IMRT 40 treatments vs hypofractionated IMRT

Tim-

That caution is true for all radiation - if someone has a urinary stricture before any type of radiation, it will acutely worsen before it gets better. Over time, it will return to or be better than baseline. They are referring to:

"Baseline IPSS questionnaire results were strongly associated with grade ≥ 2 late reactions in arm II patients only (Table 3; Fig 4). Although this subgroup analysis suggests that the hypofractionation regimen described is most appropriate for men without substantial baseline urinary dysfunction, the trial was not designed to specifically address this question, and confirmation is needed."

As you see, it was only an issue for older men and those with IPSS scores >12.

Do you currently have an IPSS score >12?

As for 5+ years, the evidence is that late term GI or GU or sex problems, if they are ever going to occur, occur within the first two years. You can see that in Fig 4 where the men with poor urinary function separated from the rest within 6 months. Keep in mind that in almost every external beam radiation study, the median age is about 70, and there is always natural deterioration in urinary function as they age.

A lot of this has to do with the care that is taken in planning. Hypofractionation isn't merely the "lite" version. It requires an extra level of expert planning to avoid toxicity. SBRT is a whole 'nother world. It then becomes critical to track intra-fractional motion, tighter margins and dose constraints.

Tim-

I just replied to that in the post above.

You probably filled it out when you visited your urologist

www.urospec.com/uro/Forms/ipss.pdf

The late term urinary problems were only a problem for men over 67 and those with IPSS scores >12

Hi Allen,

I did fill one of those forms out. At Cape Cod Hospital when I met with the R.O. there. I don't believe D'Amico had access to that but I could be wrong. Anyway, my total was 7.

I don't know how to word this... I guess I have to wait and see how it goes next Friday when I meet Dr. Kaplan.

Thank you,
Tim

Paxton-

You may be interested in the following article that compares SBRT to moderate hypofractionation. It's not quite as simple as you might think.

/pcnrv.blogspot.com/2016/12/sbrt-vs-moderate-hypofractionation-same.html

Sometimes, treatments may seem to be similar or different theoretically but surprises occur in clinical practice. Take protons, for example - the Bragg peak effect predicts lower toxicity theoretically, but that has never yet been observed in clinical practice.