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SRT Gy dosage

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Posted 10/10/2019 6:41 AM (GMT -7)
I had a conversation with my RO on Tuesday this week after my 10th treatment. I know he told me prior to the start of SRT that I would be getting 6800 Gy at 200 Gy per treatment over 34 treatments. The area covered would be the prostate bed and lymph node area, too.

Anyway, I could swear I'd seen people out here getting larger dosage than 6800 Gy. I questioned him yesterday and he tells me that this (6800 Gy) is the standard dosage. I told him that this was "my last shot at a durable remission" and that I did not want to get "shortchanged". He rolled with it well, and explained that the higher dosages I see are for primary RT treatment. I'm not so sure. How about it? Any of you SRT guys get more (much more) than 6800 Gy?

J
Posted 10/10/2019 7:47 AM (GMT -7)
I got 72 Gy’s (7200) over 39 treatments for Salvage radiation, I believe that is standard at MSKCC
Posted 10/10/2019 8:10 AM (GMT -7)
SRT - 39 fractions - 70.2 GY
Posted 10/10/2019 8:31 AM (GMT -7)
70 Gy's, 35 treatments. MDAnderson Houston
Posted 10/10/2019 8:34 AM (GMT -7)
70 GYs 34 treatments, Stormont Vail in Topeka

Not primary treatment
Posted 10/10/2019 8:54 AM (GMT -7)
normally they only do enough Gys to get you to start to glow in the dark and then they know they are done.
Posted 10/10/2019 9:08 AM (GMT -7)
Currently undergoing SRT 72Gy in 40 treatments.
Posted 10/10/2019 11:09 AM (GMT -7)
I have read from 68-72 is the normative range. Less than 68 is less effective. More than 72 gets markedly more toxic.
Posted 10/10/2019 2:55 PM (GMT -7)
My RO was pretty insistent that 67Gy via IGRT was appropriate for ART to prostate bed with me. The dosage limit is typically 1.8 Gy per day to minimize collateral damage from what I was told for ART/SRT and a higher dose over a shorter time period was not appropriate for ART. Seems to be a pretty controversial issue with conflicting studies like everything else with PCa. Too much radiation can reduce a patient’s longevity as well so not a simple issue.
Posted 10/10/2019 3:25 PM (GMT -7)
70.2 grays (1.8 grays for 39 treatments), with ZERO side effects during and after treatment.
Posted 10/10/2019 4:03 PM (GMT -7)
Currently undergoing SRT @72 Gy over 40 treatments
Posted 10/11/2019 5:05 PM (GMT -7)
ART for me, 68.4 gy, 38 sessions

I have final follow up with RO next week and can ask. I think that the slightly higher numbers are to cover a larger area due to longer time post-op
Posted 10/11/2019 6:47 PM (GMT -7)

NorCol said...
SRT - 39 fractions - 70.2 GY

Same here, 39 Tx, 70.2 Gy ART (7020 rad, 1.8 Gy per fraction)
Posted 10/13/2019 11:41 AM (GMT -7)
"The area covered would be the prostate bed and lymph node area, too." You probably mean 6800 centiGy or 68 Gy.

You should not radiate the lymph node area with a higher dose, you could radiate the prostate bed with e.g. 70 Gy. When radiating both, some doctors make second radiation plan to put an additional dose to the prostate bed. I would not be keen for higher doses, the risk of lasting side effects is higher too.
Posted 10/13/2019 10:08 PM (GMT -7)
72 Gy in 40 fractions.
Posted 10/14/2019 5:08 AM (GMT -7)
Looks like I'm the oddball here. 66 Gy at 33 fractions. That was way back in 2008.
Posted 10/14/2019 10:01 AM (GMT -7)
Negotiated hard with RO to bump up to 68gy. He was hesitant but complied with my wishes.
Posted 10/15/2019 8:27 AM (GMT -7)
My RO originally planned 66 Gy for SRT.

I asked him to increase the dose based on this info, which links to a paper:

https://pcnrv.blogspot.com/search?q=SRT+gy

The RO had 25 years of experience but was new to my treatment facility. He said the 66 Gy was based on the treatment facility guidelines, and that he had always used 70 or 72 Gy.
Posted 10/15/2019 12:15 PM (GMT -7)
68.4Gy in 39 treatments 1.75Gy/treatment.
I had my share of side effects - fatigue, a lovely radiation sun burn, and best of all radiation proctitis at the end - that was a real treat.

Best of luck

Rob
Posted 10/15/2019 2:01 PM (GMT -7)
I would be more concerned about adding ADT (hormone therapy) or not...
Progression-free survival is higher when ADT is added.
Did you discuss that with the RO?
Posted 10/15/2019 2:10 PM (GMT -7)
68.4 GY over 38 treatments. Seemed on the low side to me and no lupron first but the RO insisted that was the standard of care. Apparently it was too little because it failed fairly quickly.
Posted 10/15/2019 3:49 PM (GMT -7)
Senior Sailor, The RO gave me the option of 6-7 months of ADT (Lupron) and I took it. I am 7 weeks into the ADT and 3 weeks into SRT. I discussed the 6800Gy over 34 treatments with him today and he insisted this is the way to go. He stated that the 200Gy per treatment is slightly higher than those receiving 7000+Gy (170-180Gy) and that little increase in Gy per dosage makes up for the overall dosage. I actually mentioned you guys to him and what you were receiving. I am still not sold, but this RO Dr. is a leader in treating PCa and he is the Chief RO at a nationally known Cancer Center here in Philly. I got no choice but to roll with it now. J
Posted 10/15/2019 7:12 PM (GMT -7)
Finished my SRT in August 2019. Had 66 Gy at 33 fractions (VMAT Rapid Arc) + ADT ( 6 month)
Posted 10/16/2019 12:24 PM (GMT -7)

JayMot said...
Senior Sailor, The RO gave me the option of 6-7 months of ADT (Lupron) and I took it. I am 7 weeks into the ADT and 3 weeks into SRT. I discussed the 6800Gy over 34 treatments with him today and he insisted this is the way to go. He stated that the 200Gy per treatment is slightly higher than those receiving 7000+Gy (170-180Gy) and that little increase in Gy per dosage makes up for the overall dosage. I actually mentioned you guys to him and what you were receiving. I am still not sold, but this RO Dr. is a leader in treating PCa and he is the Chief RO at a nationally known Cancer Center here in Philly. I got no choice but to roll with it now. J

Looks like an excellent protocol!
Best wishes for a long knock-down, if not knock-out, of our foe.

Post Edited (Sr Sailor) : 10/16/2019 1:27:01 PM (GMT-6)

Posted 10/16/2019 2:38 PM (GMT -7)
39 sessions, 70.2 Gy, SRT (7020 rad, 1.8 Gy per fraction) Radiation was a non issue, but the after effects of ADT (six months of Lupron and seven months of Casodex) were/are uncomfortable. After reading hundred of medical studies, I don't believe most patients derive ANY benefit from ADT.

Progression-free survival by taking hormones during RT is a myth that some RO's promulgate, hoping for improved results, but not paying for, suffering, or treating the consequences. It 'may' be beneficial for some high risk patients, with high PSA, but it isn't an 'across the board' benefit for most of us, IMO.

Caveat Emptor, brothers!!!
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