Is There “SBRT” for Lymph Nodes

[6357axbz]

My RO says while my bone mets can be zapped in a few days my para-aortic lymph nodes will take about 28 days of radiation (has to do with proximity to the bowels). I recall that SBRT could have brought my 30 days of IMRT radiation treatments to my prostate down to 5 or so treatments. Is there an equivalent radiation that can reduce those 28 days for lymph nodes? Thanks

[Tall_Allen]

If they were zapping just one or two nodes they could give an SBRT boost to them, but they have to treat the whole chain of paraaortic nodes, and they are in a sensitive place, so they have to keep the doses small.

[6357axbz in reply to Tall_Allen]

Thanks TA. That helps. You’re probable the only one on this site who could have answered that.

[cesces in reply to 6357axbz]

"You’re probable the only one on this site who could have answered that."

Agreed

[Jawbreaker in reply to 6357axbz]

To Tall Allen , agreed

[6357axbz in reply to Tall_Allen]

How the heck are they able to target these lymph nodes? For my prostate they used 3 gold fiducials that were implanted.

[Tall_Allen in reply to 6357axbz]

They only target enlarged lymph nodes that they can see on a CT.

[6357axbz in reply to Tall_Allen]

I’ll have to ask my RO how he plans to target my para-aortic nodes that only show up on the UCLA GA68 PET-PSMA scan...

[Tall_Allen in reply to 6357axbz]

It was a PET/CT scan.

[6357axbz in reply to Tall_Allen]

Right. MDAs scans never showed these nodes. RO suspects they were too small to be picked up by their CT scans. Would they try to use the UCLA scan CD for targeting purposes or does the CT have to be concurrent with the radiation process?

[Tall_Allen in reply to 6357axbz]

They can use the CT you had for planning.

[6357axbz in reply to Tall_Allen]

TY

[tango65]

You could discuss the possibility of doing Lu 177 PSMA to treat those lymph nodes and possible other cancer metastases you could have.

I had Lu 177 PSMA treatment for para-aortic lymph node metastases in 2016 and it was very effective. I round was enough to control the metastases.

There are some clinical trials for Lu 177 PSMA, perhaps you could qualify:

clinicaltrials.gov/ct2/resu...

[6357axbz in reply to tango65]

When you say, “ I round was enough to control the metastases”

What do you mean “control the metastases”?

It doesn’t completely destroy it like radiation would?

[tango65 in reply to 6357axbz]

The lymph node metastases became PSMA negative after 1 treatment. Size of the nodes have remained stable and they have not enlarged in the last 4 years according to 3 Ga 68 PSMA PET/CT studies done after the treatment. The most recent study was done last January.

When I had the Ga 68 PSMA PET/CT in 2016, the nodes were PSMA positive and their size were less than 10 mm, except for one which was 11 mm.

I have continued in ADT after the Lu 177 PSMA treatment. ADT was started 2 months before the treatment.

GP24 had the same experience, with only one treatment his nodes became PSMA negative. You could consider to write him a private message.

[6357axbz in reply to tango65]

Thank-you Tango. That was very clear and concise summary! Not many can express themselves that well in writing.

Where did you get Lu177 treatments?

[tango65 in reply to 6357axbz]

I was treated at the Technical University of Munich (TUM). They use a different ligand than in Heidelberg . They use the lu 177 PSMA I&T which is a smaller molecule than the Lu 177 PSMA 617 used in many other places. This confers a theoretical advantage to the I&T ligand, but there are not data indicating it is better than the 617 ligand. Any place with experience in Lu 177 PSMA treatment in Europe or Australia could be a good place.

TUM is well equipped, they have done this treatment for years, they have published their experience, most people speaks English etc.. If you are interested, you could contact the office for foreign patients.

mri.tum.de/node/5909

Travel to the EU is restricted for people coming from the USA, but I believe it can be special arrangements for travelers going to the EU for medical treatment. The people at the TUM may know about these situations.

Best of luck on this journey!!

[GP24 in reply to tango65]

If you get into Germany, you have to be in quarantine for two weeks. As far as I understand, there were no controls yet if you do follow the instruction to do that.

Otherwise you can present a negative Covid-test certificate, done within 48 hours before your arrival, and you are free to go where you like. You can bring that with you or you can get that at a test center at Frankfurt airport, but that takes some time if you do not pay for express service. For the return flight, you can get the test at the hospital where you were treated already.

centogene.com/?id=2444

[6357axbz in reply to GP24]

Thanks for all the information guys. I have read a lot here about Lu177 and recall that it doesn’t work for everyone. I’d hate to invest the time and money and have it not work for me. It seems the radiation route is more of a sure thing.

