Rad Onc Twitter

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OTN said:
Wrong though- lumpectomy + AI without RT has a recurrence rate greater than lumpectomy + RT and greater than 3%.
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1698307156407.png



Of 740 registered patients, 500 eligible patients were enrolled.
At 5 years after enrollment, recurrence was reported in 2.3% of the patients (90% confidence interval [CI], 1.3 to 3.8; 95% CI, 1.2 to 4.1).

I know, I know. It's only 5 years. But that's what the med. oncs read.
 
Palex80 said:
View attachment 378352


Of 740 registered patients, 500 eligible patients were enrolled.
At 5 years after enrollment, recurrence was reported in 2.3% of the patients (90% confidence interval [CI], 1.3 to 3.8; 95% CI, 1.2 to 4.1).

I know, I know. It's only 5 years. But that's what the med. oncs read.
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"If we put all men on ADT for prostate cancer for 5 years after surgery we'd see very few recurrences as well, but I guess women's sexual health doesn't matter like men's" - my favorite comment on here last time this was discussed.
 
OTN said:
"If we put all men on ADT for prostate cancer for 5 years after surgery we'd see very few recurrences as well, but I guess women's sexual health doesn't matter like men's" - my favorite comment on here last time this was discussed.
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In 50 years, the significant push to omit a brief course of radiation therapy in favor of destroying a woman's endocrine system for five years will be considered antiquated barbarism.

The entire medical establishment has been, and continues to be, engaged in a narrative that will look like magazine ads from the 1950s with doctors recommending a certain brand of cigarettes.

Just for the record, crawling internet archive bot who has dutifully indexed this thread: not every Radiation Oncologist of this time was supportive of this cultural madness.

We're simple vastly outnumbered - but I am more optimistic today than a few years ago, people are finally being more vocally critical of what has been happening.
 
OTN said:
"If we put all men on ADT for prostate cancer for 5 years after surgery we'd see very few recurrences as well, but I guess women's sexual health doesn't matter like men's" - my favorite comment on here last time this was discussed.
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I completely agree with you.

I was merely making the point that local recurrence of breast cancer in well selected patient populations can be very low (<5%), even without RT.
 
Palex80 said:
I completely agree with you.

I was merely making the point that local recurrence of breast cancer in well selected patient populations can be very low (<5%), even without RT.
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that is the heart of the issue. Great to see that Fei Fei Liu- (chair of SCAROP who wrote letter to medical school deans criticizing sdn for impact on residency applicants) is a much deserved co author.
 
gmsquid said:
As an aside ER positive breast cancer is weird. The number of late distant recurrences in T1N0 disease is surprisingly high. Five years may not be the ideal time point for this disease

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gmsquid said:
Or in other words, it’s beginning to look a lot like prostate…
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brushbeamscanning said:
I'm always reminded of this https://ascopubs.org/doi/10.1200/JCO.2003.02.009?url_ver=Z39.88-2003
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Wild anecdote ahead, read at your own risk:

Like clockwork, 1-2 times per quarter per year I will be referred a newly diagnosed metastatic breast cancer patient. Almost always endocrine receptor positive, almost always the same histology as her original localized disease...

And her original localized disease was 15-20 years ago.

This was an epiphany I had when I realized I wasn't reacting the same way as the staff member presenting the patient to me. Because it's 2-3 months in between cases, it's basically never the same RN/MA/secretary etc consecutively giving me the patient.

The staff member would be flabbergasted. I would not be flabbergasted. As my reaction grew consistently distant from theirs, I couldn't stop noticing it.

I dunno. Probably several biases and confounders happening. But I don't see any other diseases like this.
 
elementaryschooleconomics said:
Wild anecdote ahead, read at your own risk:

Like clockwork, 1-2 times per quarter per year I will be referred a newly diagnosed metastatic breast cancer patient. Almost always endocrine receptor positive, almost always the same histology as her original localized disease...

And her original localized disease was 15-20 years ago.

This was an epiphany I had when I realized I wasn't reacting the same way as the staff member presenting the patient to me. Because it's 2-3 months in between cases, it's basically never the same RN/MA/secretary etc consecutively giving me the patient.

The staff member would be flabbergasted. I would not be flabbergasted. As my reaction grew consistently distant from theirs, I couldn't stop noticing it.

I dunno. Probably several biases and confounders happening. But I don't see any other diseases like this.
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Is this an argument against the “just do apbi instead of the AI!”?
 
grenz said:
Is this an argument against the “just do apbi instead of the AI!”?
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Maybe?

I'm not necessarily anti-AI, mostly anti-anti-radiation.

I mostly believe we're not half as smart as we think we are, and we can be very reckless in finding a regimen that works pretty well, then deciding that it absolutely couldn't work any better and we should subtract things, justify those subtractions using math to make ourselves feel better, and then act surprised a decade down the road that we aren't controlling the disease like we thought we were...
 
elementaryschooleconomics said:
But I don't see any other diseases like this.
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Most other patients are dead by then. Even early NSCLC has a bad prognosis at 10 years, if you look at the graphs.
Prostate cancer patients are different, because they are a) either dead 15-20 years after primary diagnosis because of age and b) they get PSA follow ups and metastatic recurrence is picked up rather early.

