Post by Tony Crispino on Aug 6, 2014 14:48:45 GMT -8
John, great post...
I think key data referenced in the article is a retrospective Prostate Cancer Clinical study comparing toxicity. In that study the following conclusion was drawn: "Although PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment."
It really does not take a Harvard training to ask the question to an institution that has been using this modality for over 20 years "where's your published data?". There is no question that when LLMC started out PBT was way better than the EBRT options available in 1994. But as Brian states in his article:
"It is incumbent on proton therapy researchers and clinicians to demonstrate the superiority of PBT over existing, less costly technologies. Efficacy data will need to prove that PBT is either more effective (i.e. better tumor control), reduces toxicity (complications and side effects) and/or improves patient-reported quality of life. I am a strong believer that high-quality studies will eventually support these findings for many cancers."
This would indicate that while maybe a better technology, there is a huge question that we may be bringing a nuclear bomb to a gun fight with prostate cancer treatment. I recommend the article John just linked to anyone interested. There are some terrific references and links in that article.
Also note: That MD Anderson, in cooperation with Harvard, are performing a clinical trial today and LLMC is not a participating center. I believe that is no surprise. But Brian still leaves open the possibility that better trials and better data could still prove PBT as superior.
Did ASTRO and Lancet go too far? I don't think so. They are calling for better data. And they do outline cases where PBT may be appropriate:
In identifying and describing appropriate use of proton-beam therapy, the policy lists four circumstances when use of the technology is reasonable:
- Target volume is close to a critical structure, requiring a steep dose gradient outside the target to limit the structure's exposure.
- A decrease in dose inhomogeneity in a large treatment volume is required to avoid an excessive "hotspot" within the target volume.
- Use of photon-based therapy carries an increased risk of clinically meaningful normal-tissue toxicity.
- The same area or an adjacent area has been previously irradiated, increasing the need for sculpting to limit the cumulative radiation dose.
"The policy emphasizes that "proton-beam therapy is not considered reasonable and medically necessary unless at least one of the criteria listed ... is present."
That quoted language is linked in Dr. Lawenda's article. Click Here
Thank you Dr. Lawenda for the great information...
I think key data referenced in the article is a retrospective Prostate Cancer Clinical study comparing toxicity. In that study the following conclusion was drawn: "Although PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment."
It really does not take a Harvard training to ask the question to an institution that has been using this modality for over 20 years "where's your published data?". There is no question that when LLMC started out PBT was way better than the EBRT options available in 1994. But as Brian states in his article:
"It is incumbent on proton therapy researchers and clinicians to demonstrate the superiority of PBT over existing, less costly technologies. Efficacy data will need to prove that PBT is either more effective (i.e. better tumor control), reduces toxicity (complications and side effects) and/or improves patient-reported quality of life. I am a strong believer that high-quality studies will eventually support these findings for many cancers."
This would indicate that while maybe a better technology, there is a huge question that we may be bringing a nuclear bomb to a gun fight with prostate cancer treatment. I recommend the article John just linked to anyone interested. There are some terrific references and links in that article.
Also note: That MD Anderson, in cooperation with Harvard, are performing a clinical trial today and LLMC is not a participating center. I believe that is no surprise. But Brian still leaves open the possibility that better trials and better data could still prove PBT as superior.
Did ASTRO and Lancet go too far? I don't think so. They are calling for better data. And they do outline cases where PBT may be appropriate:
In identifying and describing appropriate use of proton-beam therapy, the policy lists four circumstances when use of the technology is reasonable:
- Target volume is close to a critical structure, requiring a steep dose gradient outside the target to limit the structure's exposure.
- A decrease in dose inhomogeneity in a large treatment volume is required to avoid an excessive "hotspot" within the target volume.
- Use of photon-based therapy carries an increased risk of clinically meaningful normal-tissue toxicity.
- The same area or an adjacent area has been previously irradiated, increasing the need for sculpting to limit the cumulative radiation dose.
"The policy emphasizes that "proton-beam therapy is not considered reasonable and medically necessary unless at least one of the criteria listed ... is present."
That quoted language is linked in Dr. Lawenda's article. Click Here
Thank you Dr. Lawenda for the great information...
