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SBRT Late Stage Radiation Toxicity-Anyone Experienced These?

Posted by gsd @gsd, Mar 2 11:55am

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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heavyphil | @heavyphil | Mar 26 1:35pm
In reply to @gsd "First, thank you to @heavyphil, @jeffmarc, @vircet, and @bens1 for contributing information about the somewhat confusing..." + (show)
@gsd

First, thank you to @heavyphil, @jeffmarc, @vircet, and @bens1 for contributing information about the somewhat confusing availability (or lack thereof) of gated SBRT treatment centers. This is an example of the tangible benefits of this portal and the incredible knowledge of the men who participate in it. @bens1's comment about some treatment centers hiring former Viewray employees to maintain their existing systems and preserve their investment makes sense and would explain why some centers no longer use MRIdian, while others continue to do so.

Here is some additional information I found this morning:

"ViewRay Systems, Inc. (formerly known as ViewRay, Inc.) was a company that designed, manufactured, and marketed the MRIdian MRI-guided radiation therapy system. The company ceased operations and filed for Chapter 11 bankruptcy in October 2023, and its assets were acquired by Chindex Medical Limited (a subsidiary of Shanghai Fosun Pharmaceutical (Group) Co., Ltd.). " At least one site that had ceased MRIdian operation in 2023, the Siteman Cancer Institute at Washington University Medical Center in St. Louis, resumed delivering MRIdian treatment in February of this year.

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Ironically, I owned some shares of ViewRay in my stock portfolio; had tons of promise! Excellent clinical outcomes and widely hailed as a disruptor in the radiation field - their success with pancreatic tumors is unparalleled.
But something was up with Fosun out of Shanghai; they kept buying shares until they were a “beneficial owner” of the company and I got spooked.
Lost a few bucks but not my shirt so it was a learning experience. Don’t know if the PRC is using the system in their hospitals but tend to doubt it.

REPLY
heavyphil | @heavyphil | Mar 26 1:42pm
In reply to @gsd "@thmssllvn, thank you for your suggestion! You are right! Brachytherapy is an attractive alternative and was..." + (show)
@gsd

@thmssllvn, thank you for your suggestion! You are right! Brachytherapy is an attractive alternative and was my first considered alternative to gated SBRT because the seeds are placed in the prostate and travel with it as it moves. Exposure of OAR to radiation toxicity due to prostate movement isn't an issue. I discussed brachytherapy as an option with two radiation oncologists at Mayo Rochester and got mixed recommendations because of my history of moderate LUTS (lower urinary tract symptoms). One didn't think brachytherapy would be a problem with my level of LUTS (14-15 on AUA / IPSS Urinary Symptom Score). One expressed concern. A 2023 study (https://doi.org/10.3390/curroncol30060426) demonstrated an average increase in IPSS scores of 7-13 points for months 3-9 after brachytherapy, gradually reducing to +3-7 points above baseline at 18-24 months. During that period, a patient with pre-treatment moderate to high-moderate lower urinary tract symptoms (LUTS) would have an International Prostate Symptom Score (IPSS) score in the low to upper 20s (Severe) and be at moderate risk for prolonged catheterization. My understanding is that patients with pre-treatment severe LUTS (IPSS scores > 20) are not candidates for brachytherapy without first addressing LUTS. Additionally, my understanding is that the surgical address for LUTS (TURP, HOLEP, TULSA) often precludes brachytherapy in prostates less than 60-70 g because there is not enough remaining prostate tissue to place brachy seeds safely. I may revisit brachytherapy, pending my investigation into gated EBRT.

For others reading this, I am not a doctor. I am educating myself as a patient about treatment options so that I can make the best choice, given my diagnostic classification (Gleason 3/4, grade 2, with no apparent extracapsular involvement) and quality of life (QOL) considerations.

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Just out of curiosity, since your LUTS definitely predisposes you to bladder issues if you do any type of radiation, have you looked into focal therapies that use other means?
TulsaPro has emerged as an excellent alternative (see the various threads on this board) and even whole gland ablation can be done if necessary. Might be worth a look.
A friend of mine might be having MRI guided ultrasound (they’re all similar in that they destroy the cancer) at Sloan Kettering in NYC so that’s another avenue for you to explore. Best,
Phil

REPLY
mikewo | @mikewo | 2 days ago

I had the SRBT 5 proton sessions at Mayo Phoenix with a SpaceOar gel spacer. I am coming up on my 2 year anniversary of my last radiation treatment on April 26, 2025. So far, no problems either urinary or bowel and I drink 2 mugs of coffee every morning. I think I am actually peeing better now than before the radiation but would need to do a uroflow test to prove it.

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