Rad Onc Twitter

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fiji128 said:
This job is located in Elkins, WV, which is probably about one hour’s drive to the closest interstate. I would say that pay is low for such a super isolated location.
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Elkins! Called it

Very pretty. Have spent a weekend there. Good Rafting not far away.

Far from civilization. Suboptimal for those that are seeking multiculturalism/biryani.
 
RealSimulD said:
Elkins! Called it

Very pretty. Have spent a weekend there. Good Rafting not far away.

Far from civilization. Suboptimal for those that are seeking multiculturalism/biryani.
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You don’t really need a radiation therapy center in Elkins if most of rad onc can transition to 1 to 5 fractions… and/or, there won’t be a radiation therapy center in Elkins if most of rad onc can transition to 1 to 5 fractions. One of the best ways to keep a place like this viable is for remote rad onc supervision to become a permanent thing, Mr. Pandemic-is-Over President. AFAIK most solo rad oncs still must quarantine if COVID positive.
 
Fpg1245 said:
Speaking of Preoppanc…is anyone referring for this? We tried something similar when I was a resident but never really happened. Folfirinox seems to be the king
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It seems to me that the only pathway is to be consulted at the time of initial diagnosis, proceed with either FOFIRNOX or Gem/Abraxane and then insert yourself using PREOPANC or an alternative chemoRT prior to surgery. Although a bit dodgy, this scenario is still plausible if there is no pushback from either surgery or medical oncology. I can't imagine that a 3 week regimen of PREOPANC would be harmful from delaying surgery, immunosuppression or reducing/delaying chemotherapy.

The only downside to PREOPANC that I see is that similar to the CROSS esophageal regimen, PREOPANC dosing might be suboptimal if the patient never makes it to surgery. However it sounds like some on this board are suggesting 0 Gy instead...
 
theradiator said:
It seems to me that the only pathway is to be consulted at the time of initial diagnosis, proceed with either FOFIRNOX or Gem/Abraxane and then insert yourself using PREOPANC or an alternative chemoRT prior to surgery. Although a bit dodgy, this scenario is still plausible if there is no pushback from either surgery or medical oncology. I can't imagine that a 3 week regimen of PREOPANC would be harmful from delaying surgery, immunosuppression or reducing/delaying chemotherapy.

The only downside to PREOPANC that I see is that similar to the CROSS esophageal regimen, PREOPANC dosing might be suboptimal if the patient never makes it to surgery. However it sounds like some on this board are suggesting 0 Gy instead...
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Giving 3 weeks of RT to the guts of a group of normal patients would decrease their long term survival (just ask Ralph W eg). If the patients had a pathology that irradiation would help, in terms of survival, this survival decreasing aspect of radiotherapy would be “outshone.” I am just not sure radiotherapy directed at pancreas cancer improves survival, so you have to at least countenance two sided outcome possibilities. “It wouldn’t hurt” is a rationale for irradiating whose irrationality is correlated with the proposed radiotherapy dose, imho.
 
theradiator said:
or dose reduction

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might be something to this
theradiator said:
The only downside to PREOPANC that I see is that similar to the CROSS esophageal regimen
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Are we establishing a track record of SBRT prior to surgery not being helpful for meaningful clinical outcomes? (pancreas, prostate, probably lung next). This doesn't mean that there isn't a pCR benefit. Even in pancreas, there is probably a small pCR benefit, but clearly no evidence for improved survival outcomes.

When surgery is performed for many cancers, is it likely that there is some relatively low dose regimen that is optimal for improving long term outcomes? Palex's 50 Gy tumor? Radical.
 
TheWallnerus said:
Acceptance… the final stage of grief
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I love SDN and learn all the time from this forum. Isn't our field in a precarious enough situation that we need to try to fight for our indications that are at least supported by randomized data showing improved overall survival? Although not a huge patient population, pancreas is an example of this. I understand that this is based on principle - and maybe a slightly selective reading of existing randomized trials - rather than the real world school of hard knocks. It may also speak to the notion that if the radiation oncologist has established enough credibility locally that the patients will come? That the radiation oncologist is willing and able to see the patient at the time of diagnosis in the hospital maybe even before medical oncology? Maybe the radiation oncologist actually has equal or more stature than a junior surgeon or interventional gastroenterologist who is also fighting for market share? Lots to unpack here but let me state that SDN has that fighting spirit because I have seen it.
 
fiji128 said:
This job is located in Elkins, WV, which is probably about one hour’s drive to the closest interstate. I would say that pay is low for such a super isolated location.
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Entirely depends on workload... I did not see that referenced. I'm guessing not real busy.
 
theradiator said:
I love SDN and learn all the time from this forum. Isn't our field in a precarious enough situation that we need to try to fight for our indications that are at least supported by randomized data showing improved overall survival? Although not a huge patient population, pancreas is an example of this.
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There is no overall survival linked to radiation therapy in the treatment of pancreatic cancer.
 
