ASTRO, ASCO, & AUA strongly endorse a... - Prostate Cancer N...

Prostate Cancer Network

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ASTRO, ASCO, & AUA strongly endorse a shortened course of IMRT for primary therapy

Tall_Allen
Tall_Allen

They strongly endorsed moderate hypofractionation (20 or 26 treatments) but only conditionally endorsed SBRT because they didn't consider any data after 3/31/2017. I think SBRT will receive a strong endorsement by this time next year.

There is no reason any patient should have to suffer through and pay the expense of 40-44 primary IMRT treatments anymore. If you have an RO telling you you need 40-44 treatments, show him the new guidelines.

pcnrv.blogspot.com/2018/10/...

15 Replies

I thought SBRT was well accepted and well established? What is the conditional endorsement about?

Gemlin_
Gemlin_ in reply to cesanon

Maybe because until the long time follow-up trials with thousands of patients have been done, the late toxicity and quality of life must be considered unknown by scientists?

Tall_Allen
Tall_Allen in reply to cesanon

There have been 8 randomized clinical trials for hypofractionation, but only one for SBRT and that has only been presented but hasn't yet been published in a peer-reviewed journal. Because of their March 2017 cutoff for considering published studies, the task force also could not include the Meier et al. multi-institutional trial, the consortium results (on over 1000 men) that will be presented next week at ASTRO, or Alan Katz's 10-year update. The task force is well aware of all that. By this time next year, I think it will get strong endorsement.

cesanon
cesanon in reply to Tall_Allen

In your personal opinion are there any situations in which you would prefer imrt over sbrt?

Tall_Allen
Tall_Allen in reply to cesanon

As primary treatment for low/intermediate risk PC - I can't think of any situation in which putting a patient through 40-44 treatments is preferable to 5.

For high risk patients, SBRT is in clinical trials - whether it is more effective than brachy boost therapy remains to be seen. At one year of f/u there have been very low side effects and no recurrences.

cesanon
cesanon in reply to Tall_Allen

That sounds like a no. That you can't.

SergFL
SergFL in reply to Tall_Allen

There is one and it is big one. It's called insurance.

Thank you for valuable information. Tall_Allen, I have not seen you post until this evening, but asked my RO doctor yesterday the same question. Why I receive 44 imrt treatments as primary treatment (low risk/ 1/12 of G6 (8%)) and he gave me print-out from NCCN Guidelines Version 4/2018 where it shows the regiment for Definitive Therapy at 75.6 Gy to 81.0 Gy at 1.8 Gy per fraction.

As I understand that there are several guide lines and RO doctor can choose what works best.

Tall_Allen
Tall_Allen in reply to SergFL

This is brand new. ASTRO pretty much dictates the standard of care with radiation. There is a difference between what a doctor can do (without being sued) and what he should do. ASTRO is strongly recommending that all patients SHOULD be offered moderately hypofractionated IMRT. They are not saying that that is what he MUST do.

The latest NCCN physician guideline (version 4.2018) actually states:

"Overall, the panel believes that hypofractionated IMRT techniques, which are more convenient for patients, can be considered as an alternative to conventionally fractionated regimens when clinically indicated. The panel lists fractionation schemes that have shown acceptable efficacy and toxicity on PROS-D page 2 of 3 in the algorithm above." (MS-18)

Your RO is deceiving you. The reason is simple: This change will cut his revenues in half. Consider a different RO if you can.

SergFL
SergFL in reply to Tall_Allen

I understand he makes more money with more treatments but only insurance can force change. I can not change RO as I am already doing treatment and there are very few options allowed by insurance. I wanted to do SBRT from doctor in Naples FL specializing in PC but this doctor is out of insurance service area and insurance offered alternative SBRT place in the area, but this SBRT RO doctor treats all form of cancer and in business since 2012. The IMRT place I am going now is in business since 2006 and treated over 1000 patients. Yes, they use older equipment variant 2100EX, but have very experience support team. They specializing in PC only.

Tall_Allen
Tall_Allen in reply to SergFL

Yes - if you are mid-treatment, you are stuck with it. All you can do is slog through it. Be sure to exercise heavily. The best SBRT doctor in Florida is Debra Freeman in Tampa.

SergFL
SergFL in reply to Tall_Allen

I wanted to get treatment with Debra Freeman (her main office in Naples FL) but insurance said no. I will do heavy exercise.

SergFL
SergFL in reply to SergFL

I also have personal question. Any recommendation for treating burning feeling during urination as it slowly increases. I do not drink coffee or limit tea intake. Most of the time I only drink water.

Tall_Allen
Tall_Allen in reply to SergFL

Try Pyridium - it's available over the counter - very soothing. But be careful- it stains everything bright yellow - don't wear white briefs and be careful about splashing.

SergFL
SergFL in reply to Tall_Allen

Thank you. I will try it.

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