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MRI-linac question about BCR
I am aware of the mirage trial and the decreased side effect profile with sbrt mri-linac.
I am wondering what are the numbers for biochemical free progression?
That trial has not released its 5 year data yet. What BCR data are patients using to take advantage of the 2mm margins?
I am schedule to see a MRI linac doc in a month four hours away. so far I have seen 2 well known experienced cyberknife docs within an hour from home. one has the latest tech but new (months)team associates. the other ck doc has an older machine with updated software with same team for ten years.
appreciate info re BCR with MRI linac. Which BCR data set are patients using?
unfavorable intermediate, bilateral disease, low volume 43 34. artera-adt not needed,confined ,PSA 12
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You should take a look at this video by Dr. Mack Roach at UCSF about radiation long term effects and how different types actually work. MRI linac Is discussed a lot.
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5 ReactionsThere is another video where Dr. Mark Moyad talks to Dr. Roach at PCRI. If you search for that, you can find it at YouTube. When I try to paste it in here, I get the video above instead of the video I am trying to post.
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1 Reaction@erbill - Great question and one that has also been on my mind. We're in similar Gleason 7, unfavorable intermediate risk situations. I'm scheduled for five SBRT fractions in early June.
I'll be watching for comments in this thread.
@jeffmarc - I have watched the videos you identified. They were good. Perhaps I need to rewatch them. Also appreciated the Dr. Geo episodes with NYU Langone radiation oncologist Jonathan Hass on his encouraging use of his practice's SBRT Cyberknife equipment.
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1 ReactionI am surprised that data isn’t out there already - I think the tech was commercially used about 7 yrs ago?
With your Gleason score you should probably push for slightly wider margins (pretty sure MRI linac can do this) - maybe 5 mm’s - just to be sure.
But once you do that there’s really no difference between that and Cyberknife, right?
The experienced CK doc with the latest equipment and inexperienced radiotherapists said he would do 3mm margins all around, with spaceoar and fiducials done in the OR. Dose: 36 gray to the margins and prostate and 43 to the two DIL. BCR free 75% 10yr maybe 85 with adt.
The other experienced CK with older equipment and experienced radiotherapist said 0-3mm, and 5mm other areas. fiducials done in office . no spaceoar "cuz CK is precise"
36 gray to margins and 40 to DIL. 85-90% w/o ADT 10yr bcr free rate.
The CK docs are an hour away and the unseen mrilinac ROs are 3.5hrs away.
I watched Mac Roach. It appears that PCRI recently reposted the original mac roach video done 9/24.
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1 ReactionWell, six of one…but IMO a spacer is very important with cyberknife - this is photon - not proton - therapy so beams pass THRU the gland and could damage the rectum. They try to avoid this but why take the chance? You’re getting fiducials anyway!
As for ADT, Artera says you don’t need it; I was high volume uni-lateral G4+3 (no genetic test at that time) and my cancer came back. If it were me, I would do a 4-6 month course of Orgovyx. That 10% extra cushion may not seem like much now, but down the road you’ll kick yourself if your cancer comes back. Best,
Phil