Mark Storey

Dr. Mark Storey MD - Radiation Oncologist. @OKProtonCenter. Background: #MDAnderson @VanderbiltU @BMESociety #RadOnc
My blog:

[Mark Storey @ProtonStorey]

If radiation were a drug....

Full editorial on my blog. #radonc

[Mark Storey @ProtonStorey]

@TylerSbrt @HimanshuNagarMD @Soum_Roy_RadOnc @VedangMurthy @DrSpratticus @DrAndrewLoblaw @AmarUKishan @NicholasZaorsky Curious. You have HR guys sitting at <0.1 at six months and stay on them for six more and honestly felt like more ADT would have beneficial? I have zero in that cohort. Just curious

[Mark Storey @ProtonStorey]

@HimanshuNagarMD @TylerSbrt @Soum_Roy_RadOnc @VedangMurthy @DrSpratticus @DrAndrewLoblaw @AmarUKishan @NicholasZaorsky Been offering shortening based on post treatment kinetics for nearly five years. Five years in - no regret cases.

[Mark Storey @ProtonStorey]

Do you have details? Was it doubling time related or absolute or uptake related? In general data says 95%+ concordance - do you think it is significantly different here due to these other factors? I think we need to be moving that way - would just be surprised, for this trial, at this timeline, moving the primary was able to capture what we have learned in the past 24 months or so. Thanks in advance.

[Mark Storey @ProtonStorey]

@seanmmcbride Yes. Normally it isn't a bad thing to look at but here - 100% up front vs likely the same thing later, carries much less value. Plus as we iterate faster, there is a larger and larger benefit to delay. The available drug might be 3x better than current ones.

[Mark Storey @ProtonStorey]

@StephenChunMD @lauren_henke @NRGonc @UTMDAnderson @krishnan_patel @JeffersonUniv @APDicker @Veracyte @ASCO @RTOGFoundation @felixfengmd @MaryFengMD No. Data says 2 in 3 benefit. Just how best to parse.

[Mark Storey @ProtonStorey]

@DrSpratticus @WallisCJD @ChrisSweens1 If the radiologist is aware the PSA is up, it approaches 99.9%.

[Mark Storey @ProtonStorey]

@DrSpratticus @ChapinMD Well done on the thread. I'm afraid 99% of people will only see this👇 When, if it were me, I'd avoid intensification almost across the board. Hopefully biomarker / predictive items continue to show ability to parse this cohort.

[Mark Storey @ProtonStorey]

Consider this. If they believe this, insurance should be paying for our MOC. They could make more in that model. Of course they don't believe this. Other option is drive down radiation billing so in budget neutrality they can get more for radiology. But most likely just conflated data that lets a board member promote "benefit" - saying see, you must keep paying - it benefits the system.

[Mark Storey @ProtonStorey]

@SprakerMDPhD I don't doubt that younger people use less fractions. And even isolated 65 yr olds using more fractions than 65 yr olds working in environments with younger people, but to think that is MOC causality is laughable "science". And the link to dollars is not that simple. Just poor

[Mark Storey @ProtonStorey]

ABR board member says there is value in MOC. Article paywalled but no mention of site of service and likely proton codes not eval'd. Just a partial look at one variable in a complex system and then conflating data.

We see this exact error all the time.

https://t.co/K9i8MNuROr

[Mark Storey @ProtonStorey]

This looks like the end game is nearing. Was hoping this would be pushed.
https://t.co/GY9ZTILZFA

[Mark Storey @ProtonStorey]

@savadMG If it seems complicated - it is.

[Mark Storey @ProtonStorey]

$39 dollars for IMRT in CA. New Jersey at $21. These are real Medicaid rates post the CMS restructuring. Goal: 1) Raise awareness, 2) Actionable letter.

Rome burns.

[Mark Storey @ProtonStorey]

@savadMG Medicare is federally run. Medicaid programs are state run and states got to "reset" payments when the federal program "restructured" radiation payments.

[Mark Storey @ProtonStorey]

14 facility closures year to date. More than 20 considering closer by end of summer.

Industry has sold the US equipment and sees our market shrinking so their interest is elsewhere in the globe.

If you lead a large program - your voice is critical to these financial issues.

[Mark Storey @ProtonStorey]

AI says RayStation python scripting can handle this essentially in one click via the route you are discussing. Burning dose into the pixels so the "dumb" PACS end can display. We're busy and don't control the PACS but have a few doing projects - I'll see... What AI says vs. reality isn't always right, but it followed right along with your thread easily. 10 min of steps into a repeatable script. Again, give me a bit.

[Mark Storey @ProtonStorey]

@Nat83052921 @HardenedBeam Maybe but 640 randomized pts point to far less tube requirements. It would be quite ironic for this to be bias in favor of protons.

[Mark Storey @ProtonStorey]

This isn't quite right though. There were improvements even in the negative TORPEDO trial - just temporary. This is kind of the opposite take to leaning into an OS survival.

"No QoL". From a patient perspective, I'd think they 100% think these are improvements.

[Pierre Blanchard, MD @PBlanchardMD]

No QoL difference with IMPT vs IMRT in oropharyngeal cancer in the TORPEdO 🇬🇧 trial.
How to explain the differences w/ @SJFrankMD 🇺🇸 trial? Planning? Patients? Crossover in the 🇺🇸 trial? Real absence of difference?

Cc @EmmaHall71 @