IMRT vs IGRT- Which does SRT better?

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 8/31/2010 4:53 PM (GMT -6)   
Ok, which of these machines has an edge on the other as far as SRT is concerned? IMRT or IGRT
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., margins clear GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, reoccurance?
ED continues: Bimix- .3ml or Trimix- .15ml

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23531
   Posted 8/31/2010 5:01 PM (GMT -6)   
James, the Greenville Clinic does both, and they convinced me that the IMRT was better suited for the prostate bed area. Again, all things PC, sure you will get a variety of answers.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5615
   Posted 8/31/2010 5:02 PM (GMT -6)   
It was my understanding that IGRT is an advance, adding more precision to IMRT. Maybe I missed something, but the IGRT was promoted as the "next" generation. I did the Calypso version. Look at my IGRT thread. The Calypso machine did shut things down in two sessions when my insides moved, so I had real time evidence that it really did something.
My IGRT journey -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23531
   Posted 8/31/2010 5:07 PM (GMT -6)   
That's interesting, 142. Even though they use both machines, I was told that they could be more precise with the IMRT Tomalis machine. Now I see why we all go nuts making decisions.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3085
   Posted 8/31/2010 5:28 PM (GMT -6)   

they are they same machine but the IGRT is enhanced with "wings".  i.e., an IGRT machine is also an IMRT but not vice versa.

F8


age: 55
PSA on 10/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
ADT, brachy and IGRT

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23531
   Posted 8/31/2010 5:29 PM (GMT -6)   
James, this article did some good explaining:

http://www.cancerinfotech.com/igrt.asp
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 8/31/2010 5:34 PM (GMT -6)   
I had IGRT with the latest machine.  It uses a quick CT scan prior to each session to allign the body and supposedly requires less time for each treatment. I would imagine that each treatment center will want to use the machine they need to pay off first!! Squid.

don826
Veteran Member


Date Joined May 2008
Total Posts : 745
   Posted 8/31/2010 5:36 PM (GMT -6)   
Hi James,
 
IGRT and IMRT are the same treatment. IGRT stands for "Image Guided Radiation Therapy". IMRT stands for "Intensity Modulated Raditaition Therapy". The image guided part is the placement of the "fiduciaries" (gold seeds) using a sonograph to locate the prostate. The seeds are then mapped using a CT scan. The mapped seeds are then studied by the radiation oncologist for planning the proper angles of attack. During the planning the desired dose is also calculated.
 
Now comes the IMRT part. The radiation beam is shaped to fit the prostate seed locations. This will deliver a varying amount of radiation depending on the location with the higher dosage to the area between the seeds and lower doses to the extremeties. Sort of like triangulation using the seeds as beacons. This is to place most of the radiation on the affected area and less to the surrounding tissue. Thus intensity modulation. The seeds also play a part in fixing the target of the beam prior to each session.
 
You will also be given "tattoos" during the intial CT scan to locate the seeds. The alignment beam will use these to position the table prior to each session. Prior to the radiation the seed locations are checked and then the treatment begins after all is in alignment. (image guided/intensity modulated) In my case the machine used was the Varian. The head rotated 360 degrees around me while I layed still on the table. It stopped at seven station and delivered the radiation for a specified dose at each location. The reason for the sevne locations is to limit the exposure to surrounding tissue and to get a more complete treatment of the targeted area.
 
There is a new Varian called Rapid Arc that does not stop. And I think there is an upgrade to that as well that allows for higher doses and fewer treatment session. You can google the Varian website and get all the information you need. There are other machines out there as well and all are similar. I looked at cyberknife but wasn'e right for me.
 
Sorry for the long post.
Don
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 9/1/2010 8:39 AM (GMT -6)   
I found this jewel of a site, full of good info. that explains the various radiation methods and their uses.

www.radiologyinfo.org/en/sitemap/modal-alias.cfm?modal=onco

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7456
   Posted 9/1/2010 9:02 AM (GMT -6)   
When I was looking at it, i went with IMRT using my own reasoning. They had both IGRT and IMRT available, but IGRT is a precise point and shoot. Since I had the positive margins and seminal vesicles, I felt that being too precise could miss the cancer. I probably was not fully understanding of the technology, but a wider area being hit was better in my thoughts. In three weeks, I have the Calypso manufacturer at our UsTOO meeting. They will go over everything Calypso.

I'll let you know if I feel anything differently.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23531
   Posted 9/1/2010 12:54 PM (GMT -6)   
Tony, my radiation oncologist used the same logic in deciding to use IMRT with me, vs. IGRT. My clinic had both machines. The only think odd I remember about that decision, was at that clinic, there were always mobs of people and scheduling issues with the IGRT machine, and on the IMRT machine they used with me, it was rare that anyone was waiting to use it. Not sure why.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7456
   Posted 9/1/2010 1:05 PM (GMT -6)   
Many cancers require a more precise beam. I am certain that the intent is to minimize side effects. Precise delivery of radiation is a better way to go to do that. The question is if you are not precisely sure where a cancer is, then is a wider area beam best? I bit on that logic, but looking back I have no idea if that is really true. But I can say this, I have had 38 IMRT treatments adjuvant to surgery and hormone therapy and I have no SE's and my cancer is currently under control...

