Radiation Therapy - How many sessions?

Just had RT #16 of 33 and also saw the RT doctor. A different doc yet again; I have yet to see the same one twice!, but this one was at least one who said "Oh yes I know a lot about you" as she had been part of the team that had worked out my plan.

I checked with her why I was having 33 sessions (ie 66Gy with 2 at each session) as nearly all the other guys I've been bumping into the the waiting room had mentioned that they were having 39 sessions (ie 78 gy with 2 at each session)

She explained that if RT is the primary treament, ie the prostate is still present, then they give 39 sessions and that if the RT follows surgery and there is no prostate around then they give 33 sessions to the prostate bed. And she added that if they only had to kill the tuimor, then they could basically give all 66gy in one dose, but they spread it out like they do to reduce the damage to surrounding tissues over the course of the seven weeks. However...

She then said that they have now introduced a new third method, or rather an alternative one to the 33 sessions. There are now some patients who are having their 66 gy spread over just 19 sessions, and with 3.4 gy at each session. (I think I've got the math right) These guys only get RT on Mondays Wednesdays and Fridays, so the overall time for RT is more or else the same as with 33 sessions.

Has anyone else heard of this, as I can clearly see the benfit of almost having the number of triups a guty has top make to the hospital?


Othwerwise a bit of a difficulty developed today, which I guess is a side effect of the RT, namely I seem to have been having to pee about twice an hour all day and have felt like my bladder is full the whole time. The doc said she could give me tablets to calm my bladder down, but I am going to wait a couple more days minimum to see if it goes back to the way it was yeterday of its own accord.

Alfred

Alf,
Yeah, when RT is giving as the primary treatment for PC, not uncommon to go 39-42 treatments, usually from above 70 gys to sometimes over 80 gys. That is because there is a prostate in place, of course.

With our SRT, Salvage Radiation, it can range from 33-39 typically for treatments (not in all cases), and the gys can be as low as 60 to the mid 70's, depending on the individual data and history of the patient.

I went for 39 great ments for a total of 72 gy, which is higher than average in my area for SRT.

I saw the same radiation oncologist each and every week of my treatments, same one that made my plan. Usually saw her every Monday.

The urgency you describe is very typical side effect while going through the SRT, never experienced that, since all mine were done with a catheter in place. Since you have to travel so far, might be wise to take the tablets from the dr, should ease some of those feelings.

As far as those stronger doses given over lesser time, my own dr. said that not member people could endure that much radiaition poisoning without really getting sick or having more serious side effects. From my own experience, I would tend to agree.

Good luck as you continue. You are getting there, a day at the time.

David in SC

Alf, I believe you, of course, but couldn't imagine the average person enduring 4 gys a day dose. That's way over what is considered normal for radiation poisoning to the body. Probably would have done me in at that rate, lol. Geez thats a lot of radiation at one time

where i live, if a machine was down (never heard that happen here before) or if the patient is too sick. can't be there, etc, they skip the treatment and add it back on the tail end of the treatment number. saw that lots of time, when i was going through mine. despite my foul reaction to it, i toughed it out and never missed or postponed a treatment, just wanted it to be all over with.

There is clearly a dose that is too high, but what is it 3.8 or 4.1 or 5?

There is also the question of the total dose, plus the daily dose, or the dose per 48 or 72 hours etc.
the fact that she said 3.4 gy per session and not 4 makes me think that this is about fine tuning the maximum permitted daily dose. If it was say simply 22 sessions of 3gy then I'd feel that they were simply redoing the math for no good reason.
Frankly I'm glad that it's not 66 sessions of 1gy each.

The current arrangement at this hospital regarding the servicing the machines is that there are eight machines plus one spare which patients get sent to on the day when their normal machine gets its service. (And they are in the process of adding another machine.)

Also where are your RT departments located in the building? mine is in a single story block above ground, but I have heard that other RT buildings are underground or in bunkers. The dangerous bits of the deperment are in the middle of the wing and shielded with concrete walls/roof etc but the waiting and changing areas etc are around the outside so there are windows and glass walls etc to give it a very open character. The room itself is also very large, light and spacious so it doesn't feel the least claustrophobic.

Alf

Alf,
I am doing 39 at 1.8 gy per day. I was told mine is shorter (they normally do 45 days) and lesser dose since this is followup rather than primary.

I remember all the training for radiation "accidents" and Civil Defense - there is a breaking point for radiation, and going over that does long term damage. One would hope that these doctors know what they are doing, but I would take 39 days at half the dose as a good thing. Higher dosages sound like lab rat fodder to me.

Alf, I finished 26 of 38 today ( will have total 68.4gys).  Same problem, urgency and frequency.  Told doctor today and he recommended an over the counter drug called pyridium ( but said can turn your underwear orange if leak etc.) He also recommended very little liquid after 9:00 pm so I don't have to be getting up at night.  He said should return to normal about 3 weeks after radiation stops.  Just in case,  I carry a plastic urinal in the car, used it after surgery in hospital.  Hang in there, you'll be OK.

Alf, it's a shame your appt. are not at a set time. Mine were the very same time for all 39 treatments, seems to me it was at 1430 everyday. That way, I could plan my day around it.

I'm not yet sure whether always having it at a different time is a good or bad idea. And even though today's appointment was at the same time as yesterday I and to go to a diferrent wing in the department today anyway as my normal nachine was having its service.
Yes I'm being seen at a big department 8 or 9 machines, which are in use from 8am till 5pm approx with a new patient every 15 minutes. The whole hospital and Institute are for cancer patients only, so you don't see any other sort of patients. It is sobering to see the other folk coming along for RT who clealry do not have PCa who are often in wheelchairs or hospital beds or walking with drips on racks. Many of them are very ill, thin, grey, bald etc and occasionally you encounter someone who is clearly having a bad time emotionally. Almost everyone who you walk past, or who walks past you says "hello" or smiles be they staff or patient.
The staff are very helpful, friendly etc. There are also volunteers who are often walking around handing out free coffee, tea, lemonade etc to both patients and relatives.

Anyway my bladder was a great deal better behaved today, in fact frequency was back to the same as last week and urgency was only there half the time.

Strange thing today was that there was a shift change during my session so I was set up by two male nurses and then two ladies took over.

And weirdly the machine I was on today was not the same as normal in as much as the bit I lie on was a newer design and felt warmer and somehow softer; the RT "eye" was the same as it whirred and clicked and clunked around me.

I was also home 3hours & 15 minutes after setting off which is a record.

Alfred