[MateoBeach in reply to 6357axbz]

Yes I am glad you recognize that. Lu- PSMA treatments can be effective in controlling lymph node Mets for a time but in less than half of patients. Becoming PSMA negative does not mean no cancer remaining. The radiation is a much better choice to do first to try to clear them completely. And if that turns out to not be completely successful you still have the Lu-PSMA treatments in backup. That is my strategy for my own positive lymph nodes on Ga- PSMA scan

[Concernedwife24 in reply to MateoBeach]

My husband is also going to have radiation to those nodes seen on the psma pet scan. We are very nervous about side effects and possible complications.

[6357axbz in reply to Concernedwife24]

What SEs and complications have you heard about?

[Concernedwife24 in reply to 6357axbz]

We are worried about incontinence urine or stool he is perfect right now.

[6357axbz in reply to Concernedwife24]

I’m no expert here but those SEs seem to be more associated with radiation of the prostate. Where did you hear those are associated with para-aortic lymph nodes?

[Concernedwife24 in reply to Concernedwife24]

Correct. My husbands nodes are in the pelvic region and near rectum. Not sure about para aortic

[tango65 in reply to 6357axbz]

You should consider and discuss with your RO, the location of the nodes. If they are close to the main arteries and veins, I believe Lu 177 PSMA may be safer. Mine were close to the abdominal aorta and the inferior vena Cava and the RO decided radiation was very problematic.

A theoretical advantage of Lu 177 PSMA over direct radiations is that Lu 177 PSMA is a systemic therapy. Nobody knows if treats smaller mets that are not seen but it is a possibility.

[TeleGuy in reply to tango65]

I've been in and out of Germany for 177Lu-PSMA therapy during the pandemic with no problem. TUM provides a medical necessity letter that the German Border Patrol recognizes (see my prior replies on this topic for URLs). The airlines are checking this letter and Lufthansa has even sent it to the border patrol to verify before they let you on the plane. Quarantine is not necessary because you're basically going right into medical care.

Tango65 and GP24 I'm jealous of your immediate response to the treatment. I've done 5 cycles for LN mets. A couple of paraaortic nodes still have significant uptake on the 177Lu-PSMA SPECT/CT the day after treatment, however an FDG PET scan I had last week (4 weeks post treatment) shows much less activity than we saw three cycles ago. I see the doc next week and look forward to seeing what this suggests. We had been talking about some spot radiation to knock those nodes down further.

[tango65 in reply to TeleGuy]

Thanks for the information.

Best of luck!!

[GP24 in reply to TeleGuy]

tango65 and I were both hormone-sensitive while getting the Lu177 treatment. I think that makes the difference. Most treatments work better when applied early.

I had SBRT radiations to my lymph node mets before, but when I returned with many new mets I got rejected and got a Lu177 treatment instead. So radiating mets with SBRT works well but you have to expect new ones to show up again. Still I would prefer to destroy any visible met because SBRT has very low side effects and it takes just three sessions. It also makes you feel better having destroyed the mets.

[GP24]

tango65 mentioned that I got Lu177 treatment for my lymph node mets. I reported it in this thread:

healthunlocked.com/advanced...

Refering to your original question "Is There “SBRT” for Lymph Nodes"?

The answer is yes. See this trial by Dr. Palma:

bmccancer.biomedcentral.com...

I had lymph node mets radiated with SBRT twice. New ones appeared in about a year after the radiation.

However, this may also be the case with IMRT radiation to the pelvis. The template used for that will not cover all lymph nodes which may be affected and also, you can get distant lymph node mets.

After my second SBRT radiation they did not want to repeat it and I got the Lu177 treatment instead. After 1.5 years I am still observing now and will get another PSMA PET/CT when the PSA value has reached 2.0 ng/ml again.

[wilcoxsaw]

You might want to speak to a radiation oncologist that specializes in scanning beam proton technology, such as Dr Rossi at California protons or someone equivalent. Because of the physics of the proton and the preciseness of that technology it may be possible to reduce the number of treatment days versus the 28 that you mentioned.

I speak from experience, not journals. My nodes were treated using 15 fractions with no side effects or damage to adjacent structures. A radiation oncologist would best determine the number of fractions given your case specifics.

Hope this helps!

Scott

[6357axbz in reply to wilcoxsaw]

Thanks Scott

[David20451]

I had a seriously enlarged lymph node on the iliac chain irradiated twice, one year apart with 5 treatments of SBRT each time.

[Rocketman1960 in reply to David20451]

Only once for me but next pet scan it was not active anymore.

[Howard53545]

TA is right. They used a CT scan for planning then nuked my pelvic nodes.

[6357axbz in reply to Howard53545]

So it seems the GA68 PET-CT scan can be used to identify the location of the tumors in a node and a traditional CT scan has sufficient resolution to accurately target that node, once it is known that a tumor exists there.