Joshua D. Palmer, MD has been an unparalleled leader in the field in championing the clinical adoption of molecular imaging to personalize & optimize CNS tumor management. Privileged to have him as a colleague and a mentor.

Excellent talk by Joshua D. Palmer, MD showing the benefits of DOTATATE PET to guide management of meningiomas. Fantastic images showing where/when MRI is inferior to PET #ISRSUSA2024 ISRSy

New from the #RedJournal : Alex Louie MD, PhD and George J. Li show in a retrospective review that SBRT prescribed homogenously can be a safe and effective way to manage both early stage lung cancers and metastases located in and around the mediastinum. #radonc bit.ly/lilouie1

Drew Moghanaki 🐕 Jeff Bradley, MD Sana Karam, MD, PhD NICOLAS trial was negative and I can’t understand why BMS still decided to proceed to CM73L. it could also have been positive , who knows ..but signals were not encouraging. IO consolidation still works very well. Time to think about induction before RT and consolidation.

Marco Schwarz Jeff Ryckman Joel Poder Matt Spraker

Jeff Ryckman Joel Poder Matt Spraker And then at some point we will also get rid of the PTV, but that is a longer conversation.

Jeff Ryckman Tyler Seibert MD PhD Simon C Nat Lester-Coll, MD Priyamvada Maitre 💙alison birtle Adam Sharp Henning Willers, MD Lauren Henke, MD, MSCI Corey Speers Aadel Chaudhuri, MD PhD Alison Tree 💙🇺🇦 Constantinos Zamboglou Pierre Blanchard, MD Jeff, this is utterly wonderful to see… not sure you realise how unusual it is to witness the wonders of Skye in those conditions! Enjoy the Cuillins tomorrow - they were my dad’s favourites.

Matt Spraker Jeff Ryckman D98%... DMin referes to extrapolated sub-pixel dosis. using this would result in less conformal doses - hence: leave it....

Jeff Ryckman Matt Spraker I’m blown away that you wrote such a well thought out response road tripping through Scotland!

We were also taught never to use Dmin and Dmax. The boring response would be ‘because ICRU 83 says so’. Instead it recommends to use D98%, D2% I think even D95%. 1/2

Matt Spraker Jeff Ryckman Near-Dmin planning objectives (e.g. D99 or D98) are IMO much more robust and meaningful than Dmin.

Alison Tree 💙🇺🇦 Matt Spraker Jeff Ryckman Indeed, Karolina Guricova showed that in the FLAME cohort the coldest spot to the GTV determines outcome when comparing near minimum dose D98% vs. median dose D50%.

thegreenjournal.com/article/S0167-…

Thanks for having me on! Fun discussion about a huge topic we only scratched the surface of. Hope this is helpful to community oncologists and others managing these patients. Team work makes the dream work!

Tune into Oncology Brothers below for IR vs. rad onc in HCC -the boxing gloves were out!

Just kidding. We didn't get into studies in detail given time constraints, but I generally consider this framework for liver-confined HCC:

-Small tumor (<~3 cm), favorable location – several

#GISeries : Where are the #RadOnc & #IRad ? Here they are…

Importance of collaboration/MultiD in #gism w/Dr. Nina Niu Sanford Jeff Ryckman Harris Chengazi

Full 🗣️
- cancernetwork.com/treatment-algo…
- Oncbrothers.com/liverdirectedt…
- Also on “Oncology Brothers” podcast

#OncTwitter #MedTwitter CancerNetwork®

Matt Spraker Jeff Ryckman FLAME trial team have some great data on this for prostate. Min dose more predictive of control than the usual metrics Cédric Draulans

Jeff Ryckman Drew Moghanaki 🐕 Mark Storey Bill Loo MD PhD ⚡️☢️ Gerry Hanna Stanford Medicine Shankar Siva Nikki P SABR Clive Peedell Corinne Faivre-Finn 💙 Jolyne O'Hare 💙 Cathryn Crockett Our practice is similar to yours with MD created tuning ring to guide 50% dose fall off. We evaluate 50% dose fall off and hot spots (usually <110) outside of PTV more than any specific constraint. This practice and the use of 25 Gy is why i think our G2+ tox rate is low.

Jeff Ryckman Drew Moghanaki 🐕 Mark Storey Bill Loo MD PhD ⚡️☢️ Gerry Hanna Stanford Medicine Shankar Siva Nikki P SABR Clive Peedell Corinne Faivre-Finn 💙 Jolyne O'Hare 💙 Cathryn Crockett We report the estimated metrics for > 20% incidence of any grade CW pain but I think the nuance of how to best interpret these data can get lost when dichotomized. Clearly coverage should not be sacrificed for this low grade, self limiting event.

Lucas Vitzthum Jeff Ryckman Mark Storey Bill Loo MD PhD ⚡️☢️ Gerry Hanna Stanford Medicine Shankar Siva Nikki P SABR Clive Peedell Corinne Faivre-Finn 💙 Jolyne O'Hare 💙 Cathryn Crockett I got rid of all CW constraints upon arrival at UCLA and added just one: keep it <105%. This improved our intermediate dose compactness resulting in almost no patients coughing post-SBRT ever since. Our temporary CW pain incidence remains anecdotal and <1%.

Drew Moghanaki 🐕 Mark Storey Bill Loo MD PhD ⚡️☢️ Lucas Vitzthum Gerry Hanna Stanford Medicine Shankar Siva Nikki P SABR Clive Peedell Corinne Faivre-Finn 💙 Jolyne O'Hare 💙 Cathryn Crockett Fascinating study highlighted in the original post! Surprising lack of discussion on traditional single fraction CW metrics in the full publication (e.g., D1cc < 22 Gy; note how Timmerman 2021 dmax metrics would have been comfortably met with 25/1 and dmax < 120%). Curious about

Henning Willers, MD Linda Martin Hey Linda Martin, curious if rad oncs at your institution commonly administer 50/5 to mCRC tumors without an SIB. Perhaps it's worth discussing with them to iron out any misconceptions.

I'm sure they're well-versed in this data and probably encounter around a 5% local