Mark Storey

If radiation were a drug.... Full editorial on my blog. #radonc

@drbeckta 9999 was a great trial though...

Conversely: Me, seeing a patient referred back locally after going to Urban Tertiary Center, when I start reading the Academic Consult Note that contains two pages of boilerplate "per RTOG 9999 and NRG 1122..." Just to recommend the standard thing from the NCCN Guidelines.

@PDBrownOnc Thanks! It's one I did a few years back, but now with AI I feel more confident that it truly is a comprehensive list of the worlds RCT data. I argued for hours with about 4 different AIs looking for additional datasets - still not positive I didn't miss one, but it's close :)

@ProtonStorey Wishing you the best on your next adventure. Thank you for your review of IMRT RCTs it is excellent

Bit of news with one quote from the article: Honestly I have less visibility today regarding my path than I’ve had since my teenage years. I’ve straight-lined a path for 40+ years - time to meander a bit create some boredom for the mind to find my next passion.

@NicholasZaorsky @ARRO_org @ASTRO_org Well done in sharing resources and help educate the next gen. That said, can't see and not think AI will win if this is what our knowledge testing looks like.

Radiation oncology and biology dose thresholds, commonly tested on board exams. I made this in 2016. I hope it helps current @ARRO_org @ASTRO_org residents taking #radonc exams.

@drbeckta We're working hard to make our specialty irrelevant. I feel quite confident, it is more of a statement of how stretched resources are globally than a reflection of best practices in the US where resource models are completely different.

Well this is...interesting. With the obligatory disclaimer that I personally, frequently use 5-fraction regimens in breast, it's definitely not something I'd use in the post-mastectomy setting. Matt's right - they do actually have this as "Acceptable" and provide zero citation to support it. In fact, digging around the literature, I'm aware of only one source that could be cited, which is the FAST-Forward trial. In FAST-Forward, a whopping 173 post-mastectomy patients received 5 fractions to the chest wall...and that was split between 27Gy (loser arm) and 26Gy (winner arm). This population was, obviously, too small to conduct any sort of statistical analysis on. So 84 patients received the winning 26Gy in 5 fractions to the chest wall. Somehow, this made it in to the 2020 RCR Consensus Statements, and now the 2025 St Gallen Consensus? Really? Look, I agree that it is LOGICAL that it's probably not statistically inferior (which is distinct from "not as good"), but last I checked, we were pretending to practice evidence-based medicine, not logic-based medicine. To be clear, I'm not against ending the kayfabe of evidence-based medicine. But we should either try a bit harder (as in: use citations), or just abandon the show entirely. Because there are A LOT of things I can do in the world of logic-based medicine that have significantly more backing in the scientific literature than 5-fraction radiotherapy to the chest wall. We should also start calling "consensus statements" something more accurate, like "grimoires of the medical adepts".

Over the last few years, I had reviewed the data and am convinced this is what the data says - Here are my top three versions of this data relating to clinical opportunities. (topic of primary interest back in 2023). protons101.substack.com/p/prostate-can… protons101.substack.com/p/protons-101-… protons101.substack.com/p/favorable-in…

Nice to see this article on de-escalation: Optimal Duration of Androgen Deprivation Therapy With Definitive Radiotherapy for Localized Prostate Cancer: A Meta-Analysis | Reproductive Health | JAMA Oncology | JAMA Network jamanetwork.com/journals/jamao…

@zklaassen_md @sagarapatel @urotoday Looks like meeting present I guess - still the baseline differences mean it needs to be validated unless I'm missing something.

@zklaassen_md @sagarapatel @urotoday Article link? Surprised a bit at the difference in plaques at the onset of a randomized study - want to look at confounding. Thanks - interesting.

REVELUTION: Coronary Artery Plaque Progression After ADT in Men w/ #ProstateCancer - RCT Comparing Relugolix vs Leuprolide @sagarapatel @urotoday #SUO25 🌞n=28 ADT alone; n=31 RT + leuprolide; n=31 RT + relugolix 🌞BL and 12 mo coronary CT 🌞vs no ADT: Relugolix -- no statistical diff 🌞vs no ADT: Leuprolide assoc w/ significantly ⬆️: - Total coronary artery plaque vol (+79.1 mm3, p=0.004) - Non-calcified plaque vol (+71.9 mm3, p=0.001) - Calcified plaque vol (+19.9 mm3, p=0.04) - Low-attenuation plaque vol (+5.1 mm3, p=0.03)

@MHadziMD @JoaquinJCabrera Yep - as always - no clear measurable differences based on what they opted to evaluate - is the more appropriate language. Of course, more dose leads to more toxicity in the central mediastinum.

@JoaquinJCabrera I find it really hard to believe that toxicity is the same. For centrally located disease as is most common with SCLC, esophagitis even with 45BID is often raging.

