Radiation...whats the record?

[Ron53]

I was just wondering what the current record is for the number of rounds of radiation for fellows on this site. I need something to shoot for...In 2020 I had 33 to pelvis area, in 2022, 11 to a vertebra, and starting next week, 10 to a rib...for a total of 54...I'm sure that can be beat!

[Derf4223]

It's not the number of rounds that matters, its the cumulative dose-on-target-volume that matters.

[Tall_Allen]

For the pelvic lymph nodes, 25 treatments is standard; for bones, 1-5 is standard. I think your RO is making a lot of money off of your insurance.

[Still_in_shock in reply to Tall_Allen]

I remember 800/6600 Fossa/Nodes, over 33 days. I presume it was 4 days fossa, 29 days Nodes.

[ron_bucher in reply to Tall_Allen]

First time I've heard 25 being standard for pelvic lymph nodes. I've heard 35-37 many times. Has the standard changed? Is there a url we can reference? Is it possible his RO (and my RO) used more treatments with lower dose to minimize damage to healthy tissues?

[Tall_Allen in reply to ron_bucher]

It's usually 25 treatments x 1.8 Gy per treatment = 45 Gy, and it's been that way for decades.. I know Vedang Murthy stretched it to 50 Gy in 25 treatments in his POP-RT trial. Your RO may have changed it in order to bill Medicare more because he is reimbursed by the number of treatments.

[ron_bucher in reply to Tall_Allen]

If 45 Gy is spread over more treatments, will there be less risk to damaging healthy tissues?

[Tall_Allen in reply to ron_bucher]

It doesn't work like that. Fractionation affects the cell-kill rate.

[Kshiprakapoor]

Not sure but my father got 40 radiation at pelvis area (5-10 mins) per session. His psa never rose back again but his hemoglobin was reduced drastically and doctors said its due to such heavy treatment nothing serious but after covid recovery his hemoglobin was too low and constant fever was there and he was detected with blood cancer . Which I feel was radiation side effect+covid

[Leigh2350 in reply to Kshiprakapoor]

My sympathies to your father for having such a hard time. Is the blood cancer Myeloma ? This plus prostate cancer seems to run in my family.

[Kshiprakapoor in reply to Leigh2350]

not sure , but we lost him 2.5 yrs back. He fought for 1.5 yrs very bravely with it.

[Still_in_shock in reply to Kshiprakapoor]

Actually it was less than 90 seconds.

[Leaffan57]

36 to the prostate bed…5 to rib 3 , 5 to rib 4 and 5 to my hip after Mets appeared so 51 shots… you win. The last 15 knocked the shit out of me.

[wilcoxsaw]

80 to date, all proton, no issues resulting from treatment. Have a friend over 100, some proton most photon.

[Ron53 in reply to wilcoxsaw]

A record I hope not to break!

[ulfhbg]

Hi !

I’m not really sure what exactly your question is but i suppose you’re wondering about the amount of radiation you can have to a specific area, for example the prostate gland. So looking at my radiation treatments to the prostate and nearby lymph node:

HDR Brachy 2 x 14 GY to the prostate

3 x Lutetium cycles 7.4 GBq/cycle. High activity in prostate and 2 LNs. Just a very best guess we’re talking about 20 - 40 GY (and perhaps higher) in the tumor lessions

VMAT RapidArc 20 hypofractionated sessions, 2.8 GY / fraction in prostate, 3 GY / fraction in LNs with PC and 2.2 GY / fraction in other regional LNs in the pelvis.

So, probably 100 + GY in the prostate gland. But like i said, I’m not really sure what the question is and perhaps you can get better information from some of the experts in this excellent forum.

Best - wishes Ulf

[vintage42]

"...what the current record is for the number of rounds of radiation..."

I had 20 IMRT for prostate and 30 IMRT for pelvic nodes. No record there. Never knew the dose, which I guess is what matters.

[ulfhbg in reply to vintage42]

Hi

Yes, actually the dosage per fraction is more of gamechanger when killing of prostate cancer. So, more GY / fraction seems to be more effective

’Old’ conventional EBRT was like 70 + GY in total with doses of 2 GY/fraction. Now you do 60 GY / 20 fractions equals 3 GY/fraction. If you look at SBRT the total amount of GY is even more less but the GY / fraction is even higher

But if you only look at the total amount of fractions newer radiation treatments ’looses’ compared to older treatments but from my perspective I’m ok with that

Best wishes - Ulf

[BanjoPicker in reply to ulfhbg]

I was prescribed 77.3 Gy delivered in 43 sessions. This was 2 years ago. My RO felt that my urinary problems would flare up if his usual 20 sessions were instituted.

[AnOrangeADay in reply to BanjoPicker]

yes, i have heard of that. in fact, we chose sbrt, and because of urinary issues, we did it once per week for 5 weeks. never heard of that trick before. i guess it gives normal tissues more time to recover.

[ulfhbg in reply to BanjoPicker]

Hi !

