Rad Onc Twitter

[maxxor]

My understanding of rt in the oligometastatic setting is to theoretically kill all of the remaining cancer. The proposition here is not that it makes new Mets. It's that it releases a growth ligand that could make subclinical disease become clinical. This would happen anyway if there is subclinical disease, rt or no. Hence, what does this have to do with anything? Sbrt for oligomets doesn't work if there's subclinical disease elsewhere, not because it induces new Mets out of the ether.

As a diagnostic wielder of radiation, this is what I read as well.

Maybe it’s not a ligand at all. Maybe radiation is immune suppressive and the down regulation of the immune system allows suppressed Mets to thrive?

Hence let’s give immune therapy and RT at the same time!

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[CurbYourExpectations]

With the prefaces of me not being an expert or very smart, my initial thought was that SBRT decreases "metastasis", but increases tumor growth in poly metastatic cancer patients. So I thought about it differently, but need to read it cuz I could be completely off, busy clinic days. What is weird is that we don't see any significant increase in mets in SBRT cases in the primary tumor (of micrometastatic disease, so logically, this is not clinically relevant and won't pan out). But I am hopeful whatever the nonsensical ranting that is happening on twitter does pan out and somehow this shows ablating cancers in polymetastatic diseases with a molecular inhibitor is somehow beneficial in non treated sites. The paper being negative regarding radonc is, I guess I would say uncalled for (but how many times do I say stuff I shouldn't? Daily? You guys have witnessed it, I hide behind an anonymous account and admit i'm an idiot 99% of the time), but if the actual stuff becomes relevant and we start seeing decreases in metastatic growth, that is a boon for RadOnc. Ralph isn't dumb, he's very intelligent imo (who cares about my opinion?), he knows that being flamboyant gets people talking about his pubs. Tbh idk, smart people... what should I think

 

[drowsy12]

because it's anti-radiation. ibram x kendi was a middle author.

it’s not anti radiation at all

 

[Ray D. Ayshun]

With the prefaces of me not being an expert or very smart, my initial thought was that SBRT decreases "metastasis", but increases tumor growth in poly metastatic cancer patients. So I thought about it differently, but need to read it cuz I could be completely off, busy clinic days. What is weird is that we don't see any significant increase in mets in SBRT cases in the primary tumor (of micrometastatic disease, so logically, this is not clinically relevant and won't pan out). But I am hopeful whatever the nonsensical ranting that is happening on twitter does pan out and somehow this shows ablating cancers in polymetastatic diseases with a molecular inhibitor is somehow beneficial in non treated sites. The paper being negative regarding radonc is, I guess I would say uncalled for (but how many times do I say stuff I shouldn't? Daily? You guys have witnessed it, I hide behind an anonymous account and admit i'm an idiot 99% of the time), but if the actual stuff becomes relevant and we start seeing decreases in metastatic growth, that is a boon for RadOnc. Ralph isn't dumb, he's very intelligent imo (who cares about my opinion?), he knows that being flamboyant gets people talking about his pubs. Tbh idk, smart people... what should I think

I'm not sbrting 1 of 10 visible Mets. It's 1 of 1. This paper means zero to me as far as I can tell. it's still interesting, but clinically irrelevant.

 

[Ray D. Ayshun]

it’s not anti radiation at all

Sure, you're right, technically. But it's very easy to take this and run with it. That rectal trial last year wasn't anti radiation, but the newspaper articles made it such. I would argue that the fact this is in Nature Nature is a little anti radiation though. It seems like a slow month in natural science if this is sneaking in.

 

[drowsy12]

Glad he’s walking back his knee jerk hyperbole from before.

Also this surgeon is right. It also makes rad oncs look silly.

 

[Ray D. Ayshun]

Glad he’s walking back his knee jerk hyperbole from before.

Also this surgeon is right. It also makes rad oncs look silly.

"Radiation" is such a vague term for a Nature paper title. Is it dsbs, is it free radical damage to proteins, immune inhibition? It's some sort of localized thing that happens that manifests systemically. If they sbrt'd a normal tissue, would the same thing happen? I presume this was a control (can't read the paper).

Re cetuximab, a quote from RW suggests it's efficacy in this context.

“Interestingly, the combination of radiation and amphiregulin blockade decreased both tumor size and the number of metastatic sites,” Weichselbaum said.

In any case, this is interesting, irrelevant, and treatable. But ultimately NBD so long as it's not editorialized to inanity. Twitter makes anyone who participates look silly.

 

[drowsy12]

 

[BobbyHeenan]

Chirag Shah was right (how many times can we say this)....

We have a distribution problem, not a lack of residents. Churning out more residents just puts more rad oncs in the cities. "Solving" the rural rad onc issue is not accomplished by more residents.

First step to regaining trust in ASTRO/Red Journal....I want to see a "where are we now?" update to that red journal back-and-forth.

 

[DrProtonX]

Chirag Shah was right (how many times can we say this)....

We have a distribution problem, not a lack of residents. Churning out more residents just puts more rad oncs in the cities. "Solving" the rural rad onc issue is not accomplished by more residents.

First step to regaining trust in ASTRO/Red Journal....I want to see a "where are we now?" update to that red journal back-and-forth.

There’s a relatively easy fix for it. Increase the pay, give tax break and loan forgiveness.

 

[BobbyHeenan]

There’s an relatively easy fix for it. Increase the pay, give tax break and loan forgiveness.

Exactly...like he said a decade ago.

 

[Ray D. Ayshun]

ASTRO's plan is to eliminate those rural facilities. I think the ultimate goal is 0%.

 

[NotMattSpraker]

ASTRO's plan is to eliminate those rural facilities. I think the ultimate goal is 0%.

Eliminate? Or acquire and make it a network satellite covered part time by a physician?

Anecdote, but I'm seeing more of the latter.

 

[Ray D. Ayshun]

Eliminate? Or acquire and make it a network satellite covered part time by a physician?

Anecdote, but I'm seeing more of the latter.

sorry, yeah, that's true. Some of them are finding out those places are tough to staff at academic sat pay.

Edit: I'm one of those red dots fwiw

 

[CurbYourExpectations]

sorry, yeah, that's true. Some of them are finding out those places are tough to staff at academic sat pay.

Edit: I'm one of those red dots fwiw

Thanks for your service

 

[fiji128]

It looks like some lucky grad got he El Paso, Victoria and Lubbock TX jobs.

 

[alwaysbeIMRTing]

Another red dot checking in. Perhaps one of the loneliest ones on the map. I lasted < 2 years. The place is now staffing with non-BC locums and they will never be able to hire a new grad again.

All of those red dots should be making minimum 1M with 4 day week and 8 weeks PTO. And they better be nice to you. Really nice.
Unfortunately many want to bait-and-switch a new grad and chain them to the machine in BFE at MGMA median. When you complain that they lied, they show you the door, smear your name to future employers, and hire eager-to-please locums. Seen it happen to probably half a dozen peers at this point.

There can be some great rural solo employed gigs. In fact, I think this is the best job in the field. The happiest rad oncs I know are those in good solo gigs where they have total freedom. But you have to be very, very careful in vetting these. A new grad just doesn't have the experience to do this. Which is why the stats are showing over half leave in a few years.

 

[fiji128]

These Astro and IJROBP arguments are stupid. As said above, you have to make the job attractive enough for someone to take when there is a serious location handicap. But the underlying thinking is someone should magically want to fill these spots basically on the same terms as any other place with maybe a modest bump in pay.