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SBRT for Oligometastatic Lymph Nodes

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Posted 12/16/2020 9:47 PM (GMT -5)
Hello all,
Haven't posted here in ages, but I wanted to provide an update and possibly gather a few thoughts.

I've been on continuous ADT for a couple of years and resistance was clearly setting in, with my PSA rising to 1.72 in September. My oncologist added bicalutamide 50mg and ordered scans. By December PSA had dropped to 1.43 but I understand the response to bicalutamide is usually short lived. Bone scan was clear and the CT showed the same enlarged lymph node (2.2 cm, lower left pelvis) that has grown or shrunk on scans over a number of years depending if ADT treatment was on or off. Another nearby node was 1 cm in diameter.

My oncologist suggested SBRT (5 fractions, but I forget the total dose) to one or both nodes. The target area is outside of the field of my salvage radiation 13 years ago and should be safe, but SRT left me with horrendous side effects and next to zero cancer control, so I am a little gun shy. Proximity of the large intestine is the main concern, but with a lower dose and tighter focus than SRT the risk should be minimal. I had a planning CT yesterday and expect to meet the rad onc shortly and proceed.

I'm under no illusion that this could be curative, no doubt I have countless micromets circulating around, but it should knock back the PSA somewhat and perhaps delay the need to move further down the list of dwindling treatment options.

I have read some of the older threads on this topic and if anyone has any experience or wisdom in this area I'd be happy to hear about it.
Posted 12/17/2020 7:31 AM (GMT -5)
Going in to the hospital today to get my butt cast + barium + I.V. dye resist for an MRI + CAT to more clearly locate my 3 'hot' pelvic lymph nodes (1.2, 1.3, 1.4 mm diameter) so they can get spot-cooked along with salvage radiation to nearby areas that were not treated with adjuvent radiation 8 years ago after surgery.

The recent update on the ORIOLE study showed a significant increase in immune system CD8+ 'killer T' cells in ORIOLE patients. The docs believe that this increase is due to the presence of dead cancer cell protein fragments circulating in the blood stream after treatment. The increased number of CD8+ T cells are believed to be killing off micromets elsewhere in the body after being 'alerted' to the presence of the cancer.

"...significant changes were observed in the T cells of patients on the SABR arm 90 days after treatment, but no change in the T cells of those in the observation arm. It is possible that the radiation dose may prime the immune system to tumor antigens and increase the anti-tumor CD8+ T cell response."

I also had really bad radiation treatment side effects. Some are still there 8 years later, but not near as bad as they were at my RT side effect nadir 3 & 1/2 years out from RT. My (new) radiation oncologist believes he can "cure" me of my cancer with this proposed RT schedule (25-28 treatments) and assures me that the side effects won't be as bad as they were the first round. He says he has at least 1 guy in this therapy at all times and has done quite a few of us. He is sure he won't hit any major structures as targeting and dosing has improved a lot in the last 10 years.

I am currently dealing with the side effects of leuprolide and enzalutamide chemo which ain't no walk in the park either. The chance of getting off those in a year and maybe having no further sign of PCa is worth the gamble, IMHO.

Of course, your mileage may vary.....
Posted 12/17/2020 8:12 AM (GMT -5)
Thanks for your comments trailguy. I had read a bit about abscopal effects of various treatments but your quote from the ORIOLE study is hopeful. Wishing you all the best with your treatment plan.
Posted 12/17/2020 8:53 AM (GMT -5)
Technology has improved a lot in 13 years. Getter done.
Posted 12/17/2020 4:58 PM (GMT -5)
I also had SBRT to lymph nodes as a part of the ORIOLE trial. Click on my story below.

...Jerry
Posted 12/17/2020 10:11 PM (GMT -5)
Great results Jerry!

Thanks
Posted 12/17/2020 10:53 PM (GMT -5)
Offense is better than defense. I also bet the radiation dosing/aiming technology is way better now than it was 13 years ago.
Posted 12/23/2020 1:24 AM (GMT -5)
Do the entire pelvic area
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