Rad Onc Twitter

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taserlaser said:
Not that this was ever close to anyone’s bread and butter, but another one bites the dust. STRASS finally out.

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Very topical. I have a 15cm RP sarcoma coming up and neoadjuvant xrt was being considered. To be honest in my training we rarely performed neoadjuvant xrt and instead would mark any concerning margins with clips as fiducials for possible post op XRT. Curious about people's thoughts.
 
DoctwoB said:
Very topical. I have a 15cm RP sarcoma coming up and neoadjuvant xrt was being considered. To be honest in my training we rarely performed neoadjuvant xrt and instead would mark any concerning margins with clips as fiducials for possible post op XRT. Curious about people's thoughts.
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Post-op xrt in RP sarcoma is a loser. Can't give the dose required for traditional sarcoma due to bowel constraints. In your case if you're adamant on upfront resection, I would resect, even if positive margins just observe, and then when patient develops recurrence (especially if liposarc and risk of metastases is miniscule) do pre-op to a smaller field followed by resection.

If surgeons were concerned about getting negative margins then we'd consider doing pre-op RT, and try to boost the medial/posterior rind (where tumor abutted vessels and rest of retroperitoneal space where getting negative marigns would be difficult)

But yes, based on this trial, there is no need for routine use of neoadjuvant RT in RP patients. If I was a RP Sarcoma patient and the surgeon was confident he could get negative margins, I'd say go ahead with the surgery by itself.
 
DoctwoB said:
Very topical. I have a 15cm RP sarcoma coming up and neoadjuvant xrt was being considered. To be honest in my training we rarely performed neoadjuvant xrt and instead would mark any concerning margins with clips as fiducials for possible post op XRT. Curious about people's thoughts.
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This remains one of my favorite papers/ideas.
1600277797812.png

1600277843921.png

Why not use the tumor as a SpaceOAR? Kinda ideal in RPS, though they only went to 50.4 in this trial.
 
I’m hoping that is a fellowship for medical students or international folks who want to spend a year in the US. Unlike the Wisconsin fellowship, this seems to have no path to becoming a funded researcher. So the future for such a fellow looks kind of bleak.
 
elementaryschooleconomics said:
I would like to take this opportunity to present the next Horseman of the Apocalypse:

View attachment 318470

This is easily my favorite!
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Holy crap. Nothing says "I need to be in Tampa no matter what" than this fellowship. The only FORTs in the future are the sofa forts you will be making with your kids sitting at home unemployed.
 
radiaterMike said:
I’m hoping that is a fellowship for medical students or international folks who want to spend a year in the US. Unlike the Wisconsin fellowship, this seems to have no path to becoming a funded researcher. So the future for such a fellow looks kind of bleak.
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Unlikely, based on the application requirements:

1600365615105.png
 
DoctwoB said:
Very topical. I have a 15cm RP sarcoma coming up and neoadjuvant xrt was being considered. To be honest in my training we rarely performed neoadjuvant xrt and instead would mark any concerning margins with clips as fiducials for possible post op XRT. Curious about people's thoughts.
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I ran this paper by some of my old academic surgical colleagues; and they pointed out to the long time it took to accrue the patients; as well as a large proportion of low grade tumors. So though I think it rules out 'uniform' pre-operative radiation therapy for RP sarcoma; it's not an indication NEVER to offer preoperative radiation to these patients.
 
CaesarRO said:
Makes one foresee a possible future in which Rad Onc does only radiosurgery and radiosurgery is much like actual surgery.

Patient schedules OR time, comes in for their single fraction planning and same day treatment, goes home and is done.

If APM really moves us all to per-case billing, having patients actively "on treat" would be all down side
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This is really very close to my world over the last few years; being a GI specialist in an employed practice. I haven't gotten past 7 patients on treatment all year; and still will have over 10K RVUs. For me, APM will push the '5 fractions' to '1 fraction,;' and at least in my world filled with liver tumors; would make SBRT much, much more competitive with embolization and ablation technologies. But, please don't jump on me; I get the real-world implications for everyone who treats a more routine patient mix; and I benefit from a robust liver transplant program covering nearly 1/2 a state.
 
