Jennifer Wo

@Rad_Nation @manjuggm @JonAshmanMD @AnnRaldow_MD @Rad_Nation Thank you so much for inviting us, and for all of the participants engaging on this important topic! And extra thanks to the moderators! #RadOnc #JC

Thanks so much to the new #ASTRO #RectalCancer guideline co-authors Drs. Jennifer Wo, Ann Raldow, & Jon Ashman for joining us this weekend to share your insights! CT #Appreciation #RadOnc #JC @JenniferWo4, @JonAshmanMD, & @AnnRaldow_MD #RadOnc #JC

Time flies (and here in Canada, can sometimes freeze :) It's that time again for the #RadOnc #JC to officially come to a close. Feel free to post any closing thoughts (CT)!

@JonAshmanMD @IanJPereira @MontefioreD @cancerphysicist @GI_RadOnc @jryckman3 @Rad_Nation @radoncreview @RadoncTables @EstesRadonc @WashURadOnc @ReIChinMD @KrishanJethwa @UqbaKhan @JohnRTMonsonMD @RazaSayyed12 @eduhor82 @j_lukovic @CCO_Education @LoughboroughW @dralicihat @Dr_Ivanoncologo @VPrasadMDMPH @DrChowdharyMD @AnnRaldow_MD @JonAshmanMD We don't routinely boost LLN's either, although I do push on our surgical colleagues to dissect them at time of resection if radiographically involved at presentation. #RadOnc #JC

@IanJPereira @MontefioreD @cancerphysicist @GI_RadOnc @jryckman3 @Rad_Nation @radoncreview @RadoncTables @EstesRadonc @WashURadOnc @ReIChinMD @KrishanJethwa @UqbaKhan @JohnRTMonsonMD @RazaSayyed12 @eduhor82 @j_lukovic @CCO_Education @LoughboroughW @dralicihat @Dr_Ivanoncologo @VPrasadMDMPH @DrChowdharyMD I am not aware. We have not been routinely boosting these nodes at our shop. Hey @JenniferWo4 @AnnRaldow_MD what about LLNs at your institution or any trials? #radonc #jc

T0: Let's start with some introductions - feel free to say hello (it will also help with some person-centred engagement :) #SayHello T0 #RadOnc #JC

@manjuggm @pierfra22138137 @NiuSanford @IanJPereira @DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @manjuggm Totally agree. So important with so many long term survivorship implications. Our GI NP is running a prospective study for education and intervention with vaginal dilator use for pelvic RT patients. #RadOnc #JC

@pierfra22138137 @NiuSanford @IanJPereira @DrN_CancerPCP @subatomicdoc @ASTRO_org @JenniferWo4 @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino Thank you so much for this info! We hear about young women getting depressed, families breaking up & all sorts of mental stress for patients that have developed vaginal stenosis. Happy to see trials like this. Need similar trials in rectal cancer #Radonc #JC

This weekend we're discussing new @ASTRO_org guidelines for rectal cancer & radiation therapy w/ @JenniferWo4 @JonAshmanMD @AnnRaldow_MD on #radonc #jc radonc.radiationnation.com/rectal-cancer-… FYI @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis

@emmadunne @IanJPereira @AnnRaldow_MD @Rad_Nation @JonAshmanMD @subatomicdoc @emmadunne Yes, agree. But it's the only prospective coop group study that addressed this question. So while there are certainly flaws, it's the data we've got. Some meta-analyses, however, has suggested benefit for IMRT,but certainly at greater costs. #Radonc #jc

@IanJPereira @AnnRaldow_MD @JenniferWo4 @Rad_Nation @JonAshmanMD @subatomicdoc Some problems with the RTOG 0822 trial- they compared the GI tox to the RTOG 0247 study - needed 71 pt to prove a 12% decreased in GI tox but only got 68pt and only 58pt followed the protocol! Not optimal IMRT used as protocol included a conformal boost. #RadOnc #jc T10

Introducing (again) T10... Any newer tech being incorporated into #RectalCancer guidelines? What are the barriers to their adoption/effectiveness? Is there a risk for bias (i.e. time/era)? c @JenniferWo4, @JonAshmanMD & @AnnRaldow_MD! #RadOnc #jc T10 #IMRT

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation However, guidelines committee acknowledged that "IMRT/VMAT may be beneficial when external iliac nodes and/or inguinal nodes require tx or when 3D conformal techniques may confer higher risk for toxicity." Future studies may further elucidate benefit. #Radonc #jc

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation For younger pts, depends on clinical stage. For early stage which could be treated with TME alone, important to discuss long term risks of CRT (sexual health, secondary cancer) and risk of chemo. For later stage, consider dose intensification w/ chemo. #RadOnc #jc

