Rad Onc Twitter

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medgator said:
We call out the proton w****$ all the time here. They are just as bad, and in my neck of the woods the urologists hate them as much. I just don't see the rad Onc equivalent of hifu, cryo etc happening in upfront pca management at the same scale.

Even many in academics are anti proton, including, notably, Dr Spratt
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Been a long time since I popped in to see what is up on SDN. Hope everyone is doing great and surviving Covid! I see people are staying up to speed on everything somehow. Amazing.

I think many of you brought up excellent points. It is important to have a very good relationship with your referring docs, including of course urology. This is needed if you want to actually be able to give the best care to patients...need to see them first! However, once they know you care most about patients and not just giving RT, they will start to respect you and be open to your opinions and working together how to best manage patients. I love our urology group and together we have grown by nearly 4 fold in 5 years with some really great new GU radonc hires to expand the program. That is despite all of the push back I give urology. However I think I equally give push back to radonc, radiology, medonc, etc, with the focus on being for the patient. So my surgeons know my intent, but I agree you should be careful if you don’t have that relationship yet with your team.

Building your local team is key, and you can let idiots like me take some of the public punches 😁 I find that showing my name works best for me as I have nothing to hide. The world sees my stance, strengths, and major flaws. However, I totally get why that doesn’t work for everyone. I do believe all of you though can gain the highest level of respect from all specialists and levels of your institution/organization. As a college drop out with a 2.5 high school GPA, if I can do ok, many of you are way smarter.

As some of you know, there is a cost to trying to tell it like it is and you will be wrong at times. That cost may not be worth it for everyone. As I see even on this thread, ppl have very diverse viewpoints and so you are bound to upset someone even if you have the purist of intentions.

Hope everyone is doing well and keep up the awesome work. Gonna do some more SDN reading to see what is up in radonc world.
 
Dan Spratt said:
Been a long time since I popped in to see what is up on SDN. Hope everyone is doing great and surviving Covid! I see people are staying up to speed on everything somehow. Amazing.

I think many of you brought up excellent points. It is important to have a very good relationship with your referring docs, including of course urology. This is needed if you want to actually be able to give the best care to patients...need to see them first! However, once they know you care most about patients and not just giving RT, they will start to respect you and be open to your opinions and working together how to best manage patients. I love our urology group and together we have grown by nearly 4 fold in 5 years with some really great new GU radonc hires to expand the program. That is despite all of the push back I give urology. However I think I equally give push back to radonc, radiology, medonc, etc, with the focus on being for the patient. So my surgeons know my intent, but I agree you should be careful if you don’t have that relationship yet with your team.

Building your local team is key, and you can let idiots like me take some of the public punches 😁 I find that showing my name works best for me as I have nothing to hide. The world sees my stance, strengths, and major flaws. However, I totally get why that doesn’t work for everyone. I do believe all of you though can gain the highest level of respect from all specialists and levels of your institution/organization. As a college drop out with a 2.5 high school GPA, if I can do ok, many of you are way smarter.

As some of you know, there is a cost to trying to tell it like it is and you will be wrong at times. That cost may not be worth it for everyone. As I see even on this thread, ppl have very diverse viewpoints and so you are bound to upset someone even if you have the purist of intentions.

Hope everyone is doing well and keep up the awesome work. Gonna do some more SDN reading to see what is up in radonc world.
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Hey Dan thanks for stopping in again. You're always inspirational 🙂 Without inundating you with an orgy of hyperlinks, I want to say that as a rad onc I am disillusioned with how rad onc is doing in prostate cancer. There are numerous data points (of which you are aware I'm sure) of the significantly decreasing utilization of RT in prostate cancer the last ~20y, definitive and post-op. (How much of that is due to decreased screening... there were about 232,000 CaPs/yr in 2005 and only 192,000/yr now... vs urologists shifting referral patterns IDK.) In that time frame, we have IMRT'd, then IGRT'd, both of which brought about phenomenal decreases in RT toxicity. Then we began treatment-shortening, making the treatment more "lifestyle" feasible and convenient. So all these great things in rad onc... they have been INVERSELY correlated with RT's use in prostate cancer the last couple decades. We can have all the nice relationships in the world with urologists, but it isn't helping our field. Prostate was the bread and butter of rad onc. It would not surprise me if we are treating ~33% less absolute CaP cases, as a field, nationally, than 15y ago (one more link, sorry). Anecdotally, I used to be awash in CaP. Nowadays, not so much. I am not partners with any urologists though. (But I am trying!)

