this? Go to the Head & Neck Cancer Support Group.

@jersey3422

I am hoping for a good outcome for your husband. Be patient with him because he’s got a hard road ahead. I was very difficult to deal with because I wouldn’t eat. Don’t try to force him. It will do more harm than good. Radiation is super painful and I’m sad for anyone who has to go through it. Get Aquafor for his neck to rub on. Start that immediately and also try Helios for his throat. They both were a really big help for me. Later maybe ask for a Gabapentin script if he has tongue issues. That helped me too. Saying prayers for you both. 🙏🏼

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My neck was very very burnt externally from the radiation, and I was advised by my care team at Mayo to use 4 products in conjunction with each other to assist in healing:
• Aquafor/lidocaine mixture,
• Xeroform (Dukal Xeroform Petrolatum Gauze, Sterile, 5" W x 9"),
• Domeboro (Domeboro Rash Relief Medicated Soak, Calming & Soothing, Powder Packets)
• Gauze that was like a turtle neck (couldn’t find the exact brand).
Two or three times each day, I would first soak my neck using a medicated wash called Domeboro. I would dip a bandana in the solution and wrap it on my neck for perhaps 20 minutes. I would then mix Aquafor and liquid lidocaine 50/50%. I would open a Xeroform strip, unfurl it, cut it in two pieces and spread the Aquafor/lidocaine mixture on one side of the Xeroform and put it on my neck with the mixture against my neck. I would use the gauze to hold it in place. I would leave it on for perhaps an hour or more, until it felt like it was drying.
For me, after the Domeboro, the skin actually looked kind of white and gelatinous. As it healed, the skin area like that decreased, I guess meaning it was healing. I did this for close to 2 months after treatment until my neck appeared healed.

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@jonesja

I was diagnosed with HPV cancer of base of tongue March 2023. I had TORS surgery to remove tumor and lymph nodes through right neck dissection. 2 of which had cancer. I am 57. I chose Proton vs Photon Radiation as I feel it is much less damaging . In my opinion Proton is more targeted with less side effects. However, It is a battle as insurance companies do not want to pay for Proton when Photon is 50% less costly or more. Proton is like a pencil beam hitting the target and stopping. Photon is more like a flashlight beam which travels through the target area. I had to drive an hour to Proton treatment. Alot of people drive much further. Currently I am 120 days post 30 rounds of Proton Radiation to "cleanup" any cancer that may have been left behind from HPV16 base of tongue and Few Lymph nodes . l was very worried about going on a feed tubing , Dysphagia and Not being about to swallow (eat or drink). I started doing mouth,Neck, tongue and swallowing exercises prior to proton Radiation. If you have a Speech therapist they can help you with this. It was a struggle to eat during radiation and I FORCED myself. He will lose appetite and everything has no taste. However as far as today 120 days out of treatment. I can eat and drink about anything I want. My taste buds are about 35% and seem to be coming back . My throat mucositis is almost gone away and Saliva production is slowing getting better. My hair has stopped falling out. My stamina is back to about 80% . I chose no Chemotherapy as they could see the tumor through a PET scan. As I understand Chemo will travel throughout the body to "find" the cancer and attack it. Has he received a full body PET scan?

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The problem with radiation is that the after affects can appear out of nowhere at any time. I thought I was free and clear, months after the same treatment for my throat cancer.

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@imaginus

The problem with radiation is that the after affects can appear out of nowhere at any time. I thought I was free and clear, months after the same treatment for my throat cancer.

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My experience is radiation issues can go on for years, nephropathy being the main one not to mention bone death (osteoradionecrosis) and the lasting effects of disfigurement both internal and external. This is why I advocate for Proton beam rather than Photon because accuracy matters. Any doctor who doesn't agree with that statement is welcome to join any of us on the table with our heads strapped down. Still, any radiotherapy is better than death most would agree.

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@maeono

Thank you for your response. Just starting to look at other options. He just had surgery last week and originally he thought it would just be surgery and maybe radiation but hopefully not. The outcome of the surgery changed that and now the plan is another surgery, radiation and maybe chemo. That was unexpected and a disappointment. His oncologist has a lot of experience as evidenced by his published research. But I know educating ourselves is important too for informed discussions and decisions. Trying to gather that!

