SEBASTIAN SOLE

#APCCC26 @APCCC_Lugano No one better to debate than @piet_ost Is early SRT "equivalent" to adjuvant RT in high risk/locally advanced disease? Statistically, absolutely not if you believe the RADICALS-RT data.

New @EurUrol! Pooled trials @PeterMacCC / @UTMDAnderson shows adding Pembrolizumab to MDT for oligometastatic #kidneycancer ⬆️ PFS (28 vs 17 mo; HR 0.57), esp. after prior therapy - shorturl.at/WWvBg - Correlative data confirm MDT+ICI-evoked immune activation #Kcsm #RadOnc

Long-term survival for patients with newly-diagnosed metastatic cancer has more than doubled ⏫in the past 40 years. However, not all patients live longer. youtu.be/LMmFZRgWlCQ ascopubs.org/doi/10.1200/OP… Work via @JCOOP_ASCO from team at @UHhospitals @CWRUSOM @MayoClinic

#APCCC26 Jochin Walz crushes his talk and makes the strong case why waiting until imaging is positive after RP is inappropriate and non-evidence based. Early is better!

Congreso @SochiraCl Turno de @SEBASOLE y el Rol de la RT en el escenario metastasico NSCLC @hletelier @DrewMoghanaki

@SEBASOLE @SochiraCl #XIXCongreso #OMD #NSCLC

I am thrilled to announce that Renaissance Institute completed the initial phase of its first course of LDRT for an #Alzheimers patient today. The patient began the treatment course with a MOCA of 15, complete anosmia & ageusia, and A&Ox1. By the end of Renaissance-modified treatment fractionation, the patient had recovered their sense of taste, was A&Ox4, able to remember my staff’s names, and MOCA improved to 19. We look forward to opening this new & innovative fractionation scheme in the upcoming LDRT-MIND trial. #radonc #neurology #dementia

Interesting that a review on TNT for LARC- w/ extensive discussion of RT toxicity & RT omission - has 0 rad onc authors, cites bowel tox data from 2005, and mischaracterizes PROSPECT data: no better QoL with chemo as they state, but different toxicity profile and no diff in HRQoL

Radiation is a powerful anti-cancer agent, but I considered it a weak immunomodulator. Our new study @CD_AACR changed my mind: in the right context, RT can incite potent systemic immune responses in patients (even rare irAEs). Which context? brnw.ch/21x1b6E A 🧵 /1

💬 Editorial: Stereotactic radiation offered modest symptom relief & better long-term neurocognitive outcomes than hippocampal-avoidance whole brain radiation, but was associated w/ higher rates of new brain metastases & salvage whole brain radiotherapy. ja.ma/4bEOp4E

More lesions ≠ WBRT anymore? 🤯 Phase 3 data just changed how we think about 5–20 brain metastases. 🧠 Trial: SRT vs HA-WBRT (JAMA 2026) 👥 Population: • 5–20 brain mets • Good PS, expected survival ≥4 months • Mean ~14 lesions ⚡ Arms: • 🎯 SRT (1–5 fractions) • 🧠 HA-WBRT (30 Gy/10 fx ± memantine) 📊 Key Results: • ↓ Symptom burden with SRT (MDASI-BT Δ −1.06, P<.001) • Better neurocognition at 12 months • Better performance status early & sustained • Similar survival & grade ≥3 toxicity ⚠️ Trade-offs: • ↑ New brain mets with SRT   45.4% vs 24.2% • ↑ Radiation necrosis (mostly asymptomatic) • More salvage WBRT needed 🎯 Takeaway: Even with up to 20 brain mets, SRT offers better QoL + functional outcomes 👉 At the cost of higher intracranial relapse risk 🔖 Think beyond lesion count. Think patient-centered outcomes. 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #RadiationOncology #BrainMetastases @oncoalert

Check out our new @IJROBP SBRT special issue podcast! Highway to the Danger Zone - SBRT in difficult scenarios With practical tips to avoid toxicity in difficult situations! podcasts.apple.com/us/podcast/hig…

‼️❓Is trusting only PSA reasonable in metastatic prostate cancer? 🚨Post hoc analysis of ARCHES + PROSPER shows PSA can miss radiographic progression on enzalutamide. 🚨Among patients with radiological progression, 25% had no PSA rise and 60% did not meet PSA progression criteria. ‼️‼️Imaging-only progression also predicted worse OS. 👉doi.org/10.1200/JCO-24… @JCO_ASCO @ASCO @OncoAlert @APCCC_Lugano @urotoday @DrYukselUrun

