Is radiation therapy the same quality everywhere?

Posted by jhp @jhp, Dec 19, 2022

Bone biopsy came out and it is tentatively stage 4 NSCLC adenocarcinoma. We have two options to choose from after the orthopedic surgery to radiate the bone metastases. They said it was okay to start radiation asap, but whether or not we wanted to wait was up to us.

1) NCI facility
Pros: experienced and is ranked in US News and World Reports
Cons: three week wait time until radiation can begin

2) local hospital
Pros: can offer radiation treatment this week
Cons: not NCI, unranked in lung cancer, honestly it's only residents after 3PM and on the weekends

I know chemotherapy is standardized so it's the same drug everywhere, but is radiation the same everywhere or does technology and experience factor into what quality of radiation is given? I was advised that the insurance wouldn't pay for radiation mapping twice, so it won't be possible to start at one place and switch over for radiation. I am not sure if that means just one radiation spot or if they map all the spots needed to radiate at once.

Any advice is much appreciated.

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1) Facility 1 offers:

intensity-modulated radiation therapy (IMRT). 

stereotactic radiosurgery (SRS)

stereotactic body radiation therapy (SbRT)

high-dose-rate (HDR) and low-dose-rate (LDR) brachytherapy

CyberKnife and GammaKnife radiosurgery

hyperthermia

high-intensity focused ultrasound (HIFU)

hypofractionated IMRT and brachytherapy

2) Facility 2 offers

Varian TrueBream® linear accelerator (LINAC)

Varian Trilogy®

3D guided stereotactic body radiation therapy (SBRT)

stereotactic radiosurgery (SRS) when targeting tumors in the brain

Image-Guided Radiation Therapy (IGRT) 

Intensity-Modulated Radiation Therapy

RapidArc® Radiation Therapy

Cyberknife seems to be praised a lot. I'm not sure how everything else compares.

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Good morning. It looks as if you have done a lot of research and this is great. There are no two labs alike so even chemicals can vary a teensy bit. "Technology and experience factor into" everything in science is very truthful. After 25 years of lung cancer, making this kind of decision really is unfair but necessary at times. I suggest making a decision about what will fit into your life the best, taking into consideration that once you make a decision you will need to stay with it until it doesn't work or if other things change.

Looking at all that is offered at the NCI-approved facility I would choose that one. What do your doctors say about the wait? Might they do something else while you wait for radiation?

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@merpreb

Good morning. It looks as if you have done a lot of research and this is great. There are no two labs alike so even chemicals can vary a teensy bit. "Technology and experience factor into" everything in science is very truthful. After 25 years of lung cancer, making this kind of decision really is unfair but necessary at times. I suggest making a decision about what will fit into your life the best, taking into consideration that once you make a decision you will need to stay with it until it doesn't work or if other things change.

Looking at all that is offered at the NCI-approved facility I would choose that one. What do your doctors say about the wait? Might they do something else while you wait for radiation?

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Hi,

I recently completed SABR treatment and agree with Merry. I'd go with the NCI-rated institution. 3 weeks is not a long time to wait and if means a higher quality of care in general, it is worth going to the NCI-rated facility.

My choice between a local faciity and a NCI-rated institution came after a failed biopsy at the local faciity. I have not regretted going to the higher rated facility. In fact, I looked at the whole situation as a gift that led me to the better quality of care. You deserve nothing less than excellent quality of care.

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Thank you for your advice @merpreb and @bpb

No, dad is still at the out of state hospital and covered under the emergency orthopedic situation. Oncology is not covered, so they will be sending him back to the home state for that.

I managed to get a sooner appt. for dad at a third option, a top ten NCI hospital with everything that the NCI facility here has. Apparently it wasn't that this top hospital was unavailable, but just that it didn't occur to the current hospital to ask since they routinely recommend the NCI facility instead. They were gracious enough to follow up once I requested it and it's been arranged. This top hospital was actually the place that demurred regarding the orthopedic issue, so he was sent out of state. If he had been accepted here, he could have already started treatment, but no use crying over spilled milk. The current out of state hospital seems to want to keep him until he can walk again, even though their original plan was to discharge him and have PT at home. I'm wary that this could delay his treatment even further.

I guess my main concern right now is that the NCI facility said they were starting to roll out something called radiodynamic therapy (but only for certain cancers, so not sure if this would actually be available in this situation) and they have a special machine for this that the top NCI hospital doesn't have. Results are promising in mice and they have Phase I trials now. Conversely, the top NCI hospital has proton therapy (whether or not it can be used in this situation is also unknown) which the NCI facility doesn't have.

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It looks like there are good choices. Make sure when you're asking questions that you get answers to your questions about the radiodynamic therapy and proton therapy. If your dad's had a biopsy, ask for the biomarker or DNA report on the tumor(s). That will give you good information and some direction. Some of the mutations have their own advocacy groups . . . like ALK and others. Other mutations do not yet have therapies. So you might ask up front what biomarkers or mutations are these two different therapies used for.

Wishing you and your dad the best!
BPB

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@jhp

Thank you for your advice @merpreb and @bpb

No, dad is still at the out of state hospital and covered under the emergency orthopedic situation. Oncology is not covered, so they will be sending him back to the home state for that.

I managed to get a sooner appt. for dad at a third option, a top ten NCI hospital with everything that the NCI facility here has. Apparently it wasn't that this top hospital was unavailable, but just that it didn't occur to the current hospital to ask since they routinely recommend the NCI facility instead. They were gracious enough to follow up once I requested it and it's been arranged. This top hospital was actually the place that demurred regarding the orthopedic issue, so he was sent out of state. If he had been accepted here, he could have already started treatment, but no use crying over spilled milk. The current out of state hospital seems to want to keep him until he can walk again, even though their original plan was to discharge him and have PT at home. I'm wary that this could delay his treatment even further.

I guess my main concern right now is that the NCI facility said they were starting to roll out something called radiodynamic therapy (but only for certain cancers, so not sure if this would actually be available in this situation) and they have a special machine for this that the top NCI hospital doesn't have. Results are promising in mice and they have Phase I trials now. Conversely, the top NCI hospital has proton therapy (whether or not it can be used in this situation is also unknown) which the NCI facility doesn't have.

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Glad to hear that there is a plan, and he’ll be seen by a good cancer care facility. I have to echo bpb’s comment about the biopsy and biomarker testing. That is critical in determining a comprehensive/systemic treatment plan. Any NCI facility should perform those tests. Wishing you the best, Lisa

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@bpb

Thanks for the advice. I will definitely ask those questions. At the current out of state place, they took the biopsy from the bone mets and did biomarker testing on it. Because he's not receiving oncology treatment, there's an oncology doctor on his team, but they're not really his doctor. I wanted to ask if this was comprehensive or just common biomarkers being tested, but it's been five days and still no luck hearing back from them. It did take me a week to manage to speak to a resident…at this point, I should just ask the oncologist who will be taking over his care once he transfers back in state since the results should be out soon.

Best wishes and happy holiday

@lls8000

Thanks, I will definitely ask those questions. Yes, there is a plan in place now, but I'm nervous because the hospital is keeping him atm even though the plan was discharge two days ago because he is receiving PT for walking after the leg procedure. The normal recovery time is 2-3 weeks, but radiation asap is okay. They say it's unsafe for him to come home because we have stairs, but I'm wary this could delay his appt with the oncologist. I'll have to ask if they can ship him over to his oncology appt or will crossing state lines again mess up the insurance part.

Best wishes and happy holiday

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