Daniel Portik

Accurate.

1/7 🧵 New in @LancetOncology: we built a Delphi consensus on primary endpoints for MDT trials in oligometastatic cancer — because the endpoints we've been using were designed for drugs, not for ablation. On behalf of the EORTC–ESTRO OligoCare consortium.

@DawnsMission Needle biopsies are standard because knowing exactly what you’re treating overwhelmingly outweighs the exceedingly small risks. Major reviews do not show increased metastasis from routine biopsy. Fear-based misinformation harms real patients.

Provocative finding from the EA5181 study shared by @JoeChangMD at #TexasLung26. The in-field progression rate after the PACIFIC regimen is only in the single digits. A statistic that needs to be on the scale when surgical resection of N2 disease is considered. cc @MARIANOPROVENCI @FordePatrick @DrJNaidoo @gerryhanna @RamalingamMD @teekayowo

Just when you thought you cannot be surprised anymore:

@jryckman3 @TheLancet One of my takeaways is: can we stop for a minute to appreciate how good IMRT has become?

🧵 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) 👇

Say hello to Srón! It's our new 3D-printed head for teaching nasopharyngoscopy. (Srón means nose in Irish, pronounced "shrone") You can print Srón yourself for free, or order one from us, at sron.ca

Very honoured to have taken part on this long endeavour covering so many topics led by @cancerphysicist and @71Rianne . It was truly a learning experience!

The Olympic drone pilots are the best thing that happened the games, unsung heroes, period. The coverage this year is officially on another level. We can finally feel so much closer to the action, it's pure magic, unreal. Is it just me, or is this the best upgrade in years?

@DrewMoghanaki Birds of a feather, flock together. Or we are whom we spend time with. If we are in bubbles, we only hear our own ideas. We need to get our voices out there to our neighbouring specialities.

This is a study about “linchpin surgeons” When present, patients with stage I NSCLC are more likely to receive MDT care, leading to less siloed decisions and higher SBRT use. When scarce, care defaults to “first stop wins,” and SBRT use declines—even when appropriate. @LorraineC_MD @BTongMD @hari_keshava @STS_CTsurgery @TomVargheseJr #radonc @QuadShotNews redjournal.org/article/S0360-…

🚀 MDT in oligometastatic #ProstateCancer 🚀 👉WOLVERINE IPD meta-analysis in @TheLancetOncol 🧪 7 randomized trials, 574 pts 📉 MDT → ↓ progression, ↓ radiographic progression, ↓ time to CRPC 🔁 Consistent benefit across SOC (obs, ADT, ARPI) 🛡️ Low toxicity, short treatment courses ⚖️ OS not definitive; but this is the strongest evidence yet to integrate MDT 👏 @ChadTangMD @piet_ost 🔗 to study shorturl.at/566C9 🔗 to editorial shorturl.at/cq7IK @PCFnews @urotoday @UrologyTimes

A win for video games!

@toddscarbrough Would like to hear some Lessons Learned from departments where patients refused the twice-a-day due to logistical reasons. How did you convince patients? How did you change workflows? Did insurers also jump in to make the switch? And any other ideas also.

Twice a day RT to 60 Gy is *the* standard of care for limited stage SCLC It should replace *the previous* #radonc standard of care: twice a day to 45 Gy If you don't (oftenly, persuadingly) offer twice a day RT for small cell #lungcancer ... rethink those life choices

@Mat_Guc showing data on the % of patients in oligomets RCTs where radiation was used as the treatment modality. Conclusion: the randomized data most strongly support the use of radiation rather than surgery or RFA

@curiosityonx Nova Terra

What name would you choose for the very first Martian city?

@jryckman3 What I find concerning is how quickly some jump to transpose in vivo data to clinical situations, even though we have thousands of patients in trials and platforms not showing an explosion of metastasis after SBRT...

Comments off. Go figure. 🤦

In this week’s @JAMAOnc - full published paper of a randomised trial of craniospinal vs involved field RT in treatment of leptomeningeal metastatic disease ➡️ PFS 8.2 vs 2.3 months, p<0.01 First trial that has really shifted the dial in this difficult clinical setting. #RadOnc 🔗 jamanetwork.com/journals/jamao…

@jryckman3 I do think that the organ preservation dilemma will start growing bigger and bigger in the community's mind. With all neoadjuvant approaches coming towards us, why not use RT instead of surgery for organ preservation?

Well said. IMO, much of the perceived surgical advantage still stems from Halstedian dogma despite lack of modern randomized evidence comparing organ preservation and resection for stage I to III NSCLC in the era of immunotherapy, targeted therapy, and high-quality nodal sampling. And since EBRT and surgery are not scalable, only about 4 percent of global oncology research spending goes toward primary radiotherapy or surgical oncology questions. It is no surprise these trials are challenging to fund and even harder to enroll without modality bias from clinicians and patients alike. Eagerly awaiting VALOR for operable stage I lung (HT @DrewMoghanaki). I’m unaware of any ongoing RCT randomizing RT versus surgery for stage III NSCLC in today’s systemic therapy landscape. We need randomized data for “operable” patients because observational modality comparisons are deeply confounded by indication. Raising this point often leads to accusations of “anti-surgery rhetoric,” when the intent is simply to advocate for evidence that aligns with patient goals around organ preservation and informed decision-making. Asking for randomized evidence is not radical. It is patient-centered. However, it is a matter of incentives, in the same way a farmer takes advantage of the shining sun. Until we have more data, as Jill has said, decisions must center on what matters most to patients through informed decision making. Beautifully written piece, @BLawenda.

Delayed surgery as an approach

@DrewMoghanaki shows us why more patients with early stage #lungcancer will have SABR over surgery -#SABR2025