It Doesn’t Feel Pity, Or Remorse, Or Fear, And It Absolutely Will Not Stop, Ever, Until The Radiation Plan is Done!

[Gfunk6]

Cool study out of Princess Margaret showing that AI-driven machine learning significantly outperforms humans with regard to radiation treatment planning.

AI outperforms humans in creating cancer treatments, but do doctors trust it?

The impact of deploying Artificial Intelligence (AI) for radiation cancer therapy in a real-world clinical setting has been tested by researchers in a unique study involving physicians and their patients.

www.sciencedaily.com

Despite the plans being superior, the treating physicians went with the human plans once they learned that the AI created it.

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[Chartreuse Wombat]

Dosimetrists should be nervous

 

[brushbeamscanning]

I thought they were a bit generous with the time it took to develop a prostate plan. Nevertheless I'm sure AI/ML will help with treatment optimization in the future.

 

[TheWallnerus]

"Dr. Conroy, Medical Physicist at Princess Margaret, points out that following the highly successful study, ML-generated treatments are now used in treating the majority of prostate cancer patients at Princess Margaret."

I am glad this AI contouring technology will only be applicable for prostate. Jk of course. On the cultural flipside, the ROs in at least a few countries I know of don't contour their own targets (or OARs etc) as is now. So AI for them will just be another name for "dosimetrist." In, I think, 50 years or less, I don't see any reason why there couldn't be an "assembly line" of sorts (embellishing a bit) with patients lying down on a long conveyor belt that has a ring-based CT and/or MRI and/or PET scanning device along the pathway and seconds after the scan as the patient is going down the belt they then slowly pass through the Halcyon-type device which has already contoured EVERYTHING and placed the optimal dose. Like a radiation Disney ride.

 

[Neuronix]

Why conveyor belt? Same machine can act as sim and treat. They're already doing this on Viewray--MRI only sim on the device, contour, plan on console, treat. Patient doesn't even move. This is the way of the future. Prospective trial is already coming with 1 fraction SBRT.

Right now a lot of auto-contouring is straight garbage. Auto planning is getting really good though. Once both are ready... I often wonder what this field will look like by the time I retire. Plan specific QA is already a relic of the past, they don't even bother in most countries.

 

[RickyScott]

"Dr. Conroy, Medical Physicist at Princess Margaret, points out that following the highly successful study, ML-generated treatments are now used in treating the majority of prostate cancer patients at Princess Margaret."

I am glad this AI contouring technology will only be applicable for prostate. Jk of course. On the cultural flipside, the ROs in at least a few countries I know of don't contour their own targets (or OARs etc) as is now. So AI for them will just be another name for "dosimetrist." In, I think, 50 years or less, I don't see any reason why there couldn't be an "assembly line" of sorts (embellishing a bit) with patients lying down on a long conveyor belt that has a ring-based CT and/or MRI and/or PET scanning device along the pathway and seconds after the scan as the patient is going down the belt they then slowly pass through the Halcyon-type device which has already contoured EVERYTHING and placed the optimal dose. Like a radiation Disney ride.

Dont see role for radoncs in this world. Can easily just give other docs a few extra months of training.

 

[fiji128]

I have yet to see auto countering that is consistently good enough to use but from what I have seen published the AI planning is catching up really quick. I would not want to be a dosimetrist aged 40 for sure.

 

[Mandelin Rain]

Dont see role for radoncs in this world. Can easily just give other docs a few extra months of training.

This is my concern.

I know everyone is super bearish on short term job market issues (which I think are a bit overstated).

I've yet to see anyone bearish enough on the long term viability of this specialty as we move further and further into technician territory.

 

[Ray D. Ayshun]

This is my concern.

I know everyone is super bearish on short term job market issues (which I think are a bit overstated).

I've yet to see anyone bearish enough on the long term viability of this specialty as we move further and further into technician territory.

After pre-authing some oxycodone for my oral cavity cancer patient I'm not sure I'd be upset having to find something new. Death by a thousand paper cuts. If nothing else, there's no AI for pre-authing as far as I can tell.

 

[TheWallnerus]

This is my concern.

I know everyone is super bearish on short term job market issues (which I think are a bit overstated).

I've yet to see anyone bearish enough on the long term viability of this specialty as we move further and further into technician territory.

Are you really a technician if you aren't doing anything besides talking to patients and counseling them on treatments, prescribing (but not delivering) treatments, and managing the side effects thereof? Maybe rad onc will transition into a non-technical thing if AI is doing most the "circle drawing." We'll be more like our med onc brethren/sistren (but of course still somewhat constrained by our one form of chemotherapy: •OH). Oh and all the more reason to eliminate physics as a stand-alone board exam.

