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There is a pretty active thread going on SIR Connect about the use of SBRT instead of RFA/Cryo/MW, etc. for HCC, any solid tumor met to the liver, lung, and potentially others. Would be interested in getting perspective of people that post on here based on what you're seeing in your practices. I think this could be disruptive for a few reason:
1) Appeal to patient: SBRT is totally non-invasive. Sure, it can take several fractionations and patient may have to miss more time from family or work, but the marketing appeal and appeal from patient perspective is not hard to agree with.
2) Business/$$ reasons: The papers I've seen on SBRT aren't that impressive (a few retrospective articles) and it isn't in the NCCN guidelines for HCC at least. However, at our institution (and especially in some private practices per the SIR Connect people), many patients are being treated with SBRT. As oncology groups are now often large conglomerates that include med onc, surg onc, and rad onc (but usually not IR) and own these facilities, there is a powerful financial incentive to do SBRT over a percutaneous ablation as long as its not worse than percutaneous ablation. In these practice settings, for financial reasons, SBRT doesn't need to be proved to be better than RFA or MW to catch on, just not worse, which is a big deal.
3) Widely applicable - this technology can be adapted to lots of different tumor types
What is the best response to not only improve this therapy but keep IR involved?
-Investigate synergistic therapies (i.e. pre-SBRT embolization or something like that)
-Focus on cost-effectiveness (not that anyone seems to care about this). Recent article in Radiology looked at this, SBRT is really expensive (hence why onc groups prefer to use it in #2 above, "Cost" = "Revenue")
-Expose the conflicts of interest - it'd be interesting to investigate SBRT use in multidisciplinary groups that include Rad Onc vs. more fragmented systems where the med and surg ones don't have a financial incentive to refer to SBRT. This wouldn't be a very successful strategy and would likely just make people mad (i.e. multiple studies show that neurologists order way more MRs if they own equipment, hasn't changed anything)
And finally, disaster scenario:
-What's the chance that SBRT could be used for multifocal unresectable disease and reduce the use of TACE/Y90? It seems like this would be difficult to implement. I'm not sure if a reduction in percutaneous ablation cases is too much of a blow for IR departments, but a reduction in TACE/Y90 would be pretty bad.
1) Appeal to patient: SBRT is totally non-invasive. Sure, it can take several fractionations and patient may have to miss more time from family or work, but the marketing appeal and appeal from patient perspective is not hard to agree with.
2) Business/$$ reasons: The papers I've seen on SBRT aren't that impressive (a few retrospective articles) and it isn't in the NCCN guidelines for HCC at least. However, at our institution (and especially in some private practices per the SIR Connect people), many patients are being treated with SBRT. As oncology groups are now often large conglomerates that include med onc, surg onc, and rad onc (but usually not IR) and own these facilities, there is a powerful financial incentive to do SBRT over a percutaneous ablation as long as its not worse than percutaneous ablation. In these practice settings, for financial reasons, SBRT doesn't need to be proved to be better than RFA or MW to catch on, just not worse, which is a big deal.
3) Widely applicable - this technology can be adapted to lots of different tumor types
What is the best response to not only improve this therapy but keep IR involved?
-Investigate synergistic therapies (i.e. pre-SBRT embolization or something like that)
-Focus on cost-effectiveness (not that anyone seems to care about this). Recent article in Radiology looked at this, SBRT is really expensive (hence why onc groups prefer to use it in #2 above, "Cost" = "Revenue")
-Expose the conflicts of interest - it'd be interesting to investigate SBRT use in multidisciplinary groups that include Rad Onc vs. more fragmented systems where the med and surg ones don't have a financial incentive to refer to SBRT. This wouldn't be a very successful strategy and would likely just make people mad (i.e. multiple studies show that neurologists order way more MRs if they own equipment, hasn't changed anything)
And finally, disaster scenario:
-What's the chance that SBRT could be used for multifocal unresectable disease and reduce the use of TACE/Y90? It seems like this would be difficult to implement. I'm not sure if a reduction in percutaneous ablation cases is too much of a blow for IR departments, but a reduction in TACE/Y90 would be pretty bad.
