Rad Onc Twitter

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elementaryschooleconomics said:
I'm begging the authors (who I know read this thread, or at least are told about it): please release the granular data for this manuscript. If they already have and I missed it, could someone post it?
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Perhaps you can officially request for that. In clinical trial manuscripts there is a standard sentence in the manuscript concerning data sharing at the end of the manuscript. Journals request that sentence, actually. Perhaps this applies to this kind of research too?
 
As a mix of nationalities that gets blended to “white” by default (despite most of my blood coming to this country last generation from non wealthy / represented countries ), who also grew up less advantaged, and who also had a father in prison and obstacles to overcome, I only feel somewhat sad for Dr Mahal that he has to jump to these things, real or perceived, as a support or defense. I choose not to in my life. But it could also be that no one would care if I did, there are no programs for me, and I don’t happen to fit into the correct narrative of 2021. Shaking my head.
 
Pre-op RT ---> Surg for DCIS.
What is the rationale for this approach, does anyone know (approx. 5-day 6Gy regimen)?

PS: I thought surg +/- post-op RT is fine, no issues.


 
Radonc90 said:
Pre-op RT ---> Surg for DCIS.
What is the rationale for this approach, does anyone know (approx. 5-day 6Gy regimen)?

PS: I thought surg +/- post-op RT is fine, no issues.


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jondunn said:
Smaller target I suppose preop
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I also do not understand the concept.

Especially the "smaller target" argument may sound good at first, but this is DCIS we are talking about. This is a "target" that is not apparent on CT and even following image fusion with MRI, one may still under- or overestimate the extent of the disease.

I see no reason to do this.
 
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Palex80 said:
I also do not understand the concept.

Especially the "smaller target" argument may sound good at first, but this is DCIS we are talking about. This is a "target" that is not apparent on CT and even following image fusion with MRI, one may still under- or overestimate the extent of the disease.

I see no reason to do this.
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Its more of a way to get radiation into the preop game, which is the stepping stone into definitive treatment with no surgery as the next obvious step. Maybe for older pts we start omitting surgery instead of radiation
 
radiation said:
Its more of a way to get radiation into the preop game, which is the stepping stone into definitive treatment with no surgery as the next obvious step. Maybe for older pts we start omitting surgery instead of radiation
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Lumpectomy is very minor and can even be done under local. Virtually everyone is a surgical candidate.
 
radiation said:
Its more of a way to get radiation into the preop game, which is the stepping stone into definitive treatment with no surgery as the next obvious step. Maybe for older pts we start omitting surgery instead of radiation
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Maybe for older patients we should start omitting any treatment for DCIS.

I am still curious about target definition, how are they planning to do it?
 
Palex80 said:
Maybe for older patients we should start omitting any treatment for DCIS.

I am still curious about target definition, how are they planning to do it?
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When we ran a preop RT study for IDC there were 2 goals - primary was minimize postoperative whole breast RT and only use if tumor extent was greater than planned (use the preop dose as “boost”) and obtain tissue for correlative studies on irradiated tissues.
 


how much is he getting paid by industry?

never forget - there is always a Grift, folks!
 
jondunn said:


how much is he getting paid by industry?

never forget - there is always a Grift, folks!
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I'll never forget a Tomotherapy rep one time saying something to the effect: "If you have a center and Tomo is your only machine, Tomo is the standard of care for every patient in that center."
 


Anyone know which MR linac he’s referring to? Not in the know enough clearly
 
Radonc90 said:
As a profession, we should:
- be sensitive to the cost of Tx. If indicated (such as IMRT for HN cancer, Gyn cancer etc.), then use the fancy technology.
If not indicated, use the basic technique.
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Indeed.
But not all think the same, apparently.



