UCSF announces proton therapy

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IonsAreOurFuture

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Hot off the presses, UCSF announces a new proton center:


I actually thought UCLA, UC Irvine or City of Hope would have beaten them to it, what with the Bay Area being hard to find land in, but it sounds like a brown site power plant is being redeveloped.

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Hot off the presses, UCSF announces a new proton center:


I actually thought UCLA, UC Irvine or City of Hope would have beaten them to it, what with the Bay Area being hard to find land in, but it sounds like a brown site power plant is being redeveloped.
Not saying it won’t happen, but this is the 5th time UCSF announced a new proton center.
 
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Still wild that Florida has 10+ proton centers and the state of California has.... I believe just the one in San Diego?

Florida man medical care strikes again
 
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Still wild that Florida has 10+ proton centers and the state of California has.... I believe just the one in San Diego?

Florida man medical care strikes again
Well, you forgot to count Loma Linda. But that is more like an undead center.
 
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Florida is fee for service and capital of Medicare fraud and other schemes.

California is Kaiser and value based care.

There are things I dislike about California and California healthcare but proton gravy train proton grift is not one of its faults.
 
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Well, you forgot to count Loma Linda. But that is more like an undead center.

Technically, you are correct.

However, unless that center has undergone huge upgrades (not likely), I would NOT consider Loma Linda to be anything resembling contemporary proton therapy. I mean most if not all of the 4 centers in Tampa are likely better than getting treated at the Loma Linda proton center.
 
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did they ever update machine to pencil beam etc or add igrt? Surely they aren’t using same proton tech from the 90s?
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I've talked to physicists who were formerly employed by Loma Linda and their machine is on life support. The amount of manpower required to keep that thing humming is truly astounding.

For those of you that are familiar with Warhammer 40k lore:

Loma Linda is the Carrion Lord of protons for whom a thousand physicists are sacrificed every day, so that it may never truly die.
 
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Technically, you are correct.

However, unless that center has undergone huge upgrades (not likely), I would NOT consider Loma Linda to be anything resembling contemporary proton therapy. I mean most if not all of the 4 centers in Tampa are likely better than getting treated at the Loma Linda proton center.
Have heard something like opposed laterals for prostate?
 
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with only one field treated on a given day!
 
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Ugh. As a uro in the region I forsee a sudden increase in billboards and patient interest. UCSF radoncs and uros will go from loudly anti-proton (as those patients were flying off to san diego) to suddenly being able to offer advanced technology you can't get in the community.

Here's hoping bay area nimbyism keeps this from happening until after i retire.
 
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Ugh. As a uro in the region I forsee a sudden increase in billboards and patient interest. UCSF radoncs and uros will go from loudly anti-proton (as those patients were flying off to san diego) to suddenly being able to offer advanced technology you can't get in the community.

Here's hoping bay area nimbyism keeps this from happening until after i retire.
If it is a single gantry set up, they will probably use it judiciously as they will be limited to 30 pts a day, half of whom will be kids.
 
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did they ever update machine to pencil beam etc or add igrt? Surely they aren’t using same proton tech from the 90s?
Loma Linda is still using passive scatter and lacking CBCT image guidance, so not really comparable to a newer center from 2015 onward.

The accelerator is going on 35 years old - started treating in 1990 - which is really amazing for a piece of medical hardware. They've treated well over 20,000 patients with that one machine pumping out protons.
 
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Loma Linda is still using passive scatter and lacking CBCT image guidance, so not really comparable to a newer center from 2015 onward.

The accelerator is going on 35 years old - started treating in 1990 - which is really amazing for a piece of medical hardware. They've treated well over 20,000 patients with that one machine pumping out protons.

Amazing in the worst possible way
 
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Loma Linda is still using passive scatter and lacking CBCT image guidance, so not really comparable to a newer center from 2015 onward.

The accelerator is going on 35 years old - started treating in 1990 - which is really amazing for a piece of medical hardware. They've treated well over 20,000 patients with that one machine pumping out protons.
Any patient treated after 2010 (2015?) was 100% unnecessary
 
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They gave us TACE vs. Protons, which everyone should be using to advocate for SBRT over TACE. Good trial.

 
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They gave us TACE vs. Protons, which everyone should be using to advocate for SBRT over TACE. Good trial.


Finally taking a page from the pharma playbook i see.

Compare new/expensive treatment against old/ineffective drug and not against effective/cost effective treatment.

See the 10 trials comparing ARSI's to lupron in mCRPC, mCSPC, nmCRPC, etc and none comparing them to abiraterone.
 
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Finally taking a page from the pharma playbook i see.

Compare new/expensive treatment against old/ineffective drug and not against effective/cost effective treatment.

See the 10 trials comparing ARSI's to lupron in mCRPC, mCSPC, nmCRPC, etc and none comparing them to abiraterone.
If this will at least stop a single IR from recommending TACE over SBRT, I'll call it a win.

It won't though.
 
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If this will at least stop a single IR from recommending TACE over SBRT, I'll call it a win.

It won't though.
Should be happening already, but we both know IR isn't ever going to do that (at least not in the community setting IMO)


 
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If this will at least stop a single IR from recommending TACE over SBRT, I'll call it a win.

It won't though.

I know at least one center in my town was doing a lot of TACE about a year ago. Like wayyyy too much. It seems to have stopped entirely, now just doing Y-90.

There is hope!
 
