Rad Onc Twitter

[ROforbetterorworse]

---

Members do not see this ad.

That’s elective nodal irradiation, not gross disease.

Which still would improve QOL compared to 56/63 to Ln

You mentioned you can’t wait to improve HN QOL

Now is your chance

 

[ROforbetterorworse]

No……… they did not.

That’s literally the point of early salvage.

I’m alarmed you think this

If every patient was going to get salvage RT anyways then we would just treat them post op

Fair enough. It’s about 1/3 for eST. But the principle isn’t trying to omit it completely.l but to delay RT until nexessary

Give it long enough follow up and it will be much higher than 1/3

 

[jondunn]

Which still would improve QOL compared to 56/63 to Ln

You mentioned you can’t wait to improve HN QOL

Now is your chance

I believe in waiting for phase III evidence as a community doc.

If i didn’t, then i would be going to 60 gy already based on the phase II from UNC.

do you NOT look forward to causing less side effects?

 

[deleted941485]

Which still would improve QOL compared to 56/63 to Ln

You mentioned you can’t wait to improve HN QOL

Now is your chance

FLASH Head and Neck. The ultimate in QOL!! Forget planning, rad bio, Sim set up, or anything else. 1 shot 5 seconds $0. Aim and Fire.

 

[jondunn]

FLASH Head and Neck. The ultimate in QOL!! Forget planning, rad bio, Sim set up, or anything else. 1 shot 5 seconds $0. Aim and Fire.

Nonsense

 

[ROforbetterorworse]

I believe in waiting for phase III evidence as a community doc.

If i didn’t, then i would be going to 60 gy already based on the phase II from UNC.

do you NOT look forward to causing less side effects?

We all want less side effects but most of us on here don’t express themselves as superior or not greedy relative to the rest of our colleagues

That’s what you continuously express

 

[medgator]

I believe in waiting for phase III evidence as a community doc.

If i didn’t, then i would be going to 60 gy already based on the phase II from UNC.

do you NOT look forward to causing less side effects?

0 Gy would be the least toxic, obviously

 

[jondunn]

We all want less side effects but most of us on here don’t express themselves as superior or not greedy relative to the rest of our colleagues

That’s what you continuously express

Never said greedy. But do call out dumb when dumb!

 

[jondunn]

0 Gy would be the least toxic, obviously

Yeah well vaccines will make that the case for many. No radiation, no TORS.

 

[deleted941485]

Nonsense

Admittedly so...How about Ipi/nivo-->TORS followed by 1 year of nivo and circDNA. Fixed that for you. Rendering RO totally blameless for QOL issues. Bet you can't wait for that one.

 

[jondunn]

Admittedly so...How about Ipi/nivo-->TORS followed by 1 year of nivo and circDNA. Fixed that for you. Rendering RO totally blameless for QOL issues. Bet you can't wait for that one.

Not sure what you are really getting at here. I think you’ve lost the plot.


Back to the original post - I think the idea that clinical trialists, many of whom never set foot in a lab, are doing trials so they can have more time in lab…….was silly at best, idiotic at worst.

 

[deleted941485]

Not sure what you are really getting at here. I think you’ve lost the plot.


Back to the original post - I think the idea that clinical trialists, many of whom never set foot in a lab, are doing trials so they can have more time in lab…….was silly at best, idiotic at worst.

I've had 2 tell me that they had no interest in seeing patients after doing a 5 year residency. One of them is very well published in the prostate space. There are probably many more who feel this way. Most people would not express this view in public for obvious reasons. But I mean read between the lines man seriously

 

[jondunn]

I've had 2 tell me that they had no interest in seeing patients after doing a 5 year residency. One of them is very well published in the prostate space. There are probably many more who feel this way. Most people would not express this view in public for obvious reasons. But I mean read between the lines man seriously

Two what? Two physician scientists who want to be in lab full time and work to get grants to support that? Shock of the century.

We are talking about different things

 

[RickyScott]

I've had 2 tell me that they had no interest in seeing patients after doing a 5 year residency. One of them is very well published in the prostate space. There are probably many more who feel this way. Most people would not express this view in public for obvious reasons. But I mean read between the lines man seriously

Do they want to be paid like they are seeing pts?

 

[deleted941485]

Do they want to be paid like they are seeing pts?

Idk what their pay expectations are but when your that well published they’re getting something

 

[Palex80]

With HPV, we are, but the bigger impact in HPV will be vaccination anyways.

Indeed, however:

Vaccination for HPV became availble in 2006 and originally only young kids were vaccinated, later the adolescents and even later young adults.
I think it's safe to say that it will take a few decades from now to see a serious drop in incidence, considering the age peaks HPV-related malignancies occur. Cervical cancer is another issue.

