out.of.the.basement / radiation.medicine Jason Beckta, MD, PhD

Episode Four (part...one?) of the “Real World LDRT” miniseries (sponsored by Xstrahl) gets more into the evidence behind LDRT. Specifically, the two RCTs out of the Netherlands published a few years back showing that LDRT had no benefit in osteoarthritis.

So...couple small problems with that. Namely, the trials had less than 30 patients in each arm, used too high of a dose, used only half the standard treatment, and...oh, yeah. In the LDRT arm in one of the trials, 2/3rds of the patients had >5/10 pain for >15/30 days per month despite analgesics/therapy for >5 years. That's VERY severe pain, by any definition.

...and:

One of the primary outcome criteria was "greater than 50% relative improvement in pain/function AND >20 points in absolute improvement" on their specific measurement tool.

...and:

"...both studies were powered to detect a large effect of low-dose radiation therapy. Using the primary outcome, allowing for a 15% dropout rate, [they] aimed to include 27 patients per group, assuming an expected difference of 40% in the proportion of responders between the low-dose radiation therapy and sham intervention groups, 80% power and 5% α level, and that 40% of the sham intervention group would be responders..."

Is there any intervention on Planet Earth that would show a positive signal with a design like this?

Please. Please. Please stop citing these trials.

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Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠⁠⁠⁠https://xstrahl.com/⁠⁠⁠⁠

***

OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support.

jason@coldlight.org


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Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

On April 5th, 2024, ASTRO held an actual, honest-to-goodness "town hall" style virtual meeting with ~200 members of the Radiation Oncology community showing up to make their voices heard.

Yowza. There's a reason this took me over a week to make and clocks in at almost two hours.

Buckle up for a very special Cold Light episode as we "watch the watchers" and explore the topic of virtual supervision discussed in a virtual meeting.

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OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support.

jason@coldlight.org


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Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Episode Three of the “Real World LDRT” miniseries (sponsored by Xstrahl) is everyone's favorite topic: coding and billing!

[insert the sounds of a gleeful studio audience here]

The secret sauce is to remember you can bill it like normal (ideally, 2D or "complex isodose"). The radiotherapy CPT codes are disease agnostic (no, they're not just for cancer - heard that one before).

But importantly - as doctors primarily treating cancer, we don't realize how massive the burden of osteoarthritis is for the American population.

The even more secret sauce? LDRT is, by far, the most economical treatment option to both the patient, and the healthcare system as a whole.

Remember: 3 Gy in 6-every-other-day fractions, assess at 12 weeks, and deliver a second identical course if necessary/desired.

It really is that easy.

***

Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠⁠⁠https://xstrahl.com/⁠⁠⁠

***

OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support.

jason@coldlight.org


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Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Episode Two of the “Real World LDRT” miniseries (sponsored by Xstrahl) is all "meat and potatoes", as the kids used to say (back when FDR was president).

I start with a high-level overview of the laboratory evidence for LDRT, followed by how to get your first patient and what you say to them when they ask "how does this work??"

Hint: it's like NSAIDs and prednisone, just a different pathway.

We then explore my favorite CTSIM setups and target volumes/PTVs.

Remember: 3 Gy in 6-every-other-day fractions, assess at 12 weeks, and deliver a second identical course if necessary/desired.

It really is that easy.

Find the presentation/slides for this episode at:

Beckta, Jason (2024). Getting started with radiation therapy for arthritis - mechanisms, getting your first patients, setups, treatment planning.

https://doi.org/10.6084/m9.figshare.25546417.v1

***

Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠⁠https://xstrahl.com/⁠⁠

***

OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support.

jason@coldlight.org


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Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Episode One, Part Two of the “Real World LDRT” miniseries (sponsored by Xstrahl) circles back to the 1940s and the extraordinary flaws of the "linear no threshold" (LNT) model of radiation risk. We explore backroom deals, handshake science, corporate greed, regulatory capture, hormesis, OSHA violations, putting radium in the throats of 2.5 million children...you know, the regular, everyday stuff.

Why? Because a common hesitation to deploying LDRT for arthritis is the risk of the treatment itself causing cancer.

Spoiler alert: there has never been a case of secondary malignancy from therapeutic radiation below a magical threshold dose.

And LDRT stays below that threshold.

Don’t believe me? That’s why this miniseries exists!

Relevant papers and sources at ⁠http://u.pc.cd/OhN⁠

Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠https://xstrahl.com/⁠

OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support.

jason@coldlight.org


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Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Kicking off the “Real World LDRT” miniseries sponsored by Xstrahl, Episode One/Part One takes us all the way back to 1895 and Wilhelm Roentgen aiming his newly discovered “X-rays” at his wife’s hand. Within 3 years, radiotherapy was treating arthritic conditions in Europe before coming to America in 1906. By 1930, the scientific literature contained more than 6,000 patients treated by LDRT for arthritis (and other degenerative inflammatory conditions) - with orthovoltage techniques accounting for most (if not all) reports. Today, a common concern preventing the use of radiotherapy for arthritis in every practice in America is the alleged “lack of evidence”...an odd complaint for one of the only therapies in use for ~125 years with tens of thousands of patients experiencing excellent outcomes.

Don’t believe me? That’s why this miniseries exists!

Relevant papers and sources at http://u.pc.cd/OhN

Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at https://xstrahl.com/

OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support.

jason@coldlight.org


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Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support