Re: Stereotactic radiotherapy (CyberKnife*) for prostate cancer

[Guest guest]

Isn’t it an indictment on the

medical world that this piece concludes:

<snip> To date, no form of

radiotherapy has been compared to another with a prospective randomized trial. <snip>

No comparisons available to the medical world, let alone men with prostate

cancer – how can anyone decided what is the best therapy? In the absence

of relevant studies, surely the information provided in anecdotal evidence is

better than no information at all?

<snip> Therefore, I do not believe

this to be necessary before offering patients the option of CyberKnife®. <snip>

This statement at the conclusion of the piece, seems to be saying in other

terms “Two wrongs make a right. No one else has done a prospective trial,

so why should we?”

I did a short write up on CyberKnife®

on my site for anyone interested in this variant of EBRT (External Beam

Radiation Therapy) – it is at http://www.yananow.net/cyberknife.htm

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of B

Sent: Saturday, 3 April 2010 6:49

AM

To:

malemedicalproblems ; malemedicalproblemsgooglegroups;

ProstateCancerSupport

Subject:

Stereotactic radiotherapy (CyberKnife*) for prostate cancer

" This paper reports on the largest

series of patients treated with CyberKnife* for prostate cancer at one

institution. In the year since we compiled the data, we have continued to be encouraged

by the efficacy and toxicity profile. We still have not seen a local failure in

the low or intermediate risk patients, with our early group treated with 35gy

having a median followup of 42 months. For two reasons, we have decreased our

dose back from 36.25 Gy to 35 Gy....

Click on the below link for the full story:

<http://www.urotoday.com/3341/browse_categories/beyond_the_abstract/beyond_the_abstract__stereotactic_body_radiotherapy_for_organconfined_prostate_cancer_by_alan__j_katz_md_jd04022010.html>

You're welcome to browse

within the above medical web site,

but you'll be requested to register, which you can safely do.

Non-doctors are welcome and there's never any spam.

[Guest guest]

<snip> To date, no form of radiotherapy has been compared to

another with a prospective randomized trial. <snip> No comparisons

available to the medical world, let alone men with prostate cancer – how

can anyone decided what is the best therapy? In the absence of relevant

studies, surely the information provided in anecdotal evidence is better than

no information at all?

The problem with this is the different

radiotherapies are not the same. Just like no one’s prostate cancer is

the same. A couple of weeks ago I spent a significant with a radiation

oncologist with a specialization with prostate cancer. He my wife and I spent a

significant time discussing the different forms of radiotherapies and how

applicable they would be to my situation. Each different method has its benefits

and detriments. Trying to group those into a randomized study would be

comparing apples and oranges. Let the doctors decide what is the best

tool to use for a given case.

<snip> Therefore, I do not believe this to be necessary

before offering patients the option of CyberKnife®. <snip> This

statement at the conclusion of the piece, seems to be saying in other terms

“Two wrongs make a right. No one else has done a prospective trial, so

why should we?”

With statements like this it make me

concerned about the validity of the product that person is hawking. If

they can’t prove their product is useful by the science of its use marketing

statements like this make it sound more like snake oil than a valid form of

theropy.

.._,___

[Guest guest]