TL;DR: relationships and RT improvements are not increasing RT CaP utilization (nationally). What will?
 
scarbrtj said:
Hey Dan thanks for stopping in again. You're always inspirational 🙂 Without inundating you with an orgy of hyperlinks, I want to say that as a rad onc I am disillusioned with how rad onc is doing in prostate cancer. There are numerous data points (of which you are aware I'm sure) of the significantly decreasing utilization of RT in prostate cancer the last ~20y, definitive and post-op. (How much of that is due to decreased screening... there were about 232,000 CaPs/yr in 2005 and only 192,000/yr now... vs urologists shifting referral patterns IDK.) In that time frame, we have IMRT'd, then IGRT'd, both of which brought about phenomenal decreases in RT toxicity. Then we began treatment-shortening, making the treatment more "lifestyle" feasible and convenient. So all these great things in rad onc... they have been INVERSELY correlated with RT's use in prostate cancer the last couple decades. We can have all the nice relationships in the world with urologists, but it isn't helping our field. Prostate was the bread and butter of rad onc. It would not surprise me if we are treating ~33% less absolute CaP cases, as a field, nationally, than 15y ago (one more link, sorry). Anecdotally, I used to be awash in CaP. Nowadays, not so much. I am not partners with any urologists though. (But I am trying!)

TL;DR: relationships and RT improvements are not increasing RT CaP utilization (nationally). What will?
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As much as I hate to see insurance or evicore or some CoC standard drive practice.....

I think it’s going to take some sort of check box in those spaces that say “prostate cancer patient met with rad onc before making decision about surgery versus radiation.”
 
scarbrtj said:
Hey Dan thanks for stopping in again. You're always inspirational 🙂 Without inundating you with an orgy of hyperlinks, I want to say that as a rad onc I am disillusioned with how rad onc is doing in prostate cancer. There are numerous data points (of which you are aware I'm sure) of the significantly decreasing utilization of RT in prostate cancer the last ~20y, definitive and post-op. (How much of that is due to decreased screening... there were about 232,000 CaPs/yr in 2005 and only 192,000/yr now... vs urologists shifting referral patterns IDK.) In that time frame, we have IMRT'd, then IGRT'd, both of which brought about phenomenal decreases in RT toxicity. Then we began treatment-shortening, making the treatment more "lifestyle" feasible and convenient. So all these great things in rad onc... they have been INVERSELY correlated with RT's use in prostate cancer the last couple decades. We can have all the nice relationships in the world with urologists, but it isn't helping our field. Prostate was the bread and butter of rad onc. It would not surprise me if we are treating ~33% less absolute CaP cases, as a field, nationally, than 15y ago (one more link, sorry). Anecdotally, I used to be awash in CaP. Nowadays, not so much. I am not partners with any urologists though. (But I am trying!)

TL;DR: relationships and RT improvements are not increasing RT CaP utilization (nationally). What will?
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The way to really integrate urology into the equation is multi-specialty groups or even urorads, but we all know how ASTRO misguidedly felt about that and it was a real waste of political capital to fight a (losing) battle which actually ended up hurting a segment of its own members.

So now we have urologists doing cryo and hifu out in the real world rather than collaborate with RO. I wonder how @Dan Spratt feels about that
 
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medgator said:
Yup... Definitely can't start trash talking other physicians you work with until at least 3-4 years in. In mid career practice, i feel quite comfortable talking $h!/ when warranted. Shinde needs to simmer down until he gets a bit more seasoned into his practice
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Maintaining a non-anonymous professional social media presence to promote your academic cancer center and build your career as a junior attending would totally exhaust me. Despite good intentions, words posted on the Internet tend to be read and (mis)interpreted in so many different ways beyond the control of the original poster. The misinterpretations can't be corrected in realtime like you could face-to-face during tumor board...the misinterpretation just festers over days/weeks and likely hurts professional relationships. I imagine the necessary damage control takes a lot of time and effort in these circumstances.

