🧵 Tweetorial: 1/ MRI is now central to prostate cancer workup — but does what we see on MRI predict outcomes? In a national cohort of 2,275 veterans, we found that MRI-detected EPE is common & highly prognostic.

New in Advances in Radiation Oncology: Wallach et al. propose “curative oligometastatic radiotherapy” (CORT) as a distinct treatment-intent category for carefully selected patients with oligometastatic disease when cure, or exceptionally durable disease control, may be attainable. The concept goes beyond metastasis-directed therapy alone: all known disease, including the primary when needed, is addressed with curative intent. Proposed favorable features include limited metastatic burden, favorable disease biology or effective systemic options, controlled extracranial disease, good performance status, low tumor markers or favorable ctDNA, and a long disease-free interval. The nuance: this is a terminology and clinical framework, not a validated prognostic model. CORT may improve communication, shared decision-making, trial design, and data collection, but selection must remain individualized and disease-specific. A useful reminder that metastatic disease does not automatically make every course of radiotherapy palliative. #radonc #OligometastaticDisease #OncTwitter

📌 Patient selection for APBI after breast-conserving surgery: Updated evidence-based recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) Breast Cancer Working Group 🔗 pubmed.ncbi.nlm.nih.gov/4205… @OncoAlert #OncoAlertAF @ESTRO_RT #BreastCancer 👉🏻GEC-ESTRO Breast Cancer Working Group recommends two categories as guidelines for selecting patients eligible for APBI‼️

I like this analogy. Triaging patient concerns is critical to safety & quality of care. The more decisions a physicians needs to make quickly, the more likely fatigue will set in and mistakes can be made. medicine is a team sport, the whole team needs to work together.

Can SABR offer a long-term option for patients with RCC who are not surgical candidates? 5️⃣-year results from FASTRACK and FASTRACK II: 🔹98% local control 🔹1 local progression 🔹No grade 4 AEs 🩺 Shankar Siva, MBBS, PhD | @TheLancetOncol | #KidneyCancer ascopost.com/news/june-2026/…

Healthcare is the only market where the seller hides the price and calls it compassion. You know the price of a flight before you board, price of a steak before you order, and certainly the price of a used truck before you buy it. Healthcare trained you to accept blindness as normal. That was not an accident. The opacity is the product. Price discovery is the one force incumbents cannot survive. Sowell said there are no solutions, only trade-offs. The hospital traded your ability to compare for its freedom to charge. Visible prices end the game.

Thrilled to share #PRIMARY2 Trial Results. This is the first randomised trial to show that adding [⁶⁸Ga]Ga-PSMA-11 PET-CT to MRI can safely halve the number of men needing a prostate biopsy. Hot off the press in @TheLancetOncol 🎉 In 660 men across Australian sites with PI-RADS 2-3 but high clinical risk, PSMA-PET: - Avoided biopsy in nearly half (49%) - Was non-inferior for detecting clinically significant cancer (12% vs 16%) - Halved the overdiagnosis of insignificant cancer (32% to 14%) Fewer biopsies, less overdiagnosis, whilst not missing clinically significant prostate cancer: a real step forward for the diagnostic pathway. Enormous congratulations to @ButeauJames @PeterMacCC , who led this as the centrepiece of his PhD and presented it as a plenary at #EAU26 in London. And to my brilliant co-lead @drlouiseemmett - this was a true partnership across our two centres. Thank you to the UROLOGISTS @DrDanielMoon @declangmurphy (& many others), nuclear medicine physicians, technologists, radiopharmaceutical scientists across every site, and to @AnnetteVDHeyden and the @pros_tic who held it all together. We are grateful to our funders: @PCF_Science, @nhmrc, St Vincent's Curran Foundation, Peter MacCallum Cancer Foundation, and @ANZUPtrials Most of all, thank you to the 660 men who took part. Open Access article: thelancet.com/journals/lanon…

RTOG 0848: neg overall, but benefit in pN0 (adj chemoRT improved OS 5yr 48% v 29%). Caveats: small N0 subgroup (N=91), gem chemo, pre neoadj era. My main takeaway: RT has role in (select) resectable PDAC & future trials need to focus on biologically favorable subset. @OncoAlert

