HealingWell
Search Close Search
☰

Is Proton therapy more effective than IMRT?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/24/2009 12:33 AM (GMT 0)
I heard an commercial about Proton radiation at MD Anderson and was wondering if it is more effective with less side affects than IMRT. Also is it covered by Medicare?
Posted 9/24/2009 1:15 AM (GMT 0)
Ed,
My dad had proton out at Loma Linda California back in 1996. It was the first center to offer proton's. His side effects during treatments was having to urinate frequently and not being able to make it to the bathroom and having a mucus discharge from his rectum. He still caries a container with him if he doesn't have a bathroom available readily. Towards the end of his treatments he started getting very tired. Was it more effective then IMRT? I do not know. But his 13 year post PSA level was .002 I believe. I posted earlier this month about his PSA if you want to look it up for sure on this forum. about 5-7 years after treatment he developed ED. He tried Viagra and didn't like the headaches. I've talked to him about other methods but he and my mom our happy and healthy. He is 77 and fine overall. His only complaint is the need to find the bathroom frequently.

Larry
Posted 9/24/2009 1:24 AM (GMT 0)
More effective? no. Less SE's, so they claim. But study information is scant. Loma Linda has been doing PBT since the early 90's but have not released long term data. And newer types of radiation delivery systems have severely reduced the SE's with conventional IMRT.

PBT is effective and has been used for years. MD Anderson will have data in time, and since they are a multifaceted center, we can hope it is unbiased. Most PBT patients are quite pleased after therapy, and I was quite pleased with the SE's after IMRT. Long term SE's do set in in both therapies, but the information is much more scant with PBT. I always wonder why that is.

There is talk that unless PBT is proven better, and soon, many insurance companies will not cover it soon. PBT is very expensive when compared to IMRT and both the government bill, HR3200, and you can bet insurance companies, will deny claims if there is a Least Cost Alternative (LCA). Already Blue Cross has petitioned Medicare to stop covering PBT, but I think everything stopped awaiting to see what happens with HR3200.

Tony
Posted 9/24/2009 1:40 AM (GMT 0)
Lots of debate on this health care issue, but it would be a good idea that products would have to be proven more effective to justify the extra costs. I think I read the beam cost is $125 million, really seems like it is better suited for other things. If you go to their website they feature a lot of golf pictures so made me question the difference.
Posted 9/24/2009 4:06 AM (GMT 0)
I did research into the various forms of radiation. The proton guys claim that protons are the safest, but the other radiation specialists claim that their radiation treatments are stronger and just as safe.

IGRT is said to be an improvement over IMRT in IGRT being more accurate and stronger. You might want to look at brachytherapy (seeds) also. Many doctors claims it is safer and superior to radiation beams.

As always, research, research, and research some more before deciding on a final treatment. Don't let anybody rush you into anything.

EDIT--Oops. Just read your profile and it looks like you've already dealt with your prostate cancer. Well, for anyone considering radiation treatment--RESEARCH them all. :)
Posted 9/24/2009 5:04 AM (GMT 0)

Sounds like you guys ought to stick to discussing what you know and it appears none of you know much about Protons.

Just seems to be very topical to diss the teatment based on cost or proof of efficacy.

U of Penn recently released a study showing that PBT delivers 1 1/2 to 2 1/2 times less radiation to adjacent tissues than IMRT. Radiating adjacent tissue and possible positive margins is one of the reasons I went the PBT route.

Blue Cross of Texas, Oklahoma, New Mexico and Illinois has dropped any action taken to stop reimbursement for protons. This happened several months ago, partly due to letter writing campaigns from PBT patients in those states.

I find it funny that except for NM all of those states have a treatment center.

Loma Linda has published 10 year data from 2004 and is ready to publish 15 year data soon.

engineer55 how do plan to prove that PBT is or isn't more efficacious? There is a reason that no randomized studies have been done not the least of which is an ethical issue in who would you choose to not receive PBT?

Posted 9/24/2009 5:41 AM (GMT 0)
I read about the petitioning and it was a great community effort. The LCA issue is still very real and this could effectively keep reviving the issue of coverage until scientific study results are available showing that PBT is better and safer. All we know right now is that it's costlier. Apparently Tufts University is all over this and has released this data Mike Scott lists in his post at the Infolink last week...

http://prostatecancerinfolink.net/2009/09/18/proton-beam-radiation-a-systematic-review/

Tony
Posted 9/24/2009 1:01 PM (GMT 0)
Thank you all for your input. I hope my situation doesn't require either therapy, at least not for a while. Living in Austin TX. I continue to hear those ads from MD Anderson and was curious to hear from those who might have had PBT.
Posted 9/24/2009 2:07 PM (GMT 0)
We have a few guys who did PBT, Jayadub is one, there are more. Smilingoldcoot, Richard, did it in Jacksonville, Dutch and Jay in Loma Linda.

