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Is it a standard practice to have your pelvic lymph nodes radiated during the IMRT of your prostate?

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Posted 9/13/2017 4:09 PM (GMT 0)
Wonder if any high risk (G9) had IMRT treatment without radiating the lymph nodes at the same time?


Is it pretty standard now to treat the pelvic lymph nodes while having IMRT for high risk patients?

Thanks.

Akai
Posted 9/13/2017 4:47 PM (GMT 0)
There is no standard. It's only done when indicated. There is usually some suggestion, radiological or nomogram based, to add the extra radiation. A GS9 has a significant probability of LN infiltration. Discuss it with your RO.
Posted 9/13/2017 6:35 PM (GMT 0)
Interesting question, and I have no idea. Maybe one of the smart folks here will chime in. I'll relate my personal choice though.

Nomograms predicted almost a 40% chance of my lymph nodes being involved but undetectable, so we irradiated them. Dr. Mack Roach was one of the proponents of it that encouraged me to do this back in 2013.

If I recall correctly, the suggestion at the time was if the Roach formula suggested 15% or more likelihood of lymph node involvement that it was worth irradiating them. The Roach formula is:
[2/3 × PSA] + [Gleason score − 6] × 10. For me at diagnosis the formula yields: (2/3)*5.2 + (9-6)*10 = 33.5%, therefore zap the buggers. Did it help? Who knows...

I had no side effects from it.

Not sure if it's still recommended or not. This stuff goes back and forth a lot.
Posted 9/13/2017 7:33 PM (GMT 0)
No standard other than the RO assess that when planning the treatment. Each case is slightly different. Your milage may vary. Past performance isn't an indication of future performance.

Andrew
Posted 9/13/2017 9:52 PM (GMT 0)
Thanks all.
When I was still at G6 and consulted with Dr. Rossi at Scripps Proton, he suggested treating the LNs.
When I consulted with Dr. King for SBRT, I was G9 then, Dr. King suggested treating LNs.
Now I am doing IMRT (following HDRBT boost), my RO's plan includes treating LNs but leave it up to me if I do not want it he can rework the plan.

Redwing, my statistics are pretty much like yours, using your formula, it yields pretty much 33%. So, it looks like a go and hope for the best. I am still concerned about the SEs though.

Akai
Posted 9/13/2017 10:33 PM (GMT 0)
Can anyone comment on the potential additional side effects from pelvic lymph node radiation? I can't find much information specific to pelvic lymph node radiation. Is lymphedema the primary concern and how likely is that?
Posted 9/14/2017 4:01 PM (GMT 0)
Quick question, are 'whole pelvic radiation' and 'pelvic lymph node radiation' the same thing?
Posted 9/14/2017 4:44 PM (GMT 0)
My RO said the following, and my LN were not treated:

"Whether or not to treat the nodes is an area of controversy, with no definitive evidence that it is useful. Since it can add significant toxicities, it is only done when absolutely indicated (for example when imaging shows enlarged pelvic nodes)."
Posted 9/14/2017 4:53 PM (GMT 0)
Astronaut-

The primary concern is bowel/rectal toxicity. Lymphedema/lymphocele is a very minor concern with radiation - it is an important concern with surgical dissection.

Kent-

Whole pelvic radiation may include the prostate (if there hasn't already been a prostatectomy) and prostate bed. Pelvic lymph node radiation may exclude those areas, for example, if the prostate has previously been radiated.
Posted 9/14/2017 6:53 PM (GMT 0)

akai said...
So, it looks like a go

Since you are a Gleason 9 it is very likely that there are affected lymphnodes which will cause a recurrence. So to fight the cancer have the lymph nodes radiated.

George
Posted 9/14/2017 8:02 PM (GMT 0)
All the docs I met said to radiate the nodes due to the risk level. We did so and I had zero adverse side effects.
Posted 9/15/2017 11:43 AM (GMT 0)
Hi Akai, good question to the group. For a G9 patient it seems almost all of the ROs want to zap the lymph nodes. It seems most guys I talk to have no issues, or minor issues that resolve quickly after treatment ends. After getting advice to treat my lymph nodes by Dr King and other ROs I did so. For me I seem to be in the minority and have had to deal with Chronic Radiation Enteritis. Finished IMRT last May and still suffering. Can't say why I am the lucky one for that, but I did use a local RO instead of going to UCLA or other major institution. It is a tough call to go against the standard advice as a G9 wondering if you make that decision will it come back haunt you. Good luck on your IMRT. Take care. -JR
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