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Yeah, sorry to offend. Have read through some literature, seems like many negative randomized trials, but good results on retrospective studies. Didn't see the russian trial in full yet, can't seem to find it anywhere online. But glad to see people on here excited about it. I do hope it works out, hopefully the Mayo trial is positive.
Posted here 😉
There’s gonna have to be an America sham trial for stable reimbursement. BCBS California has policy to not cover LDRT for OA eg.
I'm actually fine participating in healing by placebo. Placebo undoubtedly impacts our effectiveness regarding palliation and may positively impact outcomes like survival.
Meh...the body is a highly variable dosimeter when it comes to particles (excluding photons). That intrinsic dosimetric uncertainty may well shrink or destroy our "therapeutic window" right within the target volume while sparing us dose outside of the target.
pubmed.ncbi.nlm.nih.gov
Effects of low dose rate radiotherapy on pain relief, performance score, and quality of life in patients with knee osteoarthritis; a double-blind sham-controlled randomized clinical trial - PubMed
Results showed significant pain score improvements and enhanced joint function with no adverse effects. Findings were compared with previous studies, revealing mixed conclusions on low dose radiation therapy (LDRT) efficacy. Mechanistic hypotheses suggest LDRT may modulate inflammatory pathways...
Sham-controlled, benefit of 0.5Gy x 6 compared to sham placebo.
Sufficient?
That being said, I do support a Sham-controlled placebo trial in a US population. Of course those who are not in academics are not curious about this, will continue to treat. And that's fine, while we ask the question as to whether this works or not.
Requiring OA patients to undergo LDRT prior to considering joint replacement would be such a dramatic change in paradigm that departments wouldn't know how to treat the patients they were sent.
State?
There are people out there who know how to perform this
www.auntminnie.com
Buy tomo and just say you’re always doing a high dose MVCT?
I didn’t say it was the only mechanism. This argument is like criticizing someone for saying DNA damage inducing mitotic catastrophe is main MOA RT for cancer. Sure there are other mechanisms, but there is a main one.
Just to pile on a little late in the conversation, but if you look at the evidence for other interventions for arthritis there is precious little RCT data showing a benefit. This includes things like cortisone injections and joint replacements
As someone who is relatively new to practice and hasn’t had to think about this stuff until now, I found it extremely educational and helpful. I was encouraged that the hospital cost basis should stabilize payments for freestanding and hopeful that RUC indeed made a crosswalk error that can be fixed.
The only thing that's grown in the specialty has been residency slots.
Remember when I said there was a group of rad oncs out there that thought treating benign conditions, especially OA, was a scam and were antagonistic to rad oncs doing it because they believe linacs should only be used to treat cancer? And many here thought I was making that up? Well...
We have all had those patients that demand treatment simply because they have cancer and can't sleep at night doing nothing. They cannot be talked into active surveillance under any circumstance and if you don't treat them, they will go down the street to urorads or even the local academic satellite who will (or god forbid with protons). If they are hellbent on getting treatment anyway, then I will at least offer them the least toxic and most convenient treatment available. This is different from talking them into it. I share your suspicion that the rad oncs chastising RT for benign indications are likely guilty of more egregious sins in the onc domain.
Those slots begat more academic rad oncs. The per annum growth of academic rad oncs actually outpaces resident growth… so we got TWO growth markets 😉
In my very limited experience, academic centers are most likely to treat G6 disease in an 80 year old.
If that happens I'd only ever do IMRT.
You mean you guys aren't making your prostate patients breath-hold already?
We only use fart hold with smell guidance. It is a technological revolution.
I was wondering if a bear sh*ts in the woods
This is interesting as some fart smeller, I mean smart feller, once developed a “solid water” device to accomplish prostate immobilization (like a rectal balloon, but more reliable) AND flatus elimination all in one fell swoop:
If you want to be a prostate RT expert one day you realize you’ll need to become facile with a mild amount of untitillating butt stuff.
If there can be artificial intelligence why can’t there be artificial urgencies… it’s like an urgency but better in every way.
It's all a simulation...
