MD, MPH - Lung Cancer Specialist and Professor, David Geffen School of Medicine at UCLA | Co-Director, Lung Precision Oncology Program, VA Greater Los Angeles
A Canadian radiation oncologist with more energy than anyone I know completes a practice-changing randomized trial that shows SBRT for spine metastases DOUBLES the CR rate. As long as it's delivered in TWO fractions (not one). ๐จ๐ฆ
#ASTRO20
#radonc
@SahgalArjun
BREAKING: A new randomized trial demonstrates the benefit of SBRT for patients with EGFR+ stage IV NSCLC. It demonstrates both PFS and OS benefits (n=62). ๐จ๐ณ
#radonc
@EGFRResisters
@jillfeldman4
I'd like to emphasize that
@_ShankarSiva
has set a new bar for preparing a talk. He used images derived using AI, and the transitions were simply spectacular.
#ESTRO23
#radonc
Still don't believe in the power of cancer advocacy? This bill was just signed by our governor. It declares that it will soon be a CRIME for an insurance company in California to deny biomarker testing for stage III or IV cancer.
#lcsm
#radonc
The next time that someone in the Ivory Tower perseverates over the value of studies that rely merely on a PFS signal, please share this slide that
@jillfeldman4
created which sheds light on what patients often endure to get that PFS signal.
#lcsm
#radonc
The Timmerman Files are finally published, along with the confession "In all honesty, except for the spinal cord, all other limits for this original table were my educated guesses".
#radonc
I know at least a dozen radiation oncologists who have worried for decades that IMRT would increase the risk of secondary cancers compared to conventional 3DCRT. A SEER-linked Mediare study of 65,235 patients with at least 2 years of survival now tells us this.
#radonc
The VALOR study has now officially enrolled 50% of its planned accrual of 670 participants. We are truly grateful to all of the US Veterans with operable stage I lung cancer who are volunteering to participate in this study.
@VAResearch
#CSP2005
This surgeon once taught me to be aware of bullies who use phrases like, "Surgery remains the standard of care".
He taught me that it's more accurate to say, "We have historically preferred surgery", and then explain why.
He also pioneered the field of Surgical Oncology.
How is it possible that the only 3 prospective comparison studies of Surgery v SBRT for operable stage I NSCLC show similar to superior outcomes after SBRT, yet the
@NCCN
guidelines donโt even mention SBRT as an option for this population?
#radonc
NEW STUDY: another prospective cohort study comparing Surgery to SBRT for stage IA NSCLC shows no difference in CSS or OS (median f/u = 57.6 months).
#radonc
The ProtecT team releases another analysis that shows what happened to 2,565 men with prostate cancer who were randomly assigned to receive surgery, radiation therapy, or active monitoring.
#pcsm
#radonc
@QuinteTBristol
I was just informed that the Final Results of the largest phase III lung SBRT trial that few have heard about may be presented at
#ASTRO22
. ๐จ๐ฆ
#radonc
#lcsm
This list continues to expand and now includes the BRAF BOMBERS!
Make sure to save a copy of this photo on your phone and share it with any patient with one of the following mutations so they can find their tribe.
#radonc
Radiosurgery for Refractory Depression likely saved the lives of patients who participated in this IRB-approved clinical trial. Treatment target = bilateral anterior limb of the internal capsule)
#radonc
Kudos to
@TheLancet
for publishing this seminal randomized study demonstrating Nivolumab's benefit in eradicating invisible tumors that our PET/CT, EBUS biopsies, and SBRT beams can't see. I'm curious why it didn't get submitted or published in NEJM instead.
#radonc
New Zealandโs Prime Minister, Jacinda Arden, announces their countryโs investment in 12 new linacs for patients with cancer. ๐ณ๐ฟ
#radonc
@PhilipHope19
VIDEO:
A nationwide Dutch study (ESLUNG) demonstrates similar OS for stage I NSCLC treated with Lobectomy or SABR (HR 0.89, 95ย % CI 0.65โ1.20).
#radonc
#CSP2005
๐บ๐ธ Wishing a safe and uneventful military deployment for our friend and colleague,
@EvanThomas84
, who will spend the next few weeks in Iraq.
#radonc
Worried about the efficacy of a treatment in a study? Think you can deliver better care than a clinical trial team? If so, then you might want to think about this before surrendering to your gut instinct.
#radonc
This SPECTACULAR phase III randomized clinical trial was once thought impossible to complete. How did they do it? By inviting a medical anthropologist (Jenny Donovan at
@QuinteTBristol
) to help design and lead the study.
