Michael Weisman

🧵 Just published in @TheLancet: TORPEdO – the first phase 3 RCT designed specifically to test whether IMPT (proton beam) improves late function & QoL vs modern IMRT in oropharyngeal SCC. Short answer: It doesn’t. Long answer (with the numbers that matter) 👇

📌 Stereotactic body radiotherapy in patients with bone oligometastases from breast cancer – results from a European multicenter cohort study ☢️🌍 🔗 sciencedirect.com/science/articl… @OncoAlert #OncoAlertAF #BreastCancer #RadOnc 🔹Stereotactic radiotherapy of bone oligometastases with excellent local control.
🔸Well-tolerated treatment with especially low fracture rates.
🔹Prospective studies are needed to determine the role of standardized SBRT concepts.

@DrSpratticus @CShahMD @ASRT @ASTRO_org Great points and ones that bring into question why you would want to train others to do something that will quickly be automated, just for short term convenience. What will you have them do when it becomes automated? If it’s more of our tasks, are we overtraining physicians?

@CShahMD @ASRT @ASTRO_org I see your point. But for contouring and image review we already and increasingly will allow AI do this. I guess I don’t understand why we are ok with having software algorithms eventually devalue our time/effort/reimbursement but not ok with humans doing this.

Grateful to @ASTRO_org for releasing a statement highlighting their lack of support for the concept of APRTs in the United States. It’s not what’s best for patients most importantly or the specialty. @NehaVapiwala @SameerKeoleMD magnetmail.net/actions/email_…

@EvanThomas84 @_ShankarSiva @DrewMoghanaki @DrSpratticus @NiuSanford @jryckman3 @ASTRO_org @the_RSS @NRGonc Important to remember that 20 yrs ago, much of the #RadOnc leadership was denouncing SBRT (often with fierce resistance). Thanks to the courage of @BobTimmermanMD and the overwhelming success of #SBRT, most today are not aware of this.

Wow, many issues w this 47-pt, sponsor-run, single-arm histotripsy study. Short 🧵 1/4 1. Post-hoc imaging re-read: primary read w validated criteria showed 1-yr LC 63%, but they emphasize a post-hoc re-read (using new “experience” w histo imaging) bumping local control to 90%.

Among patients with oropharyngeal squamous cell #carcinoma, proton therapy for head and neck cancer was associated with a higher 3-year incidence of osteoradionecrosis compared with intensity-modulated radiation therapy. ja.ma/4ri4y5T

Interesting work in #hncsm #radonc unknown primary with unilateral neck disease looking at ipsilateral neck RT vs elective mucosal coverage +/- bilateral neck RT. Kudos to 🇬🇧 investigators for putting together this national retro work. Few considerations: - HPV+ was imbalanced between the groups. The benefit of elective mucosal coverage is highest in HPV+ group. - elective mucosal sparing for HPV+ with unilateral neck disease in this setting could be reasonable to consider in patients who have been VERY comprehensively investigated with mucosectomy/lingual tonsillectomy and ipsi palatine tonsillectomy, in addition to both PET and MRI. See FIND study @DrJohndeAlmeida @Dr_AliHosni. Without a thorough surgical workup, would be cautious regarding this RT approach and heterogeneity was a limitation of this cohort as acknowledged. - salvage can be challenging if an oropharyngeal primary declares itself after initial neck RT alone, especially if not amenable to surgery with clear margins (eg deep BOT). While the salvage contra neck RT fairly straightforward, field matching can become a challenge if salvage primary PTV(s) overlap with initial ipsi neck PTV. Need to consider technology available (protons, online ART technology permitting smaller PTVs) to handle management of this kind of recurrence and reduce reRT risks if it were to occur.

Here are all the oligomets RCTs. HRs < 1 in green. @Mat_Guc

Magnitude of benefit of SABR for EGFR+ disease is very similar to other treatments that are much more toxic @Mat_Guc

SBRT is a major option for the treatment of celiac pain, with low rate of adverse events and a high & durable pain control. @lauren_henke at #SABR2025

Randomized Trial Spine SBRT Target Tumor only vs. Tumor+ Elective Coverage ↑↑tumor control with Elective Target coverage academic.oup.com/neuro-oncology…

@SeanPitroda @drdavidpalma @NiuSanford @piet_ost @CJTsaiMDPhD @rweichselbaum TMZ titles is the argument. The science is taking a back seat to it.

@drdavidpalma @NiuSanford @piet_ost @CJTsaiMDPhD @rweichselbaum No one knows the nature of post-RT progression definitively. We propose RT awakens dormant mets-validated in three prospective human trials. Your RCTs weren't designed to test this and don't disprove it. How exactly do your trials refute dormancy escape?

Nice viewpoint & biologically interesting hypothesis, but how would one actually distinguish b/w new tumors from “badscopal” effect vs. normal metastatic progression in humans? & are there any RCTs that demonstrate accelerated progression post ablative RT (I can't think of one)?

Here's why protons for HN cancer might be TORPEDOed: With weight loss, IMPT can get bad, fast. OAR doses go way up: 27% increase for parotid and >100% increase for esophagus by week 2 for bulky tumours. 🔥 Maybe a negative spiral? Worse plan, more weight loss, even worse plan.

📢 Phase III RCT in locally advanced #OPSCC: proton 💠 vs conventional #radiotherapy 🔆 ❌ No diff. in 12-mo gastrostomy rate, QOL, or swallowing. ⚖️ Similar 2-yr local control & OS (~95%). 👉 High-quality IMRT remains standard; IMPT not required. #ASTRO25 #RadOnc @ASTRO_org

💥Phase III BART trial (n=153) in locally advanced #BladderCancer after cystectomy + chemo: 🔹 RT (n=77) vs Obs (n=76) 🔹2-yr locoregional recurrence: 8% RT vs 26% Obs (p=0.006) 🔹OS trend ↑RT (68% vs 57%), not sig 🔹No ↑ severe late adverse events 👉Adjuvant RT ↑ control & DFS, esp T3/4 & N+ pts. #ASTRO25 #RadOnc

WOW! 🧠METIS trial (n=298) in #lungcancer brain mets: SRS ➕ TTFields ⚡vs SRS alone ✅ TTFields delays intracranial progression (HR 0.72, p=0.044) 📉12-mo progression: 47% vs 59%; ⬆️ with immunotherapy (HR 0.63) ❌No QoL / cognition decline; AEs mild skin #ASTRO25 #RadOnc #lcsm

Multicenter, randomized, sham-controlled trial LDRT vs OA Knee OA were allocated to receive sham irradiation, total 0.3 Gy/6 fractions, or total 3 Gy/6 fractions Endpoint: OMERACT-OARSI response rate at 4 m 70.3% (3 Gy) vs 41.7% (sham) p=0.014 #ASTRO2025

A pleasure (as always) hosting @BobTimmermanMD for thought provoking and forward thinking considerations in #radonc @HMethodistMD grand rounds! #PULSAR #CUT