Tony

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 967
   Posted 9/1/2010 1:19 PM (GMT -6)   
James, I looked at the site in your post. There was no indication which is best for SRT. Is there no consensus? I am currently having IMRT. Tattos, but no gold seeds. I was assured by my rad oncologist that I was getting the best treatment available.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 508
   Posted 9/1/2010 9:37 PM (GMT -6)   
I am presently going through IGRT. Don described it very well. I watch them line up my 4 gold seeds by imaging just prior to the treatment each day on a monitor.

I don't see the argument in favor of a wider, less accurate beam. I would think that you can get the same intended coverage more precisely with IGRT, and it might be possible to avoid nearby organs in the process if they are not likely to be affected. The way I understand it, the shape of the target area can be more precisely designed using a combination of computer graphics, and daily imaging. I just don't understand why "less precise" could be better.
Jeff
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09: 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear
PSA after, 2010: March, 0.17; April, 0.17; May, 0.24; June, 0.31; July, 0.29; Aug, 0.41
Started salvage IGRT on August 4, plan 72Gy total, 40 doses

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 2200
   Posted 9/1/2010 10:08 PM (GMT -6)   
I'm going with SubicSquid! The cost of this stuff is staggering, even for a big hospital.

That's why radiation treatment costs three times what surgery does..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

Windsor11
Regular Member


Date Joined Jan 2014
Total Posts : 45
   Posted 2/20/2014 10:11 PM (GMT -6)   
Good evening, gentlemen.

I have participated in other threads of this forum, but this seems fitting at this juncture.

First, a summary of my status:

60 years old
Health otherwise: Excellent
April 2013 PSA: 5.7
Traditional biopsy in May 2013: Results benign
Urologists suspected prostatitis and subscribed 30-day regimen of Cipro
October 2013: PSA 5.3; active surveillance begins
December 2013: PSA still 5.3; patient inists on MRi;
January 2013: 3D MRI at Massey Cancer Center in Richmond, VA, shows suspicious area in transitional zone
Mid-January 2013: Final pathology report concludes there is only one tumor, moderate in size, Stage 2, located in the transitional zone at the right apex; Gleason Score: 7 (3+4), favorable intermediate risk

I have ruled out surgery for various reasons, chief of which it is not necessary given the parameters of my diagnosis. But now I am frankly in angst as to whether to go with IGRT/IMRT or the Calypso method for radiation.

Your thoughts?

Thanks --

Windsor11

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5615
   Posted 2/20/2014 10:27 PM (GMT -6)   
You have posted this twice (a tiny rule violation), so I answered on the other thread.
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12 (next planned for 3/14);Prolia 6-mo inj 12/12, 06/13, 12/13

Windsor11
Regular Member


Date Joined Jan 2014
Total Posts : 45
   Posted 2/20/2014 10:31 PM (GMT -6)   
My sincere apologies for the double posting. I was unaware of the rule. Never again, I promise.

turpT1a
Regular Member


Date Joined Dec 2013
Total Posts : 57
   Posted 2/20/2014 10:33 PM (GMT -6)   
Tony,

Welcome back. Your input is highly appreciated.
10/1997(age 50): psa 1.0;10/98: psa 3.4; 6/2000; psa 4.2
7/2000: negative biopsy
From 2000 to 2011, psa gradually rose to a high of 9.6
2006 and 2009: negative biopsies
4/12: TURP performed;7 out of 245 chips cancerous;Gleason 7(3+4)
5/12: psa 1.0
6/12: mp-mri negative
8/12: second opinion on biopsy by Epstein at JHU: gleason 6
10/12:PCA3 21
PSA fluctuated around 1.0 since.
6/2013: negative mri

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3085
   Posted 2/20/2014 11:04 PM (GMT -6)   
Tony's post was 3.5 years ago cool

ed
age: 58
12/09 -- PSA 6.8
G7 -- 3+4 (12-12 cores pos)
HT, BT and IGRT
9/11/13 -- 3-year post treatment PSA 0.2
(PSAs .2, .3, .2, .3, .2, .1, .2)

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3085
   Posted 2/20/2014 11:07 PM (GMT -6)   
I was 55 when I last posted on this thread and I'll be 59 next month! I guess my demise wasn't as imminent as I thought back then cool

ed
age: 58
12/09 -- PSA 6.8
G7 -- 3+4 (12-12 cores pos)
HT, BT and IGRT
9/11/13 -- 3-year post treatment PSA 0.2
(PSAs .2, .3, .2, .3, .2, .1, .2)
New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, April 15, 2014 10:55 PM (GMT -6)
There are a total of 2,102,187 posts in 233,644 threads.
View Active Threads


Who's Online
This forum has 148908 registered members. Please welcome our newest member, username330.
317 Guest(s), 11 Registered Member(s) are currently online.  Details
logoslidat, momtofourangels, Rockon, Chotti, Scaredy Cat, Drew967, orchid_rain, Acheybody, Patrick M, Flip Flop, username330


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest  Follow HealingWell.com on YouTube
Advertisement
Advertisement

©1996-2014 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer