5 versus 7 weeks of radiation

This is for salvage, right?

Sounds like a good plan! Best of luck!

Larry-

You can't directly compare Gy's between a hypofractionated protocol and a conventionally fractionated protocol. 26 treatments at 2.5 Gy/fraction (=65 Gy) is biologically equivalent in its cancer control to 37 treatments at 2.0 Gy/fraction (=74 Gy).

Howard, how are you feeling after the 5 weeks?

I'm starting to get antz in da pantz with mine starting in about a month...

Zzarth

No- same machines. They use IG/IMRT linacs. Here's an article about it:

/pcnrv.blogspot.com/2016/08/can-salvage-radiation-therapy-be-safely.html

Howard will likely be treated according to the Kruser et al, study protocol described in the article. This is still experimental. There's every reason to believe it will be as safe and effective as hypofractionation has been in primary radiation therapy.

Howard,

This is a good topic and I'm close behind you with SRT. I will be at the RO in the morn. to discuss results of F-18 Amumin Scan and for mapping/moulds of that area. Have you had that part of the procedure yet? If so, Can you give me a heads up on what to expect.

TA- thanks for the link and I plan to discuss it with my RO and get his thoughts..5 wks sounds a lot better than 7.5wks

James

James,
Nothing unexpected, they will fill your bladder with a caterer or glasses of water, the latter for me, then a CT scan followed by tattoos to mark site for radiation, then oncologist will construct a plan feed it the machine then it’s off to the races.

My husband is in his planning CT as we speak. They will start him after Thanksgiving. We sure wish he would have 5 weeks of treatment instead of 7. It will be such a struggle with his work. He has his own business with several crews working for him. Hopefully he can get a time where he can go get work started and then sneak off to get blasted. The other complication is the full bladder/empty bowel thing.

lol@10 years of toxicity data. Almost all toxicity after radiation shows up within 2 years. After that, age effects on urinary and sexual function predominate.

James A. said...
to discuss results of F-18 Amumin Scan and for mapping/moulds of that area.

When I asked my RO about how they determine what to radiate, he said they go to the farthest margin possible... so they don't really don't deliver different radiate to different patients ...

I'm confused...

Are your RO's using different approaches than mine?

What's considered the best?

Zzarth

James A-

Here are a few things you can show him. They are all about primary radiation treatment. While salvage radiation will usually have worse outcomes than primary radiation, there is no reason to believe that the temporal pattern for emergence of side effects will be any different.

The ProtecT clinical trial was the first to randomize patients to either active surveillance or therapy and watch them over many years. It provides the first and best data we have about the temporal pattern of the emergence of side effects relative to a randomly matched control who did not have treatment.

/pcnrv.blogspot.com/2016/09/patient-reported-outcomes-from-protect.html

But I do agree that if you wait long enough, urinary, rectal and sexual outcomes will deteriorate. That's because of the natural deterioration in those functions with age, regardless of any radiation treatment. The average age of men undergoing radiation is 70, so if he wants to wait 10 years, they will be 80. It would be silly to blame the deterioration on radiation when age is a well-known culprit.

In 80-84 yo men who have not had radiation or any other treatment, 82% suffer from some urinary incontinence. Among men 75 or older, 45% will have suffered loss of erectile function irrespective of any treatment.

In the following, the researchers made an attempt to separate the effect of age from the effect of radiation on erectile function after brachytherapy. They found that after 9 months whatever effect on erectile function that is going to happen has happened:

/pcnrv.blogspot.com/2016/08/half-of-long-term-erectile-function-ef.html

For both SBRT and IMRT given as primary therapy, 10-year functional outcomes are similar and low:

Allen said...
Late-term urinary and rectal side effects were infrequent and mild in both studies:

Late-term urinary side effects:
Grade 2: 9%, Grade 3: 3% in the Katz study
Grade 2: 9%, Grade 3: 5% in the MSK study

Late-term rectal side effects:
Grade 2: 4%, Grade 3: 0% in the Katz study
Grade 2: 2%, Grade 3: 1% in the MSK study

Of those who were previously potent before radiation, 56% were potent (sufficient for intercourse) 10 years later (median age 79) in both studies.

/pcnrv.blogspot.com/2017/09/record-10-year-sbrt-study-among-low.html

It's pretty clear by now that anything that is ever going to happen because of the radiation therapy will have happened within the first couple of years.

Note that the CT/PET scan I had last week, combined with a 3T MRI identified a 2.6cm tumor remaining in my prostate bed. Thankfully no LN or SV involvement. Amazing what this new chemistry and technology can do.

Good luck!