Sure. And those systemic therapy trials deserve the same criticism. “Pharma gets away with weak data too” is not a methodological defense of weak radiation data.
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Is this true?
I agree that pharma has the power to run trials that are basically too large (Natalee trial comes to mind), but (to my knowledge) aside from watching MSI-H rectal cancer literally melt away with IO, no practice defining systemic therapy trial has anywhere close to 17 patients in an arm.
I was super supportive of these studies - glad we did them. That guy at Emory got a lot of **** for it but I felt it was appropriate to study
But as far as comparing to Pharma .. like I tell my kids, I don’t care how much iPad time Hunter gets, you’re in my house it’s my rules.
Im sorry this is a very wild statement and you are smarter than this.
pharma trials at large are at a million times higher level in terms of the bar than this study.
Don't get me started... "That guy at Emory" actually managed to "match" a control group, who only got half as much Dexamethasone as the LD-RT cohort.
Dexamethasone, the only drug that was (back then) proven truly beneficial for COVID.
95% of the LDRT and only 50% of the "matched" control group got it.
And then, the main conclusion of this paper was
"Adding LD-RT to standard drug treatments reduced biomarkers of inflammation"
Perhaps "adding LD-RT" was not the crucial part. Perhaps doubling the amount of people that got dexamethasone also reduced biomarkers of inflammation?
Also interesting, in the Emory-paper:
An ongoing phase III trial has been powered based on these findings. A sample size of 150 randomized patients will be used to determine LD-RT’s effect on intubation rates and intubation-free survival.
Where is that trial?
But "that guy at Emory" was not the only one.
Matthew Katz kept talking about the trial that he was running on LDRT for COVID.
ClinicalTrials.gov
clinicaltrials.gov
Did anyone ever see any of the results?
Spoiler: None were ever published.
Actually, we had a wonderful thread about those trials. Good times!
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There is some data somewhere that the vast majority of clinicaltrials.gov trials never see a publication light of dayDon't get me started... "That guy at Emory" actually managed to "match" a control group, who only got half as much Dexamethasone as the LD-RT cohort.
Dexamethasone, the only drug that was (back then) proven truly beneficial for COVID.
95% of the LDRT and only 50% of the "matched" control group got it.
View attachment 423123
And then, the main conclusion of this paper was
"Adding LD-RT to standard drug treatments reduced biomarkers of inflammation"
Perhaps "adding LD-RT" was not the crucial part. Perhaps doubling the amount of people that got dexamethasone also reduced biomarkers of inflammation?
Also interesting, in the Emory-paper:
An ongoing phase III trial has been powered based on these findings. A sample size of 150 randomized patients will be used to determine LD-RT’s effect on intubation rates and intubation-free survival.
Where is that trial?
But "that guy at Emory" was not the only one.
Matthew Katz kept talking about the trial that he was running on LDRT for COVID.
View attachment 423124
ClinicalTrials.gov
Did anyone ever see any of the results?
Spoiler: None were ever published.
Actually, we had a wonderful thread about those trials. Good times!
However, it is indeed very "back-patting" when people toot the "Here is my phase 3 trial" horn
AOC just recently said "Woke 1 was crazy" ... so was the COVID era
Don't get me started... "That guy at Emory" actually managed to "match" a control group, who only got half as much Dexamethasone as the LD-RT cohort.
Dexamethasone, the only drug that was (back then) proven truly beneficial for COVID.
95% of the LDRT and only 50% of the "matched" control group got it.
View attachment 423123
And then, the main conclusion of this paper was
"Adding LD-RT to standard drug treatments reduced biomarkers of inflammation"
Perhaps "adding LD-RT" was not the crucial part. Perhaps doubling the amount of people that got dexamethasone also reduced biomarkers of inflammation?
Also interesting, in the Emory-paper:
An ongoing phase III trial has been powered based on these findings. A sample size of 150 randomized patients will be used to determine LD-RT’s effect on intubation rates and intubation-free survival.
Where is that trial?
But "that guy at Emory" was not the only one.
Matthew Katz kept talking about the trial that he was running on LDRT for COVID.
View attachment 423124
ClinicalTrials.gov
Did anyone ever see any of the results?
Spoiler: None were ever published.
Actually, we had a wonderful thread about those trials. Good times!
The studies were not good. I agree with you. I still stand by my thoughts from late spring 2020 - if nothing works and these people are going to die anyway, why not try something novel ? Retrospectively, looks like it doesn't work. But, if it did, that would have been amazing.
Iirc because Ralph W and David Kirsch said the 1 Gy of radiation was going to kill people
I am for trying novel things.
I am not for pushing LDRT for covid the way it was pushed. May I even remind you of this gem?
