Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
elementaryschooleconomics said:
This is literally the reason I never considered Cleveland for school, training, or work.

I went to Cleveland once. I haven't returned to Ohio in the 20 subsequent years after that visit.
Click to expand...
I interviewed at the Cleveland Clinic for residency in the dead of winter after spending all my life in the South. Taking public transportation from the airport to downtown Cleveland felt like taking a train trip through Mordor. Desolation everywhere.
 
RSAOaky said:
I interviewed at the Cleveland Clinic for residency in the dead of winter after spending all my life in the South. Taking public transportation from the airport to downtown Cleveland felt like taking a train trip through Mordor. Desolation everywhere.
Click to expand...
Having trained in the northeast, I think there’s something to the desolation and academic productivity. Fewer distractions I suppose.
 
RSAOaky said:
I interviewed at the Cleveland Clinic for residency in the dead of winter after spending all my life in the South. Taking public transportation from the airport to downtown Cleveland felt like taking a train trip through Mordor. Desolation everywhere.
Click to expand...
I took that same train to both CC and Case.

Case was the only place I interviewed at that I didn’t rank.
 
I also interviewed in Cleveland in the dead of winter and you couldn't pay me enough to live there.
 
Mandelin Rain said:
Sriracha for Indian (and some Thai) food. Franks for Buffalo flavored stuff. Cholula for breakfast stuffs. Trader Joe’s Habenero for most anything else.
Click to expand...
I really, really respect you @Mandelin Rain. But, Sriracha for Indian food hurts my heart. Truly.

I know there are many Indians here (this is #radonc of course). I can understand some spicy Maggi, aachar (obviously), even chili crisp. But, Sriracha?

I'm not sure how to even proceed.
 
RealSimulD said:
I really, really respect you @Mandelin Rain. But, Sriracha for Indian food hurts my heart. Truly.

I know there are many Indians here (this is #radonc of course). I can understand some spicy Maggi, aachar (obviously), even chili crisp. But, Sriracha?

I'm not sure how to even proceed.
Click to expand...
I learned of the delight of Sriracha and Indian food from an Indian doc, who “put that **** on everything”.
 
RealSimulD said:
I really, really respect you @Mandelin Rain. But, Sriracha for Indian food hurts my heart. Truly.

I know there are many Indians here (this is #radonc of course). I can understand some spicy Maggi, aachar (obviously), even chili crisp. But, Sriracha?

I'm not sure how to even proceed.
Click to expand...
Ranks even below using usurped taco bell fire sauce in the sauce drawer. Every Indian has one
 
RadOncDoc21 said:
I’m sure the cost of care is less at MSKCC
Click to expand...
I would rather go to my local community cancer doctor for a couple of weeks for palliative radiation, than go to MSKCC, get a single fraction treatment, and then get a $45,000 bill for "services not covered" under my PPO.
 
These hit piece articles/marketing by folks at places like M$KCC shouldn't even be published until they comply with the federal price transparency rules. At a minimum there should be a COI disclosure about pricing in these articles.
 
RSAOaky said:
9:30

Dan Spratt: "You have to really ask yourself are you doing this because you want to achieve impact in this world? The byproduct of impact, sure, as you've heard, I have papers and grants, I have a good salary, I might have been recognized for things, but those are byproducts and I can care less what my CV looks like. I do it for the impact and these things come with it."

Also Dan Spratt: I've changed multiple national guidelines and work w/ NCI, NRG, CMS, FDA, & pharma, I'm kind of a big deal
Click to expand...
Anonymously shared with me... Spratt just keeps sounding more and more like a class act
 

Attachments

  • Screenshot_20220119-164556_Messages.jpg
    Screenshot_20220119-164556_Messages.jpg
    105.5 KB · Views: 232
TheWallnerus said:
Did you guys catch the ketchup reference. Can you trust a man who hates mustard. (8:28)

Click to expand...

Wow. I finally watched this and have so many things to say.

1. he clearly doesn't enjoy food if his meals are that efficient
2. how much time did he waste calculating all the time he saved?
3. isn't there some saying somewhere that boredom/wasting time spurs creativity? so isn't wasting time in some way actually productive?
4. it is really sad that some of his take away advice is for students to learn how to play a game. I mean its not wrong, but I find it sad.
5. I'm trying to take down the damn wall but the patriarchy (AHEM) seems to like it there.

