Podcasts about radonc

In this episode, we're joined by Dr. Daniel Indelicato and Dr. Rohan Deraniyagala, two distinguished experts whose work is transforming the landscape of pediatric oncology. With decades of combined experience and groundbreaking research, Danny and Rohan offer invaluable insights into the world of proton therapy. Listen as they unpack the distinct advantages of proton therapy, shedding light on why this method is especially beneficial for children by minimizing harmful side effects and enhancing quality of life post-treatment.The views expressed in this podcast are those of the interviewees. By listening to this, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating.  Consult your own physician for any medical issues that you may be having.  This entire disclaimer also applies to any guests or contributors to the podcast.  Under no circumstances shall Ion Beam Applications SA (IBA), any guests or contributors to the podcast, or any employees, associates, or affiliates of IBA be responsible for damages arising from use of the podcast.

Join Radiating Hope for a climb at Mt Hood: https://secure-web.cisco.com/1n7iiZ7BuD_zMeQIf6zbr9PDPGuit_9x5tQEZ8_qjtJkPUNtM8ViRpMp36FhrRrPnTTc-gldRGqCWkDSbevXQE462yscQGpxC1eVFVIVeRXKnXUj7qA7JOJz-lVj6E7BSk6ZoQkXd5OoT1czTSJPeFDFHi7qHHrAUXeVpCbAQLKC09qOaLrXMjzebeJo3vu5ziGzknc9ZUbmrz6Xrv_GqK3tuYZ7ZvUmnzN6hn2ul9EXh7nFP0nowPYsrohdS209Gj48EtehOz9hj-TtB_IpvN8NjKeKd9SFZ_0Z0C3bGfgLcACLuvjz3MYfEHwCpSgo2/https%3A%2F%2Fwww.radglobaladventures.com%2Fmt-hood-trek.htmlSupport HUG Help Ukraine Group: HelpUkraineGroup.org 

Welcome to MattPAC*, a new Accelerators pilot concept! Radiation Oncologist Dr. Matt Spraker aims to introduce important healthcare policy concepts rooted in current events. Each show is designed to be efficient with your time and inspire you to get engaged with #RadOnc advocacy in 30 minutes or less.  In MattPAC #1, Matt covers two current congressional bills that are currently being considered for inclusion into next year's Medicare legislation: HR 2474 and HR3674. These bills seek to link Medicare physician pay to inflation and boost practice expense reimbursement for freestanding practices. The history of Medicare, administration processes, the payment formula, and sites of service are covered for context. Here are some good resources for further reading on these topics:A paper on how Medicare drove hospital desegregation, especially in the south.Power To Heal: Medicare and The Civil Rights RevolutionHow is Medicare Funded?Information about Medicare administration and procedures, WikipediaA lot of info on the RUC, AMAThe medicare physician fee schedule payment formula, MedicalBillersAndCoders.comInteresting write up of history of conversion factors, AMAMedicare payments are not keeping up with inflation, AMAFramework for Rational Medicare, AMAAMA letter to congress about these issues, March 2023AMA commends MedPAC for recognizing challenges of inflationary environment, April 2023HR 2474A Primer On Office Based Specialty Care, USPAUSPA Letter to MedPAC about threats to free standing specialty practices, such as Rad Onc2023 survey of multi-specialty practices regarding Medicare cutsHR 3674The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.*MattPAC is not a political action committee, it's just a cute name. If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

The NRMP did their weird thing where they release "preliminary" Match application statistics which...I don't quite understand why they do that, but whatever. I originally planned on exclusively talking about emergent properties and mental frameworks around paradox without bringing up our RadOnc baggage, but alas, the universe doesn't care about plans. For the slides with all the various details and statistics and citations: http://u.pc.cd/TGs7 OOTB is produced by Photon Media, a project of the 501(c)(3) nonprofit Cold Light Legacy. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD.Our discussion concludes with a discussion of proton and adaptive radiotherapy, Wagyu beef, life advice, and Simul's Hot Seat.Here are a couple of book recommendations from the show: Why We Sleep by Matthew Walker, PhDOutlive by Peter Attia, MDThe Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD. No notes. It's Bob Timmerman, just listen. The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy.

This week, Dr. Matt Spraker hosts medical student and Rad Onc applicant Dr. Laura Flores, PhD to discuss The Rad Onc Match! With all these links there's no room for a summary, so just listen!Rank Order List: Buyers and Sellers Edition and accompanying videoThe Accelerators Podcast, Composite QoL Measure for #RadOnc HappinessThat WaPo article about physician salaries and an excellent SDN post explaining why the number reported for Rad Onc is inflatedMatt Spraker's Threads ERAS competitivenessDegree during residencyTweet from Dr. Mary Mahoney on applicant demographicsHolistic ReviewThe Accelerators Podcast, ACROPolis Live! at #ACRO2023Out Of The Basement Podcast, History of RadOnc: the "2018 exams"The Accelerators Podcast, In Conversation with Join LuhShah et al., The ASTRO Workforce StudyACGME Program Requirements for Radiation OncologyFor a deep dive, please check out the many Photon Media podcasts on the workforce.  From The Accelerators Podcast: The One About JobsFacility Volumes to Assess the Job MarketAnalyzing Job Board PostingsNew Starts: ResidentsFrom Out Of The Basement:Rad Onc Job Secrets Part 1 and Part 2ASTRO Workforce Interim (2022) and Final AnalysisSupply and Demand ImpactPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

The Accelerators co-hosts Drs. Matt Spraker and Simul Parikh hang out over lunch and discuss a potpourri of #RadOnc current events! We cover ASTRO's ROCR policy proposal, Dr. Sameer Keole's ASTRO presidential campaign and engagement on Student Doctor Network, and the recent dysphagia optimized IMRT trial. Then, Simul hypothesizes about the future of radiation oncology under case rate payment models. We close with some more thoughts about proton therapy inspired by Dr. Mark Storey's latest piece.Here are a lot of links to things we discussed on the show:The Moto ROKR Accreditation Programs by the ACR, ACRO, and ASTROASTRO ROCR Policy Page Register for the ROCR Town Hall this Friday, July 21 4:00 PM - 5:00 PM ETWhat Big Medicine Can Learn from the Cheesecake Factory by Atul GawandeOut.Of.The.Basement with Beckta, MD: The Code Bundling Conundrum: A Medicare Misadventure (the saga of 77280-77290 and 77301)ASTRO Strategic PlanNutting et al., Dysphagia Optimized IMRTKamran et al., Esophagus-Sparing IMRTOncora.aiCommon Sense OncologyThe Accelerators Podcast: Mobilize the Canadians! A Workflow EpisodeProtons 101 by Mark Storey, MDPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