 

[evilbooyaa]

Oh and all the more reason to eliminate physics as a stand-alone board exam.

I wouldn't be surprised if it's 2050 and the physics board exam is still a thing.

I will attempt to remember to check back on this 30 years from now, if dementia or something hasn't gotten me by then.

 

[Ray D. Ayshun]

I wouldn't be surprised if it's 2050 and the physics board exam is still a thing.

I will attempt to remember to check back on this 30 years from now, if dementia or something hasn't gotten me by then.

Dementia won't affect this. Physics boards is long term ****. Would need some type of Oliver Sachs worthy thing to happen to remove memories of the ******* hoops we've jumped through. I'll probably ritualistically check the physics pass rate yearly until I'm gone.

 

[ramsesthenice]

Are you really a technician if you aren't doing anything besides talking to patients and counseling them on treatments, prescribing (but not delivering) treatments, and managing the side effects thereof? Maybe rad onc will transition into a non-technical thing if AI is doing most the "circle drawing." We'll be more like our med onc brethren/sistren (but of course still somewhat constrained by our one form of chemotherapy: •OH). Oh and all the more reason to eliminate physics as a stand-alone board exam.

Worry not my marine brethren. AI is coming but not replacing those of us already in the field. It won’t do anything good for the market crunch, but what non-surgical/non PM&R doctors are not already basically technicians prescribing treatments without delivering them and then managing side effects and assessing responses? I love the technical aspects of treatment planning and would be sad to see it slip away over time but I’m pretty busy clinically and it’s already a fairly small part of what I do. I would be far more concerned if I were a diagnostic radiologist or a pathologist. It is conceivable that assistive systems requiring 20% of current physician effort levels could be a reality within 15-20 years or so and does anyone think administrations won’t jump at the chance to trim the fat? I don’t.

Even for those fields, I still think it is many years before substantial numbers of existing positions are replaced. It will start with not replacing people or expanding with increasing volume.

 

[medgator]

When skynet can get sued and give a deposition, then I'd be worried about our jobs

 

[TheWallnerus]

AI algorithm produces autosegmented contours for radiotherapy

Automatically segmented contours generated on CT scans by a deep-learning algorithm can yield positive results when utilized clinically in radiotherapy planning, according to research published online June 8 in Radiation Oncology.

www.auntminnie.com

 

[Lamount]

I am not all that worried about AI replacing us for a simple reason... one cannot sue a computer. Even if Siri does your contours for you, you are still going to have to "sign off" on them

 

[TheWallnerus]

I am not all that worried about AI replacing us for a simple reason... one cannot sue a computer. Even if Siri does your contours for you, you are still going to have to "sign off" on them

Multiple ways it could all work out. Certainly it could homogenize the quality of radiation MD-to-MD, center-to-center. If a given patient is going to have the same exact clinical targets and OARs at Harvard or Hialeah (and ultimately AI-planned dose too), then maybe it'll make academics hush up about community quality being substandard. "You got a HAL-9000, I got a HAL-9000, we all got HAL-9000s... big whoop buddy." AI will actually improve the quality of care of all these old fart ROs who can't contour worth a crap and allow them to practice until they're centenarians. AI will make it where when you get out of residency you'll go practice in a center in the boonies side by side with an RO who, although he has dementia, cranks out absolutely stunning RO work. He may drool on the patients but he can sign off on some really well done contours.

 

[RickyScott]

I am not all that worried about AI replacing us for a simple reason... one cannot sue a computer. Even if Siri does your contours for you, you are still going to have to "sign off" on them

I think AI contorting and planning Breast and prostate w/out nodes is very possible within the next 5-10 years. Don’t see why a urologist or breast surgeon could not practice as a radonc for those disease sites after taking a weekend course or listening to cme on a podcast.

 

[TheWallnerus]

I think AI contorting and planning Breast and prostate w/out nodes is very possible within the next 5-10 years. Don’t see why a urologist or breast surgeon could not practice as a radonc for those disease sites after taking a weekend course or listening to cme on a podcast.

ding

same thing for cardiologist... those guys will have chutzpah and cojones to do it too

all it will take is a viable Steve Jobs like character: "People don't know what they want until you show it to them."

 

[RickyScott]

ding

same thing for cardiologist... those guys will have chutzpah and cojones to do it too

all it will take is a viable Steve Jobs like character: "People don't know what they want until you show it to them."

