Radiation after RARP

Are they talking about having the adjuvant Radiation real soon? I would not be surprised because the fact that you’ve Had such an aggressive case. The only one of those radiation techniques I’ve heard of is VMAT, Where they use 3-D treatment to get to all of the spots, they were radiate going around your body.

Are any of these MRI guided? That would be the best option, but I don’t know from the description of the names. What actually they mean by them.

This technique sounds really interesting and might have real good chance of not affecting my tissue.

SGRT with HyperArc is a highly precise, automated, and non-invasive radiotherapy technique for treating brain tumors and metastases. It combines Surface Guided Radiation Therapy (SGRT)—which uses 3D cameras to monitor patient movement in real-time—with HyperArc, a technology that delivers high-dose, conformal radiation (radiosurgery) from multiple angles (non-coplanar arcs)

You looked at the descriptions of the other techniques, Did any of them seem better than this one?

SGRT (surface guided) and Deep Inspiration Breath Hold are more compatible with breast or lung cancers. The surface does not show how full the bladder is. Adaptive RT is for specific well-defined tumors.

That leaves IMRT which should always include IGRT (image guided). That is what is typically used for salvage radiation. The other option not mentioned is SBRT which has higher doses and fewer treatments. This would be novel for salvage treatment but is gaining more traction for primary treatment especially for intermediate cases and is the primary treatment to zap a few metastases. Proton could also be used rather than photon to have like treatments replacing either IMRT or SBRT.

@jim18 Yup, I had IGRT using TruBeam RapidArc(?) machine.
Cone beam (like a CT scan) is done at beginning of every session to verify that all inside organs, bladder, rectum align with the simulation set-up.
The machine goes all around you and even under you (the table is carbon fiber to allow photons to pass thru) so it’s pretty cool…except that it’s YOU on the table😩

Hi. Hope you recover well. My husband is on the last week of his radiation treatment at Stuttgart Klinikum. He decided to go there after having appointment to Prof. Dr. Münter. He has got the moderate-hypofractionation radiation treatment (using VMAT / IGRT): 25 sessions to prostate bed and whole pelvic lymph node, plus the SIB(boost) to prostate bed and one PSMA-positive lymph node on right external iliac. He also has been on Orgovyx, which will be 6-12 months long. So far, his side effect is only fatigue, which he combats it with healthy diets and exercise. But along the way, he's diagnosed with diverticulitis. We have good experience with the entire team there. They are very caring and have taken good care of my husband.

@jeffmarc The cancer center my husband goes to also offer Ethos, but he is not a candidate for it because his radiation area is vast anatomical region (prostate bed & pelvic lymph nodes plus the SIB). The Ethos machine is made by Varian. From what I was told by another PC patient in Germany, it is similar to MR Linac systems (such as Elekta Unity or ViewRay MRIdian) in term of both system being advanced radiotherapy technologies, which is designed for Online Adaptive Radiotherapy (ART). It does take longer time to complete each session, comparing to VMAT technique.
https://westernradiationoncology.com/treatment-technology/adaptive-radiation-therapy/

@prettypass2000
It really does sound like they have better equipment over there than they do in many hospitals here.

Good to hear you have a lot of options

@jeffmarc I have learned all of these options when we went to appointments with three radiation oncologists. Out of my curiosity, I asked them what machines do they use, and they told us about those. I came home to do more research on each machine.

My husband said they use Elekta machine for VMAT/IGRT radiation treatments he received.

@heavyphil I had the same machine, it uses hundreds of "beamlets" as it rotates around you to minimize radiation outside the prostate field. As far as choice of machines, my rad oncologist says patient setup and positioning is the most important factor in getting a good result.

@bob1955 Totally! And they emphasized that the results (SE’s) were directly proportional to bladder and bowel prep.
You really are an active part of this process - thanks for your post!
Phil

Thanks everyone for the helpful inputs.
I am now more prepared to go into the discussion with my treatment team.

As always, stay strong and be positive!

Dinu