In this episode of ASCO Educational podcasts, we'll explore how we interpret and integrate recently reported clinical research into practice. Part One involved a 72-year old man with high-risk, localized prostate cancer progressing to hormone-sensitive metastatic disease. Today's scenario focuses on de novo metastatic prostate cancer. Our guests are Dr. Kriti Mittal (UMass Chan Medical School) and Dr. Jorge Garcia (Case Western Reserve University School of Medicine). Together they present the patient scenario (1:13), going beyond the one-size-fits-all approach (4:54), and thinking about the patient as a whole (13:39). Speaker Disclosures Dr. Kriti Mittal:  Honoraria – IntrinsiQ; Targeted Oncology; Medpage; Aptitude Health; Cardinal Health  Consulting or Advisory Role – Bayer; Aveo; Dendreon; Myovant; Fletcher; Curio Science; AVEO; Janssen; Dedham Group  Research Funding - Pfizer Dr. Jorge Garcia:  Honoraria - MJH Associates: Aptitude Health; Janssen Consulting or Advisor – Eisai; Targeted Oncology Research Funding – Merck; Pfizer; Orion Pharma GmbH; Janssen Oncology;  Genentech/Roche; Lilly  Other Relationship - FDA Resources  ASCO Article: Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019 ASCO Course: How Do I Integrate Metastasis-directed Therapy in Patients with Oligometastatic Prostate Cancer? (Free to Full and Allied ASCO Members) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed on the podcast page.  Dr. Kriti Mittal: Hello and welcome to this episode of the ASCO Education Podcast. Today, we'll explore how we interpret and integrate recently reported clinical research into practice. In a previous episode, we explored the clinical scenario of localized prostate cancer progressing to metastatic hormone-sensitive disease. Today, our focus will be on de novo metastatic prostate cancer. My name is Kriti Mittal and I am the Medical Director of GU Oncology at the University of Massachusetts. I am delighted to co-host today's discussion with my colleague, Dr. Jorge Garcia.  Dr. Garcia is a Professor of Medicine and Urology at Case Western Reserve University School of Medicine. He is also the George and Edith Richmond Distinguished Scientist Chair and the current Chair of the Solid Tumor Oncology Division at University Hospitals Seidman Cancer Center.  Here are the details of the patient case we will be exploring: The patient also notes intermittent difficulty in emptying his bladder with poor stream for the last six months. A CT scan of the abdomen and pelvis demonstrates enlarged prostate gland with bladder distension, pathologically enlarged internal and external iliac lymph nodes, and multiple osteolytic lesions in the lumbar sacral, spine, and pelvic bones. A CT chest also reveals supraclavicular lymphadenopathy and sclerotic foci in three ribs. So this patient meets the criteria for high-volume disease and also has axial and appendicular lesions.  The patient was admitted for further evaluation. A bone scan confirmed uptake in multiple areas identified on the CT, and a PSA was found to be greater than 1500. Biopsy of a pelvic lymph node confirmed the diagnosis of prostate cancer. This patient is somewhat different from the first case we presented in terms of timing of presentation; this patient presents with de novo metastatic high-volume disease, in contrast to the first patient who then became metastatic after undergoing treatment for high-risk localized disease.  Would you consider these two cases different for the purposes of dosing docetaxel therapy when you offer upfront triplet therapy combinations?  Dr. Jorge Garcia: That's a great question. I actually do not. The natural history of someone with localized disease receiving local definitive therapy progressing over time is different than someone walking in with de novo metastatic disease. But now, with the challenges that we have seen with prostate cancer screening, maybe even COVID, to be honest with you, in North America, with the late care and access to testing, we do see quite a bit of patients actually walking in the office with de novo metastatic disease. So, to me, what defines the need for this patient to get chemotherapy is the volume of his disease, the symptoms of his disease – to be honest with you – and the fact that, number one, he is clinically impaired. He has symptomatic disease, and he does have a fair amount of disease, even though he may not have visceral metastasis. Then his diseases give him significant pain.  Oral agents are very good for pain control. I'm not disputing the fact that that is something that actually these agents can do. But I also believe I'm senior enough and old enough to remember that chemotherapy, when it works, can actually really alleviate pain quite drastically. So for me, I think that the way that I would probably counsel this patient is to say, "Listen, we can give you ADT plus an oral agent, but I really believe your symptomatic progression really talks about the importance of rapid control of your disease.” And based upon the charted data from the United States, and equally important, PEACE-1, which is the French version of ADT, followed by abiraterone, if you will, and certainly ARASENS is the standard of care for me for a patient like this will be triple therapy with ADT and docetaxel.  What I think is important for us to remember is that, in ARASENS, it was triple therapy together. I am worried sometimes about the fatigue that patients can have during the first six cycles of docetaxel. So oftentimes, I tell them if they're super fit, I may just do triple therapy up front, but if they I think they're going to struggle, what I tell them is, "Hey, we're going to put you on ADT chemotherapy. Right after you're about to complete chemo, we'll actually add on the darolutamide." So I do it in a sequence, and I think that's part of the data; we just still don't know if it should be given three at front or ADT chemo, followed by immediately, followed by an ARI. So I love to hear if that's how you practice or you perhaps have a different thought process. Dr. Kriti Mittal: So I usually start the process of prior authorization for darolutamide the day I meet them for the first time. I think getting access to giving docetaxel at the infusion center is usually much faster than the few weeks it takes for the prior authorization team to get copay assistance for darolutamide. So, in general, most of my patients start that darolutamide either with cycle two or, depending on their frailty, I do tend to start a few cycles in like you suggested. I've had a few patients that I've used the layered-in approach, completing six cycles of chemotherapy first and then layering in with darolutamide.  I think conceptually the role of intensifying treatment with an androgen receptor inhibitor is not just to get a response. We know ADT will get us a PSA response. I think the role of an androgen receptor inhibitor is to prevent the development of resistance. So, delaying the development of resistance will be pertinent to whether we started with cycle one, cycle six, or after. So, we really have to make decisions looking at the patient in front of us, looking at their ECOG performance status, their comorbidities, and frailty, and we cannot use a one-size-fits-all approach.  Dr. Jorge Garcia: Yeah, I like that and I concur with that. Thank you for that discussion. I think that you may recall some of our discussions in different venues. When I counsel patients, I tell the patients that really the goal of their care is on the concept of the three Ps, P as in Peter. The first P is we want to prolong your life. That's the hallmark of this regimen, the hallmark of the data that we have. That's the goal, the primary goal of these three indications is survival improvement. So we want to prolong your life so you don't die anytime soon from prostate cancer.  The second P, as in Peter, is to prevent, and the question is preventing what? We want to prevent your cancer from growing, from growing clinically, from growing radiographically, and from growing serologically, which is PSA and blood work. Now, you and I know and the audience probably realize that the natural history of prostate cancer is such that traditionally your PSA will rise first. There is a lead time bias between the rise and the scan changes and another gap in time between scans and symptoms. So it's often not the case when we see symptomatic disease preceding scans or PSAs, but sometimes in this case, it's at the same time. So that is the number one. And as you indicated, it's prevention of resistance as well, which obviously we can delay rPFS, which is a composite endpoint of radiographic progression, symptomatic progression, and death of any cause.  But the third P is I called it the P and M, which is protecting and maintaining, and that is we want to protect your quality of life while we treat you. And we want to maintain your quality of life while we treat you. So to me, it's critically important that in addition of aiming for an efficacy endpoint, we don't lose sight of the importance of quality of life and the protection of that patient in front of us. Because, undoubtedly, where you get chemo or where you get an oral agent, anything that we offer our patients has the potential of causing harm. And I think it is a balance between that benefit and side effect profile that is so critically important for us to elucidate and review with the patient.  And as you know, with the charted data, Dr. Alicia Morgans now at Dana-Farber, published a very elegant paper in JCO looking at the impact of docetaxel-based chemotherapy as part of the charted data in the North American trial and into quality of life. And we clearly define that your quality of life may go down a bit in the first few months of therapy, predictably because you're getting chemotherapy. But at the end of the six months, nine months, and certainly at the end of a year mark, the quality of life data for those who receive ADT and chemotherapy was far better than those who actually got ADT alone.  Now, if you look at the quality of data for RSNs, a similar pattern will appear that although chemotherapy is tied to misconceptions of significant toxicity, in our hands, in good hands, and I think our community of oncology in North America are pretty familiar with the side effects and how to manage and minimize side effects on chemotherapy, I think it still requires a balance and a thoughtful discussion to make sure that we're not moving forward chasing a PSA reduction at the expense of the quality of life of the patient. So I think orchestrating that together with the patient as a team is critically important as well.  Dr. Kriti Mittal: Thank you, Dr. Garcia. Moving on to the next concept we'd like to discuss in today's podcast the role of PARP inhibitors. Case Two was treated with androgen deprivation docetaxel and darolutamide. Consistent with current guidelines, the patient was also referred to germline testing and was found to be BRCA 2-positive. The patient's disease remained stable for 24 months, at which time he demonstrated disease progression, radiographically and clinically, and his disease was termed castration-resistant. There has been a lot published in the last few years regarding the role of PARP inhibitors in metastatic castration-resistant prostate cancer, or mCRPC.  The PROfound trial led to the approval of olaparib in patients with deleterious mutations in HRR genes for those who had been treated previously with AR-directed therapy. The TRITON2 trial led to the approval of rucaparib in the same month for mCRPC patients with BRCA mutation for those patients who had previously been treated with AR inhibitors and taxine-based chemotherapy. More recently, we saw data from the TRITON3 trial exploring the role of rucaparib versus physicians' choice of docetaxel versus AR-inhibitor therapy in the mCRPC space for patients harboring BRCA 1, BRCA 2, or ATM mutation. Based on these data, it would be very tempting to offer a PARP inhibitor to the patient in case two. While regulatory authorities are still reviewing those data for approval, how would you consider treating this newly castrate-resistant patient in the frontline setting? Would you consider a PARP inhibitor in the frontline treatment of mCRPC in this patient with a BRCA 2 mutation? Dr. Jorge Garcia: So that's a loaded question, to be honest with you. We have compelling data, but controversial data, as you know as well. So I think that since we have a genomic profile on this patient and we know he had high volume disease, then the first thought to me is not a genetic or a genomic question or a sequence. It's actually a clinical question, to be honest with you. And that is: How are you progressing? Because I think that if you're progressing serologically, you and I may think of that patient differently. If you're progressing radiographically with alone plus minus PSA production but no symptoms, you may also tilt your scale into this life-prolonging agents in a different way. Whereas if you have true symptomatic disease, knowing what you know, prior therapy, CrPC with a BRCA 2 alteration, then you may actually go for something different.   So if it's a rising PSA, if it is radiographic, but the patient is stable clinically, is not basically compromised by symptomatic disease, I do feel that a PARP inhibitor as a single agent would be a very reasonable choice. In this case, you can use, obviously, rucaparib. You can use olaparib. I don't have a vested interest in either/or. I think either/or is fine. The subtleties and side effects, as you know, the olaparib data was probably the data that you and I probably are more accustomed to, used to the most just by virtue of how the agents got registered in the United States. But either/or, I think a PARP inhibitor would be a reasonable approach.   I think the question perhaps, and I pitch that back to you, is what are you looking for with a PARP inhibitor? Because, as you know, all DNA repair deficiencies are not biologically the same. They do not respond the same way to PARP inhibitors. And even BRCA 2, where we think it's monoallelic or biallelic, may have subtleties in how those patients respond to PARP therapy. But the answer is yes, obviously, you have a biomarker, the patient has it, you can use it. I think the question is, how are you going to follow the patient? And what is going to be the endpoint that you're going to pay attention to in this case to find that the patient has a benefit or not granted, that could be PSA driven, but I think that perhaps I'm pushing you to think beyond PSA.  Dr. Kriti Mittal: I agree, Dr. Garcia. I think we need to think about the patient as a whole. PSA-based changes in treatment are not generally part of our practice. I think evaluating the patient for symptoms and also thinking about the sites of progression, sites of disease they've had in the past, preventing development of cord compression, because some of these patients progress very rapidly and present with cord compression at the time of progression. Those are the things we are trying to predict and prevent. I think in a patient with BRCA 2 mutation, in this situation, I would feel compelled to offer rucaparib, given that even in the intention-to-treat analysis, the hazard ratio was 0.6 in terms of median progression-free survival. I think what was quite impressive was the subset analysis comparing rucaparib versus docetaxel. And that was something surprising. And I think we'll have to wait for long-term outcomes. But certainly, for a BRACA 2-mutated patient, this could be a reasonable consideration provided the drug is available and approved.  Dr. Jorge Garcia: As you know, the three most common DNA repair deficiencies that we see are BRCA1, BRCA2, and ATM. BRCA2 is probably the one that we see the most. But we also recognize that with the limited data we have for ATMs, that patients with an ATM abnormality do not tend to benefit the most. And then yet we have also another series of DNA repair deficiencies, deficiencies, PALB2, CHEK2, CDK12 and so forth. And yet we have some exquisite responses to some of those patients.   So I can tell you that I have a patient of mine who had an ATM mutation, a germline ATM mutation, and I predicted that initially that the likelihood of benefit to a PARP inhibitor would be low. He was placed on a PARP inhibitor and surprise, surprise, he was on a PARP inhibitor for almost a couple of years. What I want to convey to the audience is that if you have the appropriate biomarker, you certainly should consider a PARP inhibitor in this scenario.   I think the bigger question is also understanding that not every DNA repair would benefit the same way. So being very thoughtful and very structured as to how you're going to manage the patient, it cannot be PSA only, the patient has to be followed radiographically and clinically because I would argue that if this patient had just a serologic progression, I would put the patient on a PARP inhibitor and the PSA kinetics change north, but slowly, what is the urgency of you switching the patient to something else?   And also the misconception that if you look at PROfound, that olaparib for that matter has to always be given after docetaxel. That's not the case. The makeup of PROfound is different than this patient, obviously, because this patient got triple therapy upfront, whereas most patients on the PROfound were CRPC who receive chemotherapy in the CRPC space. But yet undoubtedly, I think that your case illustrates the importance of next-generation sequencing and the importance of understanding the access to two oral PARP inhibitors that are super solid.  I think that perhaps the bigger question is going to be should you do a PARP inhibitor alone or should we use a combination of a PARP inhibitor plus an oral agent, such as in this case, maybe abiraterone acetate plus olaparib. Or maybe even thinking of TALAPRO, maybe enza plus a PARP inhibitor. So I don't know where you sit on those thoughts, Doctor-. Dr. Kriti Mittal: I change toxicity considerations, temper my enthusiasm for offering PARP inhibitors in combination with AR inhibitors or abiraterone at this time. I think I would certainly consider monotherapy with rucaparib for a patient in this situation. I am not entirely convinced that putting a patient through dual treatment in the mCRPC setting in the frontline, I don't think we are there yet. Dr. Jorge Garcia: There are two very important trials that are looking at the combination of an adrenal biosynthesis inhibitor plus olaparib in this context, and one is PROpel and the other one is MAGNITUDE. And both trials have very different results in many ways because they look at patients with a biomarker, meaning DNA repair, and patients without the biomarker. And I think the bigger question is, should this patient who was an abiraterone– Let's say this patient hypothetically was on a PEACE-1-like style. So the patient got ADT or triple therapy but was an abiraterone or an adrenal biosynthesis inhibitor instead of chemotherapy. And the patient was progressing slowly on abiraterone, you knew that the patient had a DNA repair deficiency. How comfortable with the PROpel and MAGNITUDE data would you and I feel to add on or layer, if you allow me to express it like that, a PARP inhibitor into this regime? Dr. Kriti Mittal: My personal interpretation of the currently available data is that at this point, combination therapy is not something I would use in my clinical practice. I think there are two camps in the GU oncology community of how people interpret the PROpel, MAGNITUDE, TRITON, and TALAPRO data in full. I think each of these trials had very different patient populations. I think in a biomarker unselected population, I would certainly not advocate for combination therapy. But even in the biomarker-selected population, I think how the biomarkers were tested and how the populations were defined may not always match what we are doing in clinical practice. And so I would, at this time, advocate for monotherapy over combination therapy. Dr. Jorge Garcia: I'm sure the audience will have probably read or heard about PROpel and MAGNITUDE and the data in patients without a biomarker positivity disease. So I'd love to hear your thoughts as to if you had no biomarker. By that I mean if you had a patient with CRPC, with metastatic CRPC without a DNA repair deficiency, would you consider using an adrenal biosynthesis inhibitor and a PARP inhibitor together based upon the potential synergistic of additive benefits and some of the data to suggest that you can delay rPFS when you combine therapy, but in the absence of biomarker positivity. Dr. Kriti Mittal: In the absence of biomarker positivity, I think the preclinical data are stronger than the clinical results we are seeing in trials. So while I think we should continue researching further into this because there certainly is preclinical rationale, looking at the clinical outcomes from these several trials, I would not offer PARP inhibitor to an unselected patient. Dr. Jorge Garcia: Great. Dr. Kriti Mittal: Moving on to second-line treatment for castration-resistant prostate cancer. I think talking of access issues and talking about the current treatment paradigms in the United States, there is still not widespread availability of lutetium. The listeners would love to hear your thoughts, Dr. Garcia, on practical management tips, safety issues, and the multidisciplinary nature of the management of lutetium therapy.  Dr. Kriti Mittal: So I think the challenges with lutetium are multiple. Number one is the correct identification of the patient, the ideal patient for lutetium. Secondly is who manages the patient and as you indicated, the importance of a team approach in that. Thirdly is how do we follow that patient during therapy? So it's beyond the technical aspects of who infuses the patient. Fourthly is what are the true goals of lutetium for that patient population and the side effects that those patients may embark on that some people may not be fully aware of and creates complexity. And lastly, perhaps, is how the movement, how we develop lutetium in CRPC and how we're going to move lutetium or have started to move lutetium and alike, meaning radiopharmaceuticals, radioligand-based therapies outside lutetium opinion and others as you know, earlier into the natural history of prostate cancer, maybe even in the locally advanced disease in combination with radiation or for patients with N1 positive disease. So it's a lot of movement in that space. I think that this is just the beginning of radiopharmaceutical entering diagnostics. But let me just address this succinctly, if I may. Number one, you do need a PET PSMA in order for you to select the patient because we're talking about a potential biomarker. But this is what I call an imaging biomarker. If you see it, you treat it.  So the standard of care right now for lutetium is very simple: you need to have men with metastatic castration-resistant prostate cancer. Two, you need to have failed a prior oral agent, in this case, a novel hormonal agent, independent of which agent you have seen, independent of the timing when you have seen an oral agent at the front, the middle, the end. And lastly, you have to have progress through chemotherapy. Yet again, it depends on when you see chemo.  So if you have someone who has high volume metastatic disease from the beginning, de novo disease, and you got ADT, daro, and docetaxel, and the patient progresses, that patient can go on. If that patient has a positive PSMA PET, that patient can go on to get lutetium. Similarly, if you have someone who got ADT alone in the adjuvant space for radiation therapy, progress, got an oral agent, progress, got a PARP or not, or got docetaxel, that patient could also be a candidate for lutetium. It's dependent on how you run the patient through therapy.  Secondly is who gives lutetium? So I do believe, and I may be biased, I certainly believe in the importance of a team approach with radiation oncology and nuclear medicine. But the reality of it is, I believe these patients are so advanced in their stage of their disease, then the idea of quarterback, in my personal opinion, resides in medical oncology. And I think the bigger question is going to be if nuclear medicine at your given institution is going to be delivering lutetium, or is it going to be radiation oncology? And I think, as you know, in places in America, it's RadOnC, in other places is NucMed, in our institution right now it is NucMed. Having said that, I do predict that for those places where nuclear medicine is heavily involved in delivering lutetium or partnering with MedOnc to deliver lutetium, radiation oncology in the future will have a bigger role as well because we are moving lutetium earlier in settings where radiation oncology is commonly used, such as high-risk prostate cancer patients, or even in the salvage setting, or even in patients with metastatic disease, where we want to combine radiation and lutetium, which are part of clinical trials as we think through for the future. But either/or, I think the quarterback should be really MedOnc in this case.  Thirdly is how do we do it? So clearly, at least in my practice, and I think it's probably standard across the United States, MedOnc will see the patient, determine viability and feasibility of therapy, determine who's the ideal candidate, discusses the pros and the cons, and then works along with RadOnc or NucMed to start the process. As you know, it is once every six weeks. So here in my practice, we will see the patient every time before treatment. Sometimes we see them the day off, sometimes we see them a few days before. Patients will get blood work. Specifically, we're interested in seeing everything CMPs, but certainly blood counts, red cell counts, platelets, and white cell counts, just to make sure that patients do not start with impaired bone marrow that can increase the risk for myelosuppression and therefore significant challenges with side effects, hematologic side effects, specifically. And we do that.   Sometimes we see them, sometimes our nurse practitioners would do so. And then the patient will basically follow through and complete up to six cycles of treatments. Six times six, that's actually 36 weeks or so. That's a long time on therapy for those who can get six cycles. I think the question becomes how do you follow those patients? And if we pay attention to the VISION data, as you know, those patients were actually followed serially quite closely on trial every eight weeks for the first 24 weeks, and then they stretch the scans out. But the scans that we're using in the trial are conventional imaging.  And I think the bigger question that you and I will have is if we get a PET PSMA to use to make that decision to get on lutetium PSMA, should I go back and use a CT or so to stage the patient? I think we're moving more toward PET follow-up, but we also don't know fully the impact of lutetium PSMA on PSMA metabolically during treatment. I think that we all recognize anecdotally and at least with some of the emerging data and we have the SUV may change, that PSA reductions also appear to be important as to define who is likely to benefit or not. But those are questions that remain to be seen, to be honest with you. We follow the patients serologically, clinically, and radiographically. And at least in my group, we tend to do PSMA PETs in between therapy to ascertain the impact of therapy in radiographic and also metabolic changes. And lastly is how we manage side effects. So I think that I'm pretty OCD about these patients because I have seen in my practice patients having outstanding responses to therapy but unfortunately become transfusion dependent, either transiently or permanently, just by virtue of side effects. And I think the importance of understanding the most common side effects of lutetium, in this case fatigue, myelosuppression, xerostomia, are really, really important. And that is the importance of having a multi-team effort approach so everybody is fully aware of the baseline characteristics of that patient or how the patient is enduring therapy and how the therapy is impacting the quality of life and impacting bone marrow production for those patients.  I think I remind the audience that the vast majority of our patients do have bone metastases. In fact, in the VISION trial it was around what, over 85, 90% of patients are so with bone metastases. So their marrow has already been impacted not only by disease but equally importantly by the prior chemotherapy that they may have seen. And some of the patients that we have in the first bubble effect is they have seen probably docetaxel, some may even have seen dual therapy with cabazitaxel as a second-line chemotherapy. So I think the understanding as to how you manage the side effects is critically important for our patients as well.  Dr. Kriti Mittal: Those are very relevant, practical life issues. Thank you Dr. Garcia for a terrific discussion on the application of recent advances in prostate cancer to clinical practice. [28:54] The ASCO Education podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncologists' well-being and professional development. If you have an idea for a topic or a guest you'd like to see on the ASCO Education Podcast, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. Dr. Jorge Garcia: Thank you, Kriti. It's great to see you and thanks again to ASCO for the amazing opportunity to be here with you guys today. I hope the audience can see the benefit of understanding how the many changes we have seen have impacted our patients in a positive way. So thank you again for the opportunity. Dr. Kriti Mittal: Thank you, Dr. Garcia, and thank you so much to the ASCO team for inviting me. This was a great experience.  Thank you Dr. Garcia for sharing your perspective on incorporating recent research advances into the management of patients with de novo metastatic prostate cancer. The ASCO Education Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncologists' well-being and professional development. If you have an idea for a topic or a guest you'd like to see on the ASCO Education Podcast, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

