Lymph Node Fiducial placement ?

[reconjj]

Hello All , I have recently been dx Stage IV with 1 hot lymph Node ( 5x6 ) in the pelvic area . After 5 yrs my primary SBRT cyberknife failed . The plan is to get radiation SBRT in 3 sessions to the hot node and 25 sessions to the pelvic area . I received 1- 6 month jab at VA last week . My RO is a little concerned that the hot node might shrink . So she wants me to have fiducials placed around the node asap . Is this standard protocol for this procedure , VA uses the Tru Beam linac for the 25 sessions . Thanks , SemperFi , JJ

[GP24]

Exact radiation targeting will cause fewer side effects. I would get the fiducials.

[Tall_Allen]

Ah. makes sense.

[NotDFL]

Placing fiducials typically is a minor procedure. Why wouldn't you want the best targeting for the 'hot' node eradication?

[reconjj in reply to NotDFL]

I talked to VA today , as Im scheduled for Fiducial placement tomorrow at my ROs hospital . VA said they dont do the fidicials . Not necessary they said . So Im doing the fiducials tomorrow and get this show on the road .

[Scout4answers]

The beauty of this site is that I learn something new every day, what are fiducials and why are they used?

[reconjj in reply to Scout4answers]

Hello Scout , When I had my primary radiation for PCa , ( SBRT , Cyberknife ) the radiation oncologist inserts tiny gold fiducials the size of rice into your prostate around the tumor . They stay in for life , no harm . Then the RO (radiation oncologist ) makes a plan for the radiation machine SBRT, robot . This is all mapped out so the radiation arm targets the tumor . Same as my Lymph lode where we just found a lesion . I had this done today , no big deal . Now I will go back to my RO for planning , with their medical physists to plan the radiation beam to that exact lymph node and Zap . Hope this helps

[Scout4answers in reply to reconjj]

Thanks it does

I heard them referred to as gold markers

[treedown in reply to Scout4answers]

For reference I did not get these. I had a sticker on each side, with a x drawn with a sharpy, they used to line up with lasers. Than a low level CT scan prior to each treatment. I assume because I was getting whole pelvis and abdomen radiated and they were not trying for a specific target.

[NotDFL in reply to Scout4answers]

Your prostate (and its surroundings) move around during treatment and the fiducials move along with it. The SBRT technology keeps track of the fiducials and associated software will reposition the beam accordingly.

[GreenStreet]

I recently had fiducials to target CyberKnife therapy. Fiducial insertion procedure was not a problem for me but thankfully I was made to wait (I readily agreed) because the consultant who had signed off my procedure was delayed and two other consultants declined to take it on for which I was very grateful. When the sign off consultant arrived he told me he had several years of experience in such placement. Good luck I think it must make sense

[reconjj in reply to GreenStreet]

Hello Green Street , I had the 1 fiducial implanted friday , no anisthesia a bit painful from that numbing shot , but not bad . Im waiting for a date to start 3 sessions of SBRT then 25 sessions of imrt . Thanks JJ

[GreenStreet]

Hi reconjj. Good to hear. I am sure the fiducials help the targeting so I hope your SBRT goes well. I finished my 5 sessions of CyberKnife about a week ago. So far so good from a side effects perspective but I didn’t half lay still during the treatment because my suspicious node was only 2ml away from something that I did not want too much radiation too Lol. Good luck and all the best with your treatment