D
deleted969641
No offense, and I generally agree everything you post and respect you a lot, but you are really shifting the goalposts here.How about this math.
Reported deaths in literature from SpaceOAR insertion: N≥1
Reported deaths in literature from prostate IMRT: N=0
You can't fool a Norwegian!
Or attorneys.
Doing all the no-nos: comparing across trials/databases, compiling anecdotes together to make data, scouring patient reviews online to inform decision making (interestingly enough the third comment on that site... "My stinking radiologist from the so called number 4 in the country cancer care didn't want to use the space Orr ..now I hsve rectal damage .thry say it should resolve in a month or 2")
The reality is that we have a phase 3 randomized trial of 222 patients that showed a statistically significant improvement in graded toxicity and quality of life metrics (large difference in the latter) without any reported serious adverse events. Which leads me to believe the rare adverse events that are happening via anecdote may have other factors involved other than spaceOAR just sucking in general. And the response is that we don't have good data that it works and it is safe, but we have a lot of "data" apparently that patients are embolizing and dropping dead. Hmm.. I don't think so!
If you want to talk about costs, then we need to be honest and also include in the conversation why we are routinely doing 45 fractions instead of 20 fractions for most intact prostate. The cost of the spaceOAR (which interestingly comes out to about $1600 USD in Norway) is a drop in the bucket compared to an extra 25 fractions of IMRT. Yet the argument that is typically used to justify more than doubling the treatment time is that it is "gentler" and less likely to cause toxicity. Hmm........