It's an ACROPOLIS Live! welcome party with the Accelerators (Drs. Anna Brown, Matt Spraker, and Simul Parikh). In this episode, newly matched #RadOnc residents-to-be Jazmyne Tabb, Tony Menghini, and Ashlynn Clark join the show to talk about the field. We discuss the radiation oncology learning curve, our excitement about the future of the field, the new doctors' future plans to spread the word about radiotherapy, and more. You will walk away inspired! Here are some things that were mentioned during the show:TAP Episode: I Can't Get No!... Patient SatisfactionTAP Episode: Low Dose Radiotherapy Society of Women in Radiation Oncology (SWRO)Ma et al., Patient Experience Performance at a Primary Cancer Center Versus Affiliated Community FacilitiesRadOnc Tables and RadOnc Review ConstraintseContourRadOncQuestionsROECSGRadOnc WikibooksACRO PACASTROPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Age is a main factor when determining cancer care. In this ASCO Education podcast we speak to one of the top leaders in treatment for older patients who has also credited mentorship as a foundation for his career. Dr. Hyman Muss describes his childhood in Brooklyn, serving as a general physician for troops in Vietnam (6:18), the doctor who influenced his choice of hematology and oncology (7:48) and creating one of the first geriatric oncology fellowships in in the country (21:58).  Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Hyman Muss: None More Podcasts with Oncology Leaders  Oncology, Etc. – Devising Medical Standards and Training Master Clinicians with Dr. John Glick Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 1) Oncology, Etc. – In Conversation with Dr. Richard Pazdur (Part 1) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, director of Global Oncology and Health Equity at Indiana University.  Dave Johnson: And I'm Dave Johnson of Medical Oncology at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting and inspirational people and topics in and outside the world of Oncology. We have an inspirational guest today. Pat?  Pat Loehrer: If you ask anyone who's achieved any level of success and how they've achieved it, most likely they'll mention a number of people who've influenced them along the way. Quite often, these people reflect on their mentors, and after a certain time of accomplishment and reflection, they begin to mentor others. This is very much what our next guest has done. Dr. Hyman Muss has been a mentor to me and to Dave, and he's one of the most outstanding, wonderful people in the world, and we're so excited to have him today.   Dr. Hyman Muss served in the US Army in Vietnam, where he was awarded the Bronze Star Medal. He's an experienced Clinician Scientist, the Mary Jones Hudson Distinguished Professor of Geriatric Oncology at the University of North Carolina School of Medicine, and the Director of Geriatric Oncology Program at the UNC Lineberger Comprehensive Cancer Center Program. His interest in education and research is focused on cancer and older patients, and he is internationally recognized in this area. He's been the co-chair of the Alliance Committee on Cancer and Older Adults and won the BJ Kennedy Award from ASCO in Geriatric Care. His particular interest in research expertise is in the care of breast cancer patients, with a focus on the management of women who are of older ages. He's had a major interest in breast cancer survivorship and long-term toxicity of treatment and also served as the co-chair of the Breast Committee for the Alliance Group. He serves as a mentor for medical students, medical residents, junior faculty, and more recently, his Geriatric Oncology fellows. He served on the Board of Directors of the ASCO Foundation and on the ABIM, the American Board of Internal Medicine, where both Dave and I were privileged to work with him and witness his leadership and his deep breadth of knowledge.  Dr. Muss, thanks for joining us today. Dr. Hyman Muss: What a pleasure to be here. Thank you so much for inviting me. My mother would have loved the introduction.  Pat Loehrer: Well, speaking of that, tell us a little bit. You grew up in Brooklyn, so tell us a little bit about your parents. Your father was a dentist, I think, and your uncle was a general practitioner. So give us a little bit of the early life of Hy Muss. Dr. Hyman Muss: So I grew up in Brooklyn, New York. I was born and bred there. I went to Brooklyn Technical High School. I almost went to Brooklyn College, but I came back and went to Downstate Medical Center, which was just terrific. My tuition was $600 a year, but that's another story. My parents lived in the same neighborhood. My dad was a dentist, so we knew all the people. My uncle was the GP. You came into their office, sat down, and they saw you anytime, day or night, almost 24/7, something we're probably not going back to, but they had a profound influence on me. My uncle, as a GP, used to take me on house calls in Brooklyn when they were done, and he had an old Buick with MD plates. And I would go into these families, and they loved him, and they would give me ice cream and things. Maybe that's what made me a doctor. But it was a terrific and indelible experience. I had terrific parents. In those days, doctors and medical people usually lived in the same neighborhoods as their patients, so they really knew their people well. It was a terrific upbringing. I got to love medicine and have never had a look back. Dave Johnson: So your inspiration for a career in medicine obviously started at home. Tell us more about your formal education. You mentioned your high school education. What about college? And shortly thereafter?  Dr. Hyman Muss: Yeah, well, I went to Lafayette College. I was not the best high school student, but I had good college board scores or whatever they called them then. And I went to Lafayette and I thought I was going to be a chemist, a chemistry major. But I took enough premed courses and I spent a summer in a lab building cyclic ketones. And everybody was outside sitting on the lawn of the campus. And I was in there with all these distillation apparatus, and I said, “I don't think I can do this the rest of my life.” So I applied to medical school, and I got into several medical schools. But my father at that time was dying of metastatic bladder cancer. He had been a heavy smoker, and he was still working as a dentist. He worked until the day he unfortunately died. But I got into Downstate. We lived in Brooklyn, and my uncle, the GP, said, "Hy, you need to come home and help take care of your dad." I'm an only child, so I did. And I had a wonderful experience at Downstate.   Several years ago, I was listening to NPR and heard that one of my professors had won the Nobel Prize. Dr. Furchgott in physiology, one would have never thought. And I had a wonderful education and subsequently got into what was then Peter Bent Brigham in Boston, did my internship and residency there, joined the army and medical school, so I wasn't drafted, it was a program then. And then after first year of residency, I went to Vietnam, worked with an artillery battalion, a mystical experience, but no regrets. And then subsequently came back and did hematology and oncology at Brigham and at what was then the Jimmy Fund and Sidney Farber Cancer Center. And Tom Frei had just come. And I did hematology with a guy named Bill Moloney in Boston at Harvard. I'll tell you, a wonderful man. He was like a surrogate father. My dad had died by then, and I just feel I've had every opportunity to have a wonderful education and terrific mentors along the way. Dave Johnson: So we want to ask you about both of those gentlemen, but I would like to just, if I may, drop back to your experience in Vietnam. What was that like?  Dr. Hyman Muss: Well, I was 27 years old and I was put as the doctor for 500 men in artillery. My job was to take care of the general health of the troops. Fortunately, we didn't have many casualties. It wasn't a front war like my uncle, who was a GP actually in World War II, landed in Normandy about a week later and went all through World War II as a doctor. But Vietnam was an unusual war, there wasn't really a front. So my experience was I would go out to fire bases, which were units of about 100 men in the jungle, go out three days in a week in a helicopter, do sick call, check people. I dealt with really alcohol problems, unfortunately, a lot of drug problems. You had young people with really not a lot to do during the day, nothing much to do, and no real goal of being there. I did that for a while, and actually, the reason I got the Bronze Star was because I set up– It was nothing like standing in front of a machine gun. I'm not that kind of brave guy, but I set up a drug amnesty program so I got a lot of support from our regular field people to do this, so we didn't have to keep sending kids home with dishonorable discharges. And I learned a lot. I think we were reasonably successful. I learned a lot about artillery. I think overall it was a great experience in my life. Dave Johnson: Tell us how your interest in hematology and oncology originated. Where did that come from?  Dr. Hyman Muss: When I was an intern at the Brigham, Dr. Moloney was a very famous Harvard professor. He had studied war casualties after Hiroshima, he was one of the people that found the Philadelphia chromosome in CML. He was a guy that rounded on every single one of his leukemia patients every day. So I was an intern. So in those days I would go and see all the hematology people rounding because all the acute leukemia patients and all the serious cancer patients were right on the floors, right on the wards. We had 17-bed wards, and then we had some private rooms. And he loved what he did. And before I left for Vietnam, we didn't have Ara C and daunomycin. So every leukemia patient I saw died. This is '68 to '70. Yet we tried all these different regimens. Occasionally you got someone who did well for six months, a year. But his bedside manner was absolutely wonderful to me. He knew all the patients. He'd ask them about where they lived in Boston. His humanism was terrific, and yet I loved the diseases he treated. The stakes were high. We didn't have good treatment, and I decided that that's probably what I want to do.   So when I was in Vietnam, I applied and got back in the Hematology Fellowship and came back and did that. I saw Ara C and daunomycin. I gave the chemotherapy to them, and he'd say, "Go up and treat Harry Smith with Ara C and daunomycin." I had the syringes in my pocket, guys. Forget about hoods and mixing. And I'd go up and treat them and the marrow would be gone within four or five days. I did a bone marrow. They published their regimen in the New England Journal called COD, C-O-D because they also gave vincristine. So it was cytarabine, vincristine, and daunomycin, the COD regimen. It fit Boston. And I saw it was like the emergence of cisplatin after Larry Einhorn. You saw people that never survived going into remission and I saw some remissions in AML and it cemented it.  About my second year of residency, we had a child. I was running out of money. I was being paid $6,000 a year and I had the GI Bill. I went into Dr. Moloney and he talked with Dr. Franny Moore, who was head of surgery at the Brigham, and they made me the Sidney Farber Research Fellow, doubled my salary and I had to go to the Jimmy Fund and see cancer patients. And it so happened that was when Tom Frei came to Dana-Farber. And so I started rounding with Dr. Frei and seeing those patients. And I think the first day I walked in, I knew I wanted to do more than just leukemia because I saw groups of patients with every disease. We treated everybody with CMFEP, it didn't matter what cancer they had. And I just loved it and said, "My God, there's so much we can learn. What a great career." And so that got me into the oncology portion.   And then I was offered to stay at Harvard. They were going to make me an assistant professor, but they wanted me to do lab work. And I knew my personality, it just wasn't for me. I worked with a lovely guy named Frank Bunn, one of the world's great hem guys in his lab, and he's still a close friend in his 80s. And he told me one day, he said, "Hy, I don't think the lab is for you." And he actually helped me get my first job at Wake Forest University, which turned out to be wonderful. So that's how I ended up with my circuitous in HemOnc. And it's really from great mentors, it's from Bill Moloney, it's from Tom Frei, Dave Rosenthal, tons of wonderful people along the way that not only taught me a lot, but they seemed to love what they do, which is a gift in life to love what you do and love the people you're doing it with. They instilled that in me. Pat Loehrer: From there you went to Wake Forest and there's a couple of colleagues down there, I believe, that inspired you, Charlie Spurr and Bill Hazzard, who was the founding founder of geriatrics. Tell us about that experience and how'd that shape your life.  Dr. Hyman Muss: I was looking for a clinical job and I looked at Rochester, and I got snowed in one night in Wake Forest, and I said, “Where's the contract?” And I signed it. And my mother, who was living in New York City, didn't know where North Carolina was. My mother was from a family, was born over a candy store in Greenwich Village, and said, “Where are you going?” And then I showed her where it was, and she says, “They're going to kill you down there.” And it turned out to be one of the best decisions of my life. My wife Loretta, who both of you know so well, we got out of our VW with our dog and our daughter when we moved here, and VW bug, by the way, not a van, and she cried. It turned out it was one of the best opportunities.  Charlie Spurr was an iconic oncology leader. He actually did some of the early work on nitrogen mustard in Chicago during the war, the first chemotherapy drug. He was a terrific leader. He had patients programmed in on those IBM punch cards. He had little cards for the protocols, CMFEP, CMF, AC on little laminated index cards. I learned so much from him, and he was to me, great leaders and great mentors morph from things they do themselves to teaching other people, and whose brains have the ability of having the same dopamine shot when you see one of your fellows or young faculty present a wonderful study as you do. And your brain isn't saying, “I wish I was up there.” It's saying, “Isn't this so cool that this young man or woman or fellow or medical student is doing such a wonderful job?” And I had something to do with providing the soil for this seed to grow. That's the kind of guy he was. And so it was wonderful there.  