HDR Brachytherapy Vs High Dos IMRT

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Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 8/25/2010 9:30 AM (GMT -6)   
There is an interesting study of HDR brachytherapy + IMRT versus high dosage IMRT on the Infolink forum.

http://prostatecancerinfolink.net/2010/08/23/outcomes-of-hdr-brachytherapy-imrt-vs-very-high-dose-imrt-alone/

“The authors conclude that dose escalation carried out by adding IMRT to HDR brachytherapy provided improved bPFS in the treatment of prostate cancer compared with very high-dose IMRT, independent of risk group on multivariate analysis. The most significant benefit appeared to be available for intermediate-risk patients.”

All of us want to believe, indeed even need to believe, that the treatment we chose was the best one for the circumstances. I am to this point very satisfied with my choice, which was LDR brachytherapy + IMRT + HT. However, in retrospect HDR brachytherapy + IMRT appears to be a very promising treatment option for any risk group of PCa and if I were able to revisit my own decision it might be different.

Sancarlos
Age 66
PC diagnosed 7/2009
Stage: T2c
Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11.15.2010 + hormone therapy (Lupron) + IMRT on Novalis (February-March, 2010), 45 gy.
Casodex added 8/9/2010.

PSA at time of diagnosis: 11.9
PSA 10/2009, 5.0
PSA 12/2009, 0.56
PSA 5/2010, 0.15
PSA, 8/9/2010, 0.066

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3993
   Posted 8/25/2010 9:37 AM (GMT -6)   

I have three more doses of IGRT left.  i had brachy about 3.5 months ago.  one more shot of lupron to go.  there were three of us in the radiation clinic the other day and the other two fellows, who were undergoing straight IGRT (one finished that day and the other two days later)  were wearing catheters.  granted i was the youngest....

i have every confidence that i received the very best treatment for me.

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

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 8/25/2010 10:43 AM (GMT -6)   
I just finished talking at length about this with my R-doc and he was of the opinion (through years of experience and careful study) that while combined Brachytherapy and IGRT can indeed produce high cure rates, (but not significantly higher than IGRT alone, all things being equal), the acute side-effect risk climbs to unacceptable levels.

Many times, these side effects manifest themselves years later as the injured urethra, bladder and rectal tissue require major surgery to repair and often result in double stoma's..

He freely admitted that there are probably a few specialists at advanced clinics and treatment centers who have perfected this treatment and minimized the side-effects.. He may be over-stating the risks, as I had a good friend 75 years old, who had seeds-IGRT combo done in El Paso, TX, not exactly an MD Anderson setting...He had only minor side effect issues and died of of sudden heart attack six years later at age 82.
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..

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 8/25/2010 1:29 PM (GMT -6)   
Fairwind said...
I just finished talking at length about this with my R-doc and he was of the opinion (through years of experience and careful study) that while combined Brachytherapy and IGRT can indeed produce high cure rates, (but not significantly higher than IGRT alone, all things being equal), the acute side-effect risk climbs to unacceptable levels.




What does your R-doc do? IGRT/IMRT by itself or seeds + IGRT?

My take on the literature is that brachytherapy + IMRT has a significantly higher cure rate than IGRT alone.

As for side effects I have virtually none from seeds (11-2009) + IMRT (3-2010) at this point. All of my side effects are due to HT. Personally I will trade no side effects now (with a higher cure rate), for possible side effects in the future (with a lower cure rate), any day of the week.


Sancarlos

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/25/2010 2:40 PM (GMT -6)   
The concept of radiation is fairly simple: The higher the dose and the more accurrately it is delivered will result in greater effectiveness and less side affects. The issue is how to deliver the dose. It doesn't matter if it's proton, photon, fractionated, seeds or X ray, the output energy is the same, measured in greys. More greys mean more killing power, but also more side affects to adjcent organs.
The older ERBT was about 61 gy and resulted in a lot of reoccurrances. It was found that at least 81gy needed to be given. Cyberknife, HDR Brachy, IGRT are all different ways of delivering the energy dose. Any improvements in accurracy of getting the dose to go exactly where it is intended is always better.
The reason that Brachy/IMRT combination is used is that a dose of up to 150gy can be safely given. An IMRT or Proton dose that high would fry all the surrounding area.
It's all about acccurracy and energy dose, the more accurrate, the higher the dose that can be safely given, and the higher the dose the better killing power.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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