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Article Analysis Part 1: Trade Magazine

In an attempt to compare and contrast the characteristics of a trade magazine and a peer

reviewed professional journal, I chose to select two articles discussing the use of SBRT

(Stereotactic Body Radiation Therapy) in the treatment of prostate cancer. The articles I have

selected originate from separate websites, the trade article from the website Radiology Today and

the peer reviewed article from NCBI. I immediately noticed that the Radiology Today website

was busy with advertisements and social media links, which is to be expected as it is a free

publication paid for by advertisers.1 The NCBI website contained many links to different tools

and domains useful for different sub-disciplines.

The article “SBRT for Prostate Cancer” written by Beth W. Orenstein, was accessed

using the trade magazine Radiology Today. This article aims to discuss the use of SBRT as it

relates to low risk cancers of the prostate, and does so by primarily referencing physicians, such

as Dr. Alan Katz. Dr. Katz is a strong proponent for the use of SBRT in the treatment of Prostate

cancer and claims he is achieving better results than colleagues implementing surgical and

conventional radiotherapy methods. He outlined advantages that include shorter treatment

duration and total dose, lower dose to bowel and urinary structures, and 80% retention of sexual

potency. 2 Additional advantages brought to light by other researchers also included the potential

for a lower cost than IMRT. Dr. Katz generated his data through the nearly 700 prostate SBRT

cases he had treated at the time this article was written and based his conclusions off of 5-year

data. This data suggested recurrence in only 7% of his patients and saw lower levels of prostate

specific antigen, which he predicts is an indicator for 10-15 year deterrence.2 Opposing opinions

mention the inability to base long-term success off of short-term data and that physicians may be
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promoting the use of SBRT for prostate in order make their investment in the technology more

meaningful and worth the cost.

The general theme I pulled away from this article was that the understanding of

advantages and disadvantages of prostate SBRT treatments are still in early phases, meaning

there is a lack of consensus within professional circles. It is evident that there are physicians that

have seen enough evidence to recommend this treatment to patients and are buying into the

potential benefits of SBRT in prostate. On the other hand, more conservative physicians have not

yet seen long-term data that suggests any benefits to SBRT over IMRT and other methods. I am

excited to continue following this research as it progresses.

I was excited to read this article as I enjoy learning about methodology that could

diminish risk to the patient. I was disappointed with, and critical of the lack of supporting data

presented by physicians in the article. Much of the data presented seemed be based on opinion

and trend, rather than statistic. For this reason, I found it hard to take a side and am left feeling

that I have not gained an insight into whether prostate SBRT plans are more efficient than IMRT

plans. I think the strengths of this paper include the author’s inclusion of more than several

professional opinions. Including multiple voices can present the reader with different viewpoints

and an opportunity to learn or understand a talking point from a different lens. To that point, I

also enjoyed that the author took a back-seat-approach and allowed for the interviewees to

present their professional opinions.

I think that this article presents someone who is learning Dosimetry with some interesting

points for thought as it brings up daily considerations such as lowering dose when possible and

using the most beneficial treatment options we can. I am not convinced that this article would be

particularly beneficial to an experienced professional because it fails to show a consensus for

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whether SBRT is beneficial in prostate cases and the considerations I mentioned would already

be at the center of an experienced dosimetrists mind when making plans.

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Sources

1. Hunzeker A. Reading & writing in radiation therapy & medical dosimetry. [SoftChalk].

La Crosse, WI: UW-L Medical Dosimetry Program; 2018.

2. Orenstein B. (2011, July). Proton SBRT for Prostate Cancer. (16)2,22. Retrieved from

http://www.radiologytoday.net/archive/rt0711p24.shtml. Accessed January 30, 2018.

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Article Analysis Part 2: Professional Journal

To compare trade magazines and professional journals, I chose to use a professional

journal article from NCBI titled “Stereotactic Body Radiation Therapy Versus Intensity-

Modulated Radiation Therapy for Prostate Cancer: Comparison of Toxicity” authored by Yu et

al. This journal entry was much longer and more detailed than the trade magazine article. I was

provided with detailed experimental methodology and original data based conclusions1,

compared to the more relaxed and opinion based conclusions of the trade magazine.

In this study, researchers compared 1335 SBRT patients to 2670 IMRT patients in order

to assess the differences in treatment costs and toxicity.2 This article was more clearly structured

when compared to the trade article, as it contained subsections that are required in research

articles. For example, the introduction of this paper was excellent in preparing the reader as it

included a literature review to give background on finances and risks/rewards of hypo-

fractionated prostate radiation therapy. This background information made it easy for me to

understand the importance of lower treatment costs and shortening treatment schedules.

The researchers employed data from a national sample of Medicare beneficiaries age 66

or older receiving either IMRT or SBRT prostate treatment as this age group matches a large

portion of prostate cancer patients. Due to sheer volume of IMRT patients, each SBRT case was

compared to 2 IMRT cases along with 6, 12, and 24 month follow ups. 2 I think that an N of 1335

was acceptable when accessing this type of study. Treatment costs charged to Medicare were

calculated and toxicity concerns were assessed using claims submitted to Medicare. The

researchers used this data in a model that generated random effects to assess GU, GI, and other

toxicity issues which I thought was strange. I have a hard time with data generated with a model

rather than clinical records.

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The study found the mean treatment cost for SBRT to be $13,465 and $21,023 for IMRT

in prostate treatments. Increased levels of genitourinary toxicity were found in SBRT patients at

6 and 24 months and could be attributed to urinary incontinence/obstruction and urethritis. 2

Although the model may not present the most accurate of data, I think a clear trend is shown and

the data is believable as it is shown to be consistent at 3 different time points. The results portion

of the paper was detailed yet concise, containing figures and tables to support the statistical

origins and authenticity of the generated data. The discussion portion was effective in supporting

the results and putting them into perspective. The authors compare their data to established

reports and are transparent when touching on the limitations of their study, stating the potential

for improved SBRT methodology that could relieve some of the negative finding in this study.

The authors even went so far as to suggest that SBRT may be preferable to IMRT for the insurer

and patient in some cases.

This research analyzed a national sample of Medicare beneficiaries 66 years old and

older and allowed researchers to conclude that while SBRT treatments are cheaper, patients

experience an increased incidence of GU toxicity. The author is authentic in my opinion as he

strongly mentions a need for further studies in order to investigate whether or not there are

means to reduce these levels of toxicity while staying lower in cost than IMRT treatment. I was

impressed with the work done by the researchers and the ability of the author to transfer his

findings into an easy to understand format and use accurate and up-to-date references for his

work. The hypothesis, methods, data, discussion, and conclusion all flowed well together and

each subsection built upon the next to create a formal publication intended for an audience of

professionals, academics, and researchers.1

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Sources

1. Hunzeker A. Reading & writing in radiation therapy & medical dosimetry. [SoftChalk].

La Crosse, WI: UW-L Medical Dosimetry Program; 2018.

2. Yu JB, Cramer LD, Herrin J, Soulos PR, Potosky AL, Gross CP. Stereotactic Body

Radiation Therapy Versus Intensity-Modulated Radiation Therapy for Prostate Cancer:

Comparison of Toxicity. Journal of Clinical Oncology.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986382/. Published April 20, 2014.

Accessed January 31, 2018.