Imaging costs for Medicare cancer patients on the rise

[gdpawel]

According to John Adler, the Stanford University professor who invented the CyberKnife, it is a robotic device that treats cancer with precise, high doses of radiation. Cyberknife (stereotatic radiosurgy) in general allows a much higher dose of radiation (20-60 Gy) compared with 5-7 Gy with conventional therapy. It can be placed under CT guidance.

This kind of treatment would appear to be appropriate when there is localized disease which is considered to be inoperable. If there are a great many tumors then this technique is probably not appropriate because the disease is so widespread that no amount of treating individual tumors will halt the disease.

On the other hand, if you have a single tumor which is considered to be inoperable, or if you cannot withstand open surgery for an otherwise operable tumor, this treatment might be a real consideration. The treatment is usually given as a series of five outpatient sessions spaced anywhere from a day to a week apart depending on the situation. Side effects are said to be minimal in most cases, as is often not the case with conventional external beam radiotherapy.

I personally know a cardiothoracic surgeon who uses Cyber Knife in his repertoire of treatment options. Not everything can be done with the knife (pretty much though).

I know that is is not yet known whether Brachytherapy/Proton Beam Therapy yields better clinical outcomes than other types of radiation therapy for patients with many common cancers. In some instances, surgery and Brachytherapy/Proton Beam Therapy are used together in early stage breast cancer. It's not established that it works for more aggressive breast tumors. It is still considered new for breast cancer.

Radiation-induced necrosis can occur more commonly after Brachytherapy/Proton Beam Therapy and radiosurgery, but can also occur after conventional radiation therapy as well. I had a brother-in-law who lost his life to MDS (Myelodysplastic Syndrome), which can be caused by treatment with chemotherapy or radiation therapy. This is called treatment-related MDS or secondary MDS. He developed MDS after receiving permanent seed implants with Brachytherapy for prostate cancer treatment.

There was supposed to be a study to compare whole breast radiation to three different types of partial breast radiation: multi-catheter brachytherapy, ballon catheter brachytherapy (MammoSite) and 3-D conformal external beam radiation.

In multicatheter brachytherapy, docotrs insert hollow tubes (usually 15-20) into the tumor site. Radioactive pellets are then inserted into the tubes. They are left in the breast for a few minutes, then taken out again. The tubes themselves remain in place for the length of the treatment, which is 1-2 weeks. After seeing what radioactive pellets did to my brother-in-law, I don't know about this procedure.

Ballon catheter brachytherapy is similar but it uses only one tube with a balloon at the end. The balloon is inserted into the breast and inflated with salt water to fill the cavity left by the removal of the tumor. The radiation pellet is inserted into the center of the balloon for a few minutes at a time. This is done over the course of 1-2 weeks.

3-D conformal external beam radiation (similar to traditional radiotherapy) is delivered from outside the breast. But instead of hitting the whole breast, the beams are targeted to hit only the tumor site and a small portion of surrounding tissue.

My wife and I had already discussed if she had breast cancer, off with it. She had been the one to convince me to go surgery. She had gone surgery with all her cancers. I had one sister-in-law who had breast cancer in 1995 (one year before my wife's 24 years recurrence). She had a lumpectomy with some spot radiation to the local tumor bed. In 2007, another lesion showed up and she treated it as another primary. This time, Oncoplastic surgery, combining oncology principles with plastic surgery techniques (nothing else).