Rad Onc Twitter

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RealSimulD said:
www.thegreenjournal.com

Single vs multiple fraction palliative radiation therapy for bone metastases: Cumulative meta-analysis

Pain originating from uncomplicated bone metastases, defined as those which have not resulted in and are not at imminent risk for pathological fracture or spinal cord compression, is effectively palliated by conventional external beam radiation therapy (RT) [1,2]. There has been a long-standing...
www.thegreenjournal.com

The pain relief is always the same. It's never any better with MFRT.
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Right. Was wanting to read the article if possible. All I can see is the abstract.
 
Also:

Few of you may have noted that I am doing a newsletter through our Accelerators project.

It borrows from QuadShot in that the hope it is that it will remain 5x/week or so, but rather than analysis, it's mostly aggregating links of interest, rather than supplying the analysis. I have less of a "sciencey" feel - I like practical data, cost/economics and other things as you'll see. Also, some Lagniappe of interesting non-oncologic articles.

The key difference is that I am really working on "the conversation" and will link very often to SDN, to MedNet, to Twitter - because these conversations are happening and a lot is learned, but not everyone knows how to find it, nor do they have the time. I want to get it out of people's mindsets that SDN is a "fringe". We are #radonc. So, @evilbooyaa @Neuronix - I think this is a supplement to SDN, rather than any sort of competition.

Here is today's: SimNews #6 — The Accelerators

Take a look (there are 6 so far). Please message me with ideas/suggestions (email/twitter/SDN).

-S
 
RealSimulD said:
Also:

Few of you may have noted that I am doing a newsletter through our Accelerators project.

It borrows from QuadShot in that the hope it is that it will remain 5x/week or so, but rather than analysis, it's mostly aggregating links of interest, rather than supplying the analysis. I have less of a "sciencey" feel - I like practical data, cost/economics and other things as you'll see. Also, some Lagniappe of interesting non-oncologic articles.

The key difference is that I am really working on "the conversation" and will link very often to SDN, to MedNet, to Twitter - because these conversations are happening and a lot is learned, but not everyone knows how to find it, nor do they have the time. I want to get it out of people's mindsets that SDN is a "fringe". We are #radonc. So, @evilbooyaa @Neuronix - I think this is a supplement to SDN, rather than any sort of competition.

Here is today's: SimNews #6 — The Accelerators

Take a look (there are 6 so far). Please message me with ideas/suggestions (email/twitter/SDN).

-S
Click to expand...
thank you leader
 

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RSAOaky said:
The very notion that this ragtag group of radonc miscreants that can't even agree what condiments to put on a biryani has any semblance of an organisational structure is the most absurd aspect of this all.
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Any properly made biryani needs zero condiments, except perhaps salt to taste.
 
evilbooyaa said:
Any properly made biryani needs zero condiments, except perhaps salt to taste.
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To get all radonc about this, does the raita count as a condiment?

I, for one, think it does. And then the additional sauce that comes on the side that the meat was cooked in, the concentrated stuff? I would think it is. One could also say since it's already in the dish, it's not. But, there are times where you use a sauce in a dish and to top it - is that a condiment?
 
Ok I swear I'm not intentionally picking at Sloan right now, it's just what's popping up in my Twitter feed:

1642732211089.png


From the paper:

1642732288128.png


1642732353470.png


Very bold, guys. A retrospective, 276 patient cohort study with 24 months of follow up is the backbone of "the standard" of care and they dropped a Twitter poll seeing who else was jumping on the train?

Provocative. I could go cherry-pick some retrospective, small studies with 2 years of follow-up from the Urologists or Thoracic Surgeons and claim those results are "the standard" and really light some fires...
 
elementaryschooleconomics said:
Ok I swear I'm not intentionally picking at Sloan right now, it's just what's popping up in my Twitter feed:

View attachment 348675

From the paper:

View attachment 348676

View attachment 348677

Very bold, guys. A retrospective, 276 patient cohort study with 24 months of follow up is the backbone of "the standard" of care and they dropped a Twitter poll seeing who else was jumping on the train?