And what about the overworked junior academic attending doomscrolling through the endless cherry-picked Twitterflexin' collectively posted by high-performing young faculty all across the globe, announcing all their new awards, publications, grants? Probably simultaneously motivating and depressing. The same kind of well-researched depression that Facebook generates with its bottomless barrage of keeping-up-with-the-Joneses Facebook friends' vacation photos, baby pics, etc.

So glad my hospital blocks access to Twitter and Facebook.
 
BobbyHeenan said:
...I think it’s going to take some sort of check box in those spaces that say “prostate cancer patient met with rad onc before making decision about surgery versus radiation.”
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IIRC, in the 1990s, the state of Michigan had a law stating all breast ca pts to be seen by all 3 (surg, medonc and radonc) from the outset to minimize unnecessary mastectomy. I am not up-to-date with Michigan law though.

Breast ca received tons of publicity bc it should.

Prostate ca somehow does not get that much publicity.

Imagine if there is a law stating that all prostate ca pts to be seen by all 3: urology, medonc and radonc?
 
Interesting to read this thread because I am absolutely inundated with prostate cancer referrals. The only people doing prostatectomies in my neck of the woods are the tertiary care center docs on RVU-bases salaries, especially one 'prominent' uro who will surgerize anyone with a pulse, including Gleason 10, ECE/SVI on MRI, etc. Otherwise, the private guys have completely stopped doing surgeries. Several have told me the combination of SPACE OAR, fiducials, and lupron pays as much as a prostatectomy so they have 0 incentive to take people to the OR, especially when they've felt all along radiation is a better option for most patients.
 
Reaganite said:
Interesting to read this thread because I am absolutely inundated with prostate cancer referrals. The only people doing prostatectomies in my neck of the woods are the tertiary care center docs on RVU-bases salaries, especially one 'prominent' uro who will surgerize anyone with a pulse, including Gleason 10, ECE/SVI on MRI, etc. Otherwise, the private guys have completely stopped doing surgeries. Several have told me the combination of SPACE OAR, fiducials, and lupron pays as much as a prostatectomy so they have 0 incentive to take people to the OR, especially when they've felt all along radiation is a better option for most patients.
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Yup, fees for placement (esp when GU owns a TRUS) plus contracting for lupron alternatives like trelstar or eligard does generate revenue
 
Reaganite said:
Interesting to read this thread because I am absolutely inundated with prostate cancer referrals. The only people doing prostatectomies in my neck of the woods are the tertiary care center docs on RVU-bases salaries, especially one 'prominent' uro who will surgerize anyone with a pulse, including Gleason 10, ECE/SVI on MRI, etc. Otherwise, the private guys have completely stopped doing surgeries. Several have told me the combination of SPACE OAR, fiducials, and lupron pays as much as a prostatectomy so they have 0 incentive to take people to the OR, especially when they've felt all along radiation is a better option for most patients.
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I tried very hard to get uro guys on board with fiducials, never took hold. SPACE OAR (pinches nose) reps need to re-visit my neck of woods. Also, I think it helps (re: prostate) to live in a region where the avg age older or more retirees.
 
Radonc90 said:
IIRC, in the 1990s, the state of Michigan had a law stating all breast ca pts to be seen by all 3 (surg, medonc and radonc) from the outset to minimize unnecessary mastectomy. I am not up-to-date with Michigan law though.

Breast ca received tons of publicity bc it should.

Prostate ca somehow does not get that much publicity.

Imagine if there is a law stating that all prostate ca pts to be seen by all 3: urology, medonc and radonc?
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Radonc90 said:
IIRC, in the 1990s, the state of Michigan had a law stating all breast ca pts to be seen by all 3 (surg, medonc and radonc) from the outset to minimize unnecessary mastectomy. I am not up-to-date with Michigan law though.

Breast ca received tons of publicity bc it should.

Prostate ca somehow does not get that much publicity.

