HealingWell
Search Close Search
☰

ADT duration with hypofractionated EBRT

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 3/28/2017 2:18 PM (GMT 0)
Hi,

I was wondering if with the shorter duration of hypofractionation and SBRT whether that changes the duration of ADT?

Along those lines... even with standard fractionation, what is the latest thinking regarding ADT for intermediate prostate cancer... what drugs are used and what is the latest thinking on duration of therapy?

Thank you,
Tim
Posted 3/29/2017 1:05 PM (GMT 0)
Hi All,

Please see my original question if you have a chance today... I'm going to see my first M.O. today and wanted a little preparatory info first.

Thank you,
Tim
Posted 3/29/2017 2:06 PM (GMT 0)
Hi Again,

I thought that since no one is answering this question that maybe it is a dumb question or something... Anyway... I started googling around elsewhere and found this:

http://www.cyberknifeforum.com/?g=posts&t=5918#jumptobottom

Part of why I'm asking this is I'm seeing an M.O. today at Dana-Farber in Boston and he may want to start the therapy today. But that is based upon Dr. D'Amico's (of Dana-Farber) recommendation of 44 fractions of IMRT. I'm seeing another R.O. on Friday at Beth Israel that is more likely to recommend hypofx or cyberknife treatment.

From what I'm reading on that link, at least with SBRT/cyberknife I may not need ADT at all. So at a minimum I should probably not start the ADT/HT today. I have time to decide and gather more information.

Does anybody agree or disagree with all of this?

Thank you,
Tim
Posted 3/29/2017 2:20 PM (GMT 0)
sorry no one stepped up to this question. I am not an expert in that area, but generally I see guys with your numbers given ADT as part of the RT. Not sure of SBRT changes the equation.

Likely you have some time to decide, but with a G8, not sure I'd wait too long. HT will stop the progress and give you longer to decide.

Hopefully the guys with more advanced info will be along soon.
Andrew
Posted 3/29/2017 2:25 PM (GMT 0)
Hi Andrew,

Maybe I should change my signature but I consider myself an "unfavorable intermediate risk" member. This is because Johns Hopkins review knocked my 8 down to a 4+3.

I will know even more in the next few days as Brigham and Woman's/Dana-Farber is reviewing my slides for a third opinion.

Thank you,
Tim
Posted 3/29/2017 5:20 PM (GMT 0)
I answered you via email. I should add that Dr King, on his high risk SBRT protocol, allows up to 9 months of ADT, at the patient's option. He does not recommend it for low or intermediate risk patients.

I haven't seen any analyses of this for moderately hypofractionated IMRT.

DART 01/05 showed there was a benefit to 2 years of ADT (compared to 6 months) for high risk patients treated with conventionally fractionated IMRT, but the benefit didn't hold for intermediate risk patients. ADT has proven beneficial with conventionally fractionated IMRT for unfavorable risk patients, but not for favorable risk patients.
Posted 3/29/2017 8:07 PM (GMT 0)
Any thoughts on the hypofractionated IRMT for salvage RT. I'm interviewing RO's. The first RO USMD Arlington said absolutely not. He recommended 72gys over 40 sessions. A 6 month Lupron shot, which is a no brainier. He also recommended a statin even though my cholesterol is not high and take a Vitamin D3 supplement while I'm on RT but I can remember how much here at work. He is also going to RT the LN's due to my +margin.

I meet with the 2 RO at UTSouthwestern, Dallas Friday.
I'm just trying to decipher all the info.

Thanks
Jeff

Jeff
Posted 3/29/2017 8:34 PM (GMT 0)
Hypofractionated salvage IMRT is still very investigational. My RO is developing a protocol for salvage SBRT post-prostatectomy - probably will start this summer. When the prostate is out of the picture, it creates special challenges for hypofractionation. The prostate stabilizes the position of pelvic tissues and holds onto fiducials. Lacking the prostate, fiducials may be displaced if they are used, and the very deformable tissues can move in relation to one another making precise image-targeting difficult. That kind of precision isn't all that critical for IMRT, but becomes more critical with hypofractionation. My RO is considering rectal balloons, which he is hoping to avoid.

/pcnrv.blogspot.com/2016/08/can-salvage-radiation-therapy-be-safely.html
Posted 3/30/2017 12:21 PM (GMT 0)
Thanks TA
✚ New Topic ✚ Reply