@ProtonStorey profile picture
Mark Storey @ProtonStorey
Joined June 2019
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Mark Storey
@ProtonStorey
12 Dec 2023
If radiation were a drug.... Full editorial on my blog. #radonc
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"hazard ratio for death of 1.08, a finding that is below the pre specified threshold for an unacceptable level of detriment." Think about this statement - pulled from a recent paper. Not enough excess deaths to be unacceptable detriment.
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Yes. Statistical statement worded very poorly. Just say not significant. Don't say excess deaths aren't enough to matter. They matter to those who passed due to treatment - I guarantee that.
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PROTEUS - paper says BCF is <0.2. Supplement and some talk here shows it was moved to <0.02 for time to biochemical failure. 0.02 isn't in the article. Anyone have insight? Obviously the lower you push this, the more the event free curves will separate with intensification.
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Images from paper and the supplement
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My article following the 2023 presentation with behind the scenes stories from Dr. Siva. 100% control in RCC open.substack.com/pub/proton…

Muhammad Ali
@dr_alimuhammad
Jun 2
Kidney SABR on the front cover of @TheLancetOncol. A well-deserved recognition for @_ShankarSiva for his work and efforts over the past 10 years. thelancet.com/journals/lanon…
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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. radiologybusiness.com/topics…

Radiation oncologists who maintain certification more likely to deliver low-cost cancer treatment

Whether MOC should be mandatory for all is often debated among providers, but new findings indicate that opting not to participate may affect patient care.

radiologybusiness.com
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This looks like the end game is nearing. Was hoping this would be pushed. arkansasbusiness.com/article…

UAMS Threatens to End Proton Center Partnership Over Unpaid Bills

UAMS threatened to terminate service agreements with the Arkansas Proton Center unless nearly $900,000 in overdue invoices were paid by May 28 amid ongoing financial and equipment troubles.

arkansasbusiness.com
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$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.
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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.
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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
May 18
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 @
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And this is in an area where we have great data. As I've written, this is only the beginning.
Piet Ost@piet_ost
May 6
Replying to @TylerSbrt @PCaParker @urotoday @neerajaiims @huntsmancancer @TDorffOnc @cityofhope @ChrisSweens1 @DrSpratticus @Prof_Nick_James @BertrandTOMBAL
The official response I got from the company is shocking: Allowing for radiation to the prostate (per STAMPEDE and/or PEACE) studies has the potential to confound the interpretability of the results, specifically the OS results which is a key alpha protected secondary endpoint.
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Here's an article I wrote back in DEC 2023 addressing this type of specific shift in the EMBARK trial: protons101.substack.com/p/pr…

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This has been the plan for literal years...
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Another proton center struggles against the backdrop of too much debt. Not a one off event - in fact - closer to the expectation.
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I called this as a likely outcome back in 2023 - too much debt for one vault to service. Math is quite straightforward. A look at Arkansas, Alabama, Emory, and OKC - two handled reasonably, one I don't like, and one still to be decided.
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Direct link: protons101.substack.com/p/pr…
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This week is focused on LET / RBE differences between protons and photons - what you need to consider as you flip between these modalities.
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Magnitude of the potential difference in "what you get" vs. "what you see" is surprising large - lots of caveats to this table - read the article - but also, this is direct data from our physics reference document on this known variance.
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At least 4 well documented clinical publications regarding complications consistent with LET / RBE effects at end of range when using protons.
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Mark Storey retweeted
Todd Scarbrough
@toddscarbrough
Apr 16
Replying to @ProtonStorey
Mark, the line that really got me in your piece was this one: "This new payment structure now becomes the path we must navigate as we race AI and progressive drug development."
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