Yip, in a survey of thoracic surgeons, something like 25% thought they should be giving immunotherapy… (meanwhile radonc may need credentialing to deliver 8 x 1 in penn palliative care network

 

[Lamount]

ding

same thing for cardiologist... those guys will have chutzpah and cojones to do it too

all it will take is a viable Steve Jobs like character: "People don't know what they want until you show it to them."

I would push back on the cardiology angle. Based on their current workflow, there isn't a whole lot of reasons for an EP to familiarize themselves with cross sectional imaging. Their field is very intuitive and procedural, based upon measurements they take during mapping studies. It's not super easy for them to point to a spot on a CT scan and say "there's the problem". It's truly the case that both specialties depend on each other to do it correctly.

 

[TheWallnerus]

Yip, in a survey of thoracic surgeons, something like 25% thought they should be giving immunotherapy… (meanwhile radonc may need credentialing to deliver 8 x 1 in penn palliative care network

As side note I find it hilarious/maddening when I go to a new hospital and seek to give Xofigo. And inevitably it comes up, "Are you authorized to do this? Can you give us patient logs? Show you had training?" The board certified rad onc part is irrelevant.

 

[TheWallnerus]

Based on their current workflow, there isn't a whole lot of reasons for an EP to familiarize themselves with cross sectional imaging.

"There aren't a whole lot of reasons for me to familiarize myself with cross-sectional imaging, Steve."
"How does 20,000 reasons per patient sound, Bob?"

 

[RickyScott]

"There aren't a whole lot of reasons for me to familiarize myself with cross-sectional imaging, Steve."
"How does 20,000 reasons per patient sound, Bob?"

I have seen cardiologists order and review heart mris

 

[Lamount]

I have seen cardiologists order and review heart mris

Electrophysiologists?

 

[MegaVoltagePhoton]

American medicine is still a business. Patients (savvy ones) will want to be treated by a "Real doctor" due to fear of automation. That will protect us.

plus lets not forget there are afterall side effects to our treatments. i dont think people are going to want to deal with prostate patients messaging 50 times about ed pills two days into a two year course of hormone therapy, just because a computer contoured the prostate

 

[Lamount]

I have seen cardiologists order and review heart mris

Sure… but it’s not a weekend course. They do just fine without it, and they have spent 8 years in training. There’s lots of a-fib out there. Maybe you are right, but I just don’t see it.

T-surg trying to do SBRT for medically inoperable early stage lung cancer is another story
Edit: meant for @TheWallnerus

 

[madchemist89]

I think we sometimes underestimate the complexity and difficulties associated with the delivery of even simple radiation treatments. I thought I knew everything (not literally) about rad onc after my first year of residency. I quickly learned that not to be the case, and I am still learning even after treating hundreds of patients. RT cannot be delivered safely without years of experience and training. It is very easy to be lulled into a sense of security by what appears to be a simple process with so much expert support. Not knowing what you don't know can be lethal in our field as we have learned through several high profile radiation accidents and the deaths caused in early lung sbrt studies. What we do may seem easy to us after years of practice, but we cannot forget what was required to achieve this level of expertise. When the question of other physicians delivering RT comes up, it is imperative that we educate them in regards to the actual complexity and thought required to safely deliver radiation. The last thing we or our patients need are untrained physicians delivering an extremely technical modality without proper training.

 

[RickyScott]

I think we sometimes underestimate the complexity and difficulties associated with the delivery of even simple radiation treatments. I thought I knew everything (not literally) about rad onc after my first year of residency. I quickly learned that not to be the case, and I am still learning even after treating hundreds of patients. RT cannot be delivered safely without years of experience and training. It is very easy to be lulled into a sense of security by what appears to be a simple process with so much expert support. Not knowing what you don't know can be lethal in our field as we have learned through several high profile radiation accidents and the deaths caused in early lung sbrt studies. What we do may seem easy to us after years of practice, but we cannot forget what was required to achieve this level of expertise. When the question of other physicians delivering RT comes up, it is imperative that we educate them in regards to the actual complexity and thought required to safely deliver radiation. The last thing we or our patients need are untrained physicians delivering an extremely technical modality without proper training.

