Rad Onc Twitter

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Fpg1245 said:
Exactly Radiation needs to shut up and get out of the way
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Please let's not throw the baby out with the bath water. Remember, there is a broad audience reading this forum.

I just gave a talk a few weeks ago talking about the curative nature of RT and overall survival benefits for radiation in a number of malignancies. We will still be here far into the future.
 
Neuronix said:
Please let's not throw the baby out with the bath water. Remember, there is a broad audience reading this forum.

I just gave a talk a few weeks ago talking about the curative nature of RT and overall survival benefits for radiation in a number of malignancies. We will still be here far into the future.
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I read his/her comment as sarcasm...
 
Miles Gloriosus said:
As an Ortho who is has no idea how rad/onc works, what is the low dose radiation treatments he is doing as compared to a standard hand X-ray?

I’ve never seen or heard anything in the ortho literature about using radiation for OA. I could see maybe plausible in a RA patient not responding to meds but run of the mill OA seems to be a stretch

I’m my training, we used to consult rad/onc for post op complex/revision elbow Orif or acetabular orifs to prevent HO. The rad/oncs halfway through my residency told us the risk of developing a sarcoma was unacceptably high and told us to switch to NSAIDs instead. We completely changed our protocols and never consulted them again.
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Read this thread in its entirety and the papers linked:

forums.studentdoctor.net

Benign Disease

Sorry if this has been discussed but in Germany they seem to treat a large number of patients with joint arthrosis/degenerative joints with what appears to be good results. Has anybody done this and is this covered by insurance or medicare? I have treated the occasional dupytren's but that...
forums.studentdoctor.net forums.studentdoctor.net

Just cause ortho bros dont know doens't mean it's not an option...
 
evilbooyaa said:
Read this thread in its entirety and the papers linked:

forums.studentdoctor.net

Benign Disease

Sorry if this has been discussed but in Germany they seem to treat a large number of patients with joint arthrosis/degenerative joints with what appears to be good results. Has anybody done this and is this covered by insurance or medicare? I have treated the occasional dupytren's but that...
forums.studentdoctor.net forums.studentdoctor.net

Just cause ortho bros dont know doens't mean it's not an option...
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Where do you hide a $100 bill from an orthopod?
 
Fpg1245 said:
For all the stuff germany does you’d think they’d run a prospective rando on that shiz
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It seems like they'd have trouble randomizing at this point because it is so widely used and appreciated there. This is just my assumption reading between the lines of all their writing.

It's weird I've never seen a Rad Onc comment on the quality of studies for corticosteroid injections. There is a Cochrane Review you can even go read. It is not favorable. And yet.
 
NotMattSpraker said:
It seems like they'd have trouble randomizing at this point because it is so widely used and appreciated there. This is just my assumption reading between the lines of all their writing.

It's weird I've never seen a Rad Onc comment on the quality of studies for corticosteroid injections. There is a Cochrane Review you can even go read. It is not favorable. And yet.
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I agree and think it's funny hearing an Ortho talk about the evidence behind a treatment when like their most basic **** has no evidence of doing anything
 
NotMattSpraker said:
It seems like they'd have trouble randomizing at this point because it is so widely used and appreciated there. This is just my assumption reading between the lines of all their writing.

It's weird I've never seen a Rad Onc comment on the quality of studies for corticosteroid injections. There is a Cochrane Review you can even go read. It is not favorable. And yet.
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Lol. I never thought of that. Orthos office hours are punctuated with these injections. I remember doing quite a few. Some did it under fluoro
 
A boomer rad onc once said to me when I was a young lad fresh out of residency after I brought up some “data” during our weekly chart rounds- “Who needs data, when you have common sense!”
 

