Jonathan Tomaszewski (@dr_jonathant) - Twitter Profili

Jonathan Tomaszewski@dr_jonathant·27 Şub

Might this now be possible with the POSEIDON dataset @AmarUKishan? Calculator showing 10yr MFS with RT (+/- HT) based on pre RT PSA & path features would be v useful, pending widely avail biomarker #radonc #pcsm

Jonathan Tomaszewski@dr_jonathant

Would be really helpful to be able to generate individualised estimates of MFS/PCSS/OS for salvage RT alone (beyond the subgroup data from Supp Table 4). Any plans for a nomogram/calculator, or suggestions re how to go about this? #radonc #pcsm

English

0

453

Jonathan Tomaszewski@dr_jonathant·27 Şub

@DrSpratticus Is Figure 4 potentially mislabelled? Top 2 panels being RT +/- HT, middle 2 RT +/- ST HT and bottom 2 RT +/- LT HT? Another query? Fig 2F shows MFS HR 0.79 (95%CI 0.7-0.89), but then upper bound CI crosses HR 1 for all PSA levels (Fig 4B)? 🙏🙂

English

0

1

62

Daniel E Spratt@DrSpratticus·26 Şub

#GU26 Importantly for those that focus on MFS we analyzed MFS in relationship to the ICECAP surrogate threshold effect and confirm there are improbable improvements in OS based on MFS indirectly or OS directly

English

2

5

8

1.2K

Daniel E Spratt@DrSpratticus·26 Şub

#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

English

8

48

108

16.5K

Jonathan Tomaszewski@dr_jonathant·11 Kas

@NiuSanford I would have thought the correct statistical interpr here is that there is no clear diff in trtmt effect based on T or N stage ➡️ p value for interaction >>0.05, wide CIs including HR of overall effect.

English

1

0

3

265

Dr. Nina Niu Sanford@NiuSanford·10 Kas

Good q. If decision is for pre-op therapy for T2N0, I’d favor CROSS due to lower treatment burden, cost, & toxicity for most (obviously exact tradeoffs depend on specific scenario). Per ESOPEC forest plot, FLOT ~ CROSS for T2 or N0. Can then add on adjuvant nivo per CM577.

Ziad Awad, MD, FACS@ziadtawad

@NiuSanford @OncoAlert Nice slides. Could you elaborate on reasoning for Cross among T2N0?

English

4

10

43

7.8K

Jonathan Tomaszewski@dr_jonathant·25 Eki

@alison_tree Similar concerns been expressed for mod hypofrac in past - do we know re any differential effect of IPSS on GU tox from SBRT vs mod hypofrac? #radonc #pcsm @weeloonong

English

1

2

200

Alison Tree 💙@alison_tree·24 Eki

Congratulations to Dr Ragu Ratnakumaran for all his hard work deciphering the mountain of data from PACE-B

English

1

15

1.2K

Alison Tree 💙@alison_tree·24 Eki

Ever wondered which patients get GU adverse events after prostate SBRT? Some pointers here eur01.safelinks.protection.outlook.com/?url=https%3A%…

English

7

40

103

12.1K

Jonathan Tomaszewski@dr_jonathant·2 Tem

@DrAndrewLoblaw @piet_ost @chrisparker @RTendulkarMD Another approach: Aim ≥5%⬆️MFS @ 10yr with ADT. Trials suggest need pt with MFS≤70-75% (without ADT) to observe this benefit. FFDM is ~10% > 10yr MFS (e.g per RADICALS-HD) ➡️ if Tendulkar nomogram 10yr DM >15-20% recommend ADT (depending on comorbs/pt prefs) 💡🤓🤔

English

0

1

93

Dr. Andrew Loblaw@DrAndrewLoblaw·30 Haz

@piet_ost @chrisparker I use @RTendulkarMD nomogram (PMID: 27528718) . It includes 6mo ADT as a variable. That way I can quote 5 and 10y bDFS with and without ADT and let the patient decide.

English

1

0

5

307

Dr. Andrew Loblaw@DrAndrewLoblaw·28 Haz

The @chrisparker RADICALS-HD data suggested we should be using 24mo of ADT for every postop patient. #DADSTOP didn’t validate that approach. Some pts benefit from 6mo ADT. Maybe some (please help me identify them) benefit from 24mo. Other low risk pts are good with RT alone

Jonathan Tomaszewski@dr_jonathant

@DrAndrewLoblaw Pls elaborate @DrAndrewLoblaw 🙂

English

3

35

5K

Jonathan Tomaszewski@dr_jonathant·2 Tem

Would be really helpful to be able to generate individualised estimates of MFS/PCSS/OS for salvage RT alone (beyond the subgroup data from Supp Table 4). Any plans for a nomogram/calculator, or suggestions re how to go about this? #radonc #pcsm