I would love to agree with you, but the fact remains that there are basically many "untrained radoncs" over 60 (who were bottom of their class) running around delivering radiation every day. In addition dermatologists deliver more fractions of radiation than radiation oncologists per Wallnerus. I really want to believe what you are saying is true, but am not so sure. I really doubt there would be safety issues if urologists or breast surgeons delivered radiation for those disease sites and stuck to guidelines

 

[TheWallnerus]

I would love to agree with you, but the fact remains that there are basically many "untrained radoncs" over 60 (who were bottom of their class) running around delivering radiation every day. In addition dermatologists deliver more fractions of radiation than radiation oncologists per Wallnerus. I really want to believe what you are saying is true, but am not so sure. I really doubt there would be safety issues if urologists or breast surgeons delivered radiation for those disease sites and stuck to guidelines

It’s not per me lol. (The derms are buying [mobile] linacs now.) I’m not offering up a Tommy Boy level guarantee. But could they give run for money? Sure. Our patient pool is 1.8m cancers a year of which about 550-600K get RT. The derm patient pool: 5m+ cancers a year. “Do the math” - Cal Naughton Jr.

 

[yesmaster]

there's no AI for pre-authing as far as I can tell.

Healthcare Revenue Cycle Management Solutions | Waystar

Waystar’s cloud-based software provides end-to-end revenue cycle management solutions to simplify healthcare payments and accelerate financial results.

oliveai.com

Home - Banjo Health - Intelligent Prior Authorization

The Banjo Health platform was designed by clinicians and developers, working side-by-side, to make prior authorization work better for everyone involved. You configure it to your needs, using an intuitive interface, and then put it to work.

www.banjohealth.com

Waystar Prior Authorization Platform | Prior Authorization Solutions

By automating prior authorizations, Waystar clients have doubled productivity, enhanced care + cut denials in half. See how prior auth works.

www.waystar.com

I looked into this when brainstorming startup ideas with my tech friends over the holidays. It's sort of annoying to build automation on top of inherently flawed administrative bloat but that's the gist of many health IT startups.

As for unemployment from AI, that threat is miniscule, as is the threat of encroachment from other physicians. Can you cherry pick clinical scenarios that can be performed by other physicians with AI assistance? Sure, but lots of factors keep physicians within their territory. Radiology, medical oncology, even surgery won't be invulnerable to AI, but I'm not going to start billing radiologist's CPT codes just because I downloaded an app from Google. No, our job market woes are self-inflicted, too many trainees, too much SOAP, too few jobs, etc. etc.

 

[ramsesthenice]

I think we sometimes underestimate the complexity and difficulties associated with the delivery of even simple radiation treatments. I thought I knew everything (not literally) about rad onc after my first year of residency. I quickly learned that not to be the case, and I am still learning even after treating hundreds of patients. RT cannot be delivered safely without years of experience and training. It is very easy to be lulled into a sense of security by what appears to be a simple process with so much expert support. Not knowing what you don't know can be lethal in our field as we have learned through several high profile radiation accidents and the deaths caused in early lung sbrt studies. What we do may seem easy to us after years of practice, but we cannot forget what was required to achieve this level of expertise. When the question of other physicians delivering RT comes up, it is imperative that we educate them in regards to the actual complexity and thought required to safely deliver radiation. The last thing we or our patients need are untrained physicians delivering an extremely technical modality without proper training.

Legal risk is what keeps people in their lane. Look at how many surgeons want to start giving IO. Could they? Sure. But what happens when one of those patients has a grade 5 toxicity? Our legal system is obsessed with black and white descriptions of training and qualification. Derms using low energy units for superficial treatment is one thing. Think about it. What is basically the easiest thing we do in radiation oncology? Probably prostate. Is there any reason in the world a urologist wouldn't be capable of contouring prostates and approving the plan? Of course not. So why then do urorads hire a radonc and pay them handsomely to do work they are perfectly capable of doing themselves? Because they are generous and benevolent? Me thinks not. Until there is a path to some kind of certification we are not in serious danger.

 

[Ray D. Ayshun]

Healthcare Revenue Cycle Management Solutions | Waystar

Waystar’s cloud-based software provides end-to-end revenue cycle management solutions to simplify healthcare payments and accelerate financial results.

oliveai.com

Home - Banjo Health - Intelligent Prior Authorization

The Banjo Health platform was designed by clinicians and developers, working side-by-side, to make prior authorization work better for everyone involved. You configure it to your needs, using an intuitive interface, and then put it to work.

www.banjohealth.com

Waystar Prior Authorization Platform | Prior Authorization Solutions

By automating prior authorizations, Waystar clients have doubled productivity, enhanced care + cut denials in half. See how prior auth works.

www.waystar.com

I looked into this when brainstorming startup ideas with my tech friends over the holidays. It's sort of annoying to build automation on top of inherently flawed administrative bloat but that's the gist of many health IT startups.

