What kind of radiation you had for salvage ?

Feeling lazy today so here's an AI answer to the follow up questions, but, I had IMRT. It went pretty much as described in this AI answer...One thing not mentioned here is the fact that the machine I was in (I guess not all IMRT delivery mechanisms are equal) actually takes an image before it delivers the radiation, this tells the techs whether or not you're prepared for the treatment (fullish bladder / empty bowels). The first 30 (ish) treatments were to prostate bed and area where the local lymph nodes were, that last bunch were just the prostate bed.

### What is Intensity-Modulated Radiation Therapy (IMRT)?

Intensity-Modulated Radiation Therapy (IMRT) is an advanced form of radiation therapy used to treat cancer and certain non-cancerous tumors. It employs computer-controlled linear accelerators to deliver precise radiation doses, such as X-rays or protons, directly to malignant tumors while minimizing exposure to surrounding healthy tissues. Unlike traditional radiation therapy, IMRT modulates the intensity of the beams across the treatment area, allowing for highly conformal dosing that matches the tumor's shape and size.

### How Does IMRT Work?

IMRT works by shaping radiation beams to conform to the tumor's contours and varying their intensity—stronger in high-risk tumor areas and weaker elsewhere. Beams are delivered from multiple angles using a machine that rotates around the patient, often in an arc. Advanced imaging (like CT or MRI scans) and computer planning software guide this process to optimize dose distribution. This precision helps protect organs at risk, such as the spinal cord, heart, or eyes, near the treatment site.

### Why Is IMRT Used?

IMRT is commonly used for cancers in complex areas, including the prostate, brain, head and neck, breast, lung, and gastrointestinal tract. It's ideal for tumors near critical structures and can treat both malignant and benign conditions. By enabling higher doses to the tumor with reduced spillover, IMRT improves tumor control rates, as shown in clinical trials for prostate cancer.

### Preparation and Procedure

Before treatment, patients undergo imaging scans (e.g., CT or MRI) to map the tumor and plan beam paths. Small markers may be placed on the skin for alignment. During sessions, the patient lies on a table while the machine delivers radiation—typically 5 days a week for several weeks, with each session lasting 15-30 minutes. No anesthesia is needed, and patients can usually resume normal activities immediately after.

### Benefits of IMRT

- **Precision**: Targets tumors more accurately than conventional methods, reducing damage to healthy tissue.
- **Higher Doses**: Allows escalation of radiation to the tumor for better outcomes.
- **Fewer Side Effects**: Lowers risks compared to older techniques, especially for sensitive sites like the pelvis or chest.
- **Versatility**: Applicable to various body sites and integrable with other therapies like chemotherapy.

### Risks and Side Effects

While generally safe, IMRT can cause side effects depending on the treatment area and dose. Common ones include:
- **General**: Fatigue, skin irritation, hair loss at the site. (had this but was on ADT as well, which was the culprit?)

- **Abdomen/Pelvis**: Nausea, diarrhea, urinary issues. (Didn't get any of this.)

Most side effects are temporary and manageable with supportive care. Rare long-term risks include secondary cancers years later. Always discuss with a healthcare provider for personalized risks.

As @web265 has commented, IMRT is really the main radiation used for salvage radiation. SBRT doesn’t work well, Proton radiation doesn’t even want to touch it.

The thing is they’re radiating a large area And they don’t need the concentrated beam that’s used for SBRT or proton radiation.

They have reduced the number of sessions in some cases, But they usually use 35 or more sessions.

Thanks Jeff and Web 🙂

RO that we talked to suggested IMRT if needed but I read couple of posts and papers with different things mentioned so I wondered if some other type of radiation also can be used. Some papers even mentioned proton for salvage of pelvic floor in combo with IMRT for nodes (Jacksonville , FL, UF Health Proton Therapy Institute).

RO also suggested gold beads as markers, I can find very little info about that : /. Usually, as you mentioned Jeff they use tattoo markers.

I have to do all of this research in very short period of time, so thank you both for helping 🙏 .

We had one person post on Mayo and mention they went to Dr. Carl Rossi And asked about having proton radiation for salvage radiation. He is the foremost expert on proton radiation and has been doing it for decades.

He specifically told the person that it was not used for salvage radiation.

I definitely would like to hear if you find out differently.

Thanks Jeff for additional info. This is article I read late last night about Proton for post RP salvage and adjuvant therapy :
https://pmc.ncbi.nlm.nih.gov/articles/PMC8019576/

Web - that is VERY helpful summery 😃👍 ! Thanks a bunch !!! < 3

They told me 38 sessions of EBRT. It's image guided. Machine is ethos hyper view.

Web265 said it all - everything in the prostate bed/pelvic area gets irradiated with higher doses going to the bed and the nodes.
My treatment at Sloan was called IGRT - Intensity Guided RT - which is a bit more descriptive in that a cone beam Xray is taken at the beginning of each session (as with Web265) and the beams are ‘guided’ around bladder, bowel and rectum.
But they are all photonic; I’ve had previous discussions on the forum about the efficacy about proton radiation for SRT and why you would even use it, but many hospital websites say that they CAN use proton for this.
I am sure the physics involved is way above my pay grade!
Best,
Phil

@johndavis60
Thanks John for the info : ))) !
Did they explain why they use EBRT and not IMRT for example ? Or it is just the same thing but "different packaging" ? My head will explode with amount of information I have to digest before the end of next week 😰

@heavyphil

Sooooo - it is more precise ( IGRT) ??? Please treat me as an idiot since regarding radiation machines and techniques I am !!!! 😋