Order of brachyboost

[EvFC]

Does anyone know if there is any difference in outcomes if you do the LDR brachytherapy before EBRT or vise versa? Initially we were told it would be EBRT first. Now it looks like the RO is scheduling the brachytherapy first. She is inserting the SpacerOAR and marker for the EBRT during the brachy surgery, so I am thinking maybe it’s to avoid the need for a second surgery? Haven’t had a chance to call the office yet to ask, but thought maybe someone here might know. Thanks!

[Jancapper]

Although I received HDBT + EBRT + ADT, I did receive the HDBT first after starting the ADT three months earlier. From what I have read, outside of receiving the ADT for a minimum of three months prior, the order makes no difference. The total dose delivered is the most important factor.

[EvFC in reply to Jancapper]

Thank you! He has started the ADT already.

[Tall_Allen]

Either way. Makes sense to install fiducials and spaceoar while in there. They have to wait until swelling subsides before planning for EBRT.

[EvFC in reply to Tall_Allen]

Thank you! I think they said the CT/MRI for planning would be 7-10 days after brachy and then the EBRT about 4 weeks after that.

[timotur]

I had HDR-BT with SpaceOar first, then 25 sessions of IMRT.

[EvFC in reply to timotur]

Thank you!

[TylexGP]

I did HDR Brachytherapy first with fiducial markers placement followed by EBRT.

[Mike58]

Iv'e been on 4 months ADT (Eligard) which so far I have managed very well. I've just returned from a wonderful 9-week overseas holiday without any setbacks. In a week I'll be getting the Markers and Gel inserted. Then 2 weeks after that I start the 23 sessions of IMRT. 2 weeks after that finishes I get HDR Brachytherapy, then a further 12 months ADT, and hopefully it's done!!

So mine will be the opposite to yours but I'm guessing it doesn't matter in what order it is done.

What I did note in chatting with my RO is that not many people are candidates for BT but those who are don't get as strong a dose of IMRT or EBRT because the BT more than compensates. This is actually a good thing because not having such a strong dose of RT means less of a chance of any collateral damage to other areas.

From what I am led to believe, HDR-BT is better than LDR BT as far as potential long-term side effects go and IMRT is more accurate than EBRT. I stand to be corrected.

Have you spoken with your RO about this? All the best.

[EvFC in reply to Mike58]

That’s great you were able to get away for a bit before your treatment! All the best when you start it.

My husband’s RO said she is doing the brachy first so she only has to do one surgery and so she can insert the spacerOAR and markers when she does the brachy. I am going to have to check now whether it’s EBRT or IMRT that she is doing. I think I assumed EBRT, but now I am not sure. She recommended LDR over HDR in my husband’s case.

[Teacherdude72]

My G9, aggressive: Casodex for a month before Lupron then IMRT for 25 sessions no spaceor as locally spread, then 6 weeks later had two sessions of HDR brachytherapy. My RO kept me on Lupron for 24 months.

[EvFC in reply to Teacherdude72]

Thanks for the response. How did they know yours was locally spread?

[Teacherdude72 in reply to EvFC]

MRI

[Joeym1040]

Mine. Was 24 years ago. Much changed since then

[cancerfox]

LD Brachytherapy is the gift that keeps on giving, so I wonder if undergoing EBRT with the radioactive seeds in place will really be felt in terms of fatigue from the radiation. It probably doesn't make much difference I suppose. My treatment was in the opposite order, and I was surprised how hard the LD Brachy hit me. 🦊

[EvFC in reply to cancerfox]

Thanks for the feedback. He was able to talk to his RO and she is doing it in this order so she can insert the SpacerOAR at the same time as she does the brachy surgery. We’re both worried about the radiation side effects. Hopefully they won’t be too overwhelming. He’s already seeming more tired from the ADT.

[cancerfox in reply to EvFC]

Yes, ADT is bad enough and then the radiation treatments pile on and add to the lack of energy. It almost sounds like some sort of cost-saving strategy to do the brachy surgery first in this case to include the SpacerOAR, or maybe it is to minimize the radiation effects from the brachy, but hopefully the combined radiation effects of brachy and EBRT at the same time won't be too overwhelming, as you have said. Good luck on your husband's treatment, I hope it is a big success! 🦊