Melissa

19 posts

Melissa

Melissa

@MMitchellMDPhD

Working mom

Katılım Kasım 2019
137 Takip Edilen23 Takipçiler
Melissa
Melissa@MMitchellMDPhD·
@jryckman3 @ChelainG Agreed, in the B39 trial, DCIS was the one group where there was convincingly no difference in local control between whole breast and APBI. Combined with the fact that there is no known survival advantage for radiation in DCIS, PBI certainly makes sense to minimize toxicity.
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Jeff Ryckman
Jeff Ryckman@jryckman3·
Could anyone clarify why G3 DCIS and 2-3 cm isn't suitable for PBI? Was decision linked to clinical trial representation? For outer Qs, it appears that rotating the tangents outward for L-sided primaries to fully avoid the ♥️ would not only be safe but advantageous @ChelainG
Jeff Ryckman@jryckman3

@ParikhSimul @DrSpratticus @RadOncUH @cwspeers @amandaaminmd @TedTeknosMD @DanSimonMD @NicholasZaorsky Great point Simul. Agree these are awesome! At least LVI is listed as conditional, though! I need help understanding why G3 DCIS *and* 2-3 cm requires WBI. For outer quadrant cavities in L-sided BC, couldn't we adjust tangents more steeply outward to avoid the ♥️… 1/2

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Matthew Ward
Matthew Ward@MCWardMD·
Earlier this year, we submitted a 900 word letter explaining what we think is a competing risk error in the TARGIT-A pre-pathology update. What we got back was 3,000 words that didn't address the question... (1/13) #radonc #bcsm #iort @SorenBentzen @CShahMD @theRADSofKHAN
GIF
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Breast Cancer Action
Breast Cancer Action@BCAction·
“Individual value systems can align with approaches and treatments to breast cancer,” - Dr. Van Zee, Memorial Sloan- Kettering Cancer Center + Weill Medical Center of Cornell University in “Molecular Aspects of DCIS Progression.” #SABCS22
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Birgitte Offersen
Birgitte Offersen@BOffersen·
The first results from the DBCG PBI trial support standard use of external beam PBI 40Gy/15fr for selected breast cancer pts. Less morbidity and very few cancer events (not related to PBI). PBI has been DBCG standard since 2016 for low risk BC pts. Graphs & link below 👇
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Peter WT Pisters, MD
Peter WT Pisters, MD@ppisters·
Proud for @MDAndersonNews to be ranked as the nation’s leader in cancer care by @USNews. This #1 ranking is a reminder of our responsibilities to those we serve, and it drives our unwavering commitment to our mission to #EndCancer. #BestHospitals
UT MD Anderson@UTMDAnderson

MD Anderson is proud to be #1 in the nation for cancer care in @USNews’ “Best Hospitals” ranking. We're grateful for all of you who make this possible: our faculty, employees, trainees, students, donors, advocates, patients and caregivers. bit.ly/3or8vpA #EndCancer

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Melissa
Melissa@MMitchellMDPhD·
@Rad_Nation Some pts are interested in the best local control, others in the best cosmesis, others in convenience or decreased financial toxicity (which can include less time off work or traveling to another city). I tell patients there is no wrong answer, everyone has different priorities.
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Radiation Nation
Radiation Nation@Rad_Nation·
T4: What is important for breast cancer patients for shared decision-making for treatment? #RadOnc #JC
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Melissa
Melissa@MMitchellMDPhD·
@Rad_Nation Hard to know if our willingness to rapidly change practice on early evidence will continue w/o the pressures of the COVID pandemic. However, 6 weeks was SOC for decades. Probably less hesitancy to change after experiencing the rapid evolution of breast RT in the last 5-10 yrs.
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Radiation Nation
Radiation Nation@Rad_Nation·
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
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Melissa
Melissa@MMitchellMDPhD·
@Rad_Nation Agree that there is movement towards an approach similar to prostate cancer of active surveillance for low risk early stage breast cancer. Hopefully genomic assays will increasingly determine the true benefit of radiation.
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Melissa
Melissa@MMitchellMDPhD·
@rlevitinMD @CShahMD @Rad_Nation @Icro_Meattini I emphasize the lack of long term follow up with 5fx and trend of slightly higher long term cosmetic toxicity (though absolute difference 1%). I tend to see 50/50 split. I also have a lot of patients that change their mind 10 times between consult and sim.
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Radiation Nation
Radiation Nation@Rad_Nation·
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
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Melissa
Melissa@MMitchellMDPhD·
@Rad_Nation The covid pandemic, as well as increased comfort with new fractionation schemes likely contributed to faster uptake.
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Melissa
Melissa@MMitchellMDPhD·
@Rad_Nation There were many naysayers, but after ASTRO guidelines recommended moderate hypofractionation for all breast only patients in 2018, practice dramatically changed. The shift to one week treatment after publication of UKFASTforward happened at a much faster pace.
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Radiation Nation
Radiation Nation@Rad_Nation·
T1: What data supports the use of hypofractionation in breast cancer? How has this evolved over time? #RadOnc #JC
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Melissa
Melissa@MMitchellMDPhD·
@Rad_Nation 150 patients on the START trials did receive nodal treatment. Not enough for statistical analysis, but hypothesis generating that moderate hypofractionation may reduce shoulder arthralgias and lymphedema.
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Melissa
Melissa@MMitchellMDPhD·
Great time today team building with our breast rad onc group at the RAD ONC OLYMPICS!
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Melissa
Melissa@MMitchellMDPhD·
@JuliaNEM33 I grew up poor with a single mom and my resident salary was much higher than any salary my mom made in her 30 year career. Now I make more in a year than she did in her lifetime and feel guilty, as many family members still make less than a resident salary.
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Melissa
Melissa@MMitchellMDPhD·
@theRADSofKHAN @Sushilberiwal @CShahMD @ErinGillespieMD @simonpowell213 I do council patients regarding the possible increased risk of pneumonitis, but usually still give concurrent. Since KATHERINE did give concurrent, the recommendation for the current COMPASS RD trial is to give radiation concurrent with adjuvant therapy, which includes T-DM1.
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Atif J Khan
Atif J Khan@theRADSofKHAN·
Ever wonder how RT was sequenced with TDM-1 on KATHERINE? I'm not sure how patients were actually treated, but the protocol allowed for concomitant treatment and skin AEs were very low...so probably okay to start TDM-1 during RT...(?)
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