This whole talk is just awkward. It is very obtuse and abstract without giving clear advice (if that is what is is trying to do??). The Ego is real. I came to that conclusion several years ago when watching his ASTRO Plenary session and it just gave me big Jersey shore vibes. Didn't know about the body building then, but my intuition was not wrong.
 
if you talk to anyone who overuses T, you will find out that you need to come off the T for a bit. Terrible crash I hear but it is necessary. During this cycle you take anastrozole. Less roid rage, i hear. Some folks may want to take the hand off the T.
 
thecarbonionangle said:
if you talk to anyone who overuses T, you will find out that you need to come off the T for a bit. Terrible crash I hear but it is necessary. During this cycle you take anastrozole. Less roid rage, i hear. Some folks may want to take the hand off the T.
Click to expand...
Eat clen, tren hard.
 
MEANWHILE, OVER AT MEMORIAL SLOAN KETTERING CANCER CENTER:

1642638324938.png


How reasonable, Sloan. The cost/benefit ratio of XRT near the end of life must be carefully considered, I agree. What else have you Tweeted about recently?

1642638477286.png


Proton-based craniospinal irradiation for patients with lepto? Is that...choosing wisely?

Well certainly, since these publications came from the same institution, they must have included proton CSI for lepto as an "unnecessary burden", right?

1642638996572.png


Oh, OK, I see - they were excluded. 1% or less must have been a small number, right?

1642639176033.png


Well, shoot. I can't quite tell what the "<1%" means here. Is it 1% of 517,988 total episodes?

Or is it 1% of 17,482 episodes with patient death within 90 days?

Let's be generous and assume the latter. It's not clear what the breakdown of "<1%" means between brachy, IORT, and protons. I think it's safe to say, knowing the practice patterns of America and the fact that Sloan is literally publishing on palliative protons themselves - palliative proton beam therapy is the majority of this excluded group.

1% of 17,482 is approximately 175 patients.

The "non-concordant" group (>10 fractions or combo therapy) was 3,764 patients.

That's a fairly small absolute number, considering they started with over half a million episodes. I'm a little confused, they seem to lose 30 patients between the body of the text (N = 17,482) and the Table (N = 17,452). Perhaps it's a typo, or perhaps I'm just missing where those 30 people went.

1642640095882.png


Anyway, 175 is approximately 5% of the raw "non-concordant" numbers.

Maybe my estimate of 175 is way off, I don't know. What I do know is that the conclusion of the paper states: "Our findings suggest that the burden of unnecessary radiotherapy in the metastatic setting is shared by a sizeable proportion of patients near the end of life, underscoring the importance of guideline adherence."

If they're saying that 3,764 patients/episodes out of 517,988 spanning three years is a "sizeable proportion", then I am saying upwards of 175 patients/episodes of protons within 90 days of death is also a "sizeable proportion", and maybe the institution publishing the proton CSI for lepto study should think about the message they're sending the rest of us when they Tweet about both of these topics in the same week.
 
medgator said:
Anonymously shared with me... Spratt just keeps sounding more and more like a class act
Click to expand...
Jesus, whos texting at 6 am? These must be people that don't sleep as opposed to people who sleep 8 hrs a night and still get things done bc they don't use condiments and had an elective colostomy.
 



If a RCT is the gold standard, then 30 Gy in 10 fractions is better than 8 Gy x 1 for palliation of bone metastases. Can't have it both ways.

pubmed.ncbi.nlm.nih.gov

Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases - PubMed

Both regimens were equivalent in terms of pain and narcotic relief at 3 months and were well tolerated with few adverse effects. The 8-Gy arm had a higher rate of re-treatment but had less acute toxicity than the 30-Gy arm.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
I feel like this may be why a recent patient of mine assumed that only an academic center could treat their bone met… same center that claims only a Gamma Knife can treat brain mets.
 
OTN said:



If a RCT is the gold standard, then 30 Gy in 10 fractions is better than 8 Gy x 1 for palliation of bone metastases. Can't have it both ways.

pubmed.ncbi.nlm.nih.gov

Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases - PubMed

Both regimens were equivalent in terms of pain and narcotic relief at 3 months and were well tolerated with few adverse effects. The 8-Gy arm had a higher rate of re-treatment but had less acute toxicity than the 30-Gy arm.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Click to expand...

