ASTRO 2023

[yesmaster]

Radiation oncology research and clinical trial results to be featured at ASTRO’s Annual Meeting in San Diego - American Society for Radiation Oncology (ASTRO)

Press release to announce media highlights and news briefings at the 2023 ASTRO Annual Meeting

www.astro.org

The 2 studies that add something, DART and FASTRACK, are from Canada and Australia.

The 2 studies that subtract something (hypo-fx) are from America.

It’s not just a question of number of fractions, it just seems like the impactful work happens internationally.

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[RickyScott]

Imagine citing these 2 as part of your top 10.

• Abstract 122: “A precision medicine navigator can mitigate inequities associated with utilization of genomic tests in Black men with prostate cancer,” presented by Alexander Allen, MD, University of Maryland Medical Center
• 
  
• Abstract 4: “Association between regular vaginal dilation and/or sexual activity and long-term vaginal morbidity in cervical cancer survivors,” presented by Kathrin Kirchheiner, PhD, Medical University of Vienna

 

[BobbyHeenan]

Radiation oncology research and clinical trial results to be featured at ASTRO’s Annual Meeting in San Diego - American Society for Radiation Oncology (ASTRO)

Press release to announce media highlights and news briefings at the 2023 ASTRO Annual Meeting

www.astro.org

The 2 studies that add something, DART and FASTRACK, are from Canada and Australia.

The 2 studies that subtract something (hypo-fx) are from America.

It’s not just a question of number of fractions, it just seems like the impactful work happens internationally.

Palma, Siva, and Livi....if they were a Ryder cup team I'd be really worried about their skills vs. the U.S. team. We're talking game over on hole 11 of match play.

 

[deleted1111261]

Speaking of Astro …

Will have an event at Half Door Brewery in San Diego, 9/30 at 830p

Would love to see/meet you!

 

[fiji128]

Why do people even bother going to Astro at this point other then maybe some sort of social aspect. Almost nothing useful or interesting being presented anymore. I wonder what the attendance statics look like over the past 10 or so years.

 

[mheat3]

Palma, Siva, and Livi....if they were a Ryder cup team I'd be really worried about their skills vs. the U.S. team. We're talking game over on hole 11 of match play.

"9 & 8"

As the GOAT once said after obliterating Stephen Ames who thought he was beatable:

 

[metallica81788]

Why do people even bother going to Astro at this point other then maybe some sort of social aspect. Almost nothing useful or interesting being presented anymore. I wonder what the attendance statics look like over the past 10 or so years.

Employed jobs that give 1-2 weeks for CME and have restrictions on how it can be used
It's the only way they can use full allotted vacation time

 

[deleted1111261]

A lot of people do virtual cme and take the days off from home or make Vaca out of it

 

[sirspamalot]

Haven't been in years, won't go either. Not paying the jacked non-member rate. ACRO meetings at least you learn something valuable and have plenty of free dinners and friendly sociable private practice folks to hang with.

FASTRO?

Nah.. F ASTRO !

 

[yesmaster]

I prefer SoCal to SoFlo

 

[NotMattSpraker]

Why do people even bother going to Astro at this point other then maybe some sort of social aspect. Almost nothing useful or interesting being presented anymore. I wonder what the attendance statics look like over the past 10 or so years.

Its a convenient place to meet RO friends and talk to industry. Thats it.

San Diego is awesome and I expected everyone I know to be going. This is the year I learned that a fair number of people hate ASTRO more than they love San Diego

 

[Palex80]

Come over to Europe!

 

[medgator]

Its a convenient place to meet RO friends and talk to industry. Thats it.

San Diego is awesome and I expected everyone I know to be going. This is the year I learned that a fair number of people hate ASTRO more than they love San Diego

I'm guessing Miami Beach would have been epic a few years ago if covid hadn't happened

 

[fiji128]

A lot of people do virtual cme and take the days off from home or make Vaca out of it

This is my issue. 100% prefer this route for cme time off and can be done anywhere with no meeting to eat up my day either.

