Efficacy of RT

[MaximusMDPhD]

Hi Everyone,

Long time lurker here. I'm an MD/PhD student in my 4th year of grad school. I've been interested in radonc for some time, but haven't had the chance to pick resident brains about this: is there a single resource you can peruse to learn about the value of radiation across cancer types?

Early on in med school some another student laughed off my interest in radonc saying that RT didn't matter much in the grand scheme of cancer treatment. In my casual research of clinical trials (emphasis on casual), I have never found data to unequivocally refute the challenge, which rattles my conscience.

Favorite positive findings are also welcomed as solo publications.

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[thesauce]

NCCN guidelines are your best bet. They go through each cancer and show how RT fits into the overall treatment.

Those without much knowledge of cancer seem to be hung up on the idea that this particular local modality is a last resort in cancer treatment. It's kind of annoying. For several cancers (prostate, early stage lung, and others), it is curative on its own.

Some believe chemo is going to produce a silver bullet to wipe out all cancer and make RT obsolete even though chemo on its own has never cured a patient with any solid cancer...ever.

 

[Palex80]

Some believe chemo is going to produce a silver bullet to wipe out all cancer and make RT obsolete even though chemo on its own has never cured a patient with any solid cancer...ever.

Metastatic Testicular Cancer, chemo can heal that.
On the other hand testicular cancer is hardly cancer... It's like Hodgkin's. Catching the flue can be more dangerous than Hodgkin's or TC for some patients.

 

[xrthopeful]

If anyone ever asks me why Radiation Oncology rather than Med Onc - I say 'Because I want to cure cancer'.

OP - your friend is incredibly misinformed

 

[Gfunk6]

We actually don't cure anything. We just have $10 million dollar placebo machines that whir, buzz and click.

Your friend was right, but don't let the secret out . . .

 

[Phantom1]

Early on in med school some another student laughed off my interest in radonc saying that RT didn't matter much in the grand scheme of cancer treatment. In my casual research of clinical trials (emphasis on casual), I have never found data to unequivocally refute the challenge, which rattles my conscience...

Dear Maximus,

I think you need to spend a little more time developing your PubMed searching skills, otherwise your conscience will be rattled during your PhD Defense...

 

[medgator]

Just in case the op really isn't trolling and really is ignorant....


https://www.ncbi.nlm.nih.gov/pubmed/19167731?dopt=Abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61085-0/abstract

http://www.nejm.org/doi/full/10.1056/NEJM199908123410703

http://www.ncbi.nlm.nih.gov/pubmed/17306393

http://www.nejm.org/doi/full/10.1056/NEJM199212033272302

http://m.jco.ascopubs.org/content/early/2015/02/17/JCO.2014.57.7510

There are many more tumor sites and trials but I just wanted to provide a small sampling

 

[Krukenberg]

The rad onc wiki is a quick and dirty source that will point you towards primary literature. If you want some of examples where radiation plays a key role I would check out prostate, lung (including SBRT), post-lumpectomy breast and post-mastectomy with positive nodes, anal, rectal, larynx.

https://en.m.wikibooks.org/wiki/Radiation_Oncology

 

[xrthopeful]

Don't forget cervix.

Also, if you're going to talk about adjuvant breast and prostate and not just definitive cases, don't forget to mention all of CNS, mostly all of Head and Neck, gastric, esophagus, etc etc etc

 

[thecarbonionangle]

this is a very common perception, even at the level of attendings who refer (general medicine). It is the view that radiation is some sort of last resort to cancer treatment, mostly palliative. The third year medicine residents going into heme onc next year, have no idea about radiation, and these are the people who are going to be consulted as fellows in less than a year.

 

[xrthopeful]

The third year medicine residents going into heme onc next year, have no idea about radiation, and these are the people who are going to be consulted as fellows in less than a year.

This is the funniest thing.

 

[medgator]

This is the funniest thing.

It's sad actually. 3 year heme/onc fellowship, basically half is useless for solid tumor management. Rad Onc is a dedicated 4-year oncology residency

 

[xrthopeful]

I agree.

 

[MegaVoltagePhoton]

Hi Everyone,

Long time lurker here. I'm an MD/PhD student in my 4th year of grad school. I've been interested in radonc for some time, but haven't had the chance to pick resident brains about this: is there a single resource you can peruse to learn about the value of radiation across cancer types?

Early on in med school some another student laughed off my interest in radonc saying that RT didn't matter much in the grand scheme of cancer treatment. In my casual research of clinical trials (emphasis on casual), I have never found data to unequivocally refute the challenge, which rattles my conscience.

Favorite positive findings are also welcomed as solo publications.

What "casual" searches did you do? Unless you define "cancer" as "leukemia", there is no way even a "casual" search wouldn't have proven the other student to be a *****.

 

[thecarbonionangle]

Clearly trolling just read it again. "I have never found data to unequivocally refute the challenge, which rattles my conscience." Who speaks like that with a straight face, mate.

 

[thesauce]

Metastatic Testicular Cancer, chemo can heal that.
On the other hand testicular cancer is hardly cancer... It's like Hodgkin's. Catching the flue can be more dangerous than Hodgkin's or TC for some patients.

Don't they still do an orchiectomy if they're going for cure?

 

[Palex80]

Don't they still do an orchiectomy if they're going for cure?

Good point! However I have seen patients with wide metastatic spread that never got their testes removed, since they got systemic treatment up front.
They may get an orchiectomy at the end of all the systemic "just to make sure", but usually there's no cancer left after 4x BEP +/- high dose chemo.

It's the classic failure scenario, where the patient presents with supraclavicular/mediastinal mass, dyspnea and everyone is going like "LYMPHOMA, OMG!" and noone cares to have look at the guy's balls. And then when pathology comes back everyone facepalms cause it (non-)seminoma...

 

[MegaVoltagePhoton]

Clearly trolling just read it again. "I have never found data to unequivocally refute the challenge, which rattles my conscience." Who speaks like that with a straight face, mate.

Unfortunately, I've heard several folks in our field, or wanting to be in our field, talk like that.