Before we through in the towel, we have these 2 randomized trials that have chemotherapy in the control arm and chemoRT in the experimental arm with improved overall survival. Trust me, I am aware of all of the arguments against RT and other negative trials but data is data. I guess we are the field that had the "Believers" and "Non-believers" trial.

Gemcitabine Alone Versus Gemcitabine Plus Radiotherapy in Patients With Locally Advanced Pancreatic Cancer: An Eastern Cooperative Oncology Group Trial - PMC

The purpose of this trial was to evaluate the role of radiation therapy with concurrent gemcitabine (GEM) compared with GEM alone in patients with localized unresectable pancreatic cancer. Patients with localized unresectable adenocarcinoma of the ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov

Neoadjuvant Chemoradiotherapy Versus Upfront Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Long-Term Results of the Dutch Randomized PREOPANC Trial - PubMed

Neoadjuvant gemcitabine-based chemoradiotherapy followed by surgery and adjuvant gemcitabine improves OS compared with upfront surgery and adjuvant gemcitabine in resectable and borderline resectable pancreatic cancer.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
Thanks to all my radbio training I basically understand how radiation works to kill cancer cells. Not sure why transformed pancreatic parenchyma would be immune. Maybe we're mostly doing it wrong, and have a couple times done it right. Thanks to my radbio training I also understand the therapeutic ratio. There's gotta be a simple way of shifting that. If our goal is to treat preoperatively, perhaps we now have permission to obsess a little less about hitting what's going on the bucket.
 
theradiator said:
Before we through in the towel, we have these 2 randomized trials that have chemotherapy in the control arm and chemoRT in the experimental arm with improved overall survival. Trust me, I am aware of all of the arguments against RT and other negative trials but data is data. I guess we are the field that had the "Believers" and "Non-believers" trial.

Gemcitabine Alone Versus Gemcitabine Plus Radiotherapy in Patients With Locally Advanced Pancreatic Cancer: An Eastern Cooperative Oncology Group Trial - PMC

The purpose of this trial was to evaluate the role of radiation therapy with concurrent gemcitabine (GEM) compared with GEM alone in patients with localized unresectable pancreatic cancer. Patients with localized unresectable adenocarcinoma of the ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov

Neoadjuvant Chemoradiotherapy Versus Upfront Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Long-Term Results of the Dutch Randomized PREOPANC Trial - PubMed

Neoadjuvant gemcitabine-based chemoradiotherapy followed by surgery and adjuvant gemcitabine improves OS compared with upfront surgery and adjuvant gemcitabine in resectable and borderline resectable pancreatic cancer.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
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First trial is a small Phase II
Second trial utilized an outdated treatment paradigm as the standard arm.

But I see your point.
 
Ray D. Ayshun said:
Thanks to all my radbio training I basically understand how radiation works to kill cancer cells. Not sure why transformed pancreatic parenchyma would be immune. Maybe we're mostly doing it wrong, and have a couple times done it right. Thanks to my radbio training I also understand the therapeutic ratio. There's gotta be a simple way of shifting that. If our goal is to treat preoperatively, perhaps we now have permission to obsess a little less about hitting what's going on the bucket.
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I am not sure we truly have a great grasp of how radiation kills cancer cells in vivo. For example in a nude mouse, I believe it takes double the dose to kill a tumor.
 
Ray D. Ayshun said:
Thanks to all my radbio training I basically understand how radiation works to kill cancer cells. Not sure why transformed pancreatic parenchyma would be immune. Maybe we're mostly doing it wrong, and have a couple times done it right. Thanks to my radbio training I also understand the therapeutic ratio. There's gotta be a simple way of shifting that. If our goal is to treat preoperatively, perhaps we now have permission to obsess a little less about hitting what's going on the bucket.
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You lost me after the first 6 words.
 
Thanks for mentioning therapeutic ratio. The backbone for pancreas has to be FOLFIRINOX nowadays, so how do you add radiation in a way that doesn't increase toxicity?