GI_RadOnc said:
This is really very close to my world over the last few years; being a GI specialist in an employed practice. I haven't gotten past 7 patients on treatment all year; and still will have over 10K RVUs. For me, APM will push the '5 fractions' to '1 fraction,;' and at least in my world filled with liver tumors; would make SBRT much, much more competitive with embolization and ablation technologies. But, please don't jump on me; I get the real-world implications for everyone who treats a more routine patient mix; and I benefit from a robust liver transplant program covering nearly 1/2 a state.
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I haven't seen any data suggesting 1-fraction regimens are equivalent to 5-fraction regimens in the liver...do you have anything I would have missed?
 
I’m.
GI_RadOnc said:
This is really very close to my world over the last few years; being a GI specialist in an employed practice. I haven't gotten past 7 patients on treatment all year; and still will have over 10K RVUs. For me, APM will push the '5 fractions' to '1 fraction,;' and at least in my world filled with liver tumors; would make SBRT much, much more competitive with embolization and ablation technologies. But, please don't jump on me; I get the real-world implications for everyone who treats a more routine patient mix; and I benefit from a robust liver transplant program covering nearly 1/2 a state.
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Are you kidding, we have a liver tx program too and I stopped going to liver TB and multi D because it was a waste of time. Oh great see 7 consults and stand there with 4 other specialist and nod like an idiot for 30 mins and move on. It was a joke because it was either surgery, RFA, TACE, TARE, and then maybe possibly if god was smiling on you that day you got one that the surgeons and the IR guys just didn’t feel like doing that day probably after they met their RVU targets. Utterly Ridiculous.
 
These predatory fellowships are a really good litmus test of a given institution's scruples. Any department that offers them immediately loses most of whatever credibility I had previously ascribed to it, if any. Offering a PGY-6 year without any significant gain in skill or knowledge of the field is basically just a forestalled residency. The whole "customizable" aspect they brand this with is just a clever way of saying that there is no distinct goal of the experience to that end.

For any of these new Rad Onc fellowships that subsequently appear, ask yourself: why now? I mean, why would this program come up with this fellowship now out of all possible times? It seems awfully convenient that they should occur at a time when the post-grad job market has never been more strained.

I hope someone brings this issue into the forefront more and writes an article about this to at least get a discussion going.
 
It would be really great if programs sent out a fellowship position offer to anyone inquiring about a faculty job. (sarcasm)

I'd be interested in knowing if any programs are sinking that low. Other than MD Anderson who did that last year... after signing faculty contracts only to threaten reneging the contract to a fellowship. I'm more worried about that type of predation -- yanking contracts at the last minute or forcing renegotiation to something much worse due to duress.
 
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OTN said:
I haven't seen any data suggesting 1-fraction regimens are equivalent to 5-fraction regimens in the liver...do you have anything I would have missed?
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No comparative studies; but I figure someone will start working on it as soon as the billing changes appear!

pubmed.ncbi.nlm.nih.gov

Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies - PubMed

It is feasible and safe to deliver single-fraction, high-dose SBRT to primary or metastatic liver malignancies measuring ≤5 cm. Moreover, single-fraction SBRT for liver lesions demonstrated promising local tumor control with minimal acute and long-term toxicity. Single-fraction SBRT appears to...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

I was most interested in this report with carbon ions for HCC proper. Even with this, thinking one could sim and treat the first fraction and then the next fraction the following day.

Long-Term Results of High-Dose 2-Fraction Carbon Ion Radiation Therapy for Hepatocellular Carcinoma - PMC

Carbon ion beams have several physical and biological advantages compared with conventional radiation for cancer therapy. The objective of this study is to evaluate the safety and effectiveness of 2-fraction carbon ion radiation therapy (CIRT) in ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
bergonieandtribondeau said:
These predatory fellowships are a really good litmus test of a given institution's scruples. Any department that offers them immediately loses most of whatever credibility I had previously ascribed to it, if any. Offering a PGY-6 year without any significant gain in skill or knowledge of the field is basically just a forestalled residency. The whole "customizable" aspect they brand this with is just a clever way of saying that there is no distinct goal of the experience to that end.

For any of these new Rad Onc fellowships that subsequently appear, ask yourself: why now? I mean, why would this program come up with this fellowship now out of all possible times? It seems awfully convenient that they should occur at a time when the post-grad job market has never been more strained.

