Ned Chen retweeted
Are you trying to make sense of conflicting data for treating oligometastatic lung cancers? Us too!
Here's a summary from our fellow Dr. Niall O'Dwyer: bmjoncology.bmj.com/content/…
Ned Chen retweeted
🚨Hungry for a new α/β study?🚨
🧪📉 We often quote α/β ratios in clinic as if they’re fixed truths — but where do those numbers actually come from?
This study compared in vitro vs. clinical α/β estimates across prostate, breast, and head & neck cancers and...
... they often do NOT match.
Key findings:
📍Prostate: in vitro α/β ~3.8 Gy vs clinical ~2.3 Gy
🦀Breast: fairly similar (~3.6-3.9 Gy)
🗣️H&N: clinical estimates actually HIGHER than lab estimates (~14 vs 9 Gy)
Why it matters for everyday radonc 👇
⚠️ The “standard” α/β assumptions we use for BED/EQD2 calculations, hypofractionation discussions, and protocol design may oversimplify real tumors.
🧬 Tumor heterogeneity, hypoxia, stem-cell populations, ADT, and the tumor microenvironment likely make clinical tumors behave very differently from cell lines grown in a dish.
💡 Practical takeaway:
When we debate fractionation schedules or compare regimens, remember that the radiobiology behind those BED calculations is probably messier than the spreadsheet suggests.
The paper also reinforces that the classic “10 Gy for most tumors” assumption likely doesn’t hold true for many disease sites. 📚
advancesradonc.org/article/S…
@ASTRO_org
Ned Chen retweeted
#EAU26 DRE not recommended for asymptomatic men. I could not agree more in era of MRI.
PRostate cancer guidelines 2026 update. Digital rectal exam NOW no more recommended for Asymptomatic men
SO NO MORE FOR Screening
Important for standing and for early diagnosis for SYMPTOMS only @Uroweb
Ned Chen retweeted
🚨 Practice-changing in head & neck cancer
Post-op cisplatin + RT has been the standard for 20+ years in high-risk resected LA-SCCHN.
🔬 NIVOPOST-OP (Phase 3) now shows that adding nivolumab significantly improves outcomes.
🧠 Study population
High-risk resected LA-SCCHN after surgery
High-risk features: ECE, positive margins, ≥4 nodes, multiple PNI
⚖️ Arms
🅰️ Cisplatin + RT
🅱️ Nivolumab + cisplatin + RT → adjuvant nivolumab
📊 Key results
✅ DFS benefit irrespective of PD-L1
HR 0.76 | p = 0.034
📈 3-yr DFS: 63.1% vs 52.5%
Main driver: ↓ locoregional relapse
⚠️ Toxicity
Grade 4 AEs higher with nivolumab (10% vs 5%)
Treatment-related deaths: no difference
💡 Why this matters
After multiple negative immunotherapy trials in LA-SCCHN, post-operative setting finally delivers.
🧭 Take-home
👉 Nivolumab + cisplatin-RT can be considered a new standard of care in high-risk resected LA-SCCHN.
📖 Full paper in comment ⬇️
#OncoTwitter #HeadNeckCancer #Immunotherapy #RadiationOncology @TheLancetOncol @OncoAlert @myESMO @ASCO
Ned Chen retweeted
Radiation oncology and biology dose thresholds, commonly tested on board exams.
I made this in 2016. I hope it helps current @ARRO_org @ASTRO_org residents taking #radonc exams.
Ned Chen retweeted
New out in @TheLancetOncol with Ted Schaeffer:
pubmed.ncbi.nlm.nih.gov/4103…
"Revisiting prostate cancer active surveillance candidacy"
A close look at the fallacy and risks of active surveillance (AS) in unselected intermediate risk (IR) men.
@wandering_gu @TylerSbrt
Ned Chen retweeted
Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?
mdpi.com/2812044
Ned Chen retweeted
🚫 In >2400 men with unfavourable risk #ProstateCancer, whole-pelvic RT (WPRT) ❌ did not improve 10-yr OS or DFS vs prostate-only RT (68% both arms).