We really can and do hurt people with 50 Gy to the stomach and duodenum (I've had patients needing emergency surgery for bleeding ulcers post RT), and yet we know that 50 Gy doesn't cure grossly visible adenocarcinomas. Also our integral doses to marrow and spleen are not trivial for causing cytopenias.

It seems to me that SBRT or protons, avoiding any mucosa surfaces, are probably about it, and we can forget about treating any lymph nodes for sure.
 
Ray D. Ayshun said:
Iow, can radiation really never kill pancreatic cancer?
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I am sorry, it was indeed not nice of me. I apologize.

I think why our RT approaches to pancreatic cancer have not managed to make RT an established component of multidisciplinary treatment do not have much to do with radiation biology, we won‘t find any answers there. It‘s not that we can‘t kill pancreatic cancer with RT. If you look at pCR rates of trials using SBRT in the neoadjuvant setting, the figures are not that bad and sometimes higher to those seen for instance with standard 5 weeks of CRT for rectal cancer, where RT is a standard component, still.

The problem is rather tumor biology, early metastatic affinity, a surgical procedure (as standard of care local treatment) with high morbidity and location of diease.
Pancreatic cancer seems not to be responding to IO (and we now know that some of the effects of RT can also come from activation of the immune system, so that pathway also won‘t help). It also does not respond yet to targetted agents (with the few exceptions of BRCA-mutant pancreatic cancer), so systemic control is limited in a disease that spreads early and in various ways (lymphatics, blood, peritoneal). Whipple procedures cause morbidity, meaning that we lose patients to complications (think not only the immediate periooperative period, but also the fistulas, dumping, cachexia and possible detrimental effects to the immune system - all big surgical procedures do that) and many patients are in bad shape to tolerate adjuvant treatment. Location of disease means that there is an abundance of blood and lympatic vessels for the tumor to met out (see previous point), a lot of incomplete resections and our targets are surrounded by OARs.
This is simply a very tough situation.
 
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Palex80 said:
I am sorry, it was indeed not nice of me. I apologize.

I think why our RT approaches to pancreatic cancer have not managed to make RT an established component of multidisciplinary treatment do not have much to do with radiation biology, we won‘t find any answers there. It‘s not that we can‘t kill pancreatic cancer with RT. If you look at pCR rates of trials using SBRT in the neoadjuvant setting, the figures are not that bad and sometimes higher to those seen for instance with standard 5 weeks of CRT for rectal cancer, where RT is a standard component, still.

The problem is rather tumor biology, early metastatic affinity, a surgical procedure (as standard of care local treatment) with high morbidity and location of diease.
Pancreatic cancer seems not to be responding to IO (and we now know that some of the effects of RT can also come from activation of the immune system, so that pathway also won‘t help). It also does not respond yet to targetted agents (with the few exceptions of BRCA-mutant pancreatic cancer), so systemic control is limited in a disease that spreads early and in various ways (lymphatics, blood, peritoneal). Whipple procedures cause morbidity, meaning that we lose patients to complications (think not only the immediate periooperative period, but also the fistulas, dumping, cachexia and possible detrimental effects to the immune system - all big surgical procedures do that) and many patients are in bad shape to tolerate adjuvant treatment. Location of disease means that there is an abundance of blood and lympatic vessels for the tumor to met out (see previous point), a lot of incomplete resections and our targets are surrounded by OARs.
This is simply a very tough situation.
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Thanks for the response. No offense taken
I wrote what I wrote in an absurd way, bc my thoughts were that the discussion had gotten a little absurd. The point seemed to be, don't use rt in pancreatic cancer. It's simple enough, radiation causes cancer cells to die. The vast majority of pancreatic cancer patients need this to happen. If radiation isn't helping in trials, it's because we haven't been thoughtful enough about who we treat, when we treat, where we treat or how we treat. Regarding the how we treat, it seems pretty clear that some patients could benefit from old fashioned conventional crt.
 
Ray D. Ayshun said:
Thanks for the response. No offense taken
I wrote what I wrote in an absurd way, bc my thoughts were that the discussion had gotten a little absurd. The point seemed to be, don't use rt in pancreatic cancer. It's simple enough, radiation causes cancer cells to die. The vast majority of pancreatic cancer patients need this to happen. If radiation isn't helping in trials, it's because we haven't been thoughtful enough about who we treat, when we treat, where we treat or how we treat. Regarding the how we treat, it seems pretty clear that some patients could benefit from old fashioned conventional crt.
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Or maybe we shouldn't treat. You know, there are malignant tumors out there, where radiation has been abandoned if favor of other approaches. Doesn't mean that radiation won't kill cells there, it's just that it's not worth it. Although, I have to admit this is mainly the case in patients with favorable prognosis and when other options are at least as effective or even more effective that radiation therapy.
Who knows?
 
