Carmelo Tuscano🇮🇹🇪🇺

Radiation Oncologist, MD, Metropolitan Hospital , Reggio Calabria (Italy).
Just One Rule : All lives matter ‼️

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

Very deep review in press in @IJROBP about mechanism of resistance in #Glioblastoma (@AmyWisdom8 et. al DOI :https://t.co/fXQmnhMI3R) .This table provides an at-a-glance overview of the main resistance mechanisms discussed in the paper. #radonc

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

We should stress the need to implement an intelligent strategy for spinal cord constraints, considering a safety structure that the Sunnybrook school identifies with the thecal sac — essentially a sort of natural PRV.

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

More than a review: a mini-treatise on spinal oncology.

Two crucial lessons for #radonc:
• SBRT patient selection must be driven by SINS stability criteria;
• the thecal sac may represent a “natural PRV” for spinal cord constraints.
Outstanding clinical insights !

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

EQD2 captures dose, not biology. And modern RT is increasingly biological with not homogeneous dose distributions. There are many things these curves are unable to catch. α/β = 1.5 should give us a better BRFS with hypo schemes,but this meta-analysis data don't demonstrate it.

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

What is the real α/β in Prostate Cancer?
In this meta-analysis in the 🟢 Journal on regard BRFS :
α/β = 1.5 → no correlation
α/β = 3 → everything changes (R² 68%)
Practical translation : we don't know the real α/β value
#radonc

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

@piet_ost @PCaParker IMHO this is a post-selection (PSA ≤0.2) cohort. RT doesn’t “outperform” — it selects. Only ~30% reach ≤0.2 with RT vs ~55% with abiraterone, so RT responders are a biologically enriched subset. And burden still matters: same PSA, different OS (LV ≠ HV).

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

MDT doesn’t interrupt the natural history—it reshapes it.
Our endpoints should capture that.
Kudos to the authors for this thoughtful papepr

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

In OMD, traditional endpoints are no longer enough.
PFS ≠ failure of MDT.
We need endpoints that reflect clinical reality:
👉 STFS = time without systemic therapy
👉 pPFS = transition to widespread disease
👉 QoL = the patient’s lived experience

#radonc @TheLancetOncol

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

What about supportive care with corticosteroids for these patients in the concomitant setting 🤔. Coud this affect the efficacy of Nivolumab; is there a precise threshold of steroids that investigators permitted to use? Any author around ? #radonc

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

NIVOPOST-OP (GORTEC): adding nivolumab to postop CRT in high-risk resected LA-SCCHN improves DFS (HR 0.76). Masked imaging review diluted the effect (HR 0.89) due to high false ± rates in post-RT neck (fibrosis vs relapse). Clinical/pathologic assessment remains key. #RadOnc #HNC

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

A symptomatic vertebral hemangioma treated with decompressive laminectomy + stabilization + post-op RT (45 Gy/25 fx).
Excellent MRI response and recovery from paraparesis—another reminder of the value of RT in select benign conditions. #radonc ⚡

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

The accompanying editorial adds a layer: supramaximal surgery may change biology, but its real-world impact depends on anatomy, expertise, and system-level quality. A powerful reminder that maximal resection is not just evidence — it’s context, capability, and responsibility.

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

The new RANO resection classes redefine IDH-mutant grade 2 gliomas: every cm³ of residual tumor reshapes prognosis. Supramaximal surgery isn’t just technique — it’s biology. @TheLancetOncol
#radonc

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

This figure tells the whole story: in IDH-mutant grade 2 gliomas, every cm³ matters. Residual T2-FLAIR volume shows a clean, continuous HR gradient — and supramaximal resection stands apart with striking survival separation.

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

@ElonMuskNews47 Yes

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

The EORTC GUCG-1414 study (@ZilliThomas et al., Eur Urol Oncol 2025) represents an important contribution—though with structural limitations—to the understanding of the clinical impact of different types of androgen deprivation therapy combined with radiotherapy in very high-risk or locally advanced prostate cancer.

The following table provides a concise and pragmatic synthesis that may be useful in daily clinical practice.

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

Every ray that illuminates can also burn.
Every instrument of healing can become a weapon.
What saves, if used without measure, destroys.

And yet, for more than a century, light has remained our ally.
We have learned to modulate it, to measure it, to give it form.
Sometimes it enters the body like an invisible blade; at other times, it moves around the tumor like a breath of energy.
It is the same light that once burned in Grubbe’s hands — the same that made Edison’s bulb shine — and that now flows silently through the bunkers of radiotherapy, within the precise beams of the accelerators.

There is no contradiction here, but a paradox:
radiation kills, and precisely for that reason it can heal.
As if life, in order to continue, had to learn to live with its own opposite.
It is on this fragile, luminous frontier that medicine and physics meet.
And in that meeting — between measure and abyss — hope still shines.

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

I think , if really a recurrence, this is a site in which Linac MRI would give something more. I would apply, considering this is a sort of reirradiation for anterior ano-rectal wall, a scheme of 30 Gy/5 Fr. one another day. If not HT right now, i'd add 6 months ADT in RADIOSA style.

[Carmelo Tuscano🇮🇹🇪🇺 @CTuscanoMD]

A few years ago, @rweichselbaum posed—ironically, but not entirely so—the question: what is the difference between radiotherapy and radiosurgery?
In some ways, this review attempts to answer that very question.
This table provides a synopsis of its contents. #radonc
https://t.co/bN0fDC0OZi #radonc