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For those who has radiation to pelvic lymph nodes - question

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Posted 12/22/2014 11:00 PM (GMT 0)
OK. I had surgery and then SRT to the prostate bed. I did Ht, had an HT vacation, and now I'm back. A C11-Choline scan revealed one external node with a small (5 mm) amount of cancer.

This means I get another bite of the curative apple.

I have already met with a top-notch RO (Dr. Hamstra) at Umich. I will meet with Dr. Lam next week to discuss the issue. Ok, enough with the background. Now for my question.

Snuffy Myers came out with a video warning about major issues with radiation that hits many pelvic lymph nodes. He indicated that it wrecks the T-cells and results in major issues due to messing up the immune system. Dr. Hamstra calls it BS (I'm paraphrasing). But, of course, he has a vested interest in all of this. But he may be right. With the exception of Myers' anecdotal comments, I have not heard about such devastating consequences.

Dr. Hamstra does want to radiate my nodes (many of them; not just the one hot node, since my PSADT is VERY short).

I'm seeking experiences from those who actually had this done (probably as part of the SRT).

Mel
Posted 12/22/2014 11:11 PM (GMT 0)
Mel:

I saw the Myers video, and it raised some concerns with me ... my radiation was to the entire lymph nodes up and behind the stomach. And i can see on the C11 and F18 scans that my bone marrow is lessened there. So in theory maybe i don't create as many white blood cells, etc. But a, i haven't had any repercussions over the last two years and b, just going after the pelvic nodes will keep you from the backbone so you'll be in better shape than me anyways. And c, my white blood counts are usually ok (except for chemo weeks).

Perhaps others have more specific studies, but my sense is that Myers is overstating things a bit ...

Ray

PS Dan Hamstra did my primary radiation as well; good guy tell him i say Hi.
Posted 12/23/2014 12:08 AM (GMT 0)
I had my lymph nodes irradiated as part of my primary radiotherapy. I had something like a 40% chance of positive nodes, but nothing showed on scans. So, my RO actually targeted the whole pelvic array of them as part of the treatment volume. They were all targeted, not with a whole wide field, but specifically where they all were on the CT planning scan. I think they gave them a 7 or 10 mm margin to account for movement.

I have marginally low red blood cell counts, white blood cells, hemoglobin, but not sure if that has anything to do with the lymph node irradiation. I've been told that's pretty common for those of us with RT and with ADT anyway.

Otherwise, no symptoms of any kind that I could attribute to zappin' my little ol' nodes. Glad we did it anyway, given the complications already seen at my diagnosis.

Jerry
Posted 12/23/2014 12:13 AM (GMT 0)
I think someone raised this just last week, and I've seen nothing since then to change my opinion. Radiation has an immune-stimulating effect on small areas. Radiation knocks cancer antigens into the serum, which causes T cells to kick into action. Many think that such stimulation is what causes the known immune attack against cancer even outside of the radiation field (called the abscopal effect). It may be especially enhanced by hypofractionation for unclear reasons. Because it inhibits white blood cell production in bone marrow, radiation has immune-suppressive effects when used over large areas that include a lot of bone tissue.

- Allen
Posted 12/23/2014 7:00 PM (GMT 0)
Here's an excellent review about what is currently known about the subject:

Combining Immunotherapy and Radiation for Prostate Cancer
Posted 12/23/2014 8:43 PM (GMT 0)
Allen,

Seeing that Mel's PC is hormone sensitive he probably wouldn't qualify for Provenge, but do you believe that adding Leukine might provide a similar benefit.

Thanks,

Jerry

Posted 12/23/2014 8:57 PM (GMT 0)
Mel I have been asked about this is the past and my reply has been "we don't know" about the harms of residual morbidity of radiation to the lymph system. So I took the liberty to ask a Harvard trained RO to get his take on it. You were copied in that email.

