Rad Onc Twitter

[Gfunk6]

As soon as they do away with the lymphoma section.

But . . . what will test takers do the night before the Oral Board exam? It has historically been for memorizing the names, doses, and infusions schedule for R-CHOP and ABVD.

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[Palex80]

But . . . what will test takers do the night before the Oral Board exam? It has historically been for memorizing the names, doses, and infusions schedule for R-CHOP and ABVD.

ABVD is so .... 00s
Embrace Brentuximab and IO.

 

[evilbooyaa]

Because it's in the "oral abstracts session".

I'm not sure what you mean by that. I figure at ASCO, a negative trial for benefit of RT would be a plenary.

Versus a trial that shows benefit of RT would be relegated to 'oral abstracts'.

I mean... it appears to be Embargoed. Does that mean it's more likely to be a positive result (showing benefit of post-op RT)??

Let speculation run wild.

My prediction - RT will benefit LC, with a numerically, but not statistically significant benefit to OS.

 

[MidwestRadOnc]

But . . . what will test takers do the night before the Oral Board exam? It has historically been for memorizing the names, doses, and infusions schedule for R-CHOP and ABVD.

If you don't know the doses for RCHOP you will still pass. But still kinda wild people say they were asked that in the limited time available on a exam to determine clinical competence as a rad onc.

 

[drowsy12]

Because it's in the "oral abstracts session".

I mean it's a large cooperative group trial. of course it would be an oral.

the plenaries are out, public knowledge, saw yesterday on twitter (X if you're nasty). all major trials.

 

[NotMattSpraker]

Arthritis and duputyren's section?

It would be so Rad Onc to fail oral boards because you didnt design your 3 Gy in 6 fractions field the way some boomer likes it that he read about in a book one time.

Or like you treated a person who was 49 years and 360 days old.

 

[7bobthebuilder7]

Because it's in the "oral abstracts session".


For a long follow-up? Oh, wait. It's pancreas.

You wait long enough and the pancreas curves do seperate actually so RT is great for those end survivors when biology is favorable... how you find those patients is the hard part. I can see it being positive... will it change practice, doubt it.

 

[A_DeMichele]

You wait long enough and the pancreas curves do seperate actually so RT is great for those end survivors when biology is favorable... how you find those patients is the hard part. I can see it being positive... will it change practice, doubt it.

Current practice as I see it (academic centers on East Coast) is still to refer post-op pancreas for XRT consult after chemo... I've been treating 2-3 pts per year

 

[pikachu]

I'm not sure what you mean by that. I figure at ASCO, a negative trial for benefit of RT would be a plenary.

Versus a trial that shows benefit of RT would be relegated to 'oral abstracts'.

I mean... it appears to be Embargoed. Does that mean it's more likely to be a positive result (showing benefit of post-op RT)??

Let speculation run wild.

My prediction - RT will benefit LC, with a numerically, but not statistically significant benefit to OS.

This is a trial that is doomed by design flaws, blowing itself up midway through by shifting gears from gem/erlotinib to dealers choice chemo. No matter what the actual results are it’s going to be critiqued, rightfully, as uninterpretable. Not to mention the publication lag time (WHY ?!?!?!?!?!). Hundreds of patients, millions of dollars, for bupkis. So depressing

 

[RickyScott]

Unless positive margins most academic centers that I encounter do not send pancreas for post ok xrt

 

[MidwestRadOnc]

I just got a referral for standard frac pre-op. Med onc requesting 6 weeks RT because that’s the way they always do it.

 

[medgator]

Unless positive margins most academic centers that I encounter do not send pancreas for post ok xrt

+Nodes also

 

[Palex80]

You wait long enough and the pancreas curves do seperate actually so RT is great for those end survivors when biology is favorable...

Here are the curves from CONKO-001, which studied adjuvant Gemcitabine vs. observation after resection of pancreatic cancer.
The trial ran more than 20 years ago.

RTOG 0848 was designed to show a benefit with RT and enhance the the upper curve...