Palex80 said:
Or maybe we shouldn't treat. You know, there are malignant tumors out there, where radiation has been abandoned if favor of other approaches. Doesn't mean that radiation won't kill cells there, it's just that it's not worth it. Although, I have to admit this is mainly the case in patients with favorable prognosis and when other options are at least as effective or even more effective that radiation therapy.
Who knows?
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I don't disagree with that. Like Hodgkin's. I still think rt serves a purpose there, but I'm not offended med onc won't send hd patients for 2-3 weeks of rt. Otoh, like you said, there's a chasm bt the pancreas and hd survival curve, so id argue we should keep plugging away.at pancreas and take even the little victories, like peropanc

Edit: Iow, I'll accept defeat when the pancreatic pfs or os curve could be confused with hd.
 
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Ray D. Ayshun said:
I don't disagree with that. Like Hodgkin's. I still think rt serves a purpose there, but I'm not offended med onc won't send hd patients for 2-3 weeks of rt. Otoh, like you said, there's a chasm bt the pancreas and hd survival curve, so id argue we should keep plugging away.at pancreas and take even the little victories, like peropanc

Edit: Iow, I'll accept defeat when the pancreatic pfs or os curve could be confused with hd.
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That would be a day to celebrate, even if RT isn’t part of the package. One can speculate though, with further improvements in systemic therapy, then local control may yet again become more important, but we are from that point yet.
 
taserlaser said:
That would be a day to celebrate, even if RT isn’t part of the package. One can speculate though, with further improvements in systemic therapy, then local control may yet again become more important, but we are from that point yet.
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I used to think this as well, but in the adjuvant setting as systemic therapy improved- 5fu then gem xeloda then folfironox, local control does not seem to matter.
 
I saw this seminar for precision targeting of radiation therapy elimination in lung cancer being advertised by Brendon Stiles
975C2D5A-A1C6-4523-A0D2-A3C9C823E48C.png
 
Fpg1245 said:
Corey spears: husband, father, and complete ****ing tool.
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Corey Spears is not alone and as a junior academician is just parroting the party line of "leadership". Dare I say, as a White male working in breast cancer academics, this is his only option if there is any hope of advancing his career? Have a listen to the current RedJournal podcast. Rather than opposing unnecessary and wasteful omission trials, Jennifer Bellon enthusiastically supports them and even predicts they will be successful. Prior failed omission trials and metaanalyses barely worth mentioning because that was back when systemic therapy wasn't as good. It was up to a brave mid-career Canadian to step in and say wait just a second, there might be a better way, EUROPA trial, etc. Presumably, the Canadian would like to keep working as a radiation oncologist until retirement age?

So no, we will never receive any help from our academic leaders.

This begs a separate question. Is systemic therapy really that good? I know it is very expensive, breathlessly hyped.
 
RickyScott said:
Precision and personalization are euphemisms for omissions when it comes to radiation. And those who tout it are generally strongly in favor of recruiting more minorities into the field. (I am thinking of that tool in Cleveland who claims to be familiar with math)
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theradiator said:
Corey Spears is not alone and as a junior academician is just parroting the party line of "leadership". Dare I say, as a White male working in breast cancer academics, this is his only option if there is any hope of advancing his career? Have a listen to the current RedJournal podcast. Rather than opposing unnecessary and wasteful omission trials, Jennifer Bellon enthusiastically supports them and even predicts they will be successful. Prior failed omission trials and metaanalyses barely worth mentioning because that was back when systemic therapy wasn't as good. It was up to a brave mid-career Canadian to step in and say wait just a second, there might be a better way, EUROPA trial, etc. Presumably, the Canadian would like to keep working as a radiation oncologist until retirement age?

So no, we will never receive any help from our academic leaders.

This begs a separate question. Is systemic therapy really that good? I know it is very expensive, breathlessly hyped.
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So shouldn’t Corey spears and Jennifer bellon also be vocal about residency expansion? It’s not great leap of imagination to foresee that ctdna or genetic markers may be someday predict who would actually benefit from xrt.
 
