Rad Onc Twitter

[communitydoc13]

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Agree there is no doubt that visa concerns drive people into certain kinds of jobs and locations. The one I am aware of recently is someone signing a job more than a year in advance to secure their protected status. It wasn’t an academic name hospital, but we should not think that academic names have a monopoly on large systems. There are many non academic corporations that benefit from the same advantages.

Time in advance will be typical for J1 candidates. There is a clock ticking and a lot of work to be done. Early commitment is necessary. A model where an institution puts the work in to secure a J1 slot, pays legal counsel for services and lets candidates commit in March of their graduating year is not tenable (particularly for smaller places).

 

[medgator]

the youngest boomer is 60 (ends in 1964). there are def some chairs that are still boomers (oldest one is Ralph who is probably bordering on the greatest generation rather than boomer) but I think a lot of chairs these days are Gen X

Everyone I've referenced previously is a boomer and I imagine the majority of chairs causing a lot of problems for the specialty are Boomer.

Definitely some good Gen X chairs out there but people like Dan spratt and Jerry Jaboin are few and far between and aren't the driving force of what is happening at ASTRO and scarop now

 

[drowsy12]

Dan Spratt is a millennial.

Look at that SCAROP picture. lot of Gen X.

My only point was that it’s funny how these generational terms get thrown around but people are old now. Millennials aren’t young and Boomers are less relevant every day.

 

[Barcelona PSG]

View attachment 385755

I don't understand the relationship between IMG advocacy and DEI. DEI lobby seems to put their hands in everything they pass by.

 

[Chartreuse Wombat]

I don't understand the relationship between IMG advocacy and DEI. DEI lobby seems to put their hands in everything they pass by.

Grifters gonna grift

 

[RickyScott]

I don't understand the relationship between IMG advocacy and DEI. DEI lobby seems to put their hands in everything they pass by.

I don’t understand the relationship between DEI and hating Jews.

 

[drowsy12]

 

[RickyScott]

View attachment 385773

To non oncologists, full body mri and protons for that matter sounds like a great business plan

 

[evilbooyaa]

For those who don't want to read the whole paper:

View attachment 385707

IPP = in person patients, VP = virtual patients

(in the context of E&M virtual, not supervision virtual)

GU Malignancies accounted for the largest absolute number of VP treatments

I presume all/mostly prostates

What a poor use of protons.

Protons for CNS in anything besides the non-reirradiation setting? Do GBM outcomes matter whether given by photons or protons???

Meningioma I could potentially see a use for

Craniopharyngiomas/pituitary adenomas would be great if it wasn't for all that darn inability to model the proton accurately

Brainstem gliomas/meningiomas would be great if it wasn't for all that DARN BRAINSTEM NECROSIS (due to inability to model the proton accurately)

 

[BobbyHeenan]

GU Malignancies accounted for the largest absolute number of VP treatments

I presume all/mostly prostates

What a poor use of protons.

Protons for CNS in anything besides the non-reirradiation setting? Do GBM outcomes matter whether given by photons or protons???

Meningioma I could potentially see a use for

Craniopharyngiomas/pituitary adenomas would be great if it wasn't for all that darn inability to model the proton accurately

Brainstem gliomas/meningiomas would be great if it wasn't for all that DARN BRAINSTEM NECROSIS (due to inability to model the proton accurately)

I don't send GBM's (?where is the NRG trial publication that completed enrollment years ago? )but I have sent some low grade gliomas with favorable biology or complex large meningiomas.

I don't send for brainstem gliomas (and in fact St. Jude sent me someone not long ago and rec'd photons).

 

[Palex80]

Hmmm

 

[Fpg1245]

View attachment 385917



Hmmm

I mean realistically the most you can expect is what an LC benefit?

 

[evilbooyaa]

View attachment 385917



Hmmm

16 years since inception

Wtf have they been waiting for

 

[Ray D. Ayshun]

This will end up reducing my post-op panc volume to zero. Oops, I mean this won't change my post-op panc volume.

 

[A_DeMichele]

This will end up reducing my post-op panc volume to zero. Oops, I mean this won't change my post-op panc volume.

How do you know RT won't double OS? 🙂

 

[RickyScott]

Been saying this for while - when are we going to do away with a gi section for radiation boards?

 

[drowsy12]

why are you guys all assuming it is negative? let's wait.

 

[Ray D. Ayshun]

This is a trial that I've simultaneously been waiting for and caring nothing about.

 

[medgator]

Been saying this for while - when are we going to do away with a gi section for radiation boards?

Treating so much myself these days

 

[Neuronix]

Been saying this for while - when are we going to do away with a gi section for radiation boards?

As soon as they do away with the lymphoma section.

