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RadOncDoc21 said:
The Dutch did this.
Click to expand...
Mandelin Rain said:
Click to expand...

Dose too high. Preclinical data suggests lower doses are better at killing inflammatory cells and creating an environment in which they cannot grow.

In my practice I noted patients responded better when I went from 3 Gy in 5 qd fx to qod fx.

The response rates published in German and Spanish data (85% and 95% for hands, respectively) are higher than what we usually see for placebo (60% with pain).

I have treated ~65 patients and am very much a believer. I've had patients who were very skeptical have dramatic improvement in pain and QOL.
 
OTN said:
Dose too high. Preclinical data suggests lower doses are better at killing inflammatory cells and creating an environment in which they cannot grow.

In my practice I noted patients responded better when I went from 3 Gy in 5 qd fx to qod fx.

The response rates published in German and Spanish data (85% and 95% for hands, respectively) are higher than what we usually see for placebo (60% with pain).

I have treated ~65 patients and am very much a believer. I've had patients who were very skeptical have dramatic improvement in pain and QOL.
Click to expand...
Not doubting. Just providing the info.
 
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If it‘s as good as sham-irradiation and it‘s thus all a placebo effect, are we supposed to
a) stop treating at all
b) sham-treat
c) treat with you established doses

???
 
The study has ~50 patients, the dose was not what Germans use and they did not include retreatment. They did it very differently than Germans, so the Dutch study tends to be ignored.

Idk. I see it work. Like patients calling a few weeks later crying that they finally are out of pain. YMMV. Maybe it isn’t real, but there is something I’m seeing in my experience.
 
RealSimulD said:
The study has ~50 patients, the dose was not what Germans use and they did not include retreatment. They did it very differently than Germans, so the Dutch study tends to be ignored.

Idk. I see it work. Like patients calling a few weeks later crying that they finally are out of pain. YMMV. Maybe it isn’t real, but there is something I’m seeing in my experience.
Click to expand...

I wonder what the ethical implications would be of “treating them” with 10 treatments 6 sham up front followed by 6 ream beam on treatments. Asking them how they felt after the 6 sham and again after the RT.
 
Ah yes. We have such a strong tradition of sham treatments in Radiation Oncology.

Who can forget the practice-changing dose escalation prostate trials from the 1990s and 2000s?

I believe it was Zelefsky himself who insisted that patients in the 64.8Gy arm continued on with sham treatments, which was, of course, the defining feature of that seminal work.

To this day, the controversy over 60Gy vs 70Gy in NSCLC hinges on the fact that those charlatans advocating 70Gy didn't use shams in their controls!

In DAHANCA, Overgaard heroically convinced the notoriously anti-sham Danes to have sham BID treatments, which I actually got asked about in orals.

And, obviously, the world-class education everyone receives in radiation biology imbues even the most timid resident to confidently shout "PREPOSTEROUS" at the decades of mechanistic in vivo studies found in the literature demonstrating differential effects of sub-tumoricidal doses.
 
elementaryschooleconomics said:
Ah yes. We have such a strong tradition of sham treatments in Radiation Oncology.

Who can forget the practice-changing dose escalation prostate trials from the 1990s and 2000s?

I believe it was Zelefsky himself who insisted that patients in the 64.8Gy arm continued on with sham treatments, which was, of course, the defining feature of that seminal work.

To this day, the controversy over 60Gy vs 70Gy in NSCLC hinges on the fact that those charlatans advocating 70Gy didn't use shams in their controls!

In DAHANCA, Overgaard heroically convinced the notoriously anti-sham Danes to have sham BID treatments, which I actually got asked about in orals.

And, obviously, the world-class education everyone receives in radiation biology imbues even the most timid resident to confidently shout "PREPOSTEROUS" at the decades of mechanistic in vivo studies found in the literature demonstrating differential effects of sub-tumoricidal doses.
Click to expand...

Still a bit of mystery in rad bio…too bad not as many nobody really dedicated to the science.
 