Provocative. I could go cherry-pick some retrospective, small studies with 2 years of follow-up from the Urologists or Thoracic Surgeons and claim those results are "the standard" and really light some fires...
Click to expand...
We are living in exciting times

Pay no attention to the man behind the curtain
 
elementaryschooleconomics said:
Ok I swear I'm not intentionally picking at Sloan right now, it's just what's popping up in my Twitter feed:

View attachment 348675

From the paper:

View attachment 348676

View attachment 348677

Very bold, guys. A retrospective, 276 patient cohort study with 24 months of follow up is the backbone of "the standard" of care and they dropped a Twitter poll seeing who else was jumping on the train?

Provocative. I could go cherry-pick some retrospective, small studies with 2 years of follow-up from the Urologists or Thoracic Surgeons and claim those results are "the standard" and really light some fires...
Click to expand...
That makes me a little squeamish. I do know of some places that do 30 Gy to elective nodes for anal SqCC, but still...
 
Lamount said:
That makes me a little squeamish. I do know of some places that do 30 Gy to elective nodes for anal SqCC, but still...
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I think nccn recommends 30 gy for elective nodes as an option. It's evidence based with long follow-up. Unlike this, which is clearly different, as nobody seems on the verge of suggesting 54 gy to gross disease.
 
RealSimulD said:
To get all radonc about this, does the raita count as a condiment?

I, for one, think it does. And then the additional sauce that comes on the side that the meat was cooked in, the concentrated stuff? I would think it is. One could also say since it's already in the dish, it's not. But, there are times where you use a sauce in a dish and to top it - is that a condiment?
Click to expand...

I usually don't need the raita. Nothing wrong with those who enjoy it on, but I'd rather have more of the biryani. To me it's not a condiment that I put on top of the biryani. It's like a separate thing. It's not the ranch on my salad or the ranch on my hot chicken wings. It's the celery or carrots I dip into the ranch or blue cheese to alternate flavors while I'm eating my wings.

elementaryschooleconomics said:
Ok I swear I'm not intentionally picking at Sloan right now, it's just what's popping up in my Twitter feed:

View attachment 348675

From the paper:

View attachment 348676

View attachment 348677

Very bold, guys. A retrospective, 276 patient cohort study with 24 months of follow up is the backbone of "the standard" of care and they dropped a Twitter poll seeing who else was jumping on the train?

Provocative. I could go cherry-pick some retrospective, small studies with 2 years of follow-up from the Urologists or Thoracic Surgeons and claim those results are "the standard" and really light some fires...
Click to expand...

I think radical drops in dose to elective nodal areas rather than gross disease makes a lot of sense. And, their 2-year PFS looks very good, especially without cherry picking all the non-smokers that even HN-002 did.

Despite how good the 2-yr data looks, the audacity of sloan to post a 276 pt retrospective series and claim it as their SOC is... an interesting jump in terms of "what is needed to radically change one's oncology practice". If a patient goes to them, gets treated as per *their* SOC (but nobody else in the world would ever do this) and subsequently develops a neck failure, can he sue for malpractice as receiving a non-SOC option?

It seems, tangentially, like Sloan is driven more by marketing and chest thumping than they are by actual good science.

Sloan: THIS is our SOC now, peasants! Send us your P16+ OPC H&Ns if you don't have the BALLS to go 30Gy to elective volumes like US. HAHA!
 
evilbooyaa said:
I usually don't need the raita. Nothing wrong with those who enjoy it on, but I'd rather have more of the biryani. To me it's not a condiment that I put on top of the biryani. It's like a separate thing. It's not the ranch on my salad or the ranch on my hot chicken wings. It's the celery or carrots I dip into the ranch or blue cheese to alternate flavors while I'm eating my wings.



I think radical drops in dose to elective nodal areas rather than gross disease makes a lot of sense. And, their 2-year PFS looks very good, especially without cherry picking all the non-smokers that even HN-002 did.

Despite how good the 2-yr data looks, the audacity of sloan to post a 276 pt retrospective series and claim it as their SOC is... an interesting jump in terms of "what is needed to radically change one's oncology practice". If a patient goes to them, gets treated as per *their* SOC (but nobody else in the world would ever do this) and subsequently develops a neck failure, can he sue for malpractice as receiving a non-SOC option?