High-Dose Versus Standard-Dose Twice-Daily Thoracic Radiotherapy in SCLC: Final data: Median OS in the 60 Gy group was significantly longer (43.5 versus 22.5 mo) Same toxicity. jto.org/article/S1556-…

@jryckman3 @SprakerMDPhD You know the game, FDA simply means it does what is submitted - nothing to do with cancer control.

@SprakerMDPhD 🤦‍♂️

Is this an “ablation of soft tissues” authorization and not FDA cleared for cancer? If that’s the case, it needs to be stated clearly and up front for every patient being offered this treatment. Every patient being considered for histotripsy should visit with a #radonc #HCC 🧩

@ADesaiMD @drgandara @LungCancerRx @UmbertoMalapel1 @Al3ssandroRusso Makes perfect sense. That said, look at ADT and radiation for prostate cancer - we still don't use post-treatment PSA kinetics to alter ADT duration recommendations. Clearly the more disease we clear up quicker, the less adjuvant can benefit.

#CHOICE-01 ctDNA analysis : ◼️ ctDNA-positive pts had major benefit from ICI-chemo vs chemo alone ◼️ ctDNA-negative pts → no significant difference between arms ◼️ Validated in combined RATIONALE 304/307 cohort ◼️ On-treatment ctDNA clearance linked to improved OS & PFS #LCSM

@UMmedschool @UMGCCC @TheLancetOncol Wonder if they got TTF in this study - TTF has PIII data with 695 pts. It isn't noted in the references.

New hope for glioblastoma patients: A @umgccc-led trial shows focused ultrasound + chemo boosts survival by nearly 40%. Published in @TheLancetOncol. 🔗 shorturl.at/1sEMg #Cancer #Research #MedicalBreakthrough #Science

@toddscarbrough @ASTRO_org I think 21%-22% is optimistic. On the tech side, the cut appears more than that to me. So bad people are hesitant to be honest regarding the mis-step. Maybe I'm wrong. We have centers - in about 6 months - I'll know for certain.

Danger, Will Robinson!* radiationeconomics.substack.com/p/mission-acco… *(there is one oncologist in the US by the name of Will Robinson fyi)

Ran numbers today - IMRT facility is closer to 40% on the technical revenue side. AI exercise but it looked about right - is this about what you are guestimating on the tech only side for this cohort? Simply brutal - obviously depends a bit on IGRT approach and utilization and % moving to complex code next year, but wow.

The CMS final rule is out for 2026 Predict #radonc freestanding centers will see about a 30% reduction in payment on standard IG-IMRT fractions in 2026 I don't understand how some of these centers will stay open, especially ctrs tx'ing 10-15 pts/day public-inspection.federalregister.gov/2025-19787.pdf

@DrSpratticus @CaPsurvivorship @Prof_Nick_James @AarmstrongDuke @AttardLab @angela_jia_ @NicholasZaorsky @Soum_Roy_RadOnc @YilunSun988846 @PBarataMD Well done - too often age is overlooked. Just today, two patients worried about PSA going from 0.0x to 0.0x+1. Age discussion x2 as we tried to put a simple lab into context. Age is one of few dominant predictors in this cohort.

9/9 Enormous thanks to the many co-authors @CaPsurvivorship, @Prof_Nick_James, @AarmstrongDuke, Maha Hussein, @attardlab, Karim Fizazi, @angela_jia_, @NicholasZaorsky @Soum_Roy_RadOnc @YilunSun988846, Jorge Garcia, Jason Brown, Prateek Mendiratta, @PBarataMD More refinement clearly needed as age is just a number after all!

1/n X-torial on our recent @NEJMEvidence paper out: evidence.nejm.org/doi/full/10.10… Should all men w/ conventional imaging defined mHSPC receive doublet or triplet systemic therapy?

@BLawenda @KoneruMd Link or available? Be interested to try - surprised a bit that an OCR would get the accuracy, but things change daily.

@ProtonStorey @KoneruMd The product is called VeloNote. It uses OCR through a HIPAA complaint filter that processes the data through an integrated AI. It is a web application that you use in parallel and outside of your EMR.

We are entering the "AI Paradox" of medicine. Clinically, it is going to be a Golden Era: Safer, cheaper, accessible care for billions. Economically, there will be a structural deletion of much of the industry. brianlawenda.substack.com/p/the-ai-parad… #MedTwitter #AI #Healthcare

@BLawenda @KoneruMd Care to share details on approach - integrated via API or screen reads or are you doing manual uploads? Does it run in via windows or EPIC or something Radonc related like Mosaiq. I am still struggling to beat my old AHK 2000 line code I wrote back in 09.

Nothing formal. I’ve been coding apps and building software with AI tools. One is a HIPAA complaint product that reduces complex consult note chart prep down from 30+ minutes to about 5 minutes. I use Open Evidence with custom NotebookLM videos to teach patients about their management. The acceleration of the models is unbelievable.

Practical Reviews in Cancer Management is closing shop. Just wanted to get a shout out to Jonathan Beitler and the team on that project - I've used it for decades for CME. If you have a contact, message me - I'd like to say thanks personally.