Rad Onc Twitter

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The locoregional failure rates in 1106 were similar BUT 2 year locoregional control and 2 year in field control were both numerically better although “not significant” in study with barely over 100 pts. No increased toxicities with isotoxic dose escalation or detriment to control. Study was prepacific so no IO.

i would be interested in seeing a study with appropriate power in the PACIFIC era evaluating this question. “Lymphocyte” hypothesis is nonsense here IMO in regards to the interpretation of 0617.


60/15 might not be better than 60/30 even with chemo, but it is a great regimen I use quite often with great results
 
thecarbonionangle said:
The locoregional failure rates in 1106 were similar BUT 2 year locoregional control and 2 year in field control were both numerically better although “not significant” in study with barely over 100 pts. No increased toxicities with isotoxic dose escalation or detriment to control. Study was prepacific so no IO.

i would be interested in seeing a study with appropriate power in the PACIFIC era evaluating this question. “Lymphocyte” hypothesis is nonsense here IMO in regards to the interpretation of 0617.


60/15 might not be better than 60/30 even with chemo, but it is a great regimen I use quite often with great results
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I use 15 fraction too.

But yeah point is dose escalation has not been shown to work in large field RT in NSCLC. We of course keep trying that same thing over and over and over again (see esophagus and GBM too!)

Some of you will of course ignore and drag patients stage III patients for one extra OTV and give 70
 
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jondunn said:
I use 15 fraction too.

But yeah point is dose escalation has not been shown to work in large field RT in NSCLC. We of course keep trying that same thing over and over and over again (see esophagus and GBM too!)

Some of you will of course ignore and drag patients stage III patients for one extra OTV and give 70
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Most people weren't doing 60 or 74 before 0617 and i doubt it has changed a lot of minds after despite your soapbox. Meanwhile Sclc going in the other direction.

You giving your small cell patients more dose with cis than you are your nsclc with carbo taxol?
 
Palex80 said:
So, 74 Gy destroy it „more“ than 60 Gy?
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Perhaps. With central tumors, you are hitting some big vessels every day… likely hitting a lot of circulating lymphocytes. we know that decrease of lymphocyte to neutralophil ratio (pre and post tx) is prognostic.. and I believe there are data showing this has a dose response (manuscript showing this is on my work computer and I don’t have the citation).
 
medgator said:
Most people weren't doing 60 or 74 before 0617 and i doubt it has changed a lot of minds after despite your soapbox. Meanwhile Sclc going in the other direction.

You giving your small cell patients more dose with cis than you are your nsclc with carbo taxol?
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There was a lot of hope that higher dose would be better than 60 Gy… and people were considering escalating based on PET. I think 0617 didn’t so much change practice as it prevented practice from changing
 
medgator said:
Most people weren't doing 60 or 74 before 0617 and i doubt it has changed a lot of minds after despite your soapbox. Meanwhile Sclc going in the other direction.

You giving your small cell patients more dose with cis than you are your nsclc with carbo taxol?
Click to expand...

60 is the standard of care. There’s no hint of improvement in multiple randomized trials.

I see no reason to go higher, right now

Of course as rad onc does we will continue to try to dose escalate. The current proposed trials involve SBRT boost to the primary. Will see what these show
 
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0617 showed that the there was increased mortality associated with higher dose to the heart and that imrt lowers that dose. 74 gy may very well be better if you can control oar doses better. We know that a bed > 100 is preferred to ablate lung cancers, so higher dose should be more effective theoretically.

60 gy is what I use for concurrent nsclc lung but I wouldn't fault anyone for using 66.
 
jondunn said:
60 is the standard of care. There’s no hint of improvement in multiple randomized trials.

I see no reason to go higher, right now

Of course as rad onc does we will continue to try to dose escalate. The current proposed trials involve SBRT boost to the primary. Will see what these show
Click to expand...
60-66 has been used in multiple swog, calgb and rtog trials and imo any of those doses are SOC. NCCN still endorses 60-70. .

