Hi --

Fially caught up with the radiation physicist at Hopkins. The questions I asked him were:

1) What percent of head and neck cancer patients receiving radiation are getting the tomotherapy machine, how many conventional IMRT and how many the older external beam therapy?

a) Virtually all their patients are now on the tomotherapy machine -- a small proportion of nasopharyngeal patients and some in certain clinical trials for which it is the protocol are getting conventional IMRT. None are getting the older external beam therapy that he is aware of, although they might use it in a palliative rather than curative setting. He opined that the severe xerostomia resulting from this treatment is a serious issue.

2) What does he think the advantages of IMRT (and tomo-IMRT) are, besides QOL issues?

a) First, he said they are treating the cancer just as effectively with these technologies as with the older ones -- similar rates of response etc. if not better. He said they are getting data that shows excellent dose to target and less to non-target areas. However he did say that the results are not yet in from a large ECOG study which compares the technologies -- clinical results as well as QOL.

He got called away for a consult but is willing to talk about this so I will try to get more details on the ECOG study at a later date as this is central to everyone's concerns.

Gail