Rad Onc Twitter

[jondunn]

---

Members do not see this ad.

I do one WBRT probably about every 2 months, but when I do i usually do HA-WBRT. I see no big reason not to. of course mostly SRS, talking about the WBRT cases here.

 

[TheWallnerus]

I do one WBRT probably about every 2 months, but when I do i usually do HA-WBRT. I see no big reason not to. of course mostly SRS, talking about the WBRT cases here.

HA-WBRT is paid by Medicare 100% of the time. This can be good or bad I guess 🙂

 

[medgator]

HA-WBRT is paid by Medicare 100% of the time. This can be good or bad I guess 🙂

Medicare pays for a lot of stuff that insurers and evilcore won't, although in this case, evilcore does cover it

 

[madchemist89]

I do hippocampal avoidance for non-srs candidates. I haven't done 3d whole brain in a while.

 

[TheWallnerus]

I do hippocampal avoidance for non-srs candidates. I haven't done 3d whole brain in a while.

I've been doing IMRT whole brain since 2005. Back then people called it "fraud." Yesterday's fraud is today's standard of care as the old saying goes.

 

[medgator]

I've been doing IMRT whole brain since 2005. Back then people called it "fraud." Yesterday's fraud is today's standard of care as the old saying goes.

Like radiating the prostate in M1 disease

 

[TheWallnerus]

Like radiating the prostate in M1 disease

Albert Einstein believed in general relativity before there was one objective piece of evidence that it was a good theory. He was pretty unethical.

 

[RadOncDoc21]

Not sure why I’m still getting a lot of pushback from the insurance companies. By the time I get approval, my patients (and me) are already forgetting everything.

 

[jondunn]

 

[deleted1111261]

I do hippocampal avoidance for non-srs candidates. I haven't done 3d whole brain in a while.

I think good workflow is crucial here. From a referring perspective, if they send a whole brain and I can't start them that day or the next, it will not reflect well on me, as they could not care less about HA. I think to make it a standard of care, have to create a process for staff and I think it is probably worthwhile.

 

[Neuronix]

We turn around HA-SRS cases in a day. It's still uncommon that I do them. I'm either usually doing SRS or the patient has diffuse disease or LMD that doesn't lend itself to hippocampal avoidance. There is not a lot of in-between. It does depend on how aggressive you are with stereo.

 

[TheWallnerus]

It does depend on how aggressive you are with stereo

key point

It's like "unresectability"... with the correct surgical referral what is unresectable becomes resectable (sometimes)

 

[deleted1116990]

key point

It's like "unresectability"... with the correct surgical referral what is unresectable becomes resectable (sometimes)

Until you get to the point that the neurosurgeon is so aggressive he takes your GBM patient who is halfway through EBRT and is having headaches from edema, gets an MRI showing "progression" and takes him back to OR for reresection and tells you you can finish the RT in a month.

#CATFISHLYFE

 

[Palex80]

key point

It's like "unresectability"... with the correct surgical referral what is unresectable becomes resectable (sometimes)

You mean like Stage IIIB NSCLC? 😛

 

[jondunn]

 

[OTN]

HA-WBRT is much better in terms of cognition compared with standard whole brain RT. I switched several years ago.

Super bizarre hill for Dr. Fabio Moraes to die on, considering the trials showed that HA-WBRT improved side effect profiles compared with standard WBRT. I actually had to look him up to see if he was, in fact, a radonc. He is indeed. Strange.

 

[deleted1111261]

HA-WBRT is much better in terms of cognition compared with standard whole brain RT. I switched several years ago.

Super bizarre hill for Dr. Fabio Moraes to die on, considering the trials showed that HA-WBRT improved side effect profiles compared with standard WBRT. I actually had to look him up to see if he was, in fact, a radonc. He is indeed. Strange.

I also learned from that thread. Will be more likely to consider it in the future.

 

[grenz]

 

[DoctwoB]

Need to dive deeper to draw conclusions, but there is some data for increased risk of peyronie's post RP. One study showed up to 15%. It's tricky to quantify, because the incidence of PD in the population at large is surprisingly high (~9%) but is mostly not reported.

Penile shortening does occur post RP but is temporary and equivalent to XRT + any ADT

Longitudinal recovery patterns of penile length and the underexplored benefit of long-term phosphodiesterase-5 inhibitor use after radical prostatectomy - BMC Urology

Background Penile length (PL) shortening is an underreported phenomenon following radical prostatectomy (RP) and risk factors are not fully explored. We aimed to describe longitudinal patterns of PL recovery and evaluate factors predicting complete return to baseline PL. Methods PL measurement...

bmcurol.biomedcentral.com

Reduced Penile Size and Treatment Regret in Men With Recurrent Prostate Cancer After Surgery, Radiotherapy Plus Androgen Deprivation, or Radiotherapy Alone - PMC

To report the relative incidence of the perceived reduction in penile size across prostate cancer treatment modalities and to describe its effect on quality of life and treatment regret. The incidence of patient complaints about reduced penile size ...

www.ncbi.nlm.nih.gov

 

[TheWallnerus]

Need to dive deeper to draw conclusions, but there is some data for increased risk of peyronie's post RP. One study showed up to 15%. It's tricky to quantify, because the incidence of PD in the population at large is surprisingly high (~9%) but is mostly not reported.

