Discover and read the best of Twitter Threads about #RadOnc
Most recents (24)
Let's have a closer look 🧐at the PROSPECT trial after its presentation at #ASCO23 and publication in @NEJM bit.ly/43L83oI #radonc #crcsm 1/n
First of all, the study team is to be congratulated for successful recruitment and completion of the study. Almost 1200 patients randomized - everyone who has led a multicenter trial can appreciate how challenging it can be to keep recruitment up over time.
The study enrolled patients with locally advanced rectal cancer that had to meet some specific inclusion criteria.
🔹Tumor located 5-12 cm from anal verge
🔹Sphincter sparing surgery possible at baseline
🔹Distance from MRF min. 3 mm
🔹T2N1 or T3N- or T3 N1
Exclusion:
♦️T4
🔹Tumor located 5-12 cm from anal verge
🔹Sphincter sparing surgery possible at baseline
🔹Distance from MRF min. 3 mm
🔹T2N1 or T3N- or T3 N1
Exclusion:
♦️T4
Talk from @DigiaimoRon on billing and coding in #radonc at #ACRO2023.
Cumulative payments in the field are down 30% from 2007 to 2023.
Cumulative payments in the field are down 30% from 2007 to 2023.
#radonc CPT codes are under 77xxx, historically under radiology.
Coding rules from CMS change.
Eg, CT sim and 3D plan historically could not be billed on same day.
Coding rules from CMS change.
Eg, CT sim and 3D plan historically could not be billed on same day.
Modifiers are added to CPT codes.
Commonly misunderstood part of billing: consultation and CT sim can be done on same day, but need to use a modifier.
Remember to also list ICD 10, list laterality.
"CPTs asks if you want to get paid. ICD 10 tells if you will get paid."
Commonly misunderstood part of billing: consultation and CT sim can be done on same day, but need to use a modifier.
Remember to also list ICD 10, list laterality.
"CPTs asks if you want to get paid. ICD 10 tells if you will get paid."
Radiotherapy for renal cell carcinoma: current status and future directions
#RadOnc #kcsm #KidneyCancer @ASTRO_org @ESTRO_RT @ARRO_org @RadoncUh
Thread🧵
#RadOnc #kcsm #KidneyCancer @ASTRO_org @ESTRO_RT @ARRO_org @RadoncUh
Thread🧵
Thanks to @_ShankarSiva @DrAlexLouie @rob_uzzo @uretericbud @whallradonc @LPonsky @LeilaTchelebi for improving quality of this talk.
Thanks to @AmarUKishan @UCLA for invite to present.
Thanks to @AmarUKishan @UCLA for invite to present.
For reference, kidney cancer staging is here.
Currently, role of #radonc is for smaller cancers (eg, T1a/b, some T2) and metastatic disease.
Currently, role of #radonc is for smaller cancers (eg, T1a/b, some T2) and metastatic disease.
Hey #GIOnc #Radonc friends! Let’s talk definitive CRT for locally advanced esophagus cancer! Looks like we now have at least 5 RCTs exploring dose escalation… and the standard remains 50 Gy! Let’s review!! 🧵🧵🧵1/
RTOG 8501 established the standard care of 50.4 Gy + concurrent chemotherapy for patients with inoperable, locally advanced esophagus cancer
Nearly 90% were SCC.
🔵Long-term disease control/survival was achieved in approximately 25% of patients. 0% with RT alone!!! 2/
Nearly 90% were SCC.
🔵Long-term disease control/survival was achieved in approximately 25% of patients. 0% with RT alone!!! 2/
However, local progression after 50.4 Gy + chemo occurs in approximately 50% of patients AND the vast majority occur at sites of initial gross disease. Hence the question: Would increasing RT dose improve outcomes??? 3/
In 2006, a radiation oncologist in Inglewood, California, published a report on building a Lay Patient Navigator Program in collaboration with the @RANDCorporation. #radonc 1/ 🧵acsjournals.onlinelibrary.wiley.com/doi/epdf/10.10…
2/ The focus of this report was to describe how people with cancer who are not as privileged as those living in other areas of Los Angeles might benefit from lay patient navigators.
3/ At the time, it was still an innovative concept to engage lay patient navigators to support people with cancer. Nonetheless, it made a lot of sense to study it.
