by Lauren Dubinsky
, Senior Reporter | October 05, 2015
From the October 2015 issue of HealthCare Business News magazine
“In our population, these are patients who don’t have that option — their lung function is too poor and their heart function is too poor,” says Woody. Before the emergence of lung SBRT, frail, medically-compromised patients with nodenegative inoperable NSCLC were often treated with external beam radiation therapy, which delivers lower doses over more treatment sessions. However, many of the patients experienced several side effects and the cancer often recurred. Since it was a retrospective study that evaluated only a small number of patients for less than two years, more research will be needed to confirm these results.
There used to be a notion that radiosurgery could only treat three or fewer tumors in a patient, but there was no data to support that. A study conducted in Japan and published in Lancet Oncology
last year investigated how many tumors can reasonably be treated with radiosurgery.
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The researchers evaluated patients with two to four brain metastases and patients with five to 10 brain metastases who were treated with SRS at 23 facilities in Japan. They found that there is no difference in results between the two groups of patients. “That study, along with recently updated guidelines and the ASTRO recommendations, is really fueling a change in the way these patients are treated and for the betterment of these patients,” says Gilmore-Lawless. “In the past, patients with largernumbers of metastases would either not be treated or have whole brain radiation therapy and would frequently be viewed as futile cases.”
The researchers know that it’s not a number issue, but rather the volume of tumors. Insurance companies are even willing to reimburse cases when patients have more than three metastases, says Gilmore-Lawless. Another area that many studies are looking into is the combined use of radiosurgery and drugs. The health care industry is trying to figure out which drugs are the most effective, whether there are safety issues with the combined use of drugs and radiosurgery, and what the optimal drug strategy is.
“There is an emerging belief that radiosurgery could play a role in activating the immune system potentially synergistically with immunotherapy to achieve better results,” says Gilmore-Lawless. “This is a promising new area of ongoing investigation and nobody has the answers here yet.”