Wake Forest - GK, Not a candidate for truth in advertising

[Mark]

I think most folks who read this forum understand the need to take charge of their healthcare and challenge things they are told. There have been numerous examples of blatant misinformation on a wide range of issues related to surgery, radiosurgery and even differences in types of machines. A couple of days ago, I think it was Flyersfan who commented that there are doctors who put the patient first as well those who, unfortunately put $$$ first. Surgeons who push surgery when not necessary because it pads their wallet as well as Radiosurgeons who want to pay off expensive machines. The vast majority I believe do put the patient first, but everyone once and a while you see something so outrageous it's hard to ignore.

In that spirit I thought I would share the attached exchange from the CPSG board where someone asked questions about comparisons made between CK and GK by Wake Forest Medical center. Given the advantages of CK over GK and the migration of "market share" that have resulted, I'm not entirely surprised that false claims would be made by someone, however the fact that an institution such as Wake Forest would allow this is absolutely amazing to me. For those choosing radiosurgery, all machines are not equal and you do have to determine which one you are most comfortable using and be wary of false claims 

Mark

Patient

I recently came across this website from Wake Forest's Gamma Knife Center. I found this info. interesting, particularly about the "dose outside target area" and was wondering whether anyone could comment (ie, whether it's true, what that means for patients, in particularly AN patients)? The Wake Forest website doesn't explain where any of the information comes from.

1. Gamma Knife: Radiologic accuracy better than 0.3mm

Cyberknife: 1 mm accuracy; dose outside the target area is 2-6x greater than with GK

2. Gamma Knife: Target position is confirmed 10 times per second
Cyberknife: Target position confirmed once every 10 seconds

Thanks. And if anyone else is interested, here's the link: http://www1.wfubmc.edu/gammaknife/Gamma+Knife+vs+CyberKnife/

Dr. Medberry

The people there have commercial interests with Elekta I am told. If so, they should disclose those. Here are the facts:

1. Claim: Radiologic accuracy better than 0.3m. This should actually read mechanical accuracy. There are no radiographic images obtained during Gamma Knife treatment and therefore there is no such thing as radiographic accuracy. Total accuracy is more important. This includes the lesser accuracy of MRI compared to CT, the inaccuracies that can result from frame torsion, and the inaccuracies in setting up the x,y,z settings, which varies according to whether it is being done with the Automatic Positioning System or manually. There is good experimental data showing that the accuracy of the Gamma Knife is about 1.7 mm. THe accuracy of the Cyberknife for intracranial targets is 0.89 mm. I don't think the differences are significant.
2. Claim: The CK is inherently less accurate since the positioning is optically guided, not head-frame based. See above. Rigid immobilization does not guarantee accuracy.
3. Claim: GK treatment delivered during one session. This is correct. CK is capable of delivering the same doses in a single session. We frequentlychoose to deliver the dose over multiple sessions because of biologic considerations showing that fractionated treatment may be safer in some situations. We have frequently treated tumors in single fractions, but the ability to fractionate treatment is one of the things we consider a great advantage of the CK, not a disadvantage.
4. Claim: For GK, "target position is confirmed 10 times per second". For CK, "target position confirmed once every 10 seconds". This is absolute nonsense. For the GK, target position is never confirmed during treatment. There is confirmation of the APS but that has little to do with the target. FOr the CK, target position is verified every time a beam is to be started.

One of the radiation oncologists at Wake Forest is the son of a member of the Elekta Executive Committee, in charge of Research and Academic Relations. I will leave it to you to decide whether their website should include a disclosure notice.

The Gamma Knife is a fine intracranial radiosurgery option, and the Ck community is definitely indebted to the GK for a fast start on necessary doses for intracranial tumors. That said, it is a technology which is being superceded. There are a number of us who use both, but I don't know of anyone who uses both and thinks that the GK is better.

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

[JHager]

This is, while easily the most blatant, yet another incident in which money and preference are placed before patients.  It is very much like the neurosurgeon who will tell you that radiation isn't a viable option when it is, or a radiosurgeon who claims surgery always leads to a worse outcome than CK or GK.  People stick with what they know and believe; however, such obvious misinformation is nearly criminal.

Mark, thanks for the heads up - and for everyone researching their options, this is yet another reminder to get multiple opinions from skilled veterans.  Get the facts, and then make the decision that works best for you!

[Mark]

Jennifer,

Thanks for sharing the UVA information. I would agree that the content is almost verbatim what was on the Wake Forest site. As Dr. Medberry pointed out, one of the radiation oncologists at Wake is the son of the someone working for Elktra, the maker of GK. UVA was one of the original users of GK and has a good reputation for it's use over the years. However, with that history I would be prone to believe they also have some financial relationship with Elektra.

Having been in the healthcare business for over 25 years I am aware that some device manufacturers provide a lot of financial support for  facilities and some clinicians that use their products. GK was the only game in town for years for radiosurgery and clearly new technology such as CK is passing them by, so they try to hold on to their users through whatever means possible. The University of Pittsburgh which is a world class neurosurgery center has both GK and CK , but I'm aware that they only use the GK for intracranial lesions and CK for the rest of the body treatments primarily because of a financial arrangement with Elektra, even though CK could do both. At least to my knowledge Pitt doesn't engage in the practice of misrepresenting the facts about how the machines compare.

Whether they choose to do anything with it or not, I have forwarded links to the two web sites to Accuray. From a legal perspective , the UVA and Wake Forest web false claims are clearly actionable. IMO from a ethics and patient care standpoint they are unconscionable and an embarassment for both of these medical centers

Mark