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PACE-C Clinical Trial - Stereotactic Radiotherapy

User
Posted 28 Dec 2020 at 18:23

I have been offered the opportunity to participate in the PACE-C Clinical Trial looking at conventional Image Guided Radiotherapy vs Stereotactic Body Radiotherapy (SBRT).  I would welcome views and experiences from Forum members who have participated in the trial or know of it.


From my research online and on this Forum I gather it is also known as Cyberknife, a name referred to by the Trial Coordinator in our telephone conversation but not mentioned in the Information Sheet sent to me.


I understand SBRT has greater precision when targeting the cancer, less collateral damage and reduced risk of side effects, which sounds good.  The slight disadvantage is all the additional paperwork and surveys but as I am keeping a diary of my treatment it shouldn't be too onerous! 


I am considering whether to join the trial and, of course, whether I am selected for SBRT or conventional RT will be a matter for The Sorting Hat!

User
Posted 28 Dec 2020 at 20:25

Hi John,


Cyberknife is a brand name for SBRT.


One nice thing about being on a trial, whichever trial arm you end up on, is that you tend to be monitored more frequently and in more detail than normal. That can pick up issues that might otherwise have been missed. OTOH, that might mean attending more appointments, and having blood tests for the trial which need to be within a specific time window, and a week later, having the same test again for your consultant.


If you had conventional IMRT, do you know what would be treated? I was a high risk patient in a similar way to you (T3a rather than T3b). Although no spread to seminal vesicles or pelvic lymph nodes, they were also treated at half dose on the basis that they are where micro-mets are most likely to exist outside the prostate. (Chance of micro-mets increases with higher risk diagnosis.) I liked the idea of a softer focus dosing target of IMRT, with a chance of mopping up any other micro-mets nearby. Yes, this increased the chance of side effects, and I do have some occasional painless minor rectal bleeding (which has no impact on my quality of life).


I just don't know SBRT in the same detail, but I wonder if it would provide the same protection against micro-mets? Fine targeting is great for limiting side effects in a low risk contained cancer, but I can't help feeling it might increase the chance of micro-mets escaping treatment in a high risk cancer. I would want to ask about this, and ask exactly what they would be targeting if you had SBRT and how that would compare with targeting using IMRT.

Edited by member 28 Dec 2020 at 20:32  | Reason: Not specified

User
Posted 28 Dec 2020 at 21:02
Even at the tender age of 53 , I wasn’t offered IMRT nor SBRT. My psa was considered too high although I only had 3 sites of interest at the time. My psa went 1000 + so I only had palliative EBRT ( 3 doses ) , I’m allowed three more whenever. I think it has helped but left 3 square burns forever on my body. I didn’t get any feedback at all. I wanted to try Cyber or IMRT but my psa was considered. too advanced now. My side effects although minimal yet on-going have been a pain tbh , yet still preferable to complete castration at my age. I can have another 3 sessions as when.
Take care

If life gives you lemons , then make lemonade
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User
Posted 28 Dec 2020 at 20:25

Hi John,


Cyberknife is a brand name for SBRT.


One nice thing about being on a trial, whichever trial arm you end up on, is that you tend to be monitored more frequently and in more detail than normal. That can pick up issues that might otherwise have been missed. OTOH, that might mean attending more appointments, and having blood tests for the trial which need to be within a specific time window, and a week later, having the same test again for your consultant.


If you had conventional IMRT, do you know what would be treated? I was a high risk patient in a similar way to you (T3a rather than T3b). Although no spread to seminal vesicles or pelvic lymph nodes, they were also treated at half dose on the basis that they are where micro-mets are most likely to exist outside the prostate. (Chance of micro-mets increases with higher risk diagnosis.) I liked the idea of a softer focus dosing target of IMRT, with a chance of mopping up any other micro-mets nearby. Yes, this increased the chance of side effects, and I do have some occasional painless minor rectal bleeding (which has no impact on my quality of life).


I just don't know SBRT in the same detail, but I wonder if it would provide the same protection against micro-mets? Fine targeting is great for limiting side effects in a low risk contained cancer, but I can't help feeling it might increase the chance of micro-mets escaping treatment in a high risk cancer. I would want to ask about this, and ask exactly what they would be targeting if you had SBRT and how that would compare with targeting using IMRT.

Edited by member 28 Dec 2020 at 20:32  | Reason: Not specified

User
Posted 28 Dec 2020 at 21:02
Even at the tender age of 53 , I wasn’t offered IMRT nor SBRT. My psa was considered too high although I only had 3 sites of interest at the time. My psa went 1000 + so I only had palliative EBRT ( 3 doses ) , I’m allowed three more whenever. I think it has helped but left 3 square burns forever on my body. I didn’t get any feedback at all. I wanted to try Cyber or IMRT but my psa was considered. too advanced now. My side effects although minimal yet on-going have been a pain tbh , yet still preferable to complete castration at my age. I can have another 3 sessions as when.
Take care

If life gives you lemons , then make lemonade
 
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