Rad Onc Twitter

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jondunn said:
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Gu perspective on this.

In terms of cancer control, need to see more data. What was the local failure rate? Depending on their distribution of patients (included T1-T4 N0M0), a 4% distant met rate is either catastrophically bad (for T1) or quite good if we're talking about a lot of T3-4 patients. For T1 disease surgically we expect a <5% local recurrence rate and <1% distant recurrence rate.

The renal function data is quite concerning, however. They go from essentially 50/50 split function to 70/30, implying almost a 50% loss of function of the radiated kidney. Recent series of partial nephrectomies via eunucleation have a renal function loss of about 1mL of GFR and anecdotally I fine more ofthen then not my patients renal function improves after partial nephrectomy (presumably due to renal parenchymal compression from the tumor affecting adjacent renal function.). RCC and the adjacent parenchyma have 0 renal function, so significant loss of renal function tells you the rest of the kidney is getting significant dose.
 
DoctwoB said:
Gu perspective on this.

In terms of cancer control, need to see more data. What was the local failure rate? Depending on their distribution of patients (included T1-T4 N0M0), a 4% distant met rate is either catastrophically bad (for T1) or quite good if we're talking about a lot of T3-4 patients. For T1 disease surgically we expect a <5% local recurrence rate and <1% distant recurrence rate.

The renal function data is quite concerning, however. They go from essentially 50/50 split function to 70/30, implying almost a 50% loss of function of the radiated kidney. Recent series of partial nephrectomies via eunucleation have a renal function loss of about 1mL of GFR and anecdotally I fine more ofthen then not my patients renal function improves after partial nephrectomy (presumably due to renal parenchymal compression from the tumor affecting adjacent renal function.). RCC and the adjacent parenchyma have 0 renal function, so significant loss of renal function tells you the rest of the kidney is getting significant dose.
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For sure the rest of the kidney is getting significant dose. Nephrons are sensitive to radiation, so I would expect damage to the uninvolved kidney.

I seriously hope no one is saying SBRT is better than (or even equivalent to) nephrectomy for patients who are good surgical candidates, and I don't think that was what this was suggesting. I've only done SBRT to the kidney for renal cell ca for patients who were not good surgical candidates, or for whom the urologist said they would be put on dialysis by even a partial nephrectomy, given the anatomy/location/size of the tumor (one case). In that last case case, we are 3 years out with no local or distant recurrence and no dialysis.
 
Does anyone see dramatic radiographic regression of RCC with SBRT, or just stability?

My experience has been it just stops growing, but doesn't really shrink much.
 
Mandelin Rain said:
Does anyone see dramatic radiographic regression of RCC with SBRT, or just stability?

My experience has been it just stops growing, but doesn't really shrink much.
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I've seen some shrinkage (insert Seinfeld joke), but in general doesn't change much, similar to when metastatic renal cell ca gets SBRTd.
 
The more interesting debate will be SBRT vs. percutaneous ablation for renal tumors that are either too small to be worth operating on or in poor surgical candidates.

The pro for perc ablation is that it preserves surrounding renal function. The con is a higher local failure rate (~25%) that rises as the size of the mass increases above 3cm or with proximity to the hilum due to heat/cold sink effect. SBRT will likely give better control, be less dependent on size and anatomy, but with higher surrounding functional loss.
 
The Paul Wallnerus is here to help you!

3rnZmdk.png
 
OTN said:
I'm not impressed with academic centers which have price parity between protons and their (incredibly inflated) IMRT prices.
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Yes, this isn't really a thing worth talking about without actually saying how much a course of rt costs. It's like bragging about getting a car for 20% off after it was marked up 100%
 
RealSimulD said:
Of course, like always.

Interesting that people want to focus on stories from nearly 15 years ago, rather than on the words and data the man shares. It is very sad that the same people that shun him associate with such poor stewards of our field.
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$12 million is probably what a Mayo proton center calls, “a slow week”.
 
I have a clinical trial open right now that the NIH told me had too many Hispanic patients on it, and I had to decrease the number of Hispanic accruals to make it more in line with the US population.

True story.

For anyone curious, my accural is about 50% Hispanic. I think I'm biased in the wrong direction since my workplace zip code and my home zip code are both 90% Hispanic.
 
Neuronix said:
I have a clinical trial open right now that the NIH told me had too many Hispanic patients on it, and I had to decrease the number of Hispanic accruals to make it more in line with the US population.

True story.

For anyone curious, my accural is about 50% Hispanic. I think I'm biased in the wrong direction since my workplace zip code and my home zip code are both 90% Hispanic.
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Extra spicey biryani!
 
OTN said:
Oh awesome just what we were all asking for.
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The trial is destined to succeed.
patient convenience - check
plan acceptability - it looks like 2D-irradiation of bone mets...
workflow - (whatever that means) check, eliminate a step and the workflow is smoother
scalability - (whatever that means) why not?
 
Palex80 said:
The trial is destined to succeed.
patient convenience - check
plan acceptability - it looks like 2D-irradiation of bone mets...
workflow - (whatever that means) check, eliminate a step and the workflow is smoother
scalability - (whatever that means) why not?
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Instead of putting in a proton facility or MRgWhatever, what about another sim so your docs can actually get patients started in a timely manner without trying to pound a round diagnostic scan peg into a square treatment couch hole?
 
Palex80 said:
The trial is destined to succeed.
patient convenience - check
plan acceptability - it looks like 2D-irradiation of bone mets...
workflow - (whatever that means) check, eliminate a step and the workflow is smoother
scalability - (whatever that means) why not?
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you mean the trial is destined to not not fail. or is it, not fail? or not not not fail? i'm not up to date on designing trials to "prove" my point.
 
TheWallnerus said:


The greatest trick the PDs ever pulled was convincing the med students rad onc still existed as a good career choice

- "Kaiser" Soze
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To be fair, Kaiser has been posting jobs in socal and some on this forum mention they hire from their own program.

Prob not as bad as Dartmouth DEI med student grab or Steinberg trying to throw money at med students to get his dept matched
 
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Sure, but calling it spam makes you look silly. As someone else has said, this thread is basically this forum.
 
Palex80 said:
The trial is destined to succeed.
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I agree. The question is how do we establish the evidence base for safety? Or safety culture?

Could you imagine airlines doing trials regarding reducing redundancy on outcomes? They'd likely find 1 event in 1 million flights saved by certain redundancies. Of course, I like that they're there, and the air travel industry has a strong safety culture.

We might as well do a trial of mid-plane calc vs 3D for all single fraction palliative cases. We know what the answer will be.
 
jondunn said:
Sure, but calling it spam makes you look silly. As someone else has said, this thread is basically this forum.
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Says the guy who drive by posts every random tweet he can find. Pretty useless imo, esp when you provide 0 commentary regarding many of them
 
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I strongly feel that random posting of twitter posts with no discussion hurts this forum. I’ve said it before. It’s getting out of hand.

It’s not just in this sub. It’s happening in multiple threads.
 
SubserviantToABR said:
If I needed H&N treatment, I only want Nancy Lee to contour my parotids. It is a difficult structure to delineate in the community, duh!
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Wow, quite the...interesting Tweet from Erin on that one.

It's important to leave things up to the experts on complicated T1N1 nasopharynx cases, they're basically artists:

1652491056306.png
 
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