Pablo Munoz Schuffenegger

Why TTNT matters: Patients often care about staying on a working therapy longer and avoiding the next line, which may be more toxic or less effective. That benefit can be clinically meaningful even if classic PFS looks unimpressive.

Important shift in oligoprogression research: Chang. David. Widder. Different papers, same theme: Classic RECIST-defined PFS may underestimate the real-world value of serial SBRT/MDT. The endpoint has to match the treatment strategy.

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.

You'll recognize a few names on this author list! @AgrawalAmiya @CJTsaiMDPhD & team show us that palliative RT is undergoing a major evolution ⚡️—from symptom relief ➡️ a multidisciplinary, precision-driven discipline with a dedicated workflow! What’s changing? 🧠 Team-based care is central: #radonc + physicists + advanced practice RTTs + NPs + supportive care = more personalized, efficient & safer treatment decisions ⏱️ Rapid-access clinics ✔️ Referrals seen within ~24 hrs ✔️ “One-stop” visits: consult + simulation same day ✔️ Fast-track pathways deliver RT within hours for pain crises 🚀 Workflow innovation ✔️ Simulation-free RT using recent diagnostic CTs ✔️ Single-fraction treatments (8–20 Gy) ✔️ Fewer hospital visits + faster symptom relief 🎯 Better technology = better care ✔️ IMRT/VMAT + SBRT improve conformality ✔️ Reduce toxicity to normal tissues ✔️ Enable safer re-irradiation & hypofractionation 👩‍⚕️ Advanced providers expand capacity ✔️ pAPRTs: contouring, planning, workflow leadership ✔️ NPs: toxicity management, follow-up, continuity ✔️ Earlier detection of complications + improved experience 🔬 Not just care—innovation hub ✔️ Trials reducing skeletal events with prophylactic RT ✔️ Survival gains (e.g., proton CSI in leptomeningeal disease) 🚨Bottom line: Palliative RT is no longer just supportive care—it’s fast, adaptive, multidisciplinary, and increasingly impactful on outcomes and quality of life 💡 @ASTRO_org advancesradonc.org/article/S2452-…

And now… ChatGPT for clinicians is here. These tools are useful (but not always right). As @VincentRK @Papa_Heme and @drsarahsam have said before, LLMs/AI won’t replace clinical judgment or the human touch, they make them even more essential. #MedTwitter #OncTwitter

🩻🦴SBRT vs conv EBRT → fracture risk? This comes up a lot at QA rounds. A recent review @JAMANetworkOpen was helpful: based on available RCTs, there appears to be no diff in fracture rates. SC.29 (led by @SahgalArjun @CDNCancerTrials) may add further insight.

Just released! Volume 2 of SBRT: From Clinical Trials to your Clinic in @IJROBP Truly amazing papers from end to end. Have a look at the issue highlights here. redjournal.org/issue/S0360-30…

Phase 2 RT trials often “succeed” but rarely translate. Of coop group trials, 54% met endpts, but only 17% advanced to Ph3. We propose strategies to better align Ph2 design w decision-relevant outcomes Paper out w @DavidSherMD in @JCOOP_ASCO. @OncoAlert ascopubs.org/doi/10.1200/OP…

📌 Top 10 Tips for Stereotactic Body Radiation Therapy Contouring and Planning in Oligometastatic Disease: Lessons Learned From the UK SBRT QA Program ☢️ 🔗 sciencedirect.com/science/articl… @OncoAlert #OncoAlertAF @IJROBP @fifimcdrmh @royalmarsdenNHS 
🔹Standardize definitions.
🔸 Optimize use of supporting imaging. 🔹 Motion management. 🔸 Optimize patient preparation. 🔹 Use all available TPS tools to optimize contouring. 🔸 Check auto-contouring output. 🔹 Appropriate use of OAR dose-volume constraints. 🔸 Maximize PTV coverage. 🔹 Conform tightly to the PTV. 🔸 Managing multiple lesions.

🚨Save the date! @PeterMacRadOnc SABR symposium #SABR2026 - Nov 20th-21st - another all 🤩⭐️star cast of international keynotes; @HoudaBahig @DrMLChua Stefanie Corridini @PattyDiezH @drdavidpalma sabrsymposium.com/so/19POI-P9R?l…

An honor to be part of this consensus statement from the @IASLC Advanced Radiation Technology Subcommittee @JTOonline on radiotherapy to the primary tumor in stage IV NSCLC, led by Drs. Ryan McMahon and @_ShankarSiva. Is it time to rethink management of metastatic lung cancer?

🥳 we are hiring! The @PeterMacRadOnc @pros_tic TheraRAD fellowship is a new, unique position research-based clinical fellowship under @DrMHofman ProsTIC and I. All things ☢️ Theranostics and ⚡️ #radonc PLEASE spread the word 🙏🏽🙏🏽🙏🏽 applications here; ⬇️ careers.petermac.org/job/MELBOURNE-…

Here is Version 2.0 of when to hold systemic tx during RT. Updated & w 3 additional drug categories (ADCs, CDK4/6 inhibitors, PARPi). More details on newer drugs in 🧵 below. Please use this version as reference & thanks for all input/experience crowdsourcing! (1/3)

If you're interested in SABR, check out this interview with 3 of the OG SABR pioneers in the @ijrobp special issue: Drs. Hiroshi Onishi, Suresh Senan, and Robert Timmerman. sciencedirect.com/science/articl…

🎉 After 3 yr of work, our paper is finally accepted in @IJROBP! authors.elsevier.com/sd/article/S03… MDT for breast OMD remains highly controversial — NRG-BR002, CURB, and EXTEND all came back negative. So we asked: What actually happens when MBC progresses and can ctDNA predict it?

Happy to share this interactive contouring tutorial for dose-escalated RT in locally advanced pancreas ca, which follows our NRG consensus contouring atlas. Thank you @johnroubil, @dsouzl, @aiims2738, & the @eContourRadOnc team for working on this case! econtour.org/cases/180

Someone suggested I make a table summarizing the video. Here it is!

Have you ever wondered whether you need to hold systemic during RT due to concern for additive toxicity? See this 10 min video. Categorized by systemic type (cytoxic chemo, IO, TKI, BRAF, etc) & RT regimen (SBRT/conventional/palliative) Slides🧵& full video below. 1/8

Acompáñanos al primer journal club en español organizado por el comité internacional de @ASTRO_org el 25 de Marzo. Estaremos discutiendo PACE-B con @aleberlin2. Inscríbete usando el QR code adjunto

After going sub-3 in Berlin, Harry Styles isn't slowing down. The global pop superstar chats with legendary author and fellow marathoner Haruki Murakami on the sublime simplicity of running—and how it nourishes the creative life. Read our latest Runner’s World cover story: runnersworldmag.visitlink.me/8Y7-Os