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evilbooyaa said:
Read this thread in its entirety and the papers linked:

forums.studentdoctor.net

Benign Disease

Sorry if this has been discussed but in Germany they seem to treat a large number of patients with joint arthrosis/degenerative joints with what appears to be good results. Has anybody done this and is this covered by insurance or medicare? I have treated the occasional dupytren's but that...
forums.studentdoctor.net forums.studentdoctor.net

Just cause ortho bros dont know doens't mean it's not an option...
Click to expand...
Great to hear. I think many of my ortho colleagues would love this. Now another place to offload the drug seeking, unhealthy, noncompliant patients who we don’t want to operate on.
Be careful what you wish for.
 
Miles Gloriosus said:
Great to hear. I think many of my ortho colleagues would love this. Now another place to offload the drug seeking, unhealthy, noncompliant patients who we don’t want to operate on.
Be careful what you wish for.
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Don’t worry, we will find a way not to treat!
 
Miles Gloriosus said:
Great to hear. I think many of my ortho colleagues would love this. Now another place to offload the drug seeking, unhealthy, noncompliant patients who we don’t want to operate on.
Be careful what you wish for.
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My linac is busy enough as it is treating cancer. I cringe every time I get a keloid or HO referral. My therapists would probably mutiny if we started getting inundated with OA patients
 
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medgator said:
My linac is busy enough as it is treating cancer. I cringe every time I get a keloid or OH referral. My therapists would probably mutiny if we started getting inundated with OA patients
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I like keloids for the variety, but our skin cancer waiting list is looooong and orthovoltage machine is busy busy. If we start getting OA patients by the buckets I’ll celebrate because means we can get another doc to help out. That will be a while. Looking forward to the first large case series which I’m sure will inevitably be in the red journal.
 
taserlaser said:
I like keloids for the variety, but our skin cancer waiting list is looooong and orthovoltage machine is busy busy. If we start getting OA patients by the buckets I’ll celebrate because means we can get another doc to help out. That will be a while. Looking forward to the first large case series which I’m sure will inevitably be in the red journal.
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probably PRO or advances..unless we're talking something with OA + DEI
 
CaesarRO said:
Unbelievable effect size. Literally.

But thought provoking.

Don't let the cancer touch the air!
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Wow. Agreed that at first glance it seems like random trial BS. But clearly they felt sufficient rationale to run a 1600 person RCT. And an absolutely massive effect in early breast cancer?

Boggles the mind.

Maybe I should be doing Trus guided lidocaine instillations in my proststes in Preop
 
DoctwoB said:
Wow. Agreed that at first glance it seems like random trial BS. But clearly they felt sufficient rationale to run a 1600 person RCT. And an absolutely massive effect in early breast cancer?

Boggles the mind.

Maybe I should be doing Trus guided lidocaine instillations in my proststes in Preop
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Weird immune system effects with surgery is what comes to my mind. Temporary immune suppression with upregulation of metalloproteinases is something I’ve been told before. Not rare to see new Mets arise after surgery in say things like high grade sarcomas (But one also expects a high net rate there, too). I’m not sure this entirely discounts the Fisher hypothesis like Todd S is suggesting, but it does poke a hole in it perhaps.

The lidocaine literature absolutely spans more than just breast cancer, and I’m sure this will Be trialed in other tumor types too. Will be curious to see where this goes from here.
 
medgator said:
My linac is busy enough as it is treating cancer. I cringe every time I get a keloid or HO referral. My therapists would probably mutiny if we started getting inundated with OA patients
Click to expand...

This is why I haven't marketed our LDRT program at all. Need to treat cancer patients.
 
Miles Gloriosus said:
Great to hear. I think many of my ortho colleagues would love this. Now another place to offload the drug seeking, unhealthy, noncompliant patients who we don’t want to operate on.
Be careful what you wish for.
Click to expand...
Happy to see them and re-treat them as many times as they would like!

medgator said:
My linac is busy enough as it is treating cancer. I cringe every time I get a keloid or HO referral. My therapists would probably mutiny if we started getting inundated with OA patients
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Get an old crap linac, treat 20 OA a day. Easy money.

taserlaser said:
I like keloids for the variety, but our skin cancer waiting list is looooong and orthovoltage machine is busy busy. If we start getting OA patients by the buckets I’ll celebrate because means we can get another doc to help out. That will be a while. Looking forward to the first large case series which I’m sure will inevitably be in the red journal.
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Too much social science in IJROBP - I predict Green Journal. Maybe JCO if it's really good.