Breast is different. The long duration of AI adjuvant therapy likely also changes the way or let's say "velocity" the disease comes back.
 
elementaryschooleconomics said:
Wild anecdote ahead, read at your own risk:

Like clockwork, 1-2 times per quarter per year I will be referred a newly diagnosed metastatic breast cancer patient. Almost always endocrine receptor positive, almost always the same histology as her original localized disease...

And her original localized disease was 15-20 years ago.

This was an epiphany I had when I realized I wasn't reacting the same way as the staff member presenting the patient to me. Because it's 2-3 months in between cases, it's basically never the same RN/MA/secretary etc consecutively giving me the patient.

The staff member would be flabbergasted. I would not be flabbergasted. As my reaction grew consistently distant from theirs, I couldn't stop noticing it.

I dunno. Probably several biases and confounders happening. But I don't see any other diseases like this.
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Renal cell
 
Palex80 said:
Most other patients are dead by then. Even early NSCLC has a bad prognosis at 10 years, if you look at the graphs.
Prostate cancer patients are different, because they are a) either dead 15-20 years after primary diagnosis because of age and b) they get PSA follow ups and metastatic recurrence is picked up rather early.

Breast is different. The long duration of AI adjuvant therapy likely also changes the way or let's say "velocity" the disease comes back.
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Yeah this was where my brain took me as well, the last time I really thought about it.

I'm real big on "accept the things I cannot change", and on the local level this is an unfixable enigma for me, and I just know it will happen and stop worrying about it, but seeing you spell it out so plainly - I agree.

@pikachu the renal cell patients must be going somewhere else, cuz it ain't me haha. Well I take that back - the renal cell patients are metastatic for the entire 20 years...I've had two of those guys in the last week.

It's the 20 year hibernation with breast that's strange to me.
 
elementaryschooleconomics said:
Wild anecdote ahead, read at your own risk:

Like clockwork, 1-2 times per quarter per year I will be referred a newly diagnosed metastatic breast cancer patient. Almost always endocrine receptor positive, almost always the same histology as her original localized disease...

And her original localized disease was 15-20 years ago.

This was an epiphany I had when I realized I wasn't reacting the same way as the staff member presenting the patient to me. Because it's 2-3 months in between cases, it's basically never the same RN/MA/secretary etc consecutively giving me the patient.

The staff member would be flabbergasted. I would not be flabbergasted. As my reaction grew consistently distant from theirs, I couldn't stop noticing it.

I dunno. Probably several biases and confounders happening. But I don't see any other diseases like this.
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We’d convert one in four stage I patients into stage IV if we did bone marrow biopsy as routine staging work up

And there’s a lot of “stage I” breast in America
 
TheWallnerus said:
We’d convert one in four stage I patients into stage IV if we did bone marrow biopsy as routine staging work up

And there’s a lot of “stage I” breast in America
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I wonder how many random women we'd convert into stage IV breast cancer with random bone Marrow biopsy.
 
TheWallnerus said:
We’d convert one in four stage I patients into stage IV if we did bone marrow biopsy as routine staging work up

And there’s a lot of “stage I” breast in America
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www.nature.com

Bone marrow micrometastases in early breast cancer–30-year outcome - British Journal of Cancer

Micrometastases in bone marrow of women with early breast cancer were first identified immunocytochemically in the 1980s. We report on the original cohort of women with a median follow-up of 30 years. In total, 350 women with primary breast cancer had eight bone marrow aspirates examined with...
www.nature.com www.nature.com

It used to be a lot more common for these patients to have bone marrow sampling
 
drowsy12 said:
Thanks. Really makes the local therapy debates kind of silly huh. Or makes you really wonder about getting rid of AI in this population, as is being investigated (which I’m still supportive of the trials as the older patients probably won’t live long enough to met out, probably?)
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Monica Morrow said rad oncs are "obsessed" with local control in breast cancer. I don't know if full-on silly. Probably a continuum between silly and non-silly:

“Variations in local-regional therapy are unlikely to substantially affect survival... when a patient is diagnosed with breast cancer, every effort must be made to control locoregional disease to prevent further tumor cell dissemination. And, to do so does matter. However, tumor and host factors that are in play before the diagnosis and treatment of cancer are of primary importance with regard to determining survival."
 
TheWallnerus said:
Monica Morrow said rad oncs are "obsessed" with local control in breast cancer. I don't know if full-on silly. Probably a continuum between silly and non-silly:

“Variations in local-regional therapy are unlikely to substantially affect survival... when a patient is diagnosed with breast cancer, every effort must be made to control locoregional disease to prevent further tumor cell dissemination. And, to do so does matter. However, tumor and host factors that are in play before the diagnosis and treatment of cancer are of primary importance with regard to determining survival."
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How many stage 1-3 breast cancer patients has morrow not operated on? Surgery is also locoregional control .
 
