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Palex80 said:
The rationale for this trial is truly puzzling.
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They are still looking for that reproducible XRT/IO magic that has dominated radonc translational work for over a decade now. They rationalized the failure of the concurrent XRT/IO trials by condemning ENI as a detriment to TILs.
 
The head and neck IO data has been largely underwhelming. Even in metastatic setting i have not been impressed with responses (unlike skin where commonly see 50% responses, see less than <20% in HN). I never criticize people for doing a study, should be commended. I do continue to grow even more skeptical about these studies.

Our field is obsessed with “de-escalation” but mostly time after time cancer seems to tell us, hey buddy im still here this can be deadly don't FAAFO. ORATOR 1/2, NRG HN005… like seriously this is just not shocking to me!
 
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elementaryschooleconomics said:
Depends on what part of Europe - while it's not done in America, there's a good chunk of countries where Oncologists deliver both radiation and chemo...unless we cure cancer, that's a pretty safe gig.
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Well, delivering radiation and chemo is not done in my country anymore ( but since it used to be if radiotherapy really decline i think we might be able to compensate that way).

Essentially talking about France,belgium,Switzerland,Luxembourg
 
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Ray D. Ayshun said:
You can criticize giving IO to treat the nodes, sure. Can you also criticize 25 Gy preop? What purpose does this serve beyond limiting the ability to use RT for recurrent disease?
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I'm pretty sure they were hoping that treating primary with SBRT would prime IO response to regional disease. It all goes back to this....

pubmed.ncbi.nlm.nih.gov

Anti-PD-1 blockade and stereotactic radiation produce long-term survival in mice with intracranial gliomas - PubMed

The combination of PD-1 blockade and localized radiation therapy results in long-term survival in mice with orthotopic brain tumors. These studies provide strong preclinical evidence to support combination trials in patients with GBM.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

and this...

Fractionated but not single dose radiotherapy induces an immune-mediated abscopal effect when combined with anti-CTLA-4 antibody - PMC

This study tested the hypothesis that the type of dose-fractionation regimen determines the ability of radiotherapy to synergize with anti-CTLA-4 antibody. TSA mouse breast carcinoma cells were injected s.c. into syngeneic mice at two separate ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

and any number of preclinical IO/XRT stuff starting around 2010
 
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Palex80 said:
No, it´s not that bad. You will however not make the figures that many of the US colleagues make. 🙂

It's important to know however which part of Europe you want to work at, which again has to do with the language(s) you speak.
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To be honest , any medical specialty in Europe make way way way less money lol
(few exceptions but it is still the rule).
In some countries it is the best paying specialty like in France but depends on your pratice.
While having a good salary is important to me i think going into radonc and expecting to have the best salary is still a bad move considering the job market.

More worried about mobility and being stuck in a public setting forever
 
shallwegoout said:
To be honest , any medical specialty in Europe make way way way less money lol
(few exceptions but it is still the rule).
In some countries it is the best paying specialty like in France but depends on your pratice.
While having a good salary is important to me i think going into radonc and expecting to have the best salary is still a bad move considering the job market.

More worried about mobility and being stuck in a public setting forever
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I am not sure how it is outside the US, but Rad Onc will always be a very small field in the US with a low number of jobs in any given city.

If you are worried about mobility, it is not a good choice even if the job market was great, which it is not in the US.
 
Unless of course... you have a horse....


you got this air race GIF by Red Bull
 
communitydoc13 said:
I'm pretty sure they were hoping that treating primary with SBRT would prime IO response to regional disease. It all goes back to this....

pubmed.ncbi.nlm.nih.gov

Anti-PD-1 blockade and stereotactic radiation produce long-term survival in mice with intracranial gliomas - PubMed

The combination of PD-1 blockade and localized radiation therapy results in long-term survival in mice with orthotopic brain tumors. These studies provide strong preclinical evidence to support combination trials in patients with GBM.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

and this...

Fractionated but not single dose radiotherapy induces an immune-mediated abscopal effect when combined with anti-CTLA-4 antibody - PMC

This study tested the hypothesis that the type of dose-fractionation regimen determines the ability of radiotherapy to synergize with anti-CTLA-4 antibody. TSA mouse breast carcinoma cells were injected s.c. into syngeneic mice at two separate ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

and any number of preclinical IO/XRT stuff starting around 2010
Click to expand...

At some point continuing to research immunotherapy and RT dose de-escalation for H+N ca becomes unethical. I would argue we have now crossed that point.
 
Fpg1245 said:
Should have gone to jail for this study.
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from my understanding, treating patients on a trial does not prevent malpractice suits...
i would add that i know someone who ran a very small de-escalation trial in these patients and had some bad outcomes. the trial did not get published, but they were scared about getting sued.
 
radoncftw said:
from my understanding, treating patients on a trial does not prevent malpractice suits...
i would add that i know someone who ran a very small de-escalation trial in these patients and had some bad outcomes. the trial did not get published, but they were scared about getting sued.
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I know several ROs with the “right” pedigree who ran with de escalation prematurely (were talking several years ago) and now the chickens have come home to roost.
 
radoncftw said:
from my understanding, treating patients on a trial does not prevent malpractice suits...
i would add that i know someone who ran a very small de-escalation trial in these patients and had some bad outcomes. the trial did not get published, but they were scared about getting sued.
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Is this true? And just legally, I know people can sue, but what does the consent form protect you from if not this?
 