 

[medgator]

This is my issue. 100% prefer this route for cme time off and can be done anywhere with no meeting to eat up my day eithe

I'm with @Palex80 here, if I'm going to go a meeting and make a trip out of it, I'm not going to go to San Antonio for the 35486th time to see the river walk. Estro and esmo sound cool with interesting locations, generally

 

[madchemist89]

See yall in Glasgow next year.

 

[elementaryschooleconomics]

Its a convenient place to meet RO friends and talk to industry. Thats it.

San Diego is awesome and I expected everyone I know to be going. This is the year I learned that a fair number of people hate ASTRO more than they love San Diego

*raises hand*

I've been honest with the sales reps about that this year, haha:

"Dr ESE, are you going to ASTRO?"

"I don't believe in financially supporting that organization, sorry."

The way many of them react - as in, zero reaction - makes me think this isn't the first time they've heard that answer.

But I do get the sense that, after the past few years of flubs and missteps...ASTRO should consider taking some time alone to work on themselves...

 

[NotMattSpraker]

*raises hand*

I've been honest with the sales reps about that this year, haha:

"Dr ESE, are you going to ASTRO?"

"I don't believe in financially supporting that organization, sorry."

The way many of them react - as in, zero reaction - makes me think this isn't the first time they've heard that answer.

But I do get the sense that, after the past few years of flubs and missteps...ASTRO should consider taking some time alone to work on themselves...

Ha I'm not holding my breath. Do they even think its a misstep?

The president-elect said they are doing well financially and their 990s agree. They are so ridiculous with their pricing I'd be surprised if they werent!

Chirag critiqued a number of things about the conference a year or two ago on Twitter and was accused of sexism. ASTRO continues to do those things because their goal is to make money and the conference is a huge portion of their income.

It is the most popular place to do initial interviews.

So many people just go because they have CME support and thats what Rad Oncs have always done.

They accept so many abstracts. SO MANY. It will remain an excellent choice for residents to submit their little required research projects.

I do not know a single person that thinks its a good scientific conference, but it remains the best Rad Onc networking event.

I will admit that I wont be registering, but will continue to travel to town when it is good cities so I can see friends and have meetings.

 

[thesauce]

Astro gets worse every year

 

[radoncle]

Ha I'm not holding my breath. Do they even think its a misstep?

The president-elect said they are doing well financially and their 990s agree. They are so ridiculous with their pricing I'd be surprised if they werent!

Chirag critiqued a number of things about the conference a year or two ago on Twitter and was accused of sexism. ASTRO continues to do those things because their goal is to make money and the conference is a huge portion of their income.

It is the most popular place to do initial interviews.

So many people just go because they have CME support and thats what Rad Oncs have always done.

They accept so many abstracts. SO MANY. It will remain an excellent choice for residents to submit their little required research projects.

I do not know a single person that thinks its a good scientific conference, but it remains the best Rad Onc networking event.

I will admit that I wont be registering, but will continue to travel to town when it is good cities so I can see friends and have meetings.

With respect to the numerous job postings pre-Astro, would it be beneficial to discuss the job postings currently being advertised? I think many of us are aware of many land mines currently posted on the career page. Could we help future unsuspecting potential victims by outing some of these places or conversely help by discussing some good opportunities (should any fit that description)? I’ve always wondered why hellpit jobs are not discussed more openly.

 

[SneakyBooger]

Were representatives from SDN Rad Onc invited to give a lecture?

I would sign up for that.

 

[fiji128]

With respect to the numerous job postings pre-Astro, would it be beneficial to discuss the job postings currently being advertised? I think many of us are aware of many land mines currently posted on the career page. Could we help future unsuspecting potential victims by outing some of these places or conversely help by discussing some good opportunities (should any fit that description)? I’ve always wondered why hellpit jobs are not discussed more openly.

