I didn't understand 95% of this so forgive my comment if it is stupid. I liked the European study where patient selection was a key component of the trial (if I understood you correctly). I was just proposing this type of trial design on another substack, so I'm glad to see something like it in the real world. It seems like patient selection is a real conundrum and scattershot(*) approaches are the real world norm. I will reread this 5 or 6 times to try to really understand it.
(*) Sorry I couldn't think of a better word. I'm not sure how to describe the current situation.
Selection is key - getting the people with the most potential for benefit is very important. Protons still only are 2% of radiation facilities - we need high risk patients in those specialized facilities. Thanks for reading.
Great commentary, Mark. As always, insightful and thoroughly thought out.
There is debate as to what drives human progress. Some say inventions (technology), others say "paradigm shifts" - e.g. the heliocentric Copernican model of the solar system.
I think it's both, but that technology comes first. Without telescopes and precise measuring instruments in the hands of scientists, the old astronomical models (akin to sloppy wide margins) could not be rejected.
One of the ongoing criticisms of proton therapy regards its proliferation despite the lack of randomized trial data. What this ignores though, is that a good, large clinical trial requires a multi-site infrastructure to design and conduct it, and even then it takes over a decade for enough patients to accrue and be followed for 5-10 years. Insurance denials, referral/ reimbursement patterns and lack of geographic access remain barriers to accrual for common indications, at least in the US.
Once we have good technology (IMPT), widely distributed enough for large scale research to occur, then enough data can accumulate for paradigm shifts to follow (or not).
Very kind. Yes - there are layers and layers to what we did correctly and incorrectly in the proton adventure. I *think* we are on the better side of the curve today, but as you say - we need more data - and thankfully Europe is on the horizon to assist.
I didn't understand 95% of this so forgive my comment if it is stupid. I liked the European study where patient selection was a key component of the trial (if I understood you correctly). I was just proposing this type of trial design on another substack, so I'm glad to see something like it in the real world. It seems like patient selection is a real conundrum and scattershot(*) approaches are the real world norm. I will reread this 5 or 6 times to try to really understand it.
(*) Sorry I couldn't think of a better word. I'm not sure how to describe the current situation.
Selection is key - getting the people with the most potential for benefit is very important. Protons still only are 2% of radiation facilities - we need high risk patients in those specialized facilities. Thanks for reading.
Great commentary, Mark. As always, insightful and thoroughly thought out.
There is debate as to what drives human progress. Some say inventions (technology), others say "paradigm shifts" - e.g. the heliocentric Copernican model of the solar system.
I think it's both, but that technology comes first. Without telescopes and precise measuring instruments in the hands of scientists, the old astronomical models (akin to sloppy wide margins) could not be rejected.
One of the ongoing criticisms of proton therapy regards its proliferation despite the lack of randomized trial data. What this ignores though, is that a good, large clinical trial requires a multi-site infrastructure to design and conduct it, and even then it takes over a decade for enough patients to accrue and be followed for 5-10 years. Insurance denials, referral/ reimbursement patterns and lack of geographic access remain barriers to accrual for common indications, at least in the US.
Once we have good technology (IMPT), widely distributed enough for large scale research to occur, then enough data can accumulate for paradigm shifts to follow (or not).
Keep up the good work!
Very kind. Yes - there are layers and layers to what we did correctly and incorrectly in the proton adventure. I *think* we are on the better side of the curve today, but as you say - we need more data - and thankfully Europe is on the horizon to assist.