I'm leaning with Hamstra being that he is an RO and Myers is not. I can say I know of no study that confirms what Myers is saying.
Posted 12/23/2014 10:27 PM (GMT 0)
Jerry L-
Yes, and I've encouraged him to consider that.
- Allen
Posted 12/23/2014 10:42 PM (GMT 0)
I had the Dattoli LN radiation (+ bed and two bone mets) and my immune panel is well depressed. I am on Leukine now. Myers had me on Leukine six years ago as an attempt to prolong off period from ADT. I asked about Leukine response rates and he said he did not do the immune panel at that time.

Prior to RT in 2012 I had a 6 month off period from ADT with 26 day doubling time from G9 tumor with the mets. After RT I have been off ADT 19 months and I had 10 months of T recovery and undetectable psa before recent rise. Considering the options, I call that a success.

Post Edited (tarhoosier) : 12/23/2014 3:45:43 PM (GMT-7)

Posted 12/24/2014 12:55 AM (GMT 0)
Tarhoosier,

I call that success as well.

I, too, see Myers. Along with a bunch of other things, he checks my immune system blood monthly. I start Leukine in January also in an attempt to prolong my ADT vacation. It should be interesting to see any change in blood work, especially in CD4 helper numbers.

I'm assuming Myers also has you on a statin, Avodart, and metformin?
------
Mel,

Let me know if you are thinking about adding Leukine so we can compare notes on getting it approved and logistics of the injections.

Thanks,
Jerry
Posted 12/24/2014 2:38 AM (GMT 0)
Jerry:
Yes to those three. He tried to add Celebrex but my GI said no.
I assume you mean your immune panel showed normal function and numbers before Leukine? Thus the Leukine was strictly to increase from standard range?
Posted 12/24/2014 2:46 AM (GMT 0)
Most are in range or above. CD4 low.
Posted 12/24/2014 2:46 PM (GMT 0)
@Tony Crispino
You said "So I took the liberty to ask a Harvard trained RO to get his take on it. You were copied in that email." Could you post the conclusion on the forum please? (I am about to start RT for eight small lymph node metastatses located by Nijmegen nano-MRI, I am castrate-naïve.) Thank you.
Posted 12/25/2014 7:29 AM (GMT 0)
From Dr. Lawenda.

"Pelvic XRT doesn't significantly reduce immune function since the vast majority of our immune cells are not inside the pelvic xrt field. We have hundreds of lymph nodes and WBC-rich tissues outside of the pelvic lymphatics. SBRT to a PET-avid lymph node is certainly going to have even less impact on any potential immune deficit, and as one person in the forum indicated, may actually increase immune activity."

Dr. Myers information, at least as cited, is contrary to current evidence.

Dr. Hamstra, as cited, is in line with the evidence that Dr. Lawenda understands..
Posted 12/25/2014 3:56 PM (GMT 0)
TC:

Thanks for the emails.

I appreciate it.

Mel
Posted 12/25/2014 4:22 PM (GMT 0)
Which video of Myers are we talking about? Can somebody link it in this thread...

On infolink today(and look who is the newest contributor...Mr. Tall Allen...:

http://prostatecancerinfolink.net/2014/12/25/radio-immunotherapy-in-the-treatment-of-prostate-cancer/

Post Edited (Jerry L.) : 12/25/2014 9:05:30 PM (GMT-7)

Posted 12/26/2014 4:42 PM (GMT 0)
These must be the videos from Myers on the subject:


/askdrmyers.wordpress.com/2014/11/13/treating-ogliometastatic-pca/


/askdrmyers.wordpress.com/2014/12/05/treating-oligometastatic-disease-with-radiation


Mel - Just so you know and perhaps could address a low count, why don't you have your cd4 tested before and after the radiation?

It's interesting that for the "outside the box" and cowboy-like reputation that he has, he is only saying to weigh the risks with the benefits.

Post Edited (Jerry L.) : 12/26/2014 1:17:53 PM (GMT-7)

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