All the jobs from this month are posted on another thread, feel free to post any insights you may have.

Astro Career Center and "A Roadmap for Recruiting Medical Students into Radiation Oncology during a Period of Waning Interest"

Most medical students aren't stupid and consider their career prospects when deciding on what specialty to pursue. With Astro coming up this is typical the heart of the recruiting/hiring season. There are probably 190 residents finishing residency this year in addition to all those board...

forums.studentdoctor.net

 

[evilbooyaa]

Ha I'm not holding my breath. Do they even think its a misstep?

The president-elect said they are doing well financially and their 990s agree. They are so ridiculous with their pricing I'd be surprised if they werent!

Chirag critiqued a number of things about the conference a year or two ago on Twitter and was accused of sexism. ASTRO continues to do those things because their goal is to make money and the conference is a huge portion of their income.

It is the most popular place to do initial interviews.

So many people just go because they have CME support and thats what Rad Oncs have always done.

They accept so many abstracts. SO MANY. It will remain an excellent choice for residents to submit their little required research projects.

I do not know a single person that thinks its a good scientific conference, but it remains the best Rad Onc networking event.

I will admit that I wont be registering, but will continue to travel to town when it is good cities so I can see friends and have meetings.

The thought of going to the city it's in but not actually registering for the event itself is a strategy that I had not considered previously... will have to consider for future events.

At least it's in San Diego this year!

 

[drowsy12]

Chirag critiqued a number of things about the conference a year or two ago on Twitter and was accused of sexism.

thought this was about the red journal and sue yom, did he tweet about the conference?

 

[anonymuncule]

Pace-b on Monday

Press release

Higher doses of radiotherapy cut treatment time by up to 75 per cent in localised prostate cancer patients, while maintaining high cure rates

People with low to medium-risk, localised prostate cancer can be treated as effectively using fewer and higher doses of radiation therapy delivered over five treatment sessions as they can with lower doses delivered over several weeks, according to researchers from The Royal Marsden NHS...

www.icr.ac.uk

Abstract

ASTRO 2023 Annual Meeting

 

[DebtRising]

PACE-B is going to usher in widespread SBRT adoption, and that’s a good thing for patients.

PACE-B also highlights the absurdity of the continued training of record radiation oncology residents while research continues to show the societal benefit of less radiation. Both ASTRO and SCAROP know this while continuing to promote record resident class sizes.

There is no high level talk on the supply - demand projection that was published this year at the annual meeting. That is absurd, atrocious, and the surest sign of the lack of care our elders have for us. Incoming residents have hundreds of thousands of debt or input costs and years of specialized training allowing them to do nothing else for the next 30 years, and all trends point to them being superfluous.

At least in Emergency Medicine PE sold out the field, not their own core.

 

[yesmaster]

You could argue that the rad onc old guard are wannabe PE guys who plan a brain met SRS or go to a dean’s meeting once a quarter

 

[RickyScott]

Does anyone know where

You could argue that the rad onc old guard are wannabe PE guys who plan a brain met SRS or go to a dean’s meeting once a quarter

EM residency expansion was mostly driven by HCA. Our “old guard” have similar motives.

 

[medgator]

Does anyone know where

EM residency expansion was mostly driven by HCA. Our “old guard” have similar motives.

EM professional society came out against it with a strongly worded statement.

Different situation than rad onc which had no such response from ASTRO and was far more collusional in creating the problem and subsequently ignoring/denying it.

 

[communitydoc13]

PACE-B is going to usher in widespread SBRT adoption, and that’s a good thing for patients.

Gotta give the Brits credit, they publish comprehensive results, including raw data.

Every one of these ultra-hypofractionated (5 fraction down) regimens will show worse toxicity when the volumes are the same. The question is how much and whether avoiding this toxicity through additional fractions is worth it.

In the UK, where cost at a national scale is paramount, the cost of additional fractions will be deemed not worth it.

