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madchemist89 said:
While not standard of care, libtayo can be very effective in skin cancer. NEJM phase two study showed a 50% pathCR rate in unresectable disease.
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That was all resectable, though the phase I NEJM in R/M has ~50% ORR. Not sure I see the difference in outcomes between lancet oncology follow up paper, admittedly with only 18 mo follow up and the TROG surg+RT data. But as usual med oncs out there doing whatever based on phase II data, never mind the 11% that didn't make it to surgery/ progressed to unresectable.
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I have been seeing the same pattern in the (rare) locally/regionally advanced merkel cell carcinomas.

The patients get avelumab up front, then resection and then the fight ensuits (esp. in those with favorable response), whether or not they should get adjuvant RT. Someone should think about running a trial on primary RT+IO for larger / nodal-positive MCC.
 
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drowsy12 said:
Im okay with med oncs starting with cemiplimab in advanced cases, but rad onc should follow along and should be able to consolidate, patients should not be on the drug forever in the locally advanced setting

And the decision should happen in coordination with rad onc as well. I trust my med oncs for these cases, but they also discuss the cases with me. Cemiplimab is an amazing drug for cutaneous SCC.
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Yes, in the cases scenarios as above they get me involved and are not on the cemiplimab indefinitely. I've had I think 3 cases and two of them responded really well, we rode it out 6 months then switched to radiation. One had minimal response. Not sure what the best answer is in these cases, but indefitive cemiplimab doesn't seem to be a good plan.
 
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CaesarRO said:
One of the other articles I Read explicitly said not Prostate Cancer.

I'm thinking colorectal or bladder...
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Bladder makes sense. He likely had a TUR-B and needs to go "regularly" back to the clinic for instillations.
 
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TheWallnerus said:
It is my sincerest hope that the Royal Rectum is cancer free
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all I know is his royal behind will not be waiting in an NHS queue even if they have to use the service to keep up appearances.
 
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This was sent to me. I guess Ron can’t use RTT after his name?


1707435552747.png
 
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TheWallnerus said:
Wow I have known doctors allegedly to have committed massive fraud and nothing ever happened to their license. This must be salacious.

Bill Hader Popcorn GIF by Saturday Night Live
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I was told that it was on the rtt proffesional site but then taken down after Ron called because it had been up for 10 years. Easy to call and verify.
 
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TheWallnerus said:
Wow I have known doctors allegedly to have committed massive fraud and nothing ever happened to their license. This must be salacious.

Bill Hader Popcorn GIF by Saturday Night Live
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It’s a joke. I know of one that has killed a half dozen people through incompetence/apathy and nothing happened other than him amassing a nearly 9 figure wealth from booming in the golden days.
 
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BobbyHeenan said:
I agree.

A sad part is that in a huge chunk of states (Palmetto as the LCD), Medicare will literally not pay for IMRT for APBI as of 2024 for R sided cases.

It is criminal that in a number of states , Medicare won’t cover 30/5 imrt and there should be more uproar about this.
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Hot take: IMRT should be standard of care for all breast cancer radiation.
 
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If it wasnt for the billing, we would all use IMRT way more. Even for many palliative cases IMRT is better.

IMRT should be standard of care for many cancers currently
 
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thecarbonionangle said:
If it wasnt for the billing, we would all use IMRT way more. Even for many palliative cases IMRT is better.

IMRT should be standard of care for many cancers currently
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My guess is that is how most countries operate. Wouldn’t surprise me if USA had higher percent of 3d vs peers.
 
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Perhaps I just missed it, but ABR-MOC no longer requiring SA-CME? Glad that grift is over.
 
I continue to get conflicting reports on this. I was just told that like 75 CME are required plus a QC project and OLA. This was from the ABR.

1707766105532.png

Technically, no SA-CME as you say, but I think a lot of people conflate that with all we gotta do is OLA.
 
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The QC project can also be participation in a qualifying activity, correct?

ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org

I think most people do at least one of them, even if just by accident.

Realistically, it's attend a couple tumor boards, review a handful of charts prospectively, answer some of the easiest questions ever, and most importantly... PAY YOUR DUES.

Which honestly, is probably about right for MOC.
 
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Mandelin Rain said:
The QC project can also be participation in a qualifying activity, correct?

ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org

I think most people do at least one of them, even if just by accident.

Realistically, it's attend a couple tumor boards, review a handful of charts prospectively, answer some of the easiest questions ever, and most importantly... PAY YOUR DUES.

Which honestly, is probably about right for MOC.
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I think like 10 tumor boards in 3 years is good. I was thinking ola would be good enough as all of this is a joke. 3 tumor boards a year?
 
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There is a weird requirement that you need SA-CME if you do not comply with OLA (which was around well before they discontinued required SA-CME for all). I think you can choose to not comply with OLA and take an exam instead (???) and maybe you also need to do SA-CME if you choose that route. As others said, the ABR did away with the required PQI project, and now allow for "Documentation of individual active participation in any of the activities in the table on this page meets the criteria for Continuing Certification (MOC) Part 4 requirements."


ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org
 
radiaterMike said:
There is a weird requirement that you need SA-CME if you do not comply with OLA (which was around well before they discontinued required SA-CME for all). I think you can choose to not comply with OLA and take an exam instead (???) and maybe you also need to do SA-CME if you choose that route. As others said, the ABR did away with the required PQI project, and now allow for "Documentation of individual active participation in any of the activities in the table on this page meets the criteria for Continuing Certification (MOC) Part 4 requirements."


ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org
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"Local or national leadership role in a national/international quality improvement program, such as Image Gently, Image Wisely, Choosing Wisely, or other similar campaign"

🤮
 
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RickyScott said:
My guess is that is how most countries operate. Wouldn’t surprise me if USA had higher percent of 3d vs peers.
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I doubt that Canada and UK do IMRT for > 5% of breast cases. Here, breast IMRT keeps creeping up
 
seper said:
I doubt that Canada and UK do IMRT for > 5% of breast cases. Here, breast IMRT keeps creeping up
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With EZ fluence/forward planning, I get plenty of whole breast plans that look great without the need for imrt, even when treating regional nodes. The imrt plans that treat regional nodes can dump plenty of dose into the other breast/cw, even heart if you aren't careful with avoidance structures

Outside of apbi vmat, not really seeing the role for it routinely TBH
 
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seper said:
I doubt that Canada and UK do IMRT for > 5% of breast cases. Here, breast IMRT keeps creeping up
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Hmm. IMPORT is an acronym for intensity modulated partial organ radiotherapy which I guess is how the majority if not plurality of their (the Brits) patients are treated.

What’s that? IMPORT is not “true” IMRT? Well. Americans don’t speak true English. Canadians sure as hell don’t. ;)

 
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is there any significance to this month's red journal cover image?
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given this (perhaps too few details for some)
1707915022240.png



Also: just noticed this thread had >1M views, which also seems significant.
 
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