Below is the "Ten Year study" link at that site. The numbers are favorable but it is inclusive of guys who also supplimented their proton therapy with IMRT therapy. Brachytherapy centers are now also combining IMRT to seeding with excellent early results.

http://www.protoninfo.com/TenYearData/TenYearStudy.pdf

Tony
Posted 9/24/2009 3:21 PM (GMT 0)
My father had proton treatment at Loma Linda 10 or 11 years ago and seemed happy with the result. It was salvage treatment for surgery done in 1975. It seemed to work. He lived another 10 years until almost everything else broke down.
Posted 9/24/2009 7:52 PM (GMT 0)
I am currently doing PBT at At Loma Linda. I have to agree with jayadub. Do your research about the modalities. I spent 2 months researching and am grateful I found out about Protons. Check out the stories on YANANOW, BOB, and yahoo group protoninfo, to get information directly from patients.
I would be happy to share my experience with anyone. We here at Loma Linda wonder why it is not so widely known about.
The Brotherhood of the Balloon has over 4000 members that you can read about. For the most part very few side effects...
Keep the faith
Posted 9/24/2009 9:23 PM (GMT 0)
The only head to head study I have seen is the ICER 2008 report comparing Seeds, IMRT, and PBT. I posted the link about a month ago. It's a 114 page report and uses the long term Loma Linda data and compares it to Long term data on Brachytherapy and IMRT.
In short, Proton Beam had the highest biochemical relapse rate of the three, (it was slightly higher). The acute toxicity rates were similar in all three. Proton costs 3X brachytherapy, 2X IMRT and was shown to have no advantage.
Dattoli just had an article in PAACT newsletter, basically stating that PBT is ok for small cancer tumors in the brain and other areas, but does not work well on large areas such as the prostate and cannot be conformed to contours like IMRT. He goes into a lot of technical stuff saying that the surrounding tissues actually get more radiation from Proton. Dattoli of course is biased, but if you want to know the cons of Proton it's a good read.
JohnT
Posted 9/24/2009 10:29 PM (GMT 0)
John, that sounds like some pretty serious negatives in the fine print on the proton. The cost factor would be hard to justify with a lot of HMO's and other health insurers. Didn't realize it cost that much more.
Posted 9/24/2009 11:29 PM (GMT 0)
But you would have to include the cost factor of the side effects. If Proton Beam has less side effects then the other three procedures (surgery, imrt and seeds) add up the cost of the associated side effects and compare it with proton beam. Just from anectodal experiences reading patients from posting their experiences with proton beam, it seems patients are very happy with it. I rarely found someone posting about negative side effects on Yana.
Posted 9/24/2009 11:37 PM (GMT 0)
Bob Marckini has much knowledge on proton beam, in addition, secondary cancers are more rare with proton beam compared with photon.
Posted 9/25/2009 12:34 AM (GMT 0)
I don't know if Proton has less side affects than IMRT. The studies say no dfference; patients say that there is definately a difference. It could be the plecebo affect, if you expect something it influences the outcome.
I had IMRT and seeds; a much higher dose of radiation that can be given by Proton and I have had no side affects. Killing PC is all about radiation dose whether it is Proton or Photon; the higher the dose the better the outcome.
JT
Posted 9/29/2009 11:10 PM (GMT 0)
I am a PBT guy. It is my opinion that it was MY best option even though I had a combination of  IMRT and PBT plus 2 years of Hormone Therapy. I believe one should go for the treatment that makes them feel is the best for THEM.

The stated cost of PBT was $159,000.00.  I know that Medicare and Tricare for Life did not pay that amount even though my cost was  Zero except for the 4 months in our RV at Naval Air Station Jacksonville and the trip there and back twice.

Again I state that one should do their research into all treatment options and do what they feel comfortable with and then don't look back.

Rich

Posted 9/29/2009 11:39 PM (GMT 0)
Richard you forgot that you paid for dinner with Deb and me...LOL, it is an added expense I was most grateful for.

I see Debbie all the time in Facebook, but I miss you brother. God bless you and peace to you...

Tony
Posted 10/7/2009 1:07 AM (GMT 0)

Just ran across an article in "The New Prostate Cancer Infolink". It was a study to compare proton with other treatments; "Loma Linda has failed to collect, analyze and publish data that has delayed any chance of demonstating the clinical value of PBRT in the treatment of prostate cancer." It was very critical of Loma Linda's data and said now that it will take another 15 years to have comparable data.

JohnT

 

Posted 10/7/2009 10:56 AM (GMT 0)

Here is the link to the article to which JohnT referred.  Very dissapointing and it leaves us with still comparing PBT results and SE's in an anecdotal way rather than scientifically.

Tudpcok

http://prostatecancerinfolink.net/2009/09/18/proton-beam-radiation-a-systematic-review/

Posted 10/7/2009 2:35 PM (GMT 0)

  ....don't mean to hijack a thread, but, Hi there Rich...it's good to see your post...

   Ok, back on topic....good info here!

  

Posted 10/7/2009 2:56 PM (GMT 0)

lewvino said...
Ed,
My dad had proton out at Loma Linda California back in 1996. It was the first center to offer proton's. His side effects during treatments was having to urinate frequently and not being able to make it to the bathroom and having a mucus discharge from his rectum. He still caries a container with him if he doesn't have a bathroom available readily. Towards the end of his treatments he started getting very tired. Was it more effective then IMRT? I do not know. But his 13 year post PSA level was .002 I believe. I posted earlier this month about his PSA if you want to look it up for sure on this forum. about 5-7 years after treatment he developed ED. He tried Viagra and didn't like the headaches. I've talked to him about other methods but he and my mom our happy and healthy. He is 77 and fine overall. His only complaint is the need to find the bathroom frequently.

Larry

Remember that IMRT wasn't available in 1996.

My father had external beam radiation around 97 along with seeds and had a host of issues afterwards.

Posted 10/7/2009 8:43 PM (GMT 0)
Didn't mean to imply that IMRT was available in 1996. The proton was my dad's first choice back in 1996. Now that I've had the DaVinci he has been impressed with my results so far. Though I don't get my first post surgery PSA until Oct. 19th.

Larry
Posted 10/7/2009 8:44 PM (GMT 0)
Larry, we need you in the zero club, someone has to take my place after I lost my membership, sobs.
✚ New Topic ✚ Reply