thesauce

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I recently saw a patient with a sub-cm acoustic neuroma that was essentially in the middle ear. Given its proximity to the cochlea and vestibular apparatus, I recommended fractionated RT instead of SRS.

The patient sought a second opinion with an ENT in a major city and they wrote in their note that fractionated RT would be very likely to cause hearing and balance issues and they recommended "Gamma Knife" instead. Keep in mind we have both IMRT and SRS capability in my clinic.

My partner doesn't think it's worth calling these people out because they never change. But this kind of thing just annoys me. The patient hasn't called back because they are convinced that this other surgeon from the big city must be right and I don't know what I'm doing - when the exact opposite is true.

How do you guys deal with this?
 

Palex80

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Unfortunately this happens all the time and there is very little you can do to prevent it, other than talking with colleagues from other disciplines "educating" them about RT.
When we introduced single fraction SRS it took more than a year to educate our referring physicians that we can offer the same thing a Cyberknife can offer for brain mets with our new Linac.
It took one year to have them stop asking if we can see the patient and send him to the next Cyberknife equipped clinic over 100km away.
One clinic I know simply bought a Cyberknife, although they had cutting edge LINAC-based SRS/FSRT just to have this in the portofolio and make the referring physicians happy. Crazy world...

On a side note:
In my personal view this is a side-effect of the massive marketing that has been invested into by certain radiation oncology firms to promote their tools as "superior" to others.
"Cyberknife" is a catchier name than a "linear accelerator" and physicians from other clinics often ask about treating with "cyberknife" for indications, where cyberknife has no place in, simply because they have heard so much about it by the company in symposia, etc...
 

medgator

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Makes no sense, considering fractionated probably has a better shot at hearing preservation vs single-fraction GK.
 

RadOncDoc21

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I've had this happen on several occassions and no matter how many times I confront or try to make my point across, nothing ever changes.

There will always be "experts" in other fields who offer their opinions on your field even when it's obvious they don't know anything.
 
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evilbooyaa

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Makes no sense, considering fractionated probably has a better shot at hearing preservation vs single-fraction GK.
This. I imagine when you say fractionated RT for an acoustic neuroma you mean FSRT, not standard fractionation. Non rad-oncs just don't know the difference and it's somewhat frequent to see their notes here pushing for or against radiation and they're routinely wrong. The best ones may talk to the patient about the basics of radiation, but say something like 'discuss this further with your rad onc since they're the expert', same thing I say to patients when they ask about if they'll need chemo, how much, what side effects, etc.

Had a patient with new brain mets and leptomeningeal disease. Discussed with him WBRT. NSG saw him and recommended SRS to the patient, leading to us having to go to radiology, review the imaging, get an addendum in the report saying "diffuse leptomeningeal disease", then a large e-mail chain discussing the need for WBRT.
 

Brim

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You should school those ENTs on the 4Rs by forcing them to attend rad bio lectures. It will also serve as a fitting punishment.
 
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