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

Thanks Gail. I would love to hear the details on the ECOG study.

What a huge difference between the treatment protocol at Moffitt and John Hopkins. Then when I read Brian's comments, it makes me hope that our R.O. was experienced enough to have the 'art' of IMRT down. As I noted in the thread above, we were told last March that Moffitt primarily uses IMRT for patients who did not undergo surgery. They just use conventional radiation for H&N patients who also had pre-radiation surgery. This never made any sense to me, but it is what we were told. It would also mean that they don't have a lot of experience using IMRT for patients who have already had the primary tumor and affected lymph nodes removed through surgery.

As a Moffitt patient who had surgery, Jerry only got IMRT because we learned about it ourselves and specifically requested it. Jerry ended up with a soft tissue injury at the surgery site where he got too much radiation. I wonder now if this is common or an example of not enough experience with the technology.

Thanks again for the information you provide. I find it really helpful.

Connie