🔥ACRO ROVER- Upper GI🔥

Localized Esophagus Adenocarcinoma in 5 minutes, Check it out!
@ACROresident @ACRORadOnc @RadoncROVER @ARRO_org @MayoRadOnc @NiuSanford
1/ Algorithm (simplified): cT2-4N0-N+
1st ❓: Operable❓
2nd❓: FLOT Candidate❓

🟢If operable FLOT candidate ➡️ Peri-operative FLOT ➡️ Esophagectomy
*May consider addition of pre-op CRT in select cases


2/

https://x.com/KrishanJethwa/status/1797337039689449643

🚨🚨🚨 #ESOPEC🚨🚨🚨

🔥Practice shifting trial🔥

Patients with resectable, locally advanced, esophagus/GEJ adenocarcinoma

Randomized

Peri-op FLOT (FLOT4)
vs
Pre-operative chemoradiation (CROSS)

Congrats to the study investigators!

Let’s dive in!

#ASCO24 @MayoRadOnc

1/





First… Background

Both Peri-operative chemotherapy (MAGIC/FLOT4) and pre-operative chemoradiation (CROSS) are standard of care treatment options for patients with resectable, locally advanced, esophagus/GEJ adenocarcinoma.

Each has demonstrated:
✅ Improved OS
2/

🚨🚨🚨
Rectal Cancer Tweetorial!!

Rectal cancer is a highly heterogeneous disease with rapid evolution in practice.

Let's review current data to generate a pragmatic, patient-centric, approach to management!
#GI24 #GIonc #RadOnc

Thank you @ASCO for the opportunity!🙏🏽

1/
✅Pre-operative RT reduces the risk of pelvic recurrence for patients with rectal cancer.

But some patients will suffer from acute and long term toxicity (bladder, bowel, sexual, endocrine dysfunction)

❓How can we tailor therapy to balance QoL & cancer control?
2/

🔥🔥🔥 Hey #GIonc #Radonc friends- rectal cancer management is evolving rapidly. Let’s run through a case-based review of rectal cancer!!!
#ASTRO23

55F
cT3aN0M0 rectal adenocarcinoma, pMMR
11 cm from the anal verge
No compromise of the mesorectal fascia or evidence of extramural venous invasion
Patient is amenable to low anterior resection

What would you recommend for management?

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/

The Alliance A021501 trial has landed!
First- I’d like to congratulate the authors for conducting this study. Fantastic trial concept, and the rigorous review of eligibility and SBRT QA was exceptional
So much to unpack... Let’s dive in!
🧵🧵🧵
pubmed.ncbi.nlm.nih.gov/35834226/
1/ PDAC is a devastating dz. Most notable improvements over the past decades have been related to systemic therapy. Despite curative intent surgery, pts are at high risk of both locoregional and distant disease progression.

https://twitter.com/KrishanJethwa/status/1537512956925198336

2/

📌 Clinical & radiological predictors of organ preservation in pts with #rectalcancer treated with TNT

1st some background
OPRA-Fantastic trial
👀 at chemo & radiotherapy sequencing as a nonoperative treatment strategy for pts with st II-III #rectalcancer 1/n
#CRCTrialsChat Background contd..

From OPRA trial we learned:
📌Chemo-RT➡️ chemotherapy was associated with better TME-free survival compared with chemotherapy➡️ Chemo-RT with no detriment in disease-free survival compared with historical controls. 2/n
#CRCTrialsChat #rectalcancer #NOM #CRCSM