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Please share your salvage radiation experience, especially on VMAT
I posted several weeks ago about my husband's prostate cancer recurrence on one PSMA-Positive lymph node almost 5 years post prostatectomy. After meeting three different radiation oncologists in Germany, he finally chose his treatments and got pre-authorization approved from our health insurance yesterday. Here is the recommended plan:
"1. Initiation of antihormonal therapy for at least 6 months (relugolix)
2. Salvage radiotherapy using image-guided intensity-modulated therapy (VMAT/IGRT)
of the prostatic bed and the local and regional lymphatic drainage pathways up to 50.0 Gy (ED 2.0 Gy)
as well as a simultaneously integrated boost (SIB) to a PET-suspected lymph node with
57.5 Gy (ED 2.3 Gy) or an SIB to the prostate with 62.5 Gy (ED 2.5 Gy).
A total of 25 fractions are planned."
Has anyone had experienced with 25-28 sessions of moderate-hypofractionation radiation with VMAT/IMRT? If you do, could you please share your experience with us? We very appreciate any information you all can give us. What should we know or ask at the CT planning/mapping? What are side effects - both short-term and long-term that you have experienced? Thank you in advance.
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Hello, I had 25 sessions of hypofractionated treatment to prostate bed and pelvic nodes - total 10,500gy. However, no isolated metastases were treated.
Also did 6 months Orgovyx. His treatment is almost identical to mine and I had no problems (except for the bowel challenge!).
That said, we are all truly different and his side effects could vary from zero to severe - and no one can predict what they will be.
Hopefully, he will be in the vast majority with minimal short term SE’s and nothing more.
Phil
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1 Reaction@heavyphil Thank you so much. He has one PSMA-positive lymph node, so they decided to do SIB on it simultaneously with the radiation. I have done some research on side effects so that I am aware of them. I hope he’ll tolerate the side effects well.
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1 ReactionI'm tagging a few additional members to share their radiation experiences like @robertehughes @robertmizek @seasuite @dgd1953
As you likely already know, Volumetric Modulated Arc Therapy (VMAT) and Intensity-Modulated Radiation Therapy (IMRT) are both highly effective, high-precision radiation techniques for prostate cancer. VMAT generally provides similar or superior dose distribution to IMRT. Because VMAT delivers radiation in 90 seconds or less (instead of 10 minutes for an IMRT session), it greatly reduces the opportunity for prostate to move during delivery. This faster treatment means improved targeting precision and fewer risks of missing the tumor or hitting healthy tissue. Of course, shorter treatment isn't a bad benefit either. 🙂
@prettypass2000, has your husband had the planning sessions yet? When does treatment start?
Hi and sorry for your husband’s recurrence. You’re a trooper for doing research to help him. Here’s what I can share.
Prior to my prostatectomy, two cancerous lesions were identified on my PET – PSMA scan. During surgery, only one lymph node could be reached and my PSA nadir was 0.40. After I healed, I was put on REGOLUX also known as ORGOVYX and generic Zytiga (abiraterone). Three weeks after starting it, my PSA fell to undetectable levels. The plan was for me to be on it for 18 months. Three months after starting ADT, My radiologist oncologist had me do 25 sessions of IMRT to the pelvic lymph node basin and then an additional six session boost to the remaining lymph node. I experienced some fatigue the last week of radiation and then for an additional 10 days. I handled the ADT fairly well for six or seven months and did daily resistance training. I discontinued it at 11 months to address quality of life issues that I developed. So far, I have not had any long-term side effects from the radiation. My testosterone recovered six months after discontinuing ADT and one year after discontinuation, my PSA is still undetectable.
I hope your husband has a similar outcome and you enjoy many happy and healthy years ahead!