 

[Mandelin Rain]

Breast section next, imo

 

[medgator]

As soon as they do away with the lymphoma section.

Lymphoma needs to go away way before GI imo

 

[deleted1180461]

Where is the bone met section?
Arthritis and duputyren's section?
Non-melanoma skin cancer?

All more common than lymphoma referrals in the community.

 

[Palex80]

why are you guys all assuming it is negative? let's wait.

Because it's in the "oral abstracts session".

16 years since inception

Wtf have they been waiting for

For a long follow-up? Oh, wait. It's pancreas.

 

[Gfunk6]

As soon as they do away with the lymphoma section.

But . . . what will test takers do the night before the Oral Board exam? It has historically been for memorizing the names, doses, and infusions schedule for R-CHOP and ABVD.

 

[Palex80]

But . . . what will test takers do the night before the Oral Board exam? It has historically been for memorizing the names, doses, and infusions schedule for R-CHOP and ABVD.

ABVD is so .... 00s
Embrace Brentuximab and IO.

 

[evilbooyaa]

Because it's in the "oral abstracts session".

I'm not sure what you mean by that. I figure at ASCO, a negative trial for benefit of RT would be a plenary.

Versus a trial that shows benefit of RT would be relegated to 'oral abstracts'.

I mean... it appears to be Embargoed. Does that mean it's more likely to be a positive result (showing benefit of post-op RT)??

Let speculation run wild.

My prediction - RT will benefit LC, with a numerically, but not statistically significant benefit to OS.

 

[deleted1180461]

But . . . what will test takers do the night before the Oral Board exam? It has historically been for memorizing the names, doses, and infusions schedule for R-CHOP and ABVD.

If you don't know the doses for RCHOP you will still pass. But still kinda wild people say they were asked that in the limited time available on a exam to determine clinical competence as a rad onc.

 

[drowsy12]

Because it's in the "oral abstracts session".

I mean it's a large cooperative group trial. of course it would be an oral.

the plenaries are out, public knowledge, saw yesterday on twitter (X if you're nasty). all major trials.

 

[NotMattSpraker]

Arthritis and duputyren's section?

It would be so Rad Onc to fail oral boards because you didnt design your 3 Gy in 6 fractions field the way some boomer likes it that he read about in a book one time.

Or like you treated a person who was 49 years and 360 days old.

 

[7bobthebuilder7]

Because it's in the "oral abstracts session".


For a long follow-up? Oh, wait. It's pancreas.

You wait long enough and the pancreas curves do seperate actually so RT is great for those end survivors when biology is favorable... how you find those patients is the hard part. I can see it being positive... will it change practice, doubt it.

 

[A_DeMichele]

You wait long enough and the pancreas curves do seperate actually so RT is great for those end survivors when biology is favorable... how you find those patients is the hard part. I can see it being positive... will it change practice, doubt it.

Current practice as I see it (academic centers on East Coast) is still to refer post-op pancreas for XRT consult after chemo... I've been treating 2-3 pts per year

 

[pikachu]

I'm not sure what you mean by that. I figure at ASCO, a negative trial for benefit of RT would be a plenary.

Versus a trial that shows benefit of RT would be relegated to 'oral abstracts'.

I mean... it appears to be Embargoed. Does that mean it's more likely to be a positive result (showing benefit of post-op RT)??

Let speculation run wild.

My prediction - RT will benefit LC, with a numerically, but not statistically significant benefit to OS.

This is a trial that is doomed by design flaws, blowing itself up midway through by shifting gears from gem/erlotinib to dealers choice chemo. No matter what the actual results are it’s going to be critiqued, rightfully, as uninterpretable. Not to mention the publication lag time (WHY ?!?!?!?!?!). Hundreds of patients, millions of dollars, for bupkis. So depressing

 

[RickyScott]

Unless positive margins most academic centers that I encounter do not send pancreas for post ok xrt

 

[deleted1180461]

I just got a referral for standard frac pre-op. Med onc requesting 6 weeks RT because that’s the way they always do it.

 

[medgator]

Unless positive margins most academic centers that I encounter do not send pancreas for post ok xrt

+Nodes also

 

[Palex80]

You wait long enough and the pancreas curves do seperate actually so RT is great for those end survivors when biology is favorable...

Here are the curves from CONKO-001, which studied adjuvant Gemcitabine vs. observation after resection of pancreatic cancer.
The trial ran more than 20 years ago.

RTOG 0848 was designed to show a benefit with RT and enhance the the upper curve...

 

[drowsy12]

If we want to talk about positive trials in GI - CROSS is absolutely cooked. The FLOT vs CROSS trial is a plenary at ASCO.

x.com

x.com

 

[Ray D. Ayshun]

If we want to talk about positive trials in GI - CROSS is absolutely cooked. The FLOT vs CROSS trial is a plenary at ASCO.

x.com

x.com

Noticed this when trying to figure out who that was tweeting.

