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Thread: VIEW RAY MRI guided adiation vs traditional radiation

  1. #21
    Super Moderator Top User ddessert's Avatar
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    I will say that in general, immunotherapy has been a bust in pancreatic cancer thus far - especially as compared to other non-solid Tumor cancers. It seems our stroma surrounding the tumor is being a pain in the side for many kinds of treatments.

    I’m not familiar with the one you’re talking about but will look into it for you, like how it performed in any human trials - especially pancreatic cancer.

    My take is that these immunotherapy treatments will eventually get there but that it will need to be combined with other treatments in order to overcome the tumor’s defenses. So my preference is to stay away from the single-agent trials and look at more mature ones that are combining treatments.

    Having said that, my gut feeling is that patients with MisMatch Repair (MMR) genetic defects will be among the first to respond to immunotherapies. Our mutations often mean that the tumor gets many more mutations than other tumors. That may mean that the tumor looks less like the body itself and would be more recognizable by the immune system. That’s a theory I’ve run across a few researcher/physicians and they seem to think that’s plausible. Not a lot to go on, but I’m personally looking for any advantages over guessing, no matter how small.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

  2. #22
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    more good info....thx Dave. My BRCA came back negative so that's something good.
    I have some really good info to gointo my ONC appt. tomorrow!
    Hhope you are doing well!
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    Followed up with EUS No mets/contained
    3/18 started 4 cycles of Gem/Abrax
    5/18 CT scan showed tumor shrinkage .97cm
    7/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure. No mets, 1 lymph node involvement.(distant) Staged 2B
    9/18 CA19 33 NORMAL
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    5/19 CT scan shows enlarged lymph node at surgical site. EUS biopsy determines cancer. Local and contained.
    6/19 Begin radiation. View Ray MRI 5 day regimen.
    8/19 CA19-9 down! no signs of lymph node!!!
    10/2 3 weeks of abdominal/right side pain. CT scan shows small (1mm) soft tissue nodule suspect for Peritoneal Mestastasis. CA 19- way up (1010)

  3. #23
    Mmm, but my understanding is that, once you get the cancer, BRCA can be good. It responds well to chemo such as FOLFIRINOX. I guess platinum based..D. Dessert would know more.
    February 2016- diagnosed with PC
    March 2016- inoperable due to arteries, also liver mets suspected
    March 2016-January 2017 -Gemzar/Abraxane
    February 2017 surgery-PC tumour and liver mets removed at same time
    July 2018 Back on Gemzar/Abraxane due to rising CA 19-9. Scans were clear.
    January 2019 Tried FOLFIRINOX after G/A became ineffective. FFX doesn't work. CA 19-9 rising
    February 2019 two small tumors appear on liver
    May 2019 - CA 19-9 skyrocketing. Started IMRT radiation treatment.
    August 2019 MRI done. No Evidence of Disease (NED). CA 19-9 dropped significantly. Still not normal range.

  4. #24
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    As i understand clinical trials for PARP inhibitors and gene mutations have dealt Breast Cancer exclusively. SO FDA approved drugs for BRCA are approved for BC but not PC.!!! my ONC says this will probably change in a year or so, we hope. BRCA increases your risk for BC by 87pct and ovarian cancer and does not discriminate if you already have PC. Can not even go there.
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    Followed up with EUS No mets/contained
    3/18 started 4 cycles of Gem/Abrax
    5/18 CT scan showed tumor shrinkage .97cm
    7/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure. No mets, 1 lymph node involvement.(distant) Staged 2B
    9/18 CA19 33 NORMAL
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    5/19 CT scan shows enlarged lymph node at surgical site. EUS biopsy determines cancer. Local and contained.
    6/19 Begin radiation. View Ray MRI 5 day regimen.
    8/19 CA19-9 down! no signs of lymph node!!!
    10/2 3 weeks of abdominal/right side pain. CT scan shows small (1mm) soft tissue nodule suspect for Peritoneal Mestastasis. CA 19- way up (1010)

  5. #25
    Super Moderator Top User ddessert's Avatar
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    I think PARPi started with ovarian cancers. But it is a growing and successful trend to consider treatments based on cancer genetics as well as the site of origin. Oncologists that are not on board with that thinking are behind the times!
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

  6. #26
    I don't know how old this link from PanCan is, but it's fairly negative on the SBRT as compared to standard radiation treatments.

