Rad Onc Twitter

[evilbooyaa]

View attachment 386290

So, 25 x 2.5 Gy = 62.5 Gy is well tolerable.


However, isn't there a "hidden" dose escalation when going for hypofractionation with this regime?

Isn't 25 x 2.5 Gy = 62.5 Gy "more dose" than 33 x 2 Gy = 66 Gy?

With ab a/b of 3 Gy, 24 x 2.5 Gy would be equivalent to 33 x 2 Gy (BED 110 Gy).

Single arm ph II? The conclusion is that it is A SOC. That is a reasonable statement.

The tweeter stating that Hypo is THE SOC is excessive. Shouldn't be hard to do a ph III to prove it's just as safe compared to contemporary conventional fractionated.

Assuming A/b of prostate cancer is 3 in the recurrent setting.... that's a dangerous move!

View attachment 386301

Potentially practice changing

Confirms my practice. To take a potentially curative situation of lymph node recurrence of prostate cancer and put the patient on a palliative pathway by not doing ENRT, does not compute.

3% vs 25% chance of recurrence. I know which one I'd want if I was a patient! Their toxicity data for ENRT vs MDRT was basically the same as well.

Nodal SBRT in someone who has not prevoiusly seen elective nodal RT is not the answer.

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[RickyScott]

Red journal hot garbage article of the month:https://www.redjournal.org/article/S0360-3016(24)00626-6/fulltext

the authors are very proud;

https://x.com/lovelynancie/status/1788046574594969799?s=46&t=bNjInwwyz2DPnd4UFJOtbg

 

[Neuronix]

No confounding on that one at all...

My low income, low resource, tech illiterate, foreign language speaking patients often can't use that portal.

They're also the ones who need the most help.

What drives me crazy is when the health system says that's the only way to communicate with patients electronically. No text messages, no e-mails, when this is how a lot of people today communicate.

 

[Chartreuse Wombat]

No confounding on that one at all...

My low income, low resource, tech illiterate, foreign language speaking patients often can't use that portal.

They're also the ones who need the most help.

What drives me crazy is when the health system says that's the only way to communicate with patients electronically. No text messages, no e-mails, when this is how a lot of people today communicate.

Dead people cannot use the EHR.

 

[Ray D. Ayshun]

I thought virtual healthcare was the devil.

 

[OTN]

Red journal garbage article of the month:https://www.redjournal.org/article/S0360-3016(24)00626-6/fulltext

the authors are very proud;

https://x.com/lovelynancie/status/1788046574594969799?s=46&t=bNjInwwyz2DPnd4UFJOtbg

Patients who are with it enough to be able to use the internet and proactive in messaging to better than those who don't, News at 11.

On another note, I don't like the current "let's mock the incredibly dorky med student skits" posts going around the internet. Med students doing dorky skits has been around since time began. Good thing for my class the skit will never live on the internet forever.

 

[MidwestRadOnc]

Red journal garbage article of the month:https://www.redjournal.org/article/S0360-3016(24)00626-6/fulltext

the authors are very proud;

https://x.com/lovelynancie/status/1788046574594969799?s=46&t=bNjInwwyz2DPnd4UFJOtbg

"Sending portal messages to and being sent portal messages from radiation oncology providers were associated with better survival. Future studies should elucidate how best to support patient and provider engagement."

Is there even an editor at all? HTF did that meaningless abomination of words get published?

 

[NotMattSpraker]

"Sending portal messages to and being sent portal messages from radiation oncology providers were associated with better survival. Future studies should elucidate how best to support patient and provider engagement."

Is there even an editor at all? HTF did that meaningless abomination of words get published?

I noticed the editor in chief and the authors are in the same department.

Probably a coincidence.

 

[RickyScott]

Patients who are with it enough to be able to use the internet and proactive in messaging to better than those who don't, News at 11.

On another note, I don't like the current "let's mock the incredibly dorky med student skits" posts going around the internet. Med students doing dorky skits has been around since time began. Good thing for my class the skit will never live on the internet forever.

the mocking is abt DEI. students Dont seem representative of our society. If these were graduating airplane pilots, would some people have issues?

 

[Gfunk6]

Red journal hot garbage article of the month:https://www.redjournal.org/article/S0360-3016(24)00626-6/fulltext

This is a very thought-provoking article. It makes me think of similar correlations which ought to be investigated:

1. The net worth of patients is directly correlated to overall survival.
2. Your zip code is directly corrleated to overall survival.

Let's do it!