I hope someone brings this issue into the forefront more and writes an article about this to at least get a discussion going.
Click to expand...
pubmed.ncbi.nlm.nih.gov

Caveat Emptor: Fellowship Training in Radiation Oncology; What, But More Importantly, Why? - PubMed

Caveat Emptor: Fellowship Training in Radiation Oncology; What, But More Importantly, Why?
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Dr Wallner (to his credit) has written just such an article
 
Chartreuse Wombat said:
pubmed.ncbi.nlm.nih.gov

Caveat Emptor: Fellowship Training in Radiation Oncology; What, But More Importantly, Why? - PubMed

Caveat Emptor: Fellowship Training in Radiation Oncology; What, But More Importantly, Why?
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Dr Wallner (to his credit) has written just such an article
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The concluding sentence of Dr. Wallner's article:

" Absent development of those serious educational steps, the term fellowship should be avoided in RO, perhaps to be replaced by more accurate descriptive terminology, such as clerkship or apprenticeship. "
 
StIGMA said:
The concluding sentence of Dr. Wallner's article:

" Absent development of those serious educational steps, the term fellowship should be avoided in RO, perhaps to be replaced by more accurate descriptive terminology, such as clerkship or apprenticeship. "
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Or " spacer" year while my SO finishes up training/I wait out the job market
 
medgator said:
Or " spacer" year while my SO finishes up training/I wait out the job market
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Speaking of "spacer" year, maybe we can do a RadOnc year-long spaceOAR fellowship to improve on placement by all of these impatient urologists.
 
I really don't see an end in site to fellowship expansion. It's the tragedy of the commons. Academic institutions have no disincentive not to hire a fellow for 70-80k/yr. They clearly bring much more value as a staff member than their salaries compensate. Just like expanding for more residents. There are no brakes in the equation. Those of us out in practice should consider ourselves lucky to be grandfathered into the "fellowship-was-not-standard" era.
 
StIGMA said:
It would be really great if programs sent out a fellowship position offer to anyone inquiring about a faculty job. (sarcasm)
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As a faculty member trying to help find jobs for struggling graduating residents, I have received exactly this response from three different institutions...
 
Keeping on top of all this delicious med onc research without being to dispense any of it makes me think that certain investments would be wise

Don't hate the player, hate the pharma bro game
 
medgator said:
Would be interesting to see rad onc spending vs this

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I already tried to guess

forums.studentdoctor.net

Perspective$ in Oncology

CMS Part B spending is about $1.5 billion a year for rad onc and about $7 billion a year for hem/onc. (The highest rad onc spending ever: 2011, about $1.85 billion.) Keytruda sales alone are now ~$19 billion a year. I made a graph:
forums.studentdoctor.net forums.studentdoctor.net
 
Neuronix said:
My interpretation is "Can help organ motion problem. That's it. (This is a) waste of time."
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That was my interpretation as well. How was this guy a proponent of the oligomets theory/treatment? He is anti-XRT for seemingly literally every other attempt at innovation.
 
elementaryschooleconomics said:
That was my interpretation as well. How was this guy a proponent of the oligomets theory/treatment? He is anti-XRT for seemingly literally every other attempt at innovation.
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Some “luminaries” in their time were against IMRT. The dogma was it was terrible and you would miss and certainly kill people
 
evilbooyaa said:
I have no idea what RW is going off about. Not sure what FLASH has to do with organ motion...
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I am sure Ralph complains incessantly about the temperature of the soup at the deli. These kind of objections really contradict his support for residency expansion "to bring more people in to innovate and expand field."
 
RickyScott said:
I am sure Ralph complains incessantly about the temperature of the soup at the deli. These kind of objections really contradict his support for residency expansion "to bring more people in to innovate and expand field."
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What does he want people to innovate about radiation oncology? Does anybody know?

Having met the man I can tell you I was not able to glean any idea as to what that innovation might be about.

I hope that as I get older and older I don't just spout off sound bites.
 
Zahramar said:
What does he want people to innovate about radiation oncology? Does anybody know?

Having met the man I can tell you I was not able to glean any idea as to what that innovation might be about.

I hope that as I get older and older I don't just spout off sound bites.
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Just call it "radical candor" and apparently you can get away with it.
 
evilbooyaa said:
I have no idea what RW is going off about. Not sure what FLASH has to do with organ motion...
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I think he is saying that FLASH can deliver treatment in such a rapid manner that the only benefit is to minimize intrafraction organ motion- but otherwise it won't prove to have any benefit. I wonder if Twitter offers a RRW translation feature ?
 
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