Fpg1245 said:
Corey spears: husband, father, and complete ****ing tool.
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I don't know him. Research initiatives seem reasonable to me.

But we must acknowledge that Corey Spears represents (in some vague way, again I don't know him) the ideal radonc residency candidate from the "peak peak" residency era. MSTP stud with significant cancer directed research prior to ever starting residency. Competing with this type for a real academic job was just about impossible. A whole generation of residents kicked their ass to publish clinical stuff and kill it clinically to find out that the best opportunities were going to fall to their colleagues who already had major basic science cancer pubs in hand. (I figured out I had no shot by mid residency).

I'm guessing Spears identifies as a scientist who happens to do some therapeutic radiation. (This part is rarely said out loud, because clinician scientists know that it's always better to say how much they value clinical work within a hospital environment.) This is how all the serious people imagine the field. They never wondered why they were attracting a disproportionate amount of the best and brightest young cancer researchers to the field? (It was the salary and clinical hours.)

It is so much harder to find new indications for a single therapy and harder still to create a meaningfully "new radiation" than it is to refine indications. Any clear eyed mentor speaking to an aspiring translational researcher in our field would be wise to suggest "refine indications" as a career goal. This is not bad work.
RickyScott said:
shouldn’t Corey spears and Jennifer bellon also be vocal about residency expansion
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They should be.
 
communitydoc13 said:
I'm guessing Spears identifies as a scientist who happens to do some therapeutic radiation. (This part is rarely said out loud, because clinician scientists know that it's always better to say how much they value clinical work within a hospital environment.) This is how all the serious people imagine the field. They never wondered why they were attracting a disproportionate amount of the best and brightest young cancer researchers to the field? (It was the salary and clinical hours.)
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This has been a fundamental pillar of RadOnc for the last 20 years, and has hurt our specialty far more than people imagine.
 
RealSimulD said:
Elaborate? I disagree with him on that thread. But calling him a f*cking tool .. why?
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Isn’t it obvious? He’s part of team omission like most of academic rad onc. He cares more about a splashy pub than anything else. The whole science at all costs thing is just virtue signaling
 
Fpg1245 said:
Isn’t it obvious? He’s part of team omission like most of academic rad onc. He cares more about a splashy pub than anything else. The whole science at all costs thing is just virtue signaling
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Pts can go to him for an honest assessment of whether they really need radiation for early stage breast cancer. Chirag on the other hand will probably just treat all with 5 fractions of partial breast. Corey is the guardian of a rigorous complex risk benefit analysis, a noble academic. This is his schtick- the race to zero.
 
RickyScott said:
Pts can go to him for an honest assessment of whether they really need radiation for early stage breast cancer. Chirag on the other hand will probably just treat all with 5 fractions of partial breast. Corey is the guardian of a rigorous complex risk benefit analysis, a noble academic. This is his schtick- the race to zero.
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ha, I think sarcasm

If you can do a screening mammo, a dx mammo, an US, a biopsy, a surgery with or without lymph node sampling, consider systemic therapy (by having someone order an oncotype), consider taking a pill for several years … you can tolerate 5 fx of PBI or whole breast. RT is for local recurrence. It works. This is so easy. Your “Chirag” is correct!
 
If you randomly treated 65 yo women, they'd have a lower incidence of breast cancer. It's paternalistic to say "need.". We know breast rt works at reducing local recurrence in every adequately powered trial. I was watching a norm MacDonald bit about how tiger woods sleeping with 70 of the 3000000 women he could've slept with makes him the most faithful man ever as that's statistically 0. Some women don't benefit much, and it's good to know how much, but there's always 1 in a group of whatever size that will. It's our job to define the odds of a benefit, theirs to define need.
 
RealSimulD said:
ha, I think sarcasm

If you can do a screening mammo, a dx mammo, an US, a biopsy, a surgery with or without lymph node sampling, consider systemic therapy (by having someone order an oncotype), consider taking a pill for several years … you can tolerate 5 fx of PBI or whole breast. RT is for local recurrence. It works. This is so easy. Your “Chirag” is correct!
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RealSimulD: was only getting started. He meant to include additional diagnostic mammograms, one or more MRIs, multiple biopsies of additional calcifications or nodularities, oncoplastic reconstruction, reduction mammoplasties, intraoperative ultrasound, Margin probe, additional CDK4/6 inhibitors, TDM-1 and/or immunotherapy, EKGs (Memorial Sloan Kettering only), genetic testing even if performed only a few years prior, Oncotype, Breast Cancer Index test, etc, etc and so forth. Somehow only RT - the only intervention with level 1 evidence improving overall survival - gets eliminated.