Truly was a poor trial… might as well have just treated with mineral oil.
 
madchemist89 said:
Current research approach is to run trials until you get a positive trial with your desired outcome.
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That's always been the approach. Just easier for med onc. Cis/neda/carbo/oxali.... platin. Cycle rinse and repeat. Meta-analysis time.

Or just ignore all the data and keep doing surgery.
 
seper said:
Luther Brady sliced and diced authorships in his papers and textbook however the hell he wanted 🙂 and as a junior author, our job was to stay quiet
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Brady was very supportive of medical students and residents. Always willing to make a phone call, give them an authorship, write a glowing letter etc.
180 degree turn after that. Paid faculty bottom dollar and would use IMGs (with no us residency training) as faculty. He had a number of his own private satellite practices that he staffed with hahnmenan faculty on
hanheman’s dime. Was forced out as chair for this and other unscripulous financial practices. Rumor was that he would face criminal charges at one point. I have also been told by senior faculty that his research was basically totally made up.
 
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RickyScott said:
Brady was very supportive of medical students and residents. Always willing to make a phone call, give them an authorship, write a glowing letter.
180 degree turn after that. Paid faculty bottom dollar and would use IMGs (with no us residency training) as faculty. He had a number of his own private satellite practices that he staffed with hahnmenan faculty on
hanheman’s dime. Was forced out as chair for this and other unscripulous financial practices. Rumor was that he would face criminal charges at one point. I have also been told by senior faculty that his research was basically totally made up.
Click to expand...

I’m sure a lot of med students fell for it over the years.
 
RickyScott said:
Brady was very supportive of medical students and residents. Always willing to make a phone call, give them an authorship, write a glowing letter.
180 degree turn after that. Paid faculty bottom dollar and would use IMGs (with no us residency training) as faculty. He had a number of his own private satellite practices that he staffed with hahnmenan faculty on
hanheman’s dime. Was forced out as chair for this and other unscripulous financial practices. Rumor was that he would face criminal charges at one point. I have also been told by senior faculty that his research was basically totally made up.
Click to expand...
What a great historical foundation we built
 
RickyScott said:
Brady was very supportive of medical students and residents. Always willing to make a phone call, give them an authorship, write a glowing letter.
180 degree turn after that. Paid faculty bottom dollar and would use IMGs (with no us residency training) as faculty. He had a number of his own private satellite practices that he staffed with hahnmenan faculty on
hanheman’s dime. Was forced out as chair for this and other unscripulous financial practices. Rumor was that he would face criminal charges at one point. I have also been told by senior faculty that his research was basically totally made up.
Click to expand...
Next top doctor
 
I mean...if we're invoking the Sacklers to create our "reference scale of bad", we're not doing so hot.

No one is the villain in their own story. I'm sure Brady told himself he was "giving foreigners work", and "keeping the hospital in the black", and any private side ventures were simply making sure he was paid what he felt he was "worth", etc etc.

Fortunately there's not a lot of people out there going this far...just a lot of people who look the other way because they "don't want to get involved".

It's like a certain film talked about in 1999 - "the indifference of good men" blah blah blah.

1683319796817.png
 
medgator said:


The bird is spicy today
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Im happy to see it might be a movement. Maybe if enough people leave it will motivate them to wipe the leadership and start over with a less conflicted group.

Im not sure how a Rad Onc could support that policy statement, I guess that's why no one's name is on it except the lobby group and... The Maryland Proton Center? LOL what.
 
NotMattSpraker said:
Im happy to see it might be a movement. Maybe if enough people leave it will motivate them to wipe the leadership and start over with a less conflicted group.

Im not sure how a Rad Onc could support that policy statement, I guess that's why no one's name is on it except the lobby group and... The Maryland Proton Center? LOL what.
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I walked away in 2020... I know there's been a gradual exodus away from ASTRO on the part of community physicians for years, but they haven't cared about it (yet!). They did call me when i cancelled my membership after over a decade post residency, but I'm pretty sure whatever i said fell on deaf ears.

Hopefully bigger waves will get noticed, and we will see bigger membership gains in groups like ACRO
 
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medgator said:
I walked away in 2020
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I left years before that. No meaningful education beyond what I could access elsewhere. No initiatives that impacted my community practice favorably.

But....I was already sour by the time I left residency and realized that as a community doc, I was a going to be a bit of a second class citizen in the eyes of the academics in ASTRO leadership (some of whom I knew from residency).

I wonder how much Bill Regine really knows about protons? If he's sat down and looked hard at dosimetric literature and pre-clinical work or critically evaluated much of the clinical data? I don't know, but I do know that the people I encountered who were leaders or destined for leadership were not the type to do detailed analysis.
 
