Discover and read the best of Twitter Threads about #SBRT

Most recents (7)

1/Sorry, my friend. I’m not seeing the logical connection between your question/premise & the evidence you quoted. Can you please clarify?
Your premise is that cN0 patients should not get invasive mediastinal staging. Your evidence focuses on benefits of adjuvant therapy. #tssmn
2/the whole point of invasive med staging is to ensure that patients with ⬆️likelihood of having N2 disease are directed towards upfront/definitive systemic therapy rather than non-SOC upfront/definitive local therapy. Thus, evidence should focus on Neoadjuvant therapy #tssmn
3/consider this :
do you think it’s ok to go directly to surgery or #SBRT for 6cm highly PET-avid #lungcancer which is cN0 on PET/CT, without EBUS?
@MaldonadoFabien @DanSteinfort @OtisBRickman @PulmCCM @IASLC @thoracic @ThoracicsCanada #tssmn
Read 4 tweets
One day late, but wanted to summarize #PancreaticCancer #PancSM talks from yesterday’s #ASTRO20 session on hypofractionation in GI Cancers before spill the beans on my study... 1/9
@MikeChoungMD gave a great talk on the @UMiami experience with #MRLinac for #PancreaticCancer #PancSM. This is a great technology that allows #RadOnc to replan the treatment each day based on the anatomy of the nearby bowel. #ASTRO20 2/9
In this study on #MRLinac, they showed that they can safely deliver ablative doses (about 50Gy/5 fractions) with less than 2% acute and late GI tox. #ASTRO20 3/9
Read 9 tweets
We created a 6-part #SBRT credentialing course at @UCSDRadMed, and we’re making it publicly available during #COVID19. All videos were produced and edited by @dbrown_medphys and include Dr. Daniel Simpson or me. Videos are linked below. Enjoy! #MedPhys @aapmHQ #RadOnc @ASTRO_org
SBRT Credentialing Part I - Pancreas
SBRT Credentialing Part II - Hepatocellular
Read 7 tweets
Time to weigh in with a thread on the #ADAURA trial presented at #ASCO20. I have been thinking about it carefully and listening to the chatter on #Twitter and other sites. Have also watched w/ interest the back and forth b/t @jackWestMD and @n8pennell #lcsm
(By the way, @JackWestMD and @n8pennell make @drewMoghanaki and me look like amateurs…) #lcsm
This will be insufferably long (@lcsmchat long!), so I apologize in advance. #lcsm
Read 30 tweets
THREAD on cancer treatment in #COVID19 pandemic.
The @CovidSurg collaborative have estimated that in the UK, >500,000 operations have been cancelled, including 36,000 cancer surgeries. Globally, the figures are 28.4m and 2.3m. (During peak 12 weeks of disruption) #cancer 1/
Although surgical activity is increasing again and cancer surgery is being prioritised, we are far from returning to normal levels and there is going to be an enormous backlog of cases. This will be particularly detrimental to overall cancer outcomes 2/
It gets worse. We now have data via @CovidSurg (across a range of different types of surgery) that shows a 30-day mortality rate of 23.8% in patients who develop #COVID19 infections in the post-operative period. Mortality rates of 30% have been reported after cancer surgery 3/
Read 16 tweets
1/important to understand the realities that have driven our pivot to this protocol
-surgery is SOC
-these healthy & operable patients want surgery for many reasons (including known longterm cure rates)
-surgery is being delayed/cancelled due to #covid19 as is invasive staging
-#sbrt can offer safer therapy while preserving PPE & ⬇️ risk during #covid19
-patients can elect to undergo #sbrt as bridge to surgery
-they can elect not to undergo surgery later
-surgery will allow for appropriate nodal staging & resection as per SOC...& answer🔑questions
-randomization may be something that can be considered in future but these are not patients that are considering #sbrt vs surgery:these patients want surgery but it is either not possible,delayed or highly risky during #covid19
-MISSILE has shown us safety of this approach
Read 5 tweets
1/ Decided to take a 3-day break from #covidtwitter just as our paper was released 🤦🏻‍♂️. So now is my attempt to ‘clear the air’. We continue to share our data ablating at 50W, now with contact force. @TheRealWinkle noticed some trends with PWI and btw systems (Biosense and Abbott)
2/ But as you’ve all astutely said (@paulzei) this is non-randomized, both w/ patients & operators. 3 of 6 ablators routinely perform PWI (@hardwinmd, @PatrawalaRob, and myself), but each w/ differing methods re w/in-box lesions ie size of box, mapping entrance, pace&ablate, etc.
3/ All 3 of us have changed our PWI methods the past 3 yrs b/c of Roger’s initial observations incl more pace/ablate strategies despite initial entrance block or even ‘sleeve capture’-exit block b/c of observations of anisotropic isolation (current paper only thru 12/2017 cases)
Read 13 tweets

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