From the October 2018 issue of HealthCare Business News magazine
Outcomes have been impressive. For example, early stage lung cancer patients treated with three painless outpatient SAbR treatments on an NIH-sponsored multicenter trial were shown in a recent JAMA Oncology article to have 90+ percent targeted tumor eradication with few side effects after long term follow-up.
While SAbR is not cheap, it is generally less costly than protracted courses of conventional radiotherapy. This fact led to its being approved by CMS for treating prostate cancer, a disease with many, generally expensive, treatment options. And SAbR is more effectively utilized by a Cancer Center. As recently as 2004, the average number of treatments per course of radiotherapy was 28, or nearly 6 weeks of daily treatments. Protracted fractionation is inconvenient for patients who have other things to do, but also limits the capacity of the treatment center.
At the University of Texas Southwestern Medical Center in Dallas, Texas, where I practice, we heavily employ SAbR for our patients. Our current number of treatments per course of radiotherapy is 15, about half the national average. That means that with the same capital acquisition costs for radiotherapy equipment and the same cost of labor, we can treat twice as many patients as our competitors. Our capacity is double!
But SAbR wasn’t first conceived to be just a more cost-effective cancer therapy. It was developed amid a desire to improve cancer outcomes. It was first used in the brain (e.g., treatments like the Gamma Knife and the Cyberknife), moved to the lung, then liver, and beyond. Pancreas cancer, kidney cancer and sarcomas have been tested successfully with SAbR.
SAbR is the fastest growing treatment for prostate cancer and is being tested in trials aimed at improving potency preservation compared to surgery or conventional radiation. SAbR is being used in breast cancer where a machine specifically designed for breast SAbR called the Gamma Pod was recently FDA approved. All of these sites were treated with conventional, protracted radiation prior to SAbR. But SAbR is clearly expanding radiotherapy indications.
While radiotherapy has been mostly a palliative treatment in metastatic cancer, SAbR is being tested as part of hopefully curative or life-lengthening treatments for a variety of metastatic cancers. Trials are underway that could transform the field, including randomized trials. When the number of tumors is limited (i.e., oligometastases), SAbR is used to eliminate them all. When systemic therapy is mostly working but a few tumors progress, SAbR is used to consolidate the bad actors. When immunotherapy is indicated, SAbR might be used to “immunize” one or more tumors to accentuate the response. In all cases, SAbR is used with systemic therapy in a collaborative way, playing to the strengths of each therapy while dramatically expanding the indications for radiotherapy.