They sure are advertising it a lot on tv. At least where I live in NJ for their center in NY over here. Oddly enough for prostate cancer. Claiming a lack of side effects and treatment improvement. Date: Sat, 3 Apr 2010 14:46:06 +1100To: <ProstateCancerSupport >Subject: RE: Stereotactic radiotherapy (CyberKnife*) for prostate cancerIsn’t it an indictment on themedical world that this piece concludes: <snip> To date, no form ofradiotherapy has been compared to another with a prospective randomized trial. <snip>No comparisons available to the medical world, let alone men with prostatecancer – how can anyone decided what is the best therapy? In the absenceof relevant studies, surely the information provided in anecdotal evidence isbetter than no information at all? <snip> Therefore, I do not believethis to be necessary before offering patients the option of CyberKnife®. <snip>This statement at the conclusion of the piece, seems to be saying in otherterms “Two wrongs make a right. No one else has done a prospective trial,so why should we?” I did a short write up on CyberKnife®on my site for anyone interested in this variant of EBRT (External BeamRadiation Therapy) – it is at http://www.yananow.net/cyberknife.htm All the best Prostate men need enlightening, notfrighteningTerry Herbert - diagnosed in 1996 andstill going strongRead A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html From:ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of BSent: Saturday, 3 April 2010 6:49AMTo:malemedicalproblems ; malemedicalproblemsgooglegroups;ProstateCancerSupport Subject: Stereotactic radiotherapy (CyberKnife*) for prostate cancer " This paper reports on the largestseries of patients treated with CyberKnife* for prostate cancer at oneinstitution. In the year since we compiled the data, we have continued to be encouragedby the efficacy and toxicity profile. We still have not seen a local failure inthe low or intermediate risk patients, with our early group treated with 35gyhaving a median followup of 42 months. For two reasons, we have decreased ourdose back from 36.25 Gy to 35 Gy.... Click on the below link for the full story:<http://www.urotoday.com/3341/browse_categories/beyond_the_abstract/beyond_the_abstract__stereotactic_body_radiotherapy_for_organconfined_prostate_cancer_by_alan__j_katz_md_jd04022010.html> You're welcome to browsewithin the above medical web site, but you'll be requested to register, which you can safely do. Non-doctors are welcome and there's never any spam.

[Guest guest]

Larry Helber

....

> The problem with this is the different radiotherapies are not

> the same. Just like no one’s prostate cancer is the same. A

> couple of weeks ago I spent a significant with a radiation

> oncologist with a specialization with prostate cancer. He my

> wife and I spent a significant time discussing the different

> forms of radiotherapies and how applicable they would be to my

> situation. Each different method has its benefits and

> detriments. Trying to group those into a randomized study

> would be comparing apples and oranges. Let the doctors decide

> what is the best tool to use for a given case.

If a trial were large enough to stratify the results, by Gleason

score, PSA, and other criteria, we could probably overcome the

apples and oranges problem.

My guess is that we would find that all properly done therapies

are around the same effectiveness for the low risk cases - low

PSA and low Gleason score, but that things would start to diverge

for the higher risk cases.

By " properly done " therapies, I mean therapies that are done as

well as can be for that particular type. That means having a

sufficient dose of radiation and good aiming techniques.

But we can't prove that unless we actually have the clinical

trial.

<From Terry...>

> <snip> Therefore, I do not believe this to be necessary before

> offering patients the option of CyberKnife®. <snip> This

> statement at the conclusion of the piece, seems to be saying in

> other terms “Two wrongs make a right. No one else has done a

> prospective trial, so why should we?â€

<End Terry>

I sort of understand why they don't. Any particular radiation

clinic has probably made an investment in one type of machine

(they're very expensive) and one type of training.

What we need is someone at a higher level, e.g., the U.S.

National Cancer Institute, to organize a study and bring in

whoever is needed to do it.

Even then, it won't be easy. To do it right, I think they would

need to involve the best clinics for each type of therapy and

exercise rigorous control over how data is gathered to be sure

there is no cheating - inadvertent or otherwise.

> With statements like this it make me concerned about the

> validity of the product that person is hawking. If they can’t

> prove their product is useful by the science of its use

> marketing statements like this make it sound more like snake

> oil than a valid form of theropy.

Another issue for me is that I don't entirely trust the " We done

it good " reports that come from the various treatment clinics.

Sometimes a well known, highly respected clinic will report

something like a 70% cure rate for a certain patient population

and treatment technique and then some other clinic that nobody

heard of reports a 95% cure rate for the same kind of patients

and treatment.

How can that be?

If someone publishes a claim, as these folks have done, that they

have not had a single failure, then they should make their

records open for expert independent inspection so that other

experts can verify the claims.

The clinics and doctors refuse to do this on grounds of patient

confidentiality, but there are easy ways to protect patient

confidentiality. The confidentiality argument seems to me to be

a smokescreen for the real reason, which is that an outside

expert might discover that something is amiss either in their

records or in their treatments.

I understand that even very honest doctors and businessmen don't

like the idea of someone conducting fishing expeditions in their

records. But like it or not, they should be forced to do it. If

you accept a contract from the U.S. government to do something,

you have to agree to accounting audits by independent auditors.

If you want a loan from a bank you must agree to letting the bank

see your financial records. So too, if you get a license from

the government to practice medicine, I think you should have to

agree to independent audits of your records - with appropriate

safeguards for confidentiality.

Alan