Alex Hotca, MD

GI Radiation Oncologist | MD @DrexelMedicine, Residency @MountSinaiRO, Assistant Prof. @UCSFCancer |

[Alex Hotca, MD @alexhotca]

@NiuSanford @MikeChuongMD @OncoAlert Do you recommend adjuvant RT if R1 and N+?

[Tamer Refaat, MD PhD MSCI @TamerRefaatMD]

An incredible day exploring the Pyramids, the Sphinx, & the Grand Egyptian Museum with the @ASTRO_org Global Refresher faculty before we kick off the inaugural meeting tomorrow.

Thanks, Dr. Amr Abdelaziz, for the exceptional hospitality! 🇪🇬

#ASTROGlobalRefresher #ASTRO #RadOnc

[Tamer Refaat, MD PhD MSCI @TamerRefaatMD]

Proud to join an outstanding international faculty for the first-ever ASTRO Global Refresher kicking off today in Cairo,Egypt! 🇪🇬🌍A major milestone in @ASTRO_org’s global education efforts, bringing together experts committed to advancing radiation oncology&cancer care worldwide

[Alex Hotca, MD @alexhotca]

@NiuSanford @lauren_henke @OncoAlert Still would be worried about the N+ patients to spare the lymph nodes. Long term data is needed but definitely very interesting and promising. I don’t think 25/5 to the nodes would cause significant side effects. Much needed trials in this space: IO+chemoRT for rectal ca

[Piet Ost @piet_ost]

What a beautiful message at the end of @Mat_Guc presidency at #ESTRO26 passing the torch to @BarbaraJereczek! See you at #ESTRO27 in Milano, 21-25th of May 2027.

[ilyas sahin, MD @ilyassahinMD]

New @JCO_ASCO * analysis of ~5,000 HCC patients treated with external beam radiation therapy across 30 centers in 11 countries.

Median overall survival:
-BCLC-0 (very early stage, a single tumor 2 cm or smaller): 6.8 years
-BCLC-A (early stage, single tumor of any size or up to 3 tumors ≤3 cm each): 4.6 years
-Treatment-naive BCLC-A: 5.4 years

Retrospective, but the scale is striking. EBRT belongs in the frontline HCC discussion.

[Filippo Alongi @alongi_filippo]

Wating for you @ #ESTRO26.
Advocacy in Radiotherapy is not a choice. It is an act of responsability. Radiotherapy needs efforts to amplify voices: radiotherapy saves lives, it is effective and well tolerated but underrepresented by media and poorly understood. Speak up!

[NonsparseOncologist @5_utr]

Bertolo & Develtere want cumulative incidence for RT counseling. Fine. ProtecT at 12 years: urinary leakage requiring pads 18-24% surgery vs 3-8% radiotherapy (Donovan, NEJM Evidence 2023). Applying their own framework to surgery produces numbers they’d never publish. Funny that.

[Alex Hotca, MD @alexhotca]

@DrewMoghanaki It is mind blowing how they don’t discuss prostatectomy side effects at all. It is easy to point fingers… very one sided. Lately @JCO_ASCO has published several of these one sided opinions. This is concerning

[UCSF Radiation Oncology @UCSFRadOnc]

It was a great pleasure to host Vivek Kavadi, CEO of @ASTRO_org this week at UCSF! We appreciated hearing his vision and priorities, and how we can work together to continue to make a difference for our patients! @alexhotca @snseyedinMD @VasuLabUCSF @NeurosurgUCSF

[Alex Hotca, MD @alexhotca]

@yuanjamesrao The microbubbles could spread the tumor… I won’t be surprised

[A pancreatic cancer doctor @DanZhaoMD]

Hyperprogression and Systemic Metastasis of Cholangiocarcinoma after Histotripsy Therapy - Journal of Vascular and Interventional Radiology https://t.co/ColqmsyCry

[Alex Hotca, MD @alexhotca]

@lauren_henke @MikeChuongMD Yes we do too but the radiologists don’t look at them since they are not considered diagnostic…

[Alex Hotca, MD @alexhotca]

@lauren_henke @MikeChuongMD Yes that is often the biggest issue that I see in clinic. They call it progression based on imaging that was done prior to start of radiation. Not sure what the solution is here. Not always feasible to repeat diagnostic scans right before start of radiation.

[Lauren Henke, MD, MSCI @lauren_henke]

In limited stage small cell, standard of care is a local therapy, yes *along with* systemic therapy. I agree with @alexhotca - you may be RT friendly but your phrasing is really lumping everything together. Not all local therapies are the same and I really wish my med onc colleagues would spend time understanding the details of local therapy data the way that I am expected to know the nuances and differences of systemic regimens. Please encourage people to learn the details, not lump. 🫶🏻

[Alex Hotca, MD @alexhotca]

@GIMedOnc @oncologista_BSB Why always trying to get rid of local therapies 😑? Perhaps we need more studies to integrate local therapies with new agents so that we can decrease the amount of systemic therapy needed and thus decrease the systemic side effects which are not negligible…

[Alex Hotca, MD @alexhotca]

@GIMedOnc You are generalizing to all local therapies including radiation based on 1 study using RFA?this only shows RFA should not be used in PDAC end of the story. I would argue the role of RT will only increase given pts will live longer. Generally I agree with your posts but not here

[Revolution Medicines @RevMedicines]

The FDA has issued a “safe to proceed” letter allowing Revolution Medicines to initiate an expanded access treatment protocol for our investigational RAS(ON) multi-selective inhibitor in patients with previously treated metastatic PDAC.

Our statement: https://t.co/Emx0Qu7MZZ

[The Mark Foundation for Cancer Research @TheMarkFdn]

How does lung cancer actually spread? In @Nature, ASPIRE Awardee @CharlesSwanton sequenced 501 tumor samples to trace how cancer advances from diagnosis to death. One key finding: >50% of metastases were seeded by other metastases. https://t.co/x92pbJFO8g

[Yakup Ergün @dr_yakupergun]

I think the concern is legitimate, but the framing is too broad.

A positive RCT with p<0.05 should not make a regimen permanently untouchable. Many standards in oncology are imperfect: the absolute benefit may be modest, survival may remain poor, surgery may be morbid, and chemo/XRT may be toxic. These standards should absolutely be challenged.

But poor prognosis or treatment burden alone cannot be enough to bypass the standard of care. If that becomes the logic, almost every oncology trial could justify avoiding the accepted comparator. That would not necessarily accelerate progress; it could create non-comparable studies, patient-selection artifacts, and interpretive noise.

To me, the standard of care is not a sacred object. It is the evidentiary reference point. If a trial omits it, the scientific and ethical burden should be higher, not lower: genuine equipoise, strong rationale, careful patient selection, safeguards, and endpoints that capture both efficacy and harm.

So I agree that ethics should not freeze the field. But ethics should also not become a convenient language for avoiding the hard comparison against the best available treatment.