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progression of grade 2 oligo

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  • progression of grade 2 oligo

    After 3 years of watch and wait MRI's my stage 2 oligo has shown progression . I would love to get a feel for what is the 'norm' in other countries (I'm in Australia ). I have done 6 mths temozolomide at diagnosis with radiation advised to be saved for progression - can't believe I'm at this point already. I was 54 at DX now 56. I have been advised to do radiation now - 6 weeks - 5 days out of each week with a total fo 60 Grays. Followed by EITHER temozolomide for 12 months OR PCV. I have read extensively all the latest research and studies etc., and I am pretty unhappy that there is still debate about what to do - I am looking to the specialists to tell me what to do - but they put it back on me - saying ultimately its my choice. So help me by telling me what is the standard response in YOUR country to a progressing oligo (which was always a high risk for progression because of my age, its inoperability and large size). Should I be doing concurrent temoz with the radiation (quote evidence why??) should I being doing temoz at all - should I opt for the more toxic PCV - again tell me why?? On the "up" side it is co-deleted and likely methylated. Also - just out of interest - my radiation centre only works Monday to Friday - which I was stunned to find. Shouldn't radiation be sequential with no gaps??

  • #2
    Hi
    The easy one first. In the USA, almost all "standard" radiation schedules are monday through friday with weekends off. They say it is to allow the healthy tissue to recover a little while the tumor tissue can not recover as fast but I think it is really to allow for easier scheduling - staff like to work 5 days a week. If they worked 7 days, then different people would have to be hired. I do not think it hurts to take those 2 days off and it does make it easier on the patient as well - gives them time to rest. You tend to get tired with radiation.

    As to Temodar vs pcv, there were a few studies such as https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154749/ and https://academic.oup.com/nop/article...dFrom=fulltext and https://www.neurologia.com/articulo/2018009/eng
    all of which say it is close but there is a slight edge to pcv. My own thoughts (and I am not an MD) is that Temodar is so much easier for you that I would choose Temodar anyway. When I say easier, I don't just mean convienent, but easier on your body. You might live a drop longer on average with pcv but the number of quality days will be higher on Temodar. And I do think it should be used during radiation as well as after radiation.

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    • #3
      Hello!
      Are for these studies' results for radiotherapy plus PCV only included those patients who completed all 6 cycles?
      I only had 5 due to toxicity and wonder where I could classify myself, as it is not the full 6 but, as I was told, more than most of the PCV-patients.

      Cheers!

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      • #4
        That is for all who started and they are counted even if they did one round. Check the articles but I would think many patients didn’t complete all rounds of pvc

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