Gerardo CM

Médico Especialista en Radio-oncología
Certificado por el Consejo Mexicano de Certificación en Radioterapia.
Maestro en Ciencias de la Salud.

[Ria Kraft, MD @riakraftmd]

I am so grateful to share that I passed oral boards and am officially boarding certified in #radonc! Huge thank you to @radoncresidency & my study group. While residency is still fresh in my mind, I look forward to sharing some advice to any residents that may find this useful.

[Dra LOLA DE LA MATA @loladelamata]

listos 2° sesión 25 de abril 9 am CDMX #ASTROJOURNALCLUBLATAMEIBERICA avalado @ASTRO_org revisaremos #INTERLACE #LATAM #cancercervicouterino acompañados #braquiterapia @AndrewFarach & #Colombia Dra. Valentina Coronado link https://t.co/gEBqCL4cKd #youtube @astrojournalclubconn

[David Palma, MD, PhD @drdavidpalma]

Just released! Volume 2 of SBRT: From Clinical Trials to your Clinic in @IJROBP

Truly amazing papers from end to end. Have a look at the issue highlights here.

https://t.co/1U0ryJHIjw

[Gerardo CM @cuamanigm]

https://t.co/q9BixmfAdE

[Elisabetta Bonzano MD, PhD @to_be_elizabeth]

📌 Top 10 Tips for Stereotactic Body Radiation Therapy Contouring and Planning in Oligometastatic Disease: Lessons Learned From the UK SBRT QA Program ☢️
🔗 https://t.co/WkZDZSoA4I @OncoAlert #OncoAlertAF @IJROBP @fifimcdrmh @royalmarsdenNHS 
🔹Standardize definitions.
🔸 Optimize use of supporting imaging.
🔹 Motion management.
🔸 Optimize patient preparation.
🔹 Use all available TPS tools to optimize contouring.
🔸 Check auto-contouring output.
🔹 Appropriate use of OAR dose-volume constraints.
🔸 Maximize PTV coverage.
🔹 Conform tightly to the PTV.
🔸 Managing multiple lesions.

[FATIMA BOSCH @bosch_fatima]

Imagínate buscar aprobación en un mundo que crucificó a un hombre totalmente perfecto.

[Oscar Arias @OACerebro]

Enjoy!!

https://t.co/YybiZJvXP8

[Dr Rishabh Jain @DrRishabhOnco]

More lesions ≠ WBRT anymore? 🤯

Phase 3 data just changed how we think about 5–20 brain metastases.

🧠 Trial: SRT vs HA-WBRT (JAMA 2026)

👥 Population:
• 5–20 brain mets
• Good PS, expected survival ≥4 months
• Mean ~14 lesions

⚡ Arms:
• 🎯 SRT (1–5 fractions)
• 🧠 HA-WBRT (30 Gy/10 fx ± memantine)

📊 Key Results:
• ↓ Symptom burden with SRT (MDASI-BT Δ −1.06, P<.001)
• Better neurocognition at 12 months
• Better performance status early & sustained
• Similar survival & grade ≥3 toxicity

⚠️ Trade-offs:
• ↑ New brain mets with SRT
  45.4% vs 24.2%
• ↑ Radiation necrosis (mostly asymptomatic)
• More salvage WBRT needed

🎯 Takeaway:
Even with up to 20 brain mets, SRT offers better QoL + functional outcomes
👉 At the cost of higher intracranial relapse risk

🔖 Think beyond lesion count. Think patient-centered outcomes.

📖 Full paper in comment ⬇️

#OncoTwitter #MedTwitter #RadiationOncology #BrainMetastases
@oncoalert

[ISRSy @ISRSy]

📣 DON'T FORGET: The next #ISRSWebinar

The Role of the Biological Effective Dose (BED) in SRS

🗓️ April 1, 2026 | 2pm CET
🥼 Ian Paddick, MSc, MIPEM, CSci

Consultant Physicist Past-President of the BRSS Co-Chair of the ISRS Certification Committee Honorary Research Fellow at UCL

The role of the Biological Effective Dose (BED) was developed to account for sub-lethal DNA repair effects during exposure and the resulting decrease in the clinical effect of the radiation. In conventional radiotherapy, where treatment times are short (≤10 minutes), sub-lethal repair is minimal. However, in radiosurgery, where treatments can take tens of minutes to deliver, the overall treatment time can reduce the BED of a treatment by a significant amount. This effect, evidenced originally in clonogenic cell survival studies, then animal models, has now been shown to have an important influence in clinical outcomes of SRS. The rationale for prescribing according to the Biological Effective Dose will be explored.

👉 REGISTER: https://t.co/EO5xl98jvk

[Advances, an ASTRO Journal @Advances_ASTRO]

What is the rate of sacral fracture (SF) after short course pelvic ☢️ for rectal cancer?