How to write a research abstract for presentation at a meeting
Presented at #ASTRO22 @ASTRO_org
@pipcosper #radonc
Tweetorial 🧵
Presented at #ASTRO22 @ASTRO_org
@pipcosper #radonc
Tweetorial 🧵
This thread will review the key components of each abstract section and provide examples of some of the highest scored abstracts at #ASTRO22
Since our Twitter audience is diverse, I will also highlight key features in recent @NEJM NordICC abstract:
nejm.org/doi/full/10.10…
Since our Twitter audience is diverse, I will also highlight key features in recent @NEJM NordICC abstract:
nejm.org/doi/full/10.10…
Abstracts are usually structured into 4 parts
Seeing all the Halloween stuff coming out makes me think of ghosts, aliens, myths and...wait. Myths, like normal application of lotion to skin has a bolus effect? What a great Out of the Basement topic! So let's explore just that:
open.spotify.com/episode/14MroF…
open.spotify.com/episode/14MroF…
This is one of those classic RadMed (#radonc) campfire tales that we just can't seem to shake. A wonderful paper in @JAMAOnc convincingly demonstrated that normal application of agents, EVEN SILVADENE, had unremarkable dosimetric effects.
Down the rabbit hole: a different study demonstrated that the beloved thermoplastic mask caused surface dose to be 128% relative to control...and 5mm of bolus was 158%. "Realistic" topic agents? 106-111%. So using a H&N mask is implicit agreement that myth=busted.
Desde @SEOR_ESP Recordamos hoy día 8 de Junio
Hilo 🧵 #btsm 🧠#radonc
#BrainTumorDay #DiaTumorCerebral Baja prevalencia pero alto impacto en el paciente. #tratamospersonas #aportandovida #laradioterapiacura
Hilo 🧵 #btsm 🧠#radonc
#BrainTumorDay #DiaTumorCerebral Baja prevalencia pero alto impacto en el paciente. #tratamospersonas #aportandovida #laradioterapiacura
Es la primera causa de muerte por cáncer en niños y adolescentes (0-14 años). En la población adulta, por el contrario, solo representan el 2% de los tumores malignos. #btsm 🧠
Aunque los más frecuentes son los tumores benignos ( meningiomas, neurinomas..que pueden requerir tto)
Aunque los más frecuentes son los tumores benignos ( meningiomas, neurinomas..que pueden requerir tto)
La radioterapia es, después de la cirugía, el tratamiento más importante de los tumores cerebrales, primarios o secundarios ( metástasis Un 90 % ❗❗ de las lesiones malignas 🧠)
En la actualidad se realizan tratamientos con alta precisión.
Gracias a la tecnología y a la imagen
En la actualidad se realizan tratamientos con alta precisión.
Gracias a la tecnología y a la imagen
Oral boards for #RadOnc are approaching. Here is advice to anyone taking the exam.
@ARRO_org @ASTRO_org @ACRORadOnc @ACROresident
@ARRO_org @ASTRO_org @ACRORadOnc @ACROresident
1, #RadOnc oral boards are the most clinically relevant exams (vs rad bio, physics, written exam, inservice, etc).
Many of the questions about management come straight from @NCCN guidelines, so use these as a primary reference.
Many of the questions about management come straight from @NCCN guidelines, so use these as a primary reference.
2, have a prepared script of what to say for standard questions. eg, workup, setup, margins, doses
Here is an example for prostate ca history / workup
#pcsm
Here is an example for prostate ca history / workup
#pcsm
Can we improve how we treat cancer with stereotactic radiation? Yes, we can.
Here’s a @ClinOncology editorial with Drs. @MichaelTMilano & Alina Mihai on including clinical treatment volumes (CTVs) for microscopic disease.
authors.elsevier.com/a/1eVwJ3K%7E8R…
#radonc #medphys 1/
Here’s a @ClinOncology editorial with Drs. @MichaelTMilano & Alina Mihai on including clinical treatment volumes (CTVs) for microscopic disease.
authors.elsevier.com/a/1eVwJ3K%7E8R…
#radonc #medphys 1/
Radiation therapy (RT) can non-invasively treat microscopic disease. In curative settings, RT complements or competes w/ surgery to improve cancer care and patient outcomes.
