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There is data for LDRT in animals for autoimmune gastritis?
I hope not in cows, they have multiple cavities.
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I hope not in cows, they have multiple cavities.
CAR-T for autoimmune gastritis? WOW
so you're saying I'd have to p2p a multi iso request to treat a cow?
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ADAPTIVE multi-stomach-cavity LDRT for autoimmune gastritis in cows.
With mri guided protons
I've talked to a vet rad onc about this! IBD in cats, apparently its a thing. There is some research in dogs. As far as I know LDRT is not a first line treatment for either.
I thought they said it was 1 Gy x1, but don't quote me on that.
It's the latest hype
One woman, three autoimmune diseases: CAR-T therapy vanquishes ultra-rare disease trio
Fourteen months after treatment with engineered immune cells, the recipient has no symptoms and doesn’t need to take medication.
www.nature.com
PROTON FACILITY: "Oh. Oh. Oh. Let's put bolus on all the postmastectomy photon patients and none on the proton patients!" Everyone in the room cheers! "And let's put Mepilex on more of our patients too!" More cheers!!!
I heard the quad shot summary but didn’t realize that. Eek.
Have heard stories from proton radiation therapists about having to switch to photons halfway through treatment because of dermatitis
Funny enough a lot of inside baseball proton stories are kind of “We have fixed making the protons not more toxic than photons”
Only in rad onc do we take:
and present it like we just split the atom again.
Translation: our multi-vault, block-size cyclotron can reproduce the skin toxicity profile of the old cobalt machine in the abandoned basement that grad students use to irradiate mice. Strong work.
Also, I love the casual use of “XRT” here, as if IMPT is not also external beam radiation therapy. Protons get boutique modality branding; photons get tossed into the chart-note junk drawer with “patient received XRT in 2004.” Very elegant rhetorical laundering.
And “skin as an OAR” in PMRT is doing heroic labor. Skin is not the cochlea. It is not the optic nerve. In chest wall radiation, skin is often target-adjacent, sometimes target-relevant, and occasionally something we deliberately dose because cancer biology remains annoyingly real.
The actual headline is not “IMPT reduces dermatitis.” It is comparable rates. Comparable.
With protons. After special optimization. For skin.
Keep up the strong work ASTRO!
and present it like we just split the atom again.
Translation: our multi-vault, block-size cyclotron can reproduce the skin toxicity profile of the old cobalt machine in the abandoned basement that grad students use to irradiate mice. Strong work.
Also, I love the casual use of “XRT” here, as if IMPT is not also external beam radiation therapy. Protons get boutique modality branding; photons get tossed into the chart-note junk drawer with “patient received XRT in 2004.” Very elegant rhetorical laundering.
And “skin as an OAR” in PMRT is doing heroic labor. Skin is not the cochlea. It is not the optic nerve. In chest wall radiation, skin is often target-adjacent, sometimes target-relevant, and occasionally something we deliberately dose because cancer biology remains annoyingly real.
The actual headline is not “IMPT reduces dermatitis.” It is comparable rates. Comparable.
With protons. After special optimization. For skin.
Keep up the strong work ASTRO!
Depending on how severe it is and the side effect profile of existing therapies, I think it is very reasonable to consider ldrt experimentally. Never hear of 2 gy x 2 causing side effect for malt. Why not try it?
Because usually one tries the „standard“ therapies first?
Would you also try 6 x 0.5 Gy heart-RT for a virus induced myocarditis? I mean that‘s an inflammatory condition too, right?
“Godd*mmit, I'd p*ss on a spark plug if I thought it'd do any good”
- Gen. Beringer, ‘WarGames’
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Now, at the same time, about 98% of the population lives within 50 miles of a linac. (Previous recent IJROBP article I'm too lazy to look up.)
However, the real concerning part here to me is that increasing center closures can probably not correlate with an increasingly healthy rad onc job market. But I could be wrong.
FletchersGarb
Full Member
An Ortho RadOnc! Very refreshing to see
Where is radiology oncology!?
Doximity also only does “Oncology” as a specialty, lumping together rad and heme oncs. There’s like 5x as many of them.
No they don’t. That’s medscape. Doximity has radiation oncology separately
Sorry I meant to say medscape. The person I was responding to listed medscape’s breakdown. Idk why I said doximity.
Is that true? I always assumed in those surveys we'd be lumped in with radiology.
don't forget motion management planning and delivery for 77293 and 77412 eligibility
I almost certainly got into med school and radonc residency due to having a PhD with associated publications.
