The Enemy

[deleted1111261]

Unfortunately that is the reality of being at the end of a referral chain. Referral to a center 5 miles away is not a big deal, especially if your Rad Onc system is actually on a separate EMR from the hospital that you work for. That sounds like a systems issue, not really an issue of the breast surgeon in question.

no, she meant they have their own in house emr that isn’t connected to hospital. And … I don’t think the emr is doing the heavy lifting. I’m suspecting the fact that she owns part of the Linac is the likely culprit.

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[sirspamalot]

You mean gi? I had to put one 28fx guy on break for A week for diarrhea. Data suggests it's a gi not gu issue with hypo

The guy has unexpectedly high GU symptoms. The data at least from one major randomized trial showed slight differences, but I've tended to find that GU tends to outweigh GI when it comes to the bothersome level for patients. Imodium works better than Ditropan and most guys don't wake up to go poo, but have many years of experience getting up to wee. YMMV.

Reference: The estimated cumulative 5 year incidence of Radiation Therapy Oncology Group (RTOG) grade 2 or worse bowel and bladder adverse events was 13·7% (111 events) and 9·1% (66 events) in the 74 Gy group, 11·9% (105 events) and 11·7% (88 events) in the 60 Gy group, 11·3% (95 events) and 6·6% (57 events) in the 57 Gy group, respectively. No treatment-related deaths were reported.

 

[RickyScott]

The guy has unexpectedly high GU symptoms. The data at least from one major randomized trial showed slight differences, but I've tended to find that GU tends to outweigh GI when it comes to the bothersome level for patients. Imodium works better than Ditropan and most guys don't wake up to go poo, but have many years of experience getting up to wee. YMMV.

Reference: The estimated cumulative 5 year incidence of Radiation Therapy Oncology Group (RTOG) grade 2 or worse bowel and bladder adverse events was 13·7% (111 events) and 9·1% (66 events) in the 74 Gy group, 11·9% (105 events) and 11·7% (88 events) in the 60 Gy group, 11·3% (95 events) and 6·6% (57 events) in the 57 Gy group, respectively. No treatment-related deaths were reported.

Yip, occasionally I have to break treatment on hypofrac prostate for urinary issues

 

[evilbooyaa]

Yip, occasionally I have to break treatment on hypofrac prostate for urinary issues

That hasn't happened to me - how are your bladder DVHs and homogeneity in terms of not roasting Urethra?

no, she meant they have their own in house emr that isn’t connected to hospital. And … I don’t think the emr is doing the heavy lifting. I’m suspecting the fact that she owns part of the Linac is the likely culprit.

Ah, OK. Yes, there are frequently perverse incentives to referral patterns especially in smaller communities and this is one you're unlikely to break (unless you can convince the system to hire another breast surgeon).

 

[RickyScott]

That's a rarity for me - how are your bladder DVHs and homogeneity in terms of not roasting Urethra?


Ah, OK. Yes, there are frequently perverse incentives to referral patterns especially in smaller communities and this is one you're unlikely to break (unless you can convince the system to hire another breast surgeon).

It’s very rare for me, but it never happens with conventional treatment. In my career, have had one bad rectal bleed and it was also with hypofrac.

 

[Mandelin Rain]

I've settled into 28 fractions as my go to regimen. Too many acute urinary problems with 20 fractions, imo.

 

[sirspamalot]

68/25 PSV, 70/28 P alone or if there is a big (100cc+) prostate +/- very high AUA (25+) with bothersomeness.. then no hypofrac.

 

[sirspamalot]

68/25 PSV, 70/28 P alone or if there is a big (100cc+) prostate +/- very high AUA (25+) with bothersomeness.. then no hypofrac.

Mark Storey just amped POP-RT

welp glad I choose/chose it as my go to then.. Like Homer says...

Woohoo