Dr Devang Bhavsar

Radiation Oncologist

[Dr Rishabh Jain @DrRishabhOnco]

Phase III Trial | Will this become the new TNT standard for high-risk rectal cancer?

The TNTCRT trial tested an intensified long-course TNT strategy with uninterrupted CAPOX + long-course RT versus conventional long-course chemoradiotherapy in 458 patients with high-risk stage II/III rectal cancer.

Key results:
✅ 3-year DFS: 74.8% vs 66.0%
• HR 0.67 (95% CI 0.49-0.93)
• P=0.016

✅ Metastasis-free survival:
• 77.7% vs 67.6%
• HR 0.66

✅ Pathologic CR:
• 26.4% vs 9.8%
• P<0.001

⚖️ Trade-off:
• Higher grade ≥3 toxicity during neoadjuvant therapy
27.6% vs 8.6%
• But overall severe toxicity across the entire treatment course was similar
28.0% vs 24.3%
• Major postoperative complications were also comparable.

Clinical takeaway 🩺
This is one of the strongest phase III datasets supporting doublet chemotherapy integrated throughout long-course radiotherapy in high-risk LARC, delivering meaningful improvements in DFS, MFS, and pCR with acceptable overall safety.

Will this approach replace conventional long-course CRT in your practice, or do you still prefer other TNT strategies such as RAPIDO/PRODIGE-23/STELLAR?

#RectalCancer #GIOncology #ASCO #OncoAlert

@ASCO @JCO_ASCO @oncoalert

[Jame Abraham, MD, FACP @jamecancerdoc]

GLP-1 Agonists Are Associated With a Significant Reduction in Breast Cancer Incidence in Women | JCO Oncology Practice https://t.co/zZCz60ABiC @JCOOP_ASCO @OncoAlert @ASCO

[Erman Akkus @Erman_Akkus]

Adjuvant chemoradiotherapy versus completion total mesorectal excision after local excision for early rectal cancer (TESAR): a multicentre, randomised, controlled, phase 3, non-inferiority trial @OncoAlert https://t.co/fiFLKKhBYV

[Dr Devang Bhavsar @DevangBhavsarc]

It’s just observation in few randomised trial ? Need to look at larger picture 🩻

[Dr. Nina Niu Sanford @NiuSanford]

Here is Version 2.0 of when to hold systemic tx during RT. Updated &amp; w 3 additional drug categories (ADCs, CDK4/6 inhibitors, PARPi).

More details on newer drugs in 🧵 below.

Please use this version as reference &amp; thanks for all input/experience crowdsourcing! (1/3)

[Anish Koka, MD @anish_koka]

https://t.co/WXyKfmyS8e

[Dr Devang Bhavsar @DevangBhavsarc]

@Arden_2210 48

[Dr Devang Bhavsar @DevangBhavsarc]

49/M , case of Adeno Ca , lower one third (35-38 CM) non metastatic disease, need to start pre Op RT+ CT, CT scan Thorax shows multiple cyst in both lungs (&gt;2 cm size max more then 100, normal PFT)
Expert comments @ACRORadOnc

[Shankar Siva @_ShankarSiva]

💥Phase III BART trial (n=153) in locally advanced #BladderCancer after cystectomy + chemo:
🔹 RT (n=77) vs Obs (n=76)
🔹2-yr locoregional recurrence: 8% RT vs 26% Obs (p=0.006)
🔹OS trend ↑RT (68% vs 57%), not sig
🔹No ↑ severe late adverse events
👉Adjuvant RT ↑ control & DFS, esp T3/4 & N+ pts. #ASTRO25 #RadOnc

[Oncology Brothers @OncBrothers]

Current USPSTF guidelines for cancer screening. @AmericanCancer guidelines for breast ca annual screening starting age 40 can be an “option”. ACS also endorses colonoscopy at 45y/o for colon ca! For ⬆️ risk breast ca &amp; CRC, consider earlier screening!

#OncTwitter #MedTwitter

[Oncology Brothers @OncBrothers]

Some key supportive care advances in Onc w/ data that improve QoL &amp; should be part of our practice:

1. Olanzapine
2. Diclofenac &amp; B12 for capecitabine
3. Mg for Cisplatin
4. Fezolinetant for VMS
5. Exercise
6. Cryo for neuropathy &amp; hair loss

What else wld you add #SuppOnc?
1/7

[Dr Devang Bhavsar @DevangBhavsarc]

@DealsDhamaka Publication year 1990??

[Dr Devang Bhavsar @DevangBhavsarc]

@KatsuakiMaehara Any trial going on at present to address EGFR and TP53 MT

[Dr. Nina Niu Sanford @NiuSanford]

Short course RT &gt; FOLFOX x 3 &gt; brachy (10Gy x 2) in T2-T4, small N+ rectal ca.

Organ pres 53%, ~OPRA but &lt;&lt; OPERA, likely due to T4 &amp; lower brachy dose.

Brachy can achieve CR w less chemo for lower risk pts, but operator dep, resource-limited, &amp; trials smaller/heterogeneous.

[Navjot Singh Sidhu @sherryontopp]

Today at Rajindra hospital Patiala CT mapping ( simulation ) was done for radiotherapy treatment planning by Dr. Benipal , Dr. Dangwal and Dr. Bansal. Her radiotherapy starts from monday onwards, the state of the art radiotherapy unit is more like a bunker with 4 feet concrete walls. World class high energy linear accelerator (True Beam) state of art machine being used for radiation at Patiala and Amritsar.

[David Sher @DavidSherMD]

This paper is absolutely fantastic.

It is essentially the Bible for NPC CTV delineation.

Incredible contribution to the field!

https://t.co/YIkrYLSTrD

[Pierre Blanchard, MD @PBlanchardMD]

10y results of FAST FORWARD (adjuvant #breastcancer RT) trial presented at #ESTRO25 by AM Brunt.

Compared to 40Gy/15, 26Gy/5:
1. Non inf for IBR (even superior?)
2. Similar recurrence free interval, breast cancer interval, OS
3. No diff in PRO or toxicity

Clearly 26/5 SOC for

[Dr Devang Bhavsar @DevangBhavsarc]

@5_utr Inclusion criteria???

[Dr Devang Bhavsar @DevangBhavsarc]

@DFCI_BreastOnc @TheBreastOnline @BCJoyceO @stolaney1 @PedramRazaviMD @DrSGraff Need to know about type surgical intervention done

[TMC Radiation Oncology @RadOncTMC]

Today, we bid an emotional farewell to India's first Tomotherapy machine at @ACTREC_TMC as it retires after 17 years of service.

Installed in 2007, it shaped countless cancer journeys with precision!

#EndOfAnEra #Radiotherapy