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SBRT or Cyberknife 5 fractions

Posted by erbill @erbill, 5 days ago

Hello
I have researched mri linac sbrt and cyberknife. (for five fractions)
Please comment on the following:
1)My understanding: for mri linac the patient is in the mri machine receiving radiation with adjustments due to movement for all 5 treatments.

2)the cyberknife uses a sophisticated xray activity to accomplish the same process.
I'm thinking xrays dont see soft tissue so cyberknife might be less accurate than mri guided.
3) the facility I am seeking treatment at is a NCI center. via the portal I asked the radiation nurse if they use mri guided linac for prostate sbrt and received this answer: "The MRI machine is a Viewray. Please note the SBRT technique is not routinely performed on the MRI Linac as an adaptive case. This technique can be utilized on our other machines as well".
It sounds like they are using the mri component at this facility only for staging purposes? I will find out for sure in a month.

Thanks
Ed

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erbill | @erbill | 3 days ago

thanks the facility in Tampa is the one whose RO nurse told me they didn't do adaptive radiation with the MRI linac for prostate.

Orlando and Miami must be high volume centers with all the retirees in Florida.

REPLY
bens1 | @bens1 | 3 days ago
In reply to @thmssllvn "...pcri.org. You-Tube video with Mack Roach MD UCSF radiation oncologist describes problems with the MIRAGE study..." + (show)
@thmssllvn

...pcri.org. You-Tube video with Mack Roach MD UCSF radiation oncologist describes problems with the MIRAGE study showing better outcomes for the MRI 'guided' approach. (Ten days ago, end of April 2025)

fast forward to 15.00 to 24.00 minutes but it is all interesting
https://video.search.yahoo.com/yhs/search?fr=yhs-avast-securebrowser&ei=UTF-8&hsimp=yhs-securebrowser&hspart=avast&param1=n&param2=20241208&param3=Avast+Secure+Browser%7C122.0.24368.130&param4=17%7C5.2.590%7C&p=PCRI.org+video+of+Matt+Roach+MD&type=6320#id=3&vid=2879f8c46909fbb3e1c52861b38f39cb&action=click

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@thmssllvn
I watched the video from Dr. Roche. Thank you for putting in the link. As a layman, there seems to be a lot left out in this discussion. For one, he only brought up the lower Tesla powered MRI that was part of the study without explaining the negatives or positives thereof and did not address the benefits of real time Imaging versus fused images or the higher powered built in Mri machines like the Elekta unity and the benefits of better images and real time treatment. He could have spoken about the benefits of the MRIdian or the Elekta Unity, as a group of feature benefit, but did not. He mentioned the studies limitation in gating technology without really explaining. He could have mentioned the benefits side of all this type of technology, which thousands have been treated with, and paid for and used by a number of centers of excellence including Memorial Sloan Kettering, Cornell Weil, MD Anderson and others, and why perhaps they made the choice for MRI guided linac machines over or in addition to, other types of radiation machines.

Clearly he was trying to highlight the imperfections of the Mirage study which is always helpful as a patient to understand those imperfections. It is also helpful for patients to understand why top experts in their field may choose to offer MRI guided radiation treatment over another. I am all for additional studies in this regard but like many studies in this world, one does not want to throw out the baby with the bathwater.

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