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poll- trans rectal or trans perineial fiduciary marker placement for radiation treatment?

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Posted 10/8/2016 6:38 PM (GMT -5)
Paxton and I have had it done each way ....I was wondering what is done in the majority of cases...anyone weighing in on this would be interesting to me at least ......Thanks....David
Posted 10/8/2016 7:10 PM (GMT -5)
David,

If you want to take a poll on HW, you have to fill in the top part when you start a new thread.

I think you'll find that most guys will have had transrectal placement. Concerns about infection risk have led some to use transperineal placement instead, but it's a fairly recent development. It's also easier to place in certain areas, I'm told.
Posted 10/8/2016 8:21 PM (GMT -5)
It seems that with the more modern LINACS, fiduciary markers are no longer needed to insure correct beam alignment...I would at least ask how old the LINAC that will be used to administer your radiation is...The newer machines, less than 5 or 6 years old, do a much better job overall in administering the radiation dose...Big advancements have been made in the equipment used to administer radiation.. As always, JMHO, I'm not a doctor....
Posted 10/8/2016 8:23 PM (GMT -5)
OK TA...I was confused about the procedure...sorry, i guess I could have worded it differently to get some replies ..~D
Posted 10/8/2016 8:27 PM (GMT -5)
Fairwind, I am in the process of scheduling Cyberknife SBRT. In all of the CK literature, and all of the patients I have heard from or read about, every one has had fiducials for targeting. In the case of the CK (and other SBRT systems), they use the fiducials for near-real-time target location so that they can direct the radiation to the target areas, even if they move around.

If they did not use a dynamic targeting system, it would be like a moving patient under a high-powered radiation beam. . . and I wouldn't do it.
Posted 10/9/2016 2:08 AM (GMT -5)
Paxton -
You and Fairwind are talking about different treatments. He's talking about SRT; you're talking about primary RT. For primary SBRT, it is seldom done without fiducials. Cornell has a clinical trial of doing it with a rectal balloon. I have my doubts, but that's what clinical trials are for. I asked Dr Kang why she is testing it. She thought it would be an advantage for the patient - I told her that I, for one, would rather have a one-time placement of fiducials than a balloon up my butt for 5 treatments. We'll see if she meets her recruitment goal.
Posted 10/9/2016 11:04 AM (GMT -5)
I had a 40 fraction run of SRT and then, 5 years later, a 5 fraction treatment of SBRT to nail a met on my spine..Both were done without internal markers. The same LINAC was used to administer both treatments, a Varian RapidArc. It is equipped with a built-in CAT scanner that checks for correct target position just before the beam passes during every treatment...When used as a primary treatment, the procedure could indeed be different requiring the gold markers to aid in targeting..
Posted 10/9/2016 12:07 PM (GMT -5)
I had SBRT treatment at the Cleveland Clinic in April of 2016 and participated in a study to determine if ultrasound could be used to guide the radiation therapy. The project title is "Integrated 3D x-ray and ultrasound Guided Radiation Therapy of Soft Tissue Targets". Ph.D Ping Xia is the principal investigator. The technician said it may eliminate the need for fiducials if the testing is successful. ????
Posted 10/9/2016 12:08 PM (GMT -5)
As part of my primary treatment, 6 weeks of external radiation, no internal markers needed, just three tiny dots on the skin, one on each outer hip and one center pubic area. I also had a mold taken of my lower legs, with shoes on, that was used each session, kept me in place

The dots are still there, almost 4 years later.

If the technology is in place, why are internally placed markers still needed?
Posted 10/9/2016 1:05 PM (GMT -5)
Fauntleroy asked, "If the technology is in place, why are internally placed markers still needed?"

You actually had many markers in place from your previous brachytherapy.

But the reason they do it for external beam radiation is because it provides the most accurate beam placement possible. Higher accuracy=Lower toxicity. Toxicity has been considerably reduced since markers gained widespread acceptance. And it has allowed for escalated dosing. All of the soft tissue in the pelvic area is highly deformable, and organs are always in slightly different places. The prostate is particularly motile because of changes in the bowel and bladder.

For SBRT, where sub-millimeter accuracy is vitally important, they actually have to align fiducials throughout each treatment. For IMRT, that kind of accuracy is less important, but there are still large changes in position between treatments that must be accounted for. Tomotherapy uses continuous monitoring of the prostate throughout the treatment, but the resolution isn't sharp enough for SBRT. There have been trials of other technologies, like the one rlb779 described, to use something other than X-rays (e.g., ultrasound or MRI) to get accurate imaging.
Posted 10/9/2016 2:59 PM (GMT -5)
I am having IMRT for my primary treatment along with HT of course. I'm on #25 of 40 fractions. Having the fiducials placed was not a big deal for me . A lot less traumatic than the Bx. The machine I'm on is a True Beam., not sure how old it is .It takes a image to see if I'm full and to align with the markers. I asked the tech the other day if I moved slighted does the machine stop and he said yes. He stated "oh.. that is what was going on yesterday". I was having a very difficult time holding my bladder and was trembling which was causing the machine to stop and readjust (didn't make things better when it stopped !) I'm not very knowledgable about these thins
, but I would imagine that it's the fiducials that help it track movement and realignment. I"m beginning to realize that I am over filling my bladder as I drank less on friday and it was much better. ( Still had to rush to the bathroom after)
Posted 10/9/2016 6:43 PM (GMT -5)
"You actually had many markers in place from your previous brachytherapy."

Had the external beam prior to seeding. I was treated at Dattoli cancer center so maybe they have atypical machinery??

Anything to reduce the indignity of whole process
Posted 10/9/2016 8:12 PM (GMT -5)

Fauntleroy said...

Anything to reduce the indignity of whole process

I don't know about you, but for me, after 7 years with the military back in the 1970's, and too many other surgical and medical procedures for my young lifetime, indignity doesn't play into things very much.

If the army wanted us to have modesty or privacy, these things would have Federal Stock Numbers, and I can't find any for them. . .

As I told the nurse on Friday, as she prepped me for my procedure, "You've seen it all, and I've been seen by all, so do what you need to do and don't worry about how I will feel through it." I'm sure they've seen far worse than me.
Posted 10/9/2016 8:14 PM (GMT -5)
Hey Mark !...wow ....your really moving along !!....any negative side effects at this stage ?? keep up the fight Mark and please keep us posted on your journey through to the final sessions ....David
Posted 10/13/2016 7:59 PM (GMT -5)
David, There are some SE's that are coming along as I reach the end. Urgency is pretty hard. Fatigue gets to me later in the week,worse than early in the week. My brain surely doesn't work as well but that could be from the HT.

It's hard to believe I only have 10 fractions left. It's been a grind but also seems it's gone fast. I look forward to the end and starting the next phase in this journey. My Ro is giving me a numbing prescription. It's supposed to turn my urine bright orange and stains everything . Will look great with my black under ware. Perfect for halloween!.

Glad to see you and Paxton are moving forward. The waiting and decision making is tough.


The Artistic One- Mark
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