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Question for SRT guys about doctor selection

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Posted 4/13/2011 4:16 PM (GMT 0)
We all know the many discussions about the number of surgeries required to achieve competence in open or robotic procedures. That complicates the search for a good surgeon, but it's well worth the effort to ask around.

How about radiation doctors who do SRT? Is there a rule of thumb for how much experience they should have, or are they all pretty much just following the same standard procedures? I realize some, like Purgatory, had pretty bad SEs but not sure if that was just one of those unfortunate things that happens with even the best doctors.

Also, is IMRT the standard for SRT?
Posted 4/13/2011 4:26 PM (GMT 0)
Interesting topic, although I think that it has been discussed here before. I personally think that experience counts in everything. However, when selecting RO I went with a institution/facility as opposed to the Doctor. My comfort came from the fact that the facility was a teaching hospital. Honestly, my biggest concern was the techs.
Posted 4/13/2011 6:28 PM (GMT 0)
For my SRT I saw one doc to discuss things beforehand, but he was part of a team that decided on how to plan my treatment (and the planning meeting included one of the physician assistants from the surgeon's department too.) I have since seen four different RT docs so far during my check-ups, and have had no problems with this aspect.
Alf
Posted 4/13/2011 6:56 PM (GMT 0)
Reach, I had IMRT which I think is pretty common, but it isn't the standard for SRT. The type of RT one gets and the machines used is a hot topic here. I am by no means the expert. Others will probably weigh in.
Posted 4/13/2011 7:10 PM (GMT 0)
BB_FAN brings up an excellent point.. It's the technicians that actually administer the treatment..Unless they have problems, the R-doc is not involved with that. Basically, he just writes a treatment plan, a computer program, which is loaded into the computer that controls the LINAC that is treating you...He shows up once a week to chat with you about any possible side-effects after his nurse has done the same thing...He decides on how many treatments, dose per treatment, total dose, and whether or not to include HT as part of the salvage operation..There are minor variations between patients but it's pretty much standard stuff. My R-doc prescribed 34 pelvic area treatments, 1.8Gy each. Then, at the end, the beam was narrowed and focused on the prostate bed for the last 6 treatments. This was called "Boost" and is a little unusual..It worried the techs and they called in the R-doc before starting two of those last 6 treatments..

I'm two months out and everything is back to "normal"...
Posted 4/13/2011 7:16 PM (GMT 0)
I saw an article from a radiation oncologist from UCLA a few months back. She said that the radiation team, radiologist and physicist, should have at least 250 procedures relating to prostate cancer.
Treating PC is tricky because of all the nearby organs and the irregular target. 250 is the experience level recommeded to get the optimum cancer control and limiting the side affects.
This was the only article I ever saw that delt with the experience necessary for prostate radiology. My oncologist told me that in his experience some radiologists consistantly get better results than others. This is akin to surgeons where experience and skill are formulas for successful outcomes.
JohnT
Posted 4/13/2011 8:06 PM (GMT 0)
The radiation practice I used has been radiating prostates for more than 20 years with three generations of rad-oncs. My own is the youngest in the group and he has directed more than 1,000 men through the HDR/IMRT process plus many hundred through post surgery SRT. He and the other two rad-oncs are onboarding 4-6 new PCa patients each week. Thus a lot of experience and throughput. PCa is over half of their practice. Next would be breast cancer and head and neck cancer.

Among the things that impressed me was that early in our relationship he introduced me to the two more senior rad-oncs for a general discussion and I experienced their collaberation of opinions regarding my situation. Though I was working directly with the one rad-onc, I was getting the benefit of the overall braintrust.

Several times during the two months of treatment the senior partner visited with me to see how I was progressing. This also gave me confidence that if for any reason my rad-onc couldn't procede, i would have a seamless transition to another within the practice whom I had met.

I concur that experience is very important with each specialist......the urologist, the rad-onc, and the med-onc. And it helps to have them communicate on your behalf.
Posted 4/13/2011 9:58 PM (GMT 0)
Good Question Reachout,

There are two factors involved. The planning by the Radiation Oncologist and the experience level of the technicians at the machine. If the technicians get behind and don't properly align your body against to the original mapping scan, then the radiation will hit the wrong places.

Even after overlaying the scans, they still have to adjust the table in millimeters to make sure the proper radation zones are targeted.

A hurried technician that isn't exact and careful can make the best radiation oncologist look bad. Likewise, a technician can't make up for a bad mapping done by the oncologist.

In the overall scheme, having lots of experience in both areas is important. Seeking the best oncologist usually will result in the best technicians. They seem to go hand in hand, but there are exceptions.
Posted 4/14/2011 12:19 PM (GMT 0)
Thanks for all of the replies. This board is, as usual, very helpful. So if I have to go this route, besides finding an experienced RO, I'll be extra nice to the techs.
Posted 4/14/2011 1:28 PM (GMT 0)
I current post regarding treatment in July got me a bit concerned. I had my SRT in August and September. Since I had traement at a teaching hospital, I think that I would have addressed the experience and superision of the techs had I know that this is the time period in which the are normally rotated in there assignments.
Posted 4/14/2011 5:08 PM (GMT 0)
The newest LINAC's, like the Varian RapidArc, have built in safeguards to make sure you are positioned correctly and your rectum and bladder are in their proper positions before the beam is energized..

The hospital where I was treated had 15 minutes of slack time built-in between patients to give the techs a buffer should there be a problem..Twice during my 40 treatments, the techs delayed the treatment for a few minutes until a doctor was in the control room because of positioning problems. Once, I had to get off the table and "clear my bowels" before treatment could proceed..
Posted 4/14/2011 5:42 PM (GMT 0)
Bottom line: It seems much harder to get a fix on the competence of an RO and staff. It really is.

I met with the RO twice and eventually I just went with my gut feeling and also tempered by the fact that my local facility is THE MAJOR facility in mid-Michigan and they do use the Varian Trilogy RapidArc. Still, who knows...

I was much more confident on the surgery side as I was getting done by, for sure, one of the top people in the country.

If SRT fails, I will most assuredly be seeking out a top medical oncologist specializing only in PC. As of now, my thinking is Dr. Hussein at Umich and probably also a consult with Dr. Scholz in LA

Mel

Posted 4/14/2011 6:45 PM (GMT 0)
I agree with Mel, I interviewed and heavily grilled 3 different radiation oncologists before my SRT, chose the one that appeared the most qualified and experienced, and it got me no where. She was the one responsible for destroying my bladder and bladder neck, put me into a year of extreme pain, and forced me to have a urostomy. And that's after I spent much time researching. Much easier to check out a surgeon in my opinion
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