How many times is having radiation done safe in a lifetime?

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/2/2009 11:30 AM (GMT -6)   
Here's a question that's been bothering me, and my former rad. oncologist, nor the two I met with recently can or will answer, my uro/surgeon didn't know, but then it's not his field.
 
How many times in a person's lifetime can they safely undergo full blown radiation treatments?
 
When I had it done in 2000, for neck and throat, it was 36 treatments.  I don't remember the grys, wouldn't have known to ask in  those days. I do remember the rad. oncl. telling me that each time I was zapped, it was equal to 40 chest x-rays.  It that is true, that means that was equal to 1,440 chest x-rays.
 
Plus all the other radiation based tests I have had in my life.
 
I am wondering is the cure this time with salvage radiation going to multiply my woes in the end?  Am I already overloaded with radiation from the prior?  When is too much, too much?
 
It's more than I can think about, and my own research doesn't come up with much, and these doctor's don't want to answer for some reason.  There has to be an answer.
 
Concerned in SC, David
 
P.S.  I thought radiation caused cancer in the first place?


Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days
 


Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 202
   Posted 9/2/2009 12:21 PM (GMT -6)   
I've read that we each receive radiation equivalent to the radiation from 400 chest x-rays from natural sources during the course of the year. So, using this measurement, you received less than 4 years of natural radiation as a result of your previous radiation treatment.

Not very scientific, but it gives some perspective.
Dave
Age:54
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 9/2/2009 12:34 PM (GMT -6)   

Hi David,

The answer to your question is "it depends". Dose, body part, interval between doses, environmental exposure and so on. I am attaching an article that I read before starting my IMRT as primary treatment. It is lengthy and somewhat technical but it will give you some understanding of the effects.

David, I surely hope that things turn around for you. I read your posts frequently although I do not post comments often.

Best wishes,

Don

http://https://netfiles.uiuc.edu/mragheb/www/NPRE%20402%20ME%2040

PS. I am not sure I got the whole address in but try a Google search with this much and it should take you to the PDF.
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
PSA 06/09 .36 or .30 depending on who did the test
 
 
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 9/2/2009 12:40 PM (GMT -6)   
Too much radiation can cause cancerous tumors...OH - just what you wanted to hear.
 
In the past, the radiation you received was very specific and targeted your neck..Same thing will happen when they target your nether region...
 
It was on the news just last night - a local hospital to me is now 1 of 4 in the USA that has a new low rad cat scan machine. Its all but Guaranteed not to cause more issues that its designed to cure.
 
So in short - walking through an xray machine at the airport all day is bad for you. Getting zapped by a doc to cure your current ailments is ok for you ..

Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 9/2/2009 1:28 PM (GMT -6)   
There is a dose maximum but I cannot recall what that is.

Let me put it one way; Paul had radiation for TCa in 1995. It was amde clear then that his lifetime dose was close enough to be counting every exposure from this point on.

Our duaghter is also in the same boat yet she's not have radiation treatment, only a whole lot of e-rays and scans. They've been counting her exposure for years already.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/2/2009 4:04 PM (GMT -6)   
Thanks Dave and Don for your input, will check out that link later.

Thanks for your spin, Steve.

You too swimom, my best to your daugther too.

I did learn today that one Chest CT is equal to three years natural radiation exposure. In the past year, have had 2 of those, plus a full bone scan, and another CT around the time of my dx. That's a lot in one year, geez.

Guess when I meet with the 3rd and hopefully final radiation oncologist, I can get a more accurate answer from her.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days
 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/2/2009 8:21 PM (GMT -6)   
It seems to me that we are talking about three different levels of radiation exposure here.

Occupational exposure – here the goal is not raise the risk level above that of the rest of the population.

Medical Test Exposure – here the general standard is the same as occupational exposure, that is, to do no harm. Currently there is a movement to pay more attention to the cumulative lifetime levels.

Medical Treatment Exposure -- at this point the rules change because the balance is between the danger from the condition being treated and the danger from radiation. I think that for the vast majority of patients the disease risk so far outweighs the radiation risk that it is and easy call. Yes, radiation risk is raised but the patient’s life is extended.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/2/2009 8:39 PM (GMT -6)   
I will re-ask my question a different way, I am wondering how safe it is to go through major radiation twice in 10 years?
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 9/3/2009 4:56 AM (GMT -6)   
Since it's an entirely different part of your body - I'd guess its a lot safer then not having it. As you mentioned - ask your new Doc when you meet her.
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/3/2009 7:25 AM (GMT -6)   
That's all I can do, Steve. It has to do with accumulated radiation in one's lifetime.

david in sc
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 9/3/2009 12:54 PM (GMT -6)   
7. Should patients with cancer be concerned about the radiotherapy they undergo?
 
