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Importance of Radiation Oncologist experience

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Posted 10/4/2018 12:35 PM (GMT -5)
I am getting ready to meet with a radiation oncologist and then likely will have some type of radiation treatment soon after through that doctor. The details of my prostate cancer are in my signature below.

I know with something like a prostatectomy it's very critical that the surgeon has a lot of experience. How critical is it with a radiation oncologist? The hospital I am going has 3 radiation oncologists that focus on prostate cancer and I was connected to the one with the least experience. I don't necessarily think that means the doctor won't be good, but I am wondering how critical the experience is.
Posted 10/4/2018 12:42 PM (GMT -5)
Radiation is much more of a team sport - ROs, physicists, nurses, and technicians all make up the team. The RO leads the team and makes the medical decisions, so yes experience is important ...

but you need to be assured that the whole team is good, knows their stuff. Your RO will plan the treatment with a physicist, it's the techs who do the day in, day out work. Generally you'll see an RO once a week during treatment, but due to schedules, days off, etc, your main RO might not be every week and sometimes another RO does the weekly check up. The nursing staff will check on you too.

So, look at the RO and the whole team.

Andrew
Posted 10/4/2018 2:00 PM (GMT -5)
When I was getting ready for my radiation treatment, I spoke with two ROs, one where I live, which is kind of a backwater, medically-speaking, and one at a major big-city medical center with a fairly famous cancer center. It would be much more convenient to get the treatments in my own town rather than drive 45 minutes each way to the big medical center; but I was also concerned that I might not get the best treatment. I asked the big-city RO if there was any reason not to have the treatments done by the local guy in my town. He said, no, there's no reason not to have the local RO do the job. I thought that was interesting because I was giving him a chance to toot his own horn and disparage the small town RO, but he didn't. One other thing, the RO does not administer the treatment -- that's done by technicians. I saw the doctor once a week when he checked up on my side effects.
Posted 10/4/2018 2:15 PM (GMT -5)
The RO programs the LINAC (the machine that delivers the radiation treatment). He determines where the beams will pass and the dose delivered on each pass..The machine will follow his instructions. The other people involved make sure he has not overlooked anything when they review the instructions he has written. They work as a team.. Since there are two other RO's working in the same facility, they all probably share skill and knowledge..Just be sure the LINAC that will treat you is a newer one. Something like a Varian Rapid-Arc or better. The newer equipment is MUCH more capability than the older machines especially in avoiding damage to healthy tissue..
Posted 10/4/2018 2:55 PM (GMT -5)
As long as your nurses, technicians and the guy who services and calibrates the LINAC are competent, and the physicist + RO's developed a good dose volume histogram (DVH), you'll be fine. Given your pathology, they should do a very good study of your case.

Mostly full bladder; mostly empty colon. smile
Posted 10/4/2018 2:58 PM (GMT -5)
When I initially went to Virginia Mason my RO was Dr Badiozanomi. I met with him on 2 different occasions. I also met with my RO here in Walla Walla. I asked that the 2 Drs confir with one another and would leave it up to them. They agreed that I would be just fine having my IMRT here at the cancer center. It saved me from going to Seattle for an extended time. It was important to me to be close to home. And besides my RO here said that her machine was newer than theirs, which was also very inportant to me.
It worked out well and I very much respect my RO and her abilities. Having my 2 RO's work together and manage my case was very comforting to me.
You could also contact Dr Nelson's office and ask him as you seem to tust his opinion. I would.


Mark


Mark
Posted 10/4/2018 3:29 PM (GMT -5)
I had Proton therapy at UFPTI and was assigned to a RO there who has considerable experience and has been treating with Proton since UFPTI opened in 2006. On one of my weekly visits with him he mentioned that midway in my treatment there would be some checks made to ensure that calibrations and settings for my particular treatment were still as they should be. I asked him who did this and he said he and the team do it in the beginning and midway through. He does the initial setup but every aspect of his settings were evaluated by the team and any differences in the evaluations are discussed and corrected if necessary.