Fpg1245 said:
Still a bit of mystery in rad bio…too bad not as many nobody really dedicated to the science.
Click to expand...
link.springer.com

Low-dose radiotherapy of osteoarthritis: from biological findings to clinical effects—challenges for future studies - Strahlentherapie und Onkologie

Osteoarthritis (OA) is one of the most common and socioeconomically relevant diseases, with rising incidence and prevalence especially with regard to an ageing population in the Western world. Over the decades, the scientific perception of OA has shifted from a simple degeneration of cartilage...
link.springer.com link.springer.com



www.sciencedirect.com

Low dose ionizing radiation effects on the immune system

Ionizing radiation interacts with the immune system in many ways with a multiplicity that mirrors the complexity of the immune system itself: namely t…
www.sciencedirect.com www.sciencedirect.com

1681523318443.png
 
OTN said:
Dose too high. Preclinical data suggests lower doses are better at killing inflammatory cells and creating an environment in which they cannot grow.

In my practice I noted patients responded better when I went from 3 Gy in 5 qd fx to qod fx.

The response rates published in German and Spanish data (85% and 95% for hands, respectively) are higher than what we usually see for placebo (60% with pain).

I have treated ~65 patients and am very much a believer. I've had patients who were very skeptical have dramatic improvement in pain and QOL.
Click to expand...

Same. That trial also had 50 patients. It’s something but there are retrospective studies of 1,000 of patients demonstrating relief in a condition that doesn’t get better on its own.
 
I completely, deeply understand those who are skeptical about LDRT for OA.

I first stumbled on the literature in 2016 or 2017.

I thought it was weird. I didn't believe it. But there was so much of it. It ran counter to what everyone who trained me and practiced around me said.

And it kept coming out. There were in vivo mechanistic studies. It was mostly from countries with national healthcare systems so I couldn't really use "greed" as an explanation.

Then it crept onto SDN. And more papers.

And it felt deeply hypocritical to me to continue to ignore it. I spew on and on about "evidence" and not doing things "because that's how they've always been done".

So I started doing it, because really - it's 3Gy. 3Gy is basically equivalent to watching your microwave cook a Hot Pocket from close range (joking, joking).

And yeah...it seems to work. Patients are so happy. They're so happy you listened to them and offered them something different for their pain. You didn't shrug them off. And it's not life or death like everything else we do. It's really gratifying.

We're so caught up in our own echo chamber about how evil we are for "the fractions" and "the beam" that we miss how much cheaper this is to patients and society. Comparing 6 fractions of LDRT to a joint replacement? It's not even on the same planet. Even buying someone just a few months with fewer pain meds, or injections, or surgery - it's awesome.

I would just encourage skeptics to think about it. I would never encourage anyone to do anything they aren't comfortable with - just pause before immediately closing the door to the possibility that it works. It took me literally years to "deprogram" myself so...I understand.
 
elementaryschooleconomics said:
I completely, deeply understand those who are skeptical about LDRT for OA.

I first stumbled on the literature in 2016 or 2017.

I thought it was weird. I didn't believe it. But there was so much of it. It ran counter to what everyone who trained me and practiced around me said.

And it kept coming out. There were in vivo mechanistic studies. It was mostly from countries with national healthcare systems so I couldn't really use "greed" as an explanation.

Then it crept onto SDN. And more papers.

And it felt deeply hypocritical to me to continue to ignore it. I spew on and on about "evidence" and not doing things "because that's how they've always been done".

So I started doing it, because really - it's 3Gy. 3Gy is basically equivalent to watching your microwave cook a Hot Pocket from close range (joking, joking).

And yeah...it seems to work. Patients are so happy. They're so happy you listened to them and offered them something different for their pain. You didn't shrug them off. And it's not life or death like everything else we do. It's really gratifying.

We're so caught up in our own echo chamber about how evil we are for "the fractions" and "the beam" that we miss how much cheaper this is to patients and society. Comparing 6 fractions of LDRT to a joint replacement? It's not even on the same planet. Even buying someone just a few months with fewer pain meds, or injections, or surgery - it's awesome.

I would just encourage skeptics to think about it. I would never encourage anyone to do anything they aren't comfortable with - just pause before immediately closing the door to the possibility that it works. It took me literally years to "deprogram" myself so...I understand.
Click to expand...

I spent the last week fishing with a friend from med school who is an orthopedist. I told him about LDRT for arthritis, the data, etc.