In a retrospective cohort of 68 DLBCL patients with partial metabolic response on interim PET after 4 cycles of R-CHOP, PET-directed residual site RT was associated with improved response and PFS. 29 patients received additional R-CHOP risk-adapted pRSRT: • Deauville 4: 24 Gy • Deauville 5: 40 Gy Compared with no RT, pRSRT improved EOT CR: • Overall: 72.4% vs 41.0% • Deauville 5 subgroup: 83.3% vs 22.2% PFS also favored pRSRT: • 2-year PFS: 85.8% vs 52.9% • 5-year PFS: 57.2% vs 44.1% • Multivariable HR 0.26, p=0.018 No statistically significant OS difference was observed, with limited events and no deaths in the RT cohort. Toxicity was generally manageable, though one grade 4 bowel perforation occurred. Although this cohort was treated in the R-CHOP era, the question remains highly relevant in the POLARIX/pola-R-CHP era: when residual PET-avid disease persists despite improved systemic therapy, PET-directed RT may still have a role as a selective consolidation strategy. #lymsm #DLBCL #OncTwitter

Are you trying to make sense of conflicting data for treating oligometastatic lung cancers? Us too! Here's a summary from our fellow Dr. Niall O'Dwyer: bmjoncology.bmj.com/content/…

Fantastic Gray Zone case and commentaries that touch on the key issues in managing esthesioneuroblastoma. A Scent of Doubt: The Dilemmas of Adjuvant Therapy in Esthesioneuroblastoma - International Journal of Radiation Oncology, Biology, Physics redjournal.org/article/S0360…

All doctors are underpaid.

This is not a popular opinion. But true. When I explain that the average Pediatrician is earning less than a Buc-ee’s gas station manager, and the average surgical specialist earns around what a Walmart General Manager earns, then the idea starts to ring true. #txlege

A picture worth 1000 words - and then some - to patients w/ #kidneycancer eligible for noninvasive local therapy. 👏 @_ShankarSiva & team for the diligence & discipline to get here. @ESTRO_RT @Uroweb @ASTRO_org @AmericanCancer @UroOnc @AmerUrological @ASCO

Whoa, completely out of left field. Engineered adenoviral gene therapy plus RT leads to improved DFS over SOC RT (ADT optional) in localized prostate cancer. No increased toxicity. #radonc

✨ Inspiring to see @imrtlee representing ☢️ radiation oncology on the ASCO main stage. Practice changing work reducing treatment toxicities and integrating radiographic biomarkers to personalize radiation @MSK_RadOnc @MSKCancerCenter #ASCO26 #RadOnc

Working really hard to get FDA approval so all can get FMISO PET. ❤️❤️❤️

Fantastic proof of concept coming, great read here. pubmed.ncbi.nlm.nih.gov/4220… I personally enjoy the 0.5 cm anatomically confined expansion around the DIL to receive traditional base dose with de-escalation of rest of gland @BrandonMahal #RadTARGET #OncTwitter

New findings from MSK researchers that will be presented at #ASCO26 this weekend found that carefully selected patients with HPV-positive #throatcancer can receive significantly less radiation while maintaining excellent outcomes. An analysis of 430 patients showed a 97% five-year overall survival rate, even among patients who received less radiation. “This has been an absolute game-changer for treating certain people with throat cancers caused by HPV,” says MSK radiation oncologist @imrtlee. “The difference in toxicity is dramatic.” @ASCO Learn more: bit.ly/49tCmWi

Congratulations to @Anil_Tibdewal & Thoracic Oncology Unit @TataMemorial on an outstanding presentation @ASCO 2026 Annual Meeting! Proud moment for @RadOncTMC & Indian Oncology on global stage with landmark phase III data addressing timing of brain RT in oncogene-mutated NSCLC

RAD-IO at #ASCO26: durvalumab added to chemoradiation in muscle-invasive bladder cancer cleared its efficacy bar in a bladder-preservation approach. Single-arm, benchmarked against prior CRT data. Durvalumab given before, during, and 12 months after chemoRT (55Gy/20Fr 5-FU/mitomycin C). 55 enrolled, 54 treated. 🎯 12-month DFS 80% (40/50), 95% CI 0.67 to 0.89, beating the ≥75% go bar 📊 12-month OS 96% 🔍 But 39% discontinued durvalumab early, toxicity in nearly half. Completing the full adjuvant year is not a given. Signal suggests further investigation warranted in randomized setting @Prof_Nick_James #BladderCancer #MIBC #GUonc