Radiation oncology today: where common sense meets beauty. 🙂
 
kimplera said:
When we ran a preop RT study for IDC there were 2 goals - primary was minimize postoperative whole breast RT and only use if tumor extent was greater than planned (use the preop dose as “boost”) and obtain tissue for correlative studies on irradiated tissues.
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Interesting, yet:
a) postoperative WBRT is no longer necessary for a lot of patients, you have IMPORT-LOW and Livi for quite a lot of patients now. I suspect that the patients that need WBRT nowadays are not the ones entering such a trial of IDC.
b) So the preoperative dose was considered the boost. But the preoperative dose was certainly not 10-16 Gy given in 2 fractions per day. It was likely a considerable higher BED. And some of these patients had to have postoperative WBRT. Now I fully understand that a lot of that irradiated tissue with the full dose was removed during surgery, but still large parts of breast tissue at the resection margins likely received higher doses that the usual 10-16 Gy of boost given over 5-8 fractions. So, these unfortunate patients who did require WBRT ended up with higher doses in the breast with a neoadjuvant-PBI-approach than if they had gone for post-BCS WBRT with boost. It's a bit like in the intraoperative trials, where some patients required WBRT after all and ended up having quite high BEDs in the breast with fibrosis.


Still, several issues IMHO:

a) how do you delineate an intact DCIS on a planning CT?
b) how can you make sure that the patients actually need RT (other than obvious ones with G3 on biopsy or big DCIS or premopausal), what about all the postmenopausal "small" G1 DCIS patients, where it's considerably easier to discuss pros and cons of adjuvant RT when you have the full pathology report post BCS.
c) DCIS-surgery is supposed to remove all the calcifications. Provided the neoadjuvant RTT route is the ticket to omitting surgery for DCIS and only irradiating those patients, what kind of follow-up do you suggest? All the calcifications are still there after RT and bearing in mind swelling / fibrosis in the breast, they may even change configuration/size, thus triggering unnecessary biopsies/surgeries in the future.
d) Is that preoperative RT regime going to be only partial breast RT or WBRT with a boost to the site of the DCIS? If it's PBI:
1) PBI is not yet considered standard for DCIS (but it's an option)
2) potential issues with target delineation (--> point A)
3) how large is the risk of having DCIS in the surgical specimen beyond the borders of the PTV and how is one supposed to correlate the PTV to the postoperative specimen?

BREAST IS THE WORST!
 
RealSimulD said:
Was just about to post that. I wonder which academic center contacted Ankit. That's some bull****.
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I wonder which Chair wouldn't contact Ankit. It's what keeps me posting here under a pseudonym. Talking about these issues is much more mainstream now than in 2017 or 2018, but there's a lot of sensitive folks out there who can easily make waves if their feelings are hurt. They might even write an editorial in PRO about how hard they got Canceled by the internet.
 
A programmatic identity! Well, these mid-tier Chairs are about to experience very protracted and painful period of adjustment to their identity
 
1635890702057.png


Thank God.
 
I don’t get the peer review thing though - don’t we all do that already?
 
jondunn said:
I don’t get the peer review thing though - don’t we all do that already?
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I think most (all?) academic systems do, but in the community, I'm not sure how widespread it actually is. Practices with multiple docs, and/or various accreditations that require it (i.e. APEx) generally do. But I imagine there's a decent chunk of small, independent hospital outpatient departments with 1-2 docs without accreditation which don't do it.
 
thesauce said:
I have started a clinical trial of pre-op protons for DCIS. I will also begin offering this off-trial
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I see your DCIS trial and raise you my proton trial for DEFINITIVE treatment of Dupuytren's contracture. I mean electrons are so dirty, they scatter all over and they keep on going well after they hit the target. With IMPT I will have the ability to stop my treatment at the precise depth I desire.

My primary endpoint will be 10-30 year risk of secondary malignancy. My trial is powered to reduce that risk by x100 fold from 0.1% to 0.01%.
 
Gfunk6 said:
I see your DCIS trial and raise you my proton trial for DEFINITIVE treatment of Dupuytren's contracture. I mean electrons are so dirty, they scatter all over and they keep on going well after they hit the target. With IMPT I will have the ability to stop my treatment at the precise depth I desire.

My primary endpoint will be 10-30 year risk of secondary malignancy. My trial is powered to reduce that risk by x100 fold from 0.1% to 0.01%.
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MR-guided i would hope, better for soft tissue
 
RickyScott said:
protons are so yesterday. Mayo starting up carbon ions. Next, we will have some hawking neutrinos and dark matter.
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Reps are pushing it hardcore throughout the region, not to mention the ad spend. Would put UF proton pimping to prostate pts back in the day to shame
 
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