He said the orthopedic literature for what they do for arthritis is terrible to quite terrible. Nowhere near the data we would expect in oncology. In fact, our LDRT data is better than what they have for lots and lots of their procedures.
 
OTN said:
I spent the last week fishing with a friend from med school who is an orthopedist. I told him about LDRT for arthritis, the data, etc.

He said the orthopedic literature for what they do for arthritis is terrible to quite terrible. Nowhere near the data we would expect in oncology. In fact, our LDRT data is better than what they have for lots and lots of their procedures.
Click to expand...

Orthos don’t let evidence get in the way of a good TKA.

There’s better evidence and less risk for LDRT for OA compared to that it seems.

Are there specialty specific evidence standards?

If so maybe adopting the Ortho standard for adopting a practice should be done here as this is technically not oncology
 
Fpg1245 said:
Orthos don’t let evidence get in the way of a good TKA.

There’s better evidence and less risk for LDRT for OA compared to that it seems.

Are there specialty specific evidence standards?

If so maybe adopting the Ortho standard for adopting a practice should be done here as this is technically not oncology
Click to expand...
Evidence standards for oncology are far, far stricter than they are for orthopedics, at least based on my convo with my friend
 
OTN said:
Evidence standards for oncology are far, far stricter than they are for orthopedics, at least based on my convo with my friend
Click to expand...

I feel like cards, GI, onc are all pretty evidence driven. That being said perhaps a lower standard in certain circumstances would not be a bad thing per se. Risks of harm are low. Not particularly costly etc
 
Because RadOnc has spent the last two decades fortifying our insane "one-upmanship" of trying to memorize the most data to recite back to each other, we assume everyone else is doing the same.

They are not. Oncology standards are on a different planet.

I will resist the temptation to throw stones at anything in particular, because my own house has a lot of glass in it. But...the risks of harm with LDRT are incredibly low, in a relative sense.
 
elementaryschooleconomics said:
Because RadOnc has spent the last two decades fortifying our insane "one-upmanship" of trying to memorize the most data to recite back to each other, we assume everyone else is doing the same.
Click to expand...

Where did this come from and why are RadOncs the weirdest?
 
My theory is that radiation oncology is the only specialty that has gone from a bottom of the barrel match anyone specialty to one of most competitive and then back down to a bottom of the barrel in a 20 year span. The match anyone leaders who graduated at the bottom of their medical school class were in a unique position of “leading” elite, top of the class talent. In order to make the bottom of the class, lower IQ, leaders “seem” smart and knowledgeable, they adopted this culture of intellectual masturbation where there was an obsession of memorizing meaningless minutiae, often losing sight of the forest through the trees.
 
Bequerel said:
My theory is that radiation oncology is the only specialty that has gone from a bottom of the barrel match anyone specialty to one of most competitive and then back down to a bottom of the barrel in a 20 year span. The match anyone leaders who graduated at the bottom of their medical school class were in a unique position of “leading” elite, top of the class talent. In order to make the bottom of the class, lower IQ, leaders “seem” smart and knowledgeable, they adopted this culture of intellectual masturbation where there was an obsession of memorizing meaningless minutiae, often losing sight of the forest through the trees.
Click to expand...


It stems from deep seating feelings of inadequacy that you just don’t see among even academic surg or med oncs.

For all the “talent” they accumulated over the last 10 years they seem more than content to squander it.
 
Fpg1245 said:
It stems from deep seating feelings of inadequacy that you just don’t see among even academic surg or med oncs.
Click to expand...
There may be deep feelings of inadequacy, but I don't think this is where the evidence craze comes from.

First, it is there because it can be there. We are experts in a single modality and we are not spending hours in an OR or SICU. Medonc in the community has far too many interventions at this point to know the data well regarding any of them. Surgeons are too busy doing their thing. Given the insane paper productivity of many surgeons in training, I am convinced that any time they are actually thinking about evidence, they are simultaneously publishing it.

Second, radiation is just bad in the collective imagination of the public. It became therapeutic around the same time it became massively destructive. Our 2nd malignancy data still derives from Hiroshima or meltdown events. Our culture derives from this experience. We need very good reasons to radiate someone because radiation is itself viewed as intrinsically bad.

Agree that 3 Gy to a joint in a 60+ year old patient has a very favorable risk profile.
 
communitydoc13 said:
There may be deep feelings of inadequacy, but I don't think this is where the evidence craze comes from.