In the US, where the emphasis is on financial duty to self or institution, additional fractions will remain worth it for captive patients and hypofractionation will be a tool for recruiting distant patients or retaining patients.

I would personally not opt for SBRT prostate for me or five fraction whole breast for my wife.

 

[BobbyHeenan]

At 2 years as I recall sbrt had worse toxicity on PACE B. I guess it evened out at 5 year follow up?

?will have to wait on final publication?

 

[theradiator]

Gotta give the Brits credit, they publish comprehensive results, including raw data.

Every one of these ultra-hypofractionated (5 fraction down) regimens will show worse toxicity when the volumes are the same. The question is how much and whether avoiding this toxicity through additional fractions is worth it.

In the UK, where cost at a national scale is paramount, the cost of additional fractions will be deemed not worth it.

In the US, where the emphasis is on financial duty to self or institution, additional fractions will remain worth it for captive patients and hypofractionation will be a tool for recruiting distant patients or retaining patients.

I would personally not opt for SBRT prostate for me or five fraction whole breast for my wife.

The other thing about British data:

consistent 1% 5 year local failure for breast in all trials - how hard to British mammographers look for calcifications/DCIS?
95 to 96% 5 year biochemical control - juiced by infrequent yearly PSA testing

 

[RickyScott]

Just noticed that the theme for Astro is “pay it forward “

 

[Miles Gloriosus]

Pace-b on Monday

Press release

Higher doses of radiotherapy cut treatment time by up to 75 per cent in localised prostate cancer patients, while maintaining high cure rates

People with low to medium-risk, localised prostate cancer can be treated as effectively using fewer and higher doses of radiation therapy delivered over five treatment sessions as they can with lower doses delivered over several weeks, according to researchers from The Royal Marsden NHS...

www.icr.ac.uk

Abstract

ASTRO 2023 Annual Meeting

Prostate cancer trial: Radiotherapy doses can be cut safely

Experts say the findings could lead to "enormous change" in the way the treatment is delivered.

www.bbc.co.uk

 

[elementaryschooleconomics]

Prostate cancer trial: Radiotherapy doses can be cut safely

Experts say the findings could lead to "enormous change" in the way the treatment is delivered.

www.bbc.co.uk

Wow, that headline is HILARIOUS when contrasted with this recent post:

ASTRO: "We had a board meeting where we agreed to have more meetings to talk about why all of our efforts to minimize radiation over the years is being noticed, and we assigned ourselves a catering budget for these meetings. Please don't ask us about the key performance metrics for the outcomes of these meetings, that's bullying."

 

[BobbyHeenan]

At 2 years as I recall sbrt had worse toxicity on PACE B. I guess it evened out at 5 year follow up?

?will have to wait on final publication?

? Are they going to report cumulative incidence of toxicity events?

 

[communitydoc13]

? Are they going to report cumulative incidence of toxicity events?

Well right there in the press release 5.5% vs 3.2% Grade 2 or higher at 5 years. This of course is not the headline.

 

[anonymuncule]

? Are they going to report cumulative incidence of toxicity events?

Apparently yes

 

[RadOncBeamer]

So from the 2022 publication, 2 year CTCAE g2+ tox nearly double, bladder QoL worse at 2 years. At 5 years the statistical significance washes out but the signal is still clearly there with a persistent near doubling of g2+ tox. Agree that with a larger sample size this would likely be significant. Somehow this will be spun as a win for sbrt. Not sure that I agree, nor will I be offering this as my default option.

 

[levels]

Prostate cancer trial: Radiotherapy doses can be cut safely

Experts say the findings could lead to "enormous change" in the way the treatment is delivered.

www.bbc.co.uk

brb, explaining BED to the masses

 

[Ray D. Ayshun]

So from the 2022 publication, 2 year CTCAE g2+ tox nearly double, bladder QoL worse at 2 years. At 5 years the statistical significance washes out but the signal is still clearly there with a persistent near doubling of g2+ tox. Agree that with a larger sample size this would likely be significant. Somehow this will be spun as a win for sbrt. Not sure that I agree, nor will I be offering this as my default option.