OTN said:
This is why I haven't marketed our LDRT program at all. Need to treat cancer patients.
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Hire another doc!
 
evilbooyaa said:
Get an old crap linac, treat 20 OA a day. Easy money.

Hire another doc!
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The only thing i can think of that's worse than urorads would be worse than derm rads and the only thing worse than derm rads imo would be OArads. You really think a new doc would look forward to being the benign msk guy?

Extra Linac make sense if vault space available, not sure if building a center with vault makes sense now in current environment to treat a bunch of OA.

TLDR - theory vs reality, not sure it's that simple
 
radoncftw said:
same, we are busy enough treating cancer patients.
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"Busy enough" on what end?
Therapy hours are long? Get another vault and hire more. Despite their inflated salaries given the staff (not faculty) shortage seen nationwide, they will more than pay for themselves even treating a few OAs a day....
Physicians are too busy to see OA consults? Hire another Doc or could even hire a NP to discuss LDRT for OA consults...

medgator said:
The only thing i can think of that's worse than urorads would be worse than derm rads and the only thing worse than derm rads imo would be OArads. You really think a new doc would look forward to being the benign msk guy?

Extra Linac make sense if vault space available, not sure if building a center with vault makes sense now in current environment to treat a bunch of OA.

TLDR - theory vs reality, not sure it's that simple
Click to expand...

Not saying the OA consults have to exclusively go to one guy... that seems a tough balance. But an older partner who wants to slow down clinical volume and/or some folks interested in life style?

We're not the UK. We shouldn't think like the UK does. We talk about 'expanding indications for RT' and then when it comes down to it, everyone is 'too busy' to take the bull by the horns.
 
My new place is getting rid of an old (not really that old) linac and the vault will just stay empty. The population of this town is not growing so they probably won't ever be busy enough to get a real second machine

Not sure why we can't just keep it treat OAs and palliative patients on it, hire another therapist and grow
While I am currently busy enough with the cancer patients, I'd like the option in the future.
 
metallica81788 said:
My new place is getting rid of an old (not really that old) linac and the vault will just stay empty. The population of this town is not growing so they probably won't ever be busy enough to get a real second machine

Not sure why we can't just keep it treat OAs and palliative patients on it, hire another therapist and grow
While I am currently busy enough with the cancer patients, I'd like the option in the future.
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Service contracts and maintenance are EXPENSIVE
 
metallica81788 said:
My new place is getting rid of an old (not really that old) linac and the vault will just stay empty. The population of this town is not growing so they probably won't ever be busy enough to get a real second machine

Not sure why we can't just keep it treat OAs and palliative patients on it, hire another therapist and grow
While I am currently busy enough with the cancer patients, I'd like the option in the future.
Click to expand...

Wondering if an orthovoltage machine to treat OA if enough patients might make sense?
 
Amazing what was possible in the pre-Lidocaine and pre non-inferiority era

Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials - PMC

After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
theradiator said:
Amazing what was possible in the pre-Lidocaine and pre non-inferiority era

Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials - PMC

After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
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The Metanalysis certainly is hypothesis generating, but the evidence for radiation is not level 1 like with lidocaine.
 
hookem19 said:
Wondering if an orthovoltage machine to treat OA if enough patients might make sense?
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I think that might work. If you have an HDR vault or some space to put up some extra steel or lead shielding, it would not necessarily need a linac vault.

It's not hard to add one or 2 OA patients to the schedule on a linac and see where it goes from there.
 
RickyScott said:
The Metanalysis certainly is hypothesis generating, but the evidence for radiation is not level 1 like with lidocaine.
Click to expand...

In ten years I doubt radiation will play much of a role in breast cancer. Most of the evidence for radiation therapy in breast cancer, both PMRT and early-stage, comes before the advent of modern hormonal therapy, targeted therapy and I guess now lidocaine. DEBRA trial will probably not show any survival benefit from RT. Wonder how many prior breast trials in these meta analyses would be positive if the patients had modern systemic therapy.