Imagine if there is a law stating that all prostate ca pts to be seen by all 3: urology, medonc and radonc?
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breast surgeons have been so good about this - MDCs are incredibly common, and even expected at major centers. Breast centers provide better care then independent just doing whatever they want with retrospective tumor boards where nothing is learned.

how to get urologists to commit to this? I don’t know if there is a way. @DoctwoB - not to paint you all in same way - but there is a paternalistic mentality of the urologists I’ve worked with in multiple centers - academic, freestanding, and hospital based. Extremely hard for them to commit to sending each patient for RO evaluation. What do you think holds them back from this?
 
drewdog1973 said:
breast surgeons have been so good about this - MDCs are incredibly common, and even expected at major centers. Breast centers provide better care then independent just doing whatever they want with retrospective tumor boards where nothing is learned.

how to get urologists to commit to this? I don’t know if there is a way. @DoctwoB - not to paint you all in same way - but there is a paternalistic mentality of the urologists I’ve worked with in multiple centers - academic, freestanding, and hospital based. Extremely hard for them to commit to sending each patient for RO evaluation. What do you think holds them back from this?
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Unlike breast, surgery isn't part of the therapeutic modality in all patients
 
drewdog1973 said:
breast surgeons have been so good about this - MDCs are incredibly common, and even expected at major centers. Breast centers provide better care then independent just doing whatever they want with retrospective tumor boards where nothing is learned.

how to get urologists to commit to this? I don’t know if there is a way. @DoctwoB - not to paint you all in same way - but there is a paternalistic mentality of the urologists I’ve worked with in multiple centers - academic, freestanding, and hospital based. Extremely hard for them to commit to sending each patient for RO evaluation. What do you think holds them back from this?
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Honestly I think it’s a bit paternalistic to demand that all patients see specialists of all therapeutic modalities, though I agree with the multidisciplinary approach. I offer all my patients rad onc consultation both with a general radonc and a brachy specialist in my community. A majority of patients take me up on it. Some don’t. Some I place on AS and there’s no point to see them beyond the possibility of them being inappropriately recommended radical therapy. If they progress on AS they are again offered consultation. I’m a little more careful about who I send to the brachy guy as he would strongly recommend brachy to a rock if it had good insurance, though technically he is very good and I am a believer in brachy boost for high risk disease.

And to those have commented above yes it is wildly inappropriate IMO for patients to routinely be given non SOC options like primary Focal HIFU or cryo in a non trial setting and those who do should be named and shamed (though technically whole grand cryo is a guidelines based rec for intermediate risk disease, albeit not one I believe in or offer.)
 
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DoctwoB said:
Honestly I think it’s a bit paternalistic to demand that all patients see specialists of all therapeutic modalities, though I agree with the multidisciplinary approach. I offer all my patients rad onc consultation both with a general radonc and a brachy specialist in my community. A majority of patients take me up on it. Some don’t. Some I place on AS and there’s no point to see them beyond the possibility of them being inappropriately recommended radical therapy. If they progress on AS they are again offered consultation. I’m a little more careful about who I send to the brachy guy as he would strongly recommend brachy to a rock if it had good insurance, though technically he is very good and I am a believer in brachy boost for high risk disease.
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"I think it's a bit paternalistic to demand that all patients see specialists of all therapeutic modalities" from the one that sees them first ...

There ya go, fellas. The one that sees them first should be the one that decides. This urologist, from all their posts, is a very reasonable and thoughtful person and this is their "gut" reaction. How to even get to the less reasonable ones?

And remember, he did say "Honestly", so let's be clear that if the qualification isn't made, there may be dishonesty coming.
 
drewdog1973 said:
"I think it's a bit paternalistic to demand that all patients see specialists of all therapeutic modalities" from the one that sees them first ...

There ya go, fellas. The one that sees them first should be the one that decides. This urologist, from all their posts, is a very reasonable and thoughtful person and this is their "gut" reaction. How to even get to the less reasonable ones?

And remember, he did say "Honestly", so let's be clear that if the qualification isn't made, there may be dishonesty coming.
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So if I see a patient who doesn’t want to talk to a radonc what am I supposed to do, drag him there? Refuse to treat him?

