Radonc90

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I want to talk about (hopefully positive stuff) on ASTRO 2020 meeting.
- How you feel about the meeting.
- Tricks/Tips to navigate the website.
- Important break-through data that is potentially practice-changing.
- Any odds/ends you want to discuss are fine.

- If you can avoid politics, it'd be great...

----
So, I am using 2 separate websites:
#1. ASTRO 2020
#2. 2020 ASTRO Annual Meeting

I have a few thoughts:

1. If you like chronological format, then use the link #1 posted above.
Events are listed in location/chronological order.
Although I have to say that most of the talks are pre-recorded, so you simply listen to it like watching youtube videos.
You don't have much opportunity to ask questions.
In a way, it is very impersonal. It is nobody's fault, basically the way it is for a virtual meeting.

I may be wrong (someone please correct me), but there are very few LIVE meetings where you can Zoom in...

2. Sure, this is not a real physical meeting where you run into some old friends (such as Chicago 2019 meeting)
and just run out of the meeting into a local cafe to talk and have fun.
ASTRO should create something like that using a Zoom format so we can connect with some old friends on Zoom.

3. A main part of the meeting is to interact and ask questions LIVE.
The LIVE part is mostly missing in a virtual meeting.
As an analogy, there is a BIG difference watching a symphony live vs watching the same orchestra pre-recorded music on youtube.


What do you guys/girls think?
 
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OTN

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One trend I'm thus far noticing:

Bone mets?!? This patient needs SBRT!

And a referral to an SBRT specialist, right? Because SBRT to the spine is supposed to be hard??

I like Dr. Palma. I really do. He’s done good work. I’m sure he’s a very competent clinician. I just for the life of me have no idea why getting an MRI and treating a spinal met with SBRT should be considered complex AND require referral to yet another radonc.
 

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RickyScott

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And a referral to an SBRT specialist, right? Because SBRT to the spine is supposed to be hard??

I like Dr. Palma. I really do. He’s done good work. I’m sure he’s a very competent clinician. I just for the life of me have no idea why getting an MRI and treating a spinal met with SBRT should be considered complex AND require referral to yet another radonc.
There may be no such thing as a radonc generalist in a major Canadian city with only 2 radonc centers. In USA, it would be academic narcissism.
 
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MegaVoltagePhoton

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And a referral to an SBRT specialist, right? Because SBRT to the spine is supposed to be hard??

I like Dr. Palma. I really do. He’s done good work. I’m sure he’s a very competent clinician. I just for the life of me have no idea why getting an MRI and treating a spinal met with SBRT should be considered complex AND require referral to yet another radonc.

dude. Can there be more complaining? Sbrt is a Financial win. God damn this Place is schizophrenic about this stuff.
 
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deleted605854

There may be no such thing as a radonc generalist in a major Canadian city with only 2 radonc centers. In USA, it would be academic narcissism.

There are no rad onc generalists in any academic hospitals in Canada. They're all hyper-specialized. Even community centers are starting to become the same way.

Palma is a standup guy and generally liked by his peers and his patients, but he has beliefs about the practice of rad onc that would not be welcome in the US.
 
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Radonc90

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I liked the basic science stuff, great jobs by the current radoncs that do bench research.
The SBRT 2-fraction stuff is good too.

The "Equal opportunity CHEDI and anti-racist stuff"...I don't care for bc I was brought up to treat everyone equal,
no matter of gender, sex, religion, skin color etc. That works out great in medicine bc I treat all patients the same.

Ditto for trainees (residents, med students)...they are all treated equally and with respect.

I fully understand why ASTRO does this CHEDI stuff...
 
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deleted605854

I liked the basic science stuff, great jobs by the current radoncs that do bench research.
The SBRT 2-fraction stuff is good too.

The "Equal opportunity CHEDI and anti-racist stuff"...I don't care for bc I was brought up to treat everyone equal,
no matter of gender, sex, religion, skin color etc. That works out great in medicine bc I treat all patients the same.

Ditto for trainees (residents, med students)...they are all treated equally and with respect.

I fully understand why ASTRO does this CHEDI stuff...

Agreed.

The CHEDI stuff is working as far as ASTRO is concerned! As evidenced by my n=1 experience in meeting with some of the Candidates for this year.
 

OTN

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dude. Can there be more complaining? Sbrt is a Financial win. God damn this Place is schizophrenic about this stuff.