    This opinion differs from just about everything else I have read for SBRT.

    Those of you who have had SBRT, would you do it again ?

    Thnx.

    RW

    https://www.pancan.org/facing-pancre...ation-therapy/

  7. #27
    Newbie New User
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    RamblinWrech,

    I have looked into this myself and the issue with using SBRT is it needs to be precise to work because if it hits something outide of the Tumor like the stomach or duodenum than you have major issues. The ViewRay MRI guided systems use realtime alignment to the tumor and supposedly have much less complications. These are fairly new systems though so the study's are ongoing, the newest version of this system is in Detroit and it has even more advantages over the older ViewRay systems. I am working on getting into a trial for doing my Radiation there in Detroit after I finish three months of Chemo.

    Keith

  8. #28
    Thanks Keith !

    I saw your reply to my thread. I will have a much more detailed reply there in a minute.
    57 year old Wife's PC:
    4-19 - Constipation. "You're old, take Miralax".
    7-14-19 - Constipation with pain below the right rib cage. Again "Your old, take Miralax". I say BS and go to Urgent Care.
    7-15-19 - Urgent Care says "BS" on "Miralax" & orders abdominal CT scan.
    7-19-19 - Abd CT Scan reveals 6.0 x 4.9 cm mass in the pancreatic head which encases the superior mesenteric vein.
    7-26-19 - Biopsy confirms adenocarcinoma
    8-8-19 - Start FOLFIRINOX once every two weeks.
    9-20-19 - End first four rounds of FOLFIRINOX.
    9-27-19 - CT scan reveals tumor reduced to 4.6 x 3.2 cm (50% reduction), but now evidence of malignancy in the lymph nodes.
    10-4-19 - Onc suggests gemcitabine nab-paclitaxel due to lymph node increase/high CA19-9 obtained at 1st & 2nd treatments. NO CA19-9 obtained at 3rd & 4th treatments. ONLY one CA19-9 post treatment initiation. I demand CA19-9 test before switchig.
    10-5-19 - CA19-9 test ~ 10 weeks after treat start is 9700. Staying with Folfirinox

  9. #29
    Senior User
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    Quote Originally Posted by Kysos View Post
    RamblinWrech,

    I have looked into this myself and the issue with using SBRT is it needs to be precise to work because if it hits something outide of the Tumor like the stomach or duodenum than you have major issues. The ViewRay MRI guided systems use realtime alignment to the tumor and supposedly have much less complications. These are fairly new systems though so the study's are ongoing, the newest version of this system is in Detroit and it has even more advantages over the older ViewRay systems. I am working on getting into a trial for doing my Radiation there in Detroit after I finish three months of Chemo.

    Keith

    Hi Keith, I had my View Ray MRI at Washington University/Siteman Cancer Center in St. Louis. I had five 1.5 hour sessions, consecutively in the tube. I am 2 mos post and have had no related complications and my lymph node is gone.
    Now i have some other issues but at least i know the VIew Ray worked for me. Good Luck, if St. Louis is geographically closer to you, you may want to contact Siteman Cancer Center in STL. Let me know if you need contact info!
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    Followed up with EUS No mets/contained
    3/18 started 4 cycles of Gem/Abrax
    5/18 CT scan showed tumor shrinkage .97cm
    7/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure. No mets, 1 lymph node involvement.(distant) Staged 2B
    9/18 CA19 33 NORMAL
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    5/19 CT scan shows enlarged lymph node at surgical site. EUS biopsy determines cancer. Local and contained.
    6/19 Begin radiation. View Ray MRI 5 day regimen.
    8/19 CA19-9 down! no signs of lymph node!!!
    10/2 3 weeks of abdominal/right side pain. CT scan shows small (1mm) soft tissue nodule suspect for Peritoneal Mestastasis. CA 19- way up (1010)

  10. #30
    Newbie New User
    Join Date
    Aug 2019
    Posts
    8
    Thanks Susanmac,

    I looked at St. Lewis, Detroit is a couple hours closer though, the doctor that pioneered the system at Washington University moved to Detroit and now is working there. I guess it was his hometown so he wanted to move to be closer to his family. I am glad to hear you did not have any related complications, I am hoping to get it done as soon as I can get my chemo treatments done.

    Keith

 

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