Tris Arscott, MD

Radiation oncologist and researcher. @CompassOncology. Tweets are my own

[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

[Dr. Nina Niu Sanford @NiuSanford]

Here is Version 2.0 of when to hold systemic tx during RT. Updated & w 3 additional drug categories (ADCs, CDK4/6 inhibitors, PARPi).

More details on newer drugs in 🧵 below.

Please use this version as reference & thanks for all input/experience crowdsourcing! (1/3)

[Dr Rishabh Jain @DrRishabhOnco]

🚫 SUPREMO Trial: Why It Does NOT Change PMRT Practice Today?

🔍 What SUPREMO actually tested?
•Chest wall RT alone after mastectomy
•Treatment era: 2006–2013
•All node-positive pts → full axillary dissection
•Minimal regional nodal irradiation (RNI)

📉 Key findings
•❌ No OS benefit overall
•✅ Node-positive pts: lower locoregional recurrence with RT
•Very low-risk cohort:
•25% node-negative
•41% only 1 micro/macro node
•Just 3% chest-wall recurrence without RT

🎯 Why this doesn’t reflect 2025 practice?

Modern PMRT → Chest wall + SCF + IMN (full RNI)
SUPREMO → Chest wall only

Modern surgery → Sentinel node biopsy
SUPREMO → Full axillary dissection

Modern systemic therapy → Genomic + biologic risk-driven
SUPREMO → Older-era treatments

🧭 Real-world takeaway
PMRT with RNI remains SOC for most pts with 1–3 positive nodes
(ASTRO–ASCO–SSO 2024 guideline)

🧪 What’s coming next?
MA.39 / TAILOR RT will clarify if low-burden node-positive + low Oncotype pts can omit PMRT.

📌 Bottom line
SUPREMO ≠ Skip RT.
It reflects old surgery + inadequate RT volume in a low-risk population.

📚 Citation

Kunkler et al. NEJM. 2025.
DOI: https://t.co/fxXd7Mvc9V
(ASTRO commentary: The ASCO Post, Nov 2025)

#OncoTwitter #MedTwitter #BreastCancer #RadiationOncology #PMRT #ASTRO #ASCO
@myESMO @esmo_open @ASCO @OncoAlert @ASTRO_org

[Tris Arscott, MD @wtarscott]

Excited to be back at #astro2025 !

[NEJM @NEJM]

Presented at #ASCO25:

A 3-year structured exercise program after adjuvant chemotherapy for colon cancer improved disease-free and overall survival, physical functioning, and fitness, as compared with health education alone. Full CHALLENGE phase 3 trial results: https://t.co/j3kWJDjuVz

@ASCO

[Tris Arscott, MD @wtarscott]

Encourage an active healthy lifestyle during and after cancer treatment, so great to see this

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

The most practice changing trial from #ASCO25 is now live on @NEJM .If this was a drug, this would be approved today. Globally relevant and low-cost intervention that is not only delaying relapse but actually improving survival.
Perfect case example of a #cancergroundshot trial.

https://t.co/ZnqeplJ7IA

[Tris Arscott, MD @wtarscott]

@ModaCenter @sofitukker Are there openers tonight?

[Gerry Hanna @gerryhanna]

Can QUAD be used for thoracic tumours?

🟰YES!

➡️ 3 cycles of quad shot is safe and feasible with concurrent systemic therapy for centrally located thoracic tumours
➡️Limited grade 3 toxicities
➡️ Majority of patients experienced symptom relief as measured by PROs

#ASTRO24

[Tris Arscott, MD @wtarscott]

@DrLesterColl @UVMHealth @UVMMedCenter @UVMLarnerMed @UVMcancercenter Congrats!

[American Brachy @AmericanBrachy]

Are you a PGY4/5? We invite you to apply for our 300in10, 2-month fellowship program focusing on advancing #brachy. This is an opportunity to immerse yourself in a community committed to training competent brachytherapists. https://t.co/x3ufmtPxKe @AndrewFarach @daniel_petereit

[Gustavo @gusviani]

🎙️ OPRA updated analysis confirms the long-term organ preservation with total neoadjuvant therapy for #rectalcancer ‼️@OncoAlert @ASCO
📌Ph2 trial w/ 👥random to induction CTH followed by CRT (INCT-CRT) or vice versa
- Complete/near-complete responders were offered WW, incomplete responders ➡️🔪
🥇🎯: DFS. 🥈 🎯: TME-free survival
📊RESULTS
-324 👥, median FU 5.1 y
- 5-y DFS rates: INCT-CRT 71%, CRT-CNCT 69% (no sig)
- TME-free survival: INCT-CRT 39%, CRT-CNCT 54% (P = .012)
- 94% of regrowth within 2 y, 99% within 3 y
- DFS similar for TME post-restaging and WW followed by TME post-regrowth (both 64%, N🚫 sig)
#radonc https://t.co/mD3wkwU6ih

[Shearwood McClelland III, MD, FASCO @TheDrWood]

Grateful for our work examining the success of peer-to-peer authorization strategies highlighting @NCCN guideline-cited Level 1 evidence in reversing insurance denials for spine #SBRT being published in @AJCOonline! #KillCancer #FixPriorAuth #SPORTSMEN
https://t.co/7T2Lgbmcju

[Giulio Francolini @GiulioFrancoli1]

Happy and proud to discuss results from ARTO trial results during XXXIII SIURO congress! @siuroIT

[Todd Scarbrough @toddscarbrough]

IMPORT 10y:

Late normal tissue effects at 10y ~5% in PBI arm vs ~30%(!!!!) in whole breast arm, and local control "better" with partial breast(!)

Frankly, whole breast radiotherapy is the *wrong* tx for older women w/ early, low risk #breastcancer

https://t.co/fbD56Jm03y

[Tris Arscott, MD @wtarscott]

This is hugely important for our patients in making an informed decision about adjuvant treatments -- particularly as we enter #BreastCancerAwarenessMonth ! Fully agree RT alone (particularly #APBI) should be discussed alongside single modality endocrine therapy

[Brian Lawenda MD @BLawenda]

This #ASTRO2023 presentation was one of the most important for our specialty. Tumor boards are recommending adjuvant endocrine therapy alone after surgery, but rarely RT-alone. Low-risk breast cancer is one of the most common things we treat. We need better advocacy for RT.

[Tris Arscott, MD @wtarscott]

@GhiamAlireza @CompassOncology @NovartisMedical We work with our PET technologist and physicists

[Tris Arscott, MD @wtarscott]

Treated our second #pluvicto patient today @CompassOncology ! Proud to offer #radiopharmaceutical tx to patients in the #PNW and those able to travel. Please reach out if need information. Thanks @NovartisMedical for helping get us up and running 💉☢️ #ProstateCancer #psma

[Stephen Ramey @StephenRameyMD]

💥First plenary #ASTRO23 @vinaigondi presented PCI +/- hippocampal avoidance for small cell lung cancer. 🧠

⭐️HVLT-R no different (primary end point)
⭐️Did reduce first failure in any cognitive test (2nd endpoint)
⭐️No diff in intracranial failure 👏

[Tris Arscott, MD @wtarscott]

Amazing to catch up with my #radonc residency program coordinator at #ASTRO23 - 4 decades of experience (!) and tireless commitment to @PennRadOnc trainees. Thank you! And so great to see you 🥰 @CBaffic #pennradonc #radonc4life

[Ron DiGiaimo @DigiaimoRon]

Comparison of all #radonc compared to Keytruda and Optdivo #medonc wow and look at the patient numbers too …