Yes, saying 5 yr toxicity data trumps 2 yr toxicity data is like saying we're all gonna die anyway.

 

[RadOncDoc21]

Yes, saying 5 yr toxicity data trumps 2 yr toxicity data is like saying we're all gonna die anyway.

I’m hopeful I’ll beat the odds… I started adding more turmeric to my diet!

 

[RickyScott]

Not sure I undestand: for 5 yr toxicity, do they mean toxicity being experienced at the exact moment in time? , ie pt could have had rectal bleeding at 4 yrs that resolved, and this woldnt count?

 

[BobbyHeenan]

Not sure I undestand: for 5 yr toxicity, do they mean toxicity being experienced at the exact moment in time? , ie pt could have had rectal bleeding at 4 yrs that resolved, and this woldnt count?

Agree. Looking for clarity .

 

[drowsy12]

It appears to be cumulative incidence. That means that at some point in the 5 years after treatment, 3.2 percent of patients in the standard treatment arm had a grade 2 or higher GU late toxicity and 5.5% in the SBRT arm.

My thoughts:

1) Those numbers are very similar, especially when considering this is grade 2+ tox. I would like to see the grade 3+ late toxicity numbers, but expecting it to be low, around 1% like other SBRT studies.
2) No one has to do SBRT if they don't want to, but this data shows it's a pretty darn safe treatment. Lots of good options exist for prostate RT, clearly.

 

[Ray D. Ayshun]

It appears to be cumulative incidence. That means that at some point in the 5 years after treatment, 3.2 percent of patients in the standard treatment arm had a grade 2 or higher GU late toxicity and 5.5% in the SBRT arm.

My thoughts:

1) Those numbers are very similar, especially when considering this is grade 2+ tox. I would like to see the grade 3+ late toxicity numbers, but expecting it to be low, around 1% like other SBRT studies.
2) No one has to do SBRT if they don't want to, but this data shows it's a pretty darn safe treatment. Lots of good options exist for prostate RT, clearly.

Don't we need to also know cumulative 5 yr g2 tox in an untreated population of old men?

 

[thesauce]

So just another trial showing similar cancer outcomes and higher toxicity with shorter courses of RT.

More ground-breaking research. Can’t wait for next ASTRO.

 

[communitydoc13]

It appears to be cumulative incidence. That means that at some point in the 5 years after treatment, 3.2 percent of patients in the standard treatment arm had a grade 2 or higher GU late toxicity and 5.5% in the SBRT arm.

My thoughts:

1) Those numbers are very similar, especially when considering this is grade 2+ tox. I would like to see the grade 3+ late toxicity numbers, but expecting it to be low, around 1% like other SBRT studies.
2) No one has to do SBRT if they don't want to, but this data shows it's a pretty darn safe treatment. Lots of good options exist for prostate RT, clearly.

Absolutely true. Also true that when I am offering options, I will modify my spiel about toxicity from, « about 1/50 men who receive fairly conventional fractionation will have significant long term urinary toxicity » to « about 1/25 men who receive SBRT will have significant long term urinary toxicity »

 

[Palex80]

https://x.com/_shankarsiva/status/1708529714527342653

I thought RTOG 0415 compared 73.8 Gy in 41 fractions (41 x 1.8) to 70 Gy in 28 fractions (28 x 2.5).

I always thought this was more of dose escalation trial using hypofractionation, since the BED of these 2 schedules is different.

It´s not the HypoFx that works here, it´s the BED!

Discuss…

 

[anonymuncule]

Fantastic Fasttrack

Edit: TROG 15.03 phase II clinical trial of Focal Ablative STereotactic Radiosurgery for Cancers of the Kidney - FASTRACK II - BMC Cancer