However, this is an insane metric IMO. I wonder what percentage of these publications contribute to medical insight? The number of publications at the top of the list is huge.
My experience with med stud research made me convinced that, overwhelmingly, it demonstrates one thing: commitment to career (not to job performance). It's as though med students are part of the mechanism for bringing marginal publications to fruition and padding the CVs of their mentors...as well as those publications being the currency for personalized advocacy in the network of doctors that matter.
Glad the radonc number is not among the top echelon any longer. It was stupid. It did not advance our field (nor are all those neurosurgery med student pubs).
I'm sure the new crop of residents is more than good enough.
I absolutely hated playing the "oh of course I love research and want to be just like you when I grow up, Mr. Academic Doctor!" game but it had to be done. Such nonsense they still make people play it.
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I actually think it’s smart in some ways. In a small field like ours, research does tend to drive it (lately driving it into the ground with a lot of these 2 v 3 fraction bs trials, etc). But at one point, we actually did do meaningful research.
So if you actually want to produce researchers, are you going to look for it in a room full of people that say they want to be researchers or a room full of people that don’t? Even if half of the room of people saying they want to be researchers are lying, the number of actual researchers you get in the end are going to be higher.
So, mathematically, if people tell the truth, you get the same number of researchers. I get what you mean, but it sets up a phoniness of motives and interests in the tender years, at 26 or whatever and then over the years you keep justifying little dishonesties. I don’t like it. I wish I had been true to myself. My real goal at the time - “bring academic level of care to the community”. It’s as honorable as wanting to do research, IMO.
Residency competitiveness used to be determined primarily by step scores and class rank/AOA.
Now step 1 scores are no longer released, and many schools no longer grade their students.
Without these metrics to filter applications and judge applications, more residencies are using number of publications as a metric.
Now step 1 scores are no longer released, and many schools no longer grade their students.
Without these metrics to filter applications and judge applications, more residencies are using number of publications as a metric.
"No longer grade their students" wow I was not aware of that.
I think this is the rub.
I don't begrudge academia for wanting to perpetuate itself, although it would be nice if any given generation thought a little bit about pyramids of opportunity, staying too long and the diminishing opportunities for their academic progeny. Diminished academic opportunity (not including non-academic, academic jobs, which are abundant in radonc) is the rule across almost all disciplines. Becoming an English Professor used to be a reasonable aspiration for the bright and motivated.
I'm not an academic, but I love academia in principle. Anything that is a little less strictly financially transactional is a little bit more human IMO.
It's the sheer number of publications that drives me crazy. It is very hard to do original research or support original ideas IMO, and these are not standards for publications in clinical medicine. I could never bring myself to grind out retrospective publications, much less travel away from family for research opportunities. Admittedly, I have the arrogance of the failure.
I think it's just me being wistful, but our successful colleagues over 60, many of whom developed real, substantial research programs, never had to treadmill pubs like this early in their careers. They were learning, failing and publishing rarely until they got opportunities to have other people work for them. I think you bring along better thinkers this way.
I suspect at some point, meritocracy works against innovation.
4 pubs coming into residency is a lot. Good for these kids.
Plenty of med schools have been like this for decades now, no? At least when I was in school it was already pass/fail for everything, clerkships included. Step 1 was always the great differentiator. Taking that score away has been more detrimental than taking away grades in my opinion.
Academics is structurally unsound in many ways. It is not unlike a medieval society with lords and serfs and you work on the lord’s land. NIH dollars are limited and under attack or subversion by successive administrations. Trendy science is rewarded, and old PI’s also rewarded.
None of that is relevant to me anymore. What does affect community rad onc’s is the fact that most academic hospitals hide behind a veneer of academics so they can charge their elevated rates or hold PPSE status, but they have no accountability for actually producing science or research that improves the field. Instead they engage in hospital system satellite monolith empire building, driving up costs for society and patients, and driving down physician reimbursement and autonomy.
None of that is relevant to me anymore. What does affect community rad onc’s is the fact that most academic hospitals hide behind a veneer of academics so they can charge their elevated rates or hold PPSE status, but they have no accountability for actually producing science or research that improves the field. Instead they engage in hospital system satellite monolith empire building, driving up costs for society and patients, and driving down physician reimbursement and autonomy.
The priorities of the average academic rad onc department are (in order of priority):
1. Revenue
2. Loyalty
3. Prestige
Research is performed when:
1. It is not in conflict with clinical revenue
2. It is in alignment with departmental and institutional priorities
3. It increases prestige with the goal of increasing number of patients
NIH dollars are not enough to support most research programs, and have not been for a long time. Research programs are largely supported with philanthropy and diverted clinical revenue.