You misunderstood- I like the data and I like how it’s going to help patients, finances be damned. I just didn’t understand Dr. Palma’s tweet. Someone else explained how Canadian radoncs are hyperspecialized, which made sense.
 
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You guys/girls should watch the ASTRO Special Session 07: Grey Medal Winner Lester Peters, MD.
ASTRO screwed up typo, should be Gray (à la Louis Harold Gray), not Grey!!!

Nice review of the history of radiobiology:


"So then I says to him, look at this new paper that came out in 1960 by McCulloch and Till, have you seen it? I says, I bet your average clinical Radiation Oncologist will have to memorize this for a board exam! Yes, to practice medicine! Now, I know that doesn't really help out patient care in the slightest, but it'll be a gas to make those darn resident physicians memorize these things..."

- History of Radiation Biology, probably

(in all seriousness I will watch this later)
 

Radonc90

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So if you stop a radonc in the hallway and ask:

1. How do you spell Gy in full (is it Grey or Gray)?
2. What is his full name?
3. Who was he and what did he do?

I wonder how many radoncs out there can answer correctly w/o looking up Wikipedia lol...

This is should be a question in ABR OLA seriously...
History of the field is important!
 
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deleted605854

So if you stop a radonc in the hallway and ask:

1. How do you spell Gy in full (is it Grey or Gray)?
2. What is his full name?
3. Who was he and what did he do?

I wonder how many radoncs out there can answer correctly w/o looking up Wikipedia lol...

This is should be a question in ABR OLA seriously...
History of the field is important!

If the field becomes history then who benefits from knowing the history of the field ?
 
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So if you stop a radonc in the hallway and ask:

1. How do you spell Gy in full (is it Grey or Gray)?
2. What is his full name?
3. Who was he and what did he do?

I wonder how many radoncs out there can answer correctly w/o looking up Wikipedia lol...

This is should be a question in ABR OLA seriously...
History of the field is important!

Ah, the eternal question though - will knowing his full name help a patient in the slightest? There's no room for trivia after undergrad!

I love this stuff to death on a personal level but on a professional level there's no room for bar trivia.
 
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scarbrtj

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So if you stop a radonc in the hallway and ask:

1. How do you spell Gy in full (is it Grey or Gray)?
2. What is his full name?
3. Who was he and what did he do?

I wonder how many radoncs out there can answer correctly w/o looking up Wikipedia lol...

This is should be a question in ABR OLA seriously...
History of the field is important!
You spell it gray, never capitalized (like a newton e.g.) because it’s a derived SI unit. The Red Journal makes this mistake a lot surprisingly. Abbreviations are capitalized.

I’ll be over here in the corner. Don’t read SDN.


I’m a purist... I use rems.
Fun fact: the gauge next to the flux capacitor in the DeLorean reads in roentgens.
 
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FrostyHammer

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Was this thread meant to be about useful findings at ASTRO? I take it nothing since the spine SBRT trial.
Some blame on the pandemic, but this is exactly why I made zero effort to pay to virtually watch ASTRO this year. They gave me very little reason to.
 
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medgator

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MDACC SRS for brain mets trial also is somewhat useful, though I've been avoiding WBRT as much as possible for several years now.
Kinda hard to avoid imo when people come in with a ridiculous number of mets. Does anyone believe that wbrt actually kills people?
 
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OTN

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Kinda hard to avoid imo when people come in with a ridiculous number of mets. Does anyone believe that wbrt actually kills people?

Agree that with large-volume mets tough to avoid, and if you do give SRS the integral dose to the brain is close to that which you would give with WBRT.

WBRT certainly can cause toxicity, but agree never Grade 5.

EDIT: So, to wrap up ASTRO, we have 24 Gy in 2 fractions for spinal mets > 20 Gy in 5 fractions and SRS for 3-15 brain mets. Anything else significantly practice-changing? Bueller? Bueller?
 
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radiation

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Agree that with large-volume mets tough to avoid, and if you do give SRS the integral dose to the brain is close to that which you would give with WBRT.

WBRT certainly can cause toxicity, but agree never Grade 5.

EDIT: So, to wrap up ASTRO, we have 24 Gy in 2 fractions for spinal mets > 20 Gy in 5 fractions and SRS for 3-15 brain mets. Anything else significantly practice-changing? Bueller? Bueller?

