This is a curious finding, as the more numerous 3-D versus IMRT trials never did consistently show a survival benefit to IMRT over 3-D for H&N cancer, despite significant toxicity reduction for IMRT. I would argue that 3-D to IMRT is a bigger leap than IMRT to protons.
I agree on it needing to be validated. Interesting question - could prob write an entire article honestly. I moved to IMRT some 20-25 yrs ago - OC, lips and nausea worse - parotids and dry mouth better - wasn't home run but clearly better. Not sure I agree that step was bigger. Data-wise this is simply levels stronger. Only 3D/IMRT I know of are Tata series and Parsport - largest cohort at 2 yrs was Parsport with <30 per arm at 2 yrs disease free - this is over 140 per arm. Data on shift to IMRT was basically non-existent so hard to judge IMO. Very few of us these days have 3D>>IMRT>>Proton experience so thanks for following along and giving insight on your perspective.
1. serious conflict of interest (pro? ton$ !), and $eriou$ly no joke
2. impossible to logically explain that regardless of subset analysis, "proton$ wins".. please
3. survival benefit? maybe* toxicity improvement leading to survival benefit? maybe? nah
4. I'm not buying it, and its unrealistic to expect average H&N treatment to suddenly result in the popup of ton$ of expen$ive proton centers for a cancer making up 3% of the cancer pop.
Thanks for reading. I try to be as clear as one can be on where I am - name of site etc etc. Not sure how to be more obvious. Been part time for a bit - don't need to work but enjoy what we get to do (vast majority of money from 18 yrs on photon side). But sure we all have opinions and biases. So I guess you think they are equivalent or close enough not to matter despite primary and all secondary outcomes - if that's the case, we differ. As I said, most will wait on more data - very reasonable.
This is a curious finding, as the more numerous 3-D versus IMRT trials never did consistently show a survival benefit to IMRT over 3-D for H&N cancer, despite significant toxicity reduction for IMRT. I would argue that 3-D to IMRT is a bigger leap than IMRT to protons.
I agree on it needing to be validated. Interesting question - could prob write an entire article honestly. I moved to IMRT some 20-25 yrs ago - OC, lips and nausea worse - parotids and dry mouth better - wasn't home run but clearly better. Not sure I agree that step was bigger. Data-wise this is simply levels stronger. Only 3D/IMRT I know of are Tata series and Parsport - largest cohort at 2 yrs was Parsport with <30 per arm at 2 yrs disease free - this is over 140 per arm. Data on shift to IMRT was basically non-existent so hard to judge IMO. Very few of us these days have 3D>>IMRT>>Proton experience so thanks for following along and giving insight on your perspective.
1. serious conflict of interest (pro? ton$ !), and $eriou$ly no joke
2. impossible to logically explain that regardless of subset analysis, "proton$ wins".. please
3. survival benefit? maybe* toxicity improvement leading to survival benefit? maybe? nah
4. I'm not buying it, and its unrealistic to expect average H&N treatment to suddenly result in the popup of ton$ of expen$ive proton centers for a cancer making up 3% of the cancer pop.
Thanks for reading. I try to be as clear as one can be on where I am - name of site etc etc. Not sure how to be more obvious. Been part time for a bit - don't need to work but enjoy what we get to do (vast majority of money from 18 yrs on photon side). But sure we all have opinions and biases. So I guess you think they are equivalent or close enough not to matter despite primary and all secondary outcomes - if that's the case, we differ. As I said, most will wait on more data - very reasonable.