 

[MidwestRadOnc]

The skits were always stupid and a bad look for our profession.
But the reality is that it's too late anyway as our image to the public has been destroyed by pharma making us legal opiate/stimulant/benzo/weed dealers, the hospital lobby pointing the finger at rich doctors as the cause of high healthcare costs, the insurance industry dictating how we practice, and the legal profession completely owning us at every turn. Oh, and of course our own specialty organizations throwing us under the bus, then backing up to make sure we're good and dead. So sure, make all the stupid out-of-touch skits you want, med students! Somehow I don't think med students in China are doing this nonsense and posting on their version TikTok (even if they were allowed).

 

[RickyScott]

anecdotally, I have found that patients who fly to the cleveland clinic or mayo for heart surgery do better vs the local VA.

 

[Doctorer]

All these times I've stressed over elective nodal coverage, when i really should have been encouraging my patients to buy second homes.

 

[evilbooyaa]

All these times I've stressed over elective nodal coverage, when i really should have been encouraging my patients to buy second homes.

If you were a good doctor you would just refer all your patients to a name brand PPS-exempt cancer center

Those who can't go, I mean why even bother treating them, they're going to have worse outcomes since they're not of sufficient SES to have a good cancer outcome!

/s

 

[Ray D. Ayshun]

I think the red journal is just trolling us at this point. I guess they've won the Internet today.

 

[Gfunk6]

I can hear your RN, MBA overlord already:

"Hey [first name of physician], you are WAY behind on your EMR inbox patient messages. Didn't you see that new article that answering them improves patient survival? Chop, chop!"

 

[thecarbonionangle]

Red journal hot garbage article of the month:https://www.redjournal.org/article/S0360-3016(24)00626-6/fulltext

the authors are very proud;

https://x.com/lovelynancie/status/1788046574594969799?s=46&t=bNjInwwyz2DPnd4UFJOtbg

Generally speaking, it is a good example of the academic incentive to “publish”. If you have to put out things in numbers to get promoted, you end up putting out junk to get promoted.

 

[Gfunk6]

Generally speaking, it is a good example of the academic incentive to “publish”. If you have to put out things in numbers to get promoted, you end up putting out junk to get promoted.

 

[NotMattSpraker]

Generally speaking, it is a good example of the academic incentive to “publish”. If you have to put out things in numbers to get promoted, you end up putting out junk to get promoted.

It is so small minded that it genuinely makes me sad for the future of our field.

If I was a resident now, I would be working on a skillset to supplement clinical radiation oncology to make sure I stay valuable even if the field does not. Its not for me, but informatics is a very logical choice for many in this field. There are MDs in my organization that serve informatics leadership roles. I have no doubt this will have some demand pretty soon for both academic and community networks, and is easier to combine with clinical than procedural/surgical jobs. It seems like a really cool job overall and you can help a lot of people and other physicians.

Its also kind of a new job and Id guess you could try to even negotiate a bit, wouldnt that be something?

We should be training innovative clinical informatics researchers to do great things in our consolidated data driven future as part of our pivot.

Do something useful for the hospital and stimulating for yourself while you are forced to supervise the linac.

We should not be rewarding generating the easiest possible study out that you can poop out of the university network data warehouse.

 

[medgator]

Red journal hot garbage article of the month:https://www.redjournal.org/article/S0360-3016(24)00626-6/fulltext

the authors are very proud;

https://x.com/lovelynancie/status/1788046574594969799?s=46&t=bNjInwwyz2DPnd4UFJOtbg

Should have its own thread honestly at this rate. Weekly/monthly hot garbage out of the IJROBP....

 

[fiji128]

Should have its own thread honestly at this rate. Weekly/monthly hot garbage out of the IJROBP....

I was actually thinking of putting out a top 5 worst articles in the red journal list post on a yearly basis but never got around to it.

 

[evilbooyaa]

Should have its own thread honestly at this rate. Weekly/monthly hot garbage out of the IJROBP....

I think an entire thread devoted to just dunking in IJROBP day after day might come off as a bit antagonistic....

 

[pikachu]

I was actually thinking of putting out a top 5 worst articles in the red journal list post on a yearly basis but never got around to it.

Downside is that actually requires you to read the red journal

 

[RickyScott]

Downside is that actually requires you to read the red journal

To be fair, I didn’t read this pos article. I really doubt the authors are so stupid as to not understand causation/correlation but who knows. My best guess is that they are trying to make some larger point abt disparities and racial/class grievances, and perhaps Zionist oppressors.

 

[medgator]

I think an entire thread devoted to just dunking in IJROBP day after day might come off as a bit antagonistic....

Realistically, what was the last practice changing article you read in the red journal? When was it published? Last 5 practice changing articles? 10?