Calvarium bone mets

[MeliaQuinn]

Wondering if calvarium/skull/head mets are better treated with proton/pencil beam radiation or Cyberknife? I am confused. My husband's radiation oncologist says that he cannot radiate although the mets have not infilitrated into the brain. Wondering if we need to seek advice beyond what our city has to offer. He has been knocked off the Vision Trial for the second time. Frustrating! Really don't understand what is going on with this trial? They give him a slot, and then turn around and pull it before any blood work, scans, etc. are even performed. Thanks for any information that you all may have!

[Tall_Allen]

Did he ever have Xofigo? That might be better than Lu-177-PSMA-617 anyway. Why did they knock him off? Lack of PSMA avidity?

CyberKnife was originally developed for brain tumors. Proton is also used for brain tumors. So, I would think that either could work - why does the RO say not? Is it near the brain stem?

[MeliaQuinn in reply to Tall_Allen]

Apparently they are not near the brain stem as far as I know, but there are many within the calvarium. I don’t think this radiologist has the right tools for conducting proton or Cyberknife. He has also recommended Xofigo because of Mets everywhere. My husband has not done the Xofigo yet because it would exclude him from the Vision Trial. He has not had the PSMA scan yet either. The trial told him he had a slot and then two nights ago the doctor called and said they filled it with someone else. She said the decision came down from above and that she had no say in the matter. She said something about there being other patients that had more recent scans, etc. available then he had even though she should have had his very recent MRI of his skull showing all the mets. At this point his oncologist wants to start him on enzalutamide and see how that works-he is amenable to the Radium-223 also. I think my husband’s hemoglobin and hematocrit is a little low so that may be why the onc wants to wait on the Radium-223? Thanks!