He’s the expert and knows you so I expect him to give you the correct treatment

The only things that I’ve read upon is studies have shown that 60gy / 20 fractions (3gy / fraction) to 70 gy / 35 fractions (2gy / fraction) and then my best guess is that your 77,3 gy / 43 sessions ( 1,8 gy / fraction) is equally good. From what I’ve read the complications rates are almost similar.

So not saying what is the best radiation treatment, your RO is the expert and probably gave the perfect treatment modality for you

Best wishes - Ulf

[BanjoPicker in reply to ulfhbg]

During my last 3 treatments I was hoping that my diminishing urine stream would not turn into a dead stop. I had an exceptionally large medial lobe that interfered with flow. Prostate swelling was to be avoided and my RO felt bigger single doses would encourage swelling. Despite the lower single doses, at the end of the course, swelling was evident in my long stands at the urinal. Thirteen months after my last radiation hit, I endured a TURP. Now I pee like a teenager.

[ulfhbg in reply to BanjoPicker]

Hi !

Sounds like your M.O. knew what was best for you and it sounds like the outcome was ok so, really happy for you and you seem to be in a good place

best wishes - Ulf

[BanjoPicker in reply to ulfhbg]

I read your bio and am amazed at the complicated treatment path you are navigating. I truly wish you well in your journey. I live in California, but my heritage is Scandinavian (Danish). I found it interesting that you opted out of Swedish care and found better options in Finland.

[ulfhbg in reply to BanjoPicker]

Hi !

Yes it’s been a rollercoaster and not a straight way forward and time will tell (doing next 3-month PSA test in October and I’m really is stressed out).

Well, after failing the HDR Brachytherapy and re-diagnosed to T3BN1M0 there was not many options left in the Swedish care but systemic care (Sweden is primarily prostatectomy territory) so I took my chances in Finland instead. Well, we’ll see what the PSA test shows and take it from there.

So, some good scandinavian genes

Best wishes - Ulf

[Hawk56]

My radiation treatments:

March 2016 SRT 39 IMRT 70.3 Gya

July 2017 WPLN 25 IMRT 45 Gya

April 2023 SBRT 5x8 Gya

No side effects then or now.

Kevin

Clinical history

[Nfler in reply to Hawk56]

Total of 69 huh no pun intended, with no side effects that’s pretty good…😁

[Ron53 in reply to Nfler]

69...69...something about that number in the back of my mind...just can't remember...

[Nfler in reply to Ron53]

😂

[velobard]

I'm sure I don't have the record, but more than I would have preferred if not for the alternative. I had my primary round of radiation in 2010. I can't recall the exact number then, but roughly 3 dozen. Two years ago I had five more to zap a few hot lymph nodes, and in the coming weeks we're going to zap a few new, relatively faint ones (the one from two years ago are still dark), so I'm in the neighborhood of 45 once this next set is completed.

[EdBar]

45 IMRT sessions to my prostate and several nodes back in 2014, more recently 3 SBRT sessions to two different ribs over the last couple of years.

Ed

[icanwintwice]

64 here.....39 to my prostate, 25 to my metastasis in my lymph nodes....cancer free today!!! fighting to stay that way. keep the faith brother

[BigJ32]

25 to prostate and pubic bone.

[j-o-h-n]

Are you guys counting dental X-Rays?

Good Luck, Good Health and Good Humor.

j-o-h-n

[Ron53 in reply to j-o-h-n]

....sure, but only IAW insurance allowances of one set every two years...

[j-o-h-n in reply to Ron53]

Real or False teeth?

Good Luck, Good Health and Good Humor.

j-o-h-n

[ron_bucher]

I never paid attention to dosage because I trust my RO to create each plan to maximize effectiveness and minimize damage to healthy tissues.

So far my total trips to the microwave have been about 80-82. Salvage IMRT (37 as I recall), prophylactic radiation of lymph nodes above the local area (another 37 as I recall), and SBRT (5) targeted at a pelvic tumor that was just outside the original salvage area.

And of course for each round there was an initial trip to get scanned in the same room for the doc and physicist to set up the plans.

Just finished the 5 sessions of SBRT about three weeks ago, my PSA has already dropped more than 80%, and is headed toward undetectable. All of my onco docs are seeing great patient results by zapping tumors that light up on PSMA scan - and doing it WITHOUT ADT.

I'll be happy to visit the microwave again if/when any other criminals light up a PSMA scan.

[ulfhbg]

I can say without a doubt that I would have been extremely happy if the 2 HDR brachyfractions I had in 2022 had done it”s job and killed of the PC ’beast’.

Well, that didn’t happen and I’m clearly not holding any record of actual fractions either

Best wishes - Ulf

[Mascouche]

Should this be calculated in rounds or in Gys?

Got 38 rounds (or 87 Gy) to my prostate and lower abdomen/pelvic region

Got 3 rounds (or 27 Gy) to the metastasis in my right-shoulder blade

Total: 41 rounds (or 114 Gy)