What about Vmat?

[Concern972]

How does it compare to other radiation? Priority is for reducing bladder and bowel side effects.

[Tall_Allen]

I was treated on a VMAT linac. It just means that the X-rays are sprayed out of the nozzle in an arc. The beams are shaped by a multi-leaf collimator. It is very fast and very conformal. Compared to other linacs like CyberKnife, and Tomotherapy, it gives similar dosimetry:

redjournal.org/article/S036...

My RO used both CyberKnife (robotic) and RapidArc (VMAT). He preferred the homogeneity he got with RapidArc, but the differences are minor. VMAT still requires fiducials. He can do it without fiducials, but the toxicity may be higher.

Unfortunately, there doesn't seem to be a Viewray linac in Dallas:

viewray.com/find-mridian-mr...

[Concern972 in reply to Tall_Allen]

Dr Lubbe does not use fiducial markers in his prostate cancer treatment. They take a 360 degree cone beam CT scan immediately prior to every radiation treatment and then align the platform precisely to the image contained in the treatment planning (again in 3D). From start to finish, a VMAT session lasts about 3-5 minutes and that includes the alignment process which is the majority of the time. Dr Lubbe is NOT a fan of ADT.

[Tall_Allen in reply to Concern972]

Yeah. Cone Beam CT alone is not as accurate as fiducials. I had both with my vmat. If he has high risk Pc, the data show a clear benefit to adt. He should find a more competent doctor.

[Tall_Allen in reply to Tall_Allen]

Here is the evidence that with high-dose imrt for high risk patients, adding 28 months of ADT improved outcomes markedly:

thelancet.com/journals/lano...

This trial showed that 18 months of adjuvant ADT is enough:

europeanurology.com/article...

[fluffyfur]

Hubs had VMAT at MD Anderson. Salvage radiation though. So far no side effects other than fatigue.

[doc1947g]

I am in the Ufavorable Intermediate Risk with a G(4+3=7) Grade 3.

I had 6 cores out of 12 positive on the right side at 85% G4, then on a special pre-RT Scan they found multiple tumors on both sides. 73 y.o. with Lymphoma LNH and many acute chronic diseases.

I have been on Lupron Depot 22.5mg/12weeks X2 from May 2020 to Nov 2020 and on

No fiducials VMAT-RT 3Gy X 20Fx in June 2020 and my

PSA = 0.01µg/L and my

Testosterone = 0.3nmol/L or 0.086526µg/L or 86.526ng/L or 8.6526 ng/dL