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Posted 12/18/2017 11:02 AM (GMT 0)
Interesting read on HDRBT

https://www.americanbrachytherapy.org/guidelines/Guidelines_High-Dose-Rate_Prostate.pdf

Denis
Posted 12/18/2017 2:21 PM (GMT 0)
Good Article....Not sure why some posters are claiming that BT is on the decline? When I consulted with my RO at MSKCC he basically said that if I required radiation, he would do BT. He also mentioned that they have not done 40+ RT in almost a year and that BT was the way to proceed.
Posted 12/18/2017 3:16 PM (GMT 0)
Low dose BT, which implants seeds, has been on the decline. What Denis has committed to is High Dose BT, which is a totally different technique. It does not use seeds, but rather plastic tubes to temporarily place radiation within the prostate. HDRBT has been rising in usage, due to good statistics.
Posted 12/18/2017 4:09 PM (GMT 0)

ASAdvocate said...
Low dose BT, which implants seeds, has been on the decline. What Denis has committed to is High Dose BT, which is a totally different technique. It does not use seeds, but rather plastic tubes to temporarily place radiation within the prostate. HDRBT has been rising in usage, due to good statistics.

Oh ok.....Thanks for the clarification my RO must of been referring to HDRBT! So when someone says that BT is on the decline...that is not 100% correct either! - Only low dose BT! Thanks again ASadvocate!
Posted 12/18/2017 5:21 PM (GMT 0)
I suspect that both LDRBT and HDRBT monotherapy use have been declining (the national databases don't separate them). In the National Cancer Database among newly diagnosed localized PC patients, BT-only use peaked in 2002 at 16.9% and was down to half that rate (8.2%) by 2010. In the SEER database, BT-only use fell from approximately 16.7% in 2002 to 11.0% in 2009. There's just not enough money in it to make it economically attractive.
Posted 12/18/2017 5:47 PM (GMT 0)
Tall Allen so a combination of HDRBT and IGRT or IMRT is on the rise as opposed to monotherapy?
Posted 12/18/2017 5:52 PM (GMT 0)
That is my understanding. HDRBT combined with IMRT is A speciality of the RO that Denis is seeing.
Posted 12/18/2017 6:40 PM (GMT 0)
Unfortunately not. Brachy boost therapy was on the decline as well. In the NCDB, utilization of brachy boost therapy fell from 5.4% in 2003 to 2.5% in 2010.

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4429530/

And that was not due to an overall decline in unfavorable risk cases. Looking at only high risk men who received radiation either dose-escalated IMRT or brachy boost as initial therapy, brachy boost utilization declined from 27.6% in 2004 to 10.8% in 2013. For intermediate risk patients, the decline went from 33.1% in 2004 to 12.5% in 2013.

www.brachyjournal.com/article/S1538-4721(17)30004-1/abstract

Perhaps those numbers will turn around as the outcomes of the ASCENDE-RT study, first presented in 2015, become more well known.

/pcnrv.blogspot.com/2017/03/brachy-boost-gold-standard-for.html
Posted 12/18/2017 7:02 PM (GMT 0)
Haven't read the article yet but would think SBRT, with its relatively easy course of treatment for the patient and now mostly accepted good results, and SE levels comparable to or better than other treatments, would be scooping up patients who might have previously gone particularly for 40 treatments of EBRT, but also for LDRBT and HDRBT.

TA - do you have stats?



dbell said...
Good Article....Not sure why some posters are claiming that BT is on the decline? When I consulted with my RO at MSKCC he basically said that if I required radiation, he would do BT. He also mentioned that they have not done 40+ RT in almost a year and that BT was the way to proceed.

Post Edited (Works Out) : 12/18/2017 12:07:22 PM (GMT-7)

Posted 12/18/2017 8:14 PM (GMT 0)
oops, I got out-of-step and posted a comment in another thread...for my own simplicity, I've simply copied/pasted it here, where it was originally intended to address an earlier question/comment on the sub-topic of BT decline:


NKinney said...
The article titles are quite revealing (listed alphabetically by source):

  • ASCO Pubs: Brachytherapy: Where has it gone?

  • Australasian Physical & Engineering Sciences in Medicine: Brachytherapy: a dying art or missed opportunity?

  • Brachy Journal: The declining utilization of brachytherapy for the treatment of prostate cancer: Can magnetic resonance imaging reverse the trend?

  • Cancer (ACS): The Rise and Fall of Prostate Brachytherapy: Use of Brachytherapy for the Treatment of Localized Prostate Cancer in the National Cancer Data Base

  • Medscape: Backing off from Brachytherapy? Deciphering the Decline

  • Prostate Cancer Advisor: Brachytherapy: An Underused Option for Prostate Cancer?

  • PubMed: Declining use of Brachytherapy for the treatment of prostate cancer

  • PubMed: Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?

  • Renal and Urology News: Prostate Brachytherapy on the Decline

  • U.S. Medicine: Brachytherapy Usage Decreases in Prostate Cancer






edit: oops, I posted this in the wrong thread. In another thread today someone else asked about the decline of BT...I'll post it there, too

Post Edited (NKinney) : 12/18/2017 1:10:21 PM (GMT-7)

Post Edited (NKinney) : 12/18/2017 1:37:09 PM (GMT-7)

Posted 12/18/2017 8:24 PM (GMT 0)
SBRT utilization has increased, but it hasn't made the gains that we'd have predicted based on excellent oncological and toxicity outcomes, price and convenience. Among men who received radiation of any kind as primary therapy in 2012, 8.8% received SBRT (up from <1% in 2004).

onlinelibrary.wiley.com/doi/10.1002/cncr.30034/abstract

It has limited availability for prostate cancer, and the cost of implementation can be high for an RO just getting into it. Because reimbursement is so much lower than IMRT, ROs are reluctant to adopt it. I've heard ROs quote bogus studies to patients to talk them out of it. However, the evidence is becoming undeniable, so I think utilization will continue to grow.
Posted 12/18/2017 8:34 PM (GMT 0)

Tall Allen said...
SBRT utilization has increased, but it hasn't made the gains that we'd have predicted based on excellent oncological and toxicity outcomes, price and convenience. Among men who received radiation of any kind as primary therapy in 2012, 8.8% received SBRT (up from <1% in 2004).

onlinelibrary.wiley.com/doi/10.1002/cncr.30034/abstract

It has limited availability for prostate cancer, and the cost of implementation can be high for an RO just getting into it. Because reimbursement is so much lower than IMRT, ROs are reluctant to adopt it. I've heard ROs quote bogus studies to patients to talk them out of it. However, the evidence is becoming undeniable, so I think utilization will continue to grow.

Also, we are seeing on other posts today that SBRT may be denied by the insurance carrier as they see it as an "unnecessary insurance expense". No knock on SBRT! (BCBS has denied my MRI request even after two appeals and discussions with two DR's from MSKCC) I personally am becoming very concerned about my PCa and what my insurance carrier will cover. This is important TX but I also have to weigh the medical costs that I may have to incur for TX. The carrier can make any excuse they want but the bottom line is always the $$$!
Posted 12/18/2017 8:35 PM (GMT 0)

Tall Allen said...
SBRT utilization has increased, but it hasn't made the gains that we'd have predicted ...

I'd second that thought.
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