Rad Onc Twitter

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BobbyHeenan said:
“Cost effective” comparison of 15 3D vs 3 proton.

?no 5 fraction IMRT? Which has more data than any proton course.

This has got to be a ploy for get your breast cancer treated in Rochester in a week with protons, no?

I just can’t imagine it’s in any way better than Livi 30/5 (or even 26/5) except for maybe some tiny sliver of patients.

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What course of proton beam irradiation only costs $4-5k???

medgator said:
"Psuedo" brachy with protons. More like pseudoscience

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Proton Shills gonna Proton Shill.... literally a conference for grifters, by grifters.
 
Bequerel said:
I always figured Brachy would go the way of the dinosaurs by then of my career. Never thought radiotherapy for early stage luminal a breast cancer could go extinct first!
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If/when bundled payments (RIP APM) come around... brachy will probably rise from the ashes
 
RickyScott said:
Made wallnerus can fill us in, but I believe upen was charging over 10k a fraction to some insurers?
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2022-06-30 14_37_09-Simul Parikh on Twitter_ _Protons self pay_ $16k_fx in mid-Atlantic, $9k_f...png


Up to $25K/fx they're getting paid from their best insurance payor
 
medgator said:
"Resectable" stage III nsclc is in the eye of the beholder... It's like pornography or something like that
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Problem is that it may not matter whether one is "resectable" or not if medonc get their hands on it first and CT surgery hedges

That's where we lose
 
metallica81788 said:
Problem is that it may not matter whether one is "resectable" or not if medonc get their hands on it first and CT surgery hedges

That's where we lose
Click to expand...

Now (or I guess until recently):
Med Onc: "Patient going to need a pneumonectomy, ok screw it let's just do chemoRT + Durva"
2 months later: "Great, no pneumonitis, let's get em on Durva"

Future:
Med Oncs: "Patient going to need a pneumonectomy, well we'll try to make it resectable with chemo/immuno!"
2 months later: "Aw shucks, it's still not resectable! Well, should be safe to do chemoRT, right??"
2 months later: "Man RO, patient really had a rough go of chemoRT. Lot of pneumonitis. Man, RT is really rough, isn't it! Can't give Durva with this bad pneumonitis, man what the hell!"

2 months of extra treatment that leads to withholding of the thing actually proven to improve OS. Not pCR, not EFS. OS.

Attention all Med Oncs: NEOADJUVANT CHEMO/IMMUNO IS NOT MEANT TO MAKE UNRESECTABLE THINGS RESECTABLE. IF YOU WOULDN'T GIVE THEM NEOADJUVANT CHEMO IN THE PRESENT THEY SHOULD NOT GET CHEMO/IMMUNO IN THE FUTURE.
 
evilbooyaa said:
Perhaps Mayo is one of those places that does proton = IMRT reimbursement, like Maryland? But still, 5k for 3 proton fractions seems... really cheap doesn't it? Like even 5k for 15 FX photon WBI seems really low?
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Most of their patients being treated for breast are still getting typical fractionated schemes. The 3 fraction treatment must be a specific protocol
 
Is this “unaffordable “ because the salary you have to pay a doc to supervise non remotely is prohibitive? Because the price the patient pays is the same whether the doc is in the building or not.

I have mixed feelings about supervision requirements.

 
BobbyHeenan said:
Is this “unaffordable “ because the salary you have to pay a doc to supervise non remotely is prohibitive? Because the price the patient pays is the same whether the doc is in the building or not.

I have mixed feelings about supervision requirements.

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Pay should be the same regardless of whether you are sitting there watching youtube or 60 miles away by phone. If you're doing all the treatment plans, OTVs, image review, etc. for the whole practice, it's a cop out to say you are 0.8 FTE and we are just going to pocket 20% of what we would otherwise pay you for each day you are not on site and only available by phone.
 