I’ll discuss how matters using curative lung cancer and metastatic disease as examples. 2/
I’ll discuss how matters using curative lung cancer and metastatic disease as examples. 2/
Stereotactic RT lets us give very high doses safely. Advances in medical physics & computer programming, matched w/ clinical trials, show we can improve tumor control & decrease central “in-field” failures. Its evolution initially required ignoring microscopic disease. 3/
*THREAD* 1/17 People with #bonemets should be supported & encouraged to engage in regular physical activity to manage side effects from cancer & treatments. Recommendations to guide practice in @JCOOP_ASCO ascopubs.org/doi/pdf/10.120…
2/17 Method: International Bone Metastases Exercise Working Group: Multidisciplinary, international panel of physicians, PTs, exercise physiologists & researchers, formed to develop best practice recommendations based on published research, clinical experience & expert opinion.
3/17 Healthcare provider survey found practitioners were uncertain of correct risk management approach. 75% of physicians & NPs agreed patients look to them for guidance, but 86% not comfortable making recommendation #oncology #clinonc #medonc #exonc
link.springer.com/article/10.100…
link.springer.com/article/10.100…
1/
🚨Delighted to do a quick #tweetorial on our short report in the💚#GreenJournal @RadiotherapyOn1
☢️Heterogeneous immunogenicity of SARS-CoV-2 vaccines in #cancer patients receiving
#radiotherapy💉
➡️thegreenjournal.com/article/S0167-…
#radonc #COVID19 #CovidVaccine #lcsm
#OncoAlert
🚨Delighted to do a quick #tweetorial on our short report in the💚#GreenJournal @RadiotherapyOn1
☢️Heterogeneous immunogenicity of SARS-CoV-2 vaccines in #cancer patients receiving
#radiotherapy💉
➡️thegreenjournal.com/article/S0167-…
#radonc #COVID19 #CovidVaccine #lcsm
#OncoAlert
2/
Inspired by:
[Our patients]
Doctor, is the #radiotherapy I am getting affecting how well my #CovidVaccine works?
[Us]
🤷
Inspired by:
[Our patients]
Doctor, is the #radiotherapy I am getting affecting how well my #CovidVaccine works?
[Us]
🤷
3/
There is large heterogeneity when looking at immunogenicity of #COVID19 vaccines in #cancer patients & esp #lungcancer patients shown by @vivek_naranbhai & team in @JCO_ASCO
Chemo may suppress antibody levels somewhat.
What about #radiotherapy?
➡️ascopubs.org/doi/pdf/10.120…
There is large heterogeneity when looking at immunogenicity of #COVID19 vaccines in #cancer patients & esp #lungcancer patients shown by @vivek_naranbhai & team in @JCO_ASCO
Chemo may suppress antibody levels somewhat.
What about #radiotherapy?
➡️ascopubs.org/doi/pdf/10.120…
Hey #EPeeps and #RadOnc communities... we have some new data to share today about how **radiation can actually reprogram heart cells to make them act younger**. This is my first attempt at a Twitter thread 🧵 Please be kind...
(1) To develop a better/safer/faster way to fix abnormal heart rhythms, we helped create *noninvasive cardiac radioablation* - a 7-minute precision-focused radiation treatment to arrhythmia circuit(s) in the heart. bit.ly/NEJM2017
(2) The goal with noninvasive cardiac radioablation is to deliver full-thickness ablation (read: destruction) to the semi-scarred heart tissue causing problems. It solves many shortcomings of ablating heart scar with catheters.
1/ 🙏 patients, investigators and funders for
@TROGfightcancer 13.01 SAFRON II trial at #ESTRO21. n=90 pts with 133 pulmonary oligometastases, across 13 centers in 🇳🇿+🇦🇺. Median F/U = 3 years, randomization for single (SF) 28Gy vs 48Gy in 4fx (MF). #radonc #LCSM @PeterMacCC
@TROGfightcancer 13.01 SAFRON II trial at #ESTRO21. n=90 pts with 133 pulmonary oligometastases, across 13 centers in 🇳🇿+🇦🇺. Median F/U = 3 years, randomization for single (SF) 28Gy vs 48Gy in 4fx (MF). #radonc #LCSM @PeterMacCC
2/ No difference in SF vs MF. Both were safe (G3+ AEs were 5% MF v 3% SF), and effective - 2yr OS 85% MF v 88% SF (p=0.44), LC 83% MF v 73% SF (p=0.13). No diff. in DFS (median 13.2 MF v 14.3 SF, p=0.99). Mean time to systemic treatment ~29mo. SABR did not impact QoL measures
3/ Both SF and MF arms drove systemic immune activation
- ⬆️%CD4+FoxP3+ Tregs, ⬆️ %CTLA-4 and %PD-1 expressing CD4+, CD8+ and/or CD4-CD8- T cell subsets
- modestly ⬆️ % change of CD4+ T cell and CD8+ T cell subsets expressing PD-1 or TIGIT in the SF arm as compared to MF arm
- ⬆️%CD4+FoxP3+ Tregs, ⬆️ %CTLA-4 and %PD-1 expressing CD4+, CD8+ and/or CD4-CD8- T cell subsets
- modestly ⬆️ % change of CD4+ T cell and CD8+ T cell subsets expressing PD-1 or TIGIT in the SF arm as compared to MF arm
Impact of radiation therapy facility volume on survival in patients with cancer.