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Agree with that, as well, but you’re focusing on mere facts and reality 😜
2020 was a weird time depending on where you lived. I think many would have accepted this type of treatment if the other option was vent > death.
FletchersGarb
Full Member
what is CureRays and is still alive??
Look at a chicken. That’s a dinosaur. And that’s what gastric cancer is to rad onc: chicken feed.
Still amazes me to this day that Joel Tepper got gastric cancer. That’s like Lou Gehrig getting Lou Gehrig’s disease.
Malcolm mattes started out as an Astro authority on DEI and racial grievances, then arthritis and now stomach radiation.
And Joel declined radiation..
If he went to a decent place for surgery, why not?
Just because DM is an idiot doesn't mean David Samadi is NOT an idiot.
Grifters going to grift.
Only in America
You are just jealous because you never thought of five fraction SBRT-lite for OA.
Also, you are probably not aware that CyberKnife does not, in fact, use radiation. I submit to you:
Not sure if they are using fairy dust or anti-matter . . . but it works without radiaiton.
Not having worked much with a CK before, but I thought there needed to be a substantive amount of MUs to allow for it to make any sense with splitting beam angles etc. Previous med physicist told me a much higher dose/fraction needed. I don’t even want to know what the plan looked like at 0.5-0.6 Gy lol. We are running into this issue with concomitant boost (don’t get me started on that vs SiB )with mod hypofrac breast, it just adds just a tiny amount of MUs which limits conformality.
But yes that is a funny screenshot to see
You’re out of your element Donny
The FT fracas continues!
I love Ryckman. The guy is is guileless. But two quotes remain forefront of mind:
"History is written by the winners*." - George Orwell
"I have always depended on the kindness of strangers." - Blanche DuBois
Probably shouldn't bring up that IMRT parachuted into rad onc clinics circa 2000-2005 and became the ~100% used RT treatment for prostate cancer based on little to no clinical data. Or that "IMRT" can now mean IMRT (and a rectal spacer, sotto voce 😉)
* diagnosers
I love Ryckman. The guy is is guileless. But two quotes remain forefront of mind:
"History is written by the winners*." - George Orwell
"I have always depended on the kindness of strangers." - Blanche DuBois
Probably shouldn't bring up that IMRT parachuted into rad onc clinics circa 2000-2005 and became the ~100% used RT treatment for prostate cancer based on little to no clinical data. Or that "IMRT" can now mean IMRT (and a rectal spacer, sotto voce 😉)
* diagnosers
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found this message in my inbox today. Nothing to do with radiation oncology and blatant political activism. (and yes I believe climate change should be taken seriously)
Hi everyone,
Session 4 of the ACRO–ROVER Climate-Resilient Radiation Oncology Educational Series is approaching: September 1st, 2026 12:00–1:00 PM ET
Global Perspectives
Doctors Rohini Bhatia MD, Phylicia Odume DO, MS, May Abdel-Wahab MD, PhD, & Joseph Weygand PhD will share real-world examples from diverse settings showing how climate disrupts radiation oncology access globally and in underserved areas, along with innovative resilient care models that work across resource levels.
Hi everyone,
Session 4 of the ACRO–ROVER Climate-Resilient Radiation Oncology Educational Series is approaching: September 1st, 2026 12:00–1:00 PM ET
Global Perspectives
Doctors Rohini Bhatia MD, Phylicia Odume DO, MS, May Abdel-Wahab MD, PhD, & Joseph Weygand PhD will share real-world examples from diverse settings showing how climate disrupts radiation oncology access globally and in underserved areas, along with innovative resilient care models that work across resource levels.
Climate change and the burning of fossil fuels has been associated with an increased production of medical linear accelerators and proton machines
The biggest climate change comes from proton centers who force patients to drive or fly across the country to get treatment.
More generally speaking, large hospital/academic consolidation results in the same.
More generally speaking, large hospital/academic consolidation results in the same.
global perspectives = third worldism.
Is it? political activism?
Or is it addressing a real circumstance?
I mean, in locals where relocation due to fires, grid failures due to usage/temp or unreliable water supplies have actually been things, presumably there are some models for therapeutic radiation that are more robust?
Advocating for increased payment is political activism. Advocating for differential proton reimbursement is probably grift.
I'm also confused about the third worldism comment? I guess a gleeful embrace of the righteous capitalist hegemon is the way? For everybody?
The problem - to me - is that for people that do come on to the side of the environmentalists (me included) - where do we stop? One could say without renewable energy in the long term, we will end our civilization, so maybe we mobilize more and more of our radiation oncology research to go in that direction? Because, frankly, a few articles and webinars will not do it. But, that will crowd out oncology research.
I tweeted something along these lines about education/SES. We know education improves SES. And we know improved SES leads to better cancer outcomes. But, it's not a good use of all (or even some?) of our research in radiation oncology to improve educational outcomes in America, b/c then the argument extends to this being the primary thing we look at.
