How do you time same-day chemotherapy and radiation for patients undergoing concurrent chemoRT?

For the first treatment day (during combined chemo/XRT courses), is it ok to give XRT first then send the patient for chemo or should the chemo be given first? What about Day #2 (assuming a multiple day chemo regimen?)? What about continuous 5FU (turn on a Monday and turn toff on Friday)? Which of these timings are (if any) critical? It might be easier to treat with XRT first since it's shorter and more predictable, but is that the right thing to do?

3 Answers

Mednet Member

Radiation Oncology · University of Texas MD Anderson Cancer Center

Answered on

A great question. It is similar to recipes for pasta sauce - with rare exception no matter how you make it, it's usually good.

There are retrospective data which suggest that capecitabine is most effective one hour prior to RT. That is the ideal sequence. However, since it is prescribed q12 hours it is usually not practical. Infusional chemotherapy is even more challenging due to travel, patient delays, waiting for lab results, etc. In the real world, if chemotherapy and radiation are delivered ...

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Radiation Oncology · University of Rochester

Answered on

When possible we try to deliver chemo prior to RT. Probably makes more sense for oral drugs given daily than IV drugs weekly (or less often). We do have a hard and fast rule that CRT starts on M/T/W but not Thursday or Friday. In head and neck cancers, if the patient gets RT first and chemo starts later that day, (or even the next day) I don't worry much. Likely more important to minimize the overall treatment time than extend over another weekend.

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Radiation Oncology · University of Florida

Answered on

I don’t think that the precise timing matters.

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