Para-aortic vs. dogleg RT?

[QuantumSheep]

Hi everyone --

I know from communications with Dr. Einhorn that his facility uses just the para-aortic area radiation field (as do most hospitals in Canada and Europe) while most American treatment centers still opt for the para-aortic + pelvis "dogleg" field.

It's been baffling to hear from many doctors, including Dr. Bosl from Sloan Kettering (one of TCRC's experts), something along the lines of "well, the studies show that irradiating just the para-aortic field could be every bit as effective as the entire dogleg area. But we do the dogleg anyway."

I just wanted to know, for those of you (or your loved ones) who have been through radiation therapy, which method was administered and any words of wisdom your doctors may have imparted to you. Is para-aortic only truly just as (or very nearly as) effective? Are there known percentages of the risk of recurrence in the pelvic area that would be missed by para-aortic only? To what effect does irradiating the pelvis increase the chances of infertility?

Thanks!

[dadmo]

The only thing I can add here is a general comment about Sloan, and it is my impression only. They are very aggressive in the way they treat cancer and if they don't have irrefutable proof that a new treatment will be as curative as what they use as a current standard they will not change their treatment protocol. It must also be remembered that they are one of the leading testicular cancer research facilities, so it’s not as if they are waiting for someone else to get in the lab. Motzer, Bosl and Sheinfeld do an amazing amount of world-class investigation and still they are very conservative when it comes to changes. This is not in anyway a criticism of them, they are world class when it comes to the treatment of tc it is just my observation.

As a disclaimer my son was treated by Motzer and Sheinfeld and I am ecstatic with the results, Jason is coming up on the 2 year anniversary of his RPLND and because of the work done by that team he should have many cancer free years ahead of him.

[Karen]

My husband had para-aortic (15 days for a total of 25Gy), as per the guidance of his radiation oncologist here in NJ. We went to Sloan for a confirmation of the diagnosis and treatment options and I asked Sheinfeld if he though the PA was OK or is he needed the dog-leg. His response was it didn't differ significantly. Ray was fine with the PA since there would be less lower GI disturbance and less of a field being zapped, especially since this was precautionary RT. What I thought was interesting, and didn't find out until after the fact (my husband's not a big talker!) was that rather than a front to back and back to front zap, he also had left to right and right to left. I figure whatever way they can target the nodes best with minimal hits on the rest of his organs may be an advantage. We're done with the baby making so infertility wasn't a concern.

[wjhall]

I am going through RT now. Para Aortic only. I questioned my doctor about the procedure since all I had read implied that the dog leg was standard protocol. He showed me some literature whch showed negligable differences in the results from cases studied.

He said "There practice stopped doing the dog leg portion well over a year ago" Currently 5 patients are being treated for testicular cancer including me at this facility. Richmond Radiation Oncology - Dr. David Randolph. Richmond, VA.

Jay

[QuantumSheep]

Thanks for the replies. I had my "mapping" today at St. Vincent's in New York and they are pushing for the dogleg because of my additional risk factors (i.e. large-ish tumor and the presence of vascular invasion). I played devil's advocate for a while but in the end deferred to their expertise because after all, nipping this in the bud now (or at least attempting to) is certainly preferrable than risking recurrence and chemo later on.

"Less yappin', more zappin'." -- Homer Simpson

[Sans rt1]

I had the para-aortic. It was explained to me as giving equivalent results (i.e. percentage of reoccurence) to the dogleg with less side-effects. After my treatment, when I was getting ready for my first follow-up, I became concerned about the recommended follow-up for this treatment. This was because the pelvic lymph nodes had not been zapped. In my research I found that there is a decent percentage of the few reoccurences in the pelvic lymph nodes. So, I was happy to hear that the latest follow-up protocol includes periodic (i.e. yearly) pelvic CT scans in addition to chest xrays and bloodwork.

If I remember, your phasing and tumor size was almost the same as mine, so you are probably justified in going for the RT, and the para-aortic pattern is the accepted treatment. Just be sure to research and make sure your follow-up plan includes periodic pelvic CT scans.

[QuantumSheep]

It's strange to me that everyone here had para-aortic only but both my 1st and 2nd opinion doctors (at St. Vincent's and Sloan Kettering) still do the para-aortic plus pelvic dogleg. Sigh. Just that much more short-term loveliness for me to deal with!