Rad Onc Twitter

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RadsWFA1900 said:
People seem content with waiting for this shoe to drop. No innovations on the RT side are ever going to bring us back. Once a site is gone it’s gone for good.
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Organ-sparing rectal cancer treatment will help- lots of enthusiasm for this on the medonc side, and no one is trying to remove XRT from this process. Yet.
 
RickyScott said:
The concluding slide of the talk: "until we have better systemic control of PDAC, RT is unlikely to be enough to drive an OS benefit."


View attachment 355970
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to irradiate or not to irradiate is the question. We should always radiate...positivity. In any case, PREOPANC was decent.
 
grenz said:
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fight club i am jacks GIF
 
Moonbeams said:
LOL. Results at 5 years for luminal A breast cancer and a question about does age matter?

Seriously? How many times have we seen a recurrence of luminal A 20 years out.
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If this annual rate of recurrence keeps up, it would take 30 years to hit a 15% local recurrence rate. Pretty low
 
grenz said:
If this annual rate of recurrence keeps up, it would take 30 years to hit a 15% local recurrence rate. Pretty low
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I don't think we can extrapolate like this. First, on endocrine therapy there are close to zero recurrences always within the first couple year of follow-up and historically there was seen an increase in recurrence rate after 5 years f/u.

I just don't think these trials are helpful at 5 year f/u and predicted that they would all show very low rates of recurrence within this time interval.

80 year old woman today has a 10 year life expectancy.

Probably the breast CA community is moving to a new philosophical model where they will accept 15 % local recurrence over a 15 year window to avoid 5 fractions of XRT while firmly recommending endocrine therapy in a population where XRT more significantly reduces risk of recurrence (Luminal A).
 
communitydoc13 said:
I don't think we can extrapolate like this. First, on endocrine therapy there are close to zero recurrences always within the first couple year of follow-up and historically there was seen an increase in recurrence rate after 5 years f/u.

I just don't think these trials are helpful at 5 year f/u and predicted that they would all show very low rates of recurrence within this time interval.

80 year old woman today has a 10 year life expectancy.

Probably the breast CA community is moving to a new philosophical model where they will accept 15 % local recurrence over a 15 year window to avoid 5 fractions of XRT while firmly recommending endocrine therapy in a population where XRT more significantly reduces risk of recurrence (Luminal A).
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I totally agree with you, but regardless of how we feel, medoncs have a major impact on who gets radiation.
 
Palex80 said:
I am sorry, but as radiation oncologists we have done a terrible job when it comes to clinical research in the field of pancreatic cancer.
Most of the trial we conducted were negative for RT in any setting of the disease and poorly designed.
It's not hard for med oncs to hit on us when it comes to pancreatic cancer.
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There are cases where their opinion is not wrong, but it is still inappropriate. The fact that you have to have a presentation about how we use different RT modalities and different doses to accomplish different things at one of their biggest national conferences demonstrates that.

Despite them knowing very little about what we do, I get just as much fraction-shaming from medoncs as we see from fellow radoncs. Medoncs sometimes argue against RT even when they've been proven wrong - just look at lymphoma or GYN: they design a clinical trial to exclude RT and it comes out negative (doesn't satisfy its end point) and they still conclude RT isn't needed because of toxicity - even when the toxicity from additional chemo is higher. Then they just do what they wanted to do all along.
 
thesauce said:
There are cases where their opinion is not wrong, but it is still inappropriate. The fact that you have to have a presentation about how we use different RT modalities and different doses to accomplish different things at one of their biggest national conferences demonstrates that.

Despite them knowing very little about what we do, I get just as much fraction-shaming from medoncs as we see from fellow radoncs. Medoncs sometimes argue against RT even when they've been proven wrong - just look at lymphoma or GYN: they design a clinical trial to exclude RT and it comes out negative (doesn't satisfy its end point) and they still conclude RT isn't needed because of toxicity - even when the toxicity from additional chemo is higher. Then they just do what they wanted to do all along.
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We wont survive as a field unless we can prescribe systemic treatment like gyn-onc
 
RadsWFA1900 said:
What a garbage study. Doesn’t take much for these idiots to celebrate especially when it’s omitting RT.
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Risk of contralateral breast cancer (which would be affected by endocrine therapy) is almost the same as the risk of local recurrence in the cancer-affected, not-irradiated breast. This is striking.
 
Palex80 said:
Risk of contralateral breast cancer (which would be affected by endocrine therapy) is almost the same as the risk of local recurrence in the cancer-affected, not-irradiated breast. This is striking.
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Because god forbid both should ever be offered to patients. It’s either ET or RT now can’t have both.

Never mind there was already a study done with even older patients with T1.
 
RadsWFA1900 said:
Because god forbid both should ever be offered to patients. It’s either ET or RT now can’t have both.

Never mind there was already a study done with even older patients with T1.
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Hormone therapy just delays failure until it is stopped, but it is only going to take one study …
 
RadsWFA1900 said:
Because god forbid both should ever be offered to patients. It’s either ET or RT now can’t have both.

Never mind there was already a study done with even older patients with T1.
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I am asking myself, if I have been irradiating the correct breast in these patients. Maybe I should have been treating the other one (too). 🤣
 
RickyScott said:
Hormone therapy just delays failure until it is stopped, but it is only going to take one study …
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The fact that we’ve revisited this question as many times as we have is absurd borderline ******ed behavior. It’s like you keep running the same study until it comes out the way you want it. I hate med oncs for this reason.
 
RadsWFA1900 said:
The fact that we’ve revisited this question as many times as we have is absurd borderline ******ed behavior. It’s like you keep running the same study until it comes out the way you want it. I hate med oncs for this reason.
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Who said that only med oncs ran all those trials? Some were designed by us.