 

[jondunn]

Indeed, however:

View attachment 350032
Vaccination for HPV became availble in 2006 and originally only young kids were vaccinated, later the adolescents and even later young adults.
I think it's safe to say that it will take at least a few decades from now to see a serious drop in incidence, considering the age peaks HPV-related malignancies occur. Cervical cancer is another issue.

Agree will be decades

 

[deleted941485]

Two what? Two physician scientists who want to be in lab full time and work to get grants to support that? Shock of the century.

We are talking about different things

You’re being deliberately clueless. If I provide any additional info they will be easily identifiable.

It’s a plausible viewpoint for academic physicians that really are not interested in seeing patients. They need publications grants or no grants and don’t want to be bothered with clinical duties.

 

[medgator]

You’re being deliberately clueless. If I provide any additional info they will be easily identifiable.

It’s a plausible viewpoint for academic physicians that really are not interested in seeing patients. They need publications grants or no grants and don’t want to be bothered with clinical duties.

Looking at JDs previous postings in this thread along with his current probationary status should tell you everything you need to know about him

 

[elementaryschooleconomics]

Ah interesting, I assumed this was widely known -

1) I absolutely do not mean to disparage an entire group of people with a single statement. There are many excellent physician-scientists who maintain strong clinical skills/interest. Some of them post regularly on SDN.

2) There is a SIGNIFICANT population of academic physicians (especially MD-PhDs) who have little to no interest in being in the clinic. They actively do whatever they can to minimize their clinic time, or, if they have to be in clinic, make it as "easy" as possible. This isn't just in RadOnc - but it's fairly widespread in RadOnc. I assume because it's more of an MD-PhD attitude (of which, I am) and RadOnc has the highest percentage of MD-PhDs.

In residency, I quickly learned which faculty I shouldn't make any statements of clinical interest around to avoid sarcastic comments fired my way. I remember early in my PGY-2 year when I was first learning about holding XRT for severely low WBCs, and one attending seemed to use a different cutoff than another attending. Their cutoffs didn't seem to be evidence-based, and I naively said (aloud) that it would be interesting to design a project around that topic. The faculty sitting next to me immediately goes "Who f***ing cares, that's clinical crap, don't waste your time on that". It wasn't said in a jovial tone, I can assure you.

I assume we all have countless stories of that nature.

In fact, it would be interesting to design a study examining the effects of biting/negative comments from faculty about the clinic made in the presence medical students/residents on their perception of the clinical interest of said faculty.

 

[jondunn]

Of course some academic physicians don’t want to be in clinic. (Though of course some do BecuSe they want to steal our patients right)

The idea that some clinical trialiats are purposefully looking at trials cutting radiation so THEY can be in lab more is idiotic. For multiple reasons

1) takes years for the indication to change
2) the vast majority aren’t lab people!!!!
3) there are so many other motivations to do clinical trial research including many non-noble reasons that it’s ASININE to say it’s for more lab time lol

A lot of people are being dense AF

 

[jondunn]

there are many multiples more of lurkers here than posters - never forget

People who actually care about the important things that do matter that as discussed here should point out and push back when things don’t make sense - there’s a reason so many people point to SDN as a cesspool - because there are many times things are posted that don’t make sense.

 

[jondunn]

Looking at JDs previous postings in this thread along with his current probationary status should tell you everything you need to know about him

You should come up with a new retort. You were banned for weeks once. I don’t hold that against you. It’s boring.

Which one am I today - a satellite doc, a PD, a resident who hasn’t passed boards?

I laughed recently when you pulled the same thing on evilbooya.

 

[elementaryschooleconomics]

2) the vast majority aren’t lab people!!!!
3) there are so many other motivations to do clinical trial research including many non-noble reasons that it’s ASININE to say it’s for more lab time lol

You're interpreting "lab" too literally. Think "academic time" instead.

there are many multiples more of lurkers here than posters - never forget

People who actually care about the important things that do matter that as discussed here should point out and push back when things don’t make sense - there’s a reason so many people point to SDN as a cesspool - because there are many times things are posted that don’t make sense.

 

[RickyScott]

while tone sometimes may be extreme on sdn, it is has been much more accurate than any other source re direction of the field.

 

[jondunn]

while tone sometimes may be extreme on sdn, it is has been much more accurate than any other source re direction of the field.

Sure. That’s my point.

 

[medgator]

Sure. That’s my point.

"there’s a reason so many people point to SDN as a cesspool -"

 

[jondunn]

"there’s a reason so many people point to SDN as a cesspool -"

Agree!

 

[thecarbonionangle]

I’ve been accused of being a Chair on here. Maybe I am, maybe Im not, we’ll never know folks! And that is the beautiful thing about anonymity. Beneath masks is an idea.

 

[jondunn]

I’ve been accused of being a Chair on here. Maybe I am, maybe Im not, we’ll never know folks! And that is the beautiful thing about anonymity. Beneath masks is an idea.

Certain someone also accused me of being a proton shill once lol.