While the non-believers were arguing and debating the 2015
@TheLancetOncol
publication of the STARS-ROSEL pooled analysis, the SBRT cohort at MD Anderson was expanded to n=80 by
@JoeChangMD
et. al. to finally get us the 5y OS data (87%).
#radonc
#lcsm
One of the nicest thoracic radiation oncologists I know was just appointed Chair at City of Hope. Congrats Terry! I'm sure that David Carbone and many others will sorely miss you.
#radonc
#lcsm
@cityofhope
Updated results from SAFRON-II will be presented this Sunday at
#ESTRO23
, once again demonstrating the value of single-fraction SBRT for oligomets (28 Gy x 1 versus 12 Gy x 4).
#radonc
@_ShankarSiva
Results from DOLPHIN were just reported and give us the first signal of what can happen when Durvalumab is delivered with concurrent CRT.
#WCLC2022
#radonc
1/
NEW STUDY: another prospective cohort study comparing Surgery to SBRT for stage IA NSCLC shows no difference in CSS or OS (median f/u = 57.6 months).
#radonc
The SPCG-15 is randomizing 1,200 men between Surgery and RT for high-risk prostate cancer. The characteristics of the first 600 patients enrolled is now published.
#radonc
#pcsm
27 years after the LCSG 821 randomized trial established lobectomy as the standard of care, a contemporary randomized trial (JCOG0802, n=1,106) now informs us that segmentectomy offers superior survival for stage I NSCLC tumors โค2 cm.
#radonc
#lcsm
Why do so many journal reviewers not understand the boundaries of retrospective studies of observational data? This highlighted word is incorrect. Needs to be replaced with "IS ASSOCIATED WITH".
#radonc
#lcsm
@BrendonStilesMD
@biniamkidaneMD
๐งต2/ Metastasis-directed Tx to the ๐ซ has limited trial evidence (surgery or SABR). Whilst convenient, popular during
#COVID19
, there is reluctance for single fraction fraction ๐ฅ SABR for perceived toxicity.
@TROGfightcancer
SAFRON II randomised n=90 with 133 ๐ซ mets to 1 vs 4fx
Here's what happened at an advanced
#radonc
department with the most sophisticated equipment in the world (MRIdian, Protons, etc) after it opted to Drop the Sim.
What a time to be a radiation oncologist. One becomes the FDA Commissioner, and another discovers a new vital sign for people with lung cancer!
#lcam
#lcsm
#radonc
A thoracic surgeon publishes the results of a randomized clinical trial in Nature Communications demonstrating the effects of SBRT before surgery when combined with a checkpoint inhibitor.
@AltorkiNasser
Came in early on my last day at the Atlanta VA before anyone else arrived to see this. Iโm gonna miss them all. I was very lucky to work with amazing people who were all committed to a single mission of excellence for our Veterans with cancer.
#radonc
Warning: be suspicious of radiation, medical, and surgical oncologists who blindly professes surgeryโs superiority over chemoradiation for stage IIIA (N2) NSCLC. Especially if they reference the RTOG 9309 / INT 0139 study. A THREAD 1/
This is huge. Potentially an even bigger setback than RTOG 0617. The implications of these results cannot be overstated. We should have listened more to the translational radiation oncologists who predicted this outcome.
@KaramLab
@JieDengMDPhD
@max_diehn
@theabzlab
@SeanPitroda
PACIFIC-2 does not meet PFS endpoint. Phase III study of concurrent chemoradiation + duvalumab vs CRT alone for stage III NSCLC. Toxicity? Negative interaction? Or due to intrinsically different population: PACIFIC enrolled only those who completed CRT.
Many already know how amazing
@christine_lovly
is and the value she continues to add to the lung cancer community. She is now contributing even more as a member of the
@LUNGevity
Scientific Advisory Board.
#lcsm
Whenever people state "It's not fair for a non-smoker to get lung cancer" it simultaneously implies that smokers deserve to get lung cancer.
I learned this, and many other pearls, from the clairvoyant and simply charming
@jillfeldman4
.
#WorldLungCancerDay
#lcsm
#lcam
#radonc
The Canadian group that brought us 4 Gy x 15 for stage I NSCLC now report their experience with this Rx for central lung tumors (n=111). ๐จ๐ฆ
#radonc
@DrPatCheung
@DrAlexLouie
1/๐งต
The use of SBRT for oligoprogressive cancer often increases the MILEAGE of a current line of systemic therapy. Stated differently, it can also prevent "Systemic Therapy Escalation"
@_ShankarSiva
@IyengarPuneeth
@jillfeldman4
#radonc
Here is what happened to 12 patients with ALK, EGFR, or ROS1-driven brain metastases who were treated with upfront TKI instead of radiation therapy.