Not even going to respond to the last paragraph because it doesn’t merit it.
 
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Every patient that comes to me that hasn't seen a urologic surgeon that can do modern surgery sees one. Almost everyone takes me up on it. Seeing the guy that does the biopsy isn't enough.
 
scarbrtj said:
I tried very hard to get uro guys on board with fiducials, never took hold. SPACE OAR (pinches nose) reps need to re-visit my neck of woods. Also, I think it helps (re: prostate) to live in a region where the avg age older or more retirees.
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Fiducials alone I think pay 200ish at best, so they aren't as excited about that, but throw on space + fiducials + frequent visits by hot spaceOAR rep and interest piques. In full disclosure, my personality meshes well with the bro surgeons so Im sure that contributes substantially to the referrals.
 
RickyScott said:
Is there any data on the use of xrt vs surgery in the VA system? I assume docs would be less motivated by Incentives?
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Haha. No data, but anecdotal. I did residency at a place that split us bt va and academic center. At va, vast, vast majority got rt. At academic center, they saw radonc for the first time for salvage.
 
Chief of Uro at my hospital still collected (March) speaker fees from Levitra (or one of them ED drugs sellers). He bragged how he sold stethoscope to his medschool classmates
 
medgator said:
Link? Have never seen AUA or ASTRO guidelines endorse cryo for even low risk disease in the upfront setting
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Once again, just playing devils advocate here. I don’t use or recommend cryo This is from Aua/Astro joint guidelines on localized prostate cancer

18. In select patients with intermediate-risk localized prostate cancer, clinicians may consider other treatment options such as cryosurgery. (Conditional Recommendation; Evidence Level: Grade C)

and more later on


Whole Gland Cryosurgery
50. Clinicians may consider whole gland cryosurgery in low- and intermediate-risk localized prostate cancer patients who are not suitable for either radical prostatectomy or radiotherapy due to comorbidities yet have >10 year life expectancy. (Expert Opinion)
51. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that cryosurgery has similar progression-free survival as did non-dose escalated external beam radiation (also given with neoadjuvant hormonal therapy) in low- and intermediate-risk disease, but conclusive comparison of cancer mortality is lacking. (Conditional Recommendation; Evidence Level: Grade C)
52. Defects from prior transurethral resection of the prostate are a relative contraindication for whole gland cryosurgery due to the increased risk of urethral sloughing. (Clinical Principle)
53. For whole gland cryosurgery treatment, clinicians should utilize a third or higher generation, argon-based cryosurgical system for whole gland cryosurgery treatment. (Clinical Principle)
54. Clinicians should inform localized prostate cancer patients considering cryosurgery that it is unclear whether or not concurrent ADT improves cancer control, though it can reduce prostate size to facilitate treatment. (Clinical Principle)
55. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that erectile dysfunction is an expected outcome. (Clinical Principle)
56. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery about the adverse events of urinary incontinence, irritative and obstructive urinary problems. (Strong Recommendation; Evidence Level: Grade B)

As opposed to HIFU which is appropriately dumped on.

HIFU and Focal Therapy
57. Clinicians should inform those localized prostate cancer patients considering focal therapy or HIFU that these treatment options lack robust evidence of efficacy. (Expert Opinion)
58. Clinicians should inform localized prostate cancer patients who are considering HIFU that even though HIFU is approved by the FDA for the destruction of prostate tissue, it is not approved explicitly for the treatment of prostate cancer (Expert Opinion).
59. Clinicians should advise localized prostate cancer patients considering HIFU that tumor location may influence oncologic outcome. Limiting apical treatment to minimize morbidity increases the risk of cancer persistence. (Moderate Recommendation; Evidence Level: Grade C)
60. As prostate cancer is often multifocal, clinicians should inform localized prostate cancer patients considering focal therapy that focal therapy may not be curative and that further treatment for prostate cancer may be necessary. (Expert Opinion)
OUTCOME EXPECTATIONS A
 
DoctwoB said:
Once again, just playing devils advocate here. I don’t use or recommend cryo This is from Aua/Astro joint guidelines on localized prostate cancer