It seems, tangentially, like Sloan is driven more by marketing and chest thumping than they are by actual good science.

Sloan: THIS is our SOC now, peasants! Send us your P16+ OPC H&Ns if you don't have the BALLS to go 30Gy to elective volumes like US. HAHA!
Click to expand...
Very strong point - it is not SOC. Not the SOC. Not A SOC. It’s experimental AF.

I would like to point out that I appreciate their strategy of de-escalation that isn’t less fractions or less of an emphasis on the curative nature of what we do. This is better for patients, less toxic and doesn’t minimize our role. This is how it’s done. Now let’s get an RCT
 
If we can de-escalate elective areas to 30 Gy, could we eliminate them altogether? That would offer the greatest toxicity benefit.
 
Not only did MSK reduce to 30 Gy to neck, but direct GTV->PTV for 70 Gy. But they put ~1.3 cm beyond primary for the CTV30. Any "suspicious node they put 50 into.

Examples for MSKCC supplemental data so you can see how they contour:

1642801177135.png

CTV50 in blue into air and bone. CTV30 coming in to cover low RP nodes and looks like extending anteriorly into digastric for some reason.

1642801277246.png

CTV30 in yellow in air and out of SCM on left. Why into Sup pharyngeal constrictor on right?

1642801408900.png

Small BoT tumor, looks like GTV70 overdrawn into post pharyngeal wall and into epiglottis. Again not understanding why CTV30 into air and L post pharyngeal wall.
 
madchemist89 said:
If we can de-escalate elective areas to 30 Gy, could we eliminate them altogether? That would offer the greatest toxicity benefit.
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The right answer for 70-80% of patients with an N0 is 0 Gy. Haven't been able to choose them out yet. ACRIN trial best data. Looking forward to sentinel lymphoscintigraphy guided elective treatment trials.
 
I think up maybe because what we lost from the Uber competitive candidates setting their eyes on what they think may be more desirable fields, others that may have been interested but anxious because of scores/grades/research became more so when it appeared to be less competitive.
 
1) While the applicants may be "better" this year (however you choose to measure that), we'll all find out who dual-applied to other specialties after the Match.

2) This is why the Potters and Spratts of the world needn't whine about the "fall from grace". They have the raw material. Do something with it.

3) Does anyone want to take bets on when Boston Scientific opens the unaccredited "Augmenix Endowed Fellowship in GU RadOnc" program? I mean, I guess they've already created unofficial endowed positions for existing faculty. Are you an Augmenix Endowed Professor if you've accepted >$100k? Or is the bar like, >$200k?
 
elementaryschooleconomics said:
1) While the applicants may be "better" this year (however you choose to measure that), we'll all find out who dual-applied to other specialties after the Match.

2) This is why the Potters and Spratts of the world needn't whine about the "fall from grace". They have the raw material. Do something with it.

3) Does anyone want to take bets on when Boston Scientific opens the unaccredited "Augmenix Endowed Fellowship in GU RadOnc" program? I mean, I guess they've already created unofficial endowed positions for existing faculty. Are you an Augmenix Endowed Professor if you've accepted >$100k? Or is the bar like, >$200k?
Click to expand...
Let's follow up on these tweets in a few months and see how many places are cleaning without SOAP.....
 
jondunn said:
Spratt is gonna be PISSED when he matches a guy who eats ketchup!

can you imagine the faculty meeting? I wouldn't want to sit in throwing distance of Chairman Dan
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Sprat will be happy as a pig in sh if he matches a us md.
Edit- in fairness, he is very bright and ambitious but no reason to go with case over cc. Probably 30-40 programs I would rank over case, including every program in Florida and nyc (with exception of downstate and Columbia)
 
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Ray D. Ayshun said:
Might be that the superstar students, like a chair we've been discussing, are awkward as **** to talk to. Maybe they're just interviewing avg students who have reasonable hobbies, get stoned occasionally, and are actually fun to talk to.
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I don’t know why this isn’t how we selected people in the past. Is a 265 that much better than a 235? Are 20 pubs that much better than 10?

Minimum standard is really what they should look at and then go with personality / fit. But, that would really hurt the current faculty’s feelings who had to be superhuman …
 
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