SBRT with CT planning vs MRI planning

[JWS13]

Just had zoom with Dr. Amar Kischan from UCLA regarding SBRT.

Was about to schedule and he threw in a "kicker".

He said the SBRT with CT instead of MRI (have defibrillator can't have MRI) increases the risk of serious adverse events (bowel (proctitis's), urinary and ED by 5% instead of 1% total with MRI .

Anyone had SBRT with CT or at UCLA 3 years or more ago , did you have any serious urinary , bowel or ED side effects. (That's when UCLA was ONLY using CT Planning) not MRI.

Does California Proton with Rossi use CT or MRI planning and are they equal or better to UCLA's SBRT program.

All replies appreciated. Thanks.

[Yearofthecow]

yes that would exclude the use of an MRI

Not really too much of a kicker I think though, because the use of SBRT with CT scanning is the traditional way of doing it.

What they will do is implant fiducials, gold markers in the prostate to act as trackers for the CT scanning as the SBRT radiation is applied to keep it in the area to be radiated, and minimize exposure to areas outside the prostate. It is still monitored during treatment, just using a CT scan

As for Proton therapy, you should make an appointment with Rossi and see what options they have for you. That is what I would do.

I believe like SBRT, they use either MRI of CT imaging for tracking.

Regardless what you decide, there will be viable options for you that will take care of the PCa

5% is still relatively low. The other advantage of SBRT, is 5 treatments, hypofractionated. Not sure how many treatment sessions required with proton therapy.

All the best

[Schwah]

I had SBRT to individual Mets twice with kishan. He’s an absolute superstar. I’d follow his best advise without looking back.

Schwah

[Tall_Allen]

You misunderstood. The risk of serious (Grade 3) side effects with sbrt is 0% acute urinary, 1.3% late term urinary, 0% acute rectal and 0 late-term rectal. The risk of annoying (grade 2) side effects is 26% acute urinary, 12% late-term urinary, 8% acute rectal, and 0% late-term rectal (see table 2):

redjournal.org/action/showP...

Kishan finds he can reduce those by 5% (which is minimal) by MRI targeting.

Proton reported side effects are about the same as IMRT.

prostatecancer.news/2016/08...

There was a presentation at the ASTRO meeting last week that showed urinary and rectal side effects of protons were slightly worse but the difference was not statistically significant.