 

[drowsy12]

If we want to talk about positive trials in GI - CROSS is absolutely cooked. The FLOT vs CROSS trial is a plenary at ASCO.

https://x.com/doccatenacci/status/1783161243735400808?s=46&t=rlNDSubO1Ki87D

 

[Ray D. Ayshun]

If we want to talk about positive trials in GI - CROSS is absolutely cooked. The FLOT vs CROSS trial is a plenary at ASCO.

https://x.com/doccatenacci/status/1783161243735400808?s=46&t=rlNDSubO1Ki87D

Noticed this when trying to figure out who that was tweeting.

UChicago oncologist settles SEC charges, pleads not guilty to criminal insider trading - The Cancer Letter

In the morning of Nov. 10, 2020, Daniel V.T. Catenacci, director of the GI oncology program at the University of Chicago, did some trading, court documents say. Catenacci bought 8,743 shares of Five Prime Therapeutics Inc., knowing that the company was about to release positive results from a...

cancerletter.com

In any case, most of my patients have been interested in trying to keep their esophagus.

 

[RickyScott]

+Nodes also

More often than not in my experience, academic centers reason that nodes are systemic issue and dispense with local postopntherapu

 

[Palex80]

I am dropping my DREs

 

[Palex80]

If we want to talk about positive trials in GI - CROSS is absolutely cooked. The FLOT vs CROSS trial is a plenary at ASCO.

https://x.com/doccatenacci/status/1783161243735400808?s=46&t=rlNDSubO1Ki87D

And even if FLOT does not overperform CROSS, the problem is just around the corner... FLOT+IO has already demonstrated better results (so far only in terms of pCR in the Matterhorn and Keynote585 trials).

So, if:

FLOT = CROSS
&
FLOT + IO > FLOT

Then the medoncs will safely assume that

FLOT+IO > CROSS

 

[Palex80]

Noticed this when trying to figure out who that was tweeting.

UChicago oncologist settles SEC charges, pleads not guilty to criminal insider trading - The Cancer Letter

In the morning of Nov. 10, 2020, Daniel V.T. Catenacci, director of the GI oncology program at the University of Chicago, did some trading, court documents say. Catenacci bought 8,743 shares of Five Prime Therapeutics Inc., knowing that the company was about to release positive results from a...

cancerletter.com

In any case, most of my patients have been interested in trying to keep their esophagus.

Well, that guy should be careful about what he is tweeting. He said in his tweet that ESOPEC is "negative RT Ph3 study".

Although all we know is that ESOPEC will be presented at ASCO.

Maybe ASCO should step in?

 

[TheWallnerus]

View attachment 385983

I am dropping my DREs

I never miss a chance to post this

 

[TheWallnerus]

Noticed this when trying to figure out who that was tweeting.

UChicago oncologist settles SEC charges, pleads not guilty to criminal insider trading - The Cancer Letter

In the morning of Nov. 10, 2020, Daniel V.T. Catenacci, director of the GI oncology program at the University of Chicago, did some trading, court documents say. Catenacci bought 8,743 shares of Five Prime Therapeutics Inc., knowing that the company was about to release positive results from a...

cancerletter.com

In any case, most of my patients have been interested in trying to keep their esophagus.

Interesting website with interesting articles, and this is a snippet from one of 'em. I need to adjust my med onc salary range.

 

[Fpg1245]

Well, that guy should be careful about what he is tweeting. He said in his tweet that ESOPEC is "negative RT Ph3 study".
View attachment 385984

Although all we know is that ESOPEC will be presented at ASCO.

Maybe ASCO should step in?

This dude is out of control. Has a consulting company and clearly likes to be abrasive and make waves to draw attention.

Is this what all GI med oncs are like? Because he’s definitely not the first one I’ve seen adopt this approach

 

[Ray D. Ayshun]

This dude is out of control. Has a consulting company and clearly likes to be abrasive and make waves to draw attention.

Is this what all GI med oncs are like? Because he’s definitely not the first one I’ve seen adopt this approach

None of the local med ones seem interested in flot. Rt clearly beneficial in esophagus wrt cure. Not the case in pancreas. I had to beg a patient to see a thoracic surgeon today re stage I nsclc. This is a convoluted way of saying medoncs in my neck of the woods like chemorads for esophagus and rectal,and would have to see superiority of chemo to switch, and patients in my neck of the woods want to avoid surgery.

