now bean counters looking at radiation therapy vs cyberknife

Lani · 10-09-2009, 10:19 AM

in this case for bone mets, but hopefully not for brain mets in the future

Efficacy, safety and quality of life need to be weighed in

2009 BC SYMPOSIUM: ABSTRACT #152: Cost comparisons for a course of radiation therapy for painful bone metastases from breast cancer using different technologies and fraction schema
[American Society of Clinical Oncology]
Background: Providers are faced with an array of options when sending their patients (pts) with painful bone metastases (PBM) for treatment (Rx) with radiation (RT). It has been shown (Hartsell et al. & others) that a single fraction(fx) of RT has equal efficacy to a 10 fx course with respect to pain relief & freedom from narcotic usage at 3 months. Nevertheless, some believe that delivery of a higher dose, as facilitated by fractionation and conformal Rx, may allow for greater long term palliation in select subgroups, such as pts with long life expectancies or radioresistant histologies. Different delivery systems & techniques—conventional RT (XRT), stereotactic radiosurgery (SRS), Cyberknife (CBK), & others- can be used, but are associated with different amounts of time involved by providers & pts alike, as well as different levels of reimbursement (reim).
Methods: CPT codes and Medicare reim were reviewed for seven potential scenarios for treatment of PBM. Freestanding (Fstd) estimate and Outpatient(OP) hospital estimate are based on WPS Medicare Michigan Locality 01 2009 and 2009 APC national reim rates. Using CPT codes that would be typically associated with a course of Rx, seven scenarios were reviewed: single fx and four fx courses with CBK in Fstd center and OP hospital settings, four fx course of SRS, and one and ten fx courses of XRT in an OP hospital setting.
Results: The results of the analysis is reported in the table.
Conclusions: There is a wide range of expense associated with the delivery of palliative RT for PBM, ranging from $1700 for a single fx of XRT delivered in an OP hospital setting, to $16118 for four fx of CBK in an OP hospital setting. This may have implications on the choice of modality for RT delivery for some providers and pts alike. Further research should examine the relative efficacy of the varied approaches commonly utilized for Rx of PBM to determine whether more expensive options are relatively cost-effective in any pt populations.

hutchibk · 10-09-2009, 03:21 PM

3D conformal IMRT sterotactic radiosurgery (Varian brand is the machine that my rads onc uses) is equally as adept, if not superior, for treating many bone and brain mets as Cyber, so efficacy is a non-issue and safety is not any different with IMRT. Cyberknife is just a brand name of the same technology, but the machine operates a little differently. Varian type IMRT srs is not as expensive as Cyber.

As far as quality of life, with Cyberknife, one of the problems is that some patients might not be able to tolerate lying on the table for the duration of treatment (> 1 hour). IMRT, like I have had for my brain mets, is a few consecutive days of 10-15 minute treatments.

Cyberknife, Gammaknife and Proton Beam all have very sexy names that draw people into believing they are automatically superior treatment options, which is not necessarily true.

Lani · 10-09-2009, 03:31 PM

3D conformal IMRT sterotactic radiosurgery (Varian brand is the machine that my rads onc uses) is equally as adept for treating bone and brain mets as Cyber, so efficacy is a non-issue and safety is not any different with IMRT. Cyberknife is just a brand name of the same technology, but the machine operates a little differently. Varian type IMRT srs is not as expensive as Cyber.

can you cite articles on each of these statements?

Also perhaps needing to be considered is the possibility that the radiation targetting may not be as exact when there are several different sessions as
despite masks,beanbags, etc there may and probably are differences in postioning and therefore the area targeted from day to day

hutchibk · 10-09-2009, 05:11 PM

I can't link my rads onc's brain to this forum, but he is a physicist who is also a rads onc, who has worked with both brands (Cyber and Varian) and has chosen Varian technology as the future for his practice, his patients, and for his experience of superiority with the brand. I will look for backup in articles, but I take my genius doctor at his word. *also you can also google for yourself*

I am CTed on the table for perfect measurement and precise targeting everyday when I get rads. ("There probably are differences in positioning..." - hate to be a stickler, but "probably" sounds like a subjective opinion.)

Also, I have read similar discussion of the technologies online, I particularly remember a doctor/medical student forum that touted the positives of 3D conformal IMRT vs Cyber.