First, it is there because it can be there. We are experts in a single modality and we are not spending hours in an OR or SICU. Medonc in the community has far too many interventions at this point to know the data well regarding any of them. Surgeons are too busy doing their thing. Given the insane paper productivity of many surgeons in training, I am convinced that any time they are actually thinking about evidence, they are simultaneously publishing it.

Second, radiation is just bad in the collective imagination of the public. It became therapeutic around the same time it became massively destructive. Our 2nd malignancy data still derives from Hiroshima or meltdown events. Our culture derives from this experience. We need very good reasons to radiate someone because radiation is itself viewed as intrinsically bad.

Agree that 3 Gy to a joint in a 60+ year old patient has a very favorable risk profile.
Click to expand...
To be fair, you need a good reason to cut someone open, or snake a camera past one of their sphincters.
 
Palex80 said:
Click to expand...

Preopanc??

I'd argue she's just wrong.

Say the data is mixed, sure, I'll bite. Say the data is not great because the systemic therapy is outpacing radiation? Sure, I'll bite.

But say there is absolutely no evidence that radiation in any form improves outcomes and I say ... Huh? This is a "leader" in our field?
 
TheWallnerus said:
"I'm going to give some big 'ol radiation doses to a major organ with no evidence that it works"

Whether evidence is there or not, this is not the mindset of a doctor I'd like treating me
Click to expand...

If I ever get pancreatic cancer I'm going to kitchen sink it, data be damned. Nothing works great in that terrible disease.
 
TheWallnerus said:
"I'm going to give some big 'ol radiation doses to a major organ with no evidence that it works"

Whether evidence is there or not, this is not the mindset of a doctor I'd like treating me
Click to expand...
Is Lisa going to take pancreas off the boards? Not really a role for postop xrt either.
 
CaesarRO said:
Preopanc??

I'd argue she's just wrong.

Say the data is mixed, sure, I'll bite. Say the data is not great because the systemic therapy is outpacing radiation? Sure, I'll bite.

But say there is absolutely no evidence that radiation in any form improves outcomes and I say ... Huh? This is a "leader" in our field?
Click to expand...
Most “leaders” think the best radiation is no radiation. They will settle for less dose if data forces their hand but our field is obsessed with “de-escalation”. You see med onc run a 0.5 pacific study where you only give one year of IO vs 6 months. Didnt think so. Even if they have or will, you get the general flavour of my comment
 
Neuronix said:
They could have easily found a pancreatic surgeon or med onc who does not believe in RT for pancreas cancer. There are plenty to choose from.
Click to expand...

She's a chair at this point. Not interested in treating patients. Focused on getting invited to give 'hot takes' in a disease site she is... not even in the top 15 of Rad Oncs I would be interested in her opinion on in terms of pancreatic cancer.
 
evilbooyaa said:
She's a chair at this point. Not interested in treating patients. Focused on getting invited to give 'hot takes' in a disease site she is... not even in the top 15 of Rad Oncs I would be interested in her opinion on in terms of pancreatic cancer.
Click to expand...
I guess neither Lisa nor Columbia got any stake in using an MR-linac
 
Neuronix said:
They could have easily found a pancreatic surgeon or med onc who does not believe in RT for pancreas cancer. There are plenty to choose from.
Click to expand...
Why look so hard, when you can always ask a radiation oncologist…



I had a look at trials she has run, looking for her as first or last author:


pubmed.ncbi.nlm.nih.gov

Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001 - PubMed

HA-WBRT plus memantine better preserves cognitive function and patient-reported symptoms, with no difference in intracranial PFS and OS, and should be considered a standard of care for patients with good performance status who plan to receive WBRT for brain metastases with no metastases in the...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
I do not do HA-WBRT and I certainly do not give memantine with it. Hell, I can‘t even remember when I last did WBRT.

pubmed.ncbi.nlm.nih.gov

Five-Year Patient-Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer - PubMed

This study confirms that, based on long-term changes in bowel and urinary domains and toxicity, the 5- and 12-fraction regimens are well tolerated. These ultrahypofractionated approaches need to be compared with current standard radiation therapy regimens.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
We already have 2 randomized phase III trials with several hundreds of patients doing the same and who have reported 5-year results, (UK&Norway), but here‘s a Phase II.