Looking again at the trials, there were flaws in the past. Lots of patients with not-clear margins, no oncotype and so on. Omission of RT in early breast cancer is an accident waiting to happen.
 
Palex80 said:
Who said that only med oncs ran all those trials? Some were designed by us.

Looking again at the trials, there were flaws in the past. Lots of patients with not-clear margins, no oncotype and so on. Omission of RT in early breast cancer is an accident waiting to happen.
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The sheer number of the trials already out there. Those sampling errors would have washed out.
 
Palex80 said:
Risk of contralateral breast cancer (which would be affected by endocrine therapy) is almost the same as the risk of local recurrence in the cancer-affected, not-irradiated breast. This is striking.
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Palex80 said:
I am asking myself, if I have been irradiating the correct breast in these patients. Maybe I should have been treating the other one (too). 🤣
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/runs in to room
/lets stinky silent fart
"The failure rate in the contralateral unirradiated normal breast was about triple the failure rate in ipsilateral unirradiated normal IMNs in EORTC 22922... since irradiating ipsilateral IMNs makes sense in N+, irradiating contralateral breasts makes even better sense!"
/runs out of room
 
TheWallnerus said:
/runs in to room
/lets stinky silent fart
"The failure rate in the contralateral unirradiated normal breast was about triple the failure rate in ipsilateral unirradiated normal IMNs in EORTC 22922... since irradiating ipsilateral IMNs makes sense in N+, irradiating contralateral breasts makes even better sense!"
/runs out of room
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Skeletor will be back next week with more fun oncology facts for you to deny
 
TheWallnerus said:
/runs in to room
/lets stinky silent fart
"The failure rate in the contralateral unirradiated normal breast was about triple the failure rate in ipsilateral unirradiated normal IMNs in EORTC 22922... since irradiating ipsilateral IMNs makes sense in N+, irradiating contralateral breasts makes even better sense!"
/runs out of room
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Time to cancel Wallnerus. Abject lack of impulse control.
 
thesauce said:
Acceptably low to who? Her?

Did she serious ask if age matters in breast cancer? Has she read any published breast cancer trial....ever?
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And age certainly matters if you're going to live 20 years but only take 5 years of your AI.
 
thesauce said:
How is he not an expert?
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That what’s my initial thought. Breast radiation should only be provided by a skilled breast radiation oncologist intimately familiar with retrospective series. Only they would be qualified to opine on the matter.
 
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thesauce said:
How is he not an expert?
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RickyScott said:
That what’s my initial thought. Breast radiation should only be provided by a skilled breast radiation oncologist intimately familiar with retrospective series. Only they would be qualified to opine on the matter.
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Ralph W:

Expert on completely rewriting the prevailing alternative hypothesis in favor of placing his own complete zero-evidence WAG ("the oligometastases hypothesis has not given rise to a new paradigm for governing the treatment of breast cancer") at the top of the heap in metastatic breast cancer

vs

Total neophyte re: xrt for low risk breast cancer


ohhhhh kay

QP7Mya7.png
 
RickyScott said:
That what’s my initial thought. Breast radiation should only be provided by a skilled breast radiation oncologist intimately familiar with retrospective series. Only they would be qualified to opine on the matter.
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Meanwhile you can barely pass your boards and stumble through a oncology follow ship and somehow be qualified to dispense a myriad of systemic agents without question. I really resent to pseudo privilege that exists in RO for a far more restricted field.
 
RadsWFA1900 said:
Meanwhile you can barely pass your boards and stumble through a oncology follow ship and somehow be qualified to dispense a myriad of systemic agents without question. I really resent to pseudo privilege that exists in RO for a far more restricted field.
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Half of the fellowship relegated to heme in many cases
 
TheWallnerus said:
Ralph W:

Expert on completely rewriting the prevailing alternative hypothesis in favor of placing his own complete zero-evidence WAG ("the oligometastases hypothesis has not given rise to a new paradigm for governing the treatment of breast cancer") at the top of the heap in metastatic breast cancer

vs

Total neophyte re: xrt for low risk breast cancer


ohhhhh kay

QP7Mya7.png
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Thats quite an response by fisher. I guess the oligomet breast trial was the test of Ralph’s hypothesis.
 
medgator said:
Half of the fellowship relegated to heme in many cases
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Can we just surrender now and hope MO takes pity on us? Seriously, it’s over. We know what the future will be at this point. Whatever clout or respect we have left over should be used to leverage getting out of this cul de sac of death we’ve created. The job certainly won’t be cushy or as well paid but honestly it’s better than sitting around all day being basically unneeded worried that the next ASCO pub or admin meeting will result in you losing half your income or your job.
 
RadsWFA1900 said:
Can we just surrender now and hope MO takes pity on us? Seriously, it’s over. We know what the future will be at this point. Whatever clout or respect we have left over should be used to leverage getting out of this cul de sac of death we’ve created. The job certainly won’t be cushy or as well paid but honestly it’s better than sitting around all day being basically unneeded worried that the next ASCO pub or admin meeting will result in you losing half your income or your job.
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communitydoc13 said:
Great work. The authors may also be making the assumption that the "charge" on the charge master list or wherever they are getting it represents what someone without insurance will pay.

This is almost certainly false, with the charge representing roughly the highest amount that they might collect from a favorable payor. Typically, those without insurance pay less for services than those with Medicare and often somewhat comparable to Medicaid. Those without insurance and a new cancer diagnosis will often go through an expedited process to get disability based on diagnosis and then establish some sort of coverage based on this status.

They should take a sample of uninsured patients (let MSKCC find some in their system) and find out where these folks are getting care and how much they are paying.

The authors know full well that the lowest charge for Pembro from any center far exceeds affordability for anyone without insurance other than the filthy rich.
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Can an uninsured patient even get through the door at Sloan?
 
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