The QD arms of the small cell trials are 70/35, thought i wouldn't fault anyone for doing 60-66 if pt can't come in for bid tx.

See that's the thing, JD, you only see black and white, while IRL most of us realize things are often shades of gray
 
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medgator said:
60-66 has been used in multiple swog, calgb and rtog trials and imo any of those doses are SOC. NCCN still endorses 60-70. .

The QD arms of the small cell trials are 70/35, thought i wouldn't fault anyone for doing 60-66 if pt can't come in for bid tx.

See that's the thing, JD, you only see black and white, while IRL most of us realize things are often shades of gray
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T1a squamous cell? 60 Gy
T3 adeno? 60 Gy

Looks fine to me.

JD, you can do an SIB to 64.8 in 30 and not have to bill that extra evil 77427 and get the same BED as 66. I do it all the time. Leave the N2 nodes at 60. Works great.
 
Moonbeams said:
T1a squamous cell? 60 Gy
T3 adeno? 60 Gy

Looks fine to me.

JD, you can do an SIB to 64.8 in 30 and not have to bill that extra evil 77427 and get the same BED as 66. I do it all the time. Leave the N2 nodes at 60. Works great.
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7 77427's
I'm in heaven
 
just more data that adds to the story for primary treatment in selected metastatic patients. good news for any local therapy guy/gal.
 
DoctwoB said:
Presumably yes. Can’t vouch for the data personally. And honestly that’s part of why this hasn’t been bigger news, rightly or wrongly trials out of China/other questions aren’t viewed the same as US or European studies.
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Academic fraud in China is a big problem, so I also view results from there skeptically
 
grenz said:
Academic fraud in China is a big problem, so I also view results from there skeptically
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Reasonable unfortunately, you don't have to look far to find articles like this. China’s research-misconduct rules target ‘paper mills’ that churn out fake studies

This data seems in line with what I'd expect, however, based on prior retrospective data, a prospective non-randomized trial out of Belgium with similar results, and just extrapolating from STAMPEDE. A SWOG trial is looking at this currently, not sure when results are expected though.
 
medgator said:
The look of a guy who hates catsup as much he hates belts

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When you have a very trim waist, you tailor your pants. When you tailor your pants, technically you don’t need a belt. #NotASprattApologist

www.wsj.com

Do Guys Still Need to Wear a Belt With a Suit?

As fashion sours on the cinched look, some suit wearers reject belts as unnecessary and visually distracting, while others strongly disagree. Where do you stand?
www.wsj.com www.wsj.com
 
forums.studentdoctor.net

Pathology vs RadOnc

Would you advise a medical student to go into path or radonc? An interesting discussion, considering radonc's history and its current implosion. Here's a funny conversation I saw on their form: Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with...
forums.studentdoctor.net forums.studentdoctor.net

Funny the impact jokes here have, though lol certainly I think we are still much better field than path, money wise at least.
 
jondunn said:
forums.studentdoctor.net

Pathology vs RadOnc

Would you advise a medical student to go into path or radonc? An interesting discussion, considering radonc's history and its current implosion. Here's a funny conversation I saw on their form: Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with...
forums.studentdoctor.net forums.studentdoctor.net

Funny the impact jokes here have, though lol certainly I think we are still much better field than path, money wise at least.
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What do you think the chances that radiation oncology will experience a catastrophic black swan event within 30 years where 50%+ of jobs are eliminated?
Geographic limitations and existential risk may weigh in on their preference?

 
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certainly -just talking about one thing, not other things.
 
Also think that the post over there about how we have train wreck patients is false

One of the reasons (well multiple) that rad onc burnout is so low (and why we continue to work forever) is that our patient population is generally grateful and nice to work with.
 
RickyScott said:
What do you think the chances that radiation oncology will experience a catastrophic black swan event within 30 years where 50%+ of jobs are eliminated?
Geographic limitations and existential risk may weigh in on their preference?