Huge congrats to Dr Saad Ashraf on his @FrontOncology case report! 👏 This unique case of OPD highlights 8 courses of SABR for 17 metastases over 5 years, delaying systemic therapy changes 8x to prioritize patient QOL in a HER2+ breast cancer. Read: frontiersin.org/journals/oncol…

🌟 The Abscopal Effect : When local radiation has systemic impact ✨ 👥 What is it? Radiation to a single tumor site → unexpected regression of distant, non-irradiated tumors. ⚙️ How does it work? • 🔥 Radiation kills cancer cells → releases tumor antigens • 🛡️ Immune system gets activated → T-cells attack metastases elsewhere • 💉 Often boosted with immunotherapy (RT + ICI combos) 📊 Reality check Rare in clinic, but growing evidence with IO combinations. 💡 Takeaway Radiation = not just local control… it can spark systemic anti-tumor immunity. 👉 Turning the body into its own “vaccine factory.” #OncoTwitter #RadOnc #medtwitter #ImmunoOncology @OncoAlert @astro @asco @myesmo

Fantastic news for renal cancer patients. Latest NICE guideline recommends #SABR to primary RCC for selected patients with stage IA and IB disease! nice.org.uk/guidance/ng256… #radonc #medonc #SBRT Big thanks to @_ShankarSiva who has pioneered this important treatment option

This is malpractice if outside of a clinical trial. The rest of us in real oncology world will be dealing with messy salvages of the failures long after you’ve abandoned these men.

#ASCO #GU26 – Discussion After POSEIDON (#305) & ASCENDE-RT (#306): @OncoAlert How should we apply this in clinic? Discussed by Bridget F. Koontz, MD @apolo_andrea @ReginaBarCar 🔎 Key discussion points: ▪️ At 15 years, no clear OS benefit with brachy boost (ASCENDE-RT) ▪️ Disease control improved, but competing mortality matters ▪️ EBRT remains a highly effective curative option ▪️ In salvage RT (POSEIDON): No clear OS benefit from adding ADT when PSA <0.5 ng/mL ADT benefit appears PSA-dependent (>1.6 ng/mL) 🩺 Practical takeaways: ✔️ In PET-PORT setting → minimize ADT ~6 months reasonable when PSA ≥0.5 ✔️ Reserve long-term ADT for: – Very high PSA – N1 disease ✔️ Consider brachy boost in: – Young fit men – VHR localized disease – Patients where reducing ADT duration matters 💡 The real shift: Not escalation by default. Not de-escalation by default. Risk-adapted personalization based on: Life expectancy PSA kinetics Nodal status Biologic aggressiveness Precision radiation oncology is selection, not intensity. @AmarUKishan @DrSpratticus @DrChoueiri @brian_rini @montypal @PGrivasMDPhD @Silke_Gillessen @tompowles1 @BraunMDPhD @DrDanielHeng @ravikanesvaran @EfstathiouEleni @apolo_andrea @neerajaiims @acampsmalea @BRicciutiMD @HHorinouchi @FadiHaddad_MD @Abdallah81MD @FernandoOnco @ElisaAgostinett @to_be_elizabeth @bavilima @realbowtiedoc @Erman_Akkus @Lucarecco @GaiaGriguolo @JankovicK @MarioBalsaMD @DrMirallas @GIMedOnc @OscarTahuahua @UOzkerim @Onco_Cifu88 @PaulJiL @DaisukeKotani @DraMartinezLago #ProstateCancer #RadiationOncology #GU26 #OncoAlertAF #ClinicalDecisionMaking

💰 slide of POSEIDON by Dr. Bridget Koontz @bridget_koontz @AmarUKishan @DrSpratticus Full manuscript JUST RELEASED👇 thelancet.com/journals/lance… @DrChoueiri @yekeduz_emre @DrYukselUrun @crisbergerot @Silke_Gillessen @neerajaiims @urotoday @brunolarvol @OncLive

#GU26 @TheLancet Extremely proud to co-lead with @AmarUKishan and all investigators in MARCAP for helping make these exciting results possible. Presents POSEIDON assessing use of hormone therapy use and duration with post-op RT for recurrent PCa: An individual patient data meta-analysis of 6 trials thelancet.com/journals/lance… @ASCO