UChicago oncologist settles SEC charges, pleads not guilty to criminal insider trading - The Cancer Letter

In the morning of Nov. 10, 2020, Daniel V.T. Catenacci, director of the GI oncology program at the University of Chicago, did some trading, court documents say. Catenacci bought 8,743 shares of Five Prime Therapeutics Inc., knowing that the company was about to release positive results from a...

cancerletter.com

In any case, most of my patients have been interested in trying to keep their esophagus.

 

[RickyScott]

+Nodes also

More often than not in my experience, academic centers reason that nodes are systemic issue and dispense with local postopntherapu

 

[Palex80]

I am dropping my DREs

 

[Palex80]

If we want to talk about positive trials in GI - CROSS is absolutely cooked. The FLOT vs CROSS trial is a plenary at ASCO.

x.com

x.com

And even if FLOT does not overperform CROSS, the problem is just around the corner... FLOT+IO has already demonstrated better results (so far only in terms of pCR in the Matterhorn and Keynote585 trials).

So, if:

FLOT = CROSS
&
FLOT + IO > FLOT

Then the medoncs will safely assume that

FLOT+IO > CROSS

 

[Palex80]

Noticed this when trying to figure out who that was tweeting.

UChicago oncologist settles SEC charges, pleads not guilty to criminal insider trading - The Cancer Letter

In the morning of Nov. 10, 2020, Daniel V.T. Catenacci, director of the GI oncology program at the University of Chicago, did some trading, court documents say. Catenacci bought 8,743 shares of Five Prime Therapeutics Inc., knowing that the company was about to release positive results from a...

cancerletter.com

In any case, most of my patients have been interested in trying to keep their esophagus.

Well, that guy should be careful about what he is tweeting. He said in his tweet that ESOPEC is "negative RT Ph3 study".

Although all we know is that ESOPEC will be presented at ASCO.

Maybe ASCO should step in?

 

[TheWallnerus]

View attachment 385983

I am dropping my DREs

I never miss a chance to post this

 

[TheWallnerus]

Noticed this when trying to figure out who that was tweeting.

UChicago oncologist settles SEC charges, pleads not guilty to criminal insider trading - The Cancer Letter

In the morning of Nov. 10, 2020, Daniel V.T. Catenacci, director of the GI oncology program at the University of Chicago, did some trading, court documents say. Catenacci bought 8,743 shares of Five Prime Therapeutics Inc., knowing that the company was about to release positive results from a...

cancerletter.com

In any case, most of my patients have been interested in trying to keep their esophagus.

Interesting website with interesting articles, and this is a snippet from one of 'em. I need to adjust my med onc salary range.

 

[Fpg1245]

Well, that guy should be careful about what he is tweeting. He said in his tweet that ESOPEC is "negative RT Ph3 study".
View attachment 385984

Although all we know is that ESOPEC will be presented at ASCO.

Maybe ASCO should step in?

This dude is out of control. Has a consulting company and clearly likes to be abrasive and make waves to draw attention.

Is this what all GI med oncs are like? Because he’s definitely not the first one I’ve seen adopt this approach

 

[Ray D. Ayshun]

This dude is out of control. Has a consulting company and clearly likes to be abrasive and make waves to draw attention.

Is this what all GI med oncs are like? Because he’s definitely not the first one I’ve seen adopt this approach

None of the local med ones seem interested in flot. Rt clearly beneficial in esophagus wrt cure. Not the case in pancreas. I had to beg a patient to see a thoracic surgeon today re stage I nsclc. This is a convoluted way of saying medoncs in my neck of the woods like chemorads for esophagus and rectal,and would have to see superiority of chemo to switch, and patients in my neck of the woods want to avoid surgery.

 

[Fpg1245]

None of the local med ones seem interested in flot. Rt clearly beneficial in esophagus wrt to cure. Not the case in pancreas. I had to beg a patient to see a thoracic surgeon today re stage I nsclc. This is a convoluted way of saying medoncs in my neck of the woods like chemorads for esophagus and rectal,and would have to see superiority of chemo to switch, and patients in my neck of the woods want to avoid surgery.

Yeah in the community they don’t seem as enthusiastic. But academic places seem almost dogmatic in their approach and are prepared to eviscerate if you don’t go along.

 

[Mandelin Rain]

FLOT great for gastric. Chemorads great for esophageal/GE Jxn. Absent some huge signal, let's just leave that alone.

 

[medgator]

FLOT great for gastric. Chemorads great for esophageal/GE Jxn. Absent some huge signal, let's just leave that alone.

Bingo. Never get gastric referrals anymore unless the surgery really ****ty