Click to expand...

Exciting developments in unirradiation oncology
 
jondunn said:
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Plagiarism is unethical... "onward and upward" is the Charles Thomas catchphrase of catchphrases 😉

qDQMKJz.png
 
CaesarRO said:
I think the dostarlimab data in locally advanced rectal cancer suggests that we may have been wrong assuming immunotherapy was like chemotherapy. It certainly seems like immunotherapy may have more ablative potential than previously realized. I don't think it's unreasonable to propose ways that radiation as done in the RT-alone era may impede the IO and work towards testing models of IO+RT that are complementary.

As new data comes in, it's worthwhile updating your prior assumptions.
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Is this trial testing the most selected patient population in an immunotherapy trial ever?

Immunotherapy works SUPER well in many trials, like, 10-20% of the time 🙂
 
DS should be commended for publishing this. It certainly cannot be easy to publish disastrous results (cystectomy). Criticism of studies is expected especially if controversial, so he should not be surprised. I guess i would encourage Clive to try to stick his neck out and do a trial himself.

We need more people like this to try to advance the field. Bob T “killed” some people to figure out some lung SBRT.
 
thecarbonionangle said:
DS should be commended for publishing this. It certainly cannot be easy to publish disastrous results (cystectomy). Criticism of studies is expected especially if controversial, so he should not be surprised. I guess i would encourage Clive to try to stick his neck out and do a trial himself.

We need more people like this to try to advance the field. Bob T “killed” some people to figure out some lung SBRT.
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Agreed, these are the trials fields need. I'm sure irradiating the rectum prior to APR was highly controversial, I mean think about the anastomotic complications! Bummer about the outcomes, but kudos for designing and running the trial.
 
DoctwoB said:
Agreed, these are the trials fields need. I'm sure irradiating the rectum prior to APR was highly controversial, I mean think about the anastomotic complications! Bummer about the outcomes, but kudos for designing and running the trial.
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I just don't know here. I think there are multiple trials that show the toxicity of combined surgery and severe neoadjuvant hypofractionation in prostate is not good. And, what is the theoretical benefit? At some point we always max out the benefit of local therapy. This seems to be along the lines of (can we do this)?

Has anyone ever done the much more reasonable trial of neoadjuvant regional nodal radiation to 45-50 Gy then prostatectomy in the very high risk cohort?
 
communitydoc13 said:
I just don't know here. I think there are multiple trials that show the toxicity of combined surgery and severe neoadjuvant hypofractionation in prostate is not good. And, what is the theoretical benefit? At some point we always max out the benefit of local therapy. This seems to be along the lines of (can we do this)?

Has anyone ever done the much more reasonable trial of neoadjuvant regional nodal radiation to 45-50 Gy then prostatectomy in the very high risk cohort?
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Did not include nodes in this study.

pubmed.ncbi.nlm.nih.gov

Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer - PubMed

Neoadjuvant RT is feasible with moderate urinary morbidity. However, oncologic outcomes do not seem to be substantially different from those with selective postoperative RT. If this multimodal approach is further evaluated in a phase 2 setting, 54 Gy should be used in combination with...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Bigger issue is that no one wants to do preop (because is screws you on the backend if salvage XRT is needed)
 
thecarbonionangle said:
DS should be commended for publishing this. It certainly cannot be easy to publish disastrous results (cystectomy). Criticism of studies is expected especially if controversial, so he should not be surprised. I guess i would encourage Clive to try to stick his neck out and do a trial himself.

We need more people like this to try to advance the field. Bob T “killed” some people to figure out some lung SBRT.
Click to expand...
I agree. This is very important to publish.
I think we have a problem that academic institutions are financially motivated to 5 fraction everything just like rural community centers are motivated to 30-44 fraction everything
The difference is that at least we know standard fractionation is safe
Consent for phase 1-2 trials is extremely important. (Not trying to imply it was not appropriately obtained). Patient just has to know what they might be signing up for
 
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