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Number of radiotherapy sessions

User
Posted 08 Apr 2023 at 20:52

I am being treated for T3aN0M0, i.e. cancer outside the prostate capsule, no evidence of lymph node involvement or seminal vesicle involvement or any cancer elsewhere (metastases) . I live in France. I have been offered 8 weeks of image guided External Beam Radiation Therapy to the pelvic area (seminal vesicles and lymph glands)  as well as the prostate. I am already on hormone therapy. I have had a second opinion from a Sheffield based oncologist while I am visiting family. The Sheffield oncologist thought that what my French oncologist proposed was within the normal regimes. He did say that he would probably focus on the prostate and not treat the pelvic area and would probably do 4 weeks of radiotherapy.  But he said the evidence for one regime compared to the other probably was not sufficient to make a choice. He thought the French protocol was reasonable as there is variation even within the UK and thought the French protocol would be as likely to work as any found in the UK.

Any thoughts as to the benefits of 4 versus 8 weeks of therapy? Other than the convenience  (I am retired and live 20 minutes by car from the oncology department, so no big deal).

 

 

   

User
Posted 09 Apr 2023 at 01:03

In the UK, the standard RT treatment was 37 fractions each of 2 Gy, five times a week. However, following results of the CHHiP hypofractionated trial there has been an increasing change to 20 fractions of a slightly higher dose. However, the total number of Gys given is less with the hypofractionated version to achieve the same effect. Some men have been treated with super hypofractionation with even fewer fractions at yet higher dose and this may be the way forward but this has not yet been accepted as a standard like the 20 fraction one. Notwithstanding this, some Oncologists still prefer the 37 fraction version, particularly if they feel it is better suited to a specific patient. It would be interesting to establish whether this thinking is similar in France or if a more rigid approach is adopted. The basis for the change in the UK is here https://pubmed.ncbi.nlm.nih.gov/27339115/ 

Good that you have been offered Image Guided EBRT.

Edited by member 09 Apr 2023 at 01:22  | Reason: Link added

Barry
User
Posted 09 Apr 2023 at 02:07
I was told if the lymph nodes are included it's always 37.

Including lymph nodes would seem sensible for a t3a.

User
Posted 09 Apr 2023 at 08:50

No everyone(including me) is suitable for 37 sessions if they are treating more than just the prostate - I was told my plumbing was in the wrong place and there was too much risk of collateral damage

User
Posted 09 Apr 2023 at 17:23

Originally Posted by: Online Community Member
I was told if the lymph nodes are included it's always 37.

Nope - I had 32 sessions. Your oncologist will design the optimum treatment programme for you personally. 

Best wishes,

Chris

 

User
Posted 09 Apr 2023 at 22:28

Hypofractionation can be used with the prostate which tolerates the high doses well, but isn't so suitable for some other organs, and isn't usually used when doing all the pelvic lymph nodes. Hence the treatment regime with more sessions (fractions). Prophylactic treatment of lymph nodes is usually done at a lower dose anyway. Mine pelvic lymph nodes were done as 23 x 2Gy = 46Gy, but this was part of a different treatment regime which also included HDR Brachytherapy to the prostate.

 
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