Adam Currey

@SaraBelPonMD Congratulations!!!

Check out the paper, 🔥 off the press! advancesradonc.org/article/S2452-…

Keep your 👀's on @Advances_ASTRO Editorial Board and give us a follow because there is more content headed your way! #ASTRO24 @khintenlang @JillRemickMD @BenLok @mirandalammd @stevebraunstein @mknoll_md @ACurreyMD @JingZeng98195 @KrishanJethwa @RachelJimenezMD

@kharofaJ @MCWRadOnc @carmenbergom @BethEri81895034 @DrMeenaBedi @DrMalikaSiker You know us, waiting to make an entrance at the alumni event tonight! Great pic everyone! @MCWRadOnc

@CShahMD @Rad_Nation Agree. EUROPA is a really interesting trial. Some data suggests endocrine compliance may be as low as 50% - it's not easy for a lot of patients. Contrast that with the ease of a 5fx regimen that is really well tolerated

@Rad_Nation I see a few changes: 1. With EUROPA and other data, hopefully we can offer patients RT alone as deintensifcation rater than endocrine alone with RT having better compliance, lower/different toxicities and better LC

T5: How do you see radiation for early-stage breast cancer changing in the coming years? How do we take our COVID-19 experiences and use them to frame future decisions? #RadOnc #JC

@Rad_Nation I think more 5fx WBI. Also more use of multigene assays to drive treatment decisions. Results of trials like IDEA, NRG B007 will really be interesting.

@Rad_Nation @CShahMD @ACurreyMD @MMitchellMDPhD @MylinTorres @carmenbergom @ChelainG The original drivers - starting with START-P - in the 1990's were to reduce burden for patients. As those trials were delivered in the NHS reimbursement had nothing to do with it. #radonc #jc A nice history of those trials (with video) here: icr.ac.uk/news-features/…

@Rad_Nation @kelseycorrigan @MMitchellMDPhD @acurrey @CShahMD @HinaSaeedMD @IBCradiation @SueEvansMDMPH @daniellerodin @KimCorbinMD @allisongardaMD @raymailhotvega @NerdicasMaximus @JeffCaoMDMBA @JessikaContrer1 @jenncroke Really great question. I offer mod hypofx as the 'standard' and then explain the data around FAST-Fwd as an alternative, sharing 5-yr data. So far, there are quite a few who still want moderate hypofx (my guess is 50/50). But I suspect that will evolve with time.

Curious to hear from @kelseycorrigan, @MMitchellMDPhD, @Acurrey, @CShahMD, @HinaSaeedMD, @IBCradiation, @SueEvansMDMPH, @daniellerodin, @KimCorbinMD, @allisongardaMD, @raymailhotvega, @NerdicasMaximus, @JeffCaoMDMBA, @JessikaContrer1, @jenncroke! #bcsm #RadOnc #JC

@Rad_Nation One interesting factor is breast size. FAST Forward used some pretty tight dose constraints around dose homogeneity that I think are really important. Those are harder to achieve in a patient with larger breasts.

T3: What patient and physician-level factors predicted for the use of ultrahypofractionation? Who are ideal candidates? What is the current role for 5 fraction breast radiation? How do external factors like COVID-19 impact these decisions? #RadOnc #JC

@Rad_Nation I tend to use it more in older patients, although I don't have a set age cutoff. It's always shared decision making. Certainly don't use it with regional nodal cases. I tend to use the FAST-Forward 26Gy in 5.

@CShahMD @Rad_Nation Agree. Really impressive results on both these trials. At times I hear others quote LRR rates seen on old NSABP B06 or other early BCT trials. Concepts on those studies are still valid, but numbers are outdate. These new studies show really how good we have gotten with BCT

@Rad_Nation its a great question; Fast-forward was powered for local control which i think provides support. Also, in FAST, what i find amazing is in 915 patients at 10 years, there were only 11 ipsilateral recurrences, to me thats amazing and speaks to the progress that has been made

T1: What data supports the use of hypofractionation in breast cancer? How has this evolved over time? #RadOnc #JC

@Rad_Nation I’m a #radonc at @MCWradonc in Milwaukee. I primarily treat breast cancer at our main hospital. I also work at the VA

Welcome to our July #RadOnc #JC discussing ultrahypofractionated radiation in early-stage breast cancer (tinyurl.com/4ypbrnvw)! Introduce yourselves below! Please use both #RadOnc and #JC hashtags in your responses to help track the conversations!

