Jennifer Wo

GI Radiation Oncologist, Massachusetts General Hospital
Boston, MA

[Jennifer Wo @JenniferWo4]

@Rad_Nation @manjuggm @JonAshmanMD @AnnRaldow_MD @Rad_Nation Thank you so much for inviting us, and for all of the participants engaging on this important topic! And extra thanks to the moderators! #RadOnc #JC

[Jennifer Wo @JenniferWo4]

@JonAshmanMD @IanJPereira @MontefioreD @cancerphysicist @GI_RadOnc @jryckman3 @Rad_Nation @radoncreview @RadoncTables @EstesRadonc @WashURadOnc @ReIChinMD @KrishanJethwa @UqbaKhan @JohnRTMonsonMD @RazaSayyed12 @eduhor82 @j_lukovic @CCO_Education @LoughboroughW @dralicihat @Dr_Ivanoncologo @VPrasadMDMPH @DrChowdharyMD @AnnRaldow_MD @JonAshmanMD We don't routinely boost LLN's either, although I do push on our surgical colleagues to dissect them at time of resection if radiographically involved at presentation. #RadOnc #JC

[Jennifer Wo @JenniferWo4]

@manjuggm @pierfra22138137 @NiuSanford @IanJPereira @DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @manjuggm Totally agree. So important with so many long term survivorship implications. Our GI NP is running a prospective study for education and intervention with vaginal dilator use for pelvic RT patients. #RadOnc #JC

[Jennifer Wo @JenniferWo4]

@emmadunne @IanJPereira @AnnRaldow_MD @Rad_Nation @JonAshmanMD @subatomicdoc @emmadunne Yes, agree. But it's the only prospective coop group study that addressed this question. So while there are certainly flaws, it's the data we've got. Some meta-analyses, however, has suggested benefit for IMRT,but certainly at greater costs. #Radonc #jc

[Jennifer Wo @JenniferWo4]

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation However, guidelines committee acknowledged that "IMRT/VMAT may be beneficial when external iliac nodes and/or inguinal nodes require tx or when 3D conformal techniques may confer higher risk for toxicity." Future studies may further elucidate benefit. #Radonc #jc

[Jennifer Wo @JenniferWo4]

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation For younger pts, depends on clinical stage. For early stage which could be treated with TME alone, important to discuss long term risks of CRT (sexual health, secondary cancer) and risk of chemo. For later stage, consider dose intensification w/ chemo. #RadOnc #jc

[Jennifer Wo @JenniferWo4]

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation Outside the scope of our guidelines--but good question! For elderly, important to weigh surgical risk of TME vs baseline sphincter function and tolerability of chemo and CRT. #RadOnc #JC

[Jennifer Wo @JenniferWo4]

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation Unfortunately, results of PRODIGE and RAPIDO have not yet been published, and therefore, could not be factored into our guidelines. But definitely practice changing and promising! #RadOnc #jc

[Jennifer Wo @JenniferWo4]

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation Institutional adoption of TNT currently varies, while awaiting publication of the PRODIGE and RAPIDO, but at my institution, yes--we have routinely adopted TNT for node positive patients. #RadOnc #JC

[Jennifer Wo @JenniferWo4]

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation. MRI pelvis has been universally adopted as standard of care clinical staging tool. Advantages of MRI over ERUS are 1) less user dependent, 2) can be interpreted by any provider, 3) provides info on EMVI, distance to mesorectal fascia and 4) LN+. #radonc #jc

[Jennifer Wo @JenniferWo4]

@JonAshmanMD @subatomicdoc @manjuggm @colontown @AnnRaldow_MD Agree! Similarly, I do not discourage use, but I do not routinely recommend it currently. Certainly, worth a try for patients post-treatment if they note bowel irregularity.
#radonc #jc

[Jennifer Wo @JenniferWo4]

@DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @DrN_CancerPCP Thanks for your comments. Totally agree survivorship is critical for all of our patients, especially with the rising rates of young onset CRC, so important to address! Beyond the scope of our guidelines, but totally agree! #RadOnc #jc

[Jennifer Wo @JenniferWo4]

@IanJPereira @DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @NCCN @ASCO Thanks @IanJPereira! Next steps (T11) will be to further personalizing care for our rectal cancer patients-both in terms of treatment intensification for high risk disease/de-escalation for response or lower risk disease based on clinical and radiographic response! #RadOnc #jc

[Jennifer Wo @JenniferWo4]

@IanJPereira @DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @NCCN @ASCO Thanks @IanJPereira. For methodology, we determined key questions (KQs) which we felt were timely and relevant, and them the KQs were assessed using the Population, Intervention, Comparator, Outcome, Timing, Setting (PICOTS) framework.

[Jennifer Wo @JenniferWo4]

@subatomicdoc @Rad_Nation @ASTRO_org @JonAshmanMD @AnnRaldow_MD Thanks@subatomicdoc! We worked hard to pull this CPG together, and hope will helpful in guiding clinical practice for rectal cancer! #radonc #jc