18. In select patients with intermediate-risk localized prostate cancer, clinicians may consider other treatment options such as cryosurgery. (Conditional Recommendation; Evidence Level: Grade C)

and more later on


Whole Gland Cryosurgery
50. Clinicians may consider whole gland cryosurgery in low- and intermediate-risk localized prostate cancer patients who are not suitable for either radical prostatectomy or radiotherapy due to comorbidities yet have >10 year life expectancy. (Expert Opinion)
51. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that cryosurgery has similar progression-free survival as did non-dose escalated external beam radiation (also given with neoadjuvant hormonal therapy) in low- and intermediate-risk disease, but conclusive comparison of cancer mortality is lacking. (Conditional Recommendation; Evidence Level: Grade C)
52. Defects from prior transurethral resection of the prostate are a relative contraindication for whole gland cryosurgery due to the increased risk of urethral sloughing. (Clinical Principle)
53. For whole gland cryosurgery treatment, clinicians should utilize a third or higher generation, argon-based cryosurgical system for whole gland cryosurgery treatment. (Clinical Principle)
54. Clinicians should inform localized prostate cancer patients considering cryosurgery that it is unclear whether or not concurrent ADT improves cancer control, though it can reduce prostate size to facilitate treatment. (Clinical Principle)
55. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that erectile dysfunction is an expected outcome. (Clinical Principle)
56. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery about the adverse events of urinary incontinence, irritative and obstructive urinary problems. (Strong Recommendation; Evidence Level: Grade B)

As opposed to HIFU which is appropriately dumped on.

HIFU and Focal Therapy
57. Clinicians should inform those localized prostate cancer patients considering focal therapy or HIFU that these treatment options lack robust evidence of efficacy. (Expert Opinion)
58. Clinicians should inform localized prostate cancer patients who are considering HIFU that even though HIFU is approved by the FDA for the destruction of prostate tissue, it is not approved explicitly for the treatment of prostate cancer (Expert Opinion).
59. Clinicians should advise localized prostate cancer patients considering HIFU that tumor location may influence oncologic outcome. Limiting apical treatment to minimize morbidity increases the risk of cancer persistence. (Moderate Recommendation; Evidence Level: Grade C)
60. As prostate cancer is often multifocal, clinicians should inform localized prostate cancer patients considering focal therapy that focal therapy may not be curative and that further treatment for prostate cancer may be necessary. (Expert Opinion)
OUTCOME EXPECTATIONS A
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Level C and "expert opinion"? Really? The only level B evidence that's in the cryo section is regarding the morbidity. That's all you need to know about it lol

Care to tell us what RP and the radiation options are in those same guidelines?
 
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Ray D. Ayshun said:
Haha. No data, but anecdotal. I did residency at a place that split us bt va and academic center. At va, vast, vast majority got rt. At academic center, they saw radonc for the first time for salvage.
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My experience also.
 
Hard to mingle with referrings in Covid times. Looking forward for that to be over.

Reaganite said:
Fiducials alone I think pay 200ish at best, so they aren't as excited about that, but throw on space + fiducials + frequent visits by hot spaceOAR rep and interest piques. In full disclosure, my personality meshes well with the bro surgeons so Im sure that contributes substantially to the referrals.
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medgator said:
Level C and "expert opinion"? Really? The only level B evidence that's in the cryo section is regarding the morbidity. That's all you need to know about it lol

Care to tell us what RP and the radiation options are in those same guidelines?
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Hey they’re your guidelines too! (joint AUA /Astro).

Nothing unexpected. AS for all very low risk. AS “preferred” for all low risk but allows for exceptions. Favorable intermediate AS, RP, XRT, brachy monotherapy all options. Unfavorable intermediate or higher use ADT with XRT. Consider brachy boost in high risk. For high risk surgery or xrt with adt plus or minus brachy, emphasize multimodal care.
 
