Proceedings of the 52nd Annual ASTRO Meeting S575

dose (BED) is high in the target volume, with low dose outside the target volume and small side effect. The overall survival rates of1-, 2-, 3-year to patients with stage I - II NSCLC were 88%, 78% and 78%. One case of grade III radiation pneumonitis was observed.The overall survival rates of 1-, 2-, 3-, 4-, 5-year to patients with stage I - II liver cancer were 83%, 75%, 58%, 42% and 34%respectively. No liver function damaged was observed during treatment. The grade I - II liver damage was 14%, and 4% with gradeIII. The overall survival rates of 1-, 2-, 3-, 4-, 5-year to patients with stage I and II pancreatic cancer were 68%, 34%, 30%, 21%, and17% respectively. The grade I and II gastrointestinal late reaction rate was 9%, and 3% with grade III.

Conclusions: The highly focused, hypofractional g-ray SBRT resulted in promising local control and survival rate with minimaltoxicity in the treatment of solid organ malignancies, including lung cancer, hepatocarcinoma and pancreatic carcinoma. As a safeand effective radiotherapy technique, it is worthy of being studied and applicated.

Author Disclosure: T. Xia, None; H. Li, None; J. Wang, None; Y. Wang, None; P. Li, None; D. Chang, None; J. Wang, None; W.Wu, None.

2831 The Negative Impact of Stark Law Exemptions on Graduate Medical Education and Health Care Costs:

The Example of Radiation Oncology

M. S. Anscher1, B. M. Anscher2, C. J. Bradley3

1Virginia Commonwealth University Medical Center, Richmond, VA, 2Private Practice, Berkeley, CA, 3Virginia CommonwealthUniversity School of Medicine, Richmond, VA

Purpose/Objective(s): To determine the impact of ownership of radiation oncology facilities by non-radiation oncologists on ra-diation oncology training programs, and to review the literature to determine potential impact of these business arrangements onutilization of radiation oncology services.

Materials/Methods: A survey was designed and emailed to directors of all 81 US radiation oncology training programs in thiscountry. Also, the literature was reviewed to determine the impact that these business arrangements may have on patient careand health care costs. The situation as it pertains to prostate cancer is used to illustrate the primary findings.

Results: Ownership of radiation oncology facilities by non-radiation oncologists is a widespread phenomenon. More than 50% ofsurvey respondents reported the existence of these arrangements in their communities, with a resultant reduction in patient volumesat local academic centers 87% of the time. Twenty-seven percent of programs in communities with these business arrangementsreported a negative impact on residency training as a result of decreased referrals to their centers. In addition, review of the literaturesuggests that ownership of radiation oncology facilities by non-radiation oncologists is associated with both increased utilizationand increased costs, but does not increase access to services in traditionally underserved areas.

Conclusions: Ownership of radiation oncology facilities by non-radiation oncologists appear to negatively impact on residencytraining by shifting patients away from training programs. Although driven by other specialties, these facilities cannot exist withoutthe cooperation of the radiation oncology community. In addition, the literature supports the conclusion that self-referral results inoverutilization of expensive services without a benefit to patients. As a result of these findings, recommendations are made to fur-ther study these issues, and to insure that patients are made aware of financial arrangements that may place their interests in conflictwith their physician’s financial interests.

Author Disclosure: M.S. Anscher, Celsion, B. Research Grant; BioProtect, B. Research Grant; CivaTech, F. Consultant/AdvisoryBoard; B.M. Anscher, None; C.J. Bradley, None.

2832 Patterns of Referral for Stereotactic Radiosurgery for Patients with Brain Metastases in Alberta, Canada

B. L. Brunet1, C. Newcomb2, H. Lau2, P. Craighead2, B. Danielson1

1Cross Cancer Institute, Edmonton, AB, Canada, 2Tom Baker Cancer Centre, Calgary, AB, Canada

Purpose/Objective(s): The Alberta Radiosurgery Centre (ARC) is located in Calgary, and is the only stereotactic radiosurgery(SRS) facility in the province of Alberta, Canada. Our study reviewed the referral patterns and characteristics of brain metastasespatients referred to ARC from 2000 to 2009.

Materials/Methods: Information on brain metastases patients referred for SRS was obtained from the ARC database, which cap-tured basic demographic, referral, and treatment information on patients assessed between January 1, 2000 and August 31, 2009.Additional information was obtained by review of Electronic Medical Records to verify and complete data elements. Descriptivestatistical methods were used to evaluate the data, and a geographical information program (BatchGeocode) was used to calculatedistance from patient residence to ARC using postal code information and Google Maps� travel distance algorithm.

Results: Three hundred ninety-three patients accounted for 437 brain metastases referrals to ARC. The most common primarycancers, comprising 90% of referrals, were lung, breast, melanoma, renal, and colorectal. Eighty-two percent of referrals receivedwhole brain radiotherapy as part of their treatment. Of the WBRT treatments, 71.5% were performed in Calgary, 28% in Edmonton(the only other cancer centre in Alberta with radiotherapy facilities during this time period), and 0.5% outside Alberta. The year2000 had only 7 recorded referrals, while the first 8 months of 2009 saw 72 referrals. Between 2000 and 2008, the average yearlyincrease in referrals was 42%. Calgary physicians accounted for 69% of referrals, while Edmonton physicians accounted for only29%, and 2% were from other physicians. Almost half (46%) of referred patients were from Calgary, only 15% from Edmonton,36% from other Alberta locations, and 3% from outside Alberta. Fifty percent of patients referred lived within 25 miles of ARC.Sixty-eight percent of referrals lead to consultation, and 75% of consults resulted in treatment. Poor patient performance status wasthe most common reason why SRS was not performed.

Conclusions: The ARC facility has seen a rapid progression in volumes of referrals over almost 10 years. However, most referralsare Calgary-area residents, with half of referred patients living in close proximity to ARC. As well, the majority of referrals weremade by Calgary-area physicians. Increased awareness of the ARC program and referral process may improve access to SRS forbrain metastases patients across Alberta.

Author Disclosure: B.L. Brunet, None; C. Newcomb, None; H. Lau, None; P. Craighead, None; B. Danielson, None.