RO may have a role in this COVID crisis, but we need a clinical trial.....

[deleted969641]

This is an embarrassment. Junior high school science projects have been better conceived.

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[thecarbonionangle]

This is an embarrassment. Junior high school science projects have been better conceived.

It is easy to criticize. Man in the arena tried and failed. Good for them. Lack of innovation and sticking neck out is absoluteky slaughtering this field. We don’t need more turtles/catfish.

 

[thecarbonionangle]

Just need to open up the proton trials now.

low dose bath caused lymphopenia negating any benefit. no sparing of lymph nodes.

 

[radonc17]

This is an embarrassment. Junior high school science projects have been better conceived.

that’s very harsh

I was skeptical RE logistics given my time on COVID floors but they pulled it off

All patients received SOC with dexamethasone and still progressed to intubation so these very sick patients

They tried their best and did it on RCT. Just didn’t work

 

[Palex80]

low dose bath caused lymphopenia negating any benefit. no sparing of lymph nodes.

Actually we don't really know if treating the lymph nodes is necessarily a bad thing, do we?

In the second half of the 20th century total nodal irradiation after organ transplantation was tested. I believe it was even used in some autoimmune diseases, like multiple sclerosis. I'm not saying that it works, I'm saying there may be some rationale to it. And the old techniques from the first half of the 20th century (on which the whole LDRT-hype was based on) certainly did not spare lymph nodes. We simply do not know / understand enough.

 

[thecarbonionangle]

Actually we don't really know if treating the lymph nodes is necessarily a bad thing, do we?

In the second half of the 20th century total nodal irradiation after organ transplantation was tested. I believe it was even used in some autoimmune diseases, like multiple sclerosis. I'm not saying that it works, I'm saying there may be some rationale to it. And the old techniques from the first half of the 20th century (on which the whole LDRT-hype was based on) certainly did not spare lymph nodes. We simply do not know / understand enough.

There is plenty of data out there on lymphopenia outcomes with radiation and cancer therapy. Most recently i even saw data correlating it to vertebral body dosimetry. There could be something there. I would not dismiss it!

 

[evilbooyaa]

This is an embarrassment. Junior high school science projects have been better conceived.

Agree with other posters - I think it was a valid concept to try. They may continue to try to accrue on trial, or maybe it's a patient selection issue, but I would not do this off trial based on the IJROBP paper. It may not be completely dead, but that doesn't mean it had zero value in even attempting it.

 

[Palex80]

More Emory-propaganda...

 

[evilbooyaa]

More Emory-propaganda...

Man he's really tripling down on this despite another trial with more patients that refuted his data.... And I mean even his own trial data refutes his own conclusions if an unbiased observer looks at the data...

 

[Palex80]

New article from Spain.

Could pulmonary low-dose radiation therapy be an alternative treatment for patients with COVID-19 pneumonia? Preliminary results of a multicenter SEOR-GICOR nonrandomized prospective trial (IPACOVID trial) - Strahlentherapie und Onkologie

Purpose To evaluate the efficacy and safety of lung low-dose radiation therapy (LD-RT) for pneumonia in patients with coronavirus disease 2019 (COVID-19). Materials and methods Inclusion criteria comprised patients with COVID-19-related moderate–severe pneumonia warranting hospitalization with...

link.springer.com

I am having trouble comprehending if the trial was "positive" or not.

 

[TheWallnerus]

Mo Khan in news again!

COVID-19 renews interest in radiation, but doctors caution against pilgrimages to radon-filled mines

The gas is known to cause lung cancer, but some clinical trials suggest low-dose treatments may have benefits

www.phillyvoice.com

 

[evilbooyaa]

Mo Khan in news again!

COVID-19 renews interest in radiation, but doctors caution against pilgrimages to radon-filled mines

The gas is known to cause lung cancer, but some clinical trials suggest low-dose treatments may have benefits

www.phillyvoice.com

Holy **** people are crazily stupid. Just go get low-dose RT for your arthritis from @SneakyBooger

"Nobody got lung cancer from us because they didn't come back and tell us they got lung cancer". My goodness. I lost a few brain cells reading that article.

