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Different types of Radiation? Is one place better then another?

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Posted 4/11/2012 10:02 PM (GMT 0)
Is radiation radiation or do some places do it better?

Mayo Clinic vs Dattoli. One local one not
Posted 4/11/2012 10:30 PM (GMT 0)
Radiation is no different from surgery if you consider that it has to be done with ultimate precision according to a plan that has to allow for the position of your internals, and has to be perfectly repeated ~40 times.

It is a combination of a great plan built by (hopefully) a highly skilled Radiation Oncologist, a skilled team of technicians to do the work, and a modern piece of equipment to do it with.

You should pick a facility where they do a lot of prostate treatment plans. As in surgery, the more they have done, the better for you.

If done badly, you could have severe damage to nearby organs.

Ask David (Purgatory) if you want a case study for radiation gone horribly wrong.

 

Posted 4/11/2012 11:16 PM (GMT 0)
There is definitely a difference between proton radiation therapy and conventional (x-ray or photon) radiation therapy. Generally speaking, the proton radiation does a better job of targeting the tumor and avoiding damaging the surrounding organs and tissue than does the photon radiation therapy. Both use ionizing radiation to kill the cancer cells. The proton therapy is much less available due to the high cost of the facility (it needs to accelerate protons to a high velocity and energy state in order to produce the desired radiation profile). Although it is newer and less is known about the long-term outcome, it is generally considered as providing less collateral damage and is therefore more desired.

I would agree with 142 regarding the requirements for precision and expertise of the person / care facility wielding the tool: you need high skill, and more experience, to properly guide the radiation as needed to do the best job of hitting the tumor and avoid the surrounding tissue.

The form that I had for my radiation therapy was the conventional photon radiation. It was image-guided radiation therapy (IGRT), which is performed by inserting gold seeds (markers) into the prostate bed for reference, and then they made measurements of the site that they intended to radiate. The produce a 3-dimensional image of the space that they intend to hit, and some very sophisticated computer modeling is performed to determine the paths that the radiation will take, from many different angles, to effectively produce a kill dose of radiation to the desired region, while best avoiding the surrounding tissue. Unlike some facilities, which have you drink a large amount of water to fill your bladder prior to each days' dose, my oncologist just had me drink a very repeatable amount (8 ounces 1 hour before the treatment, right after emptying my bladder). He found this to be just as effective as the full bladder method, without the bad outcomes of the poor folks that couldn't hold it for the full duration of the treatment (which usually only takes 15 minutes or so each of 40 or so days).

I have heard that the proton therapy requires the use of an inflatable bladder that they insert rectally each day of treatment; that doesn't sound like much fun. But it is probably worth the fewer side effects.

I wish you the best with your choice!
Jeff
Posted 4/11/2012 11:25 PM (GMT 0)
I should also mention that the radiation treatment that I had was what is called "salvage radiation" (SRT), which is performed after a radical prostatectomy was performed and a recurrence of the cancer happens. If you are using radiation as your primary treatment, the gold seeds may not be used for positioning (someone else can chime in with the details of that procedure, I am not as familiar with that one).

One other thing about the radiation treatment I had: they perform a calibration each day, just prior to the treatment, using Xray imaging to make sure that your daily organ positioning has not significantly moved, and if it has, they adjust the pattern accordingly. It is impressive to me the level of sophistication they have, and the care they take to try to properly administer the dose. That said, obviously in practice there are lots of opportunities for error. I feel blessed to have had what I felt were very conscientious technicians at the helm, and a very knowledgeable oncologist in command.
Posted 4/11/2012 11:26 PM (GMT 0)
For the best results your RO should have at least 250 procedures for PC. Both Dattoli and Mayo are very good choices. Since Dattoli only does PC I think that gives them the edge. For run of the mill low or intermediate grade PC it probably wouldn't make a difference. If I were targeting nodes or had a higher grade PC I would go to Dattoli if I could afford the time and travel expense.
JT
Posted 4/11/2012 11:28 PM (GMT 0)
"I have heard that the proton therapy requires the use of an inflatable bladder that they insert rectally each day of treatment; that doesn't sound like much fun. But it is probably worth the fewer side effects."

The "inflatable bladder" (i.e. balloon) sounds rather ominous, but you get used to it after the first couple of treatments.

As far as my treatment, I've had almost no side effects since the original urinary discomfort, which lasted about 1 month post treatment. I have had some very minor rectal bleeding which could be radiation proctitis or possibly bleeding hemorrhoids (I have a history). This hasn't been an issue.

...Jerry
Posted 4/12/2012 9:30 AM (GMT 0)

Im_Patient said...


I have heard that the proton therapy requires the use of an inflatable bladder that they insert rectally each day of treatment; that doesn't sound like much fun. But it is probably worth the fewer side effects.


The more correct term is "rectal balloon" and it serves the dual purpose of helping to hold the prostate in a constant position each day for delivery of the proton beam, plus also shielding the majority of the rectum from the beam itself. It does not hurt and in fact is another safeguard used in proton treatment that most photon facilities could use, but choose not to. Here is a reference to a study that confirms the effectiveness of the balloon: http://ptcog.web.psi.ch/PTCOG45/Monday%20Talks/27grover.pdf
Posted 4/12/2012 2:48 PM (GMT 0)
jlig,

Agree with 142's comments above. It depends on the skill of the team. I had IGRT (after BT) done by a very experienced radiation oncologist and his team of technicians. I have had no issues to this point...two years out. I also believe that very high quality treatment is not limited to places like Mayo or Dattoli. A lot of experience is key.

Regards,

Joe
Posted 4/12/2012 6:29 PM (GMT 0)
I had my primary treatment at the Monticello Cancer Center. At Dx I had standard RT, Proton (400 mi. but still available), and IGRT (calypso, they use transponders placed in the prostate. The call it a GPS system) as my choices other than surgery. I was familiar with the Cancer Center here as I am a Chaplin for the hospital and the center plus they are only 4 blocks from my home. I agree that experience is the key. The best technology in the hands of an inexperienced Dr. and/or technicians can be very bad. My treatment went very well. Hope I have been at least some help.

Ken
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