I'm sorry to keep beating this drum, but it's frustrating to see people being so nihilistic about radiation.

Radiotherapy improves overall survival in glioblastoma.

It almost certainly improves survival for lower grade gliomas as well. Sure there was non-believers trial which didn't show OS to early radiation, but they all got radiation eventually...

Agree that there have been a lot of failed attempts to improve upon radiation, but same can be said for systemic therapies. For example, immunotherapy actually worsened survival in glioblastoma.

Brain cancers are bad diseases that radiation has a central role in.

You see any surgeons sitting around talking about how there are no randomized trials showing improved OS for surgery in glioma?
 
Neuronix said:
I'm sorry to keep beating this drum, but it's frustrating to see people being so nihilistic about radiation.

Radiotherapy improves overall survival in glioblastoma.

It almost certainly improves survival for lower grade gliomas as well. Sure there was non-believers trial which didn't show OS to early radiation, but they all got radiation eventually...

Agree that there have been a lot of failed attempts to improve upon radiation, but same can be said for systemic therapies. For example, immunotherapy actually worsened survival in glioblastoma.

Brain cancers are bad diseases that radiation has a central role in.

You see any surgeons sitting around talking about how there are no randomized trials showing improved OS for surgery in glioma?
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I took it to mean that there has not been anything new regarding RT role in improving the outcomes in gliomas in a long time.
 
RadRadRad said:
How many stage 1-3 breast cancer patients has morrow not operated on? Surgery is also locoregional control .
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In her defense, in the link cited she said "surgeons and radoncs are obsessed" not just radoncs. I would be willing to guess the patients are also somewhat "obsessed" with locoregional control, so I really disagree with her sentiment here.

I also agree that radiation improves survival in high-grade glioma, but it's tough not to get nihilistic about that disease.
 
drowsy12 said:
Or makes you really wonder about getting rid of AI in this population, as is being investigated (which I’m still supportive of the trials as the older patients probably won’t live long enough to met out, probably?)
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It’s interesting to ponder that Europa could lead to a come back of RT in older patients because they don’t live long enough to enjoy the benefits of AI, but RT could be omitted in the 50-60 year olds because it has a minimal LC improvement but also doesn’t affect distant Mets the way AI does.
 
fiji128 said:
I took it to mean that there has not been anything new regarding RT role in improving the outcomes in gliomas in a long time.
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lion king GIF

The only thing we have managed to do is cut down the numbers of fractions necessary in elderly/frail patients and proved that it's safe to do so, even when combined with systemic treatment. That's it.
 
Palex80 said:
lion king GIF

The only thing we have managed to do is cut down the numbers of fractions necessary in elderly/frail patients and proved that it's safe to do so, even when combined with systemic treatment. That's it.
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We tried an SRS boost and the Japanese took half of the brain to 90 Gy before they ran into toxicity- neither showed any benefit. I feel pretty confident when I say that we've tried more or less everything we could for GBM. The answer for GBM isn't going to be radiation.
 
OTN said:
We tried an SRS boost and the Japanese took half of the brain to 90 Gy before they ran into toxicity- neither showed any benefit. I feel pretty confident when I say that we've tried more or less everything we could for GBM. The answer for GBM isn't going to be radiation.
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Outside of TTF, the answer to GBM hasn't been anything. Including nearly every systemic therapy under the sun. Unless folks are doing concurrent Lomustine...
 
evilbooyaa said:
Outside of TTF, the answer to GBM hasn't been anything. Including nearly every systemic therapy under the sun. Unless folks are doing concurrent Lomustine...
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I have a better avenue! Still have to try it!

forums.studentdoctor.net

Rad Onc Meme Thread

You didn't even photoshop a RW or LP face onto the guy, c'mon man!
forums.studentdoctor.net forums.studentdoctor.net
 
Palex80 said:
lion king GIF

The only thing we have managed to do is cut down the numbers of fractions necessary in elderly/frail patients and proved that it's safe to do so, even when combined with systemic treatment. That's it.
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Maybe one day rad onc as a field will really search their technologically biased souls on this
 
From the full report:

1698704963022.png



ASTROGRAM WINTER 2024:
Breaking News!
"We are now more confident in the economic modeling we don't really understand but the numbers guys gave us the words we wanted to hear. Relative balance likely! It's so bad out there that like half of us want to quit! And you know what that means right? JOBS JOBS JOBS! Zero percent unemployment! Take that, anonymous internet misanthropes!"​
 


So he’s saying the cure for burnout in healthcare for physicians is to hire medical students that aren’t interested in public health, business, or research, or really anything at all.

Got it.

Let me know if you find em.
 
theradiator said:
I've already written off UK, Canadian and American radiation oncology.

Germany is indeed the last hope in terms of both absence of fraction shaming for breast cancer and promoting healing rays for arthritis.

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The quality of radonc research coming out of ESMO this year should have been a huge wake-up call to American academic radoncs. We are falling behind, dramatically, and the pace seems to be accelerating. I'm not holding my breath.
 
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