OTN said:
Oh, sure, I get it. Hard things are hard. That's why we've been overrun with "non-inferiority" trials over the last decade. I'd just like for academia to start to do some heavy lifting.
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What do you think 3 fractions partial breast protons is? In lung, paradigm changing radoncs like Percy lee are exploring single fraction sbrt on an mri linac!
 
Moonbeams said:
Pay should be the same regardless of whether you are sitting there watching youtube or 60 miles away by phone. If you're doing all the treatment plans, OTVs, image review, etc. for the whole practice, it's a cop out to say you are 0.8 FTE and we are just going to pocket 20% of what we would otherwise pay you for each day you are not on site and only available by phone.
Click to expand...

I agree but your run of the mill bean counter admin may not.
 
Moonbeams said:
Pay should be the same regardless of whether you are sitting there watching youtube or 60 miles away by phone. If you're doing all the treatment plans, OTVs, image review, etc. for the whole practice, it's a cop out to say you are 0.8 FTE and we are just going to pocket 20% of what we would otherwise pay you for each day you are not on site and only available by phone.
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I warned you! You’re on the admin’s hit list now.
 
TheWallnerus said:
Lauren Henke is doing single fraction MRgRT breast

Guess what

No sign it doesn’t work
Click to expand...
TheWallnerus said:
Lauren Henke is doing single fraction MRgRT breast

Guess what

No sign it doesn’t work
Click to expand...
In the vast majority of these low risk cases an adjuvant firm talking to post lumpectomy will get the cancer gone for good so why not
 
TheWallnerus said:
Lauren Henke is doing single fraction MRgRT breast

Guess what

No sign it doesn’t work
Click to expand...

Yep. And then you take off the last fraction and there’s no difference there either.

THEN, 10 years from now, someone does 0 vs 25 fractions for breast and finds a huge benefit to 25 fractions.

When you step down a couple fractions at a time, you find no significant difference, but when you add them all up, it’ll become obvious.
 


Shankar Siva is certainly a great researcher. However, I have doubts about the conclusions drawn in this recent article.

Basically, this is an analysis of patients undergoing SABR for oligometastatic disease in a single insitution.
The two points raised are that:
- medical operability does not impact survival
- treating all mets is better than not treating all mets with SABR in terms of PFS and OS

Now, the first point is certainly interesting. I will not get into it.

The second point however is debateable, in my opinion. This is based on a comparison of 333 patients that had "total" treatment (treating all active mets with SABR) versus 68 patients that had only "partial" treatment (not treating all active mets with SABR, but only some).

The issue is however, that 65% of the entire patient cohort had only 1 active metastasis.
So, when comparing the two groups of "total" vs. "partial" treatment, what the authors are doing is actually comparing the "total" group which is made up in 78% by patients who have only 1 metastasis (since all the patients with 1 metastasis have to be in the "total" group; if the patient has one metastasis and you SABR that metastasis, you have SABRed all metastases in that patient) with the "partial" group that is made up by patients with more than one metastases...
Is that a fair comparison?
Does that really tell you that it's better to give SABR to all sites of active disease in patients with more than 1 metastasis?
Or does it merely tell you that patients with 1 metastasis have a better survival than those with more than 1 metastasis?

What would be necessary to show the point that treating all metastatic sites with SABR would have been two groups of patients, balanced in terms of number of metastases (which obviously need to be more than 1), histology, PS, age, treatment indication etc... Then, you would need an analysis to show if SABRing all versus not all metastases changes outcomes.
 
Palex80 said:


Shankar Siva is certainly a great researcher. However, I have doubts about the conclusions drawn in this recent article.

Basically, this is an analysis of patients undergoing SABR for oligometastatic disease in a single insitution.
The two points raised are that:
- medical operability does not impact survival
- treating all mets is better than not treating all mets with SABR in terms of PFS and OS

Now, the first point is certainly interesting. I will not get into it.

