Any diet restrictions with radiation? What were your side effects?

Meal suggestions while undergoing radiation

A radiation technician told me “steak and potatoes.”

Hi bens1
What was the month and year of your MRIdian treatments? According to the Viewray MRIdian website as of June 5, 2023 it seems that they no longer use a CT scan but rather use their newest MRI machne which is integrated with a proton beam machine (Linac). No fusion of images are used. Could it be that your machine was an older model? The site says "Findings published on January 12, 2023, in JAMA Oncology demonstrate the superiority of MRIdian "MRI guidance" in stereotactic body radiotherapy (SBRT) for localized prostate cancer compared to "CT-guided" SBRT. Then says MIRAGE phase III randomized controlled trial (NCT04384770) shows a significant reduction in acute (≤90 days) genitourinary (GU) and gastrointestinal (GI) side effects with MRIdian MRI-guided versus CT-guided SBRT." I believe Viewray mentioned that fiducial markers are no longer required, however is SpaceOar still being inserted? Is it possible I'm confusing your CT scan for "mapping purposes" with a radiation treatment which uses a CT scan along with a proton beam machine? More detail would be helpful.

web265: I started my MRIdian treatment in January of this year and finished my 5 treatments in February, mid month. I had a ct scan and an MRI before my treatment to help with mapping. Those images were used within the machine for comparison purposes as the built in MRI was primary for real time mapping and process purposes. Different cancer centers seem to treat imag mapping and preparation in slightly different ways. I knew this going in and had no problems with "extra just in case mapping". When I had the spaceoar put in, my RO also inserted fiducials in case my machine broke down. I had no problem with that either but would have started the treatments again after the machine was repaired but I was ok with anything that gave her a better mapping perspective. Fiducials and more imaging was not necessarily needed but again, I had no problem with that kind of "extra."

I had seen the Mirage study both online and I discussed it with 3 of the 5 RO's I had consultations with so I was aware of the results. It was the Mirage study that was the impetus for my Orlando's cancer center to change their policy to 2 mm margins from 3 mm.

Spaceoar was first suggested by the first 2 RO's I spoke with but I brought it up to the other 3 and they agreed it made sense. The first RO who brought it up was at Weill Cornell in New York city and his time with the mridian machine has been primarily prostates. He used spaceoar regularly though he did defer to the patients wishes if they wanted a different type of spaceoar from another company but he was a spaceoar believer. He felt that the extra 1/2 inch separation between the rectum and the prostate made a difference even though the Mirage study did take spaceoar and no spaceoar into account.

bens1 What were the MRIdian treatment centers(TCs) you consulted with if you don't mind me asking? Did you encounter any negative attitudes from the medical personnel. In other words, if you got your biopsy from TC #1 and then got your five treatments from TC #2, were you told to not come back to TC #1 to consult with say a urologist or anyone else? In my case I got my biopsy at a hospital in Maryland but they don't offer MRIdian. In fact it is not available in either Md or in DC ! That leaves Philadelphia, NYC or Boston. I'm willing to drive/fly to any of them.
About Spaceoar & Fiducials: During a biopsy the doctor roots around in the prostate a number of times. Then, the doctor has to root around again to place the Fiducials. Doesn't that potentially disturb/damage healthy tissue? Do Fiducials stay in the prostate forever or do they dissolve in time?
What are 2mm margins? I think I know, but perhaps you can define them.
How many days did the 5 treatments take and what was the dose each time?
Since mid February, have there been any side effects up till now?
By the way, I am rockin2047 and not web265.

rockin2047: sorry about the mixup. My fault. I spoke with radiation Oncologists at Weill Cornell/New York Presbyterian, Moffit Center, Miami Cancer Center and Orlando Cancer Center, all of whom had the MRIdian. I also spoke with an RO who worked with my Urologist.

I did have one radiation oncologist, who had a real attitude. You could tell from the moment he opened his mouth. Among other things, I had asked him about the dynamic planning capabilities of the Mridian, which by that time I had discussed and read about, and he told me if I wanted to use those capabilities to go someplace else. He did not like being questioned, regardless of my tone, and I was respectful but that person, not the institution was not someone that I wanted pressing that radiation button, regardless of his experience.

My independent Urologist did my biopsy and it was done in a surgical center. No issues.My Urologist did not like to have too many questions asked but he got the job done. He also knew next to nothing about the MRIdian but no problem with considering someone or someplace else to do Radiation or prostate removal.

My RO at Orlando Cancer did Spaceoar and the fiducials through my rectum. The fiducials disappear after 60-90 days or so. I was concerned both with the biopsy because of what you described regarding potential damage and I was concerned with the spaceor. If I had to do it all over again, I would do a fusion biopsy for better guidance but I would not have changed anything else. I picked my RO partly because of her experience, previously working at MD Anderson, as well as working with the Mridian machine, but also her professionalism and attitude. Secondly, I had confidence in her team. Not only did my RO do more than a few Spaceoar’s but so did her anesthesiologist, and there was a representative in the operating room from spaceor to monitor what was going on who also had a great deal of experience. I felt I was in reasonable hands but yes I was worried and hoped that I had minimized the risk with the choices that I did have control over. I guess I should also mention that I met with my RO yesterday and the in our discussion she said that in a study that was done they found that those that did spaceoar had less side effects in general related to radiation than those that did not use spaceor, but she said nobody seems to know why that is the case.

As I understand it, most Radiation, whether it is proton or photon, involves radiating most or all of the prostate. After that, there is a distance from the edge of the prostate that they include, just in case. That is the margin that I am talking about that goes from basically the edge of the prostate into healthy tissue. That was another reason I liked the Mridian with its 2 mm margins versus 4 to 6 mm with Proton.

I had started the radiation in late January, and had treatments Tuesdays and Thursdays but the last one, the fifth, was on a Friday, second week in February. I cannot tell you what my dose was because I don’t remember but I do remember thinking about how the dose was applied and calculated. One of the benefits as I perceived it, to the MRIdian was that it required three people to operate it (vs 2 or less for Proton or other radiation machines). The three people were the radiation oncologist, the dosimitrist and the physicist. All of them highly skilled and educated and my RO raved about her team and their experience so I was ok with how they were going to manage the radiation.

After the third treatment, I started to have urine restrictions greater than what I had before. I had expected that possibility and I had discussed it with my RO. She prescribed Flomax before I had the radiation, so I was prepared for it. It took one day for the Flomax to take affect. My flow went back to what it was before the radiation and it has pretty much stayed that way. I went off Flomax about three weeks ago. Other than that, I had no pain and no blood anywhere.

Dr.Nager, at Cornell Weill/NY Presbyterian was actually my first consultation with a RO. His primary cancer focus is prostates and using the Mridian machine for that purpose. Had I chosen New York City, I would definitely had chosen him to do my treatment and I could tell by my experience setting up the consultation with his staff, that it would’ve been a smooth and professional experience for me. You will find his videos on the viewray.com website as that’s where I heard about him in the first place. I was brought up in New York City, so I could have made that choice, but geographical convenience was also part of my formula for quality of life before, during, and after the treatment. By the way, he is also part of the clinical trial team that is testing the Mridian machine for two treatments versus five treatments in that trial. Good luck and am happy to answer any questions that may help with your decision process. There is a lot going on so gathering info from as many reasonable sources as possible is important.

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