@LeilaTchelebi @wedney2017 @NirajGusani @PennStHershey
Via @JournalCancer @ACS_Research
acsjournals.onlinelibrary.wiley.com/doi/full/10.10…
pubmed.ncbi.nlm.nih.gov/34398470/
@LeilaTchelebi @wedney2017 @NirajGusani @PennStHershey
Via @JournalCancer @ACS_Research
acsjournals.onlinelibrary.wiley.com/doi/full/10.10…
pubmed.ncbi.nlm.nih.gov/34398470/
Facility volume has been explored as a surrogate of quality of care in medicine.
pubmed.ncbi.nlm.nih.gov/12230353/
@AnnalsofIM
pubmed.ncbi.nlm.nih.gov/12230353/
@AnnalsofIM
In oncology, facility surgical volume is correlated with survival.
Work from @StoltzfusKelsey @LeilaTchelebi @DanTrifMD @NirajGusani in @JNCCN
Work from @StoltzfusKelsey @LeilaTchelebi @DanTrifMD @NirajGusani in @JNCCN
Salvage therapy for prostate cancer after prostatectomy: international consensus on evaluation and management
@NatRevUrol
rdcu.be/csM2z
pubmed.ncbi.nlm.nih.gov/34363040/
#PCSM
@NatRevUrol
rdcu.be/csM2z
pubmed.ncbi.nlm.nih.gov/34363040/
#PCSM
Since the 2000s, the use of radical prostatectomy has been increasing for prostate cancer (vs external beam and brachytherapy).
@EUplatinum
pubmed.ncbi.nlm.nih.gov/27597241/
@EUplatinum
pubmed.ncbi.nlm.nih.gov/27597241/
The increase in prostatectomy includes all risk groups, particularly those with high-risk features
Inspired by @PaulNWilliamz thread to create a 🧵for new #radonc attendings (disclaimer: three-years being attending so feel free to add advice 😊) @roecsg @S_W_R_O and others! 1/20
✅ Checklists are your friends — you may be working with software and systems you didn’t use at your residency and just simming a patient may take many steps in different programs — eventually you won’t need the checklists! 2/20
Introduce yourself! Don’t worry if no one knows who you are. You may have been introduced in an email that went out weeks before your arrival so don’t be offended if your colleagues (esp in other oncology fields) don’t know you! 3/20
Ok here's my attempt at a thread for incoming PGY2's. First off congrats for finishing intern year. It's an accomplishment in itself. Although you don't know it yet, much of the doctoring skills you've developed will be the corner stone for how you work with patients! 1/25
PGY2 Radonc IMO is one of the most challenging years. Unlike other specialties in medicine where you spend 4 years of medschool to build on your medical knowledge and skills in an integrated fashion, Radonc maybe a 15 minute discussion in a class, if lucky 2/25
Even with away rotations it's just the surface of what radiation oncology is.Why is PGY2 such a shell shock? It's because intern year is just a stepping stone to getting into radonc. It's not your future. As an intern you're not invested in it as your categorical colleagues. 3/25
@DrAttai T2. Let’s talk now about radiation specifically for breast cancer. We’ll start w/ breast conserving therapy (BCT) – a term for breast conserving surgery w/radiation as a combined strategy with similar results to a mastectomy. #bcsm #radonc 1/
@DrAttai T2. Vera Peters, whose mother had breast cancer, was a radiation oncologist advocating for smaller surgery w/RT in the 1960s-1970s. Amazing researcher and helped push us toward BCT as an option thefoldingchairhistory.com/2018/03/23/dr-… #bcsm #radonc 2/
@DrAttai T1. Radiation therapy (RT) is the use of ionizing radiation as way to focus subatomic energy to interact with a particular part of body in order to treat a disease. #bcsm #radonc 1/
I cleared my schedule in anticipation of 2nd jab side-effects, and I’m aching all over with muscle pains, so it’s just the right time to channel my inner grumpy old man (I’m moving like one anyway).