pubmed.ncbi.nlm.nih.gov

Long-Term Outcomes of NRG Oncology/RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Anal Canal Cancer - PubMed

Dose-painted IMRT with 5FU/MMC for the treatment of anal canal cancer yields comparable long-term efficacy as conventional radiation cohorts. Enhanced normal tissue protection lowered rates of grade 3 and higher late effects without compromising pelvic tumor control.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Ok, this one has been practice forming, I guess.

pubmed.ncbi.nlm.nih.gov

RTOG 0518: randomized phase III trial to evaluate zoledronic acid for prevention of osteoporosis and associated fractures in prostate cancer patients - PubMed

For patients with advanced, non-metastatic prostate cancer receiving LHRH agonist and RT, the use of zoledronic acid was associated with statistically improved BMD percent changes. The small number of accrued patients resulted in decreased statistical power to detect any differences in the...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
„We gave biphosphonates, bones look thicker now.“

pubmed.ncbi.nlm.nih.gov

A randomized, double-blind, placebo-controlled trial of a beta-hydroxyl beta-methyl butyrate, glutamine, and arginine mixture for the treatment of cancer cachexia (RTOG 0122) - PubMed

This trial was unable to adequately test the ability of beta-hydroxy beta-methylbutyrate, glutamine, and arginine to reverse or prevent lean body mass wasting among cancer patients. Possible contributing factors beyond the efficacy of the intervention were the inability of patients to complete...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Nope.

Add to that the negative RTOG0631, that we just discussed past week.


Truly transformative science.
 
Last edited:
RickyScott said:
Is Lisa going to take pancreas off the boards? Not really a role for postop xrt either.
Click to expand...

I got hammered on oral boards for initially saying there is no indication for RT in a post op pancreas case. But finally acquiesced and told them what my post op volumes and doses would be if I were to treat. Good times.
 
Palex80 said:
Why look so hard, when you can always ask a radiation oncologist…



I had a look at trials she has run, looking for her as first or last author:


pubmed.ncbi.nlm.nih.gov

Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001 - PubMed

HA-WBRT plus memantine better preserves cognitive function and patient-reported symptoms, with no difference in intracranial PFS and OS, and should be considered a standard of care for patients with good performance status who plan to receive WBRT for brain metastases with no metastases in the...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
I do not do HA-WBRT and I certainly do not give memantine with it. Hell, I can‘t even remember when I last did WBRT.

pubmed.ncbi.nlm.nih.gov

Five-Year Patient-Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer - PubMed

This study confirms that, based on long-term changes in bowel and urinary domains and toxicity, the 5- and 12-fraction regimens are well tolerated. These ultrahypofractionated approaches need to be compared with current standard radiation therapy regimens.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
We already have 2 randomized phase III trials with several hundreds of patients doing the same and who have reported 5-year results, (UK&Norway), but here‘s a Phase II.

pubmed.ncbi.nlm.nih.gov

Long-Term Outcomes of NRG Oncology/RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Anal Canal Cancer - PubMed

Dose-painted IMRT with 5FU/MMC for the treatment of anal canal cancer yields comparable long-term efficacy as conventional radiation cohorts. Enhanced normal tissue protection lowered rates of grade 3 and higher late effects without compromising pelvic tumor control.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Ok, this one has been practice forming, I guess.

pubmed.ncbi.nlm.nih.gov

RTOG 0518: randomized phase III trial to evaluate zoledronic acid for prevention of osteoporosis and associated fractures in prostate cancer patients - PubMed

For patients with advanced, non-metastatic prostate cancer receiving LHRH agonist and RT, the use of zoledronic acid was associated with statistically improved BMD percent changes. The small number of accrued patients resulted in decreased statistical power to detect any differences in the...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
„We gave biphosphonates, bones look thicker now.“

pubmed.ncbi.nlm.nih.gov

A randomized, double-blind, placebo-controlled trial of a beta-hydroxyl beta-methyl butyrate, glutamine, and arginine mixture for the treatment of cancer cachexia (RTOG 0122) - PubMed

This trial was unable to adequately test the ability of beta-hydroxy beta-methylbutyrate, glutamine, and arginine to reverse or prevent lean body mass wasting among cancer patients. Possible contributing factors beyond the efficacy of the intervention were the inability of patients to complete...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Nope.