It has same pain control and more acute toxicity - how is it standard ? 😊

Sorry, this is my one hill to die on. The pain control is the same. The re-treatment rate is due to physician’s not believing 8 Gy works AND also less comfort with re-treatment (in the old days) after 30/10 vs after 8/1. Recent meta - analysis showed zero difference in pain scores.

I’m not saying 8/1. Go bigger 10-12 Gy if treating hip or something 3D, 14-16 if treating with conformal or give the Ol’ 24/2 “Canadian bacon” a try !
 
RealSimulD said:
It has same pain control and more acute toxicity - how is it standard ? 😊

Sorry, this is my one hill to die on. The pain control is the same. The re-treatment rate is due to physician’s not believing 8 Gy works AND also less comfort with re-treatment (in the old days) after 30/10 vs after 8/1. Recent meta - analysis showed zero difference in pain scores.

I’m not saying 8/1. Go bigger 10-12 Gy if treating hip or something 3D, 14-16 if treating with conformal or give the Ol’ 24/2 “Canadian bacon” a try !
Click to expand...

If we want to change the standard of care for bone metastases, then someone should be doing another RCT which helps us clinicians decide which regimen would work best. I'm not saying 30 Gy in 10 fractions is exclusively what I use (it is not), but "RCT is the gold standard" is absolutely a true statement. 30 Gy in 10 fractions vs 12 Gy in 1 fraction vs 24 Gy in 2 fractions: that would be a good RCT.

Remember when we used to do those?
 
OTN said:
If we want to change the standard of care for bone metastases, then someone should be doing another RCT which helps us clinicians decide which regimen would work best. I'm not saying 30 Gy in 10 fractions is exclusively what I use (it is not), but "RCT is the gold standard" is absolutely a true statement. 30 Gy in 10 fractions vs 12 Gy in 1 fraction vs 24 Gy in 2 fractions: that would be a good RCT.

Remember when we used to do those?
Click to expand...
30/10 vs 12-16 / 1 was done and the single fraction was better …
 
  • Like
Reactions: OTN
i really think 30/10 is over-utilized, and it is to keep people on beam. I understand this. I can't fault people in a small clinic that needs to have people on the machine and not get shut down.

what I don't understand is people who think it is better. it is not. come on.


but this is the oldest, most boring topic in radiation oncology. none of us are breaking new ground on this discussion.
 
RadsWFA1900 said:
I really think the fx discussion has run its course. The academics have to be right and the pragmatic evil community docs are wrong. Can we all move on now? We don’t need another trial.
Click to expand...
We will never move on.

Dan Spratt will never let his brain and soul admit that single to 5 fraction SBRT palliation at his center can be as expensive as doing 150 standard palliative fractions in 10 patients at an outside community center.
 
TheWallnerus said:
We will never move on.

Dan Spratt will never let his brain and soul admit that single to 5 fraction SBRT palliation at his center can be as expensive as doing 150 standard palliative fractions in 10 patients at an outside community center.
Click to expand...
This is true.

And I’m not an academic zealot. I’m just steadfast on this. I’m not coming from cost point of view. The data shows it is as effective. We have 25 trials showing same pain relief, and recent meta analysis showing same.

But, yes single fraction at Sloan is more $$$ than 10 at free standing. But single fraction at free standing is less than 10 fraction at free standing.
 
RealSimulD said:
This is true.

And I’m not an academic zealot. I’m just steadfast on this. I’m not coming from cost point of view. The data shows it is as effective. We have 25 trials showing same pain relief, and recent meta analysis showing same.

But, yes single fraction at Sloan is more $$$ than 10 at free standing. But single fraction at free standing is less than 10 fraction at free standing.
Click to expand...
Could you throw the meta-analysis up? Now that I'm out of academia I don't have access to that journal. While this debate was taught to me as not being a debate, I've come to learn that academics have a bent toward proving fewer fractions are better and sometimes create endpoints or inclusion criteria that essentially predetermine the outcome. If 30 in 10 isn't better in certain populations, then I have trouble understanding how SBRT could be better.
 
You must log in or register to reply here.

Similar threads

uchihastan
Rad Onc vs. Heme/Onc
Replies
18
Views
2K
medgator
M
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
7K
RickyScott
R
TheWallnerus
Rad Onc is in a dark place
Replies
13
Views
3K
RickyScott
R
M
Rad Onc Oral Boards: To quote or not quote studies?
Replies
2
Views
191
medgator
M
Top