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Conventional IMRT as a primary treatment is a thing of the past (or should be)

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Posted 6/29/2016 6:38 PM (GMT 0)
This year, there have been several large randomized clinical trials proving that hypofractionated IMRT (done in 19-28 treatments) is not inferior in cancer control or toxicity to conventional IMRT (done in 40-44 treatments). The question is - will ROs give up the golden goose?

Hypofractionated radiation therapy for localized prostate cancer: an update

This is quite aside from proving the value of SBRT (4-5 treatments) in a randomized comparative trial.
Posted 6/29/2016 7:42 PM (GMT 0)
THANK YOU ! TA for this information ....gives me more to consider and to ask the RO about in Oct. ....the more I read , the more I`m worried about urinary blockage problems after the planned 45 radiation sessions with markers, IGRT... I`ve have had a WEAK stream ,for years, seems like a no brainer for prolonged cath. necessary during sessions or weeks after ? The shorter sessions or combined HDR is still worrisome ...enjoying a month into fatigue with the 6 mo. Lupron ....David
Posted 6/29/2016 7:42 PM (GMT 0)
I hope so, I'm afraid of surgery so I'm looking at radiation. I thought I had a good "local" place for SBRT using a new fancy Vero machine at Upstate in Syracuse, turns out they have the new 40 million dollar cancer center and aren't using the machine they don't know how and apparently have had problems. Plus they told a friend that SBRT is "experimental". They'd better change their prostate cancer brochure and website. They also have Jim Boeheim the SU basketball coach recommending the prostate cancer team..he had surgery with Catalona!! Essentially the same thing at Wilmot at the University of Rochester...so much for "local" SBRT.
Posted 6/29/2016 7:45 PM (GMT 0)
I guess I will "spend a day" at Roswell..they have affiliation with our local hospital Cayuga Medical Center..referred to a friend as "Cayuga Death Center"..LOL Not that that means diddly squat.
Posted 6/29/2016 7:49 PM (GMT 0)
David, If you have HDR you will have at most 25 IMRT sessions. No overnight catheter for HDR and no catheter for IMRT. I spoke with my rad onc about an overnight catheter and he has never done that. He has done more than 2,000 HDR procedures. If you can get HDR and SBRT that would be grand.

Sheepguy, also look at HDR if you can't find SBRT.
Posted 6/29/2016 7:57 PM (GMT 0)
JNF...thank you for following up on the cath subject....appreciate it. I`m going to call Fl. and see if I can speak to my rad doc. and see WHY he says I would need a cath for 3 days after the 2 HDR`s ....I will let you all know what he says for sure.....
Posted 6/29/2016 10:44 PM (GMT 0)
The last time I talked to my RO he said he was changing his protocol from 40 fraction down to 29.. So I guess he has been reading the studies. Too little to late for me though.

Carl
Posted 6/29/2016 11:00 PM (GMT 0)
The way I look at it is that there were always be improvements in medical technology, and that's really a wonderful thing. The improvements in cancer control and toxicity of radiation therapy have been impressive over the last dozen years. From an economic standpoint it can be hard. If an RO in community practice took out a loan for a couple of million dollars to pay for new equipment, physicist, and other staff, what is he to do when a quantum improvement comes along? This is going to mean that only large tertiary care facilities do the volume needed to payout the investment. On the other hand, we want a local supplier to do the work when it means getting treated every day for several weeks.
Posted 6/30/2016 1:49 AM (GMT 0)
The fewer times on that rotten hard radiation "couch" the better. I like the idea of SBRT. In fact, if it becomes "standard of care" some day, I bet the cost reduction will quickly make it mandatory. The developments/degradation of coverage in the insurance industry, and eventual major pushes for cost reduction, may even accelerate acceptance of cheaper options like SBRT ahead of proof of effectiveness/safety.

Not going to wade into this one, other than to say an effective & safe option that allows fewer treatment sessions would be a good thing. Iff (if and only if) it is as effective and safe as proven methods. Maybe enough studies are being done, have been done, to be as convincing as anything ever is in medicine.

It's tough too, when studies report 10 year survival statistics, because those take, well, 10 years! I'm hoping that if my sons ever have to face this beast that these treatments will be settled science by then.
Posted 6/30/2016 3:53 AM (GMT 0)
No RO in his right mind is going to change from 40 fractions to 25 fractions voluntarily..If insurance companies are willing to pay for a 40 fraction treatment procedure then that's what the patient is going to get..

Each of my 40 fractions was billed to Medicare at $3200.00 Times 40 equals $128,000
Posted 6/30/2016 3:57 PM (GMT 0)

Fairwind said...
No RO in his right mind is going to change from 40 fractions to 25 fractions voluntarily..If insurance companies are willing to pay for a 40 fraction treatment procedure then that's what the patient is going to get..

Each of my 40 fractions was billed to Medicare at $3200.00 Times 40 equals $128,000

Yeah, how about something like 5 fractions? My guess, if they can get away with it, is it will be proportional to the dose or some such. There will be a way that the total cost is $128,000 no matter how it's performed.

Or, as I was suggesting, if it's $3200/session, and you can do it in 5 sessions, then the insurance industry will coerce that into becoming the standard of care and become all that they'll pay.
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