And as I moved on, we got a new Chief of Medicine, Bill Hazzard. And I still hear from Bill on rare occasions, but Bill was one of the first geriatricians in the United States. He wrote the textbook, and his wish was that all the faculty and all the specialties get involved in a geriatric project. And so I had all those little index cards, and I looked and saw how many older people with metastatic breast cancer we'd given chemotherapy to. And these were little protocols, nothing like the protocols today, no 50-page consent forms, 50 pages of where your data is stored. They were like, here's the treatment, here's the dose mods. And I looked at those 70 patients with one of our residents, Kathy Christman, she may be retired now, but in any event, we wrote a paper and showed the old people did as well as the young with breast cancer. And we published it in JAMA. And it's one of the few papers in my career, I got no reviewers. They accepted the paper. I got no reviewers. So because I'm from Brooklyn, and my English is not what it should be, I had my friends read it to just make sure I didn't say anything egregious. But it got published and the next thing I know, my friends in medical oncology in the state were calling me. They said, “I got a 75-year-old woman here.” I'm saying, “Guys, I just wrote this paper. I really don't know anything about older people.” But slowly, with Bill Hazzard and others, I got more and more interested. I started reading about Geriatrics and I ended up making it a focal point of my career. It was kind of happenstance. And Bill was a wonderful mentor.  And then as I subsequently moved on, I worked with terrific people like Harvey Cohen, Lodovico Balducci, and Martine Extermann, all of them heavily involved with ASCO over the years as well, and B.J. Kennedy. They were wonderful to work with. And BJ was inspirational because BJ would get up at an ASCO meeting and he'd say when he saw the age cut off, he'd say, “How come you didn't let old people on that study? There'd be 1000 people in the audience.” And so he really was a great mentor. And I had the bittersweet opportunity of writing his obit for JCO years ago and kept up with his family a few years, but he was a wonderful man. Dave Johnson: I'm just reflecting on the fact that today, patient registries are sort of mainstream, but certainly in the ‘70s, ‘80s, even into the ‘90s, having a list of patients with a particular disorder seemed almost novel in many respects. And to have that was a godsend.  Dr. Hyman Muss: It was a godsend. I still remember those little file cards. And he called it the Oncology Research Center and it was a godsend. And you've got to remember, this is like ‘74, ‘75, it's a long time ago. Dave Johnson: So many of our listeners may not be as familiar with Wake Forest as they are with Duke and North Carolina, the other medical schools located there. But you were at right at a point where I mean, it was one of the top oncology programs in the country at that time. Still is, I don't mean to diminish it, but there was a who's who of people there at the time. And you were also involved in creating, I think, one of the first cooperative groups of sorts. It was the Piedmont Oncology Group. Tell us about that.  Dr. Hyman Muss: Oh, yeah, well, that brings back memories. So the NCI at that time wanted to get more, I think, rural and other smaller places involved in research. And they put out an RFA to form like regional cooperative groups. And we formed the Piedmont Oncology Association, the POA. We actually did well for a few years. We wrote some really good studies. We got one or two New England Journal articles. I worked with all the people, mainly in the community, community docs who would go on, and put people on the protocol. I mean, I looked at all the X-rays and scans in a lot of these patients myself as part of the studies we did. And it turned out to be a wonderful organization and it's still run today by Bayard Powell, who is one of our terrific fellows who's the head of Oncology at Wake Forest.  But after a while, we just couldn't compete with CALGB, of which I was a member of also, and ECOG and SWOG, even North Central Group, which was kind of formed in a similar venue, eventually merged. So we did a wonderful job for a while but the truth is we just didn't have the manpower to write studies for every disease site. So eventually we kind of petered out as a clinical trials group. But it's been maintained for educational programs and it's really served as a good resource for a lot of good education for the community oncologists who give most of the care in this country in the state. So it's been good. I think Pat kind of exceeded us with HOG, the Hoosier Oncology Group, which was in a similar vein. But it was a great experience and it was all Dr. Spurr, who thought of doing this and built it.  Dave Johnson: Certainly, it was inspirational in many people in and outside of Wake Forest. So with such an idyllic life, what in the world possessed you to move north to Vermont?  Dr. Hyman Muss: Well, you get this urgent life. You want to be a leader, you want to be a chief. Now, I tell younger people, if they love what they do, don't do it. So I got a wonderful opportunity at the University of Vermont to go up there and be Head of HemOnc. Chief of Medicine was a terrific guy, Burt Sobel. The university at that time, at one time it had a wonderful Oncology program. It had a federally funded cancer center with Irwin Krakoff and Jerry Yates, two other iconic guys. I don't know what the politics were but it had lost a tremendous amount of faculty, especially its clinical faculty, and they needed to rebuild it. And I went up and I thought, “Well, I'm in my 50s. This is going to be a great opportunity. If I don't do it now, I may never get the chance.” So I went up there and actually, it was a great opportunity. We hired terrific people. We got CALGB and we participated. We had actually a very good accrual for a small place and we had a very small but very effective cancer center. So it turned out to be a really good experience.  I worked with wonderful people. I recruited some wonderful people. But over time, the issues of the business of medicine, all the issues that happened, I'm saying I'm kind of losing my focus on clinical care and clinical trials, which I love to do. I don't need to tell either of you. I mean, Dave, you've been chief and department chair and Pat has run cancer centers. After a while, the administrative tasks just were so overwhelming and I didn't enjoy them, that I said, “I've got to get back in some type of more clinical focus.” And that's when I decided to look around and fortunately found what's turned out to be a dream job at UNC.  But it was a time of life. Maybe my ego got in the way of my logic. I don't regret it. I met and I think we rebuilt a wonderful clinical program. But you realize some of the resources of big places with-  we never had the research infrastructure to hire a lot of people and get big programs going on and great translational programs, just didn't have the funding. But it was great, and I have no regrets. And I learned how to tolerate the cold weather. And I have a lovely daughter, Sarah, who still lives up there. So we get back occasionally. And I've kept up with a lot of the people there. There are some wonderful people at UVM.  Pat Loehrer: From there, though, you were pulled down to North Carolina, where you've, again, built an incredible breast program there is outstanding. But you've created a Geriatric Oncology program, one of the first geriatric fellowships in oncology in the country. So tell us a little bit about that and what you feel may be your legacy is there at North Carolina.  Dr. Hyman Muss: Well, I had the opportunity over the years when I was at Wake, really, I got to know Shelley Earp, who's our cancer center director. I think maybe you were close to him, Pat. The longest surviving cancer center director on the planet, or among them. And we were good friends. And North Carolina's legislature actually gave the University of North Carolina substantial funding to improve cancer care in North Carolina, not just research. And so I had talked with Shelley about maybe moving, and because of the generosity of the state, really, he was able to really get me going, start a Geriatric Oncology program. And what I wanted to do was develop trials. As Dave says, I built a registry in 2009 here for older cancer patients using geriatric assessment. I have 2000 patients, which has been a resource for all types of faculty and fellows, and students to write papers. But I was able, with the support, to do things like this right from the get-go. And plus, I joined probably one of the best breast groups on the planet with Lisa Carey and Chuck Perou, and Larry, terrific people, Claire Dees. I had great luck in doing this, so I was able to really focus, get great support from my colleagues to build studies focusing on older people.  And then I had the great fortune of meeting Ned Sharpless, our prior NCI director. And Ned is one of the world's great aging biologists. And I don't mean aging as an adjective, he's really been a master on why we age, the biology of aging, cell senescence. So Ned taught me all about cell senescence and the mechanisms, especially the gene expression p16, which is like our own CDK inhibitor. And so I was able to start using his lab, collect samples, treat people with chemotherapy, follow them off with geriatric assessment. It was a great opportunity to do that here, and we got a lot of studies going and we showed what the pediatricians have known for years, that chemotherapy dramatically ages people, not just children, but adults. But it also allowed me to work with my colleagues in lymphoma and lung cancer to do little studies along the way.  And we eventually then built a T32 program. We got a T32, which we're kind of completing now our first five years to train oncology specialists in geriatrics. So the way we do it is they can be surgical oncologists, GU, we had a GYN oncologist, medical. With their HemOnc training, they do a year where they work with the geriatricians, so they go on geriatric inpatient service for a month and they really learn about older people. And part of it is a project. So we've been able to build that and develop a lot of programs with that. And I should say we've been very successful with mentorship and with ASCO support for things like YIAs, the late and great Arti Hurria, who absolutely an amazing woman. Some of her legacy at ASCO, the YIAs, and things. We've been successful in applying for some. So we've been able to build a whole spectrum of med and hematologists. We have an interest in Myeloma and AML focusing on older people. We've been able to build a whole team approach, including translational projects related to older people. And it's just been a great opportunity, and hopefully, my legacy here will be, too, and I'm working on it.  We have a wonderful guy, Bill Wood, who is very effective and has built this incredible coaching program to continue this legacy. Like many of us in this field, we are bothered because we all know the stats, we all know that first slide of the demographics of cancer, and yet it's been very hard in our culture to provide a lot of the services and build the clinical trials we need to best care for older people. It's still a major problem in this country. So as I cut back on my clinical care, I'm going to still advocate to try to improve the care of older people. Do geriatric assessment, build it into your clinical programs, get your hospitals to support you, convince them, build business plans, et cetera. And hopefully, that'll be my ultimate legacy, that we've made greater awareness of the older people, other than the usual stats, and we're really trying to care for them in a much more global sense, in a much more holistic sense than we've done. I hope we'll be successful. It's a slow haul, but we've got lots of great young people coming up through the pipelines, ASCO has been a great player in this. Many of you know people like Supriya Mohile and William Dale, Heidi Klepin, people, the next generation that's going to keep building this. So I hope the legacy will be that we get more buy-in, more interest, more trained people in other oncology-related subspecialties RadOnc, SurgOnc that will really focus on the care of older people. Dave Johnson: I don't think there's any doubt that that will be a part of your legacy Hy, but I think your legacy will be much broader than the world of geriatric oncology. Your mentorship leadership, your clinical skills, your educational capabilities, all of that will certainly last for many, many years in the future.  Well, I don't want to bring up a touchy topic, but you yourself are geriatric and we're wondering what your plans are for your semi-retirement. I recognize you're not retiring, but what do you like to do outside of medicine? Dr. Hyman Muss: I'll tell everybody who's interested in hearing this. On Tuesday, I had my 80th birthday.  Dave Johnson: Congratulations.  Dr. Hyman Muss: And I think I'm one of the most blessed guys. I'm pretty healthy. I married up -  my wife Loretta, who both of you, Pat Loehrer and Dave Johnson, know well.  Dave Johnson: Yeah, you definitely married up.  Dr. Hyman Muss: Yes. It's really carried me most of my life. She's great and so she flew up our three kids and we celebrated and I'm very fortunate. I have the enthusiasm and strength to do more clinical medicine. But I think the time has come for me to cut back my clinical medicine, so I'm going to do that in June. The hardest thing I've done is say goodbye to so many of my patients here.  We've been blessed. We have a lovely family. We're pretty close. I'm never bored, probably you two know well, I love to do things like fishing, outdoor stuff. I've really gotten into woodworking, so I'm not going to be bored. But there will be a small piece out of me when I walk out of that clinic in June. I know that and my two close psychiatry friends think it's going to really be a hard fall, but I don't think so. I still have some grants. In fact, I'm working with a fellow in City of Hope, Mina Sedrak, who's been very involved in ASCO, too. We are hoping to get an R01 looking at senolytic drugs that may prevent aging, and exercise in older women with breast cancer to see if we can reverse the trends of chemo. So my brain is still on that stuff, but the clinical care is going to be tough.  I had a note and for some reason, we talked about so many things. I wanted to mention that one of my great opportunities was joining the CALGB and then the Alliance and getting the support of Dr. Schilsky, Rich Schilsky, who's been one of the icons of ASCO to build cancer in the elderly working group with Dr. Harvey Cohen at Duke. And Harvey is one of the world's great geriatricians. And using that to get studies done, to incorporate studies with Arti Hurria on geriatric assessment, and really have it as a place where a lot of younger investigators could get started on a career in geriatric oncology. And that was really a great opportunity. It was kept on by Dr. Bertagnolli, who now is our NCI director, and I think was really the first group to really give good support for this. Dave Johnson: So we want to thank you very much for being our guest today.  We also want to thank our listeners of Oncology, Etc. This is an ASCO Educational Podcast where we talk about oncology medicine and much more. So if any of our listeners have an idea or a guest they would like for us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit ASCO's website at education.asco.org.   Thanks again for being our guest, Hy.  Dr. Hyman Muss: My pleasure. Thank you so much. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