 

[Lamount]

Holy **** people are crazily stupid. Just go get low-dose RT for your arthritis from @SneakyBooger

"Nobody got lung cancer from us because they didn't come back and tell us they got lung cancer". My goodness. I lost a few brain cells reading that article.

...just wait for the radium cough drops.

What's the worst that could happen?

 

[TheWallnerus]

Holy **** people are crazily stupid. Just go get low-dose RT for your arthritis from @SneakyBooger

"Nobody got lung cancer from us because they didn't come back and tell us they got lung cancer". My goodness. I lost a few brain cells reading that article.

This article and thus Mo Khan are on one of the most visited websites in the world today, the Drudge Report

 

[BobbyHeenan]

Wasn't there some questionable articles about radiation hormesis and prolongation of life maybe a few years ago?

Like some apartment complex where they found low levels of radiation and the inhabitants lived longer and had less cancer?

I swear I read it (?or maybe it was a fever dream?).

Pretty spurious, but it was a good read when you're tired of reading about all the different ways to five fraction a breast.

 

[seper]

Don’t be rude to Mo. He writes your MOC questions, I’ve heard

 

[madchemist89]

Radiation hormesis, while not a currently accepted model, does have some support in the radiobiological literature. The currently accepted no threshold model represents the most conservative interpretation of limited data set derived mainly from the atomic bomb survivors, which has very large error bars at the low end of radiation. Hormesis may be legitimate we just lack the data at the low radiation end to know what is really going on. There is debate about what is the best model at this time. At least that is my understanding from my radbio course and reading.

 

[RadOncDoc21]

Wasn't there some questionable articles about radiation hormesis and prolongation of life maybe a few years ago?

Like some apartment complex where they found low levels of radiation and the inhabitants lived longer and had less cancer?

I swear I read it (?or maybe it was a fever dream?).

Pretty spurious, but it was a good read when you're tired of reading about all the different ways to five fraction a breast.

5 fractions better then no fractions which is where for some reason we are trying to go, while patients can stay on hormone/immunotherapy for 50 years past death.

 

[BobbyHeenan]

5 fractions better then no fractions which is where for some reason we are trying to go, while patients can stay on hormone/immunotherapy for 50 years past death.

I really hope the 5 fraction vs hormone therapy trial also includes cost of the inevitable Prolia , etc.

I had a 70+ yo patient yesterday tell me she spent nearly $1,000 on dental care getting ready for her prolia with her arimidex.

I swear 30/5 Livi APBI is amazing. I see little to no acute reaction when given every other day . I really hope just 30/5 turns out to be “the one.” Or maybe add on AI and have VERY quick trigger to stop it at first QoL detriment.

 

[medgator]

I really hope the 5 fraction vs hormone therapy trial also includes cost of the inevitable Prolia , etc.

I had a 70+ yo patient yesterday tell me she spent nearly $1,000 on dental care getting ready for her prolia with her arimidex.

I swear 30/5 Livi APBI is amazing. I see little to no acute reaction when given every other day . I really hope just 30/5 turns out to be “the one.” Or maybe add on AI and have VERY quick trigger to stop it at first QoL detriment.

That or the occasional clots or low grade uterine ca with tamoxifen etc. Endocrine therapy side effects really undersold imo by the med oncs and rad oncs doing these trials

 

[BobbyHeenan]

That or the occasional clots or low grade uterine ca with tamoxifen etc. Endocrine therapy side effects really undersold imo by the med oncs and rad oncs doing these trials

My anecdotal experience is 1/3 don’t even know they’re on it, another 1/3 are bothered but press on bc their docs told them to, and the final 1/3 are miserable and won’t do it after a few months off and on.