#radonc
#lcsm
MR-guided SBRT was associated with 100% local control in the 25 patients treated with a BED10 >100 Gy, single fraction, or fraction size >10 Gy/day.
#radonc
A plain language summary of the Revised STARS trial that compared SABR to Surgery is now online. I'm curious if
@RajaFlores
is aware of it.
#WCLC23
#radonc
What will lung SBRT treatment planning look like after 4DCT is replaced with 5DCT? The first clinical experience with this breakthrough system was presented at
#UKSABR22
on behalf of Dan Low.
#radonc
MYTH: Smoking causes lung cancer. Therefore we can prevent lung cancer by just focusing on getting everyone to quit.
FACT: There are many reasons why people get lung cancer. Smoking is one, and we need more research to identify the others.
#WorldLungCancerDay
#lcam
#lcsm
From center stage at
#ASTRO21
to writing her own editorial in the flagship
#radonc
journal,
@jillfeldman4
continues to teach the world about the life-prolonging benefits of SBRT for oligometastatic disease. ๐
@DavidSherMD
@IASLC
A new analysis of the RTOG 0617 data by a team in Manchester may have just demystified the heart dose issue. Might this be a new avoidance structure to optimize outcomes? ๐ฌ๐ง
#radonc
@finn_corinne
Proud to share that I have been promoted to Professor! An achievement made possible only by working with exceptional colleagues, residents, and students at an exceptional place!
@MSteinbergMD
@UCLAJCCC
@Ucla
There are two types of beliefs in this world. Those that are informed, and those that are not. Please be nice to those who express their beliefs in the latter category.
Happy Sunday everyone. While there is justified excitement around a 24% pCR rate with chemo-Nivo, we should not forget the 28% pCR rate with chemo-XRT using only 45 Gy. Thank you.
#lungcancer
#radonc
@DoctorJSpicer
@AltorkiNasser
A woman from Chicago living with lung cancer once again delivers an amazing talk that I will likely show to all future residents who rotate on my service.
#ASCO20
#lcsm
#radonc
There's a major flaw with this commonly used curve which has been misleading the public for years whenever comparing IMRT to Proton therapy for prostate cancer. Can anyone see it?
#radonc
@aapmHQ
This report might be the most misleading study ever published about lung SBRT. Poor-quality studies like this can only be accepted when a journal and its reviewers are asleep at the wheel or no longer care about minimum scientific standards.
@JSurgRes
1/๐งต
As the world familiarizes itself with the SABR-COMET and OLIGOMEZ studies,
@drdavidpalma
reminded us at
#SABR18
that we should also know the DUTCH phase II RCT that also showed an OS benefit with local ablative therapy.
A pivotal study from
@UTSW_RadOnc
demonstrates what happened to 23 patients with oligometastatic Kidney Cancer who opted for SBRT instead of systemic drug therapy.
#radonc
A lung cancer survivor just shared that trying to get advice about Radiation Oncology from a Medical Oncologist is akin to it "asking a civil engineer to solve an electrical engineering problem".
#lcsm
#radonc
@jillfeldman4
Here is a study that could be more impactful if published in a surgical oncology journal. That's because surgeons are more likely to manage these patients.
@sueyom
#radonc
I finally found it. The first RANDOMIZED study that demonstrated an OS benefit with radiotherapy for lung cancer. Completed at
@VABronx
with mesovoltage (200-260 kV), before discovery of the CT scanner, and when Roentgenologists planned the 4,000-5,000 r prescriptions.
#radonc
Hereโs a bunch of people living with lung cancer. They spent the past two days with the NLCRT to make sure patientsโ perspectives were considered by the panel assembled by the
@AmericanCancer
to develop a long term plan to
#EndStigma
.
#lcsm
"Should I hold the immune checkpoint inhibitor during stereotactic radiosurgery for brain metastases?" Another well-done study shows that it's not necessary.
#radonc
#lcsm
@MarkMishraMD
@JillRemickMD
10 years of experience at the University Hospital of Liรจge in Belgium (2010-2020) demonstrates the importance of >110% hotspots in lung SBRT plans.
#radonc
The same hospital that was founded by William Halsted more than a century ago is now led by a Radiation Oncologist, who is Dean and CEO of Johns Hopkins Medicine.
#radonc
@ASTRO_org
@SocSurgOnc
In 2006, Chris Kelsey published a (must-read) study showing the patterns of locoregional failure after lung cancer surgery. ๐บ๐ธ In 2023, Tae Hoon Lee published a study showing the patterns of regional nodal recurrence after lung SBRT. ๐ฐ๐ท
#radonc