Radiation Oncologist Quotes

(ASTRO). As the name suggests, this was based on the agreement of a panel of experts, who in the 1990s met and chose to define PSA failure after radiation therapy as three consecutive rises in PSA (taken at least three months apart from each other) after it reaches its nadir—the lowest point PSA reaches after treatment. (PSA nadir is a key concept in radiation therapy for prostate cancer. Because radiation’s effect is gradual, it may take two or three years for PSA levels to hit rock bottom. Some men reach this nadir much more quickly—within months—and some men take much longer—several years. Ideally, once PSA has reached its lowest level, it should stay put.) Although the ASTRO definition has proven useful, it has not been perfect, and not all radiation oncologists agree that this is the best way

to measure success or failure. One criticism has been that PSA increases are not always consecutive. A man’s rise in PSA with one test might be followed by a transient decrease in the next, followed by another increase. Although there may be recurrent cancer, under the ASTRO definition, this man’s treatment would still be considered a success—even though it’s just a technicality. “Fortunately, any astute radiation oncologist will not blindly follow the consensus definition in making treatment decisions,” comments Danny Song. A quirk of the ASTRO definition is that, over a short period of time after treatment, it really can’t tell us much. This is due to the gradual nature of radiation’s effects; cancer

oncologists met to discuss a replacement for the ASTRO definition. They decided to define treatment failure as a PSA level that has risen 2 ng/ml higher than a man’s PSA nadir (the lowest level it reached following treatment). This definition has been correlated more accurately with long-term results in all patients, and it takes into account such factors as hormonal therapy and the PSA bounce. Failure is now considered to occur when the PSA level reaches the nadir + 2 value. This is called the Phoenix definition. Still, it takes time to determine this value, so this equation should not be used to gauge the success of treatment in men with less than two years’ worth of PSA tests after radiation therapy. Furthermore, the consensus panel that developed this definition cautions,

Patients diagnosed with cancer and treated with our multisdisciplinary approaches are knocked down physically and emotionally, but they pick themselves up off the canvas and struggle on. They carry the reminders of the acute and chronic side effects from cytotoxic chemotheraly and radiation-induced skin and functional-organ changes. They endure the scars, complications and impairments imposed by the blades of surgical oncologists like me. Though sometimes they want to, they don't leave. They remain. They maintain. I respect the effort, the invincible spirit, and the patients, who don't give a damn about the odds or probabilities, they are going out swinging. We are tag-team partners in oncology, entering the ring to attack cancer with every move and method we know. Hell, I'll even throw a few chairs if it will help.

conventional oncologist is focused on ridding them of the weed through conventional means (such as surgery/chemo/radiation), while my job, as their integrative oncologist, is

there were also intellectual reasons to investigate and try to understand his cancer. Steve’s particular kind of tumor is a rare one. According to the National Cancer Institute (NCI), only about one thousand cases a year are discovered in the United States. As a result, research on pancreatic islet cell neuroendocrine carcinomas is not buttressed by the kind of massive database available to doctors studying breast or lung cancer, to cite two more common forms, or even other forms of cancer of the pancreas. (His own oncologist/surgeon admitted to me privately that not enough was known at that time to determine statistically what the best treatment should be—surgery, chemotherapy, radiation therapy, something else, or a combination of treatments.) So Steve’s indecision about what to do was not completely off-base.

And sometimes the people cancer places you in contact with don’t make it any easier. One radiation oncologist, for instance, had the worst bedside manner: he bluntly told us that, with treatment, Rebekah had about six months to live. That was over three years ago.