In this single institution series (n=171), pts w/ rectal adeno received short course RT (25 Gy in 5 fx), consolidative chemo, and surgery (or non-operative management). From mFU 2.2yrs:
🔘 Crude incidence SF = 7.6%
🔘 2yr cumulative incidence SF = 8.8%
🔘 Median time to SF = 1.64 yrs
🔘 Most (84.6%) SF were asymptomatic
🔘 On MVA, 🔼 SF risk if ♀️ (aHR 6.01) and hx of osteoporosis (aHR 7.37)

🔗 - https://t.co/MoUKtqA3Ke
@JHMRadOnc @ASTRO_org #radonc

[ASTRO @ASTRO_org]

FREE for ASTRO members-in-training!

Join us on Thursday, April 2 at 1:00 p.m. ET for a Live Webinar:
"eContouring for Functional Radiation Medicine - Osteoarthritis & Fibromatosis," with speaker Jessica Schuster, MD, from the University of Wisconsin-Madison.

Supported by Speed of Light - The ASTRO Foundation's Juan A. del Regato Fund

Register now: https://t.co/G5R1lqETDX

@ARRO_org @RadOncPDs @UW_RadoncDHO

[Emre Yekedüz @yekeduz_emre]

NICE 2026 guideline for the diagnosis and management of #kidneycancer :
👉https://t.co/nEkyzojcrC

@OncoAlert #cancer #oncology @DrYukselUrun @urotoday @AUC3_Official

[Gerardo CM @cuamanigm]

https://t.co/IIZtfjqPPG

[Mamtha Balla, MD, MPH, FACP @MamthaB]

🎯 Gastroesophageal Cancer: ITE/BOARDS Pearls
(Follow ASCO/NCCN guidelines for latest updates)

🧭 1) First sort by SITE + HISTOLOGY

1. Esophageal SCC → upper/mid esophagus, very radiosensitive → radiation must be involved.
2. True esophageal adenocarcinoma → distal, Barrett, still ->esophageal pathway.
3. GEJ adenocarcinoma → distal esophagus/GEJ/cardia; behaves like esophageal (Siewert I–II) or gastric (III), but boards accept either CROSS or FLOT.
4. Gastric adenocarcinoma (subcardia/body/antrum)→ intestinal/diffuse; no routine neoadjuvant RT.

🩻 2) Classic staging steps

1. Dysphagia → EGD/biopsy.
2. PET/CT to rule out mets.
3. If M0 → EUS for T/N; malignant node = round, hypoechoic, >1 cm.
- Add-ons:
- Bronchoscopy if tumor at/above carina.
- Staging laparoscopy: standard for gastric (≥cT1b), optional for GEJ.

-->Celiac nodes = regional for distal esophagus/GEJ
-->Below celiac = distant.

🎯 3) Four management buckets

1. Very early (T1a N0)- Mucosa only → endoscopic resection (EMR-Endoscopic mucosal resection /ESD-Endoscopic submucosal disection) ± Barrett ablation

2. Resectable, locally advanced (T1b+ or any N+)
- T1b(submucosa) → surgery standard.
- T2+ → needs systemic therapy (micromets).
- Options:
- Neoadjuvant CRT → surgery (CROSS)
- Perioperative chemo (FLOT preferred over MAGIC)

3. Locally advanced unresectable (T4b / medically inoperable)
- Definitive CRT(cis/5-FU or FOLFOX + RT).
- Cervical esophagus (almost always SCC) → definitive CRT, no surgery.

4. Metastatic (any distant organ or non‑regional nodes
->Systemic therapy ± local palliation.

💉 4) SCC vs Adeno: which regimen?

- Esophageal SCC- Radiosensitive; periop chemo alone not standard (INT 0113 negative).
Neoadjuvant CRT (CROSS) if resectable; definitive CRT if not surgical.

- Esophageal / GEJ adenocarcinoma
- Higher distant relapse; less radiosensitive.
- Boards: CROSS OR FLOT acceptable (ESOPEC favors FLOT but exams may lag).
- Gastric adenocarcinoma- Perioperative FLOT for fit patients.
- Upfront RT only in post‑op D1 setting (see below), not routine neoadjuvant.

🧪 Immunotherapy pearls (exam-simplified)

- After CROSS + surgery with residual disease → adjuvant nivolumab x 1 year.

- Metastatic adenocarcinoma:
- Test HER2, PD‑L1 (CPS), dMMR/MSI‑H
1. HER2– → platinum/FP + PD‑1 inhibitor (e.g., nivolumab).
2.HER2+→ trastuzumab + platinum/FP + pembrolizumab.
3. MSI‑H/dMMR** → IO-(IO is king)

- Metastatic SCC:
- Platinum/FP + PD‑1 inhibitor; no HER2 drugs.

