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IMRT?

kidclutch
Posts: 56
Joined: Oct 2017

My dad’s got a new oncologist who is switching his radiation plan to IMRT for bone metastases. I’ve done some reading and it does seem like the better option— anyone have success stories they’d like to share with me? His cancer is still responding to Lupron/Casodex, and bone scans had shown some improvement about two months ago. 

G53
Posts: 33
Joined: Jul 2018

You will only radiate bone metastases for palliation of painful from bone metastases. If your dad has no pain, you should not radiate them. You cannot destroy them with IMRT, you could use SBRT radiation for that. The standard of care for hormone sensitive PCa with bone metastases is ADT combined with a Chemo with docetaxel. This recommendation from the NCCN guidelines is based on the CHAARTED study.

kidclutch
Posts: 56
Joined: Oct 2017

He’s an oncologist with 59 years of experience in a nationally recognized top 2% cancer treatment center, so I definitely am not going to correct him on the current treatment course since I am certain he knows more than I do. They are currently proposing pulling my dad off of Lupron, though. I was just curious about others’ experiences with IMRT. My dad’s almost done with it now and the bone lesions are shrinking along with the pain! 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3307
Joined: May 2012

kid,

In your first post, you say the doctors were "switiching his RT to IMRT."

Switching from what ?  Has he received any form of radiation thus far ?

G53 was correct in stating that RT is used against tumors in the bone toward pallative effect only (it will not 'cure').  However, his statement that SBRT is better for this does not match what I have seen friends receive in the past. For one thing, men were getting pallative RT for decades before SBRT was ever invented (in fairness, before IMRT was invented either, but IMRT is the more direct historical descendent of "EB" radiation than SBRT is ).

If current therapy is working, it seems staying on course and respecting his doctor is a sound decision on your part.

The men I have known who went on Taxotere indicate to me that it is a last-hurrah technique, although a few new, post-Taxane drugs have come out in the last 6-7 years: Jevtana, Zytiga, and perhaps others.  But what really extends life a long time for metastatic PCa patients is the HT.  It needs to be played for as long, and as skillfully, as possible.

max

G53
Posts: 33
Joined: Jul 2018

Kid did not mention that his Dad suffered pain from his bone metastases. This usually does not happen as long as Lupron/Casodex are working. That was the reason for my post.

Regarding SBRT, I refer to this study: https://www.cyber-knife.net/fileadmin/user_upload/pdf/CK_PC.pdf

The higher radiation doses you can apply with SBRT allow to destroy single bone metastases. Not just treat pain as yo do with IMRT.

G53

kidclutch
Posts: 56
Joined: Oct 2017

He had ten rounds of radiation to the lumbar spine after the L3 fractured in October (which brought us to diagnosis). His hip developed a stress fracture on July 4th. The previous oncology office had outdated machines. He was fitted for IMRT at the cancer center a few weeks ago to provide more targeted care on the spinal metastases (but they are also treating the rib and hip lesions). There has been no mention of chemotherapy yet as the current treatment is working, but we are less than a year into this beast!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3307
Joined: May 2012

Good luck to him, kidclutch. It is good that you switched radiation providers; I can't imagine a place today not having IMRT/IGRT.

Most new IMRT machines, if they are made by Varian Coproration, also have SBRT capability in the SAME machine. SBRT technology is the same as brand-name Cyberknife, but from a different maker. At Varian, SBRT is named "True Beam."  Ford vs Chevy -- no real difference.  Varian is a bit bigger worldwide, but does less slick advertising than Cyberknife does.

The R.O. is who will best decide which of the available technologies is most effective for his needs.

max

G53
Posts: 33
Joined: Jul 2018

Your doctor should mention Chemo, he probably waits until the radiation is done. Currently the recommendation is to combine ADT and Chemo early on when there are bone metastases:
https://am.asco.org/treatment-newly-diagnosed-metastatic-prostate-cancer

G53

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