In anticipation of our #RadOnc Welcome Party, Accelerators co-host Dr. Simul Parikh records solo!In this episode, he shares how he thinks #RadOnc has changed since he trained many, many... many years ago. Most things are better, but a few things are worse. Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Don Parnell CMD, joins Out of the Gray (Gy) to share insights in working between the clinical sector of RadOnc and industry. We chat about the latest in Patient QA with Adaptivo and take a peek into what the future might hold.

The Accelerators (Drs. Anna Brown, Matt Spraker, and Simul Parikh) host Clinical Geneticist Dr. Elizabeth Chao, Director of Medical Genetics at UC Irvine and Vice President and Clinical Diagnostics Laboratory Director at Ambry Genetics for a discussion about medical genetics in the oncology clinic and beyond!  We start by discussing practice models for clinical geneticists and then spend some time discussing the role of genetic testing in pancreatic cancer care. We then discuss genetic testing more generally and what the future holds for the field. Our discussion concludes with Liz sharing her training path, which started in #RadOnc, to a very successful career.  Here are some things that were discussed during the show: Publication of the PALB2 pancreatic cancer susceptibility geneNCCN Guidelines for genetic/familial high-risk assessment: breast, ovarian, and pancreaticUK NHS 100,000 Genomes ProjectAmbry Genetics - The Care ProgramPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Dr. Khan joins OOTG for the first iteration in a series of chats where we discuss a multitude of topics ranging from accreditation to leadership to the business side of RadOnc. Be sure to subscribe so you're us to the latest in this valuable series.