Our breast cancer leaders are really grossly incompetent. As opposed to the 3 A's, how about the 4 D's dereliction of duty directly leading to damage to our field.
 
theradiator said:
RealSimulD: was only getting started. He meant to include additional diagnostic mammograms, one or more MRIs, multiple biopsies of additional calcifications or nodularities, oncoplastic reconstruction, reduction mammoplasties, intraoperative ultrasound, Margin probe, additional CDK4/6 inhibitors, TDM-1 and/or immunotherapy, EKGs (Memorial Sloan Kettering only), genetic testing even if performed only a few years prior, Oncotype, Breast Cancer Index test, etc, etc and so forth. Somehow only RT - the only intervention with level 1 evidence improving overall survival - gets eliminated.

Our breast cancer leaders are really grossly incompetent. As opposed to the 3 A's, how about the 4 D's dereliction of duty directly leading to damage to our field.
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Definitely a sick complex in many of our academics for sure
 
theradiator said:
RealSimulD: was only getting started. He meant to include additional diagnostic mammograms, one or more MRIs, multiple biopsies of additional calcifications or nodularities, oncoplastic reconstruction, reduction mammoplasties, intraoperative ultrasound, Margin probe, additional CDK4/6 inhibitors, TDM-1 and/or immunotherapy, EKGs (Memorial Sloan Kettering only), genetic testing even if performed only a few years prior, Oncotype, Breast Cancer Index test, etc, etc and so forth. Somehow only RT - the only intervention with level 1 evidence improving overall survival - gets eliminated.

Our breast cancer leaders are really grossly incompetent. As opposed to the 3 A's, how about the 4 D's dereliction of duty directly leading to damage to our field.
Click to expand...
Enthusiasm to omit xrt is a type of virtue signaling for some of these people.
 
theradiator said:
RealSimulD: was only getting started. He meant to include additional diagnostic mammograms, one or more MRIs, multiple biopsies of additional calcifications or nodularities, oncoplastic reconstruction, reduction mammoplasties, intraoperative ultrasound, Margin probe, additional CDK4/6 inhibitors, TDM-1 and/or immunotherapy, EKGs (Memorial Sloan Kettering only), genetic testing even if performed only a few years prior, Oncotype, Breast Cancer Index test, etc, etc and so forth. Somehow only RT - the only intervention with level 1 evidence improving overall survival - gets eliminated.

Our breast cancer leaders are really grossly incompetent. As opposed to the 3 A's, how about the 4 D's dereliction of duty directly leading to damage to our field.
Click to expand...
I don't understand how any Rad Onc (or Med Onc) can laud the omission trials. I have been out in practice for only a few mo and every single one of my breast patients who has started ET hates it. Some have already switched to a different type of ET because they can't tolerate the first agent they are receiving. I know that our treatments can cause toxicity, sometime bad toxicity, but frankly I am sick of Med Oncs minimizing the extent to which systemic therapy can cause bad toxicity too. Any thought of RT omission really hinges on patient getting long term ET. What is going to be easier for the patient? 5 Fx over 1 wk with minimal toxicity or 5-10 years of agony. Here's another thought: Imaging giving men 5-10 yr of ADT. Yikes.
 
radoncftw said:
I don't understand how any Rad Onc (or Med Onc) can laud the omission trials. I have been out in practice for only a few mo and every single one of my breast patients who has started ET hates it. Some have already switched to a different type of ET because they can't tolerate the first agent they are receiving. I know that our treatments can cause toxicity, sometime bad toxicity, but frankly I am sick of Med Oncs minimizing the extent to which systemic therapy can cause bad toxicity too. Any thought of RT omission really hinges on patient getting long term ET. What is going to be easier for the patient? 5 Fx over 1 wk with minimal toxicity or 5-10 years of agony. Here's another thought: Imaging giving men 5-10 yr of ADT. Yikes.
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You aren’t going to find the answer in science/dafa. It is abt self promotion and the psychology of virtue signalling. In corey”s wet dreams, the women of Cleveland demand him not chirag, because he is an honest arbiter of xrt necessity:
Same sht at Cornell where some tool is pushing prostate sbrt in 2 fractions with mri linac to compete with the better center next door. (Despite the fact that 2 fractions of hdr failed miserably) the mf even claimed it was cost effective despite when Cornell’s price is probably 100k
 
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