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I know at least one center in my town was doing a lot of TACE about a year ago. Like wayyyy too much. It seems to have stopped entirely, now just doing Y-90.

There is hope!
My neighborhood they all do Y90 and don't look twice at SBRT

Thankfully med Onc pays more attention to us as an alternative
 
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Finally taking a page from the pharma playbook i see.

Compare new/expensive treatment against old/ineffective drug and not against effective/cost effective treatment.

See the 10 trials comparing ARSI's to lupron in mCRPC, mCSPC, nmCRPC, etc and none comparing them to abiraterone.
?? TACE even though not the most effective treatment (SBRT is) is still widely widely utilized for HCC.

Is the suggestion that TARE is much better than TACE? IR doesn't care what they do as long as they're the ones controlling the patient. Vast majority of HCC and liver met patients who are candidates for both SBRT and TACE/TARE are MUCH better served by SBRT than they are with any sort of IR intervention.
 
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?? TACE even though not the most effective treatment (SBRT is) is still widely widely utilized for HCC.

Is the suggestion that TARE is much better than TACE? IR doesn't care what they do as long as they're the ones controlling the patient. Vast majority of HCC and liver met patients who are candidates for both SBRT and TACE/TARE are MUCH better served by SBRT than they are with any sort of IR intervention.
Agreed. We have multiple negative trials for TARE in HCC as well as in metastatic colorectal, but despite that, the pipeline (for HCC especially) often starts with IR in terms of LRT.

I try to change it because I enjoy beating my head against the wall.
 
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I've been beating my head against a wall for years trying to explain to IR that heterogeneity in dose distribution matters, so, yes, while you can get up to 3000 Gy in a tumor from Y90, you can also get only 30 Gy, so I would prefer SBRT for a solitary lesion over "super selective" Y90.

At this point I believe they are willfully trying not to understand my point.
 
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I've been beating my head against a wall for years trying to explain to IR that heterogeneity in dose distribution matters, so, yes, while you can get up to 3000 Gy in a tumor from Y90, you can also get only 30 Gy, so I would prefer SBRT for a solitary lesion over "super selective" Y90.

At this point I believe they are willfully trying not to understand my point.
Same. The concept of Dmin is lost on them.

One finally understood when sure enough the HCC relapsed in the corner of the tumor that was under perfused/dosed.
 
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I've been beating my head against a wall for years trying to explain to IR that heterogeneity in dose distribution matters, so, yes, while you can get up to 3000 Gy in a tumor from Y90, you can also get only 30 Gy, so I would prefer SBRT for a solitary lesion over "super selective" Y90.

At this point I believe they are willfully trying not to understand my point.

It is nearly impossible to explain since their livelihood depends on them not understanding it
 
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It can be nice to have lipo-iodal as a “fiducial” but I’m not convinced the tace in combo with sbrt does any heavy lifting.
Yup, this is part of the game I play as well. I just think of the lipiodol as a fiducial which may or may not treat their cancer.
 
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It can be nice to have lipo-iodal as a “fiducial” but I’m not convinced the tace in combo with sbrt does any heavy lifting.
I think it may add a bit to the efficacy, but yes, the lipiodol makes the treatment so much easier (assuming it stick around).
 
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Problem is you need the fiducial, which is placed by IR. You’ve already lost the patient right there.
 
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No not every case. May need a biopsy though. The gist of my statement is that many of the patients will see IR first. IR is going to go ahead and treat with one of their modalities regardless of evidence. Of course not every IR will do that, but many will.
 
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No not every case. May need a biopsy though. The gist of my statement is that many of the patients will see IR first. IR is going to go ahead and treat with one of their modalities regardless of evidence. Of course not every IR will do that, but many will.
Sometimes just need an afp to diagnose hcc, moreover a lot of these patients are getting evaluated at bigger centers and getting sent back to med onc in my experience if they aren't surgical candidates. Those pts then are getting referred to us more often it feels like

Same with liver mets
 
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Sometimes just need an afp to diagnose hcc, moreover a lot of these patients are getting evaluated at bigger centers and getting sent back to med onc in my experience if they aren't surgical candidates. Those pts then are getting referred to us more often it feels like

Same with liver mets
Don't even need AFP if LIRADS-5
 
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You don’t need fiducials
Eh, i think there's some variability here. There are different ways to skin the cat, but putting in fiducials in a good KPS patient will allow you to come up with a better plan 99% of the time. Whether that's clinically relevant or not is a different question, I'll admit.
 
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Eh, i think there's some variability here. There are different ways to skin the cat, but putting in fiducials in a good KPS patient will allow you to come up with a better plan 99% of the time. Whether that's clinically relevant or not is a different question, I'll admit.
I'm a believer in prostate. Not in lung. Can't say one way or the other regarding liver but I definitely have seen cases where the lesion isn't as clear and I think they would have helped
 
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I'm a believer in prostate. Not in lung or bone. Can't say one way or the other regarding liver but I definitely have seen cases where the lesion isn't as clear and I think they would have helped

How does one justify putting a fiducial in a solid tumor that is sitting in air? I never understood it.

Bone! Haha come on.
 
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I don’t treat a ton of liver, but I’m not sure I’ve ever confidently seen an actual lesion on CBCT. Without a fiducial or lipiodal, are you all lining up external contour of liver/vascular structures and assuming the lesion is in correct spot or can you actually visualize the lesion?
 
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