From ASTRO's facebook posting. Protons showing worse toxicity than photons? Better spin that!
Will the med oncs and drug reps used to tell me that erbitux skin toxicity in h&n was related to response?!?!
Just when I thought the integrity of the red journal couldn't get any worse...Here's the link to the IJROBP paper it's referencing: https://www.redjournal.org/article/S0360-3016(19)30647-9/fulltext
Or.... ya know.... bolus works really well too if you just wanna roast the skin.
We're probably only halfway down.Just when I thought the integrity of the red journal couldn't get any worse...
Women should be counseled regarding the possibility of increased grade 2 toxicities, though this may present a dosimetric advantage for physicians when treating patients in the post-mastectomy setting, or when skin was involved on presentation.
Well the med oncs and drug reps used to tell me that erbitux skin toxicity in h&n was related to response?!?!
I know... I was being tongue in cheek about proton cheerleaders who might try to insinuate the same thing. I've generally found erbitux to be quite tough and toxic for patients, certainly much more so than weekly low dose cisplatin which is a lot cheaper, and the recent data in hpv has not looked great eitherFor head and neck cancer patients receiving cetuximab + RT there are still observations supporting this:
Correlation between the severity of cetuximab-induced skin rash and clinical outcome for head and neck cancer patients: The XXXX experience
The purpose of the present study was to evaluate severity of cetuximab-induced skin rash and its correlation with clinical outcome and late skin toxicity in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy and cetuximab.Analysis ...www.ncbi.nlm.nih.govPredictive Value of Cetuximab-Induced Skin Toxicity in Recurrent or Metastatic Squamous Cell Carcinoma of the Head and NECK
Background: Skin toxicity is a common adverse event during cetuximab (Cmab) treatment. However, few reports have investigated the correlation between skin toxicity and the efficacy of Cmab in patients with recurrent or metastatic squamous cell carcinoma ...www.ncbi.nlm.nih.gov
I am not aware of any data against that theory.
I know... I was being tongue in cheek about proton cheerleaders who might try to insinuate the same thing. I've generally found erbitux to be quite tough and toxic for patients, certainly much more so than weekly low dose cisplatin which is a lot cheaper, and the recent data in hpv has not looked great either
The ASCO Post
www.ascopost.com
How the heck are we ever going to show CMS the relative cost effectiveness of photon radiation in the curative and palliative oncology management while the powers at be are trying to find ways to positively spin the clinical toxicity of financially toxic proton therapy?Heart and lung dose improvement is almost a non problem. There are one to two million women in America walking around who’ve had their breast irradiated and doing just fine heart and lung wise. Skin toxicity is perhaps one thousand times more a tangible, visible toxicity in breast RT than heart and lung toxicity. If I tried to start selling a new RT treatment for breast cancer that showed significant increases in toxicity and patient complaints, with no cure rate increase, and it was a lot more expensive... that would ordinarily be controversial.
Am I the only one who doesn't think this is so controversial? The authors argue the dosimetric advantage that protons provide regarding lung and heart dose can come at increased grade 2 dermatitis... but in breast cancer, sometimes skin is target.
Whether the decreased lung and heart dose is worth the increased financial toxicity is another conversation entirely.
A cardiothoracic anesthesiologist.
I wonder if RadOncs should trow around titles like gastrointestinal radiation oncologist more often.
Usually means somebody who is CV trained (works open heart cases, can do TEE, etc.).
I'm disappointed (and will continue to be) at physicians and medical centers that are willing to charge US citizens 150k cash, out of pocket, for a therapy that does not have any proven benefit compared to a therapy covered by medical insurance. Whether they do this for money, personal belief, or something else is irrelevant to me.
Are there many centers that do this? I agree, that's terrible.
The academic proton centers I know will only use protons when it has been approved by insurance... or for a wealthy foreign patient whom has made the trip to the US specifically for protons. Of course, they don't "deny" protons to people who's insurance doesn't approve (because that would also be unethical), but everyone works hard to dissuade them. I have never seen anyone who isn't a billionaire pay out of pocket.
My experience with one particular very large, very well-known academic medical center has not been the same as yours.
Should be reworded
Women should be counseled regarding the possibility of increased financial toxicity to the proton center if they refuse treatment, though this may present an economic advantage for physicians when treating patients with a modality that costs 300%+ more than photons with inferior outcomes.
having an unnecessary 10k in medical expenses, even if the treatment they would get would be inferior in my mind.
I am not aware of any data against that theory.