I know im biased but I’d swear 5 fractions breast radiation is less QoL detriment than the AI. If you count the prolia, hot flashes meds, dexa scans, etc it may even be less costly too.

 

[medgator]

My anecdotal experience is 1/3 don’t even know they’re on it, another 1/3 are bothered but press on bc their docs told them to, and the final 1/3 are miserable and won’t do it after a few months off and on.

I know im biased but I’d swear 5 fractions breast radiation is less QoL detriment than the AI. If you count the prolia, hot flashes meds, dexa scans, etc it may even be less costly too.

Even 16fx better. Some pts will come to me directly from the surgeon and refuse consult with med onc. Or if they agree to it and start therapy, a handful will stop after a few months. In any case 1-3 weeks has a lot less of an impact on their qol than 5 years of ai/tam therapy

 

[RadOncDoc21]

Even 16fx better. Some pts will come to me directly from the surgeon and refuse consult with med onc. Or if they agree to it and start therapy, a handful will stop after a few months. In any case 1-3 weeks has a lot less of an impact on their qol than 5 years of ai/tam therapy

Agree, by far I hear more complaints on the side effects from AI/Tamoxifen then the mild erythema I give.

 

[Radonky]

My anecdotal experience is 1/3 don’t even know they’re on it, another 1/3 are bothered but press on bc their docs told them to, and the final 1/3 are miserable and won’t do it after a few months off and on.

I know im biased but I’d swear 5 fractions breast radiation is less QoL detriment than the AI. If you count the prolia, hot flashes meds, dexa scans, etc it may even be less costly too.

Related https://ascopubs.org/doi/abs/10.1200/JCO.21.00831

 

[Palex80]

Whole lung irradiation as a novel treatment for COVID-19: Interim results of an ongoing phase 2 trial in India

Another single-arm trial, I'm looking forward to results of the randomized part.

 

[TheWallnerus]

Whole lung irradiation as a novel treatment for COVID-19: Interim results of an ongoing phase 2 trial in India

Another single-arm trial, I'm looking forward to results of the randomized part.

A little whole lung RT and ivermectin and we will get you fixed right up

 

[Mandelin Rain]

I'm willing to try whole lung XRT, horse de-wormer, and Windex infusions. But not a mask, that's a bridge too far.

 

[RadOncDoc21]

I'm willing to try whole lung XRT, horse de-wormer, and Windex infusions. But not a mask, that's a bridge too far.

Don’t forget invest in regeneron, get everybody sick and cash out!

 

[dieABRdie]

I swear 30/5 Livi APBI is amazing. I see little to no acute reaction when given every other day . I really hope just 30/5 turns out to be “the one.” Or maybe add on AI and have VERY quick trigger to stop it at first QoL detriment.

100% agree... the handful of patients I've done it for had no skin reaction at all. I'm adopting a bit slower just because the group isn't entirely in on it... but I think this will be the definite go to with longer follow up; especially with APM.

On the other hand.... it means 20% of our current daily workload will vaporize. Good for us.... bad for grads.

 

[RadOncDoc21]

100% agree... the handful of patients I've done it for had no skin reaction at all. I'm adopting a bit slower just because the group isn't entirely in on it... but I think this will be the definite go to with longer follow up; especially with APM.

On the other hand.... it means 20% of our current daily workload will vaporize. Good for us.... bad for grads.

Same here, I’ve been sprinkling it more into my practice just to add something exotic so that I will still keep seeing referrals for those patients who likely would have been sent out for omission of RT. I feel this still allows me to have one foot in the door before I’m closed out completely.

 

[TheWallnerus]

add something exotic

In the UK as of 2020 around 60% of all breast patients nationally were getting the 5 fraction regimen.

The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study

The indirect impact of the COVID-19 pandemic on cancer outcomes is of increasing concern. However, the extent to which key treatment modalities have b…

www.sciencedirect.com

 

[evilbooyaa]

100% agree... the handful of patients I've done it for had no skin reaction at all. I'm adopting a bit slower just because the group isn't entirely in on it... but I think this will be the definite go to with longer follow up; especially with APM.

