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sbrt; Henry Ford Hosp vrs Cleveland Clinic

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Posted 2/4/2016 5:18 PM (GMT 0)
I am leaning towards SBRT. Does anyone have experience or opinions on which hospital would be a better choice? Henry Ford is closer, but the RO for urology up there recommended IMRT. He said the smaller radiation doses over the longer period of time gives the normal cells more time to recover from the radiation damage.

Also, any opinions on "higher fraction doses but lower total dose (36 grays)" vrs "lower fraction doses but higher total dose (80 grays)"?

Thanks for the help.
Posted 2/4/2016 6:13 PM (GMT 0)
I really know nothing about Henry Ford Clinic. However, I can certainly vouch for Dr. Rahul Tendulkar, RO at Cleveland. I had the opportunity to speak with him a few years back when discussing treatment options. Even though I chose surgery I found him to be very bright and knowledgeable. Also has a "healing way" about him, and would listen to your concerns.
Posted 2/4/2016 6:23 PM (GMT 0)
One of our members, suz and Steve, was just treated with SBRT by Kevin Stephans at Cleveland Clinic and spoke very highly of him. You can put the name in the search bar to read her comments.

As a primary therapy, IMRT, in my opinion, is a relic of the past. (Although we have yet to see the results of a randomized comparative trial.) Many ROs are holding onto IMRT for dear life because they charge per treatment - 40 treatments vs 5. Their income is cut in half by switching to SBRT.

There is no basis for that doctor's assertion that side effects are any worse. In fact, the data lean in the opposite direction. Read this article:

Quality of life after three different first-line radiation therapies for localized disease: Part 2

As you can see, SBRT outperforms IMRT on all quality of life measures - urinary, rectal and sexual.

For the latest (9 year) SBRT results, see the link in my signature.
Posted 2/5/2016 12:17 AM (GMT 0)
Tall:

As you may recall, I've had SRT to the prostate bed only.

OK, suppose once again my PC is found in a lymph node or two. With a quick PSADT (based on my last HT vacation), it might be advisable to radiate all my lymph nodes. So, between IMRT and SBRT, which is better? Dr. Lam and the RO at Umich (an IMRT guy), seem to eschew SBRT (I'll see what Drs. King and Lam say when I see them next week). Any opinion, given this scenario?

Of course, when I see you on Tuesday, I'll give you Dr. King's assessment!

Mel
Posted 2/5/2016 1:36 AM (GMT 0)
Mel,

As I've repeatedly told you, Dr. Lam who is an excellent medical oncologist, is not a radiation oncologist, and has no specific expertise in this area.

A lot will depend on the salvage RT treatment field and timing. King, who does both IMRT and SBRT, would certainly have a more expert opinion than someone who only does IMRT. If you want an expert opinion, you have to ask an expert specialist.

But let's not kidnap this thread with considerations that aren't applicable to the OP's concerns.

- Allen
Posted 2/11/2016 5:50 PM (GMT 0)
To the OP - just saw this post. If you have any questions re SBRT at the Cleveland Clinic, please feel free to get in touch.

We were happy with treatment & would recommend Kevin Stephans. The other RO mentioned, Tendulkar, has an excellent reputation, too.

Steve is 2 months post-treatment and PSA is down to 1.30. Had a few SEs but so far, so good.
Posted 2/11/2016 9:27 PM (GMT 0)
Thank you for your reply: (1) what type of equipment was used? (2) how many SBRT's for prostate cancer has Dr. Stephans performed? (3) how many fractions did your husband receive and were they given on consecutive days? (4) what was the radiation dose per fraction? (5) what was the total radiation dose for the procedure? (6) what was the length of time between the first consultation and the first treatment? (7) did they use a space OAR or any other "extra procedures"?. Thank you for any advice you have for me. Rick B.
Posted 2/12/2016 6:14 PM (GMT 0)
Hi Rick B - I'll try to answer all your questions here

1) Cleveland Clinic uses a Varian Edge machine to deliver SBRT (I think it's the same one Henry Ford uses coincidently.)

2) I'd have to pull out my binder for the exact number of prostate SBRT cases Stephans has done, but it was significant and a comfortable number for us. We were also impressed with the credentials of the physicists.

3) Due to insurance issues, Steve had 6 fractions (they usually do it in 5) Treatment days are Monday-Wednesday-Friday so it took us two weeks to complete all fractions.

4) & 5) The exact prescription:
3750 cGy
625 cGy per fraction to 95.3% of point dose at ISO for 6 fractions

6) First meeting with doc was in August and treatment started in November. We could have started sooner, but we were still meeting with surgeons and other ROs (doing our due diligence) and then ran into an insurance denial that took some time to work around.

7) Yes on the SpaceOAR plus they used a rectal balloon.

We got a copy of the SBRT treatment plan (it's a 7-9 page document) prior to treatment and sent it to Tall Allen for his review. His much more knowledgeable eyes found it to be an excellent plan which was reassuring.

Stephan's was always impressed with our questions and level of education regrading PCa treatment, and we have this forum to thank for that. He liked having "informed" patients and took a great deal of time with us when we were in the decision making process.

Hope that helps. We wish you well as you continue on your search and will be happy to answer any additional questions you have.

Suz & Steve
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