Penile shortening does occur post RP but is temporary and equivalent to XRT + any ADT

Longitudinal recovery patterns of penile length and the underexplored benefit of long-term phosphodiesterase-5 inhibitor use after radical prostatectomy - BMC Urology

Background Penile length (PL) shortening is an underreported phenomenon following radical prostatectomy (RP) and risk factors are not fully explored. We aimed to describe longitudinal patterns of PL recovery and evaluate factors predicting complete return to baseline PL. Methods PL measurement...

bmcurol.biomedcentral.com

Reduced Penile Size and Treatment Regret in Men With Recurrent Prostate Cancer After Surgery, Radiotherapy Plus Androgen Deprivation, or Radiotherapy Alone - PMC

To report the relative incidence of the perceived reduction in penile size across prostate cancer treatment modalities and to describe its effect on quality of life and treatment regret. The incidence of patient complaints about reduced penile size ...

www.ncbi.nlm.nih.gov

XRT to the prostate in and of itself will never make a penis shorter

 

[DoctwoB]

XRT to the prostate in and of itself will never make a penis shorter

Born out by linked study above (though wouldn’t have been surprised if XRT induced fibrosis led to contracture). ADT clearly the bigger culprit.

Do novo peyronies post RP is admittedly not something I’ve seen. Clearly it occurs based on data, but I expect the majority occurs either in men with post RP ED where the curvature isn’t a primary issue or in men who have decent erectile function and the curvature isn’t limiting (since the plaque and curvature aren’t necessarily clinically relevant)

You’d be surprised how many guys have peyronies that doesn’t really limit sexual function and they don’t worry about until they see a xiaflex commercial with curved bananas. We could do a better job asking about it, but if it isn’t causing bother we might just be creating problems where none existed.

 

[TheWallnerus]

You’d be surprised how many guys have peyronies that doesn’t really limit sexual function and they don’t worry about until they see a xiaflex commercial with curved bananas.

Bent carrots now!

 

[DoctwoB]

Bent carrots now!

It’s funny since xiaflex was off label (not anymore) so they couldn’t advertise the Med, it’s an “ask your doctor about your Peyronie’s disease”

Another interesting thing about it. It’s a collegenase that softens the corporal plaque. One of the risks is corporal rupture (penile fracture) of about 2-3%. Men are told to abstain for 4 weeks post treatment. Based on the studies that’s the risk of “spontaneous rupture”. I’m willing to bet that most of those were not so spontaneous.

 

[Palex80]

Choosing wisely?

 

[DoctwoB]

Speaking of choosing wisely, what’s better then active surveillance?

Spending 100k/year to be on active surveillance.

But don’t worry. It only effects your sexual and physical function.

 

[mheat3]

Speaking of choosing wisely, what’s better then active surveillance?

Spending 100k/year to be on active surveillance.

But don’t worry. It only effects your sexual and physical function.

The "conclusions" in this paper as well as the follow up commentary such reek of being written by pharma. Since when do we have no real clinical difference but regimens are "well tolerated" with >30% AE and not even reporting patient reported QOL measures and the conclusion is that the regimen is effective?

Sometimes I feel like Mugatu

 

[Radonky]

Speaking of choosing wisely, what’s better then active surveillance?

Spending 100k/year to be on active surveillance.

But don’t worry. It only effects your sexual and physical function.

This is crazy

 

[grenz]

Interesting replies by mostly urologists

 

[madchemist89]

Interesting replies by mostly urologists

It Is 100%

 

[DoctwoB]

This is crazy

 

[jondunn]

Lol beriwal didn’t see this reply coming

 

[RickyScott]

Lol beriwal didn’t see this reply coming

Leeches, maggots, and fecal transplants are probably all more common than brachy. When cervical cancer dissappears in the 2030s, it will be dead.

 

[jondunn]

 

[jondunn]

 

[Ray D. Ayshun]

Finally! Sheep

 

[Neuronix]

 

[Ray D. Ayshun]

I have a hn patient now who can only get his oxycodone covered if it's made by a particular manufacturer.

 

[elementaryschooleconomics]

I have a hn patient now who can only get his oxycodone covered if it's made by a particular manufacturer.

Dude, WHAT IS UP WITH THIS?

I have recently encountered bizarre medication restrictions as well on "old" drugs, notably the regular narcotics I have prescribed for years and years.

 

[madchemist89]

One company denied Zofran for nausea

 

[seper]

Leeches, maggots, and fecal transplants are probably all more common than brachy. When cervical cancer dissappears in the 2030s, it will be dead.

Not completely dead due to immigration, but close

 

[temujim]

Lol beriwal didn’t see this reply coming

Is blood like ketchup?