What has prevented open and in-depth analysis of the RadOnc workforce over the last decade? To paraphrase Fight Club - you are not your job. Does the 2023 ASTRO/HMA study make sense in terms of the existing data? Do we even know how many linear accelerators there are in America? Spoiler alert: we do (sort of) know! Earn free CME by reflecting on the content of this episode: https://earnc.me/E9XHPi www.becktamd.com Twitter: @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Medical Student Special Episode: Rad Onc 101 featuring Hefei Liu

On a recent, LIVE episode of The Accelerators, the question of "what happened to RadOnc" was answered, in part, by referencing the unusually high failure rate of board certification exams. It has now been 5 years since those events, and medical students/junior residents are unlikely to know "the story". This is my version of a documentary/editorial on "the 2018 exams", which starts with a 2012 CNN report, exam restructuring, NRMP reports, ARRO letters, PRO papers - all of it. Though impossible for me to tell the story utterly objectively, I have tried to include all major milestones should folks feel inclined to "check my sources". Then, in a twist worthy of M. Night Shyamalan, I discuss why hitting this "rock bottom" has brought out some of the most inspiring people our field has, and why I think there's a bright light at the end of this tunnel. It's easy to lose hope, but remember the ACROpolis and...Rome wasn't built in a day. ***ERRATA*** I realized after uploading this that the "trending downward" paper was published prior to the 2018 exams. I'll leave this as-is, because my error demonstrates the purpose of this project. Relevant papers: https://doi.org/10.1148/radiol.12120251 https://doi.org/10.1016/j.prro.2020.04.010 https://doi.org/10.1016/j.prro.2018.03.005 https://doi.org/10.1016/j.ijrobp.2018.12.046 http://dx.doi.org/10.1016/j.ijrobp.2013.05.027 https://doi.org/10.1016/j.prro.2018.04.005 https://doi.org/10.1016/j.prro.2018.04.005 Earn free CME by reflecting on the content of this episode: https://earnc.me/E9XHPi www.becktamd.com Twitter: @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Accelerator Dr. Matt Spraker hosts the first ever live #RadOnc podcast! Drs. Todd Scarborough, Emma Fields, and Alexis Schutz join for this very special episode, recorded from the #ACRO2023 Afterparty in Orlando, Florida. We first discussed our love of ACRO, informal and collegial poster sessions, and our favorite parts of day 1 of the conference. Then, we explored the elephant in the room, the radiation oncology workforce and job market. Todd reveals himself as part of Graypeace, authors of An Inconvenient Truth, a narrative that likens workforce trends in radiation oncology to global warming. We find that, recently, graduating residents are perceiving a strong job market. But is this just a cold day masking a larger trend of global warming? Emma shares her thoughts on how the 2018 ABR initial certifying exam debacle may have initiated concerns that are driving decreased numbers of medical student applications to our field. Will programs commitment to cleaning without soap correct forecasts of radiation oncologist oversupply?  We close our session with Q&A and, of course, a discussion of our favorite radiation oncologists. We would like to extend a special thanks to the American College of Radiation Oncology for allowing us to record during their event and supporting our quest to produce balanced editorial content about the field of radiation oncology. Check out the ACROPOLIS Content Channel to check out all their supported digital properties.  Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Accelerator Dr. Simul Parikh and Dr. Jason Beckta of the out.of.the.basement / radiation.medicine podcast team up to "simul-cast" their reaction to the radiation oncology workforce study commissioned by ASTRO and completed by Health Management Associates. Simul and Jason are joined by friend of the show and #RadOnc workforce guru Dr. Todd Scarborough. They discuss the "supply side" of the model, hiring consultants, and the folly of forecasting the past. Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Crawling Out of the Basement for the first time in 2023 with The Accelerators, The Todd, and Birkenstock Beckta (now based on the set of Super Troopers, looking for Bernie's mittens). The ASTRO Workforce Taskforce paper, the final version, dropped last Wednesday. In terms of "ambitious projects", forecasting supply and demand is akin to eating not one but TWO elephants. We discuss almost exclusively the concept of supply, hiring consultants, and the folly of forecasting the past instead of just, you know, using data. --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

School is in session! The Accelerators (Drs. Anna Brown, Matt Spraker, and Simul Parikh) sit down for a radiation oncologist and colorectal specialist Dr. Nina Sanford for an informal lesson on the state of radiotherapy for rectal cancer in 2023.  We work our way through an informal discussion of total neoadjuvant therapy, sequencing of therapies, radiotherapy techniques, and my favorite new #RadOnc concept, PULSAR. We close the show by peer reviewing Simul's case and discussing the finer points of rectal cancer contouring.Here are other some things we discussed during the show:We talked about a lot of rectal studies, just check out Rad Onc Tables GI TabTodd's Twitter poll on IMRT for rectal cancer Bob Timmerman's excellent editorial about his SBRT constraintsTzeng sarcoma study referenced for bowel constraintsThe Janus StudyWax Lips and Fun Dip CandyPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Mellonie joins Out of the Gray for a second time to discuss the most common interview practices for the RadOnc space. She shares insights about how the interview process and changed in recent years- what's working and where can we improve?

In this episode of the ACRO Podcast, ACRO Resident Committee Chair, Dr. Niema Razavian and Committee Members, Drs. Alexis Schutz and Cyrus Washington, discuss MATCH advice for medical students applying to radiation oncology. This timely program is filled with great tips and advice for those considering taking the next step in a career as a radiation oncologist.

The Accelerators (Dr. Anna Laucis, Matt Spraker, and Simul Parikh) are closing out 2022 with a focus on mental health! In this episode, we are joined by friends-of-the-show Drs. Neil Newman and Christina Henson as well as Melody Wilding, LCSW. Melody is an executive coach and author of #RadOnc book club favorite "Trust Yourself: Stop Overthinking and Channel Your Emotions for Success at Work."We discuss Melody's book and The Highly Sensitive Person phenotype, which may be expressed in up to 30% of people. This can pose challenges for anyone at work, but we discuss how the phenotype may uniquely impact physicians. We also share how Melody's book has impacted our careers in different ways. The discussion then shifts to how employers and physician leaders might make our hospitals and clinics a nicer place to work and how Sensitive Striver physicians might excel in this challenging workplace. Here are some things mentioned in the show:Melody Wilding's websiteThe Highly Sensitive Person by Elaine AronPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

This week, The Accelerators (Dr. Anna Laucis, Matt Spraker, and Simul Parikh) host Dr. Natalie Ridge (@nataliezumab), a DO radiation oncologist who is finishing training and searching for a job. We again discuss the hot - or not - #RadOnc job market. It depends on who you ask. We start by discussing the fact that residents across the country face a heterogeneous job search experience as connections are essential to rise to the top of a competitive field.We then turn to an insidious problem in Radiation Oncology and other medical fields: DO discrimination. We hope leaders in our field consider these experiences in their attempts to build inclusive training programs and practices. Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

The Accelerators (Dr. Anna Laucis, Matt Spraker, and Simul Parikh) use a "small viral" tweet as a seed for discussion about technology, inequity, and community practice.  This week, we host Dr. Anna Paulsson, a community Radiation Oncologist practicing in Sonoma County, California. Recently, she wondered whether the celebration of technology in #RadOnc is furthering inequity in our field. We discuss messaging from societies and conferences to the general public, the role of industry, the PPS-exempt cancer hospitals program, and how medical education might improve with greater access to community practice physicians. Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