🔹 PC-specific survival 98%
🔹 Slight ↓ in biochemical failure with WPRT
🔹 More grade 2 GI adverse events
⁉️how to reconcile with POP-RT trial in PSMA era? Lower risk cohort? #ASTRO25 #RadOnc
Ned Chen retweeted
🚨 From R-CHOP to CAR-T: The LBCL 2025 roadmap unveiled 📌 🩺📘
👥 Epidemiology & Heterogeneity
• LBCL = ~⅓ of adult lymphomas
• Includes: DLBCL NOS, PMBCL, testicular, CNS-risk, elderly
🧪 Diagnosis
🔹 Excisional biopsy + IHC (CD20, BCL6, MYC, BCL2, Ki67, CD10, MUM1, CD5)
🔹 FISH for MYC/BCL2/BCL6 → Double/Triple Hit ID
🔹 PET-CT = gold standard for staging & response
💊 First-Line (1L) Therapy
• Early (Stage I/II, low-risk):
– 4×R-CHOP ± PET-adapted → FLYER, S1001, LYSA LNH09-1B
• Advance (IPI 2–5):
– Pola-R-CHP > R-CHOP → POLARIX
• PMBCL:
– DA-EPOCH-R or R-CHOP14 (avoid R-CHOP21) → IELSG37
• Elderly ≥80 / unfit:
– R-miniCHOP → LYSA/GELA Phase II
⚠️ Special Scenarios
🧠 CNS prophylaxis only if high-risk (CNS-IPI ≥4, testis, breast, kidney, adrenal)
💥 Double/Triple Hit → DA-EPOCH-R, R-CHOEP, R-CODOX-M/IVAC (no benefit with Pola-R-CHP)
🔄 Relapsed / Refractory (~30–40%)
• <12 mo relapse:
– CAR-T gold standard → axi-cel (ZUMA-7), liso-cel (TRANSFORM)
• ≥12 mo relapse (fit):
– Re-induction (R-DHAP/R-ICE/R-GDP/R-ESHAP) → HDT + ASCT
• 3L+ options:
– CAR-T (if naïve)
– CD20×CD3 bispecifics (glofit, epco, odro)
– Tafasitamab-lenalidomide (L-MIND)
– Loncastuximab (LOTIS-2)
🧾 Follow-up & Survivorship
🔹 Close monitoring for 2 yrs (event-free = general population OS)
🔹 No routine surveillance PET
🔹 Manage long-term toxicities (cardiac ❤️, immune 🦠, neurocognitive 🧠)
📖 Thieblemont et al. HemaSphere 2025
🔗DOI: doi.org/10.1002/hem3.70207
#OncoTwitter #Lymphoma #HemOnc
@OncoAlert @myesmo @asco @HemaSphere @esmo_open @EHA_Hematology
Ned Chen retweeted
Hypo-fractionated RT at 45 Gy in 15 FX with concurrent chemo is not inferior to 60 Gy in 30 FX in limited-stage small cell lung ca for OS and PFS. Hematological toxicity is less in 15 FX. This opens the door for hypofractionated RT with chemo in modern era using IMRT. #WCLC2025
Ned Chen retweeted
Just in @JAMANetworkOpen 👉 In pt level data from two ph3 trials (n=2187) 👉statin use associated with ⬆️ OS in advanced #prostatecancer treated with apalutamide. Congrats @ziremozay and @Soum_Roy_RadOnc Free access👉 bit.ly/3HI1ZYJ @PCFnews @urotoday @OncoAlert
Ned Chen retweeted
🎯 3-Year OS Nearly Doubled: ACCORD Trial Delivers! @OncoAlert
🎯 Objective
Evaluate if adjuvant camrelizumab + capecitabine + ☢️ ⬆️ outcomes vs. observation after curative 🔪 for extrahepatic cholangiocarcinoma (EHC) & gallbladder cancer (GBC).
🏥 Methods
•Design: ACCORD RCT (2020–2022)
•Population: 93👥, resected EHC/GBC
•Intervention: Camrelizumab q3w → capecitabine + concurrent RT
•Control: Observation only
•Endpoints: OS (primary), RFS, safety
📊 Key Results
•OS @3y: 58% vs. 31% (HR 0.43; p=0.004)
•RFS @3y: 40% vs. 17% (HR 0.46; p<0.001)
•Well-tolerated; no treatment-related deaths
👉 This RCT delivers robust evidence for CRT + immunotherapy as adjuvant standard in resectable EHC/GBC‼️
Ned Chen retweeted
HA-PCI is a standard of care for Small Cell Lung Cancer
· Secondary endpoint positive
· Recommend HA-PCI w/ better cognitive outcomes & no diff OS/intracranial control
ascopubs.org/doi/full/10.120…
Ned Chen retweeted
📢🗣️ New trial analysis from #FASTRACKII: in kidney cancer, SABR ⬆️ efficacy and ⬇️ cost than radiofrequency or cryoablation #kcsm #radonc
🔹 QALYs: SABR 4.00 vs RFA/CA 3.07
🔹 Cost: SABR A$31,053 vs RFA A$35,001 vs CA A$36,356
🔹 Net savings ~$4K/patient
shorturl.at/b7ZOb
Ned Chen retweeted
DADSPORT meta-analysis investigated ADT in post-op RT for nonmet prostate cancer
➡️Short or long ADT after postop RT ⬆️ MFS and PCSS.
➡️No clear benefits of OS when ADT is added.
➡️Potential benefit of ADT on OS confined to pts with higher pre-RT PSA
sciencedirect.com/science/ar…
Ned Chen retweeted
Great paper on unilateral vs. bilateral TORS for tonsillar SCC, featured in @QuadShotNews
Contralateral tonsillar primaries: <2%.
Post-op bleeding rate: 7% unilateral vs. 15% bilateral
G-tube rate at last follow-up: 8%
Peri-op MDADI scores: fell from high 80's to mid 70's.
Ned Chen retweeted
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/ar…
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
Ned Chen retweeted
🚨NEW in @CACancerJournal:
A comprehensive review of advances in hepatocellular carcinoma (#HCC) therapy. From surgery to IR to SBRT to immunotherapy, this is your clinical update
🧵
@NiuSanford @nbn426 @KrishanJethwa @safaviaa @ldawsonmd @aallam_mo @freddyeescorcia @5_utr
Advances in the treatment of hepatocellular carcinoma: An overview of the current and evolving therapeutic landscape for clinicians @CACancerJournal @michael_lidsky acsjournals.onlinelibrary.wi…
Ned Chen retweeted
Real-world data on 1323 EGFR+ NSCLC pts on 1L osimertinib:
• Median OS: 28.6 mo
• High-risk pts:
- TP53: 25.7
- Brain mets: 24.3
- Liver mets: 19.3
- ECOG ≥2: 18.1
This isn’t good enough. Patients & families deserve more.
sciencedirect.com/science/ar…
