Rad Onc Twitter

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RadOncDoc21 said:
Does it matter…did emergent RT help? Fortunately, I’m 100% outpatient based so I don’t have to make these decisions.
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Still baller though. Any case where you are offering emergent XRT is a Hail Mary type of case. But, to get it done immediately and very quickly, without utilizing a lot of resources (and a bit creatively) lets the team move on to the other options or breach the hospice discussion earlier.
 
FTR have seen ICU cases benefit tremendously from Emergent RT.

One case got out of ICU and had about 2 weeks of quality at home. Two weeks may seem like little but he would have died in the ICU otherwise.

The other (remarkably) had a full year before progression.

Far from the norm, but I've given up my crystal ball and try not be nihilistic. I've seen enough patients in follow up where their initial de Novo presentation would make me think "this patient's a goner" and aggressive upfront treatment managed induce remission that I feel rolling the dice is warranted.

Of course, different from 3rd line therapy with terrible performance status prior to their immediate hospitalization...
 
CaesarRO said:
FTR have seen ICU cases benefit tremendously from Emergent RT.

One case got out of ICU and had about 2 weeks of quality at home. Two weeks may seem like little but he would have died in the ICU otherwise.

The other (remarkably) had a full year before progression.

Far from the norm, but I've given up my crystal ball and try not be nihilistic. I've seen enough patients in follow up where their initial de Novo presentation would make me think "this patient's a goner" and aggressive upfront treatment managed induce remission that I feel rolling the dice is warranted.

Of course, different from 3rd line therapy with terrible performance status prior to their immediate hospitalization...
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On the other end of the spectrum you havent really lived until you get paid to randomly fill out a survey about which third line fake believe immunotherapy would be best.

Radiation Oncology has become a joke. We argue about how best to either eliminate (low or no fx) or annihilate (wallet=protons, SBRT).

The jokes on us if FLASH or abscopal effects with immunotx turns out to be the dark horse winner.
 
RickyScott said:
Ok how this? Icu pt on vent. Imported the diagnostic scan into eclipse and drew the field and then brought pt down and used a cone beam/kv to center on carina and give 8 gy off cord without a sim in under 2 hrs total
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RadOncDoc21 said:
Does it matter…did emergent RT help? Fortunately, I’m 100% outpatient based so I don’t have to make these decisions.
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medgator said:
Meme Reaction GIF by Robert E Blackmon

Used to feel great, doing commando heroic inpt RT on ICU patients.

Now that I'm in a freestanding, can't treat anyone with more than a nasal cannula and honestly i think that's probably for the better based on what I've seen with those really sick pts getting RT, end of life
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I will never forget. Residency around 2002. I had just read about a randomized trial where palliative RT for lung cancer was given in a 17 Gy/2 fx schedule. It wowed me. We had a lady on vent knocking on deaths door and were consulted for palliative RT for huge lung mass. I begged attendings to try the dangerous, horrifying, risky 8.5 Gy per fraction treatment. The lady was almost dead so I guess that’s why they relented. Treatment delivered without difficulty.

One month later the ICU lady comes walking in department… “They told me I need to come in for more lung radiation.” Rescans looked wonderful, lots of response. Everyone gobsmacked; attendings a little angry trying to decide how much more lung radiation she would need.

We all have stories!
 
TheWallnerus said:
I will never forget. Residency around 2002. I had just read about a randomized trial where palliative RT for lung cancer was given in a 17 Gy/2 fx schedule. It wowed me. We had a lady on vent knocking on deaths door and were consulted for palliative RT for huge lung mass. I begged attendings to try the dangerous, horrifying, risky 8.5 Gy per fraction treatment. The lady was almost dead so I guess that’s why they relented. Treatment delivered without difficulty.

One month later the ICU lady comes walking in department… “They told me I need to come in for more lung radiation.” Rescans looked wonderful, lots of response. Everyone gobsmacked; attendings a little angry trying to decide how much more lung radiation she would need.

