I spoke to our radiation physicist Thursday at Hopkins (he was looking ragged after 5 days' of trying to get the tomo-therapy machine back up, working until 3:30 am) BUT he always will take time to answer a few questions. He said that the radiation planning is a major factor in outcome of any radiation (tomo, IMRT or conventional) and that comparing numbers from different ROs who might have different approaches complicates the statistics. Hopkins compares in-house, as do the other larger institutions, to minimize this problem. But it does come into play when you get large retrospective studies which take data from a variety of sources.

He was quite blunt that the expertise of the senior RO planning Barry's therapy, as well as the use of the tomo machine, was a major factor in his getting through with relatively reduced side-effects. By chance I met our original RO in the hall (he's now retired, was in to give a talk) and spoke with him briefly as well. He said they are achieving very high rates of control with both IMRT (older data thus fairly long-term) and tomo-IMRT in cancers of Barry's extent (Stage IV technically but sort of a 3 1/2 according to both Hopkins and Sloan-Kettering as one lymph node was enlarged slightly and thus suspicious, but never biopsied). Barry was the last patient he did a plan for.

Gail