Nat Lester-Coll, MD

🤩 Finally OUT in @JCO_ASCO! BART RCT from 🇮🇳 largest ph3 for adjuvant RT in high risk MIBC post cystectomy A decade of persistence from @VedangMurthy ☺️ @RadOncTMC @TataMemorial @ACTREC_TMC @PaulSargos @Xristodouleas ascopubs.org/doi/full/10.12…

👏🏽👏🏽👏🏽@neildwallaceie at #ESTRO26 - 1687 patients receiving single fraction SABR for #lungcancer and pulmonary oligomets, @PeterMacRadOnc / @ClevelandClinic / @RoswellPark. Fantastic local control, and low adverse rates. Should we be using “one stop” SABR more often #radonc ?

#ESTRO26 @cancerphysicist APHRODITE trial: EDRT (62Gy SIB) boosted 6-mo cCR to 49.4% vs 33.3% with SDRT in early rectal cancer (+16%; OR 2.27, p=0.038). First RCT evidence for dose escalation benefit + low toxicity!

@VedangMurthy is one of the smartest prostate oncologists out there and, when he presented at MSKCC grand rounds, he made the important point that, in India, the local disease they're seeing is much more advanced than in the US (and presumably Europe). Recall, PEACE2 included MRI-defined T3 disease. My conclusion, integrating PEACE2, the NRG data presented at ASTRO, and POP-RT, is that in screen-detected HR or VHR localized PCa, especially where PSMA PET is NED in the pelvis, the benefit of elective pelvic nodal irradiation is de minimis. Once these trials are published, I think SOC, in screen detected, PSMA PET imaged HR or VHR N0 disease, is prostate-only RT. That said, when you have PSMA PET N0 HR/VHR disease that is so locally advanced that it's causing symptoms or where you have GS9 disease where an MRI shows EPE/SVI apparent to even a 1st year medical student, only then should one consider elective pelvic nodal RT. My two cents.....#ESTRO26

“The addition of darolutamide helps, but only as long as you give it” 🎯 DART trial presented by @piet_ost #ESTRO26

#ESTRO26 the pendulum continues to swing—this time against against pelvic RT in high risk prostate ca ⛔️ improvement in MFS, PCSS, OS ! Presentation of PEACE2 by @PBlanchardMD

#ESTRO26 The practice changing long term outcomes of FASTRACK II summarized in one slide👇

@SbrtSean see you there Sean!

Looking Forward to #ESTRO26 in Stockholm! Treating the Primary in Metastatic Prostate Cancer: For All or Few? For: Pierre Blanchard Against: Jochen Walz For: Julie Murray Against: Ursula Vogel Are You For or Against?

5-Abstract 4500: RADICAL RADICAL brings radium-223 into RCC; pairing bone-targeted radiotherapy with cabozantinib for pts with bone mets. Much needed efforts to overcome a major challenge in RCC. @DrRanaMckay @ASCO @OncoAlert

@drbeckta Jim set the bar high indeed Working on my güiro skills

My current boss is hopefully taking notes on how to be as cool as my old boss. No pressure or anything @DrLesterColl

@jryckman3 @changjeesuk1 awesome 🙏

@changjeesuk1 @DrLesterColl almost done with this nomenclature hierarchy. Goal to save dosi clicks with autopopulated clear checks and to provide clarity with assigned clear check, structure sets, and prescribe treat. hopefully will have everything done in the next month.

Rad Onc community question: We’re re-evaluating our internal disease classification system for stats. What does your department use? Any categories you’ve added or changed over time? Would appreciate any examples.

Wanted to highlight our AASUR trial. Was an awesome multi-institutional collaboration. Especially grateful to @ThePCCTC and @UMichRadOnc team (@DrSpratticus, Jason Hearn, et al were our 2nd leading accruers). But a true team effort. And many thanks to @JNJInnovMed and @PCFnews for funding. TL;DR: in VHR localized PCa, a short course (6mo), ADT/ARPI regimen combined with 40/5 prostate-only SBRT had favorable toxicity profile, rapid T return, and, despite not meeting superiority threshold, BCR rates that looked similar to long course ADT historical controls. These patients were not DECIPHER-selected or PSMA PET staged. It may be that scADT/ARPI+RT would provide equivalent results in the vast majority of RT-treated VHR, localized dz. Obviously this would require confirmation in an appropriately sized NI trial. #radonc #pcsm

#GU26 and #fengsymposium was a blast to see progress. Hoping it eventually moves away from San Fran 😁. Another red eye on the books back home. My observations from PCa sessions: - the field continues to push for over tx and many fail to recognize high risk dz is not high risk anymore for most patients. Enzarad negative, Rtog 0924 neg, ascend-RT neg for MFS/OS, peace2 neg. RT+ADT plenty for most. Many need even less. Select trials paving the way. - for mHSPC not all patients need doublet let alone triplet; age matters - continuous ADT can often be more harmful than helpful now with MDT -most BCR patients post RP do not need ADT—> get biomarker testing to help -many have jumped on bandwagon that OS too hard to improve and settling for early non-surrogate endpoints; peace3 should remind us it’s possible -sequential PARPi /Abi often just as good as combination -early germline/somatic testing for all high risk disease remains without data to support it; even testing in mHSPC unclear benefit as can give PARPi in mCRPC setting (earlier not better than later). -actinium RLT promising but toxicity remains concern -neoadj before RP remains largely ineffective, adds costs and toxicity and most still need postop tx.

🚨🚨Multiple Brain Mets Randomized Trial🚨 · Significantly less symptom burden with SRS compared to HA-WBRT · Better ADL, cognition & KPS after SRS · SRS Standard of Care 5-20 brain mets jamanetwork.com/journals/jama/…

Full free-text link to the ASTRO GU Resource Panel's response to the IRRADIATE publication @RicBertolo @EurUrolOncol authors.elsevier.com/a/1mdSX9Cfw07F… @NehaVapiwala @ASTRO_org

Frustrating @UHC @Optum #priorauth Peer-to-peer requested during my admin time multiple days this week, but “no doctor available”? Now expedited to a random unscheduled call today-Monday. We’re not available 24/7. Figure out how to schedule properly…unnecessary delays & waste!

Hot off the presses, ReCOG consensus statement endorsed by multiple Rad Onc societies now in @TheLancetOncol. Major step forward for advancing reirradiation. Congrats to authors, in particular @DrKCParadis, @ChuckMayoPhD, @elizapowerpuff. @UMichRadOnc. sciencedirect.com/science/articl…

Extremely excited to share our latest article published @TheLancetOncol a few hours ago: authors.elsevier.com/a/1mYT65EIIgTS…. The WOLVERINE individual patient meta-analysis was an international collaboration and part of X-MET collaboration. Goal was to evaluate MDT in oligomet prostate ca.

Credit @RicBertolo for spotlighting degree of burden in these affected pts. For accurate risks (i.e., true incidence rates of complications)? Need to push for pop-based multidisciplinary studies. We should collaborate for clarity.

3) Concerning too: conversation devolved into defensiveness, straying from science. We must rise above narrative-pushing to seek truth in order to best inform our patients.

This paper is getting a lot of attention. My concerns: 1) Selection bias: ONLY symptomatic pts enrolled, so 43% grade 3+ stat from biased 321-sample. No denominator = no true incidence. Tautological & misleading