CyberKnife radiation: is it being over-advertised?

Many regular readers may be interested in a blog post by Gary Schwitzer on the MedPage Today web site. It addresses the increasing advertising of CyberKnife radiation therapy (a form of stereotactic body radiation therapy or SBRT) as a first-line treatment for prostate cancer.

Data on the use of CyberKnife-based SBRT is certainly limited, with median long-term follow-up data for a maximum of about 5 years. These data certainly appear to be promising, but it is justifiably arguable that (as with high intensity focused ultrasound or HIFU) we really don’t know exactly how safe or effective CyberKnife radiation is for men with early stage prostate cancer.

And of course we also don’t know what percentage of the men being treated with CyberKnife radiation could actually have avoided any form of treatment by practising active surveillance.

This type of advertising of CyberKnife radiation therapy corresponds almost exactly to the type of hospital-driven advertising we saw for Intuitive’s da Vinci robot-assisted radical prostatectomy just 3 to 4 years ago, when there were also question about whether that was really “a better mousetrap.” Such advertising of robot-assisted surgery can still be seen in billboards all over the country (now more often for disorders other than prostate cancer).

As Harold DeMonaco points out accurately in Schwitzer’s blog post,

Unfortunately, excessive claims in medical advertising have been around since the dark ages. Given the high economic stakes of a competitive healthcare market, we may be seeing the beginnings of the 21st Century version of “snake oil” promotions. The Cyberknife system is not the issue here. Like most new technologies, the Cyberknife system can play an important role in improving the treatment of many cancer patients. It is the advertising that is the issue. Does a hospital really need to resort to phrases like, ‘turn devastation into hope,’ to promote the use of a new treatment option?

CyberKnife radiation may well, in fact, turn out to be a truly excellent form of radiation therapy for carefully selected patients with early stage prostate cancer. It can be carried out relatively quickly, and at a significantly lower cost than current forms of targeted, intensity modulated external beam radiation therapy. However, it would be nice if the promotion of the technology could be limited to ensure some degree of factual accuracy as opposed to emotional (and potentially inaccurate) tugging on patients’ heartstrings.

2 Responses

  1. Putting the hype aside, CyberKnife/SBRT is showing credible results as provided in a report by you in the past and in this other report, presented at the ASTRO annual meeting this past October.

  2. Median follow up is 3 years. Good luck explaining that vs. the much longer median follow-up for IMRT or even 3D conformal EBRT. If we ignore that (and that’s a big one) the cost structure for patients favors CyberKnife (fewer treatments = fewer co-pays?) possibly, or maybe not (CyberKnife costs more than IMRT in total?). Perhaps as pointed out, observation and avoiding treatment might have been appropriate for who knows what percentage — maybe 50% or more! But then, how do you pay for those machines?

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