The above does not necessarily apply to drug development research that can create huge revenues through patents if successful (though the vast majority fail) and pharma-supported research that is lucrative to the institution.
What exactly is so special about step 1 that doesn’t make step 2 just serve as its obvious replacement?
And IMO, step 2 is a much better exam. Step 1 was almost entirely just memorization. Step 2 actually required clinical application.
Wonder when the last time Vinay Prasad wrote chemo orders?
6. Don't take advice from any oncologist who doesn't know the difference between "to radiate" and "to irradiate."
Or an oncologist that spends more time posting on social media than actually seeing patients
This isn't a personal attack on anyone in particular, but I've been seeing this more often
The ones doling out the public advice aren't the ones actually in the trenches doing work
yeah there’s a lot of that, it does seem like many of the RadOncs that are vocal are higher volume docs
RadiumGrrrl
New Member
Very little. Unless med students were a part of a lab most of the research are literature reviews and meta analysis to varying qualities of “ok” to “how is this indexed by pubmed?” Some good ones exist, I’m sure, but they’re not the ones with a millions pubs.
I feel bad btw that anyone feels like they need to do research to check a box to be competitive(haven’t looked at reports and don’t know much about residency apps)
There’s money machines like Med School Insiders showing students how to reuse the same project to have different sounding abstracts. Yes that this technically is a “publication” even if your poster is not a peer reviewed paper. Their success stories included stereotypical premeds and med students who had more output than mdphd applicants with several research gap years 😭
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Did you forget that we ran trials of whole lung irradiation for COVID pneumonitis? which were positive btw....
(https://www.sciencedirect.com/science/article/pii/S0167814021090721)
So yes, I'd try heart-RT
Wow, that COVID study ... not sure that's the one to want to hang hat on
0.5 Gy x 1 as intervention.
34 patients vs 17 patients. No biomarker differences. No blinding.
From study: "It utilized a 2:1 allocation ratio for statistical comparison between the intervention and control group. Although this is scientifically not validated, this allocation has been selected for better patient recruitment and gathering additional safety profile of LDRT."
And then the control arm was, to put colloquially, "whatever". I.e. - "Remdesivir, tocilizumab, Pirfenidone, Vitamin C and zinc were used for patients in both groups in addition to ‘standard pharmacologic treatment’ according to physician’s discretion. Notably, there were several revisions to guidelines about the best use of these pharmacological drugs throughout the duration in which this trial was conducted. This had resulted in varying number of patients receiving these drugs between the two groups and some patients not receiving the drugs, which may have influenced the outcome."
Funny, I had really put COVID behind me, and now we are got this study and the show trials in Congress right now. Imma throw on "Folklore" for old times sake.
0.5 Gy x 1 as intervention.
34 patients vs 17 patients. No biomarker differences. No blinding.
From study: "It utilized a 2:1 allocation ratio for statistical comparison between the intervention and control group. Although this is scientifically not validated, this allocation has been selected for better patient recruitment and gathering additional safety profile of LDRT."
And then the control arm was, to put colloquially, "whatever". I.e. - "Remdesivir, tocilizumab, Pirfenidone, Vitamin C and zinc were used for patients in both groups in addition to ‘standard pharmacologic treatment’ according to physician’s discretion. Notably, there were several revisions to guidelines about the best use of these pharmacological drugs throughout the duration in which this trial was conducted. This had resulted in varying number of patients receiving these drugs between the two groups and some patients not receiving the drugs, which may have influenced the outcome."
Funny, I had really put COVID behind me, and now we are got this study and the show trials in Congress right now. Imma throw on "Folklore" for old times sake.
LDRT for pneumonia was certainly a part of treatment paradigms prior to antibiotics. Although the COVID LDRT trials were lackluster, they at least brought a part of radiation history into modern times that I knew nothing about pre COVID.
pmc.ncbi.nlm.nih.gov
How Radiotherapy Was Historically Used To Treat Pneumonia: Could It Be Useful Today? - PMC
X-ray therapy was used to treat pneumonia during the first half of the 20th century. Fifteen studies report that approximately 700 cases of bacterial (lobar and bronchopneumonia), sulfanilamide non-responsive, interstitial, and atypical pneumonia ...
pmc.ncbi.nlm.nih.gov
More positive than half the systemic therapy trials that yield billion dollar drug portfolios....
