Rad Onc Twitter

[Ray D. Ayshun]

Isn’t there a horror movie where the guy has to start eating part of his body to survive

DEFINE_ME

8 more fractions for unresectable Ewing's.

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[BobbyHeenan]

2 versus 5 fractions? when did we get to 5?

When they figured out you can get treatment done in one week off of work away from your home. Your catchment area just went to infinity.

 

[RickyScott]

When they figured out you can get treatment done in one week off of work away from your home. Your catchment area just went to infinity.

Lot of lies there about cost and convenience. Could stay at home and continue work while getting 5 fractions of sbrt at home. I am sure New York Presbyterian charges a s load for sbrt prostate.

 

[BobbyHeenan]

Lot of lies there about cost and convenience. Could stay at home and continue work while getting 5 fractions of sbrt at home. I am sure New York Presbyterian charges a s load for sbrt prostate.

I can’t hate too much - at least they’re doing it on trial.

I’m interested to see PACE and GU -005 report though.

I feel like we’re still trying to figure out optimal 5 fraction dosing too. And do you escalate an mri detected nodule of interest? A lot of moving parts.

 

[Neuronix]

When they figured out you can get treatment done in one week off of work away from your home. Your catchment area just went to infinity.

That plus APM. A lot of people are preparing for a world of doing as little as possible to collect a fixed payment.

 

[jondunn]

 

[RickyScott]

That plus APM. A lot of people are preparing for a world of doing as little as possible to collect a fixed payment.

Lumpectomy cavity is a lot more foregiving than prostate. Should see 2 or single fraction. I think someone had preliminary data at estro for single fraction.

 

[TheWallnerus]

Lumpectomy cavity is a lot more foregiving than prostate. Should see 2 or single fraction. I think someone had preliminary data at estro for single fraction.

Single fraction post-lump RT is a hot, trendy topic. It was hotter than DEI at ACRO. The cool kids do it with MRgRT, natch. I think they reported one local failure in 200+ patients at many years.

 

[salubalu]

2 fractions of hdr worked out so well that this trial was a given. True equipoise.These kind of trials are what make our field so special. Let’s get prostate sbrt down to 2!

I’m going to run a trial that will get it down to 0. Oh wait PROTECT…

 

[OTN]

2 fractions of hdr worked out so well that this trial was a given. True equipoise.These kind of trials are what make our field so special. Let’s get prostate sbrt down to 2!

The equipoise question is the interesting one here, as I do not understand how they can say there is true equipoise between those two arms.

 

[RickyScott]

The equipoise question is the interesting one here, as I do not understand how they can say there is true equipoise between those two arms.

My understanding is that the hdrx2 experience was both more toxic and less effective. Maybe they will try to claim that space oar reduces toxicity despite hdr dosimeteric advantage, but how can it possibly be more effective than hdrx2?

 

[OTN]

My understanding is that the hdrx2 experience was both more toxic and less effective. Maybe they will try to claim that space oar reduces toxicity despite hdr dosimeteric advantage, but how can it possibly be more effective than hdrx2?

Someone is going to need to explain to me how HDR = SBRT, then, if that's their hypothesis.

Plus, as we've mentioned before ad nauseum here, you don't need SpaceOAR for 5 fractions. So, if you're placing it for 2 fractions, then we already have one of the arms of the trial with 100% grade 1 toxicity.

 

[RickyScott]

Someone is going to need to explain to me how HDR = SBRT, then, if that's their hypothesis.

Plus, as we've mentioned before ad nauseum here, you don't need SpaceOAR for 5 fractions. So, if you're placing it for 2 fractions, then we already have one of the arms of the trial with 100% grade 1 toxicity.

I really don’t think they have a legitimate clinical hypothesis. This is marketing.

 

[jondunn]

 

[OTN]

Oh thank goodness he weighed in, I was wondering what a medonc thought of the question

 

[elementaryschooleconomics]

 

[TheWallnerus]

Oh thank goodness he weighed in, I was wondering what a medonc thought of the question

It’s like me weighing in on a DEI thread on twitter

 

[temujim]

It’s like me weighing in on a DEI thread on twitter

As a wallnerus you bring a valuable trans-species perspective that should not be airbrushed out of herstory.

 

[taserlaser]

I mean this exact statement could be made of anyone, wherever they work. It doesn't have anything to do with 'experts' or non-experts

the point is anybody anywhere should do more than the bare minimum of meeting the scorecard, if they can.

Oh man

At risk of doxing myself, we recently implemented an automated breast tangent process. I was not in the initial pilot, but in the regular roll out

I rejected every single left heart dose that it auto planned for me. The computer planned to what was met the constraint, but not clinically acceptable given the circumstance. It was one frustration among many.