Radiation, surgery, and chemotherapy are the major ways in which cancer is treated; they are used singly or in combinations depending on the cancer. The effectiveness of radiation in killing cancer cells--and, at the same time, the potential for harm to normal tissues--depends on several things, including the type of radiation used, the extent of the body that is treated, and the patient's age or other medical problems. Doctors try to avoid exposure of large parts of the body to radiation because this can cause serious side effects like a secondary cancer--one that develops after treatment for the initial cancer. However, only about 5% of all secondary cancers have been linked to radiotherapy. The risk of leukemia after large doses of radiation to localized areas of the body often is surprisingly low, because the local effect is to kill cells that might, at smaller doses, undergo transformation--the changes that a normal cell undergoes as it becomes malignant--eventually leading to leukemia. Other side effects of radiotherapy range from mild to serious; many are temporary.
 
With the development of better therapy machines and the use of computers to plan the treatment, the safety and efficacy of radiotherapy have steadily improved. Radiologists make every attempt to minimize harmful effects to normal tissues. Thus, a patient's risks from exposure to radiation are far offset by the benefits from the treatment.
http://www.nih.gov/health/chip/od/radiation/#xseven

JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 9/3/2009 2:36 PM (GMT -6)   
Dave,
 
Somehow you gotta pin down an expert on this because there IS an answer to your question.
 
When I was "interviewing" a radiologist for possible seeds + radiation therapy, I asked..."after all that would I still be able to have radiation on tumors if I got another type of cancer" and his response was yes.
 
The total accumulated radiation in ones lifetime cannot exceed "X." Therefore you need to find out how much you have accumulated and go from there. The X amount should be somewhere because its no secret number.
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 9/3/2009 2:59 PM (GMT -6)   
I'd imagine that anyone that gets close to the X number won't care since they're already so close to death. Cause isn't the alternative to not doing radiation - to do nothing?

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 9/3/2009 3:20 PM (GMT -6)   
Couple of stats

Total body radiation of 4 gys at one time will cause radiation sickness
Total body radiation of 10,000 gys at one time will cause death within an hour.

This is total body at one time.

There are no standards for radiation upper limits except at targeted locations. Example the kidneys can only stand 30 gys total. Depending on the individual, additional treatment may or may not be allowed at the kidneys again after initial radiation treatment. The same would hold true for the neck, lungs or any tissue or organs that receive radiation therapy. Having radiation in one location (neck) will not affect having radiation in another location of the body.

Hope this eases your mind some.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/3/2009 3:35 PM (GMT -6)   
Thanks Steve and Joey for some good info there, will ponder that.

Les, my concern it total lifetime exposure, not so much a particular session of radiation treatment.

David in SC

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 9/3/2009 4:00 PM (GMT -6)   
David,

You might be thinking along the lines of exposure as compared to absorbed radiation. Exposure to radiation has limitations, such as those involved with the operation of nuclear facilities, or even those that are in and around x-ray test equipment and the list goes on. That is completely different than absorbed radiation used in medical treatment. Also the type of radiation has to be factored in. You can't just blanket radiation into one group and wonder what the maximum exposure is. Maximum radiation from medical testing or treatments will be specific the area, i.e. chest, pelvic etc. Medical radiation treatment to the certain parts of your body isn't the same thing as radiation exposure which has published limitations for safety.

Does that make sense?
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/3/2009 6:35 PM (GMT -6)   
Les, no, I guess I am not clever enough to get it. There are half-lives even in a simple CT scan I have been told, and when you look at people getting 60-80 grys of radiation, even though it is spread out over weeks/months, still a lot of radiation being abosorbed.

With the 4 grys being a line in the sand for radiation sickness, you can see where some sensitive people can get sick earlier into radiation treatments.

When I was being evaluated and setup for radiaton in 2000, for the cancer that was in my throat/neck, the radiation doctor asked me a couple of questions that I thought were odd at the time. He said, are you real sensitive to the sun? I said yes, I use to get what the oldtimers would call "sun sickness" growing up. He said do you burn easy in the sun? I said way too easy, I rarely allow myself to directly exposed to the sun unprotected, all my life. He then said, that I would have a hard time with the radiation.

I was already getting burned by the end of the 4th week. By the 2nd week, my ears shriveled up and were lobster red, and hurt to the touch. I believe I had a total of 36 treatments, and during that time I lost over 30 pounds. Didn't want to eat, everything tasted metalic and nasty.

So yeah, perhaps thats some insight in why I am so touch about the prospect of salvage surgery. I am hoping and praying that methods have improved in the past 9 years, and have learned since, only recently, that throat/head radiation is particually brutal ,so perhaps it was normal.

about a month after treatments ended, I had what my dr. said at the time was a classic post-radiation crash. So overwhelmed by fatique that I could hardly function. At that time, I was wearing my IT hat, and was the Systems Manager for a 6 state computer operation.

They put me in physical therapy for 6 months, then renewed it for another six months. It took about 8 months for all my tastes buds to return to normal, and to this day, 9 years later, I have perpetual thirst, I don't drink much at a time, mostly only water, but I have to sip all the time. Spicy food or even orange juice is like me chugging down battery acid. The drs. at the time said that was just some of the perm damage that it would do.

Yes, I am really hesitant to get into radiation again, and yes, I know the alternative, I will say the DYING word, would be worse, but might shed some light on me not being gung ho about it.

David in SC
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