The second point however is debateable, in my opinion. This is based on a comparison of 333 patients that had "total" treatment (treating all active mets with SABR) versus 68 patients that had only "partial" treatment (not treating all active mets with SABR, but only some).

The issue is however, that 65% of the entire patient cohort had only 1 active metastasis.
So, when comparing the two groups of "total" vs. "partial" treatment, what the authors are doing is actually comparing the "total" group which is made up in 78% by patients who have only 1 metastasis (since all the patients with 1 metastasis have to be in the "total" group; if the patient has one metastasis and you SABR that metastasis, you have SABRed all metastases in that patient) with the "partial" group that is made up by patients with more than one metastases...
Is that a fair comparison?
Does that really tell you that it's better to give SABR to all sites of active disease in patients with more than 1 metastasis?
Or does it merely tell you that patients with 1 metastasis have a better survival than those with more than 1 metastasis?

What would be necessary to show the point that treating all metastatic sites with SABR would have been two groups of patients, balanced in terms of number of metastases (which obviously need to be more than 1), histology, PS, age, treatment indication etc... Then, you would need an analysis to show if SABRing all versus not all metastases changes outcomes.
Click to expand...

I think Matthias Guckenberg tweeted outcomes and conclusions somewhat similar to this recently. It’s very easy to draw false conclusions when you have preconceived notions and retrospective data can be massaged to prove those notions.
 
RickyScott said:
Retrospective data is more often wrong than correct in subsequent trials.
Click to expand...
It is striking that this rather obvious issue was not raised though in the discussion part of the article.
If you read the last paragraph where all the limitations are listed, they speak about the retrospective data, systemic treatment, different histologies, blablabla, but do not raise this very obvious issue!
It's a shame that this issue was not picked up the reviewers...
 
Palex80 said:
It is striking that this rather obvious issue was not raised though in the discussion part of the article.
If you read the last paragraph where all the limitations are listed, they speak about the retrospective data, systemic treatment, different histologies, blablabla, but do not raise this very obvious issue!
It's a shame that this issue was not picked up the reviewers...
Click to expand...
It is not even 50% ie it is more likely to predict the opposite.(probably because the person involved had an agenda)
 
RickyScott said:
It is not even 50% ie it is more likely to predict the opposite.(probably because the person involved had an agenda)
Click to expand...
Haha. If you look at the sensitivity and specificity of PSMA and the pretest likelihoods in some situations (ie, PSMA shows an axillary node in a high intermediate risk prostate cancer), the positive PSMA actually means the clinical reality is that of a negative test (because the PPV is so low). But I digress.
 
Gfunk6 said:
Live by the beam . . . die by the beam
Click to expand...
Perhaps eventually we'll have a Match for RadOnc residents trying to get a coveted academic satellite job, 4 clinic days and an "academic day" for $300k, q3week call, 45 minutes from main campus.

Future Red Journal articles will include virtue signaling pieces discouraging Chairs from pre-match communication with PGY5s who have interviewed for jobs like the "MD Anderson Cancer Center at Flint, Michigan" satellite gig.
 
Since "academic" places like Northwell aren't adjusting and still continue to take folks in the SOAP, what are your thoughts on "blacklisting" programs that SOAP and not hiring ANY residents from those programs? Those in hiring positions (medical directors, partners, etc.) would have to be vocal and take a stand to make it known to students that it isn't worth going to those programs for that reason alone.
 
OpusRadoncum said:
Since "academic" places like Northwell aren't adjusting and still continue to take folks in the SOAP, what are your thoughts on "blacklisting" programs that SOAP and not hiring ANY residents from those programs? Those in hiring positions (medical directors, partners, etc.) would have to be vocal and take a stand to make it known to students that it isn't worth going to those programs for that reason alone.
Click to expand...
great idea. Many more spots than us mds, so really no reason to pick one of these programs. If the medstudent has to be in a certain program due to location, they are in the wrong the field.
 
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