We all have stories!
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My hospital hates treating impatiens and I have had endless meetings over the yrs abt this. Once I gave 8.5 gy x 2 to a homeless additct on a vent and he left the hospital 2 weeks later. Guy would have been on a vent for at least 2 months before he died w/out xrt (no distant disease). I made a real effort to calculate savings, but they don’t really care. They just look at the bill and think they would have recovered it as an outpt.
 
What am i missing here, folks? Japanese hypofrac data for larynx has been out for some time and is SOC for early stage t1/t2N0 glottic cancer. 63/28 for T1, 65.25/29 for T2 is what i would do. Doesn’t surprise me. Standard fractionation is probably ok as well and some institutions use this.
 
Another Japanese trial in my inbox --- 54 Gy/15 fx prostate. FUP 77 months. No G2 GI or G3 GU long term sxs noted.

APM has re-entered the building, but wearing a clown outfit and called something else
 
RickyScott said:
Ok how this? Icu pt on vent. Imported the diagnostic scan into eclipse and drew the field and then brought pt down and used a cone beam/kv to center on carina and give 8 gy off cord without a sim in under 2 hrs total
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There's a whole branch of 'research' being done in this space from WashU.... didn't know it was even necessary to document the times I've done this lol
 
sirspamalot said:
Another Japanese trial in my inbox --- 54 Gy/15 fx prostate. FUP 77 months. No G2 GI or G3 GU long term sxs noted.

APM has re-entered the building, but wearing a clown outfit and called something else
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Retraining would be better than listening to these clowns.
 
Palex80 said:


Yes, time to bury it.

Next candidates:

FLASH
PULSAR
…
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I have to get hold of the manuscript. I kind of think there is some signal here, but nothing that's going to pass standard statistical significance (80% power for a hopeful PFS outcome) with 90 or so not terribly well selected patients.

Small negative trials will kill things.
 
Was always skeptical of abscopal and partial metastatic ablation, particularly in unselected, asymptomatic patients.

Identifying and treating high risk, asymptomatic bone metastases is still promising.

Radiation therapy for high-risk, asymptomatic bone metastases may prevent pain and prolong life - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

Phase II trial suggests radiation could ward off complications of bone lesions and extend overall survival for patients with advanced cancers
www.astro.org www.astro.org
 
Palex80 said:
View attachment 374105

Behold, I made a meme!

And since PULSAR or FLASH alone are too simple, I would like to introduce to you the concent of PULSAR-FLASH!

1 second of RT every 6 weeks for your Stage III NSCLC! Works like a charm!
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CHART improved survival in NSCLC, the only RT dose trial in Stage III ever proven to do so

Shows how evidence based we wish to be when the rubber actually hits the road (and rad oncs have to work on the weekend)
 
Also kids, remember, every time you smoke a cigarette a cancer cell gets its mitosis.. and almost all my patients keep smoking.

My wife ocassionally mentions to people that bring up smokers that they... are job security for Sirspam. In the most recent occurrence yesterday, it was an actual smoker (but a friendly acquaintance).

Smoker says "I can quit whenever I want" as she's smoking a cigarette. I point this out. She says "yes, but I have to WANT to quit" lol.

I laughed. Out loud.
 
theradiator said:
Was always skeptical of abscopal and partial metastatic ablation, particularly in unselected, asymptomatic patients.

Identifying and treating high risk, asymptomatic bone metastases is still promising.

Radiation therapy for high-risk, asymptomatic bone metastases may prevent pain and prolong life - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

Phase II trial suggests radiation could ward off complications of bone lesions and extend overall survival for patients with advanced cancers
www.astro.org www.astro.org
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They need to get that publication out ASAP
 
Good for Chuck!

He is one of the nicest guys in our field that I have interacted with. He has tons of commitments and volunteers with a bunch of organizations like the Radiosurgery Society, but he recently took the time to give me a really detailed reply to a question I've been working on. Not the usual one liner or crickets that I get when I email a dept chair.