It's not a war that will lead to computers taking over, but computers making medical authorization decisions.

 

[RickyScott]

So why then do urorads hire a radonc and pay them handsomely to do work they are perfectly capable of doing themselves? Because they are generous and benevolent? Me thinks not. Until there is a path to some kind of certification we are not in serious danger.

reason for a radonc as far as I know was because in past you needed radonc physically present while running a linac and this is no longer the case. Urologist could also pay radonc 1500$/week to sign off on all the plans (30 minutes of work). dont know of any large center with single case of grade 4 side effects from IMRT/IGRT prostate over past 10 years ( only life threatenig issues were from fiducial related infections/bleed and gastric ulcer/renal failure from extended course of motrin

 

[Mandelin Rain]

Yeah. What would a urologist do if he treated someone with radiation and they had a problem? A rad onc would do something really smart; like referring them to a gastroenterologist or even a urologist.

 

[ramsesthenice]

Yeah. What would a urologist do if he treated someone with radiation and they had a problem? A rad onc would do something really smart; like referring them to a gastroenterologist or even a urologist.

Again, the problem is not that a urologist couldn't manage a problem or that they would really be any more likely to cause major problems than a certified radiation oncologist (assuming they get some good hands on training). In our current system if you are not certified to do something then literally anything that goes wrong went wrong because you were not "qualified" to do it in the first place. Doesn't matter that for a lot of things there are low-level background rates even with acceptable plans.

Lawyer: "Dr Smith, when during your medical education did you receive formal training in radiation therapy, radiation biology, or medical physics?"

Dr. Smith: "I follow quantec guidelines to reduce the risk of toxicity and review my plans with a certified radiation oncologist."

Lawyer: "Dr. Smith are you certified by the ABR to practice radiation oncology yes or no."

Dr. Smith: "No I am not but..."

Lawyer: "So what you are saying is you were no more qualified to treat this man with radiation than you were to perform brain surgery on him correct. What else do you do without training?"

 

[Mandelin Rain]

Obviously we're not talking about doing this with no training. A 1-2 week "fellowship" on Myrtle Beach to learn how to deliver radiation to the prostate and get some certificate saying you attended and graduated? Sure.

I mean plenty of us put in SpaceOAR. How big a part of your medical education was placing a dissolvable hydrogel through the perineum under ultrasound guidance? Exactly 0%? But a rep showed you how to do it 5 times? You feel good about that in court? Beacause, really bad complications happen about the same rate as with XRT.

 

[TheWallnerus]

beep bop boop

 

[TheWallnerus]

Again, the problem is not that a urologist couldn't manage a problem or that they would really be any more likely to cause major problems than a certified radiation oncologist (assuming they get some good hands on training). In our current system if you are not certified to do something then literally anything that goes wrong went wrong because you were not "qualified" to do it in the first place. Doesn't matter that for a lot of things there are low-level background rates even with acceptable plans.

Lawyer: "Dr Smith, when during your medical education did you receive formal training in radiation therapy, radiation biology, or medical physics?"

Dr. Smith: "I follow quantec guidelines to reduce the risk of toxicity and review my plans with a certified radiation oncologist."

Lawyer: "Dr. Smith are you certified by the ABR to practice radiation oncology yes or no."

Dr. Smith: "No I am not but..."

Lawyer: "So what you are saying is you were no more qualified to treat this man with radiation than you were to perform brain surgery on him correct. What else do you do without training?"

Lawyer: "Dr Smith, when during your medical education did you receive formal training in radiation therapy, radiation biology, or medical physics?"

Dr. Smith: "I follow quantec guidelines to reduce the risk of toxicity and review my plans with a certified radiation oncologist."

Lawyer: "Dr. Smith are you certified by the ABR to practice radiation oncology yes or no."

Dr. Smith: "No I am not but we are trained to deal with all of the toxicities that result from the practice of radiation oncology that may need cystoscopy or fulguration or catheterization or operations et cetera. Radiation oncologists are not trained to handle, nor do they handle, the myriad of very complicated issues that can arise from prostate radiotherapy or the practice of radiation oncology as you say. Furthermore, one does not need to be board certified by the ABR to practice radiation oncology as, for example, it is a recognized standard of care for endocrinologists to treat patients with radioactive iodine as long as they have had the requisite training."

Lawyer: "um..."