If we can fix the environment, stop climate change, improve educational outcomes, end poverty, etc - all cancer outcomes will improve. But, I think that's not quite in our wheelhouse. Or if it is, then it will crowd out other important research more directly linked to better cancer care.
Well of course.
But playing victim to an ACRO session, when frankly, it's not crowding out anything (there are a litany of granular dosimetry papers that have occupied our trade publications for years, provided very little value, and are never accused of "crowding out") ...is just silly.
It is OK to discuss health impacts of climate change, health care disparities, health equity and other topics. Calling these things political activism rings of "wokeness" itself.
Yeah, fair enough. Not saying they should go to jail for publishing it or anything 🙂
To paraphrase Aaron Neville, I don’t know much… but I know a rad onc looking into climate change will never directly help cure a single cancer patient. However it could make the rad oncs doing the research have a happy, altruistic feeling, and that could lead to them having better patient satisfaction scores and getting a raise.
Is number two through ten 5 fraction or less RT in the most common cancers
Number one is more LDRT so older people can sort their recyclables more efficiently
All sounds good. So, should I stop racing cars for fun? Because I like to race cars for fun. I also like to slalom ski, wakeboard, and wakesurf for fun. Should I stop doing that as well? How about traveling for fun, should I stop that?
Spoiler: I'm not gonna.
What about in-person meetings? Will the academicians throughout the US stop going to ASTRO, ACRO, and ESTRO? Will they start recommending patients get treated as close to their home as possible?
Spoiler: They're not gonna.
Spoiler: I'm not gonna.
What about in-person meetings? Will the academicians throughout the US stop going to ASTRO, ACRO, and ESTRO? Will they start recommending patients get treated as close to their home as possible?
Spoiler: They're not gonna.
Is money green in England?
Weygand Laboratory
Corresponding author of our pilloried ACRO session above seems like the real deal. Involved with getting Malawi their first public radiotherapy center.
Most of his work seems like full on biological imaging geek fest.
Shameful really how we respond to good faith behaviors.
Well, I have no issue with bringing radiotherapy to less developed nations. That's wonderful.
I am all for environmental protections, but I become conflicted when academics will tell me that I should consider fractions and impact on climate when making a decision. This is not hypothetical - there is a paper on this and that's what the authors suggest.
I simply don't think this is logic-based or evidence based. Are you all referring patients to centers that are closer to their home, as long as they have the technology?
I've never gotten a patient from the big AMC 45-50 minutes from us because we were closer. They have taken my curative patients and recommended patients drive over an hour each way for 7 weeks for something I could have done myself. And, I know that one of the physicists there is very, very interested in the environmental impact of oncologic care. I would suggest to them to "think global, act local".
But, I do want to be careful in naming them, as I really hope my kids can go there for college one day.
I am all for environmental protections, but I become conflicted when academics will tell me that I should consider fractions and impact on climate when making a decision. This is not hypothetical - there is a paper on this and that's what the authors suggest.
I simply don't think this is logic-based or evidence based. Are you all referring patients to centers that are closer to their home, as long as they have the technology?
I've never gotten a patient from the big AMC 45-50 minutes from us because we were closer. They have taken my curative patients and recommended patients drive over an hour each way for 7 weeks for something I could have done myself. And, I know that one of the physicists there is very, very interested in the environmental impact of oncologic care. I would suggest to them to "think global, act local".
But, I do want to be careful in naming them, as I really hope my kids can go there for college one day.
I was a bit imprecise in my language. Rad oncs looking into climate change absolutely cure people. The act of looking at climate change, or researching it, or making an effort to curb it, by a rad onc, will never directly cure a cancer.Weygand Laboratory
geiselmed.dartmouth.edu
Corresponding author of our pilloried ACRO session above seems like the real deal. Involved with getting Malawi their first public radiotherapy center.
Most of his work seems like full on biological imaging geek fest.
Shameful really how we respond to good faith behaviors.
In that vein, I would even go as far to say that increased air pollution from fossil fuels in a “third world” country would be correlated with better radiotherapy access.
Having spent a lot of my life in ground zero for climate change and the third world, the delivery of radiation is largely unaffected by climate change. Poverty due to corruption and lack of human capital is primary driver of lack of all medical services in third world nations. Third worldism is a real political philosophy that blames all grievances on the west and has permeated academia. Ie a corrupt Marxist third world country with a median iq of 75 blames lack of medical resources on climate change.
www.zinebriboua.com
Naming the Threat: Third-Worldism
“If tolerance is born of doubt, let us teach everyone to doubt all the models and utopias, to challenge all the prophets of redemption and the heralds of catastrophe.
www.zinebriboua.com
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