Guy has many misses

 

[jondunn]

 

[TheWallnerus]

This title is way more interesting as

Perpetuating Financial Toxicities: Mistakes Were Made, But Not By Us

 

[RadOncMegatron]

This title is way more interesting as

Perpetuating Financial Toxicities: Mistakes Were Made, But Not By Us

Again, I wish her the best, but she’s going to have to start change at MSKCC or she will not be taken seriously. Hopefully, she will be a change for good and not just writing articles about financial toxicity.

The great danger here is that “financial toxicity” is now merely another topic for academics to publish manuscripts and pad the CV. It’s an area where you need to actually “put up or shut up”! Enough publishing in JCO just start making changes!

 

[medgator]

there’s a reason so many people point to SDN as a cesspool - because there are many times things are posted that don’t make sense.

while tone sometimes may be extreme on sdn, it is has been much more accurate than any other source re direction of the field.

Sure. That’s my point.

You could just argue with and contradict yourself all day, JD

 

[ROforbetterorworse]

Dear lord how many times can you write the same paper?

 

[thecarbonionangle]

Dear lord how many times can you write the same paper?

these faculty aint gonna get promoted magically. Hate the game not the playa

 

[metallica81788]

Because ofcourse they are. Im getting the feeling the reason alot of these MD PhDs liked RO so much is because it really isn't so demanding and they can focus on research. The gatekeepers though "oh if we have al these MD PhDs they'll help us innovate" news flash they didn't, They are too busy conspiring to end RO for good so they can finally get that 100% research job they always wanted.

Not speaking for everybody but I've heard of a few MD/PhD students who did this. Thought RadOnc was "cool" and "easy" and "had lots of research opportunities." Wanted heavy research situation but matched at a clinical heavy program and found out they didn't really want to do radiation oncology. One I knew lasted one year then switched fields, others probably just continue on because of the pay who knows.

 

[ROforbetterorworse]

Dear lord how many times can you write the same paper?

Well that didn’t take long

 

[deleted941485]

Well that didn’t take long

#eliminateRT for the good of the patient.

 

[metallica81788]

Would anybody say that we don't do any harm in curing H&N cancer? How's the alternative?

"Do no harm" taken out of context is garbage for what we do. #radiationworks

 

[Palex80]

#eliminateRT for the good of the patient.

 

[jondunn]

Would anybody say that we don't do any harm in curing H&N cancer? How's the alternative?

"Do no harm" taken out of context is garbage for what we do. #radiationworks

This is a false premise/total straw man argument.

 

[OTN]

This is a false premise/total straw man argument.

The vast, vast majority of medicine has the potential to cause side effects. (Well, except for RT for joint pain, of course.) So, I agree that "first, do no harm" is an anachronism, harkening back to the time when medicine couldn't really do much good for the patient, so of course first don't screw things up more than they already are.

 

[RickyScott]

The vast, vast majority of medicine has the potential to cause side effects. (Well, except for RT for joint pain, of course.) So, I agree that "first, do no harm" is an anachronism, harkening back to the time when medicine couldn't really do much good for the patient, so of course first don't screw things up more than they already are.

“Do no harm” is typically sanctomonious, like “we are there for the patients” 99% when I hear these words, I start preparing to get pissed off

 

[TheWallnerus]

The vast, vast majority of medicine has the potential to cause side effects. (Well, except for RT for joint pain, of course.)

26 Gy in 5 fx partial breast gets pretty close too. (One week or less of RT was pretty clever to get all the side effects shifted to after the patient is long gone from clinic.)

 

[deleted941485]

“Do no harm” is typically sanctomonious, like “we are there for the patients” 99% when I hear these words, I start preparing to get pissed off

Its a cudgel for admin and chairs to use on the peons who do all the work. Who knew that a somewhat noble phrase would turn into corperate speak...clearly hippocrates did not anticipate.

 

[jondunn]

Its a cudgel for admin and chairs to use on the peons who do all the work. Who knew that a somewhat noble phrase would turn into corperate speak...clearly hippocrates did not anticipate.

Hmmm. I don’t think admins gaf about ‘do no harm’.

That has nothing to do with the revenue, which is all
That matters to them

 

[deleted941485]

Hmmm. I don’t think admins gaf about ‘do no harm’.

That has nothing to do with the revenue, which is all
That matters to them

Hmm. I think you're taking a too narrow a view.

Do no harm can certainly mean don't harm the system's revenue stream by oh lets say referring out for some high end spine work or to the imaging center across town. Corperate medicine can twist it anyway that benefits them and they'll say it with a straight face.

 

[Palex80]

If you read the entire thread or the abstract, you will see that the PTV-margins were not the same.
4mm for the CT-guided SBRT and 2mm for the MRI-guided SBRT.

So, basically this is not a pure trial of CT- vs. MRI-guidance, but rather margins AND CT- vs. MRI-guidance.

 

[jondunn]

the fix is in?