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RadOncDoc21 said:
My experience also.
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Ours was the opposite, majority RP. Probably partly because the urology residents were motivated to do cases and rad onc was paid by the hour and preferred to relax. Also our radoncs didn’t hypofx as of last year and good luck getting the veterans to 6 or 8 weeks of treatment, we had a huge cachment area and that was a non starter for a lot of our patients. It was hard enough getting them to the hospital once for RP.
 
DoctwoB said:
Hey they’re your guidelines too! (joint AUA /Astro).

Nothing unexpected. AS for all very low risk. AS “preferred” for all low risk but allows for exceptions. Favorable intermediate AS, XRT, brachy monotherapy all options. Unfavorable intermediate or higher use ADT with XRT. Consider brachy boost in high risk. For high risk surgery or xrt with adt plus or minus brachy, emphasize multimodal care.
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Hifu and cryo don't make it into NCCN afaik, but haven't checked lately. Either way cryo and hifu rank well below upfront surgery or xrt options
 
medgator said:
Hifu and cryo don't make it into NCCN afaik, but haven't checked lately. Either way cryo and hifu rank well below upfront surgery or xrt options
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Agreed. The only real role I see HIFU (and other focal therapies) playing in the future is in patients who currently get (or should get) AS if it can convincingly lower the risk of progression to active treatment with a low enough side effect profile to make it worth it.
 
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Gfunk6 said:
I didn't pay for the Annual ASTRO Zoom meeting, can I get the meeting on demand for $150 too? 🙂
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Pricing includes discounts for Annual Meeting attendees and residents:

  • Annual Meeting Attendee: $150
  • Non-attendee rates:
    • Member: $500
    • Nonmember: $850
    • Resident: $250
Pricing for ASTRO online content released. Yeah, I'm not paying $500 - thank you for playing.
 
Gfunk6 said:
Pricing includes discounts for Annual Meeting attendees and residents:

  • Annual Meeting Attendee: $150
  • Non-attendee rates:
    • Member: $500
    • Nonmember: $850
    • Resident: $250
Pricing for ASTRO online content released. Yeah, I'm not paying $500 - thank you for playing.
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Wow.
 
I was always glad they did that deodorant study, because if it hadn't confirmed it didn't matter then that meant their data was wrong. One way not to worry about aluminum in deodorant: do a radiation residency and attend a physics lecture where the Compton effect is discussed. And one way not to worry about the bolus effect: look at a patient's armpit before they're treated. If it's not lathered, no need to blather 'bout bolusing. Oh, and also: try to irradiate less armpit (looking at you high tangents).
 
Ray D. Ayshun said:
I think this should go in the thread about which specialties will contribute the most to the future of oncology.
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1607377337381.png


This field has gone to ****
 
scarbrtj said:
I was always glad they did that deodorant study, because if it hadn't confirmed it didn't matter then that meant their data was wrong. One way not to worry about aluminum in deodorant: do a radiation residency and attend a physics lecture where the Compton effect is discussed. And one way not to worry about the bolus effect: look at a patient's armpit before they're treated. If it's not lathered, no need to blather 'bout bolusing. Oh, and also: try to irradiate less armpit (looking at you high tangents).
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Using aluminum deodorant during treatment is fine... so long as you don’t use 15MV
GIF by Ghostbusters
 
Lamount said:
Using aluminum deodorant during treatment is fine... so long as you don’t use 15MV
GIF by Ghostbusters
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Don't worry, I'm releasing a new, all natural - "Dr Elementary's Borated Polyethylene Deodorant and Anti-Persperant" in 2021 for this reason.

15MV all day err'y day.
 
Wow I thought that was just a parody graphic when I first saw it on twitter. Didn't realize there was an actual article there, lol. Excellent piece, great work!

Will KO do the responsible thing and reduce his residency spots by 50%? Will Randall at UK with 4 clinical faculty and 6 residents cut the resident compliment down to 4? Lets hope so.
 
elementaryschooleconomics said:
I'm shocked, the article by "Graypeace" made it into today's Quadshot:

View attachment 324803

While we can guess the author(s) based on writing style/graphics I honestly have no idea, but I presume they're reading this post so - thank you.
Click to expand...
Whoever "they" is... they stole my graphics lol. I need to fire off an angry, litigious email.
 
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