🧵 ESOPEC debate: is nCRT being underestimated? (1/2) 📉 Concerns on nCRT arm: • Low pCR (10%) vs real-world (~18%) • High distant relapse (50%) • RT technique → ↑ cardiac dose (MHD) 🔎 Potential impact on survival & systemic control 🔗 doi.org/10.1200/JCO-25-02546 @OncoAlert

Stereotactic body radiotherapy versus hepatic resection for recurrent small hepatocellular carcinoma: A post-hoc analysis with propensity score adjustment from two randomized trials - European Journal of Cancer ejcancer.com/article/S0959-8…

Recent advancements in radiotherapy for hepatocellular carcinoma For years, RT played only a limited role in HCC management. Today, SBRT can achieve >90% 2 year local control with RILD <5% (Radiation-Induced Liver Disease) Proton therapy reports ~88% 3-year local control with low hepatic toxicity. Not universally adopted, but difficult to ignore with modern data. esmogastro.org/article/S2949… @OncoAlert

Always honored to be part of the expert panel at the PCS Liver Multidisciplinary Tumor Board—especially alongside the esteemed @hpbsurgeon1 Dr. Catherine Teh. Grateful for the opportunity to contribute to such meaningful discussions. #GIradonc

CRITICS - II: TNT for Gastric Cancer?! When do we consider chemorads #ASCOGI26 #GI26

PLATO ACT5 Ph3 RCT (n=463): 53.2 v 58.8 v 61.6 Gy in T3-4/N anal SCC. No early benefit to dose escalation w similar cCR (65-67%) across dose levels. More uniform RT dose is not the answer – need better stratification, bio-driven personalization, RT/systemic integration. #GI26

Postoperative ctDNA status may be a robust prognostic marker for disease free survival among rectal cancer patients managed with upfront surgery. journals.lww.com/annalsofsur…

🧓🎯 Locally advanced rectal cancer in older patients (≥70 y) and unfit for ChT: SOFT study ☢️ SCRT (5×5 Gy) delayed surgery 📊 Downstaging 62% | R0 resection 94% | pCR 5.7% ✅ Acceptable toxicity & low mortality ➡️ SCRT: pragmatic alternative in frail patients 🔗 doi.org/10.1016/j.radonc.202… @OncoAlert

Ever thought about 🔄️re-irradiation for squamous cell carcinoma of the anal canal? Turns out... it can be done! Thanks to this ⏪retrospective study of 35 patients by @jordan_McD3 @ThatDamDoc @PrajnanDasMD @eugenekoay @ebludmir @Snoticewala @VanMorrisMD @DrEmmaHolliday @MDAndersonNews ⚡ Hyperfractionated re-RT (1.5 Gy BID, ~39 Gy (30 - 51 Gy range)) delivered: 🎯 46% cCR in recurrences 🌟 78% cCR in new primaries after prior pelvic RT 💥 Durable pelvic control in a truly tough population 🩺 Acute toxicity was similar to standard CRT (23%), and keeping dose ≤39 Gy may help avoid major late effects. 🤔There appeared to be an association with field size and rates of late toxicity! Got any of your own experiences to share? advancesradonc.org/article/S… @ASTRO_org

It was an honor to have GI radonc legend, Prof. Trevor Leong, at the @USThospital BCI Annual Meeting! Your expertise was the highlight, and your time with our trainees was priceless. See you in Manila again soon, maybe next time w/ @pixiepk1! @PeterMacRadOnc @UST1611official

The kiss 💋 between nab-paclitaxel / gem and FOLFINIRNOX ?! ♥️ Neoadjuvant regimens combined in resectable 💉 RCT 324 pts vs. Upfront surgery median EFS 15 vs. 10 months? 🧐 Doubts about control group, but again in the direction of neoadjuvant to all! cell.com/action/showPdf?pii=…

