Sorry about this non-sequitur to the most current post. I’m replying to some of the content 10+ posts back by this point.
I posted a few months back about my 3-month LDR experience with Dr. Brian Moran at the Chicago Prostate Cancer Center here
. I’ll chime in with my twopence on this topic.
Even if that's true, the average was close to 20% late grade 3+ GU toxicity... If you had to blame the practitioners at a high volume center vs blame the technique itself... which one do you think is the more likely culprit?
Just to add a little more science to the art: We keep the urethra <105% in most cases (especially post-TURP), <110% is acceptable. LDR allows for 125-130%?
At the CPCC urethra was kept under 150%. I didn’t see any G3 acute issues in the (many) follow up visits during my time there. Part of that may have been a generous urethra contour during LDR preplan using a broad brush, along with discharge with Medrol pack and Flomax.
What's the average check-in time to discharge? I've actually never observed a high-volume LDR program in person. For monotherapy it's great that it's only 1 implant though!
Usually my patients are in the department for a total of 4.5-5.5 hours. Including check-in time, IV insertion, implant, anesthesia recovery, treatment planning/delivery, and voiding/ambulation.
Similar total time frame to what you described above. Implant time was 20-30 minutes. Total anesthesia time was ~30-40 minutes. OR turnover was hourly, and on OR days there were 4-5 implants a morning (7 or 8 AM to noon). Patient recovering after anesthesia was maybe another 60-90 minutes. Anesthesia was LMA with sevoflurane and nitrous, skip the fentanyl midazolam cocktail. Honestly the LMA was coming out as the last needle went in. So walk-in to walk-out time varied from 3-4 hours.
It does on that too i bet. . HDR done in a hospital carries high facility/OR fees I'm sure
I agree time wise SBRT is better. Although our patients usually get SpaceOAR/Fiducials prior to SBRT so ~1.5hr for SpaceOAR/Fiducial/CT sim. You're right though throughput is way higher with EBRT/SBRT for sure.
I also tend to think SBRT for high-risk disease is subpar to something with a brachytherapy boost. Time will tell.
I'd like to see a trial of SBRT w/ HDR boost, 5Gy x 5 to pelvis, 5-6Gy x 5 to prostate and ??? with HDR boost.
Reimbursement depends on the insurance but "Cost" which can be calculated using time driven activity based costing (TDABC) is about the same for HDR mono (2 implants, 2 fractions) and SBRT.
The cheapest (cost for hospital to perform/TDABC) is LDR monotherapy.
Will be interesting to see how things play out with APM!
Not my numbers to share. But outpatient clinic-based LDR run the way the Chicago Prostate Cancer Center setup did is cost-effective. A fraction of the proposed numbers in Anne Hubbard’s presentation on bundled payment last ASTRO. I’m not surprised @Aphtalyfe
that LDR is the cheapest where you are, too.
As far as the ASCENDE-RT GU toxicity rates – no idea. Every GU radiation oncologist on my job interview trail (both private and academic) said that the published G3 toxicity rate is much higher than what they’ve seen. Some suggested that the ASCENDE protocol was inflexible regarding on-the-fly implant adjustments for pre-plans that may otherwise have resulted in implant objectives being met.