Kevin Stephans MD

If you want to learn more about ⁦@ClevelandClinic⁩ radiation oncology during the #ASTRO22 meeting, please stop by our booth #2596. We look forward to connecting with you. ⁦@bikeVeloSano⁩ ⁦@CleClinicMD⁩ #CleClinicCancer

@soumon_rudra @haydencrane5 @CleClinicMD @CCA_Alliance @CrainesCrew @curecc @lisamariecraine @DrEstfan As soon as possible, ideally a few hours. No additional tracer is given for PET as just used to detect the 1% of beta particles/electrons from Y90 which create photons to estimate dose - the longer one waits the weaker the signal will be.

@MdStephans @haydencrane5 @CleClinicMD @CCA_Alliance @CrainesCrew @curecc @lisamariecraine @DrEstfan Unique approach to combine Y90 and EBRT. How soon after Y90 do you have to get the PET?

(2/4)Treated w 4 cycles gem-cis, followed by y90 and consolidative high dose hypofractionated XRT (a/w improved survival compared to conventional XRT by @haydencrane5 and Randa Tao). Lower dose PTV’s on edge to maintain normal tissue. 60-67.5 Gy/15 fx to center. higher better.

@drjamesgood @haydencrane5 @CleClinicMD @CCA_Alliance @CrainesCrew @curecc @lisamariecraine @DrEstfan There are times we do dose paint (if most of tumor was well covered except perhaps a small part w aberrant blood supply), but most often (70+%) end up treating whole lesion due to heterogeneity of coverage. Can leave areas near serial structures that were treated cool.

@MdStephans @haydencrane5 @CleClinicMD @CCA_Alliance @CrainesCrew @curecc @lisamariecraine @DrEstfan Yes. Whilst the Y90 enthusiasts will tell us they can deliver 1000 Gy to the tumour etc, in my (admittedly quite limited) experience of delivering Y90, it is far from homogenous. Do you ‘dose paint’ to Y90 cold spots? From the images above, it looks like you don’t.

@drjamesgood @haydencrane5 @CleClinicMD @CCA_Alliance @CrainesCrew @curecc @lisamariecraine @DrEstfan We get a PET after y90 to assess distribution by Brehmstrahlung, can also tell by MRI changes. Ok recovering some areas w EBRT as long as serial tissue is not overdosed, and enough other liver spared. In this case almost entire left liver.

@drjamesgood @haydencrane5 @CleClinicMD @CCA_Alliance @CrainesCrew @curecc @lisamariecraine @DrEstfan Great question. Our strategy with these large unresectable tumors that are lateralized is to get as much dose in as possible. Y90 delivers high dose to portions of tumor, but is heterogeneous and will also under-dose portions of tumor. External beam allows supplementation.

(4/4) PET scan negative for residual disease too. Will follow. Integration of multidisciplinary care and access to new technology can open doors. Grateful to the brave patients who have walked this path, amazed to see what they can accomplish in treatment and in life.

(3/4)Now over 2 years from treatment with no radiographic evidence of residual disease. Intact liver function and excellent performance status. Fortunate to work with excellent colleagues in medical oncology, interventional radiology, and hepatobiliary surgery @ClevelandClinic.

(1/4)As Cholangiocarcinoma awareness month draws to close wanted to point out aggressive multi-disciplinary treatment offers opportunity for success w unresectable CCA. 18 cm tumor w outflow obstruction resulting in aborted trisegmentectomy due to unstable BP and liver bleeding.

The @ClevelandClinic 14th Annual International Symposium on #SBRT and #SRS will be held February 25-27, 2022, bringing together world leaders in brain, spine and body-targeted stereotactic radiation modalities and techniques. Join us! ccfcme.org/sbrt

New publication with @jihyunRadOnc. 🌟Our observations suggest that early antiarrhythmic effects after cardiac radioablation result from conduction disturbances and membrane potential alterations without necrosis. (ahajournals.org/doi/10.1161/JA…)

I did a thing today...I volunteered to give vaccines with the Cuyahoga County Health Dept and the Medical Reserve Corps. It felt great to help move us forward in the fight against COVID19.

Excellent review article in Seminar of Radiation Oncology by @danielrgomez44 about consolidative thoracic radiotherapy in oligometastatic lung cancer #radonc sciencedirect.com/science/articl…

Prospective contour review takes effort, but @DrAndrewVassil has that covered. Great to work with colleagues who go the extra mile every day. #PatientSafetyAwarenessWeek

Full publication of randomised Scandinavian dose escalation trial for LS SCLC 45Gy / 30 Fx / 3 weeks vs 60Gy / 40 Fx / 4 weeks ⬆️ 2a OS 74.2% vs 48.1% ⬆️ Med OS 37.2 mo vs 22.6 mo ↗️ Med PFS 18.6 mo vs 10.9 mo (p=0.13) ➡️ Grade 3+ toxicity and SAEs #radonc tinyurl.com/ryrfztj2

@ndesai2005 @Issarami @RTendulkarMD @DrSpratticus Innovative clinical trial by @ndesai2005 randomizing low/intermediate risk prostate cancer to +/- nerve sparing to quantify impact on QOL and cancer outcomes post treatment. Open at UTSW, CCF, Penn, U Colorado and more.

@Issarami @RTendulkarMD Example images of case to illustrate —strong team enrolling over 50% complete despite covid @DrSpratticus @RTendulkarMD @MdStephans and John Christodouleas UPenn and Tyler Robbins U Colorado

Nerve-sparing prostate SBRT is currently being tested in the POTEN-C randomized trial by @ndesai2005 et al. Patients love the concept

Great summary for role of adjuvant versus salvage XRT is important for our patients with biochemical recurrent #prostatecancer - @felixfeng with 22-gene classifier from @NRGonc RTOG 9601 trial that may help us define high risk populations needing ADT. @ASCO #GU21