Proton therapy vs. normal radiation for lymph nodes?

What lymph node dose are they considering? My nodes were done with IGRT by IMRT to 50.4 Gy due to the likelihood of their involvement, around 40% or higher; no observed involvement yet. They used 10 MeV x-rays, for what that's worth.

NJ Jon -

Per an email I received in past week, Proton Therapy was recently listed in not recommended category by the American Society of Radiation Oncologists (ASTRO)

www.medscape.com/viewarticle/811528

If I recall, medscape requires an ID and a password but is no cost.

So I will save some administrivia for those of you who do not wish to enroll:

[quote]"Prostate Cancer Controversies

The recommendation to stop routine use of proton therapy in men with prostate cancer is a blow to centers that advertise and employ the expensive treatment.

Proton therapy for prostate cancer should be now limited to clinical trials, says ASTRO.

An expert agreed. "I advocate that approach," said Michael Zelefsky, MD, a radiation oncologist specializing in genitourinary cancers at Memorial Sloan-Kettering Cancer Center, in New York City. "Studies are needed to elucidate the clinical benefit," he said. "There is no evidence of superiority over standard dose escalated photon therapy."

At the same time, Dr. Zelefsky emphasized that proton beam is not in its infancy as a technology. "I do not think it is experimental at this point," he told Medscape Medical News in a phone interview.

Earlier this year, ASTRO issued a statement that voiced support for the clinical trials and collection of data from patient registries that seek to inform best practices on the use of proton therapy for prostate cancer.

Dr. Steinberg said he has not yet received any "pushback" on the proton beam and prostate cancer recommendation. "But the day is young," he said with a smile.

The other ASTRO recommendation relating to prostate cancer calls for clinicians to present active surveillance as a management option for patients with low-risk disease before discussing radiation treatment.

The recommendation is no longer as controversial as it was in 2010 when the National Comprehensive Cancer Network first issued a guideline calling for active surveillance to be the only recommended option for very low-risk disease.

"Basically we re-emphasizing something we already know," Dr. Steinberg said about the active surveillance guidance."[ end of quote]

I have a hard time believing that the 10 or so centers that already spent beau coup dollars on the equipment and the dozen or so in process will just write that off.

Further, I have yet to meet anyone who had the proton therapy who was not a zealot about how well it had gone.

This is proton therapy in general, so not specific to the question you asked.

Also make sure to verify that insurance will cover proton if you decide to go that route.

LupronJim

There are three ways in which radiation can be applied to the lymph nodes:
1. Wide area radiation to the lower lymphatic system.
2. Full body radiation to the entire lymphatic system.
3. When under 5 lymph nodes are identified by a nano particle scan; the nodes are targeted individually.
Proton would have no benefit in any of the three methods and would be less effective in the first two.

I should add that one study showed that boosting the dose to the pelvic lymph nodes up to 54 Gy using IMRT was safe and made no difference in urinary and rectal SEs vs prostate-only RT.

Quality of Life Outcomes in Patients With Prostate Cancer Treated With Nodal Irradiation