If radiation were a drug.... Full editorial on my blog. #radonc

Latest article is out on RTOG 0924. Bit of history, hopefully some memorable context. Cover 0924, 9413, GETUG, SPPORT and POP-RT. All linked up in a reference document. Thankfully, I get to simplify now back towards my training days roots.

Thinking about this - very good list of general topics, but I would add - one really important item. Understand your value - if you don't know your value in the market and how that value is determined, you will be underpaid - almost certainly. You can alter your yearly income

on blog at

"In oncology we have the wonderful opportunity to be impactful in the lives of those we care for. At the same moment, those same patients and families have tremendous impact on our own lives." A story about the great opportunities we have each day.

Maybe this helps to get this one out the door...

Two randomized prospective trials in the head and neck space have dropped. What can we learn? Are they as different as the conclusions appear or is there more in common beneath the headlines?

This is really the point - as the standard arm (external treatment) has moved from 6-6.5 wks to often 5 days or 3 wks, the need to compromise local control with IORT has become much less needed. External treatment simply continues to improve at a rapid rate.

Todd Scarbrough does it again. This is his as well. Amazing context in the 340B relative to our field. 50% of cancer patients will receive radiation, yet look at that growing gap in favor of drugs.

Convince me its worth reading - clearly a modeling study - just look at the "data". Won't even mention, that it is mainly confounding - again just from curves. At 6 months there is 7x risk? That would be a massive rt dose w leukemias. How does this get published?

I work with plastics to put it either low lat or low medial (lowest risk chest site) based on tumor IF I'm even going to consider protons. Most I exclude as zero dose gets across these and planning is very compromised IMO. Course exchange is other option.

hmmm... another 24 hours and I'm still not sold. Probably a smaller shift than ADT+/- Abi and Abi would be <2k for those 10 months. And I have no idea on "perfect" sequencing.

Please double check me. This says at end of tx about 33% more patients in IMRT arm couldn't swallow anything but liquids. And chewing is similar at around 30% for "not even soft foods". Very straightforward, but just trying to self-check.

This is around 85k of costs per pt. COI: We do Pluvicto in our clinic. Is PFS an appropriate endpoint? A delay of <1 yr to ADT when alt is ADT with this saved for later? And (I think) about the half the cohort had already seen ADT. What am I missing that adds to my excitement?

Torpedo: Any insights on taste, saliva, chewing, swallowing all (if anything) tilting towards IMPT. Yet wt loss far worse? Ex: 20% fewer couldn't swallow, 35% less limited to liquids only. Yet more wt loss at 1 yr. Was any live discussion showing wt over time to help validate?

Ah... It was MDACC trial slide placed into a run of torpedo slides. You can see the tag lower right and colors scheme diff. But it certainly was posted as one of 12. But I guess it was included as a reference.

Any comments on this? HN is tough road. That said, I personally can't recall a single peg at 12 months. Wt loss should track but I'd prefer the pattern rather than 12 month compare. Slide speaks to the difficulty of treatment for some in this cohort

Below are PACE-B criteria - some of these are UIR in the US. Yet we hit 95%+ control. Even the argument for genomics in this subset fall apart mathematically. (T2c did include about half staged with MRI under "clinical").

back to back pts - both UIR. Neither ADT. >3yrs - both with PSA <0.2. Clearly a cohort that we can de-escalate some of these, yet NCCN lags with no alternate path even included... And yet data says only 1 in 3 see any benefit. And we know it causes toxicity.

This QoL curve is from this recent PhIII Cx trial looking at chemotherapy radiation. RFS and OS lean towards (not significant but both trend) better with chemotherapy. But toxicity was high. Gr3 and Gr4 AE jumped from 15% RT to 43% CRT. Honestly here, I think the bump in AE is