Volker Chicata S.

Médico Oncólogo Radioterápico | ciudadano del 🌎 | trabajo en @EsSaludPeru y @clinicaSPablo Arequipa

[PDBrown @PDBrownOnc]

🚨🚨 Randomized Trial #ASTRO26 Resected Brain Met fractionated SRS vs single fraction SRS post-op cavity 🚨
• fSRS superior surgical bed control
• No diff AEs
• fSRS standard of care for resected larger brain met

[Rohit Malde @roxboxfix]

SABRINA 2026

Stereotactic ablative radiotherapy for oligometastatic breast cancer: a systematic review and meta-analysis

DOI 10.1016/j.radonc.2026.111789.

25 cohorts, 1,577 pts, 2,211 lesions

Good Local Control
minimal Toxicity

De.novo better than Oligoprogression

[Dr. Nina Niu Sanford @NiuSanford]

Highly practical ESTRO guidelines. Re-RT for locally recurrent rectal cancer should no longer be the "exception."

W thoughtful planning, re-RT (often 30–40 Gy BID, w SBRT in select cases) can safely 1) improve resectability, 2) definitively tx or 3) palliate symptoms. @OncoAlert

[PDBrown @PDBrownOnc]

Is there a survival benefit for prophylactic cranial irradiation?
Yes, according to this Randomized trial
https://t.co/ErDMqoPGUk

[Dr Rishabh Jain @DrRishabhOnco]

Adjuvant RT may finally be back in bladder cancer.

The phase III BART trial shows that modern pelvic IMRT after cystectomy significantly improves locoregional control in high-risk MIBC. 🚨

🇮🇳 Multicenter randomized trial
153 patients

90% received perioperative chemotherapy

🩻 Adjuvant RT vs Observation after radical cystectomy

📌 2-year LRFS
87.1% vs 76.0%
HR 0.43 (P=.04)

📌 2-year DFS
71.6% vs 58.7%

📌 2-year OS
70.4% vs 57.4%

Most striking finding:
❌ No isolated pelvic recurrence after adjuvant RT.

Despite historical concerns, toxicity remained low with modern IG-IMRT:
⚠️ Grade ≥3 acute toxicity: <5%
⚠️ No major increase in severe late toxicity

This is important because pelvic failures after cystectomy are often devastating and rarely salvageable.

The study strongly reopens the discussion around integrating pelvic RT into multimodality care for high-risk bladder cancer, especially in the modern immunotherapy era.

Could adjuvant RT + IO become the next frontier in MIBC?

📖 Full paper in comment ⬇️

#OncoTwitter #MedTwitter #BladderCancer #RadOnc @ASCO @myesmo @esmo_o @OncoAlert

[Rohit Malde @roxboxfix]

POP RT Vs PEACE II

2 years ADT + WPRT

Vs 3 years ADT + Prostate Only RT

Tough to choose or you already have a choice ??

[Pierre Blanchard, MD @PBlanchardMD]

Yesterday, I presented the @GETUG_Unicancer PEACE 2 trial at #ESTRO26 on the role of pelvic RT in very high risk #prostatecancer pts (staged with conventional imaging).

Twittorial below

Key conclusion: pelvic RT did not improve clinical outcomes (cPFS, MFS, PCSS, OS)...

1/n

[giuseppe Minniti @gminniti2012]

Dose–volume effects link multiple cerebral substructures to cognitive decline. Neurocognitive toxicity reflects distributed network injury beyond the hippocampus.
@ESTRO_RT CNS focus group on @RO_GreenJournal https://t.co/JptGO6G4zu

[Entisar saleh @Entisar_kilani]

Localized prostate cancer treatment algorithm ESMO guidelines.

#ESMO #oncology #medtwitter

[ASTRO @ASTRO_org]

New in #practicalRO: Target Volume Delineation for Locally Advanced Rectal Cancer. https://t.co/aD271q7tkp

[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)

[Terry Williams @TeWilliamsMD]

@ASTRO_org RPT Symposium kicked off in Palm Desert with Johannes Czernin from @UCLAHealth serving up a fantastic keynote on PSMA imaging &amp; therapy, following Stephen Hahn’s inspiring keynote on innovation &amp; teamwork. Exciting 2 days planned‼️ #MRPTS26 #radonc

[ASTRO @ASTRO_org]

In this new #RedJournal article, IROCK Contouring Guidelines now available for Renal SABR! https://t.co/SYwZKnuku7

[Oscar Tahuahua @drtahuahua]

Do we always need upfront systemic therapy in oligometastatic disease?

