Visit with the radiation oncologist

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STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 4/5/2011 1:34 PM (GMT -6)   
Just had my "so you need salvage radiation" visit. The plan is 38 treatments and 68.4 Gy. The dry run is scheduled for the 20th and I'll get my tattoos (no dragons or tigers) and such then.

Interestingly, he said he'd try for IMRT but recently they have had trouble getting insurance company approval. The insurance companies are trying to save money and will only approve 3D conforming external beam radiation instead. Sort of under his breath, the doc muttered that insurance folks don't care about quality of life issues. Color me happy. shakehead

I guess I'll learn what the pre-approval process leads to in a week or two. Either way, once tax season ends I'm still busy until mid June.

142
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Date Joined Jan 2010
Total Posts : 7078
   Posted 4/5/2011 2:17 PM (GMT -6)   
Interesting (not in a pleasant sense). The clinic where my RT was done does only IMRT or IGRT with Calypso markers. Not sure where I would find anything else.
 
My insurance paid for planting the markers as a surgery, but not for the daily fee for the Calypso machine. The clinic eventually wrote off those charges, but once we got started, the markers were "golden" twice when they showed I wasn't lined up right even though everything external was ok. My guts were out of line because of gas, probably. Regardless, I felt like it was certainly worth it for my future.
 
 
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3880
   Posted 4/5/2011 2:18 PM (GMT -6)   
I had IMRT 90 days ago and there was no issue with insurance. I have Blue Cross-Blue Shield. No question asked and they paid everything that was expected.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/5/2011 3:25 PM (GMT -6)   
I had the same experience as JNF, also BC/BS and no problems with coverage.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 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.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/5/2011 8:52 PM (GMT -6)   
Just curious -- are you doing the Varian Trilogy RapidArc?
 
Anyway I'm doing SRT and it is precisely 38 treatments, 68.4 total Gy
 
Mel

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/5/2011 9:24 PM (GMT -6)   
Same response as some of the others, Blue Cross never questioned the method. My clinic also only did IMRT and IGRT.
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 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 4/6/2011 12:28 AM (GMT -6)   
The 3D conformal is (at least) 10 year old technology..Ask your R-doc if he has access to a Varian RapidArc linac and see what he says...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/6/2011 10:06 AM (GMT -6)   
Incidentally, I am doing SRT but I have NO IDEA how much this will cost.
 
They are in-network.
 
Mel

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/6/2011 10:29 AM (GMT -6)   
What is the difference between IMRT and IGRT? Are they used for different situations? Are there studies comparing their effectiveness?

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7078
   Posted 4/6/2011 1:11 PM (GMT -6)   
medved,
 
IGRT is IMRT (Intensity Modulated)with the addition of technology to better guide the radiation beams. The IG part is "Image Guided". For some systems it is a mini-CT scan before each treatment. Some people get the gold markers. I got the Calypso markes.
 
It could more correctly be called IGIMRT, but that long a name wouldn't be easy to market.
 
The idea is that the IGRT does a better job of targeting the same IMRT beams.
 
In theory IGRT is better because there is less risk of excessive radiation to nearby tissue should your insides move around a bit, as they will if you have gas, intestinal issues, or the like. My Calypso did stop my treatments twice for a quick adjustment.
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/6/2011 3:01 PM (GMT -6)   
Thanks 142. That is interesting. Is there any argument that IGRT is not as good as IMRT? If not, why would anyone use IMRT rather than IGRT? Is it just an issue of whether/where IGRT is available?

Is IGRT the same thing as "TomoTherapy"? I saw TomoTherapy described on a medical center's website as "combin[ing] an advanced form of intensity modulated radiation therapy (IMRT) with the accuracy of CT scanning technology, all in one machine. This approach minimizes the damage to healthy tissues, and treats hard-to-reach prostate tumors that often sit close to the bladder and other essential organs."

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7078
   Posted 4/6/2011 3:44 PM (GMT -6)   
Medved,
 
There couldn't be an argument that IGRT isn't as good as IMRT just based on the fact that IGRT is "enhanced" IMRT. It might not be any better if the doctors and technicians doing the treatment plan were just really perfect and got it all right all the time, but it can't be any worse.
 
I saw the "IG" part, my Calypso markers, as a control point - a constant recheck that I was lined up right. If something moved internally, it stopped the process. Because the markers emit a unique id, it also identified me to the machine and the Techs. In my case that wasn't an issue - it was a small clinic, and we all knew each other by first names about day three, but I can see that flashing up a picture of the patient and verifying the plan in use each day would be very important for a large volume hospital. We have had some members post their "journeys" in which they rarely saw the Techs even a second time.
 
From what I understand Tomo therapy is IMRT with the daily mini-CT scan, so just a variation of IGRT.
 
Yes, you might be offered only IMRT if they don't have the extra imaging equipment. Take away the Calypso scanner, and mine would have been IMRT.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/6/2011 3:46 PM (GMT -6)   
142, that is what i had and what i was told. i had tomo imrt therapy, and they did daily, sometimes multiple times daily of what they called "snapped x-rays" from two overhead devices. my center did both igrt and imrt
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 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,
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