The Accelerators host (Dr. Anna Laucis, Matt Spraker, and Simul Parikh) another resident-attending duo to discuss the #RadOnc workforce and job market!  Drs. Mudit Chowdhary and  John Shumway (a graduating PGY-5 resident at University of North Carolina) review their recent publication evaluating trends in numbers of yearly society job board postings versus graduating residents. We then analyze some of the paper's methods and online discussion of the statistics. We then discuss the ratio of job postings to graduating residents over time and supplement the data with the lived experience of interviewing for a job in #RadOnc. There is now a strong, data-driven argument against expanding residency positions in our field, so what factors are being considered when departments decide to expand? Are people considering activity in their region? We don't think so. Finally, Mudit is optimistic that publication and discussion of this issue has initiated a contraction, or at least halted growth. We all agree that progress has been made and modern discussion of the radiation oncology workforce is improved compared to the past. Remember friends, help control the graduating resident population and don't SOAP in March!Here are some other things mentioned during the show:The Emergency Medicine Workforce Study"How Much Are Resident Physicians Worth?" by friend of the show Dr. Carmody (The Sheriff of Sodium)Mudit's article on the growth of radiation oncology residency programs The 2020 ARRO Graduating Resident Survey Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. This week, we continue our discussion on metastatic non-small cell lung cancer, focusing on NSCLC with driver mutations. * The approach to treatment of a patient with widespread metastatic NSCLC (mNSCLC) is very different than a patient without distant disease, which highlights why we do what we do:- Important to complete staging (discussed in prior episodes) to determine the extent of disease- Important to check molecular testing (looking for mutations in the cancer cells) and IHC for tumor proportion score (TPS) helps determine treatment options - If your molecular testing is identified in a driver mutation gene, there are targeted options for this! *Driver mutations are predictive of response to an oral therapy and a LACK of response to immune therapy (particularly in EGFR and ALK mutated patients) * EGFR Mutation:- Pay attention to the types of mutation in EGFR (not all are the same):-- Exon 19 deletion -- Exon 19 L858R-- Exon 21 T790M-- Exon 20 Insertion (Osimertinib [see below] cannot be used for this mutation)- Osimertinib is first-line standard of care for patients with EGFR-- Used to be a second-line agent. Many patients with EGFR mutations receiving earlier generation TKIs would develop resistance and when these tumors were sequenced, they would have Exon 21 T790M mutations. Osimertinib was effective even with this mutation and had superior overall survival data compared to chemotherapy (AURA3 Trial)--Now it is used in first-line setting for patients with EGFR mutation based on the FLAURA trial --- In this study, patients received osimertinib as first line vs. older generation EGFR-targeting TKIs (erlotinib or gefitib) and Osimertinib had better outcomes: ---- Showed that the median OS was 38.6 months with Osi vs. 31.8 months; also improved brain penetration! ---- Also effective in patients with metastatic disease to the brain: ----- Only 6% of patients had CNS progression with Osi vs. 15% with others- What if a patient is on Osi and later develops new brain mets?-- If there is progression within just the brain (and good control in other sites of the body) you can refer patient to Radiation Oncology for SRS-- Remember, based on discussion with Dr. Osmundson in our RadOnc lectures (Episode 028), it is important to HOLD Osimertinib if patient is going to get radiation to minimize the side effects- What is patient had progression of disease in several sites throughout the body?-- Management is less straightforward. -- In many of these cases, you can consider:--- Consolidative radiation - If small amounts of disease--- Changing therapy - If there has been widespread progression; likely would change to chemotherapy (without IO, since lower predictive response to IO with EGFR mutation)---- No clear guidelines if you should continue the TKI---- Remember that IO + TKIs can cause increased risk of side effects, such as pneumonitis and hepatitis. DO NOT DO THIS!* ALK Mutation:- There are many options for ALK mutations-- The first generation drug is crizotinib--- Lots of side effects —> “It is crazy to start with crizotinib”--- Studies for later generation TKIs were compared to crizotinib -- Many people today will use third generation ALK-inhibitor alectinib (Important trials: ALEX Trial and J-ALEX Trial)--- With alectinib, PFS 34.8 months, RR 83%, less CNS progression (12% vs 45%)--- 5 year OS rate 62.5%- What to do with disease progression while on ALK inhibitor?-- In ALK, you can actually switch to another ALK inhibitor and many will respond well--- Of course, with each change, you may expect not as great of a response * Lots of other mutations!- TFOC recommends just looking these up!-- Link to NCCN Guidelines on NSCLC; Page 41 has full list!- Another way to think about this, when do we NOT do TKIs as first line: -- KRAS G12C-- EGFR Exon 20 Insertion-- HER2- How do you counsel a patient when considering/starting a TKI? -- Patients with highest chance of having a targeted mutation are younger non-smokers with adenocarcinoma-- Set expectations: great outcomes overall, but still not a cure. -- Remembering the drugs: All TKIs usually end in “-nib” -- In general, the way we recommend remembering this: “Fatigue, GI, Derm (skin/nail changes)”; rarely pneumonitis References:* AURA3 Trial - https://www.nejm.org/doi/full/10.1056/NEJMoa1612674Established osimertinib was better than chemo for patients with EGFR mutation and acquired Exon 21 T790M resistance mutation* FLAURA Trial - https://www.nejm.org/doi/full/10.1056/nejmoa1713137 Established osimertinib as first-line agent for patients with EGFR mutation * ALEX Trial - https://www.nejm.org/doi/full/10.1056/nejmoa1704795Helped establish alectinib as superior for ALK mutations compared to crizotinib * J-ALEX Trial - https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30565-2/fulltextHelped establish alectinib as superior for ALK mutations compared to crizotinib * NCCN Guidelines on NSCLC - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450 Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google PodcastLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. An important component of treatment in lung cancer (and many other cancers) is the use of radiation. Here, we discuss the fundamentals of Radiation Oncology with our guest, Dr. Evan Osmundson. Basic vocabulary: - Fraction/Fractionation: The total dose of radiation divided into smaller doses - Grey: Unit of measure of radiation being delivered in each session - Bragg-Peak effect: Specific to proton therapy (as opposed to photon therapy). It describes the sharp increase in concentration of the energy when hitting the tumor, while minimizing the effects to surrounding tissue. - Radiosensitizing chemotherapy: small doses of chemotherapy used to make the cells more responsive to the deleterious effects of radiation Fundamentals of radiation oncology: *When we make a referral to RadOnc, what happens then? - Send over any available imaging that is available - Team reviews the imaging to ensure that staging is completed - Simulation scan: Uses a CT scan to “simulate” the treatment; specifically map out the tumor and the surrounding organs/structures. Multidisciplinary team reviews the scan to maximize the dose to the tumor and minimizes damage to surrounding structures. - Based on the scans, they test run the treatment on a model to ensure that the simulation on the computer is able to be replicated on a model. - The above is why it can take a while for treatment planning to take place*What sorts of imaging modalities are important to have for patients prior to getting to Rad Onc? - Send prior CT imaging - If planning for radiation to the brain, should get thin-sliced MRI w/ and w/o contrast - If prostate cancer, also consider getting MRI*Many patients express concern about the “mask fitting” - what is that? - To ensure that the same dose of radiation is administered each time, it is important for the patient to remain very still and/or the same position every session. The mask is custom fit to ensure patient is in the correct position. *How do you determine the “maximum dose” of radiation in the mediastinal area is? - The maximum dose tolerance is dependent on the structure in question. A structure “in series” such as the bronchial tree would have profound effects if tissue is injured compared to lung parenchymal tissue (If you damage some, there is plenty more that is able to compensate) - Always concern for spinal cord when radiating the mediastinum *What are side effects you counsel patients on, specifically in thoracic radiation? - Fatigue (usually not debilitating), radiation esophagitis, pericarditis (rare) - Radiation pneumonitis (usually 6-8 weeks, but can be up to one year), presents with cough, shortness of breath; likelihood of this is dependent on duration of treatment, dose of radiation, location A special thank you to our guest, Evan Osmundson, MD, PhD, Associate Professor in the Department of Radiation Oncology and serves as the Medical Director of Radiation Oncology at Vanderbilt University Medical Center in Nashville, TN!Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Dr. Matt Spraker is joined by Dr. Jason Beckta for a petite episode packed with announcements and teasers for The Accelerators Podcast Season 2.  The Accelerators will return from Summer break with renewed focus on "news and views", shorter episodes, and a new theme song generously donated by award winning musician Lucas Cantor Santiago! Check out his piece (and our theme song) "Pop With Toys" at the end of this teaser ep. There's more. Today, Jason is launching his new podcast Out Of The Basement. It's an off-the-cuff educational podcast anchored in Radiation Medicine. It's taking RadMed out of the basement and into the underground. In a timely release, Matt and Jason have a wide-ranging discussion of #RadOnc contracts, work, and life in the first two episodes. Don't miss them! Out Of The Basement will join The Accelerators Podcast in our new collaborative effort, Photon Media. Check out back at our shiny new website frequently for new episode releases and projects.Here are some other things that were mentioned in the show: -Lucas Cantor Santiago Music -Lucas teams up with Huawei to complete Franz Schubert's unfinished Symphony No. 8-Jason's website (becktamd.com)Podcast art generously donated by Dr. Danielle Cunningham. Theme music "Pop With Toys" generously donated by Louis Cantor Santiago.

Matt and I talk again. Earn free CME by reflecting on the content of this episode: https://earnc.me/E9XHPi www.becktamd.com Twitter: @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Matt Spraker joins us to talk about details of what an actual attending job in Radiation Medicine looks like, RVUs, medical director roles, etc. Earn free CME by reflecting on the content of this episode: https://earnc.me/E9XHPi www.becktamd.com Twitter: @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

In part 2 of our series on paternal leave,  Accelerator Dr. Simul Parikh hosts 3 of our favorite #RadOnc and #MedPhys experts who are also moms: Dr. Laura Dover, Dr. Kaleigh Doke, and Dr. Kelly Paradis. The episode begins with Kelly, Laura, and Kaleigh sharing their experiences with paternal leave, which can vary between institutions and clinics. They then discuss how practice and compensation structures may impact how and when parents-to-be take leave from work.Then the group covers the importance of leave for non-birthing partners and how those in leadership positions can establish healthy departmental culture surrounding parental leave.  In fact, #RadOnc and #MedPhys may have a unique opportunity in medicine to leverage remote work and enact change for parents balancing work and life! They close the discussion with tips for moms (or moms-to-be) who are interviewing for job, and thoughts on sharing home responsibilities with their partners. The episode concludes with Laura, Kaleigh, and Kelly diving in to The Accelerators Lighting Round! Podcast art generously donated by Dr. Danielle Cunningham. 

This episode marks our first episode of Campus PEPTalk Global Edition, our mini-series of PEPTalk episodes dedicated to amplifying the voices of global leaders in the field of Proton Therapy.  We are joined by Professor Roberto Orecchia, Scientific Director of European Institute of Oncology Milan to discuss randomized control trials, or “RCTs”, in proton therapy. The views expressed in this podcast are those of the interviewees. By listening to this, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating.  Consult your own physician for any medical issues that you may be having.  This entire disclaimer also applies to any guests or contributors to the podcast.  Under no circumstances shall Ion Beam Applications SA (IBA), any guests or contributors to the podcast, or any employees, associates, or affiliates of IBA be responsible for damages arising from use of the podcast.

Fill your cup with this inspiring episode of The Accelerators Podcast! Dr. Matt Spraker is joined by Dr. Julianne Pollard-Larkin, medical physicist, service chief of the thoracic physics group at MD Anderson Cancer Center, and chair of the EDI Committee of the AAPM. We discuss topics and strategies for creating an inclusive workplace for all of #RadOnc, especially now when we need it the most. We begin with a discussion of how to be a great leader and it starts self-care. Star athletes don't do it alone, get yourself a coach! The discussion then moves to our personal experiences with COVID, the importance of leading with a physical presence, and how MD Anderson Radiation Oncology is screening for burnout. We close with a more traditional discussion of DEI and Julie's important work with AAPM creating affinity groups.Some other things mentioned in the show:Black Men in White Coats Dr. Kamran et al. analysis of diversity of US medical academic faculty over time and associated tweetorial

Happy Father's Day! Dr. Simul Parikh, host of The Accelerators Podcast, rounds up an all-star team of #RadOnc dads for part 1 of our 2 part series on parental leave and achieving work-life balance as a parent. Drs. Mudit Chowdhary, Sean McBride, and Ben Willen share their experiences with leave and how zoom video calls and evolving supervision policies may (or may not) help #RadOnc dads be the best they can be. Later, the guys give tips to soon-to-be dad Ben and cover a staple Accelerators topics, pizza and vacations. Congratulations Ben! Podcast art generally donated by Dr. Danielle Cunningham.

