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Follow up after radiotherapy

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  • Follow up after radiotherapy

    What is the follow up schedule for stage 2a seminoma after radiotherapy. CT-SCANs or just chest X-RAY to limit further radiation exposure ?

  • #2
    Surveillance after radiotherapy is not my speciallity, but X-rays are irrelevant for standard TC cancer surveillance (main purpose of surveillance is lymph nodes checking that can't be done with X-rays), so CT or MRI.
    45yo, left I/O 07/30/2018, T1 pure seminoma, surveillance...
    Waiting...

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    • #3
      As I recall, with seminoma 1a I received 2 CTs the first year following radiotherapy (6mo, 12 mo). Then every 12 mo for an additional 4 CTs. No chest xrays.

      It was mentioned that after 5 years and all clear that an occasional chest therapy might be good. Its been 10 years and I have not sought an xray.

      Good luck to you.

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      • #4
        Thanks a lot. I'm asking because after radiation , lymph nodes recurrence is almost impossible.

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        • #5
          Originally posted by Harxxony View Post
          Surveillance after radiotherapy is not my speciallity, but X-rays are irrelevant for standard TC cancer surveillance (main purpose of surveillance is lymph nodes checking that can't be done with X-rays), so CT or MRI.
          This not true.chest X-rays are part of standard surveillance instead of a chest CT, because you can still see lung issues in them and the amount of radiation used is significantly less. See the NCCN guidelines.
          6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
          6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
          7/7/15: bHCG 56, AFP 42, LDH 322
          7/13/15: begin 4xEP, end 9/18/15
          10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
          10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
          4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
          4/20/16: RPLND @ IU - teratoma only!
          10/22/19: all clears up to this date!

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          • #6
            I know, I'm doing X-rays for lungs, but it's only for possible lung mets (myself once a year), can't see nodes on X-rays, also can't use X-rays for abdomen and pelvis region.
            45yo, left I/O 07/30/2018, T1 pure seminoma, surveillance...
            Waiting...

            Comment


            • #7
              If you're worried about radiation dosage from CT's, MRIs are a viable option. More expensive, more uncomfortable, and it takes a lot longer, but there's zero radiation
              Painless lump 5/18/2017
              Orchidectomy June 2017 (4.5cm, rete testis involvement)
              Chemo Summer 2017 (2x7AUC carboplatin)
              No evidence of relapse since, but plenty of anxiety about it.

              I'm also an epidemiologist, and a professor at a medical school (with NO training in oncology), oh, and gay, too.

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              • #8
                What do you guys suggest ? X-ray as followup or ct scan ?

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                • #9
                  I don't feel qualified to advise you without more information. I have decided to follow up with MRIs (and no chest x-rays), but it is an individual decision you should make with your doctor.
                  So, I'm trying to read the intent that motivates your question.

                  If you are concerned you're getting lousy advice from your doc, or that they aren't explaining things well, I'd recommend a second opinion to go over your options from another perspective.

                  If you're worried about additional radiation, then I'd suggest MRIs (with or without chest x-rays).

                  If you've decided that a lymph node relapse is incredibly unlikely, but lung metastases are possible, then chest x-ray without an abdominal CT, I suppose would be an option, but I'd really advise talking with more people about that approach, because from what I've read, lung metastases without lymph nodes popping up first is very uncommon.

                  If you're asking about a chest CT to look for chest metastases, that's really not a great option - large radiation burden to a very sensitive area of your body without much gain over a standard chest x-ray.

                  Sorry if I'm not answering your question - but if so, maybe you can put some more context around the decision you're trying to make, it will help others with more experience to chime in?
                  Painless lump 5/18/2017
                  Orchidectomy June 2017 (4.5cm, rete testis involvement)
                  Chemo Summer 2017 (2x7AUC carboplatin)
                  No evidence of relapse since, but plenty of anxiety about it.

                  I'm also an epidemiologist, and a professor at a medical school (with NO training in oncology), oh, and gay, too.

                  Comment


                  • #10
                    You are right, and sorry for the short message. I have been through radiation of lymph nodes below the lungs and I have read that metastasis in the region of radiation is very unlikely. Usually metastasis are in lungs, liver, brain, neck area, spleen maybe thyroid. I am currently being monitored by doing CT scan from pelvis to neck twice a year, and I seem this is too much. That is my reasoning behind it. So my question is if just Chest X-RAY is just enough as screening ? Anyone know what are the standard followup scans for after stage 2a seminoma after radiotherapy (this should summarize it all)?

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                    • #11
                      Hi again, well, in terms of standard guidelines, chest x-ray alone would not be recommended.
                      Although your risk of lymph node recurrence is low, the risk of lung mets before lymph node recurrence is even lower. But, you can create whatever options you want to - nobody is forcing you to take any of the tests.

                      So, if you want to avoid a lot of screening, sure, you can ask for chest x-ray alone, and see if they will go along with that or talk you out of it. You can also shop around to another oncologist who might be more comfortable with a non-standard screening regime.

                      If you don't mind frequent scans but want to avoid radiation, then consider MRIs instead of the CTs.

                      Anyone else have more informed wisdom to share?
                      Painless lump 5/18/2017
                      Orchidectomy June 2017 (4.5cm, rete testis involvement)
                      Chemo Summer 2017 (2x7AUC carboplatin)
                      No evidence of relapse since, but plenty of anxiety about it.

                      I'm also an epidemiologist, and a professor at a medical school (with NO training in oncology), oh, and gay, too.

                      Comment


                      • #12
                        The NCCN Guidelines suggest CT of the abdomen +/- pelvis at 3 and then 6 to 12 months after radiation therapy and then yearly for year 2 and 3.

                        Please keep in mind that the amount of radiation from CT scans is minuscule compared to the amount of radiation that you have received in treating the seminoma. Thus, skipping a CT because of concerns over radiation exposure, to me would be a huge risk of missing a relapse, than the benefit of avoiding the exposure for a few CTs.

                        Mike
                        Oct. 2005 felt lump but waited over 7 months.
                        06.15.06 "You have Cancer"
                        06.26.06 Left I/O
                        06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
                        06.30.06 It's Official - Stage I Seminoma
                        Surveillance...
                        Founded the Testicular Cancer Society
                        6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

                        For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

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