On the other hand.... it means 20% of our current daily workload will vaporize. Good for us.... bad for grads.

But at least it's IMRT billing, which 26 / 5 WBI can't say.

 

[deleted1111261]

But at least it's IMRT billing, which 26 / 5 WBI can't say.

When I was in AZ, the difference in reimbursement between 16 fx 3D vs 5fx PBI was about $1100. Not small amount, but less than I thought.
I am a huge fan of it. Preferred, but it wreaks havoc if you switch everybody overnight. If done right you pick up a few more >70 yo patients that may have declined RT.

 

[TheWallnerus]

When I was in AZ, the difference in reimbursement between 16 fx 3D vs 5fx PBI was about $1100. Not small amount, but less than I thought.
I am a huge fan of it. Preferred, but it wreaks havoc if you switch everybody overnight. If done right you pick up a few more >70 yo patients that may have declined RT.

There's nothing stopping some private practice with MRgRT doing a few "medically necessary replans" during 5fx breast ("We saw some swelling") to eliminate that $delta$.

 

[Gfunk6]

There's nothing stopping some private practice with MRgRT doing a few "medically necessary replans" during 5fx breast ("We saw some swelling") to eliminate that $delta$.

Except for the fact that most payors won't pay for such charges.

 

[medgator]

Except for the fact that most payors won't pay for such charges.

Can't even get many payors to pay for igrt in multiple settings, let alone a replan

 

[OTN]

Except for the fact that most payors won't pay for such charges.

Nor should they, as we have zero good data which shows a benefit to adaptive replanning. Sure would be nice if we did. We do not. Oh well, I guess we'll just run another non-inferiority trial.

 

[Palex80]

Whole-lung low-dose radiation therapy (LD-RT) for non-intubated oxygen-dependent patients with COVID-19-related pneumonia receiving dexamethasone and/or remdesevir

Low-dose radiotherapy (LD-RT) has produced anti-inflammatory effects in both animal models and early human trials of COVID-19-related pneumonia. The r…

www.sciencedirect.com

They just can't let go.

The bias is especially strong when you name your trial after what you are hoping to be able to show...

"The Radiation Eliminates Storming Cytokines and Unchecked Edema as a 1-day Treatment for
COVID-19 (RESCUE 1-19) trial is an investigator-initiated, single-institution combined phase I/II trial."

 

[Mandelin Rain]

Whole-lung low-dose radiation therapy (LD-RT) for non-intubated oxygen-dependent patients with COVID-19-related pneumonia receiving dexamethasone and/or remdesevir

Low-dose radiotherapy (LD-RT) has produced anti-inflammatory effects in both animal models and early human trials of COVID-19-related pneumonia. The r…

www.sciencedirect.com

They just can't let go.

The bias is especially strong when you name your trial after what you are hoping to be able to show...

"The Radiation Eliminates Storming Cytokines and Unchecked Edema as a 1-day Treatment for
COVID-19 (RESCUE 1-19) trial is an investigator-initiated, single-institution combined phase I/II trial."

"Among people that responded to the therapy, the rate of response was 100%."

 

[Gfunk6]

"Among people that responded to the therapy, the rate of response was 100%."

If any of you live in areas of the country with vaccine "hesitancy" XRT may be your horse dewormer.

 

[Palex80]

Disclosures: First (CBH) and last (MKK) authors disclose a provisional patent and relationship with CureRays, Inc. They also disclose industry funding by Varian Medical Systems for future LD-RT efforts. No other relevant disclosures for remaining authors

CureRays - Company Profile - Tracxn

CureRays - Developer of X-ray imaging devices for the diagnosis of multiple diseases.

tracxn.com

Varian is funding LD-RT efforts?