Advanced Prostate Cancer Consensus Conference@APCCC_Lugano

Duration of Androgen Suppression with Postoperative Radiotherapy (DADSPORT) for Nonmetastatic Prostate Cancer: A Collaborative Systematic Review and Meta-analysis of Aggregate Data sciencedirect.com/science/articl… This systematic review and meta-analysis by the DADSPORT Collaboration evaluated the impact of hormone therapy (HT) added to postoperative radiotherapy (RT) in nonmetastatic #ProstateCancer across five randomized controlled trials involving 4,411 participants. While HT did not significantly improve overall survival (OS) in the general population, it did show meaningful benefits in metastasis-free survival (MFS) and prostate cancer–specific survival (PCSS), each with a 4% absolute improvement at 8 years. Notably, OS benefits may be limited to patients with higher pre-RT PSA levels or CAPRA-S scores. These findings support the use of adjuvant HT to improve cancer outcomes, particularly in higher-risk patients. @DrSpratticus @AmarUKishan @drjefstathiou @PCaParker @_APollack @PaulSargos @felixfengmd @OncoAlert @Silke_Gillessen @AOmlin @nataliagandur @bavilima

English

1

2

7

2.5K

Jonathan Tomaszewski@dr_jonathant·1 Tem

@BLawenda Interested in this GPT, but unable to DM you. Keen to hear how baseline MFS/PCSS/OS (for salv RT alone) estimated from available data thx 🙏

English

0

35

Brian Lawenda MD@BLawenda·30 Haz

6/6 Want this GPT? ➡️ Needs GPT+ 📩 DM me and I’ll send: The GPT prompt Setup steps Evidence/extrapolation framework 💬 Ready in 5 mins. #MedTwitter #ProstateCancer #RadOnc #AIinMedicine #CustomGPT

English

2

0

1

155

Brian Lawenda MD@BLawenda·30 Haz

🚀 Built a custom GPT (Post-RP Hormone Therapy GPT) — helps you decide if short-course ADT should be added after prostatectomy using CAPRA-S + DADSPORT 2025 data. Here’s how it works 👇 📩 DM me for the instructions to build your own.

English

1

0

3

224

Jonathan Tomaszewski@dr_jonathant·28 Haz

@DrAndrewLoblaw Pls elaborate @DrAndrewLoblaw 🙂

English

0

2

5.3K

Dr. Andrew Loblaw@DrAndrewLoblaw·27 Haz

I feel vindicated!

Advanced Prostate Cancer Consensus Conference@APCCC_Lugano

Duration of Androgen Suppression with Postoperative Radiotherapy (DADSPORT) for Nonmetastatic Prostate Cancer: A Collaborative Systematic Review and Meta-analysis of Aggregate Data sciencedirect.com/science/articl… This systematic review and meta-analysis by the DADSPORT Collaboration evaluated the impact of hormone therapy (HT) added to postoperative radiotherapy (RT) in nonmetastatic #ProstateCancer across five randomized controlled trials involving 4,411 participants. While HT did not significantly improve overall survival (OS) in the general population, it did show meaningful benefits in metastasis-free survival (MFS) and prostate cancer–specific survival (PCSS), each with a 4% absolute improvement at 8 years. Notably, OS benefits may be limited to patients with higher pre-RT PSA levels or CAPRA-S scores. These findings support the use of adjuvant HT to improve cancer outcomes, particularly in higher-risk patients. @DrSpratticus @AmarUKishan @drjefstathiou @PCaParker @_APollack @PaulSargos @felixfengmd @OncoAlert @Silke_Gillessen @AOmlin @nataliagandur @bavilima

English

2

3

25

3.3K

Jonathan Tomaszewski@dr_jonathant·23 May

@TylerSbrt @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad What is your usual nodal boost dose (presuming bowel/plexus not limiting)?

English

1

0

144

Jonathan Tomaszewski@dr_jonathant·22 May

Curious to hear from #radonc re whether they contour & limit lumbosacral plexus when boosting involved pelvic nodes in #prostatecancer? (e.g PEACE V used 65Gy/25# which is 74.75Gy EQD2 for a/b=2) 🤔 @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt

English

10

1

12

2.7K

Jonathan Tomaszewski@dr_jonathant·23 May

@PCaParker @PBlanchardMD @alison_tree @piet_ost @dr_alimuhammad @TylerSbrt Sounds idiosyncratic rather than something that one can extrapolate to broader pt population. What dose do you typically use for nodal boosts?

English

1

0

1

128

Chris Parker@PCaParker·23 May

@PBlanchardMD @dr_jonathant @alison_tree @piet_ost @dr_alimuhammad @TylerSbrt Yes, we did have a case of LS plexopathy after 47Gy/20 fractions. It was a severe, persistent problem

English

1

0

1

150

Jonathan Tomaszewski@dr_jonathant·23 May

@Sushilberiwal @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt What is your typical nodal boost dose? What constraint would you apply to LSP?

