Lymph Radiotherapy

[Apollo123]

My oncologist has refused to treat my chest lymph involvement picked up on the PET scan. Does anyone know of any radiologists who have carried out riskier lymph radiation around the chest. I have no bone mets but multiple chest and pelvic involvement. Only 1 showed up on MRI but the PET scan lit them up like a Christmas tree. My Zytiga is keeping my PSA 0.01 however I would like more aggressive treatment of the lymph. Any advice would be very welcome. 👍

[Grumpyswife]

My husband is in the same boat as you. He went for Axumin scan which showed lung lesions but were told not possible to do stereotactic due to location. The RO said possibly a low dose course of ~30 days when Xtandi fails. But I am hoping for chemo sooner.

[Dayatatime]

My situation was similar with nodes in pelvis and abdomen affected. I was originally told surgery was not an option so sought a radiologists opinion about going after nodes in abdomen. That ended up being a dead end because the doctor said the chance radiation could affect other organs was to great.

I searched for a doctor that was willing to operate and found one from a major treatment center. He was willing to debulk and do an extended lymphadenectomy. My pathology report showed that all nodes removed except one were scar tissue. I did early chemotherapy consisting of docetaxel while remaining on Lupron and had an excellent response to it. The doctor said there was also scarring in areas around prostate from chemo and HT.

My opinion, chemo sucks but it's tolerable and bottom line it's a cancer killer. It gets into lymphatic system and circulating tumor cells floating throughout bloodstream. Like most treatments there are windows and hitting it while it's weak will most likely yield best results. Also as you know it's not a one size fits all disease and response to treatments vary. It might be an option to look into if you haven't already done it.

Ron

[Apollo123 in reply to Dayatatime]

Thanks for the information. 👍

[Tall_Allen]

Don't do this! Even if you can find an unscrupulous RO willing to take your money. There are some places that just can't be radiated safely, especially near the heart and other vital organs. There is no evidence - NONE - that zapping mets will increase survival. This is a LOT of risk for very uncertain benefit.

[Apollo123 in reply to Tall_Allen]

Thanks for the advice. 👍

[VS9ALC]

Just echoing what others and TA said, I am in a similar boat, small Lymph met in middle of chest - RO said no way to radiate it safely. Also have a 2 inch Lymph now near colon and same RO said there's no level of radiation he could hit it with to do any good. However he said all is not lost, there are so many other treatments that can be done.

[Hidden]

clinicaltrials.gov/ct2/resu...

[dress2544]

Six months ago when my psa jumped to 7 from 0.2 (in three months) while on lupron I was advised to take a psma pet scan. It showed metastases in my para aortic lymph nodes which is located in abdomen level. My RO first refused to do radiation. He told me to control the rising psa by systemic treatment. My MO added Aberaterone in the treatment along with lupron. When the psa started dropping on Aberaterone, the RO agreed to do radiation on para aortic lymph nodes. I completed 28 fractions of IGRT. While on radiation I had vomiting and nausea continuously. But after completing the radiation there were no issues. Last week I had done orchiectomy to avoid frequent injections of lupron. So far I am doing well. But I don't know whether radiation is possible for lymph nodes in chest as I did for para aortic lymph nodes.

[GAdrummer]

All depends on where the node is. My husband's was tucked tightly between the aorta and spine just above the diaphragm. It has ruled him out of clinical trials because it could not be biopsied. No radiation or surgery possible. A year of doxetaxel has shrunk it enough to allow valve replacement procedure thru the femoral artery. PSA has stabilized around 15.

[Break60]

I suggest Dr Dattoli a RO in Sarasota who only treats PCa. He does free one hour phone consults and will tell you what he could do for you. He did my lymph nodes in 2015 with IMRT but at that time wasn’t doing SBRT but planned to add it. It may be more appropriate for you if you have few mets. And it’s much faster due to higher dosage. I had it to a single femur met in three sessions by Dr Pablo in Savannah. If IMRT is more appropriate no one is better than Dattoli. But you’ll need to take up temporary lodging in Sarasota which is a nice location.

Bob