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Thread: VIEW RAY MRI guided adiation vs traditional radiation

  1. #1
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    VIEW RAY MRI guided adiation vs traditional radiation

    I have a node that has appeared in my surgical site, it is cancer and the course of action suggested is radiation. I was presented with the option of the traditional 5 week radiation OR a newer regimen that is only 5 days/MRI guided. The hospital i go to is one of the hospitals that helped develop the View Ray.
    Obviously the advantage of it is that it takes alot less time...5 days vs 5 weeks. And I've also read it can be twice as effective because it sees the tumor in real time and can readjust as you breath and move...more precise...less chance of zapping healthy tissue. The downside is that each session takes an hour and 15 min, in the MRI machine holding perfectly still. I am pretty anxious about this and hope i can tolerate it. My first session is July 22nd. I can't find any patient experience online....and was wondering if anyone here has heard of it. Dave? Brigitte? Thx
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    3/10/18 Followed up with endoscopic u/s and biopsy. No mets/contained
    3/20/18 Plan is 4 cycles of Gem/Abrax followed by distal pancreatomy.
    5/15/18 PANCREATITIS dx. CT scan showed tumor shrinkage .97cm
    7/05/18 FINAL gem/abrax treatment prior to surgery
    7/11/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure
    8/4/18 no mets, no lymph node involvement, clean borders NED
    9/26/18 CA19 33 NORMAL
    10/10/18 CA19 up to 53. Time to go back to treatment!
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    12/28/18 completed folirinox

  2. #2
    Super Moderator Top User ddessert's Avatar
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    That’s just one of the types of SBRT which uses high doses of radiation over fewer days. Some of the others use implanted gold beads, breathing monitors or other methods to track out the movement during the radiation exposure.

    I suspect you’re being offered this particular type because that is the machine they have. SBRT is a good alternative to IMRT (the 25-day course) as long as they don’t irradiate the small intestines but there are other less-claustrophobic ways of delivering it.

    If you mention your anxiety about being in an MRI machine that long, I’m certain they’ll first offer you some sedatives/anxiety meds to get you through. And if you insist further, they’ll probably offer the 25-day course instead. But if you keep pushing and they are not too self-promoting, they may tell you of other places nearby that offer an easier SBRT procedure.

    I’ve been in quite a few MRI machines over the last 6 years, for 45-90 minutes at a time. I’m the one that falls asleep and they have to wake me up to breathe more deeply. If you are “cooperative”, then the time needed goes down by 25%. But if you’re anxious, that’s not the place you want to be.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

  3. #3
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    I’ve been in quite a few MRI machines over the last 6 years, for 45-90 minutes at a time. I’m the one that falls asleep and they have to wake me up to breathe more deeply. If you are “cooperative”, then the time needed goes down by 25%. But if you’re anxious, that’s not the place you want to be.[/QUOTE]



    Thanks Dave. I handled the MRI well on Tues...they said it was going to be 20-25 min and we were done in 10....Hopefully like you said my sessions will be shorter. I think i can handle it...its not my favorite situation but neither is PC Have you heard that the 5 day SBRT is better than the 25 day? I read it is 2X more effective which is what swayed me. I do fear irradiating healthy tissue but they seem pretty confident in the accuracy of the targeted radiation.
    I especially worried b/c my 82 yr old dad who had his prostate radiated 10 yrs ago is now having ongoing clotting and UTI issues that they now say was caused by his radiation.
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    3/10/18 Followed up with endoscopic u/s and biopsy. No mets/contained
    3/20/18 Plan is 4 cycles of Gem/Abrax followed by distal pancreatomy.
    5/15/18 PANCREATITIS dx. CT scan showed tumor shrinkage .97cm
    7/05/18 FINAL gem/abrax treatment prior to surgery
    7/11/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure
    8/4/18 no mets, no lymph node involvement, clean borders NED
    9/26/18 CA19 33 NORMAL
    10/10/18 CA19 up to 53. Time to go back to treatment!
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    12/28/18 completed folirinox

  4. #4
    Super Moderator Top User ddessert's Avatar
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    That’s good that you were able to handle it well. I think they quote the maximum time so you’re never complaining about that. Mine have always been about 2/3 of the quoted time or less.

    I’m not sure about the difference in effectiveness, even though I was the patient advocate on the new guidelines, that was not discussed.

    We talked about how SBRT should be avoided on the small intestine (duodenum), but not comparing effectiveness.

    The other thing that was brought up (by me) was that radiation after the Whipple makes you more likely to need pancreatic enzymes (like Creon). This was from a study quoted by PanCan.org.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

  5. #5
    I'm still not entirely clear on the difference between SBRT and IMRT.
    February 2016- diagnosed with PC
    March 2016- inoperable due to arteries, also liver mets suspected
    March 2016-January 2017 -Gemzar/Abraxane
    February 2017 surgery-PC tumour and liver mets removed at same time
    July 2018 Back on Gemzar/Abraxane due to rising CA 19-9. Scans were clear.