 

[Fpg1245]

None of the local med ones seem interested in flot. Rt clearly beneficial in esophagus wrt to cure. Not the case in pancreas. I had to beg a patient to see a thoracic surgeon today re stage I nsclc. This is a convoluted way of saying medoncs in my neck of the woods like chemorads for esophagus and rectal,and would have to see superiority of chemo to switch, and patients in my neck of the woods want to avoid surgery.

Yeah in the community they don’t seem as enthusiastic. But academic places seem almost dogmatic in their approach and are prepared to eviscerate if you don’t go along.

 

[Mandelin Rain]

FLOT great for gastric. Chemorads great for esophageal/GE Jxn. Absent some huge signal, let's just leave that alone.

 

[medgator]

FLOT great for gastric. Chemorads great for esophageal/GE Jxn. Absent some huge signal, let's just leave that alone.

Bingo. Never get gastric referrals anymore unless the surgery really ****ty

 

[drowsy12]

FLOT great for gastric. Chemorads great for esophageal/GE Jxn. Absent some huge signal, let's just leave that alone.

I’m expecting the fact that it’s a plenary that there will be a OS benefit to FLOT.

 

[Mandelin Rain]

I’m expecting the fact that it’s a plenary that there will be a OS benefit to FLOT.

 

[Fpg1245]

Noticed this when trying to figure out who that was tweeting.

UChicago oncologist settles SEC charges, pleads not guilty to criminal insider trading - The Cancer Letter

In the morning of Nov. 10, 2020, Daniel V.T. Catenacci, director of the GI oncology program at the University of Chicago, did some trading, court documents say. Catenacci bought 8,743 shares of Five Prime Therapeutics Inc., knowing that the company was about to release positive results from a...

cancerletter.com

In any case, most of my patients have been interested in trying to keep their esophagus.

Seems the only way to get ahead in that town is to be a criminal

He seems to have a way of getting inside information though

 

[thesauce]

And even if FLOT does not overperform CROSS, the problem is just around the corner... FLOT+IO has already demonstrated better results (so far only in terms of pCR in the Matterhorn and Keynote585 trials).

So, if:

FLOT = CROSS
&
FLOT + IO > FLOT

Then the medoncs will safely assume that

FLOT+IO > CROSS

Cross used 4140. I know of no one that uses that dose. Maybe it’s more popular overseas?

Doubt this will change much - the same medoncs that hate RT will continue to hate RT.

 

[Ray D. Ayshun]

Cross used 4140. I know of no one that uses that dose. Maybe it’s more popular overseas?

Doubt this will change much - the same medoncs that hate RT will continue to hate RT.

Tbh, if we really wanted to go nonoperative we'd combine flot and cross + 9 gy, which I thought was happening somewhere.

 

[drowsy12]

https://x.com/subatomicdoc/status/1784214640697721342?s=46&t=rlNDSubO1Ki87D

 

[thecarbonionangle]

Ok guys take a seat. We are here to remember our great esteemed friend, the field of GI rad onc. These are our mates, the pancreas, the stomach, the rectum, the esophagus. RIP. AAAAAAAAAMEEEEEEEEN.

 

[RadOncDoc21]

Ok guys take a seat. We are here to remember our great esteemed friend, the field of GI rad onc. These are our mates, the pancreas, the stomach, the rectum, the esophagus. RIP. AAAAAAAAAMEEEEEEEEN.

Don’t forget Liver where we were never invited to the party and have to crash in from time to time!

 

[medgator]

Don’t forget Liver where we were never invited to the party and have to crash in from time to time!

Speak for yourself... Sbrt >> tace/rfa

 

[RadOncDoc21]

Speak for yourself... Sbrt >> tace/rfa

Me recommending SBRT ar our Liver Tumor Board:

 

[RickyScott]

Cross used 4140. I know of no one that uses that dose. Maybe it’s more popular overseas?