Dr. Smith: "And the dermatologists even write in the medical literature that they are the primary purveyors of radiation therapy in the arena of skin; urologists are likewise purveyors of radiotherapy for prostate cancer which we diagnose and then treat and then handle treatment toxicities thereof."

Lawyer: Erection, your onion

 

[RickyScott]

Obviously we're not talking about doing this with no training. A 1-2 week "fellowship" on Myrtle Beach to learn how to deliver radiation to the prostate and get some certificate saying you attended and graduated? Sure.

I mean plenty of us put in SpaceOAR. How big a part of your medical education was placing a dissolvable hydrogel through the perineum under ultrasound guidance? Exactly 0%? But a rep showed you how to do it 5 times? You feel good about that in court? Beacause, really bad complications happen about the same rate as with XRT.

Have heard of 2 patients end up in icu after fiducial placement. Never seen/heard of fistula or Grade 4 SE from EBRT in prostate.

 

[MegaVoltagePhoton]

I have a great idea, let’s continue to publicly talk about how our job prospects could get even ****tier (and I mean giving out ideas about taking away our turf, not warning med students, the latter is all good). Seriously, what is to gain by doing this? And as ****ty as board certification is, it does protect us.

 

[Krukenberg]

I have a great idea, let’s continue to publicly talk about how our job prospects could get even ****tier (and I mean giving out ideas about taking away our turf, not warning med students, the latter is all good). Seriously, what is to gain by doing this? And as ****ty as board certification is, it does protect us.

This is why it’s stupid to lower board standards. Physics sucks but so does having your specialty be usurped

 

[ramsesthenice]

Have heard of 2 patients end up in icu after fiducial placement. Never seen/heard of fistula or Grade 4 SE from EBRT in prostate.

Me neither. I (like everyone) occasionally do see stubborn rectal bleeding but that is usually not particularly consequential and about as bad as it gets.

 

[DoctwoB]

Me neither. I (like everyone) occasionally do see stubborn rectal bleeding but that is usually not particularly consequential and about as bad as it gets.

That just means you’re not seeing your complications. Radiation cystitis is extremely common and urethral stricture and fistulae are less common but seen as well (especially with brachy)

 

[ramsesthenice]

That just means you’re not seeing your complications. Radiation cystitis is extremely common and urethral stricture and fistulae are less common but seen as well (especially with brachy)

I have literally never seen a fistula after radiation for prostate cancer (brachy or EBRT) for which I do a lot of radiation. I see them much more than I would like for cervical cancer.

Yes, we do cystitis and strictures. We were specifically talking about severe complications which are comparatively more common with other disease sites.

 

[thecarbonionangle]

The amount of times i have seen fistulas is because other services do not know they should discuss with us before biopsing irradiated tissue. Literally all cases someone biopsied the rectum, vagina, bladder when they should not have. Of course a fistula originated. Regardless in the literature, it is extremely rare just like someone dying on the table during a RP.

 

[ramsesthenice]

The amount of times i have seen fistulas is because other services do not know they should discuss with us before biopsing irradiated tissue. Literally all cases someone biopsied the rectum, vagina, bladder when they should not have. Of course a fistula originated. Regardless in the literature, it is extremely rare just like someone dying on the table during a RP.

I mean, to be fair, we did predispose them to develop it. We are not completely in the clear even when that is the case. And if you treat more bulky cervical cancers you will see more gnarly fistulae. They do happen.

Same for strictures. They are much more common in patients getting post op after RP. It’s a joint effort. No sense in pointing fingers. No matter how you slice it severe complications after surgery or RT for PCa are thankfully low.

 

[medgator]

I mean, to be fair, we did predispose them to develop it. We are not completely in the clear even when that is the case. And if you treat more bulky cervical cancers you will see more gnarly fistulae. They do happen.

Same for strictures. They are much more common in patients getting post op after RP. It’s a joint effort. No sense in pointing fingers. No matter how you slice it severe complications after surgery or RT for PCa are thankfully low.

It's all about educating the patients was well as other specialists you work with . Have not seen that issue personally but have heard in oncolore of it happening elsewhere

 

[salubalu]

I don’t even know if radiation necrosis happens. Never seen it. It has nothing to do with me only treating right sided breast cancer though.

 

[ramsesthenice]

I don’t even know if radiation necrosis happens. Never seen it. It has nothing to do with me only treating right sided breast cancer though.

I wish I could say it doesn’t but again, do more brachy (especially with distal vaginal involvement). It is real. But generally manageable.