Monday, February 9, 2009

report from 8th Annual Cyberknife Users' meeting

this is taken from two posts on the Yahoo MB:

>>8th Annual Cyberknife Users' meeting (Feb 4-9, 2009)

Heavy emphasis on prostate ca (only lung ca had as many presentations), so I guess ARAY is putting many of its eggs in the prostate basket. The prostate data could hardly be better, with rapid PSA drops, virtually no local failures, and minimal morbidity (the main concern of critics). The data is finally substantial, with at least 3 series of over 200 pts (one with nearly 400), with many pts 3 years post-rx. Much eye-glazing data on quality of life indices and AUA scores was presented and will be published, but the bottom line was well-summarized by a Naples, Florida urology who spoke of the over 300 CK-treated pts he has seen in follow-up. He always asks pts if they would have the same treatment again and recommend it to others, and to a man the pts ethusiastically endorsed CK (something not true of his daVinci pts). I think I'm quite good with the rectal ultrasound and prostate needles (if I may say so myself), but I can tell you without any doubt that 100% of my seed pts would not recommend seeds to others or do it again. I'm still skeptical that ARAY will make substantial inroads into the prostate market given the politics and turf-infused history of treating prostate cancer. Hopefully I'm overly cynical and wrong about this.

Very good data presented on treating AVMs, acoustic neuromas, and ocular and pediatric tumors. This is very good news for the small number of pts afflicted with these rare diseases, less so for investors who want machines moved with large volumes of pts. Very little presented on pancreatic cancer, which was somewhat disappointing.


The early stage lung cancer data was extremely impressive, with several retrospective studies presented with smaller numbers of pts than the prostate studies. I would have been skeptical if not for the fact I've seen similar results in the 30 or so pts I've treated. It will take a randomized trial for the medical world to take note of this. The Roth trial is off to a slow start accruing pts, which is predictable given the vastly different treatment arms. (It is much easier to convince a lung pt he needs surgery, or needs CK, than it is to convince him to flip a coin to decide between the two.) Pts have been randomized to the surgery arm and dropped out to get CK, or initially interested in the study but refused to be randomized because they wanted CK. Since the study deals with operable pts it is not surprising that there is a non-surgical bias in those attracted to the study. I was told Chinese pts would be needed to meet accrual targets (apparently they don't have the option of dropping off study after randomization!), and that it would be 3 years before there was meaningful data.

I don't understand why ARAY limits those attending this meeting to current CK users or those with a signed contract with ARAY. It seems paranoid and self-conscious, when the data presented is largely impressive. Why not let any doc attend who was interested?

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