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SBRT Late Stage Radiation Toxicity-Anyone Experienced These?

Posted by gsd @gsd, 1 day ago

I'm considering SBRT to treat my Gleason 3/4. Several clinical studies I've read indicated that late stage toxicity side effects (4 months-3 years) after SBRT can be an issue because they tend to be a higher grade (more bothersome) than earlier occurring side effects. Ratnakumaran 's group published a study (Cancers-2023) that analyzed late occurring patient side effects in the PACE-B Trial results for 842 patients, 414 SBRT (Cyberknife) an 428 CFMHRT. They reported results were: late GU Toxicity: 31.9% and late GI Toxicity: 13.2%. According to the article, late grade side effects occur 4 months to 3 years after treatment with the median onset 27 months for GU and 31 months for GI.
Has anyone experienced the late stage side effects and if so, how did it go? Thanks!

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jeffMar | @jeffmarc | 1 day ago

What you can do to offset these issues is to make sure your doctor uses a MRIdian SBRT machine (or equivalent). The MRI guided SBRT uses a much finer beam that affects less tissue near where Radiation is needed. You can also get a SpaceOAR or equivalent to protect your rectum.

I have not really heard of people complaining about long term after effects of SBRT, at least there’s not been a major discussion from people that feel they are affected, like you describe. I had seven weeks IMRT radiation and the only issues I have after 11 years is some incontinence.

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1 reply
northoftheborder | @northoftheborder | 1 day ago

Radiation cystitis AND radiation proctitis for me after 60 gy of SBRT.

Both are mild, according to imaging (18 and 24 months later), but the symptoms of the cystitis suddenly became a big problem for me a year after I finished radiation, and took 5 months to get back under control. Now they're both just mild inconveniences, at worst.

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1 reply
gsd | @gsd | 1 day ago
In reply to @jeffmarc "What you can do to offset these issues is to make sure your doctor uses a..." + (show)
@jeffmarc

What you can do to offset these issues is to make sure your doctor uses a MRIdian SBRT machine (or equivalent). The MRI guided SBRT uses a much finer beam that affects less tissue near where Radiation is needed. You can also get a SpaceOAR or equivalent to protect your rectum.

I have not really heard of people complaining about long term after effects of SBRT, at least there’s not been a major discussion from people that feel they are affected, like you describe. I had seven weeks IMRT radiation and the only issues I have after 11 years is some incontinence.

Jump to this post

Thanks @jeffmarc! I'm always amazed at the depth of your knowledge and you unwavering commitment to help others! You're an inspiration!

REPLY
gsd | @gsd | 1 day ago
In reply to @northoftheborder "Radiation cystitis AND radiation proctitis for me after 60 gy of SBRT. Both are mild, according..." + (show)
@northoftheborder

Radiation cystitis AND radiation proctitis for me after 60 gy of SBRT.

Both are mild, according to imaging (18 and 24 months later), but the symptoms of the cystitis suddenly became a big problem for me a year after I finished radiation, and took 5 months to get back under control. Now they're both just mild inconveniences, at worst.

Jump to this post

@northoftheborder, thanks for sharing your experience! It's one thing to read a clinical study. It's another to get feedback from someone who has walked the path ahead of you!

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bens1 | @bens1 | 10 hours ago

gsd: I agree with @jeffmarc

I had the Mridian radiation machine with a built in mri so the margins around the cancer were 2 mm instead of 3-5 for most other non-built in mri machines. This meant less side effects and toxicity. I had 5 treatments in February of 2023. My Gleason was 3+4 and a 11.2 psa. I have had little or no side effects. The Elekta unity machine is another built in MRI machine.

Check out the Mirage randomized trial comparing side effects and toxicity between built in Mri and non-built in mri radiation machines.
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

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