In part 2 of our 3-part series on the oral boards, we flip the script! Friend-of-the-show Dr. Jason Beckta interviews Accelerator Dr. Matt Spraker in a fireside chat about standardized tests, #RadOnc oral boards, and life as an early career attending. Don't miss part 3, in which Matt struggles through Jason's gynecologic oncology oral boards section.Here are some things we discussed in the show: Emergency Medicine physicians call to Quarantine the Oral BoardsMatt's tweets about the value of radiation oncology oral boardsDr. Ohri's paper on radiotherapy protocol deviations and survivalPodcast art generously donated by Dr. Danielle Cunningham.

Kelly Paradis PhD, Elizabeth Covington PhD and Dennis Stanley PhD, join us to discuss the challenges faced by parents in today's fast-paced and demanding RadOnc and MedPhys fields, and offer potential solutions for improvement.

#RadOnc legend Dr. Ralph Weichselbaum joins The Accelerators (Drs. Anna Laucis, Simul Parikh, and Matt Spraker) for one of our favorite episodes ever. We kick off by discussing how to #MedTwitter, the state of technology and proton therapy, and radiation resource allocation. Then we discuss Ralph and Sam Hellman's 1995 paper, Oligometastases, the history of the concept, and where we are headed. This leads to a scientific discussion on the abscopal effect.We close the show with an epic new segment: the lightning round! We grill Ralph on pizza, the MD/PhD degree, the best cities for conferences, and why #RadOnc would benefit from broadening our scope of work to include delivery of select systemic therapies.Here are some other things that came up on the show:Michigan Radiation Oncology Quality Consortium Ralph and Sam Hellman's (2011) Oligometastases revisitedTurchan, Pitroda, and Weichselbaum (2021) on radiotherapy and immunotherapy for patients with metastatic disease. Pitroda and colleagues (2018) on molecular subtyping to define an oligometastatic state in colorectal cancer. Tsai and colleagues trial (2021) of SBRT for oligometastases from non-small cell lung cancer and breast cancer.Robin Mole's (1953) original description of the abscopal effect.Postow and colleagues (2012) NEJM case report of the abscopal effect. Sylvia Formenti's Nature Medicine (2018) paper on radiotherapy plus immune check point inhibitors. Huang and colleagues Nature (2017) paper on T-cell invigoration.McNeil, Weichselbaum, and Parker NEJM study (1981) on trade-offs between quality and quantity of life.See also: McNeil, Weichselbaum, and Parker (1978) on the Fallacy of the Five-Year Survival in Lung Cancer.Podcast art generously donated by Dr. Danielle Cunningham.

Drs. Anna Laucis and Simul Parikh use the recent criminal case of RaDonda Vaught to launch an introductory discussion of medical errors in #RadOnc. In this informal chat, they discuss important quality and safety concepts and share their experiences with incident learning, safety culture and, of course, Swiss cheese. 

Rajen joins us to chat about the development and implementation of soft skills across RadOnc and Medical Physics.

The Accelerators (Drs. Anna Laucis, Simul Parikh, and Matt Spraker) are joined by Drs. Jason Beckta, Emma Fields, Todd Scarborough, and Chirag Shah to discuss the #RadOnc job market.Join us on an epic journey through the past, present, and future of the job market. We  cover the highly variable written record of the #RadOnc workforce, how patient volumes are changing with hypofractionation, and the what the market will look like in the future.We close the show with a round robin on advice for young radiation oncologists heading into the field we all love. More information on the topics we discussed:Dr. Lawrence Davis in 1986: “The manpower crisis facing radiation oncology”Dr. Chirag Shah's letter: “Expanding the Number of Trainees in Radiation Oncology: Has the Pendulum Swung Too Far?”"In Regard to Shah"By Dr. Anthony Zietman By Dr. John LeungBy Drs. Dennis Hallahan and Stephanie Perkins By Dr. W. Robert Lee By Drs. Paul Wallner and Dennis Shrieve SDN Radiation Oncology Forum Medical School Reddit Dr. Ben Smith's team in 2010: "The Future of Radiation Oncology in the United States From 2010 to 2020: Will Supply Keep Pace With Demand?"Dr. Ben Smith's team in 2016: "The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation"Mudit Chowdhary's team in 2019: "The Impact of Graduates' Job Preferences on the Current Radiation Oncology Job Market"Follow Nicholas Zaorsky on TwitterUpdated ACGME Program Requirements for Radiation Oncology and FAQs Dr. Li's team in 2020: "Temporal Trends of Resident Experience in External Beam Radiation Therapy Cases: Analysis of ACGME Case Logs from 2007 to 2018"Podcast art generously donated by Dr. Danielle Cunningham**Update**Dr. Zaorsky comments with a thread of threads, packed with more info for a deeper dive on #RadOnc facility/utilization.Dr. Fuller tweets a deep pull from the archives.

In our final episode of 2021, Drs. Laura Dover (@LauraDoverMD), Caleb Dulaney, and Samuel Marcrom from QuadShot News (@QuadShotNews) join the The Accelerators (Drs. Anna Laucis, Matt Spraker, and Simul Parikh) for a scientific year in review!  The reports of our death are greatly exaggerated; it was a great year in #RadOnc science! Join us as we review our favorite articles of the year and commentate on their impact for #RadOnc. Caleb's Pick — The Empire One TrialAnna's Pick — The Flame TrialSamuel's Pick — The VISION Trial Laura's Pick — KROG 0806Matt's Pick — CCTG SC.24/TROG 17.06Simul's Pick — SBRT in lieu of systemic therapy for RCCHappy holidays and happy new year to all, and here's to a great '22!

Dino Radončić joins this episode of The Can Do Podcast to share his story beginning his professional career at only 16 years old moving to Spain from Serbia. He talks to Mike and Ray about mental toughness, overcoming adversity, and European basketball. Follow Dino on Instagram @dinoradoncicoffical or Twitter @DinoRadoncic6

Steve Howard, Medical Physicist within the University of Kansas Cancer Center umbrella joins us to chat about his journey into medical physics, shares exciting news about what's new for his department and what might be around the corner for RadOnc as a field.

The Accelerators (Drs. Laucis, Parikh, and Spraker) welcome Dr. Toby Chapman and Dr. Jerry Jaboin to discuss practical tips for getting started as a #RadOnc attending. We explore how to meet referring clinicians, being affable while maintaining work-life balance, and how to be your tumor board's favorite oncologist - or not. At the end, Jerry serves up the introductory wellness module that every oncologist needs to hear. Here are all the books that were recommended during the show:BIFF Conflict Communication SeriesBlinkBobiverse Series (Audiobooks)Boom TownGold DiggersThe Investor's Manifesto

Ron DiGiaimo - Chairman of the Board - Revenue Cycle Coding Strategies / The Oncology Group and RC Billing

Dr. Matthew Katz, radiation oncologist in Lowell, MA, speaks with Drs. Jack West & Charu Aggarwal about the evolution of social media in medicine, challenges of different platforms, & striving to communicate effectively with & educate broad populations.

Rebecca Moylan comes on the show to share her experiences in clinical medical physics, and how those expereinces shaped her adventures into the corporate side of RadOnc with Elekta as a Physics Specialist!

Mark Yudilevich joins us with a great deal of information about recent developments for Gamma Tile and shares his insights of the RadOnc world from non-clinical perspective.

Olivier Blasi PhD comes on the show from CAMP physics and discusses his experiences and visions for the future of Radiation Oncology as a field!

** Doctors will give you aquaphor or a petroleum product-- maybe try coconut oil or cbd oil. ** Plan for the utter exhaustion of radiation, and plan for naps. ** People want to help you. Let them help you. ** Do your research before you make a decision. ** You need to stretch medicinally through radiation. ** Take care of all of you--not just your radiated parts. ** This too shall pass. ** Calling your Radiation Oncologist a Radonk-a-donk (RadOnc) may improve your radiation appointments. ** Thanks to Rose Lee, Patron Saint and Radiation Martyr. ** Thanks to J-Zee, Patron Saint of Letting People Explain the Dumb Things They Say on Social Media--we are all just muddling along.

Tue, 23 Feb 2010 19:48:23 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/0bb55cbb-9c33-4071-b9d3-9abdd3317ccf https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at

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Tue, 07 Jul 2009 14:40:43 GMT 2009-07-07T09:38:00-00:00 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/82114611-59dc-49dc-8ba3-3de74d99f04e https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Ra

Fri, 30 Jan 2009 19:57:58 GMT 2009-01-30T13:57:00-00:00 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/65213b65-4a12-43c7-9636-bba3b6ee562e https://www.screencast.com/users/RadOnc/folders/University+of+Alabama

Tue, 27 Jan 2009 21:53:19 GMT 2009-01-27T15:52:00-00:00 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/16e3aa6a-9a07-4677-a74e-6b1520b8f9f8 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+a

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Tue, 27 Jan 2009 17:51:36 GMT 2009-01-27T11:51:00-00:00 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/62240c84-6843-46bf-a72a-5ceaddd9e1b3 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+R

Tue, 21 Oct 2008 15:48:57 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/1faadda0-4af9-444a-9853-aff4782dcea0 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmi

Wed, 01 Oct 2008 18:30:37 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/92d6cc38-9835-4379-a408-5a096287eab9 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+

Fri, 19 Sep 2008 20:00:16 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/16935321-98d3-4e7c-84db-d550280abc0a https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingha

Mon, 08 Sep 2008 12:02:09 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/93991fa0-8ee7-4f72-b870-2021287f74bb https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+

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Tue, 02 Sep 2008 15:46:04 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/91d70199-a291-4a1e-b125-eb7b6ba584b9 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Bi

Tue, 02 Sep 2008 12:42:45 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/a258db6b-6cd4-4113-93f0-dcb7153a5217 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+

Tue, 26 Aug 2008 18:02:25 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/e9ad9db9-f5d4-48fb-9cf7-a1e4d9d46b98 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+R

Tue, 26 Aug 2008 14:18:32 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/b1c30486-5b86-49e5-b573-525097d7abf5 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+R

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Tue, 05 Aug 2008 14:19:54 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/ca26884b-cc91-4ddc-ac02-50c6b69fdafd https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at

Tue, 15 Jul 2008 17:55:51 GMT https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Radiation+Oncology/media/ba88058f-de2e-4dc6-a0de-ab7022abb6a9 https://www.screencast.com/users/RadOnc/folders/University+of+Alabama+at+Birmingham+Rad