🧠 You can shrink the tumour—but not the tumour bed. New RAPIDO analysis in BJS 2025 shows why small margins after TNT can turn dangerous 👇 💡 Trial: RAPIDO (n = 920, LARC) 🎯 TNT = 5×5 Gy 6 CAPOX / 9 FOLFOX → TME vs CRT = 25–28×1.8–2 Gy capecitabine → TME 📊 8-year results: • LRR 10.8% (TNT) vs 5.8% (CRT) → HR 1.91 • Spike seen only after sphincter-preserving surgery (SPS)  → 12.1% (TNT) vs 4.8% (CRT) (HR 2.6) • 🚨 If distal margin ≤ 10 mm → 25.4% (TNT) vs 1.8% (CRT) 💥 (HR 15.5) 🔍 Why? TNT causes tumour shrinkage but leaves scattered viable cells in the original tumour bed. ✂️ Cutting “too close” (<1 cm) may slice through microscopic disease → higher local recurrence. 🇸🇪🇳🇱 Geography tells the story: Sweden = more APR → no difference Netherlands = more SPS & tight margins → higher TNT LRR 🩻 Takeaway: TNT reduces distant mets ✅ but may raise local relapse if DRM ≤ 1 cm ⚠️ ➡️ Surgeons must factor in baseline tumour bed, not just post-TNT shrinkage. 📖 Prata I et al. Br J Surg 2025 🔗 doi.org/10.1093/bjs/znaf190 #OncoTwitter #ColorectalCancer #RectalCancer #RadOnc #Surgery @OncoAlert @esmo_open @BJSurgery @myESMO

🔬 Critical Evaluation of TNT in LARC 🔗 doi.org/10.1200/OP-25-00530 🧬 Review of RAPIDO, PRODIGE-23, POLISH II & STELLAR 💊 Small DFS gain · OS benefit uncertain · Added toxicity 📊 CRT remains standard; biomarkers needed for selection #DraMartinezLago #GItumors

It’s out!!! 🔥🔥🔥 The PREOPANC-2 is in @TheLancetOncol Neoadjuvant FOLFIRINOX 🤜🤛 Gemcitabine based chemoradiotherapy in resecatble / BR ⚖️ No difference in overall survival 😰 Serious adverse events 40% 👍 Both regimens may be considered thelancet.com/journals/lanon…

First of 2 consensus statements coming out for #NPC. This one is an effort undertaken with most of the participants from #LMIC settings. Excellent inclusivity effort from @WarrenBacorro and team. kwnsfk27.r.eu-west-1.awstrac…

Neoadjuvant chemoradiotherapy followed by active surveillance versus standard surgery for oesophageal cancer (SANO trial) 💥OS after active surveillance was not inferior to standard surgery at 2 years thelancet.com/journals/lanon…

Sharing our work from @PeterMacRadOnc published @ClinOncology, reporting that neoadjuvant CRT can be clinically useful for highly selected colon cancers. Our results support the Zhang ph 3 study which showed efficacy of CRT for unresectable colon cancers. clinicaloncologyonline.net/a…

🚨SCIENCE Ph3 RCT🚨 🔥Check this one out🔥 cT2-4N0-3, T1N2-3 Eso SCC 1️⃣neo Carbo nabPaclitaxel Sintilimab 2️⃣nCRT 41.4/23) wCarbo-taxol Sintilimab 3️⃣nCRT ✅⬆️⬆️pCR CRT vs chemo (13% with chemo) ✅Sintilimab CRT vs CRT ⬆️ pCR (60% v 47%) without added AEs #GI25 @ASCO

🚨ESOPEC Pub has landed!🚨 See data review below! For now, "standard" will appropriately shift to peri-operative FLOT BUT we should not be satisfied as outcomes remain suboptimal Ongoing ❓❓ - does TNT (FLOT CRT) offer further benefit? - is it time to consider organ preservation w/ CRT? - how to manage those who cannot tolerate FLOT (pre-op CRT seems most appropriate) Much to unpack amongst our multi-D teams as we consider optimal approach for our patients nejm.org/doi/full/10.1056/NE…

External Beam Radiation therapy After Transarterial Chemoembolization Versus Transarterial Chemoembolization Alone for Treatment of Inoperable Hepatocellular Carcinoma: A Randomized Phase 3 Trial - International Journal of Radiation Oncology, Biology, Phys redjournal.org/article/S0360…