Jonathan Verma

Radiation Oncologist, @TexasOncology. Views my own.

[Jonathan Verma @JonathanVermaMD]

@drmattmc Lol

[Jonathan Verma @JonathanVermaMD]

@ZilliThomas @Mat_Guc @RaymondMiralbe1 @alongi_filippo @CiroFranzese1 @Achard_Verane I hope the biochemical / local failures after 5 yrs will not be as high as in the single fraction HDR experience

[Jonathan Verma @JonathanVermaMD]

@toddscarbrough Have never quite understood why there’s any distinction in these policies between freestanding and hospital based

[Jonathan Verma @JonathanVermaMD]

@AaronGoodman33 The former is far more cruel. Giving a patient false hope by putting them through that kind of brutal surgery, for a disease with that high metastatic rate, is honestly shocking

[Jonathan Verma @JonathanVermaMD]

@toddscarbrough @ASTRO_org This is sadly on-brand for radonc leadership

[Jonathan Verma @JonathanVermaMD]

@5_utr The best way radonc can reduce toxicity in prostate cancer treatment isn’t fx, protons, MRI linac etc… it’s getting more patients to choose radiation vs surgery

[Jonathan Verma @JonathanVermaMD]

@yuanjamesrao I wonder if 2 fx HDR outcome may be improved by giving the DIL more dose (125-150%)?

[Jonathan Verma @JonathanVermaMD]

@toddscarbrough @WinshipAtEmory @TheLancetOncol I dont understand how a local therapy could have this magnitude benefit in stage IV pts. But if it does, should we evaluate other local options for these pts?

[Jonathan Verma @JonathanVermaMD]

@5_utr @yuanjamesrao @drmattmc I agree, look at all the uptake all over the body on a PSMA PET and imagine Lu-177 going to all those places 😟

[Jonathan Verma @JonathanVermaMD]

@DrChowdharyMD @evicorehc I’ve had many denials where they want 2D for bone mets, which is ridiculous since we routinely do CT, generate 3D plans and evaluate normal organ doses

[Jonathan Verma @JonathanVermaMD]

@toddscarbrough This is very carefully presented— they walk a very fine line here saying “current data do not support improved outcomes”… which is true!

[Jonathan Verma @JonathanVermaMD]

@AndrewFarach @KamravaMD @DrAndrewLoblaw @gerard_morton How high do you typically boost the DIL?

[Jonathan Verma @JonathanVermaMD]

@_ShankarSiva @DrAndrewLoblaw @DrSpratticus @piet_ost @Prof_Nick_James @PCaParker @DocJarad @NicholasZaorsky @JulieMcCrossin @sandraturner49 @achoud72 Wasn’t the conventional schedule 73.8 Gy/41 fx?

[Jonathan Verma @JonathanVermaMD]

@yuanjamesrao Interestingly, this group found excellent 10-yr outcomes with 27/2 even in a single implant in 1 day. There’s a lot to learn about the radbio of hypo fx RT.

https://t.co/0MPXNwvVpJ

[Jonathan Verma @JonathanVermaMD]

@ParikhSimul Wtf?

[Jonathan Verma @JonathanVermaMD]

@drbeckta Bizarro world

[Jonathan Verma @JonathanVermaMD]

@drbeckta @MayoRadOnc Perhaps question but how can we have a proton fractionation RCT before a simple proton vs photon? It would not take large numbers or a long time for toxicity data and would be very useful info

[Jonathan Verma @JonathanVermaMD]

@ParikhSimul @NiuSanford Reading this article I’m struck by the toxicity in BOTH groups relative to photon experience.

RCT is so long overdue; in the meantime I don’t know how anyone can feel good about treating these patients off trial

[Jonathan Verma @JonathanVermaMD]

@jryckman3 @crossiusa @DrewMoghanaki @RajaFlores @JoeChangMD @JackARothMD @TobiasFinazzi I suspect IMRT+HDR or IMRT/SBRT with aggressive SIB may be superior to surgery for prostate cancer as well. Would love to see a trial

[Jonathan Verma @JonathanVermaMD]

@drbeckta @dschan02 @lemmiwenks @_podiatry @toddscarbrough It raises the question of how many patients should justify having a center so those patients wouldn’t have to drive. Seems like the only way for a 5-6 patient/day machine to succeed would be remote doc/physics/dosi and/or greatly increasing rural reimbursement per pt