Late in my treatment the RO explained that he was treating more of my SV than usual. My SV biopsy was negative but he decided to treat it as a precaution just in case there were a few cells in the area. He felt that the extra treatment so far was more than enough to kill any cancer that might be there but it was my decision to continue or to reduce the area to the usual amount. The risk to continuing was that the extra area of the SV was close to other tissue and exposure to radiation was probably unnecessary. He reviewed this with the committee and they were unanimous that it would be best to stop the extra treatment. I asked who is this committee? He said all RO's in the facility. I liked it that they were all in a room discussing my case. Who am I to 2nd guess you guys I answered.

Good to know that RO's are double checked and committees review treatment decisions.
Posted 10/4/2018 4:00 PM (GMT -5)
I cant add, but I will say this.. It is critical that you do not move once the final adjustments are taken care of after the cat scan. Most linacs will not shut off if you move, and there is a reason why you have three teeny, tiny tattoos.
Posted 10/4/2018 4:04 PM (GMT -5)
I think the RO should be well versed with PCa so as to have a good understanding of the diagnosis and set the appropriate radiation parameters. Then the rest of the team needs to be top notch to effectively deliver the radiation. That said, it may not always equate with actual years of experience. One RO might have fewer years under their belt, but perhaps has seen more PCa cases.
Posted 10/5/2018 5:34 PM (GMT -5)
BobMars.. I know at the Mayo it is a team effort for both radiation and chemo treatments for all kinds of cancer.

Larry
Posted 10/5/2018 6:08 PM (GMT -5)
A good friend of mine is head of Administration at an NCCN cancer center. He’s learned a lot about the medical side over his 40 year career. He told me that the RO creates the plan, with help from the dosomotrist, and then it’s executed when the technician hits the send button, so to speak. And that the plan is usually pretty standard in most cases. He said the most important thing is having the advanced technology (machine, and software).

I’m not 100% sure that’s correct, I think there is a bit of an art to creating the plan. But I think the technicians role shouldn’t be discounted. They need to be good at positioning, making sure the bowel is empty, etc.

But in my uneducated opinion, I think the RO’s role is extremely important.
Posted 10/5/2018 8:31 PM (GMT -5)
I had a similar experience to fiddlecanoe, where a very good communicative research based RO told me to have it done locally rather than travel 120 RT each day. That being said, I had an excellent work up from RO at the MD Anderson Proton Center's and consulting with the RO and the research-based person at UNM cancer I learned even more including having him inject the SpaceOar which wasn't available locally. Basically, it took a village to know what to do. Here are some of the things I wouldn't have known if I had only worked with the local RO, get a T3MRI, Bone Scan, Colonoscopy and SpaceOar injection. My local UR ordered the Polaris when I was diagnosed and my consulting UR surgeon ordered the PTEN genetic test. I also had a cystoscopy and a bladder neck dilation that I requested on my own a week prior to radiation, due to a preexisting bladder neck scarring. Also had a second opinion on the pathology. So you can do it locally, but get all the advice you can.

68 yrs., marathon runner, PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 93 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.

Post Edited (SantaZia) : 10/5/2018 7:41:56 PM (GMT-6)

Posted 10/5/2018 10:28 PM (GMT -5)
Your RO should have at least 250 cases of prostate cancer under his belt. If less than that get another one.
The more experience the better.
Posted 10/6/2018 7:32 PM (GMT -5)
If possible, find one who specializes primarily in, or only prostate cancer treatment. Unfortunately for us, the prostate gland is located in a densely packed area, where a lot can go wrong if the treatment is not planned and executed correctly.

The choice of RO is critical in a successful outcome. Your treatment is based specifically on your type and location of cancer, in relation to the surrounding structures, pubic arch, bladder, bowels, nerves etc..

It is not as simple as "microwaving" the gland and hoping for the best. The bad outcomes from radiation treatment that I've read about were, one, the cancer had already left to station, so surgery and/or radiation wouldn't help, or two, poor planning,improperly applied.
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