Is IMRT used routinely in highly ranked cancer centres?

Hello Brooklyn - I would urge you to look into proton therapy, especially regarding the heart issue, if you can at all. There is a thread about protons a few below this one if you scroll down.

While I was not treated at a place like Mayo or MD Anderson, I have been getting treatment in a major North American (west coast) city that has state of the art cancer treatment and a proton center. I believe IMRT is done here also, but again, with the heart issue, my understanding is that protons are definitely the way to go. I think IMRT is the next best, so to speak, if you cannot manage to get proton therapy.

I can appreciate that you have constraints and might not be able to do some of these things - the system is so unfair! In that case, it is my understanding that things like the breath hold can help to a meaningful degree.

Whatever you eventually do, I wish you all the best and the most successful of treatments.

Hi Brooklyn, where in Canada are you? I had IMRT done at Princess Margaret, Toronto. They used IMRT on me because the location was close to the heart and I also did it in breath-hold position.

I didn't know that, but I know it's not standard. It's possible they offered me as it was right after an unexpected cardiac arrest and I have a device implanted not too far from the radiation site, so they didn't want to take the chance.

I did a real quick google search and it looks like a year ago they started to work on a proton center in Montreal. I also got some idea that there might be protons available up in BC. A place in Vancouver called "Triumfe". I might have all this wrong, but it might be worth checking more. My sense is that you are in eastern Canada. Is there any way you could get to the US? I think there are a number of centers in the US on the east coast and into the "east midwest" if you will. Would Canadian insurance cover a trip to the US if it was deemed medically necessary? Not looking for real answers for myself to these questions, but just posing some ideas that you might want to consider and that might help. Some of the US centers might offer IMRT, even if they don't do protons, but it sounds like the easiest thing for you to do would be to push for the IMRT at Princess Margaret. Can you get a second opinion from another Canadian doctor? If the other Canadian poster, ErenTo, was able to get the IMRT, it seems like you should be able to also - maybe just have to "yell and scream" a bit?

If you do wind up having to go the traditional route, Brooklyn123, I can tell you what my proton therapy oncologist told me when it looked like I might not be able to find a way to get the protons covered (I eventually did). What she said was that they are still researching protons and that it is not 100% proven that they are better than traditional radiation (photons/x-rays). She said they still do not have the long term data necessary to make that determination. The other thing she said that might be reassuring to you is that traditional radiation has improved greatly over the years and the gap between the benefit of proton over traditional radiation has closed considerably, and it is due to vast improvements in traditional radiation therapy. Apparently with traditional radiation they not only do the breath hold now to protect the heart, but they also just sort of "skim" for lack of a better word, the top of your chest area with radiation from different side angles, rather than just going front to back like so many of the diagrams online show. This apparently helps considerably in preventing heart and lung damage down the road. She also said that the possibility of heart and lung damage is in the low percentages to begin with and that while it may ultimately be lowest with protons, it really isn't all that high with any kind of radiation.

I hope that this is somewhat helpful/reassuring and that you are comfortable and successful in whatever treatment you finally obtain. Good luck!