Pdt
Started by TheMightyAngus
nope. surgeons and invasive types.
Actually, some programs have a big PDT programs within their RadOnc dept. It's used in the OR for leukoplakia in the head and neck, carcinoma in situ, or sometimes recurrent cancer. A lot of stuff is on protocol or in house studies. Some people think it's going to replace a lot of external beam, because you can do it multiple times on the same patient.
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As a replacement for radiation: dont count on it. It has its role but its not more a replacement than chemo was. (Far less i'd hzard to guess in fact).
there are not a lot of "big" PDT within radonc.The indications you've mentioned belong to the primary surgical groups and not radonc.
there are not a lot of "big" PDT within radonc.The indications you've mentioned belong to the primary surgical groups and not radonc.
Penn has a significant PDT program and the RadOnc faculty run it. I think if you continue to spread the belief that the procedure belongs to the surgeons, gasteroenterologsts, dermatologists, etc. you do an injustice to us who want to get into radiation oncology. There are programs out there and you shouldn't discourage us from looking into it.
GammaCounter has made a good point. PDT is still an investigational modality in the management of patients with malignancy and hence, its use is not widespread since these investigations require substantial investigator commitment and funding. That said, not only is it being done at Penn (by radiation oncology), but 3 trials are open (prostate, head and neck, and lung), the funding comes via an NIH Program Project Grant (PO-1), and the PI is Eli Glatstein (radiation oncology). It is high on the Penn clinical research program agenda.
i dont quite see how im doing an injustice to you by my belief that its is and will remain primarily the domian of surgeons etc (and that this is appropraite). If i'm wrong, i'm wrong and time will tell but i fail to see the justice issue.
Frankly I'd be more interested in seeing radonc docs stop turfing out true radonc procedures as is happening left and right. Neurosurgeons have a role in radiosurgery but its predominantly seen as a neurosurgeon's niche. It most certainly should not be. Brachy for prostate is another issue as is radiolabeled drugs which I think has FAR more of a chance of being a growth field in cancer and far more likely to get yanked out of the hands of radonc docs considering the little activity there seems to be in the field to own it. In short, I dont see PDT being the future of radonc. I do see a need for radonc's to own radiation related procedures.
D
deleted4401
I agree - why is it that urologists run seed implants at many programs, and neurosurgeons so heavily involved in SRS? They play a very limited role, yet end up demanding a large amount of the service provision fees. This field, as strong as it is, has a very passive-aggressive response to turf battles. I don't know much about PDT, but if it is yet something else that we are giving up to other providers, yet it is in our domain of training, that is ridiculous.
I love the ENTs, CT surgeons, and neurosurgeons that I work with on SRS cases. Yet, honestly, in my heart and brain, I am not sure why they are involved with any part of the treatment planning process. As far as the general process, I do appreciate the referral. However, with them, or without them, we can definitely handle 99% of the treatment planning and delivery. As far as urology, one can make an argument that a well trained urologist can handle the procedure and treatment planning on their own, however hiring a physicist and dosimetrist full-time may depress their margins. At some programs the urolgists' role is nominal - peeking their head in at appropriate times. At other programs, they are inserting the needles and billing at high rates. Any resident or attending in rad-onc can handle that part, and the insertion of the source. It doesn't make sense.
I don't know much yet, but I do have some opinions. I just think people in the field need to be more aggressive. This is our niche. We need to protect every inch of it. The reimbursements in this field will not hold up. That being the case, we need to stop sharing our slice of the pie unnecessarily.
-S
I love the ENTs, CT surgeons, and neurosurgeons that I work with on SRS cases. Yet, honestly, in my heart and brain, I am not sure why they are involved with any part of the treatment planning process. As far as the general process, I do appreciate the referral. However, with them, or without them, we can definitely handle 99% of the treatment planning and delivery. As far as urology, one can make an argument that a well trained urologist can handle the procedure and treatment planning on their own, however hiring a physicist and dosimetrist full-time may depress their margins. At some programs the urolgists' role is nominal - peeking their head in at appropriate times. At other programs, they are inserting the needles and billing at high rates. Any resident or attending in rad-onc can handle that part, and the insertion of the source. It doesn't make sense.
I don't know much yet, but I do have some opinions. I just think people in the field need to be more aggressive. This is our niche. We need to protect every inch of it. The reimbursements in this field will not hold up. That being the case, we need to stop sharing our slice of the pie unnecessarily.
-S
Being a referal-based specialty, how do we manage to maintain autonomy in these cases without upsetting our referal base? Im sure those neurosurgeons (GK-RS) and urologists (seeds) have the certain financial expectations in the back of their mind. It has managed to work out ok in other cases (i.e. Head and neck IMRT-- we have complete autonomy in the process, from start to finish)
well with frameless srs, the neurosurgeons will be heading on the way out in many places. They're useful -and yes even beyond frame placement- but should not be the drivers of srs and more that neuro rads is very useful but shouldnt be the driver.
medgator youre questions is a very good one frmo a real life perspective. obviously its an issue. however part of what i like about academics is im more free to do what I think is best for the patient without consideration to the dollar. i welcome my colleagues input, god knows, but i dont have to cowtow to them for my next meal.