Doubt this will change much - the same medoncs that hate RT will continue to hate RT.

I use it. If anything some papers showed a trend to better outcomes with lower doses. Not sure how boosting tissue that ends up in pathology helps. Almost never see positive margin in ge junction. Plus a pCR denies pt opdivo. My preference is larger fields and lower doses here

 

[CaesarRO]

I use it. If anything some papers showed a trend to better outcomes with lower doses. Not sure how boosting tissue that ends up in pathology helps. Almost never see positive margin in ge junction. Plus a pCR denies pt opdivo. My preference is larger fields and lower doses here

Interesting logic. Try not to get the pCR so they can get immunotherapy?

My hopes are with organ preservation a la SANO. If we can skip the esophagectomy, that's a huge win win win

 

[thesauce]

Interesting logic. Try not to get the pCR so they can get immunotherapy?

Agree. Kind of unbelievable and there are people supporting the comment!

 

[drowsy12]

That statement is not one I agree with but it’s also true that the difference between 41.4 and 50.4 has no real bearing in this setting

 

[medgator]

I use it. If anything some papers showed a trend to better outcomes with lower doses. Not sure how boosting tissue that ends up in pathology helps. Almost never see positive margin in ge junction. Plus a pCR denies pt opdivo. My preference is larger fields and lower doses here

I think this is a situation where package time matters like in head and neck.... Just dosepaint 2 a day to involved gtv and get it done in 6 weeks or less. Not sure I buy that 41.4 is enough here, esp where surgery might not happen

 

[medgator]

That statement is not one I agree with but it’s also true that the difference between 41.4 and 50.4 has no real bearing in this setting

I've seen a few centers dose paint the gtvs to 56... That might help. Not sure I buy that 41.4 is worth anything. In the case maybe just do the Walsh 40/15 regimen and get 'er done in 3 weeks.

I'll do 41.4 when I'm forced into by dose constraints on a ridic tumor

 

[drowsy12]

We are talking about resectable esoohagus cancer here in the context of the forthcoming CROSS vs FLOT data

 

[medgator]

We are talking about resectable esoohagus cancer here in the context of the forthcoming CROSS vs FLOT data

Resectable changes, esp based on how far away you are from a center you trust to do an esophagectomy/LAD and if the pt is marginal

 

[drowsy12]

Resectable changes, esp based on how far away you are from a center you trust to do an esophagectomy/LAD and if the pt is marginal

I do 50.4 in practice too, in case they don't go to surgery.

I am speaking more on the interpretation of the trial. If there is a big OS benefit, I don't think there's much of a case to be made that the outcomes would have been different if the dose was 50.4 and not 41.4.

at any rate, we will see the data soon enough.

 

[Reaganite]

Agree. Kind of unbelievable and there are people supporting the comment!

I actually love Ricky's logic. In my mind, goal of XRT in the context of planned resection is sterilization of microscopic disease with as minimal morbidity as possible. Why do you need a pCR if you're gonna take it out anyway? pCR to chemo is a different story. I'll take that all day, every day.

 

[MidwestRadOnc]

Resectable changes, esp based on how far away you are from a center you trust to do an esophagectomy/LAD and if the pt is marginal

In the rural community you have no idea if the patient is going to get surgery or not. But anybody who thinks 50 gy is a curative dose for GI adenocarcinoma is delusional.

 

[RickyScott]

I actually love Ricky's logic. In my mind, goal of XRT in the context of planned resection is sterilization of microscopic disease with as minimal morbidity as possible. Why do you need a pCR if you're gonna take it out anyway? pCR to chemo is a different story. I'll take that all day, every day.

It’s been a while since i looked at the study, but i was under the impression that failure to receive opdivo is worse than not achieving a pCR. At my hospital pts always go to surgry

 

[seper]

41.4 Gy is hard to salvage and palliate… at the time of relapse people would ask at tumor board if you’ve done the right thing.. at least after I’ve given 50.4 Gy I can say yes

 

[MidwestRadOnc]

Med oncs here are giving IO upfront with chemo then chemoRT then surgery