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Dana Farber is a highly regarded hospital and especially for head and neck cancer. They are actually involved in clinical trials using proton therapy. There are options with lower radiation and chemo or even no chemo depending on the stage. I was treated at Mayo Clinic and they are doing less radiation and chemo and getting good results depending on the stage of cancer. If I had the ENE I would want the chemo though to help lessen the chance of spread. They are being cautious since they have not found the primary site it sounds like. There is no harm in also getting a 2nd opinion from another center such as Mayo Clinic, MD Anderson, MSK but Dana Farber is a VERY good hospital and I believe it is ranked as #4 in the country for cancer.

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@stephenrfleury

My neck was very very burnt externally from the radiation, and I was advised by my care team at Mayo to use 4 products in conjunction with each other to assist in healing:
• Aquafor/lidocaine mixture,
• Xeroform (Dukal Xeroform Petrolatum Gauze, Sterile, 5" W x 9"),
• Domeboro (Domeboro Rash Relief Medicated Soak, Calming & Soothing, Powder Packets)
• Gauze that was like a turtle neck (couldn’t find the exact brand).
Two or three times each day, I would first soak my neck using a medicated wash called Domeboro. I would dip a bandana in the solution and wrap it on my neck for perhaps 20 minutes. I would then mix Aquafor and liquid lidocaine 50/50%. I would open a Xeroform strip, unfurl it, cut it in two pieces and spread the Aquafor/lidocaine mixture on one side of the Xeroform and put it on my neck with the mixture against my neck. I would use the gauze to hold it in place. I would leave it on for perhaps an hour or more, until it felt like it was drying.
For me, after the Domeboro, the skin actually looked kind of white and gelatinous. As it healed, the skin area like that decreased, I guess meaning it was healing. I did this for close to 2 months after treatment until my neck appeared healed.

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Thank you so much for your reply! This will be really helpful if he has a reaction similar to yours. Sounds rough though and I hope your are all healed up now!

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@imaginus

The problem with radiation is that the after affects can appear out of nowhere at any time. I thought I was free and clear, months after the same treatment for my throat cancer.

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I hope you're feeling better now! Take care.

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@hrhwilliam

My experience is radiation issues can go on for years, nephropathy being the main one not to mention bone death (osteoradionecrosis) and the lasting effects of disfigurement both internal and external. This is why I advocate for Proton beam rather than Photon because accuracy matters. Any doctor who doesn't agree with that statement is welcome to join any of us on the table with our heads strapped down. Still, any radiotherapy is better than death most would agree.

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Yes - I think you're right - most are willing to do whatever is recommended. Hope is the driver. Thank you for your response.

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@goffrey

Dana Farber is a highly regarded hospital and especially for head and neck cancer. They are actually involved in clinical trials using proton therapy. There are options with lower radiation and chemo or even no chemo depending on the stage. I was treated at Mayo Clinic and they are doing less radiation and chemo and getting good results depending on the stage of cancer. If I had the ENE I would want the chemo though to help lessen the chance of spread. They are being cautious since they have not found the primary site it sounds like. There is no harm in also getting a 2nd opinion from another center such as Mayo Clinic, MD Anderson, MSK but Dana Farber is a VERY good hospital and I believe it is ranked as #4 in the country for cancer.

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Thank you for your response. Yes, exactly, they are being cautious. His doctor said that if you asked 10 doctors, 5 might lean towards chemo and 5 might not and none would be wrong. But he is leaning towards chemo and I think my brother will follow his lead. He is also looking in to second opinions. Take care!

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@maeono

Thank you so much for your reply! This will be really helpful if he has a reaction similar to yours. Sounds rough though and I hope your are all healed up now!

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Getting my results for my 3 year scan today. The radiation, as many have experienced, caused extreme skin and and muscle tightness. I also have a number of red spots and blotches which I believe are capillaries that burst. All-in-all, it's quite manageable.

At the end the day, it's a small price to pay for getting rid of the cancer.

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@stephenrfleury

Getting my results for my 3 year scan today. The radiation, as many have experienced, caused extreme skin and and muscle tightness. I also have a number of red spots and blotches which I believe are capillaries that burst. All-in-all, it's quite manageable.

At the end the day, it's a small price to pay for getting rid of the cancer.

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Clean scan yesterday! 3 year mark. Woohoo!

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