David Sher

Congratulations on #MatchDay2026 🎉 We’re excited to welcome the newest members of the radiation oncology community. The future of our specialty is bright, & we wish you success in the years to come. Welcome to the field of #RadOnc. In case you didn’t know: ASTRO's student membership is free! Join ASTRO today: ow.ly/leGt50YwOG9

@Sushilberiwal Completely agree. The challenge in clinical trials of such interventions is that this type of benefit may not be seen for many years following study closure.

@DavidSherMD Yes reducing volume and prophylactic dose may help reduce some of these late effects

Extremely important to recognize long-term complications of head and neck radiotherapy. Late radiation-associated dysphagia is still a real and extremely frustrating phenomenon. While on one hand, such late effects we see now are in patients treated with older IMRT techniques, on the other hand, some are intrinsic to irradiating such sensitive anatomy. Long-term follow-up is essential for us to characterize, but more critically, we need to continually refine how we irradiate to mitigate these risks.

We are less than one month away! Discover the latest in adaptive radiotherapy (ART), from current clinical practice to AI‑driven innovation, at our ART Symposium. Expert speakers will highlight recent ART advances. CME credits are available. Register : bit.ly/4pAWtIc

We are off at #2026RSS, with @BenSlotman opening address. Fantastic opening talks from @ErinMurphyMD and Dr Dwight Heron on stereotactic re-irradiation! Lots of learning to do for primary CNS and #hnscc head and neck! #radonc @the_RSS.

Callie, a certified therapy dog, stopped by today in her best green outfit and brought smiles to our patients and staff! #HappyStPatricksDay

Fascinating: I had not heard of using lenalidomide for severe soft tissue necrosis. It is an uncommon but exceptionally frustrating complication of CRT, especially in the T3-4 patient as described in Case #2.

@drjamesgood @KColvett It depends on the institution and clinical versus academic time, but I think 6-10 new consults per week is a reasonable estimate for academic radiation oncologists who are not physician-scientists.

@KColvett How many new patients do US academic radoncs see weekly, if a community doctor sees 20?

Academic rad onc learns a community doc sees twenty consults a week without a resident to do all of the work.

Remarkable results for kidney SAbR.

@TrudyWuMD @dgsomucla @mimi_baber @AnnRaldow_MD @MSteinbergMD Fantastic!

I’d say we had a fun time with the @dgsomucla rad onc interest group tonight walking through a HN case from consult➡️ “treatment”. PGY3 Jonathan showed off his scope skills and @mimi_baber was a ⭐️ SP! An Oscar winning performance! @AnnRaldow_MD

Adaptive radiotherapy involves modifying treatment plans to account for changes in anatomical geometry that are not adequately mitigated with changes in alignment. Online adaptive radiotherapy capitalizes on advances in image guidance, real-time tumor tracking, and the enhanced speed of multiple steps in radiotherapy planning and delivery workflows (seen in image). Learn more in the Review Article “Effects of Radiotherapy in Normal Tissue” by @DeborahCitrin, MD, and Robert D. Timmerman, MD (@BobTimmermanMD), from the National Cancer Institute and @UTSWMedCenter: nejm.org/doi/full/10.10…

Agree: it begs the question of how many historical "in-field" recurrences were actually marginal. Information such as this highlight the importance of performing prospective clinical trials of ART. We have no idea what we're missing (literally, in this case) until we formally test the technology.

Just as importantly, conventional large margin static RT does not maintain coverage of the small adaptive margin PTV. Weekly adaptive RT is both more precise AND more accurate for GBM RT.

New from @Raquib_Hannan in the #RedJournal: One of the largest cohorts of oligoprogressive #RCC treated with #SAbR during systemic therapy. tinyurl.com/rjlzhao

Check out this new Deep Margins podcast! We discuss radiation, TORS, the backstory behind the ORATOR trials, and some tips for trial design. creators.spotify.com/pod/profile/wh…

@drdavidpalma @ARRO_org @futureENTres @CFMSFEMC @SNMA @AHNSinfo @EHNSnews Amazing!!

Here's what it looks like to scope Srón. We've used Srón to teach medical students & residents how to scope. You can 3D-print one yourself for free, or order one from us, at sron.ca @ARRO_org @futureENTres @CFMSFEMC @SNMA @AHNSinfo @EHNSnews

It's extraordinarily impressive that the trial investigators successfully completed this trial, and we've learned a tremendous amount from these data.

I am a strong proponent of studying hypofractionation in H&N cancer, but it’s hard to draw definitive conclusions here. First, I think the authors made the control arm too complicated. While one may wax poetic about how 66 Gy in 5.5 weeks (6 fractions per week) should be radiobiologically comparable to 70 Gy in 35 fractions, I’m still frustrated by the decision. The most commonly used standard fractionation scheme is 70 Gy in 35 daily fractions, and I believe that is the best reference standard. Not only does that scheme bring in the real-world issues with daily fractionation (and the potential damaging treatment breaks past 7 weeks), but more importantly, it would allow for 7 weeks of concurrent chemotherapy. Especially in HPV-negative disease, 30 mg/m2 is inferior to bolus cisplatin, whereas 40 mg/m2 seems very similar (at least in the postoperative setting, HN009 findings pending for definitive CRT). Where does 35 mg/m2 sit in this spectrum? Add to that fact that only 59% of the standard-arm patients received 5 courses (81% 4 courses), and 64% of the hypofrac patients received 4 courses, and poor compliance could have compromised results. Regardless of the dose, 7 weeks of radiosensitization may make a real difference versus just 4 weeks (especially at a trifle lower dose), and we may never know if that could have influenced the final results. Overall, it’s pretty clear that these two schemes are equitoxic, which is really important since there are situations where patients just can’t make it for 6 or 7 weeks, and we now know there is no real toxicity tradeoff. On the other hand, we still don’t know whether or not 55 Gy in 20 fractions is the same as "standard" CRT over 7 weeks. I'm hopeful that some combination of higher doses with restricted volumes can get us there, but we'll have to see with future data.

I’ve been looking forward to this paper since the ASTRO Plenary talk in 2023. HYPNO-RT is out: is it worth the wait? redjournal.org/article/S0360-…