 

[elementaryschooleconomics]

Oh man

At risk of doxing myself, we recently implemented an automated breast tangent process. I was not in the initial pilot, but in the regular roll out

I rejected every single left heart dose that it auto planned for me. The computer planned to what was met the constraint, but not clinically acceptable given the circumstance. It was one frustration among many.

Hmmm your computers must have been trained by my Dosimetrists...

 

[jondunn]

 

[medgator]

Your point? Or just more JD tweet post diarrhea?

 

[Mandelin Rain]

And here I am, eating my scrambled eggs covered in hot sauce.

THANKS A LOT!

 

[Palex80]

This guy's tweets are actually kind of fun to read...



What kind of a needle is that? 2 feet long?

 

[jondunn]

agreed, he really does some wild stuff, very interesting tweets

 

[Gfunk6]

This guy's tweets are actually kind of fun to read...



What kind of a needle is that? 2 feet long?

Wowsers. It almost looks like the poor patient had an industrial related accident and was speared with a long, hollow tube.

 

[TheWallnerus]

 

[radoncftw]

this is a jon dunn type post

 

[TheWallnerus]

this is a jon dunn type post

Well as much as we say med students should be cautious about rad onc if you can wind up being Burri… choosing rad onc would be a no brainer

 

[Ray D. Ayshun]

Well as much as we say med students should be cautious about rad onc if you can wind up being Burri… choosing rad onc would be a no brainer

He's got a Pretty soso google review

 

[jondunn]

There is huge proton lobby money behind this , I have no doubt

However maybe it’s like APM - the proton lobby protects their interest but helps everyone else accidentally

 

[RickyScott]

There is huge proton lobby money behind this , I have no doubt

However maybe it’s like APM - the proton lobby protects their interest but helps everyone else accidentally

Striking down prior auth would destroy health care.

 

[jondunn]

One day he will have a tweet that sounds like it came from a normal person

 

[udrag14]

Striking down prior auth would destroy health care.

I'm for this. Prior authorization are so stupid. Let's make more barriers for cancer patients who need urgent treatment.

 

[RickyScott]

I'm for this. Prior authorization are so stupid. Let's make more barriers for cancer patients who need urgent treatment.

No one likes prior auth. With health care costs and prices already out of control, I doubt we could sustain a system without prior auth. At least when it comes to radiation, conventionally fractionated proton radiation would quickly be recommended for everything. Prior authorization is not the root of the issue. Upenn charging 300k to Pennsylvania employers for prostate proton is.

 

[RickyScott]

Upenn owns 3 protons centers within 30-40 miles: cherry hill, upenn, lancaster. Recognizing scarop president for her phenomenal work at Astro advocacy day. the rug that ties the room together.

 

[jondunn]

Business minded rad onc

 

[RickyScott]

Business minded rad onc

I disagree with him. UPenn’s of the world that are making billions in the present system are not going to transition without a huge fight to value based population capitated care. May as well say big pharm will transition to value based drugs…

 

[metallica81788]

My biggest problem with all of this "value-based" stuff is who decides what is "valuable" and how is it measured?

There are already enough factors out of our control impacting our patients' outcomes, our career satisfaction, and our salaries - let's just throw some more in there and be completely powerless!

 

[medgator]

 

[jondunn]

No prior authorization needed

 

[Mandelin Rain]

25 MAUDE reports in April alone, most of which are pretty bad, i.e. fistula.

Looks like 330 in past year. About 1 report per day.

I can't imagine using this on every guy through the door.

 

[OTN]

No prior authorization needed

Treating synchrous bilateral breast cancer is not challenging

 

[deleted1111261]

Treating synchrous bilateral breast cancer is not challenging

This is bananas.

They want us to do bone Mets, whole brain and maybe tangent breast (but watch it with the IMRT). The rest - high volume centers

 

[thecarbonionangle]

if you didnt treat with protons did you even treat bro?

 

[Mandelin Rain]

Treating synchrous bilateral breast cancer is not challenging

Do you even feather, brah?

Gotta cover that pre-sternal breast tissue (I learned anatomy from Total Recall).

 

[jondunn]

This is bananas.

They want us to do bone Mets, whole brain and maybe tangent breast (but watch it with the IMRT). The rest - high volume centers

You can only trewt bone Mets if you’re in the palliative care network.

 

[temujim]

25 MAUDE reports in April alone, most of which are pretty bad, i.e. fistula.

Looks like 330 in past year. About 1 report per day.

I can't imagine using this on every guy through the door.

Whatever you do, don't look at VAERS

 

[Ray D. Ayshun]

I got the impression they didn't do breath hold, which would very much bias this towards better proton dosimetry.

 

[OTN]

Do you even feather, brah?

Gotta cover that pre-sternal breast tissue (I learned anatomy from Total Recall).

What's challenging about feathering?