  6. #6
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    Mar 2018
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    120

    here is a quick overviews on the VIew Ray 5 day

    Quote Originally Posted by jackieb501 View Post
    I'm still not entirely clear on the difference between SBRT and IMRT.
    I'm not sure of all the differences either but this video may help!


    www.viewray.com/mri-guided-roar/
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    3/10/18 Followed up with endoscopic u/s and biopsy. No mets/contained
    3/20/18 Plan is 4 cycles of Gem/Abrax followed by distal pancreatomy.
    5/15/18 PANCREATITIS dx. CT scan showed tumor shrinkage .97cm
    7/05/18 FINAL gem/abrax treatment prior to surgery
    7/11/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure
    8/4/18 no mets, no lymph node involvement, clean borders NED
    9/26/18 CA19 33 NORMAL
    10/10/18 CA19 up to 53. Time to go back to treatment!
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    12/28/18 completed folirinox

  7. #7
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    It this helps - 3 Drs i have asked about sbrt vs the longer course of treatment - all opted for sbrt. Best wishes!
    Mar. '18 - Diagnosed Stage IV with liver mets CA-19 124,000
    Apr. '18 - Started chemo - Gem, Abrx, Cis
    July and Sept '18 - Ct scan - all tumors shrinking
    Oct. '18 - CA-19 - 1,495
    Oct. '18 - Started Gem, Abrx 1/2 dose

  8. #8
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    Quote Originally Posted by jamiepat View Post
    It this helps - 3 Drs i have asked about sbrt vs the longer course of treatment - all opted for sbrt. Best wishes!
    thx Jamie,
    I know will have to take omiprazole (pepcid) for 90 days post treatment to protect my stomach lining. That makes me a lil nervous.
    I also cannot expect results immediatlly after treatment ends...they will appear 2 months after...so the same if i had the longer term treatment.
    I think they advantages are
    a) obviously you only go for treatment 5X verses 25.
    b) the treatment is more precise and less likely to hurt healthy tissue. side effects are all similar.

    I just wish i had somewhere to see some feed back on patient experiences.

    Thanks Dave for your info! You sure know alot!!
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    3/10/18 Followed up with endoscopic u/s and biopsy. No mets/contained
    3/20/18 Plan is 4 cycles of Gem/Abrax followed by distal pancreatomy.
    5/15/18 PANCREATITIS dx. CT scan showed tumor shrinkage .97cm
    7/05/18 FINAL gem/abrax treatment prior to surgery
    7/11/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure
    8/4/18 no mets, no lymph node involvement, clean borders NED
    9/26/18 CA19 33 NORMAL
    10/10/18 CA19 up to 53. Time to go back to treatment!
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    12/28/18 completed folirinox

  9. #9
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    Join Date
    Jun 2019
    Posts
    8
    Quote Originally Posted by susanmac View Post
    thx Jamie,
    I know will have to take omiprazole (pepcid) for 90 days post treatment to protect my stomach lining. That makes me a lil nervous.
    Those two are different drugs. Omeprazole (generic name) is a PPI (proton pump inhibitor). It slows down the production of acid. Less acid in your stomach means your stomach lining can recover from whatever has damaged it. Prilosec and Nexium are also PPIs but under a brand name.

    Pepcid (famotidine) is a histamine-2 blocker. It works a little differently, but the effect is the same. It reduces the acid in your stomach a little.

    I'm going on 20+ years of stomach issues (GERD, gastritis, hiatal hernias, ulcers) and have taken just about everything there is, including Dexilant (prescription strength PPI).

    What works for me may not work as well for someone else. But the point is there are a lot of different drugs out there that will help reduce the acid in your stomach and therefore help your stomach lining repair itself from damage. And taking these meds long term usually isn't an issue. But talk to your dr about it.

    And if your doctors don't tell you, I would look up what NSAIDs (nonsteroidal anti-inflammatory: aspirin, ibuprofen, naproxen) do to your stomach lining. They all damage the lining to some degree. Normally, most people can tolerate it, and their stomach can repair the lining adequately between doses. But if you have excess acid or other issues going on, then NSAIDs might be bad for your stomach.

    Best of luck to you with radiation treatments. Hope they go well!
    Apr. '19 - Diagnosed Stage IV with liver mets CA 19-9 500,000
    May. '19 - Started chemo - FOLFIRINOX
    Jul. '19 - continuing chemo, CA 19-9 100,000
    Houston,TX

  10. #10
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    ....im kinda hoping i dont have those issues...my plate is kind of full..but if i do...i will take your advice thank you!
    +++++++++++++++++++++++++++++
    53 yrs old
    3/8/18 went to ER w/what i thought to be gall bladder issues...CT and MRI found 1.5 cm spot on body/neck of pancreas
    3/10/18 Followed up with endoscopic u/s and biopsy. No mets/contained
    3/20/18 Plan is 4 cycles of Gem/Abrax followed by distal pancreatomy.
    5/15/18 PANCREATITIS dx. CT scan showed tumor shrinkage .97cm
    7/05/18 FINAL gem/abrax treatment prior to surgery
    7/11/18 Pre surgery CT scan shows slight tumor growth (1.2cm) could be necrosis.
    8/3/18 distal pancreatomy/splenectomy-open procedure
    8/4/18 no mets, no lymph node involvement, clean borders NED
    9/26/18 CA19 33 NORMAL
    10/10/18 CA19 up to 53. Time to go back to treatment!
    10/10/18 Starting 3 mos Folfirinox adjuvant therapy.
    12/28/18 completed folirinox

 

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