We could do a lot worse for the leadership of ASTRO.
 
IonsAreOurFuture said:
Good for Chuck!

He is one of the nicest guys in our field that I have interacted with. He has tons of commitments and volunteers with a bunch of organizations like the Radiosurgery Society, but he recently took the time to give me a really detailed reply to a question I've been working on. Not the usual one liner or crickets that I get when I email a dept chair.

We could do a lot worse for the leadership of ASTRO.
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Can we please not have the enemies of 95%+ of Rad Onc (people who shill protons for all diagnoses regardless of appropriateness) leading the organization, please?
 
“Professionalism”

Drunk chairmen, Handsy chairmen, benzo dependent chairmen, outwardly racist chairmen? No problem. They are leadership, so by definition, whatever they do is professional.

Resident doesn’t wear a tie during RadBio week / clinic - called “Unprofessional” by chair

Resident doesn’t clean shave - called “jihadi” by chair.

Resident asks if NP can see the 6th inpatient of the day - unprofessional

Junior faculty experiencing post partum depressing needing an extra month? Unprofessional since the team will have to pick up her slack

Ahh, I love professionalism. When I’m a big shot, I’ll get to use that weapon, too!
 
RealSimulD said:
“Professionalism”

Drunk chairmen, Handsy chairmen, benzo dependent chairmen, outwardly racist chairmen? No problem. They are leadership, so by definition, whatever they do is professional.

Resident doesn’t wear a tie during RadBio week / clinic - called “Unprofessional” by chair

Resident doesn’t clean shave - called “jihadi” by chair.

Resident asks if NP can see the 6th inpatient of the day - unprofessional

Junior faculty experiencing post partum depressing needing an extra month? Unprofessional since the team will have to pick up her slack

Ahh, I love professionalism. When I’m a big shot, I’ll get to use that weapon, too!
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Just another weapon in the admin arsenal along with racism, not being a team player.
 
RickyScott said:
I think some of the people from upenn and maryland would disagree that “he is the nicest guy” he is driven.
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i don't know if i trust or really care about what UPENN or Marylands folks think
don't know if they are a good barometer to use
 
mehrlicht said:
Unfortunately academic leadership is like politics. It only attracts people with significant pathologic personality issues, and these are the people who make the decisions that affect the rest of us just trying to do our work and have normal lives.
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WASHU circa just before 2000 has entered the chat.. And kicked all your asses.. Everyone is crying and the black female resident has been manhandled by a small racist man from Kentucky..
 
Chuck is a nice guy…

If someone who has met him says otherwise, would agree to disagree. If someone who hasn’t met him says otherwise, I would disregard their opinion as ill-informed.

Tribalism is silly
 
This is pretty ridiculous… Dr. Simone is nice person, and very humble the (admittedly few) times I’ve spoken with him.

Maybe instead of forming a circular firing squad we could, you know, talk about solutions?

Protons are an issue but they are not the issue of the day… 42-ish centers are not shifting the tide against practicing rad oncs in the community nearly as much as anti-competitive hiring practices (SCAROP salary data), residency expansion, endless SOAPing, etc…
 
RealSimulD said:
“Professionalism”

Drunk chairmen, Handsy chairmen, benzo dependent chairmen, outwardly racist chairmen? No problem. They are leadership, so by definition, whatever they do is professional.

Resident doesn’t wear a tie during RadBio week / clinic - called “Unprofessional” by chair

Resident doesn’t clean shave - called “jihadi” by chair.

Resident asks if NP can see the 6th inpatient of the day - unprofessional

Junior faculty experiencing post partum depressing needing an extra month? Unprofessional since the team will have to pick up her slack

Ahh, I love professionalism. When I’m a big shot, I’ll get to use that weapon, too!
Click to expand...

Please tell me these examples are hyperbolic and not factual.. I unfortunately am aware of drunk chairman.. wishfully hoping the other examples may not true, possibly??
 
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