Kennedy and Protons?
Started by Ursus Martimus
Perhaps he'll pay out of pocket. . .
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Even if he gets treated by protons, it is highly doubtful that the press will run with the $$$. I mean the guy is on the verge of death and running stories on the cost of his health care would be beyond distasteful.
Does MGH normally treat GBMs with Protons? I didn't see a protocol for it on clinicaltrials.gov.
wasn't sure if you were being cynical since there have been several articles/blogs commenting on the fact he had resources to go to Duke, get an awake craniotomy amongst other things that would not be available at community hospitals . . . healthcare reform faces difficult choices.
http://www.nypost.com/seven/06052008/postopinion/opedcolumnists/how_liberal_care_would_kill_ted_114032.htm
awake cranis are done at many academic laces. Both MGH and BWH can do them.
Besides the usual cost issues and unproven efficacy issues, GBM (ok, high grade glioma), to me, is very ill-suited for proton therapy.
Hallmark of GBM histology is its diffuse microscopic infiltrative processes. In fact, a good argument can be made that we've been missing the target all along when we target edema + margin then enhancement + margin for a boost.
The selling point of proton therapy is that it "stops" and that there is less exit dose. (By the way, I am not convinced that we can do good enough dosimentry to know exactly where it stops, nor am I convinced whether the integral dose is lower.) But, even if we have the utmost precise control of the dose deposition, we wouldn't know what to target in the case of high grade glioma. Until we can figure out what to target, we shouldn't worry too much about sparing surrounding normal tissue.
Remember the first rule of target delineation. Don't miss the tumor!
Hallmark of GBM histology is its diffuse microscopic infiltrative processes. In fact, a good argument can be made that we've been missing the target all along when we target edema + margin then enhancement + margin for a boost.
The selling point of proton therapy is that it "stops" and that there is less exit dose. (By the way, I am not convinced that we can do good enough dosimentry to know exactly where it stops, nor am I convinced whether the integral dose is lower.) But, even if we have the utmost precise control of the dose deposition, we wouldn't know what to target in the case of high grade glioma. Until we can figure out what to target, we shouldn't worry too much about sparing surrounding normal tissue.
Remember the first rule of target delineation. Don't miss the tumor!
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WBRT for all Glios!
Rewind a couple or three decades, and that would have been standard of care.
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Indeed. In fact I hear a lecture once from an older radiobiologist, who claimed that the WBRT for Glios might have not been such a bad idea at all.
His reasoning was simple:
Glios are resistant to therapy besides being somewhat radioresistant, for one more reason maybe. He hypothesized that Glio stem-cells leave the primary tumor at a very early time of the formation of the tumor and start walking around in the brain. Then after therapy for the primary site is done (extensive operation + radiation) they return to that site and grow again, forming another tumor. In his opinion, that would actually explain why after very aggressive local therapy (total resection+radiation therapy with dose escalation up to 100 Gy) LOCAL recurrence remains the problem.
I have myself often been fascinated how Glios that were macroscopically totally resected recurred at the CENTER of the radiation field.
Usuallly you have the problem of recurrence/progression at a field margin/spot of subtotal resection, rather than the center.
Perhaps heßs right and we do have migrating Glio cells...
I once even treated a patient whose ventriculo-peritoneal shunt was used by Glioblastoma cells which then migrated to his abdomen and ate threw his small bowel, causing a "Gliomatosis peritonei" 😱 and leading to his death. Horrible thing...
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deleted4401
Did you all get that mailer from the Mayo Clinic rad-onc running for US Congress? Interesting ...
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Yes. I actually met him when I did a rotation there as a medical student. He was a really nice guy, although I can't speak to his political views.
I doubt he got protons....no real clinicla benefit, unless up against the chiasm or brainstem....and then likely MGH would only use it for the boost.
The unfortunate outcome is unchanged - protons or photons....and he likely won't live long enough to have any late effects
The unfortunate outcome is unchanged - protons or photons....and he likely won't live long enough to have any late effects
actually i know what s/hes saying. And he's right. They tend to fail near the original mass and thus in the middle of the field rather than at the margin which happens more often in other tumors. But it can certainly happen (10-20%)