@Rad_Nation @HinaSaeedMD @MonaArbabMD @SaraBelPonMD @ChaurasiaMD @AmishiBajajMD @AmyLeMDMPH @IanJPereira @ARRO_org @ACRORadOnc @ACurreyMD @CShahMD @kelseycorrigan @MMitchellMDPhD @IBCradiation Link to Sundays Live Hour on Twitter Spaces ⬇️ twitter.com/i/spaces/1BdxY…

We'll be joined by article authors & expert discussants Drs. Adam Currey (@ACurreyMD), Chirag Shah (@CShahMD), Kelsey Corrigan(@kelseycorrigan), Melissa Mitchell(@MmitchellMDPhD) & others - feel free to follow them on Twitter! #RadOnc #JC #bcsm

Big things will be happening @Froedtert @MedicalCollege @MCWRadOnc!!!

@Rad_Nation @KenOlivierMD @jennamkahn @RTendulkarMD #radonc #jc Thanks for the invite, this was fun! Great conversations and perspectives! See you next month!

Thanks all for joining the live hour and for the great discussion this weekend ! Special thanks to @KenOlivierMD @ACurreyMD @jennamkahn @RTendulkarMD #Radonc #JC

@HinaSaeedMD @MonaArbabMD @RadOncDoc_Niema @jennamkahn @Rad_Nation #radonc #jc Agree. That is the ideal, but really tough to track that at a high level.

@ACurreyMD @MonaArbabMD @RadOncDoc_Niema @jennamkahn @Rad_Nation Do you think higher quality training can occur from not just sim but being there for every part of treatment planning? Perhaps yes but I’m not sure how ACGME can or should include that.. #RadOnc #jc

T2: Methods: How were the ACGME Program Requirements for Radiation Oncology developed? #RadOnc #JC

@MonaArbabMD @RadOncDoc_Niema @jennamkahn @Rad_Nation #radonc #jc Unfortunately, no. Only one resident can log the case (with new rules, a second can also log a case as observed). But that doesn't mean you shouldn't still do it! Just sometimes there has to be discussion amongst residents about who will log it.

@ACurreyMD @RadOncDoc_Niema @jennamkahn @Rad_Nation @ACurreyMD Is there a problem if for a rare case, all residents do their contours and then have a session to review that with faculty? Then all can log that case.I feel this can be very valuable #radonc #jc

@ChelainG @KenOlivierMD @MonaArbabMD @Rad_Nation @KimCorbinMD @n_laack #radonc #jc Absolutely agree! I encourage our residents that when it isn't happening, to drag their attendings back to dosimetry to review contours and plans together. Most faculty want to teach, but get distracted. A little nudge can be a nice reminder

@KenOlivierMD @MonaArbabMD @Rad_Nation @KimCorbinMD @n_laack Agree. The greatest learning occurs with 1:1 discussion re: management, contours,& treatment plan eval. If most attending interaction is at consult then the majority of critical #radonc training is lost. It’s not just case number - but the quality of training. #jc @Rad_Nation

T3b. Personnel: What are the new personnel requirements (number of core faculty, faculty-to-resident ratio)? #RadOnc #JC

@MonaArbabMD @RadOncDoc_Niema @jennamkahn @Rad_Nation #radonc #jc I don't think so. Same for regular cases. If you're present at sim, do the contours or review plan with attending, you can log (as long as you're the only one logging it). But you don't have to do all those things for it to count.

@RadOncDoc_Niema @jennamkahn @Rad_Nation @ACurreyMD That is a great question especially for #brachy cases. Do you need to do the whole case to count as performed? #Radonc #JC