Radiation will continue to play a large role in diseases where it’s curative on its own without surgery(prostate, head and neck, cervical, maybe organ sparing rectal) or where survival is too short to experience long term toxicity (GBM, lung cancer, HCC, metastatic disease).
 
beamteam7 said:
In ten years I doubt radiation will play much of a role in breast cancer. Most of the evidence for radiation therapy in breast cancer, both PMRT and early-stage, comes before the advent of modern hormonal therapy, targeted therapy and I guess now lidocaine. DEBRA trial will probably not show any survival benefit from RT. Wonder how many prior breast trials in these meta analyses would be positive if the patients had modern systemic therapy.

Radiation will continue to play a large role in diseases where it’s curative on its own without surgery(prostate, head and neck, cervical, maybe organ sparing rectal) or where survival is too short to experience long term toxicity (GBM, lung cancer, HCC, metastatic disease).
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I’m not sure, if anything I’ve seen an emergence in radiation with 5 fractions for older women. We still need it for breast conservation in young women and what about all the locally advanced breast cancer patients?
 
beamteam7 said:
In ten years I doubt radiation will play much of a role in breast cancer. Most of the evidence for radiation therapy in breast cancer, both PMRT and early-stage, comes before the advent of modern hormonal therapy, targeted therapy and I guess now lidocaine. DEBRA trial will probably not show any survival benefit from RT. Wonder how many prior breast trials in these meta analyses would be positive if the patients had modern systemic therapy.

Radiation will continue to play a large role in diseases where it’s curative on its own without surgery(prostate, head and neck, cervical, maybe organ sparing rectal) or where survival is too short to experience long term toxicity (GBM, lung cancer, HCC, metastatic disease).
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if systemic therapy gets better in breast cancer, surgery may get dropped. Its the worst for cosmesis. Already starting to see some trials.
 
RadOncDoc21 said:
I’m not sure, if anything I’ve seen an emergence in radiation with 5 fractions for older women. We still need it for breast conservation in young women and what about all the locally advanced breast cancer patients?
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Strongly agree. Radiation oncology has a good 15-20 years left at least, and after that predictions are always murky. Works for me.
 
Miles Gloriosus said:
Great to hear. I think many of my ortho colleagues would love this. Now another place to offload the drug seeking, unhealthy, noncompliant patients who we don’t want to operate on.
Be careful what you wish for.
Click to expand...
Lol... yep.

We did a good bit of HO prophylaxis in residency. That starts with a 3:30pm phone call from a PGY2 "Hey..... we just got out of the OR. My attending said you'll radiate this today, right?"

"Hmmm.... risk of sarcoma far too high. Recommend NSAIDS."
 
Alas, here lies the dilemma of rad oncs. On one side the haves are content and turn away possible new indications for RT. On the other side, rad oncs are waiting in bread lines starving for crumbs.

In the middle, we’re battling against academic centers boasting about their latest new gimmick and satellites taking over while producing more rad oncs then necessary.

We argue and fight each other over fractionations and the use of bolus, while other fields continue to advance their role in cancer care.

It’s no wonder, why we’re sinking.
 
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Fpg1245 said:
For all the stuff germany does you’d think they’d run a prospective rando on that shiz
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They did:

pubmed.ncbi.nlm.nih.gov

ArthroRad trial: multicentric prospective and randomized single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis depending on the dose-results after 3 months' follow-up - PubMed

We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
Did anyone else find the results of this trial concerning? At 0.3 Gy, are we really doing anything?
 
Palex80 said:
They did:

pubmed.ncbi.nlm.nih.gov

ArthroRad trial: multicentric prospective and randomized single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis depending on the dose-results after 3 months' follow-up - PubMed

We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
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I saw this one. Was concerned that 0.3 was basically placebo

What I should have said was straight up placebo sham 0Gy RT vs 3Gy in 6fx
 
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