Add to that the negative RTOG0631, that we just discussed past week.


Truly transformative science.
Click to expand...
Come on!

This is a pretty damn good academic career here. Her biggest deficit is that she is a radonc. She may have other deficits, but his paper list alone puts her near the top of academic radoncs.

She wasn't handed Opdivo to study.

Academic radoncs study technique and fractionation or else they are masquerading as radoncs while doing interesting stuff.

Negative trials are important trials.

Compare to other luminaries in the field.

Also, I don't know her.
 
communitydoc13 said:
Come on!

This is a pretty damn good academic career here. Her biggest deficit is that she is a radonc. She may have other deficits, but his paper list alone puts her near the top of academic radoncs.

She wasn't handed Opdivo to study.

Academic radoncs study technique and fractionation or else they are masquerading as radoncs while doing interesting stuff.

Negative trials are important trials.

Compare to other luminaries in the field.

Also, I don't know her.
Click to expand...
I do not know her, either.
Yes, my post was harsh.

What's rather surprising, is the broad spectrum she has worked on. Usually, most radoncs will study one or two disease sites.
She has co-authored brain, GI, prostate, bone mets and supportive stuff. Why is that so?

Negative trials are important trials, but as described in the RTOG0631-thread, sometimes designing and conducting a trial poorly, will also ruin the trial. Think of how much money went into that trial and what the conclusions are. Did it help at all?
 
Palex80 said:
I do not know her, either.
Yes, my post was harsh.

What's rather surprising, is the broad spectrum she has worked on. Usually, most radoncs will study one or two disease sites.
She has co-authored brain, GI, prostate, bone mets and supportive stuff. Why is that so?

Negative trials are important trials, but as described in the RTOG0631-thread, sometimes designing and conducting a trial poorly, will also ruin the trial. Think of how much money went into that trial and what the conclusions are. Did it help at all?
Click to expand...
My view from across the country (don't know her at all), RTOG 0529 is her claim to fame. Important study that allowed us to meaningfully change practice. She admits herself (at one of the ASTRO refresher QAs) that she made up the constraints and was lucky it worked out.

I think she's on a lot these other trials because she's enmeshed in ASTRO leadership committees and acts as a gatekeeper
 
CaesarRO said:
My view from across the country (don't know her at all), RTOG 0529 is her claim to fame. Important study that allowed us to meaningfully change practice. She admits herself (at one of the ASTRO refresher QAs) that she made up the constraints and was lucky it worked out.

I think she's on a lot these other trials because she's enmeshed in ASTRO leadership committees and acts as a gatekeeper
Click to expand...
That ASTRO academic club is really no different than any other back slapping hang around until you get your rank upgraded nonsense.

Very few radonc academics are worth their salt when compared to other fields. Mostly because we've tapped out of stuff to do, unless you are either a) running a large trial which you get due to Club status or b) doing radiobiology (the few, the proud..etc)

I mean, think about a "Breast Expert" Clinician doing nothing but.. treating breast the same over and over.. and giving talks. What a life.
 
And the funny thing is.. I really* wanted to be a Chairman at a Top 10 place and was "on that track" but just hated (I mean truly despised) some of my fellow staff and the general environment (at a Top 10 place). Left for private practice, made 2M+ year 1, and that was the end.

I enjoyed writing papers and doing that stuff.. but, no real regrets. I would enjoy teaching residents, reviewing/editing papers etc but I absolutely will not tolerate the psychopathy that was legendary at my institution.
 
sirspamalot said:
And the funny thing is.. I really* wanted to be a Chairman at a Top 10 place and was "on that track" but just hated (I mean truly despised) some of my fellow staff and the general environment (at a Top 10 place). Left for private practice, made 2M+ year 1, and that was the end.

I enjoyed writing papers and doing that stuff.. but, no real regrets. I would enjoy teaching residents, reviewing/editing papers etc but I absolutely will not tolerate the psychopathy that was legendary at my institution.
Click to expand...

I often wonder if it was always like that or just the need to prove oneself even in the most trivial sense makes one almost psychotic.
 
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