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- Dec 17, 2007
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Whoever this person is, im not a fan of their posts. They seem pompous and rude. I saw him come after CS once on APBI. Not a good look for our field. They used to go by “5-UTR” as their name
Whoever this person is, im not a fan of their posts. They seem pompous and rude. I saw him come after CS once on APBI. Not a good look for our field. They used to go by “5-UTR” as their name
Just totally randomly, and this is unfortunately calling myself out for how much I pay attention to SDN and for how long, but:He's passionate but seemingly aggressive. Pretty classy response from Chris Parker.
Prob a Zapf Dingbats in the tweets and a Times New Roman in the streets. Imagine running an international phase III trial set to define practice and having some anonymous yayhoo roll up on twitter saying you feloniously misinterpreted your results.Whoever this person is, im not a fan of their posts. They seem pompous and rude.
The internet: an existential threat to the human race.Prob a Zapf Dingbats in the tweets and a Times New Roman in the streets. Imagine running an international phase III trial set to define practice and having some anonymous yayhoo roll up on twitter saying you feloniously misinterpreted your results.
“their”…”they”… “oh who am i kidding it’s a dude”Whoever this person is, im not a fan of their posts. They seem pompous and rude. I saw him come after CS once on APBI. Not a good look for our field. They used to go by “5-UTR” as their name
Just totally randomly, and this is unfortunately calling myself out for how much I pay attention to SDN and for how long, but:
Radiation Oncology must truly be on the ropes if @evilbooyaa is posting on the weekend.
I disagree that MFS predicts survival in the postoperative setting. Happy to be corrected but my understanding is that none of the trials included in the ICECAP analysis were postopIf there is actually a MFS benefit of adjuvant RT compared to not adjuvant (forget whether it's salvage vs not receiving RT at all), then yes, adjuvant therapy is warranted in anyone who is at signficant risk of being lost to follow-up.
This is why we still recommend adjuvant RT or chemo for stage I seminoma who is not going to do surveillance properly.
We 'over-treat' the vast majority of patients who get adjuvant therapy to improve local recurrence, QOL, all sorts of endpoints that aren't overall survival in lots of clinical scenarios outside of prostate cancer. Metastasis-free survival in prostate cancer is a predictor of overall survival.
Combine this with the fact that people are extrapolating RADICALS/RAVES to Gleason 9+ disease patients (when most of these patients were Gleason 7) and I think there needs to be some serious questions about adjuvant RT.
You are looking at prostate cancer in a vaccuum, not realizing (through no fault of your own) that adjuvant therapy with radiation (across all cancers) has pretty much always worked exactly the way you are describing (and feeling discomfort with).
The unique issue with prostate cancer is that there is a toxicity of surgery (urinary incontinence) can persist for upwards of 3-6 months until peak recovery, which is such an extreme outlier compared to other post-surgical situations where we are routinely delivering radiation therapy. And then there's a concern that delivering radiation will 'stop' recovery of that toxicity.
Fair point and I may have overstepped the data. If others have time and can investigate this I'd be appreciative.I disagree that MFS predicts survival in the postoperative setting. Happy to be corrected but my understanding is that none of the trials included in the ICECAP analysis were postop
If there is actually a MFS benefit of adjuvant RT compared to not adjuvant (forget whether it's salvage vs not receiving RT at all), then yes, adjuvant therapy is warranted in anyone who is at signficant risk of being lost to follow-up.
This is why we still recommend adjuvant RT or chemo for stage I seminoma who is not going to do surveillance properly.
We 'over-treat' the vast majority of patients who get adjuvant therapy to improve local recurrence, QOL, all sorts of endpoints that aren't overall survival in lots of clinical scenarios outside of prostate cancer. Metastasis-free survival in prostate cancer is a predictor of overall survival.
Combine this with the fact that people are extrapolating RADICALS/RAVES to Gleason 9+ disease patients (when most of these patients were Gleason 7) and I think there needs to be some serious questions about adjuvant RT.
You are looking at prostate cancer in a vaccuum, not realizing (through no fault of your own) that adjuvant therapy with radiation (across all cancers) has pretty much always worked exactly the way you are describing (and feeling discomfort with).
The unique issue with prostate cancer is that there is a toxicity of surgery (urinary incontinence) can persist for upwards of 3-6 months until peak recovery, which is such an extreme outlier compared to other post-surgical situations where we are routinely delivering radiation therapy. And then there's a concern that delivering radiation will 'stop' recovery of that toxicity.
I have overstepped as well, sort of. According to the data supplement from the ICECAP study two trials of adjuvant XRT (SWOG and ARO) included (n=800) of the more than 12,700 patients included. I believe Dan Spratt has a twitter post on this but I don't have an account on XFair point and I may have overstepped the data. If others have time and can investigate this I'd be appreciative.
*EDIT* - I have moved this to its own thread given the fact that I have committed sufficient time and effort to an informative-style post that I want to separate it from the Rad Onc Twitter megathread.
The key phrase there is "anyone who is at significant risk of being lost to follow up"
There is ample evidence that as docs we are horrible at predicting who will and won't be compliant with our treatment recommendations. As such, if we base major treatment decisions on that assessment, we are doing a disservice to a lot of patients, as well as introducing sticky ethics of application of our own implicit bias in assessing likely adherence.
FWIW I do agree with some of your concerns, that a GG2 pT3a negative margins is a very different patient from pT3b GG5 with extensive margin. Adjuvant vs. salvage in the latter patient is mostly academic, as they will almost certainly need xrt it's just a matter of time. I still will await post-operative PSA and delay treatment if undetectable. If PSA persistent it's considered adjuvant anyways. If undetectable, then i'll buy time with watching the psa until detectable, and then depending on how they are recovering start ADT and wait a bit longer.
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