FP=Flouro pyrimidine/5-FU

->No HER2 targeting in SCC
->do not continue trastuzumab beyond progression.

🍽 Gastric surgery: D1 vs D2 = dictates adjuvant

- D1 (N1 only) → adjuvant chemoradiation (MacDonald/INT 0116; 5‑FU based).
- D2 (N1+N2)→ adjuvant chemo only (CAPOX, etc.; CLASSIC).
- Adding RT after good D2 (ARTIST) → no clear benefit.

🧠 Board one‑liners

->T1a N0 → EMR/ESD.
->T1b+ or N+ → surgery + periop systemic (CRT or FLOT).
->T4a- resectable; T4b → definitive CRT.
->Celiac nodes are regional for distal esophagus/GEJ.
->Gastric ≥cT1b → staging lap.
->Cervical esophagus→ definitive CRT (even if technically resectable).
-> Residual disease after neoadjuvant CRT + surgery → adjuvant nivolumab
->FLOT > MAGIC; periop chemo only for true gastric.
->Celiac nodes = Regional for distal esophagus/GEJ.
->p16is NOT used here (that's Head & Neck).
->Trastuzumab deruxtecan (T-DXd) = 2nd line for HER2+ disease.
->Ramucirumab = Adenocarcinoma only; not for SCC.

#OncTwitter #HemOnc #MedOnc #Oncology #Cancer #ITE #Boards #ABIM #MedEd #FOAMed #gcsm
@ASCO @NCCNorg @ESMO_Open @JCO_ASCO @OncLive @TargetedOnc @HemOncFellows @IMG_Oncologists @realbowtiedoc
#OncBoards
Follow: @MamthaB (X) | @Hemonc_dr (Insta)
(see the generated image above)

[Rodrigo Sanchez Roger @RodRogSan]

⭕️ASCO GU 2026 - Los 15 mejores ensayos con posible impacto práctico @ASCO #GU26 @oncourologiaarg

[Karamvir Yadav @K_Yadavir]

CONVERT V/S PROSPECT in Rectal cancer

Radiation for all LARC? Not anymore.

CONVERT + PROSPECT challenge routine CRT.
✔ Comparable DFS & OS
✔ Local control >96%
✔ Major reduction in long-term toxicity

MRF uninvolved?
Low-risk T2N+/T3N0–1?

Selective RT is here.

#RectalCancer #Oncology #ASCO #MedTwitter @NiuSanford @OscarTahuahua @OncoAlert @hoperugo @ASCOPost @JCO_ASCO @NEJM @dr_yakupergun @myESMO

[Dr Rishabh Jain @DrRishabhOnco]

Can we skip pelvic RT in selected LARC? CONVERT says maybe. 🎯🧠

CONVERT trial | JCO 2026

In locally advanced rectal cancer with uninvolved mesorectal fascia (MRF-negative), neoadjuvant CAPOX alone achieved very low local recurrence, similar DFS and OS, and less long-term toxicity compared with standard chemoradiation.

🧪 Study population
LARC within 12 cm from anal verge
MRI-confirmed uninvolved MRF
Median follow-up 48 months

⚔️ Treatment strategy
🟦 CAPOX x4 cycles → surgery
🟥 Pelvic RT + capecitabine → surgery

📊 Key 3-year outcomes
LRRFS 97.4% (CRT) vs 96.3% (CAPOX) | HR 1.40
DFS 89.2% vs 87.9% | HR 0.88
OS 95.0% vs 94.1% | HR 0.86

🛡️ Long-term toxicity matters
Grade 2-4 late AEs 26.3% (CRT) vs 16.0% (CAPOX)
Chronic proctitis 41.7% vs 33.6%

🧠 Clinical interpretation
Non-inferiority was not formally met due to extremely low event rates.
But efficacy is comparable and toxicity clearly favors CAPOX-only.
This supports RT de-escalation discussions in carefully selected MRF-negative LARC.

🔖 Save for MDT discussions
📖 Full paper in comment ⬇️

#OncoTwitter #MedTwitter #RectalCancer #ColorectalCancer
@OncoAlert @myesmo @esmo_open @asco @JCO_ASCO

[Gerardo CM @cuamanigm]

Molecular profiles as predictors of locoregional recurrence-free survi... https://t.co/buQ5fdt2db

[Elisabetta Bonzano MD, PhD @to_be_elizabeth]

📌 Radiotherapy With a 12-Gene Expression Assay for Ductal Carcinoma In Situ
A Randomized Clinical Trial
🔗 https://t.co/O95CMEGq0o
@OncoAlert #OncoAlertAF @JAMAOnc

[Luis Moreno Sánchez @radioncoluis]

Cumulative dose evaluation in clinical reirradiation – Consensus guidance
on technical considerations by the ESTRO reirradiation focus group

https://t.co/VCkl4vnOxG