 

[jondunn]

 

[elementaryschooleconomics]

I'm intentionally obfuscating this because HE'S A KID, but we're a small specialty, anyone can go find the Tweet if they really care:

There is so much to unpack:

"Rising" high school senior? So this guy was somehow engaged in medical research at least as early as his junior year IN HIGH SCHOOL? A half second Google search tells me who is Dad is, which is why this is possible. The arms race in med school admissions marches on! Will we see middle schoolers in labs soon? I know it's already happened, who am I kidding. This is not normally my "SDN mission" so I'll leave it alone, but I share the concerns of many others about the widening divide of access to medical education.

The irony of this picture is palpable. The only reason a high school kid engages in something like this is to get a competitive advantage to their future career. So he somehow gets involved in BRACHYTHERAPY in 2022? The technique on life support within a specialty on life support?

What were his other research choices? Optimizing the design of ash trays on commercial airliners? The logistics of newspaper delivery? Interning with Encyclopedia Britannica?

I hope this helps him get into Harvard. I assume there will only be three dozen other teenagers with brachytherapy publications and perfect SAT scores applying to all of the Ivy League schools this year.

 

[thecarbonionangle]

I'm intentionally obfuscating this because HE'S A KID, but we're a small specialty, anyone can go find the Tweet if they really care:

View attachment 356397

There is so much to unpack:

"Rising" high school senior? So this guy was somehow engaged in medical research at least as early as his junior year IN HIGH SCHOOL? A half second Google search tells me who is Dad is, which is why this is possible. The arms race in med school admissions marches on! Will we see middle schoolers in labs soon? I know it's already happened, who am I kidding. This is not normally my "SDN mission" so I'll leave it alone, but I share the concerns of many others about the widening divide of access to medical education.

The irony of this picture is palpable. The only reason a high school kid engages in something like this is to get a competitive advantage to their future career. So he somehow gets involved in BRACHYTHERAPY in 2022? The technique on life support within a specialty on life support?

What were his other research choices? Optimizing the design of ash trays on commercial airliners? The logistics of newspaper delivery? Interning with Encyclopedia Britannica?

I hope this helps him get into Harvard. I assume there will only be three dozen other teenagers with brachytherapy publications and perfect SAT scores applying to all of the Ivy League schools this year.

Harari has another secret son? Im sure they keeping that seat warm

 

[BobbyHeenan]

I contend that he will be a better doctor if he waits tables, cleans dishes, works retail, or *insert another public facing, borderline thankless job* than putting together abstracts at age 17.

 

[jondunn]

I contend that he will be a better doctor if he waits tables, cleans dishes, works retail, or *insert another public facing, borderline thankless job* than putting together abstracts at age 17.

this is the classic 2nd generation problem. most of our kids will live privledged lives, like many of us did not (i certainly did not)

 

[metallica81788]

I contend that he will be a better doctor if he waits tables, cleans dishes, works retail, or *insert another public facing, borderline thankless job* than putting together abstracts at age 17.

If I was on a med school admissions committee... would essentially require some service industry or entry level job in the real world

So many med students and residents have never had a job before and it shows

 

[deleted1116990]

The amount of nepotism in this field makes me physically ill sometimes.
There are so many silver spoon types who grew up with wealthy rad onc parent(s) who pulled strings and created endless breaks for them. They cruise into med school and residency and come out with a cushy job waiting for them in their hometown. They are totally clueless what others go through.

 

[jondunn]

The amount of nepotism in this field makes me physically ill sometimes.
There are so many silver spoon types who grew up with wealthy rad onc parent(s) who pulled strings and created endless breaks for them. They cruise into med school and residency and come out with a cushy job waiting for them in their hometown. They are totally clueless what others go through.

that's applicable to way more things or people than rad onc, which is a speck of dust in society at large.

 

[RO28]

I'm intentionally obfuscating this because HE'S A KID, but we're a small specialty, anyone can go find the Tweet if they really care:

View attachment 356397

There is so much to unpack:

"Rising" high school senior? So this guy was somehow engaged in medical research at least as early as his junior year IN HIGH SCHOOL? A half second Google search tells me who is Dad is, which is why this is possible. The arms race in med school admissions marches on! Will we see middle schoolers in labs soon? I know it's already happened, who am I kidding. This is not normally my "SDN mission" so I'll leave it alone, but I share the concerns of many others about the widening divide of access to medical education.

The irony of this picture is palpable. The only reason a high school kid engages in something like this is to get a competitive advantage to their future career. So he somehow gets involved in BRACHYTHERAPY in 2022? The technique on life support within a specialty on life support?

What were his other research choices? Optimizing the design of ash trays on commercial airliners? The logistics of newspaper delivery? Interning with Encyclopedia Britannica?

I hope this helps him get into Harvard. I assume there will only be three dozen other teenagers with brachytherapy publications and perfect SAT scores applying to all of the Ivy League schools this year.

yeahhh....I saw this one and my eyes rolled onto the ground. I just can't with the things parents may be goading their children into. As someone who came from a very cut throat academic high school culture this just makes me sad.

All I can say is that I definitely was not presenting at ABS as a teenager, I had much better (the beach, duh) things to do. But then again, maybe if I had gotten involved earlier in my life I would have had the foresight to avoid this field.