The integral whole brain dose from SRS is almost always certainly going to be lower than whole brain for 99% of situations and its not even close. I have heard this multiple times from people but there are many dosimetric studies disproving this.

 
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medgator

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The integral whole brain dose from SRS is almost always certainly going to be lower than whole brain for 99% of situations and its not even close. I have heard this multiple times from people but there are many dosimetric studies disproving this.

Clinically meaningful difference?
 

OTN

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The integral whole brain dose from SRS is almost always certainly going to be lower than whole brain for 99% of situations and its not even close. I have heard this multiple times from people but there are many dosimetric studies disproving this.



That’s helpful. I can’t remember the study that did show a decent integral dose, but I stand corrected.
 

Radonc90

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Re: Music vs Anxiety.

ASTRO20: according to study from U Florida, music did not reduce pt's anxiety:

Back in ASTRO17: study from Lou Harrison's group showed music helped reduce anxiety:

Anyway, I still play music for pts (songs chosen by pt) during Tx per request...
 
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radiation

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Clinically meaningful difference?

Taking the whole brain from 30 gy to 9 gy or less is clinically meaningful, as evidenced by CC001. There are a couple of SRS vs. HA-WBRT trials now, we'll see the answer to that question in a couple years
 
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Neat idea and easily implementable in the clinic. Anyone already doing this?
 

RickyScott

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Neat idea and easily implementable in the clinic. Anyone already doing this?
Have been asking for fall off fo 75-80% 5 mm away from ptv into esophagus routinely. Imrt can fall off 4-5% per mm for most lung targets into esophagus without sig hot spots for targets that are a few hundred cc. Basically expand ptv by 5mm and countour a No 80% of the esophagus coaxially outside of this expansion. On some axial slices- when level 7 node involved- you can’t.
 
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Did I miss something or did they discretely change ASTRO 2021 to Chicago from San Diego? Probably a cheaper venue
 
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DoctwoB

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Future standard of care for xrt in high risk prostate? Seems like a comparable option to brachy boost though need to see a lot more detail on methodology. And in a big move for you guys only studied in the setting of conventional fractionation, though would be ironic if that comes down the pipe as APM does.
 
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Lamount

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Neat idea and easily implementable in the clinic. Anyone already doing this?

i don’t know exactly what he is doing, but in some cases I crop my PTV out of the esophagus and add back a 1-2 mm margin on CTV. It doesn’t make sense all the time. Other times, when esophagus dose is too high, I will use MCO and push on mean esophageal dose and sacrifice PTV coverage so long as CTV is maintained.

**edited to fix phrasing.
 
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Phantom1

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Future standard of care for xrt in high risk prostate? Seems like a comparable option to brachy boost though need to see a lot more detail on methodology. And in a big move for you guys only studied in the setting of conventional fractionation, though would be ironic if that comes down the pipe as APM does.

I think Integrated boosts to GTV only are really underutilized and might improve control rates in many disease sites...
 
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RickyScott

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I think Integrated boosts to GTV only are really underutilized and might improve control rates in many disease sites...
Typically based on fusion and biopsy, delineate a region to boost 3-4%. This study gives me a justification to go higher.
 

RickyScott

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i don’t know exactly what he is doing, but in some cases I crop my PTV out of the esophagus and add back a 1-2 mm margin on CTV. It doesn’t make sense all the time. Other times, when esophagus dose is too high, I will use MCO and push on mean esophageal dose and sacrifice PTV coverage so long as CTV is maintained.

**edited to fix phrasing.
End result is the same. It just involves paying attention to fall off and esophageal dose, not just putting check next to some dose constraint on a checklist.
 
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Radonc90

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Anyone here "going to #ESTRO20"?
The virtual registration is 600 Euros (non-ESTRO member).
 

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On some axial slices- when level 7 node involved- you can’t.
Precisely. Level 7 node involvement is the crucial point.
Trying to spare esophagus with Level 7 involvement is practically underdosing GTV (+margin).
 
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FreakFlag

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Anyone here "going to #ESTRO20"?
The virtual registration is 600 Euros (non-ESTRO member).

Nah. Attending virtual ESTRO seems impractical from the US, especially if they don't do a good job of recording everything (including Q&A after).

Most of Europe is 9 hours ahead of the West Coast and 6 hours ahead of the East Coast.

Any morning virtual live event at ESTRO, say 8am to 11am CET, would be happening around 2 to 4 am US hours.
 
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