Jonathan Tomaszewski

Radiation Oncologist, Ballarat Austin Radiation Oncology Centre • Views my own #radonc 🇦🇺

[Jonathan Tomaszewski @dr_jonathant]

Might this now be possible with the POSEIDON dataset @AmarUKishan?
Calculator showing 10yr MFS with RT (+/- HT) based on pre RT PSA & path features would be v useful, pending widely avail biomarker #radonc #pcsm

[Jonathan Tomaszewski @dr_jonathant]

Would be really helpful to be able to generate individualised estimates of MFS/PCSS/OS for salvage RT alone (beyond the subgroup data from Supp Table 4). Any plans for a nomogram/calculator, or suggestions re how to go about this? #radonc #pcsm

[Jonathan Tomaszewski @dr_jonathant]

@DrSpratticus Is Figure 4 potentially mislabelled? Top 2 panels being RT +/- HT, middle 2 RT +/- ST HT and bottom 2 RT +/- LT HT?

Another query? Fig 2F shows MFS HR 0.79 (95%CI 0.7-0.89), but then upper bound CI crosses HR 1 for all PSA levels (Fig 4B)? 🙏🙂

[Jonathan Tomaszewski @dr_jonathant]

@NiuSanford I would have thought the correct statistical interpr here is that there is no clear diff in trtmt effect based on T or N stage ➡️ p value for interaction >>0.05, wide CIs including HR of overall effect.

[Jonathan Tomaszewski @dr_jonathant]

@alison_tree Similar concerns been expressed for mod hypofrac in past - do we know re any differential effect of IPSS on GU tox from SBRT vs mod hypofrac? #radonc #pcsm @weeloonong

[Jonathan Tomaszewski @dr_jonathant]

@DrAndrewLoblaw @piet_ost @chrisparker @RTendulkarMD Another approach: Aim ≥5%⬆️MFS @ 10yr with ADT. Trials suggest need pt with MFS≤70-75% (without ADT) to observe this benefit.

FFDM is ~10% > 10yr MFS (e.g per RADICALS-HD) ➡️ if Tendulkar nomogram 10yr DM >15-20% recommend ADT (depending on comorbs/pt prefs) 💡🤓🤔

[Jonathan Tomaszewski @dr_jonathant]

Would be really helpful to be able to generate individualised estimates of MFS/PCSS/OS for salvage RT alone (beyond the subgroup data from Supp Table 4). Any plans for a nomogram/calculator, or suggestions re how to go about this? #radonc #pcsm

[Advanced Prostate Cancer Consensus Conference @APCCC_Lugano]

Duration of Androgen Suppression with Postoperative Radiotherapy (DADSPORT) for Nonmetastatic Prostate Cancer: A Collaborative Systematic Review and Meta-analysis of Aggregate Data

https://t.co/WWqOHsaC0P

This systematic review and meta-analysis by the DADSPORT Collaboration evaluated the impact of hormone therapy (HT) added to postoperative radiotherapy (RT) in nonmetastatic #ProstateCancer across five randomized controlled trials involving 4,411 participants. While HT did not significantly improve overall survival (OS) in the general population, it did show meaningful benefits in metastasis-free survival (MFS) and prostate cancer–specific survival (PCSS), each with a 4% absolute improvement at 8 years.

Notably, OS benefits may be limited to patients with higher pre-RT PSA levels or CAPRA-S scores.

These findings support the use of adjuvant HT to improve cancer outcomes, particularly in higher-risk patients.

@DrSpratticus
@AmarUKishan
@drjefstathiou
@PCaParker
@_APollack
@PaulSargos
@felixfengmd

@OncoAlert
@Silke_Gillessen @AOmlin
@nataliagandur @bavilima

[Jonathan Tomaszewski @dr_jonathant]

@BLawenda Interested in this GPT, but unable to DM you. Keen to hear how baseline MFS/PCSS/OS (for salv RT alone) estimated from available data thx 🙏

[Jonathan Tomaszewski @dr_jonathant]

@DrAndrewLoblaw Pls elaborate @DrAndrewLoblaw 🙂

[Jonathan Tomaszewski @dr_jonathant]

@TylerSbrt @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad What is your usual nodal boost dose (presuming bowel/plexus not limiting)?

[Jonathan Tomaszewski @dr_jonathant]

Curious to hear from #radonc re whether they contour & limit lumbosacral plexus when boosting involved pelvic nodes in #prostatecancer? (e.g PEACE V used 65Gy/25# which is 74.75Gy EQD2 for a/b=2) 🤔 @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt

[Jonathan Tomaszewski @dr_jonathant]

@PCaParker @PBlanchardMD @alison_tree @piet_ost @dr_alimuhammad @TylerSbrt Sounds idiosyncratic rather than something that one can extrapolate to broader pt population. What dose do you typically use for nodal boosts?

[Jonathan Tomaszewski @dr_jonathant]

@Sushilberiwal @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt What is your typical nodal boost dose? What constraint would you apply to LSP?

[Jonathan Tomaszewski @dr_jonathant]

@Sushilberiwal @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt Even if boosting nodes in close proximity to LSP to ≥70Gy equiv?

[Jonathan Tomaszewski @dr_jonathant]

@PBlanchardMD @alison_tree @piet_ost @dr_alimuhammad @TylerSbrt @PCaParker Perhaps more of a concern if taking nodes to ≥70Gy

[Jonathan Tomaszewski @dr_jonathant]

@a_dalpra @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt What dose constraint have you used for LSP?

[Jonathan Tomaszewski @dr_jonathant]

@DrewCareyMD @HopkinsMedicine Biological effect relates to both total dose & dose per fraction, cannot exceed CNII tolerance as such based purely on use of 3Gy/#. Also important to distinguish BED and EQD2 (see below). 30Gy/10# is equivalent to <40Gy at 2Gy/# (RION should be exceedingly rare at this dose).

[Jonathan Tomaszewski @dr_jonathant]

In memory of Jack Fowler: BED (Biologically EFFECTIVE Dose) ≠ EQD2 (2Gy/fraction equivalent) https://t.co/d7eUckAmJt #radonc #radbiol

[Jonathan Tomaszewski @dr_jonathant]

@HKennecke @JCO_ASCO @OncoAlert Agree with overall message, but worth noting that ~half of the n=530 treated with upfront surgery were either clinical stage I or >12cm from verge 👇

[Jonathan Tomaszewski @dr_jonathant]

OCUM trial n=~1100 but majority not informative re RT omission. Key group n=257, stage II/III <12cm from verge treated with upfront surg (MRF>1mm, no T4 or low T3, vast majority N≤1 & 6-12cm from verge) ➡️ 5yr LR 3.8%. No info re T3 substage/EMVI https://t.co/cR7FXB8PEI #radonc

[Jonathan Tomaszewski @dr_jonathant]

Expect substantial overlap with PROSPECT-eligible patients (https://t.co/hDFChtmwgx) #radonc

[Jonathan Tomaszewski @dr_jonathant]

OCUM trial n=~1100 but majority not informative re RT omission. Key group n=257, stage II/III <12cm from verge treated with upfront surg (MRF>1mm, no T4 or low T3, vast majority N≤1 & 6-12cm from verge) ➡️ 5yr LR 3.8%. No info re T3 substage/EMVI https://t.co/cR7FXB8PEI #radonc

[Cihan Gani @GI_RadOnc]

Let's have a closer look 🧐at the PROSPECT trial after its presentation at #ASCO23 and publication in @NEJM https://t.co/03yPeJodh3 #radonc #crcsm 1/n