 

[Palex80]

Why don't they simply match another 100 "control-patients" (who were never part of the trial itself) then claim it's 140 patient data?


"Reduced intubation"

From the manuscript:
Intubation-free survival was defined as the proportion of patients who were both alive and had not required intubation or mechanical ventilation during hospitalization.
Intubation rates were 14% with LD-RT compared to 32% without (p = 0.09). Intubation-free survival was 77% vs. 68% (p = 0.17)

Who cares if you die intubated or not? You still die.

 

[elementaryschooleconomics]

Why don't they simply match another 100 "control-patients" (who were never part of the trial itself) then claim it's 140 patient data?


"Reduced intubation"

From the manuscript:
Intubation-free survival was defined as the proportion of patients who were both alive and had not required intubation or mechanical ventilation during hospitalization.
Intubation rates were 14% with LD-RT compared to 32% without (p = 0.09). Intubation-free survival was 77% vs. 68% (p = 0.17)

Who cares if you die intubated or not? You still die.

They're still pushing this? Gah. I was with them in the beginning when we had nothing. That's not the case anymore. Maybe its use is justified in resource-poor environments with a Cobalt machine available?

"Intubation-free survival" is a stretch of an endpoint; p-hacking at its finest.

If I ever run out of gas on a road trip and coast down a hill to pull off the road, I'm telling my family I'm exploring my vehicle's "fuel-free travel distance" compared to historical controls. They would likely inform me that it doesn't matter if we made it that far with or without gas, at the end of the day, the car can go no further.

 

[fiji128]

They're still pushing this? Gah. I was with them in the beginning when we had nothing. That's not the case anymore. Maybe its use is justified in resource-poor environments with a Cobalt machine available?

"Intubation-free survival" is a stretch of an endpoint; p-hacking at its finest.

If I ever run out of gas on a road trip and coast down a hill to pull off the road, I'm telling my family I'm exploring my vehicle's "fuel-free travel distance" compared to historical controls. They would likely inform me that it doesn't matter if we made it that far with or without gas, at the end of the day, the car can go no further.

Its more about getting a publication for the academic promotion game then actually moving any useful science forward.

 

[TheWallnerus]

Its more about getting a publication for the academic promotion game then actually moving any useful science forward.

You know there is some truth to this. And it's saying something that young aspiring radiation oncologists... in NCI designated cancers... are feeling compelled to propel our specialty forward by making companies and/or doing research on 100% non-cancer things.

 

[medgator]

Its more about getting a publication for the academic promotion game then actually moving any useful science forward.

"Careerism"

 

[metallica81788]

You know there is some truth to this. And it's saying something that young aspiring radiation oncologists... in NCI designated cancers... are feeling compelled to propel our specialty forward by making companies and/or doing research on 100% non-cancer things.

Yes but how else were you ever going to find out about racial disparities in acoustic neuromas or how much the parking costs at MSKCC?

 

[evilbooyaa]

Its more about getting a publication for the academic promotion game then actually moving any useful science forward.

Or by "researching" "evidence" to help propel the portable RT machine company you are now a part of, become a successful CEO/CMO, and retire from the rat race that is academic radiation oncology!

I suppose a man can dream...

 

[Palex80]

So, I read the paper.

Dr. Khan claims on his Tweet that "adding LD-RT to standard drug treatments reduced biomarkers of inflammation"

Now let us have a look at patient demographics.

What do we have here?



Guess which drug reduces inflammation markers and was received by 95% of the LDRT group and only 50% of the so-called control group?

Yes, the winner is Dexamethasone!

 

[elementaryschooleconomics]

So, I read the paper.

Dr. Khan claims on his Tweet that "adding LD-RT to standard drug treatments reduced biomarkers of inflammation"

Now let us have a look at patient demographics.

View attachment 345347

What do we have here?



Guess which drug reduces inflammation markers and was received by 95% of the LDRT group and only 50% of the so-called control group?

Yes, the winner is Dexamethasone!

...yikes