Introducing T9... Any considerations for special populations in the #RectalCancer Guidelines? Is NOM similar to management for the unresectable/elderly? Differences for younger patients? #RadOnc #JC T9 #AYACSM #SpecialPopulations c @jenniferWo4, @JonAshmanMD, & @AnnRaldow_MD

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation Outside the scope of our guidelines--but good question! For elderly, important to weigh surgical risk of TME vs baseline sphincter function and tolerability of chemo and CRT. #RadOnc #JC

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation Unfortunately, results of PRODIGE and RAPIDO have not yet been published, and therefore, could not be factored into our guidelines. But definitely practice changing and promising! #RadOnc #jc

Introducing T7... We've talked a bit about Total Neoadjuvant Treatment (TNT). Ready for primetime in #RectalCancer guidelines? If so, where does it fit & why? c @JenniferWo4, @JonAshmanMD & @AnnRaldow_MD! #RadOnc #JC T7 #TNT

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation Institutional adoption of TNT currently varies, while awaiting publication of the PRODIGE and RAPIDO, but at my institution, yes--we have routinely adopted TNT for node positive patients. #RadOnc #JC

@Rad_Nation @JonAshmanMD @AnnRaldow_MD @Rad_Nation. MRI pelvis has been universally adopted as standard of care clinical staging tool. Advantages of MRI over ERUS are 1) less user dependent, 2) can be interpreted by any provider, 3) provides info on EMVI, distance to mesorectal fascia and 4) LN+. #radonc #jc

Now introducing T3... What did the #ASTRO #RectalCancer guidelines suggest on MRI (and why)? c @jenniferWo4 @JonAshmanMD @AnnRaldow_MD #RadOnc #JC T3

@JonAshmanMD @subatomicdoc @manjuggm @colontown @AnnRaldow_MD Agree! Similarly, I do not discourage use, but I do not routinely recommend it currently. Certainly, worth a try for patients post-treatment if they note bowel irregularity. #radonc #jc

@subatomicdoc @manjuggm @colontown @JenniferWo4 @AnnRaldow_MD Data of mixed quality but suggests probiotics might help with enteritis/diarrhea with low risk. That being said, we don't use on a regular basis. I don't discourage its use but I also don't prescribe it at the present time. #radon #jc

radiationnation.com/radiation-onco… @subatomicdoc wondering if you had any updates for this blogpost. It maybe of interest in the @colontown Rectalburgh neighborhood, thank you!

@DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @DrN_CancerPCP Thanks for your comments. Totally agree survivorship is critical for all of our patients, especially with the rising rates of young onset CRC, so important to address! Beyond the scope of our guidelines, but totally agree! #RadOnc #jc

@subatomicdoc @ASTRO_org @JenniferWo4 @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis Hmm, how does any #radonc guideline not address supportive and survivorship care???? @ASTRO_org @HinaSaeedMD @fumikochino

@IanJPereira @DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @NCCN @ASCO Thanks @IanJPereira! Next steps (T11) will be to further personalizing care for our rectal cancer patients-both in terms of treatment intensification for high risk disease/de-escalation for response or lower risk disease based on clinical and radiographic response! #RadOnc #jc

@DrN_CancerPCP @subatomicdoc @ASTRO_org @JenniferWo4 @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @NCCN @ASCO Thanks! Interested to hear more what that 'right amount' of guideline content and guideline task force membership composition could be - hopefully more discussion in T2 (methodology) &T11/12 (next steps) of the #RadOnc #jc on now!

@IanJPereira @DrN_CancerPCP @subatomicdoc @ASTRO_org @JonAshmanMD @AnnRaldow_MD @MontefioreD @fireflyann @ARosen380 @ng_kimmie @NiuSanford @ebludmir @DrVMisra @DrKrisDennis @HinaSaeedMD @fumikochino @NCCN @ASCO Thanks @IanJPereira. For methodology, we determined key questions (KQs) which we felt were timely and relevant, and them the KQs were assessed using the Population, Intervention, Comparator, Outcome, Timing, Setting (PICOTS) framework.

@subatomicdoc @Rad_Nation @ASTRO_org @JonAshmanMD @AnnRaldow_MD Thanks@subatomicdoc! We worked hard to pull this CPG together, and hope will helpful in guiding clinical practice for rectal cancer! #radonc #jc

@Rad_Nation @ASTRO_org Can't wait to learn more from @JenniferWo4 @JonAshmanMD @AnnRaldow_MD and other participants #radonc #jc

From now till Sunday PM we’ll be discussing the new #ASTRO #RectalCancer guidelines from PRO. practicalradonc.org/article/S1879-… TY @ASTRO_Org for making it free to access for the duration of the chat. #RadOnc #jc T0