napoleondynamite

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..and I'm preparing myself mentally for the inevitable media campaign which I'm sure will target 5 fraction prostate. At least, that is what I have seen in other cities where I have worked and CK has been implemented.

It seems that CK makes the whole setup and acquisition very seemless for any radoncs willing to give the venture a go.

I read in the announcement that the CK is backed by a group called Select HealthCare Solutions with a CEO named Matthew Cutler. Anyone know anything about these guys..are they like a venture capitol firm that invests in these centers, or?? I'm just curious how the whole enchilada works..
 

Reaganite

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I know several rad oncs invested in their other center. I think I spoke to Cutler several years ago. Seemed like a reasonable guy. If I remember correctly, you would just do the initial planning, and they would take it from there (i.e. you wouldn't have to be on site for treatment). You would, however, get essentially the equivalent reimbursement for professional services for a 5 fraction SBRT course.
 

OTN

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If you guys have stereotactic capability, what I found to be helpful is constant education of all referring MDs in town about how Cyberknife is just another machine which has stereotactic capability. Now, in our city, we have a very robust urorads practice, so my prostate volumes are very low anyway. However, after a very strong initial Cyberknife push I was able to reshape the landscape and conversation. Now, instead of saying "let's Cyberknife that" I finally have surgeons saying "we should treat that stereotactically." Took a couple of years, but it was worth the effort.
 
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Agree with above comments by OTN.

We currently have a Cyberknife unit but we will be moving to a TrueBeam platform for both SRS & SBRT in the next year or so. Unfortunately, marketing is a necessary evil (patients need to know that you have stereotactic capabilities) ... and in my opinion the TrueBeam can be marketed effectively as well... although it doesn't have the same catchy title as "Cyberknife."
 

Gfunk6

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Agree with the comments above. Dosimetry aside, the CyberKnife markets itself - aesthetically it is very appealing and that "catchy" name!!

However I agree that cutting edge accelerators (TrueBeam STx and Versa HD) have eclipsed CyberKnife's capabilities. You can get much faster treatment on the former platforms and you don't need non-stop stereoscopic imaging. Convincing your referring MDs and potential patients of this is the difficulty . . .
 

thecarbonionangle

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is it easy to learn GK from only cyberK experience or vice versa, once you look for jobs?
 

BobbyHeenan

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Agree with the comments above. Dosimetry aside, the CyberKnife markets itself - aesthetically it is very appealing and that "catchy" name!!

However I agree that cutting edge accelerators (TrueBeam STx and Versa HD) have eclipsed CyberKnife's capabilities. You can get much faster treatment on the former platforms and you don't need non-stop stereoscopic imaging. Convincing your referring MDs and potential patients of this is the difficulty . . .
Completely agree with this. The new linacs can make amazing dose distributions for SBRT as long as your planners know what they're doing. If you still want stereoscopic imaging they now offer that as well. The flattening filter free speed is unmatched by CK or GK. However, the word "knife" is not included in their platforms, so that obviously makes them inferior.

To pile on, trying to convince your referring MD's that the patient doesn't in fact need protons for their anal cancer, pre-op rectal, or right sided breast is also annoying and difficult...especially when the proton facility will treat these patients with protons if insurance approves it.
 

OTN

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Completely agree with this. The new linacs can make amazing dose distributions for SBRT as long as your planners know what they're doing. If you still want stereoscopic imaging they now offer that as well. The flattening filter free speed is unmatched by CK or GK. However, the word "knife" is not included in their platforms, so that obviously makes them inferior.

To pile on, trying to convince your referring MD's that the patient doesn't in fact need protons for their anal cancer, pre-op rectal, or right sided breast is also annoying and difficult...especially when the proton facility will treat these patients with protons if insurance approves it.
I'm with you on the protons. There's a large billboard in our city from a major academic institution that's ~3 hours away which makes it sound as if protons are a cure-all for everyone, etc. Ridiculous.
 
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@OTN I completely agree with you.

In my mind the robust marketing campaign behind proton therapy can verge on being unethical, but then again if they told the truth they probably wouldn't recruit as many patients. I can see it now...

"Proton Therapy is very expensive and looks & sounds really futuristic (and is great for pediatric/spine/CNS tumors) .... and may reduce side effects although this has never been proven in a robust Phase III clinical trial."
 

RustBeltOnc

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To pile on, trying to convince your referring MD's that the patient doesn't in fact need protons for their anal cancer, pre-op rectal, or right sided breast is also annoying and difficult...especially when the proton facility will treat these patients with protons if insurance approves it.
I pray you do not refer to ABIM medical oncology certified physicians.
 

BobbyHeenan

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I pray you do not refer to ABIM medical oncology certified physicians.


The med oncs/surg/breast oncs are actually very good and very guideline-driven...they just don't understand the intricacies of radiation planning/dosimetry and have been HEAVILY marketed/preyed upon by the proton center marketing.

Direct-to-patient advertising is also playing a role here, as patients are asking their med oncs/surgeons for referrals straight to proton facility for all kinds of cancers - because the proton facility advertises that they treat all kinds of cancers. They're put in a tough spot where the patient wants a referral for their (anal, breast, etc) to protons while I'm telling the med onc that I don't think that's necessary.
 
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RustBeltOnc

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The med oncs/surg/breast oncs are actually very good and very guideline-driven...they just don't understand the intricacies of radiation planning/dosimetry and have been HEAVILY marketed/preyed upon by the proton center marketing.

Direct-to-patient advertising is also playing a role here, as patients are asking their med oncs/surgeons for referrals straight to proton facility for all kinds of cancers - because the proton facility advertises that they treat all kinds of cancers. They're put in a tough spot ...
This is where the rubber hits the road - the oncologist has to take a hit with "patient satisfaction" and tell the patient the truth, and urge they go to a normal radiation oncologist. To do the right thing, the onc has to accept they will lose a few pts to CTCA etc
 

seper

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Just checking, is prostate SBRT universally accepted to be safe for men with good life expectancy? Did it make it into guidelines?
 

medgator

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Just checking, is prostate SBRT universally accepted to be safe for men with good life expectancy? Did it make it into guidelines?
Haven't heard, but it's pretty much only kosher in low and select-intermediate risk cases, right?
 

BobbyHeenan

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Haven't heard, but it's pretty much only kosher in low and select-intermediate risk cases, right?
As I recall, NCCN mentions prostate SBRT as a "cautious alternative" with appropriate experience, physics, etc within the "Principles of Radiation" section. I'm not sure they say whether this should be for low/int/high risk patients, though.

The vast majority of experience in the Phase I/II trials is in low/int risk patients though (Stanford, UTSW, and lots of Cyberknife centers). I've treated patients enrolled in the RTOG trial (5 fractions vs. 12 fractions) and an institutional SBRT trial, and maybe one or two off protocol but really don't offer it now off protocol. I've used a TrueBeam for the treatments.

In my experience with colleagues/centers that have Cyberknife if they offer prostate SBRT they have sold it as an alternative, while the proton centers I've dealt with have sold it as a superior option to photon XRT. Obviously, there's some heavy marketing there in each scenario, but the notion that a treatment is better than standard IMRT is certainly more prevalent from the proton centers.