IORT feasibility study and cost effectiveness!

[Kroll2013]

Dear colleagues,
does the actual clinical applications of IORT justifies such an investment ?
How to decide if it would an interesting project for a hospital? what are the pros and cons ?

ty

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[Gfunk6]

What kind of IORT are you proposing? Intrabeam device for breast cancer IORT? Or a more sophisticated electron-based IORT platform (like Mobetron)?

The answer in either case will rely heavily on your hospital's surgical expertise and willingness of surgeons to participate.

 

[ramsesthenice]

Dear colleagues,
does the actual clinical applications of IORT justifies such an investment ?
How to decide if it would an interesting project for a hospital? what are the pros and cons ?

ty

I looked into this recently as it relates to a mobitron. I have experience and several of our surgical departments are interested in getting one There may be some variation in different networks but where I am now the only thing we could recoup in rad onc was technical fees for physics. IORT (again, not sure if this applies to all types of IORT or just some) is considered a surgical technique and most of the reimbursement goes to the surgeon. The amount that they got was shockingly low too. I checked with the office manager where I trained (which had a mobi) and apparently they are experiencing similar changes.

I think that being able to offer IORT is important for select cases in terms of patient care but unless you get a different answer than I did (and I hope you do) I don't see how you will be able to convince anyone on administration that its a good monetary investment.

 

[OTN]

Financially, IORT is a huge loss for radiation oncology. Temporally, it's a huge pain to have to be "on call" to be able to go to the OR at any time. Clinically, it's inferior to whole breast RT based on the best data we currently have.

 

[Reaganite]

No! Colossal waste. Very limited uses, reimbursement sucks, etc.

 

[ramsesthenice]

Clinically, it's inferior to whole breast RT based on the best data we currently have.

Can't agree more. I think the best use of IORT is for recurrent pelvic disease after definitive CRT (usually either rectal, cervical, or occasionally endometrial). If the surgeons don't think they can get a clean margin it can help with local control.

Out of necessity (ie, not having a Mobi here) I have had to get creative and I am actually very pleased so far. If we know sidewall margins are going to be an issue in advance you can have the surgeons leave in some kind of spacer (omental flaps are nice because they can just stay in) over the margin at risk and clip it. If they buy me couple cm from bowel then I can do post op SBRT. Don't have enough data to publish yet but so far I have been really happy with the results. No local failures or significant toxicity. Its nice for us because no waiting around on call for the OR and no need for new equipment.

 

[Palex80]

Irradiation of the tumor bed in early stage breast cancer is a big and good indication for IORT. On the other hand some other alternatives exist, such as SAVI or multi-catheter brachytherapy. Some will also prefer to do external beam partial breast irradiation. Down the road however intraoperative RT may be more appealing to patients, because it's so simple and easy for them.

Right now you would be probably losing money if you were to give IORT to all you early stage breast cancer patients because you would be doing less tangents from them. Looking into 5 years from now, IORT will probably be standard of care for these cases and ASTRO will be saying "Do not deliver WBRT, if you can do PBI". So your patients will be asking for it your competition will probably pick it up.