CROSS also included 25% SCC...
Depends on the protocol. Some preop trials put in strict cuff off criteria for the last couple doses to avoid “interfering with surgery” (like holding for Plts < 100). I haven’t seen this protocol, but I suspect they may have done that. It’s always hard to know what to make from these tiny snipettes.
x.com
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Whole discussion thread about it:x.com
RTOG 0848 results presented. DFS advantage for addition of chemoRT to chemo in resected pancreas patients. 20% absolute survival advantage in N0 patients at 5 years. No mFOLFIRINOX, but that's too large of a signal to ignore.
forums.studentdoctor.net
I would call this "cutting edge".x.com
So…cut off your leg with a butter knife instead of a spoon? I won’t give a long winded answer but the only compelling role for anything “elective” in pancreatic is PNI and 30 ain’t enough.
Oops…definitely. I clicked the wrong link. Ignore me and carry on!
Wouldn’t surprise me if some proton grifters insisted on pegs for all the imrt pts.
I have not seen the protocol and maybe they did, but I feel like a legitimate proton/photon study should be legit blinded. Overseeing physician submits and approves a photon and proton plan for every patient and doesn’t know which one gets used. The department then has a designated unblinded rad onc (or 2) to review imaging and manage treatment related technical issues which require a broken blind. It’s the only way I can really trust any toxicity related data. It’s so subjective. Just blinding the study member who collects CTCAE data is not enough in my mind. No one would ever accept an unblinded randomized trial of RT +|- a small molecule radioprotector.
pubmed.ncbi.nlm.nih.gov
It will be interesting how to integrate into real practice (not 60 y/o non-smokers) for whom q3 week cis is often not given.MSKCC published their experience with 30 Gy elective, not on trial though.
Evaluation of Substantial Reduction in Elective Radiotherapy Dose and Field in Patients With Human Papillomavirus-Associated Oropharyngeal Carcinoma Treated With Definitive Chemoradiotherapy - PubMed
This cohort study found that the evaluated de-escalation strategy for elective regions showed favorable clinical outcomes and QOL profiles. Long-term follow-up data will help affirm the efficacy of this strategy as a care option for treating HPV-associated OPC with primary CCRT.
I have never seen q3 given in the community. Ever.
True, and would be tolerated much better. I let my medoncs know about this exploratory data, and we're all excited and hope the confirmatory Phase III works out.
Less common now but definitely a few years ago. Pretty good predictor of needing a treatment break or them ending up in the hospital and getting a forced treatment break
Trial was multi-institutional phase 3. It included academic and community sites, I believe 17 places. It isn’t just MD Anderson. We can make the “these hands” argument or we can believe the data. People wanted “data”. They got a trial showing non-inferiority and less PEG tubes.
It would be very difficult to double blind this. The machines look different. Most places have the proton center separate to some extent from the photon linacs. There is proton center signs everywhere. Maybe the staff even have different badges. Patients might enter through separate entrances. On the physician side also quite hard. Is it possible? Sure? Is it practical? Doubtful
Agreed ph3 should be the next step not immediately call it a new SOC. Although lets put our anal cancer hat on for giggles, wasnt IMRT roled out based on 0529 phase 2? Hmmmm.
Moving from 3D to IMRT in anal cancer isn't nearly as much of a leap as going from 70 Gy to 30 Gy though
Oh i totally agree in regards to that. I think the “descalation” crowd in oropharynx needs to address what happened with HN005 arm. It was stopped and I havent seen a word about it. Yet at the same time there are people arguing that 30 gy can be rolled out for ENI based on MSK data. Im super skeptical of this for now. My comment was in regards to comments that Frank HN IMPT trial is a new SOC. I don't believe it is currently although I’m surprised that argument isn’t being made more forcefully by him. Fact is anal cancer IMRT was declared a SOC in a phase 2. Sure subsequent studies also had IMRT. Time C/RTOG 1203 was a phase 3 in cervix. The frank study is a phase 3, just checked. He could run a larger phase 3 specifically looking at the PEG endpoint. However, I suspect it will never be enough for some. I have said this before on here, some people will always poo poo proton trials.
I wouldn’t downplay needing a PEG. That can be a fairly life altering, traumatic thing for patients even though it is reversible in most. Swallowing outcomes and recovery is worst with PEG tubes because people don’t use their swallowing muscles as much. There are also other healthcare costs associated with it like feeding tube supplies, the feeding tube liquid (nutren 1-1.5, etc), speech therapy, multiple swallowing studies. Many of the community folks here treat plenty of head and neck and it isn't only an academic thing.
No one can address the HN005 data bc hasn't been released yet. After closing 60/cis the other two arms completed ph2 accrual in Nov 23. Imagine there will be an abstract within the next year everyone can pick over.
inpatient admissions for infections, leaks, breaks in tx etc
Furthermore, the data for mortality in PEG tube placement is higher than people think
Let’s not get carried away. PEG placement in our (ambulatory) patients is not associated with this level of mortality. Not to say it can’t be morbid (and painful). PEG placed in the hospital setting is of course going to be associated with high mortality.
I understand your point and I have not seen it but do a literature search and you will see those numbers which is a wide range of mortality (not immediate always, but as a result of complications).“These hands” arguments are always there and they will always be made. Peg complications? need for a feeding tube? Death from TORS? Not in these hands!