While we are on the gripe train.. this whole OLA bs is absolute funking useless. Garbage. Nothing to do with being a good radiation oncologist whatsoever. I read the mednet, keep up with pubs (thanks scihub) and generally have a high level of inquisitiveness. Does anyone care if we draw volumes correctly by asking stupid OLA questions? COME ON. If they cared, they'd have saved the online tumor board .com that went under (forgot the name). Oh well, what matters is the money keeps flowing.

NBPAS beckons. Some hospitals take it and more are on the way. CME or GTFO, screw the grifters.
 
sirspamalot said:
While we are on the gripe train.. this whole OLA bs is absolute funking useless. Garbage. Nothing to do with being a good radiation oncologist whatsoever. I read the mednet, keep up with pubs (thanks scihub) and generally have a high level of inquisitiveness. Does anyone care if we draw volumes correctly by asking stupid OLA questions? COME ON. If they cared, they'd have saved the online tumor board .com that went under (forgot the name). Oh well, what matters is the money keeps flowing.

NBPAS beckons. Some hospitals take it and more are on the way. CME or GTFO, screw the grifters.
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Maybe so, but I would much rather do OLA than take that 10-year re-cert abomination
 
sirspamalot said:
While we are on the gripe train.. this whole OLA bs is absolute funking useless. Garbage. Nothing to do with being a good radiation oncologist whatsoever. I read the mednet, keep up with pubs (thanks scihub) and generally have a high level of inquisitiveness. Does anyone care if we draw volumes correctly by asking stupid OLA questions? COME ON. If they cared, they'd have saved the online tumor board .com that went under (forgot the name). Oh well, what matters is the money keeps flowing.

NBPAS beckons. Some hospitals take it and more are on the way. CME or GTFO, screw the grifters.
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OLA great. 5 am on the $&!;"er Monday morning half asleep and still able to answer those questions without a hitch.

Are you really griping about the difficulty of 2 OLA questions we get a week?
 
medgator said:
OLA great. 5 am on the $&!;"er Monday morning half asleep and still able to answer those questions without a hitch.

Are you really griping about the difficulty of 2 OLA questions we get a week?
Click to expand...

Literally if that's all I have to do, Ill take that deal. I don't find them particularly taxing.
 
Yeah, I'm griping. CME is sufficient. Can you imagine the overhead in the OLA program that could be, say I dunno, put towards some kind of better use? Like say.. producing high quality CME content for FREE for our beloved members?

Also, today's question cited a paper from 1986. 1986 ! The correct answer for them isn't the correct answer for my world when it comes to palliation. Ridiculous.. as if there is only one 'correct' way to deal with palliative situations. Bullshido.

Bottom line for me is.. NBPAS is much lower cost, and requires only CME after primary certification. Can you imagine paying 100 or less a year instead of 400 and not having to play the MOC game? I'm starting to believe this is way. My hospital said it will take NBPAS.

To walk away from the ABR and ASTRO fees and hoop jumping would be... amazing. If enough did so, how long before OLA disappears and CME comes back like a tsunami? Save this post, lets see if it ages well.




Life Thank You GIF by PEEKASSO
 
sirspamalot said:
Yeah, I'm griping. CME is sufficient. Can you imagine the overhead in the OLA program that could be, say I dunno, put towards some kind of better use? Like say.. producing high quality CME content for FREE for our beloved members?

Also, today's question cited a paper from 1986. 1986 ! The correct answer for them isn't the correct answer for my world when it comes to palliation. Ridiculous.. as if there is only one 'correct' way to deal with palliative situations. Bullshido.

Bottom line for me is.. NBPAS is much lower cost, and requires only CME after primary certification. Can you imagine paying 100 or less a year instead of 400 and not having to play the MOC game? I'm starting to believe this is way. My hospital said it will take NBPAS.

To walk away from the ABR and ASTRO fees and hoop jumping would be... amazing. If enough did so, how long before OLA disappears and CME comes back like a tsunami? Save this post, lets see if it ages well.




Life Thank You GIF by PEEKASSO
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Nbpas is kind the betamax vs acr/ACP etc as VHS, no?

Probably dating myself with that analogy but whatever
 
No conflict of interest here folks. Love that Ron grin. Ron is the epitome of nice, no question, but the fox in the henhouse is what we have here.

His underlings made hundreds of thousands of dollars a year helping practices bill and fine tune etc. Poorly paid low IQ admins loved the results... Can't fault it. But the total lack of boundaries between ASTRO, ASRT, ACRO and Ron are legend. Gotta tip the hat.

www.linkedin.com

When you ask friends if they’ll take pictures of you during your talk….. | Ron DiGiaimo

When you ask friends if they’ll take pictures of you during your talk….. haha …. Awesome time meeting and getting to know the incredible ASRT leadership team ASRT Foundation American Society of Radiologic Technologists Revenue Cycle Coding Strategies The Oncology Group RC Billing Regents Health...
www.linkedin.com www.linkedin.com
 
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