IMRT versus Proton Radiation Therapy

Earlier this year I had surgery to partially remove Brain Tumor (Skull Base Tumor) it was not possible to remove more than 50% of the tumor without doing serious nerve damage.

I will be needing Fractionized Radiation Therapy (RT) in the near future.

The majority of Doctor's have recommended IMRT while only a few have recommended Proton Radiation Therapy (RT).

From everything I have read Proton RT seems to have some advantages over IMRT but there must be some reason the majority of these Doctors are recommending IMRT.

I would appreciate any inputs along with recommendations for the best Hospitals to have the Radiation Therapy.

Thank you - Gloria

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Hello I am Jeremy. I made my choose based on the location of the hospital after I asked the doctors at both IMRT and at the Proton which one would help me the best and they gave me very similar answers . I wanted to stay close to home to help my recovery.You
need to gather all the information and choose what is best for you.

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Hi Gloria,

I also did all this investigation proton vs. photon. Bottomline....proton shows great promise, however, they have no statistics yet to confirm that it can match photon. We had heard that something should be posted later this year. In my case, proton only improved by 1% damage to brain stem and optic nerve. Since the difference was not great, I made the decision to stay close to home and have fractionated IMRT. I am more than 50% done and have not had any side affects yet.

If you go forward with proton, be sure to find a center strong in treating the brain. I visited Loma Linda and MD Anderson. Even though Loma Linda is closer, I felt the RO at MD Anderson was much more experienced and gave a much better comparison between therapies.

Good luck. Let me know if you need more info.

Cathy

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Hi! It's so hard to decide what to do in a case like this where you have different options. I had a similar situation with the two meningiomas that I had. First of all, what kind of tumor do you have? Is it benign or malignant? Also, where is the residual tumor located, such that the surgeon did not want to remove it any further? I think these questions would affect what kind of radiation that you have. I think that you should go to a center that does both kinds of therapy, so that they can advise you of what would be best for your situation. They would not likely be biased towards one type of treatment, since they do both, and because of doing both, they can tell you honestly what they think would work better for you. I had gamma knife radiosurgery for one tumor (skull base), but IMRT fractionated radiation for the other (cavernous sinus, affecting optic nerve). Location does make a difference sometimes. I hear proton therapy causes less exposure of healthy tissue to radiation, but I think you need to see a facility that does both to really get a clear picture. Good luck!

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Hi Castra,

Thank you for your response and I wish you well with your Radiation Treatment.

I had a few questions if you are able:

1) You mentioned that in your case that ”proton only improved by 1% damage to brain stem and optic nerve” did you mean that it only improved your outcome by 1%?

2) Did you have a Petroclival Meningioma or another type of Skull Based Tumor?

3) Did did they tell you the chances are with the Radiation, will Kill or stop the tumor from regrowing?

4) Did the Doctors you talk recommend (IMRT or Proton)?

5) From what I have been able to read up on, Proton RT starts out with less Radiation entering the body, hits more of the tumor without damaging nearby “good” tissues and that the radiation stops at the tumor again not damaging nearby tissue.

6) What is confusing is that several Top Neurosurgeons are suggesting IMRT over Proton but the research and at least one top NeuroOncologist has recommended Proton over IMRT.

If we go forward with Proton over IMRT we will probably visit and decide between MD Anderson (Houston) and Mass. General Hospital (Boston) – does anyone have any experience with either of these Hospitals for Proton RT, if so it would be great to hear from you.

If anyone has any research material that would help in deciding between IMRT and Proton RT for Skull Base Tumors I would very much appreciate your assistance.

God Bless - Gloria

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Hi Gloria...

Here are my answers:

1) Correct, only improved the outcome of protecting certain structure by 1% switching to proton.

2) Yes, Petroclival Meningioma

3) Radiation should irradiate (kill) the tumor. There is a 50% chance it will shrink the tumor.

4) All NS recommended photon over proton. My understanding is that they feel it proton has not proven itself. Also, many of the centers are not experienced in treating these types of tumors. RO's were more open about it, however, I was told to make sure the center is very experienced if I opt to go this route.

5) Yes, you are correct, but after research, it sounded like it was hard to control exactly where the Bragg's peak takes effect.

6) Yep...I had the same situation. I also found many docs want to push their own hospital's capabilities. I was very, very impressed with Dr. Brown at MD Anderson. He is an experienced RO who also evaluated me for all forms of radiation. He runs their proton center for head issues. With his input, I was able to make my decision. Mass is also very, very good. You can look up on line Proton vs Photon and get lots of good info.

Let me know if you need more info. Have a great day!!

Cathy

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I had proton therapy at Mass General. Kevin Oh was my doctor and this was for a pons tumor which is inoperable. Proton is fine but get off the Decadron as soon as possible!

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Hi Gloria,
Castra helps lot with her information.
I have similar situation with you, after surgery 17months ago, now iam so confused which treatment for my remnant tumor. Sine our type of petroclival meningioma could not 100percent removed by surgery.
Let me inform your RO suggestion. It will help me lot.
What's the location of your remnant tumor now?
And do you know the size ? Regarding regrow, I think pressed 4u is right,my pathology shows grade 1Who, Castra I think also grade 1.
What about yours?
Keep us inform.

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