FLASH conversation from Meme thread

[OTN]

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I wish both hyper- and hypo-fractionation would have been explored and tested. Shame the virtue only signals in one direction.

 

[medgator]

I would count external beam APBI as a gain, as it reintroduced us into over-70 breast cancer s/p lumpectomy. I also wouldn't downplay SBRT for oligomets as much. It's been a pretty decent part of my practice, and it's pretty satisfying to play such an impactful role in Stage IV disease when used appropriately.

Arthritis also counts, as does the increased interest in benign conditions. Sure, it should always have been a part of the playbook, but I'm glad it's finally getting the respect it deserves.

I still treat a lot of rectal cancer, and I would argue the recent data pushes back against 5-fraction rectal enough that it's finally more or less dead in routine cases.

I also still treat a decent amount of pancreatic cancer, so I can't agree it's completely dead. Our role has always been somewhat nebulous and hard to define here. Hopefully systemic advances get to the point where local control again makes a difference.

Finally, I don't think the esophageal story is over. I can, before the end of my career, see us getting to a TNT rectal-style esophageal protocol. I have a hard time believing the data wouldn't support it.

Second all of the above. Not all gi pts can tolerate FLOT and I can't remember the last time I got a referral for 5 fx rectal. Now with less APRs happening we are getting pushed more into long course organ preservation in that disease

 

[yesmaster]

If FLASH improved on radiation just a little bit and was at a price point accessible to community, it would be great.

 

[medgator]

If protons mproved on radiation just a little bit and was at a price point accessible to community, it would be great.

Also true

 

[Palex80]

This is still the meme thread, however concerning rectal cancer:

- we are out in MSI-high tumors. They only make up a tiny portion of all rectal cancer cases, but we are definetely out in that portion.
- we have competition in the early cT3 group. FOLFOX/CAPOX alone as in PROSPECT or no neoadjuvant treatment at all are guideline-conformal alternatives. In the past, every cT3 tumor received neoadjuvant RT, this is no longer the case.

 

[Doctorer]

This is still the meme thread, however concerning rectal cancer:

- we are out in MSI-high tumors. They only make up a tiny portion of all rectal cancer cases, but we are definetely out in that portion.
- we have competition in the early cT3 group. FOLFOX/CAPOX alone as in PROSPECT or no neoadjuvant treatment at all are guideline-conformal alternatives. In the past, every cT3 tumor received neoadjuvant RT, this is no longer the case.

This is fair, but we're also increasingly being incorporated in to earlier stage rectal cancers in terms of a rectal preservation paradigm. I'm seeing more and more early stage (but bulky) cancers, too big for an upfront TAE/LE, that want to give chemoRT a shot, which is supported by the recently publish STAR-TREC trial.

 

[metallica81788]

If you work in an underserved area with poorer/rural population without much competition, you are likely busier than ever. GI cancers included.