In other words:
🔹Time to critique #ESTRO2021 abstracts! 🔹
#radonc #medphys
In other words:
🔹Time to critique #ESTRO2021 abstracts! 🔹
#radonc #medphys
Standard disclaimer:
I’m just one abstract reviewer. My opinions and dislikes may not be representative.
I’m not targeting any specific authors - so even if you feel this hits too close to home, it’s probably not you that I’m thinking of (five other people did the same!)
I’m just one abstract reviewer. My opinions and dislikes may not be representative.
I’m not targeting any specific authors - so even if you feel this hits too close to home, it’s probably not you that I’m thinking of (five other people did the same!)
I reviewed clinical track abstracts this year, while my previous involvement has been on the physics track. That's obviously colouring my experience.
(I am but a lowly physicist, etc, etc ... 😂)
(I am but a lowly physicist, etc, etc ... 😂)
1/n
💊How to best combine targeted agents with #radiotherapy☢️
Ch4⃣from our book
springer.com/us/book/978303…
Biomarkers of clinical radioresistance. Great pleasure to have written this one with @max_diehn @michaelsbinkley Iris Eke @StanfordRadOnc🙏
#radonc #radbio #RTdrugcombo
💊How to best combine targeted agents with #radiotherapy☢️
Ch4⃣from our book
springer.com/us/book/978303…
Biomarkers of clinical radioresistance. Great pleasure to have written this one with @max_diehn @michaelsbinkley Iris Eke @StanfordRadOnc🙏
#radonc #radbio #RTdrugcombo
2/n
As @SorenBentzen keeps saying, absolute radioresistance does not exist. You just have to up the dose💪
That is very different from drug response, which is a yes/no situation - where more drug does not give you typically a better response (with caveats 😉)
#radonc #radbio
As @SorenBentzen keeps saying, absolute radioresistance does not exist. You just have to up the dose💪
That is very different from drug response, which is a yes/no situation - where more drug does not give you typically a better response (with caveats 😉)
#radonc #radbio
3/n
Tumors can have variable radioresistance. Lab & human data indicate that relationship between dose + tumor eradication is sigmoid🚨
Really high doses are prohibited by tolerance of normal tissue surrounding the tumor‼️
= Rationale for pursuing targeted radiosensitizers💡
Tumors can have variable radioresistance. Lab & human data indicate that relationship between dose + tumor eradication is sigmoid🚨
Really high doses are prohibited by tolerance of normal tissue surrounding the tumor‼️
= Rationale for pursuing targeted radiosensitizers💡
1/n Should the COVID pandemic catalyze a fundamental re-evaluation of hospital executive compensation? Have we reached a point where what we pay CEOs, CMOs, CFOs is unmoored from any real value proposition? A tweetorial...
3/n NFP hospitals are obligated by federal and, in many cases, state statutes to provide "charity care". But these obligations are very loosely defined with various accounting techniques used to prove that the low statutory bar is met.
Is there a radiation dose-response relationship for rectal cancer managed non-surgically?
Short answer: Yes - at least based on published patient series
Longer answer: See our #ESTRO2020 Poster Highlight - or thread below
#rectalcancer
#radonc
postersessiononline.eu/173580348_eu/c…
Short answer: Yes - at least based on published patient series
Longer answer: See our #ESTRO2020 Poster Highlight - or thread below
#rectalcancer
#radonc
postersessiononline.eu/173580348_eu/c…
Non-operative management of rectal cancer is becoming increasingly important - more and more patients are offered observation instead of surgery if they have a complete response after (chemo-)radiotherapy #radonc #ESTRO2020
Most published series are only reporting on that select group of patients - the ones who got a complete response. That's great if we want to understand if observation is a safe strategy for those patients #ESTRO2020
thelancet.com/journals/lance…
thelancet.com/journals/lance…