This meta-analysis in @JAMANetworkOpen suggests not.
SBRT achieved 70% systemic therapy free survival at 1–2 yrs, rising to 78% in prostate & 87% in renal cancer, with low toxicity & preserved QoL.
Appropriate pt selection & tx sequencing matter.
https://t.co/NDu4xq2AIV @OncoAlert

[Dr Rishabh Jain @DrRishabhOnco]

ASTRO 2025 Update: Radiation Therapy in Grade 4 Diffuse Gliomas 🧠⚡️

After max safe resection, RT remains the backbone for WHO grade 4 gliomas (IDH-mutant astrocytoma & IDH-WT GBM).

🔑 What’s new:
🧩 Integrates 2021 WHO molecular classification
💊 Recommends temozolomide + RT (standard)
⚡️ Tumor Treating Fields (TTF) now conditionally endorsed

👵 Frailty-based dosing:
<70 yrs, KPS ≥ 60 → 60 Gy/30 fx + TMZ
≥70 yrs/frail → shorter RT course

🔁 Re-irradiation: Conditional for fit patients after MDT review

⚖️ Adds focus on health disparities & equitable trial access

🧠 “The field is shifting toward molecular nuance + individualized RT—not just age or KPS.”

📓Yeboa et al., Pract Radiat Oncol 2025

🔗 https://t.co/bKUPCBw7Q4

#OncoTwitter #RadOnc #NeuroOncology @ASTRO_org @myESMO @esmo_open @OncoAlert @asco

[Dr Rishabh Jain @DrRishabhOnco]

🚨 ESTRO–ASTRO call for a paradigm shift in breast RT! 💥

📘 ESTRO Recommendations on Preoperative RT in Breast Cancer
-endorsed by @ASTRO_org & @myESMO

🔹 Why now?
Modern RT = safer, precise, hypofractionated
→ Time to rethink the “surgery-first” dogma 🔄

🔹 Potential advantages:
✅ Early-stage: sharper target, smaller volume
✅ Locally advanced: ↑pCR, ↑BCS conversion
✅ Pre-mastectomy: better reconstruction outcomes
✅ Synergy with IO, PARPi, CDK4/6i
✅ Possibility of surgery omission in select pts

🔹 Key data (27 studies, 2006–2024):
• pCR 4–60%, up to 71% in TNBC
• Feasible with modern IMRT/VMAT/SBRT
• Acceptable toxicity; fibrosis 9–13%, OS >90%

🔹 Still investigational — Phase III trials needed (Neo-RT, TOPAz, Neo-CheckRay, P-RAD…)

💡 Preop RT may reshape breast oncology-one protocol at a time.

What are your opinion is on this , please comments and let’s discuss⤵️

📖Zamagni et al. Radiother Oncol. 2025.
🔗 https://t.co/DAnDzDkYP9

#OncoTwitter #BreastCancer #RadOnc @ASCO @ASTRO @myESMO @ESMO_Open @OncoAlert

[valentinapinzi MD, PhD @valentinapinzi]

How far can we go with #reirradiation in #gliomas ?
Practical guidance from current evidence.
check our latest publication ⤵️
✅ https://t.co/0DvV4EZPbu

[Amadeo Wals @AmadeoWals]

@LuisAlberto3P MAS QUE AMPLIAR VAMOS A APLICAR #IA sobre ella y asi la tenemos reconstruida. 😅

[Gustavo @gusviani]

🚨 New Evidence in High-Risk Thyroid Cancer: Can Radiotherapy Make the Difference?

🎯 Objective
Evaluate outcomes & toxicity of adjuvant IMRT in high-risk differentiated thyroid cancer (DTC)

🏥 Methods
•Retrospective, single-center (2011–2024)
•59 high-risk DTC pts (gross ETE, +margins, aggressive histology)
•IMRT + IGRT, 60–64 Gy to high-risk, 54 Gy to low-risk volumes
•Median follow-up: 53 mo

📊 Key Results
•5-yr locoregional control: 89.3%
•5-yr OS: 84.6%
•Acceptable toxicity (Grade ≥3 dermatitis 12%, dysphagia 10%)

💡 Take-home: Targeted adjuvant IMRT can achieve excellent control in selected high-risk DTC pts

[David Palma, MD, PhD @drdavidpalma]

Important re-irradiation lesson for #radonc residents: when you look at your DVH in EQD2 (like in MIM), the "V20" that you need to look at will change.

Here's a DVH from a 60/30 plan shown as physical dose vs. EQD2. The DVH looks much better below 60 Gy &amp; a bit worse above it.