English

1

0

142

Sushil@Sushilberiwal·23 May

@dr_jonathant @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt Then yes but not routine

English

1

0

1

139

Jonathan Tomaszewski@dr_jonathant·22 May

@Sushilberiwal @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt Even if boosting nodes in close proximity to LSP to ≥70Gy equiv?

English

2

0

1

230

Sushil@Sushilberiwal·22 May

@dr_jonathant @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt No

1

0

1

301

Jonathan Tomaszewski@dr_jonathant·22 May

@PBlanchardMD @alison_tree @piet_ost @dr_alimuhammad @TylerSbrt @PCaParker Perhaps more of a concern if taking nodes to ≥70Gy

English

2

0

1

320

Pierre Blanchard, MD@PBlanchardMD·22 May

@dr_jonathant @alison_tree @piet_ost @dr_alimuhammad @TylerSbrt Nope. I’ve heard/read about LS plexopathy but never seen one. We routinely give 55-66 Gy to nodes. I remember a case discussed on Twitter (before X) by @PCaParker (if I’m not mistaken) that had received almost conventional doses. I care about the plexus. Not a single root…

English

3

0

6

562

Jonathan Tomaszewski@dr_jonathant·22 May

@a_dalpra @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt What dose constraint have you used for LSP?

English

1

0

267

Alan Dal Pra, MD@a_dalpra·22 May

@dr_jonathant @alison_tree @PBlanchardMD @piet_ost @dr_alimuhammad @TylerSbrt Yes. I have contoured it when the boost volume is near LSP. I’ve seen LS plexopathy and it can be a serious complication.

English

2

0

4

383

Jonathan Tomaszewski@dr_jonathant·27 Haz

@DrewCareyMD @HopkinsMedicine Biological effect relates to both total dose & dose per fraction, cannot exceed CNII tolerance as such based purely on use of 3Gy/#. Also important to distinguish BED and EQD2 (see below). 30Gy/10# is equivalent to <40Gy at 2Gy/# (RION should be exceedingly rare at this dose).

Jonathan Tomaszewski@dr_jonathant

In memory of Jack Fowler: BED (Biologically EFFECTIVE Dose) ≠ EQD2 (2Gy/fraction equivalent) bit.ly/2fVhw9i #radonc #radbiol

English

0

1

160

Drew Carey, Eye MD@DrewCareyMD·26 Haz

So glad to see our paper from @HopkinsMedicine on #radiation ON being shared. While TD of usual WBRT is "safe," dose / Fx is > CN2 tolerances; BED gives 60Gy equiv. With #Avastin potential to save vision, patients need monitoring #eyetwitter #onctwitter #radonc #neurotwitter

PDBrown@PDBrownOnc

Any treatment options for Radiation Induced Optic Neuropathy (RION)? Bevacizumab stabilization vision 4/6 cases Note: RION after “safe” doses rdcu.be/dfk7s

English

2

0

4

1.3K

Jonathan Tomaszewski@dr_jonathant·27 Haz

@HKennecke @JCO_ASCO @OncoAlert Agree with overall message, but worth noting that ~half of the n=530 treated with upfront surgery were either clinical stage I or >12cm from verge 👇

Jonathan Tomaszewski@dr_jonathant

OCUM trial n=~1100 but majority not informative re RT omission. Key group n=257, stage II/III <12cm from verge treated with upfront surg (MRF>1mm, no T4 or low T3, vast majority N≤1 & 6-12cm from verge) ➡️ 5yr LR 3.8%. No info re T3 substage/EMVI ascopubs.org/doi/full/10.12… #radonc

English

0

1

3

283

Hagen Kennecke@HKennecke·26 Haz

German OCUM trial shows no #radiation needed for CRM-clear, non-low #rectalcancer. N=530, cT2-3, Nany CRM >1mm, 🚫low, treated with upfront TME. 5y LR 2.9% 5y Distant Relapse 15.9% Supports PROSPECT results. ⁦@JCO_ASCO⁩ ⁦⁦@OncoAlert⁩ ascopubs.org/doi/abs/10.120…

English

1

16

32

3.8K

Jonathan Tomaszewski@dr_jonathant·22 Haz

Expect substantial overlap with PROSPECT-eligible patients (nejm.org/doi/10.1056/NE…) #radonc

English

0

4

382

Jonathan Tomaszewski@dr_jonathant·22 Haz

OCUM trial n=~1100 but majority not informative re RT omission. Key group n=257, stage II/III <12cm from verge treated with upfront surg (MRF>1mm, no T4 or low T3, vast majority N≤1 & 6-12cm from verge) ➡️ 5yr LR 3.8%. No info re T3 substage/EMVI ascopubs.org/doi/full/10.12… #radonc