PDBrown @PDBrownOnc Twitter profile

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PDBrown

@PDBrownOnc

9 months

NCCN CNS guidelines update 2023 · Higher dose 59.4–60Gy for IDH wild-type LGG or CDKN2A/B deleted, IDHm LGG · Gr2 meningioma STR or recurrent higher RT doses (59.4–60Gy) · Consider preOp SRS for brain met select cases to reduce risk meningeal recurrence

NCCN CNS tumor guidelines update for 2023

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 33 National Cancer Institute designated Comprehensive Cancer Centers ded

academic.oup.com

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PDBrown

@PDBrownOnc

1 year

Does WBRT “age” the brain? Anatomic surface-based deep learning to estimate brain age w/MRI before & after WBRT WBRT aged brain 9x faster than controls WBRT hippos aged 9x faster than HA-WBRT SRS alone NOT diff compared to controls

Whole-brain radiotherapy associated with structural changes resembling aging as determined by...

AbstractBackground. Brain metastases are the most common intracranial tumors in adults and are associated with significant morbidity and mortality. Whole-b

academic.oup.com

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PDBrown

@PDBrownOnc

8 months

Examples of target volume delineation errors for GBM, some egregious A common error: crossing the tent with a supratentorial tumor, refer to coronals to help prevent this

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PDBrown

@PDBrownOnc

1 year

Radiotherapy and radiosurgery for meningiomas

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PDBrown

@PDBrownOnc

1 year

Final Results CC001 Addition HA to WBRT+memantine · Prevented cognitive failure (HR 0.74,p=0.016) · Less symptom burden 6 & 12 mos · Less symptom interference 6 & 12 mos · Fewer cognitive symptoms overtime · NO diff OS, PFS, Toxicity

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PDBrown

@PDBrownOnc

2 years

Dose escalation #GBM trial POF study @StanfordRadOnc • #SRS 25-40 Gy/5 T1gad+cavity+ 5mm •Max PTV 150cc •Marginal: 4% may have benefitted from standard 20mm margin •OS Distant>Marg>In-field recurrence Supports thoughtful decrease magins #radonc

Patterns of Progression in Patients With Newly Diagnosed Glioblastoma Treated With 5-mm Margins in...

In patients with newly diagnosed glioblastoma (GBM), tumor margins of at least 20 mm are the standard of care. We sought to determine the pattern of tumor progression in patients treated with...

www.practicalradonc.org

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PDBrown

@PDBrownOnc

1 year

What is memory-avoidance WBRT? Avoidance of hippocampus, corpus callosum, fornix, & amygdala

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PDBrown

@PDBrownOnc

1 year

Newly diagnosed GBM 12 cycles vs 6 cycles Temozolomide, is more better? The answer is NO

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PDBrown

@PDBrownOnc

1 year

Regardless it is all vanity. Everyone is precious, almost certainly not special Just do your best and make the world a better place

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PDBrown

@PDBrownOnc

1 year

There is no such thing as a famous rad onc I could not name the most famous living rheumatologist or cardiac surgeon even though they are likely a big deal and I work in the medical field

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PDBrown

@PDBrownOnc

11 months

ASTRO PLENARY Session LBA 04 Randomized trial PCI vs HA-PCI: HA-PCI is a standard of care for Small cell lung cancer

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PDBrown

@PDBrownOnc

1 year

Practice Changing Trial BRAF & MEK inhib newly diagnosed Papillary Craniopharyngiomas · 94% response rate, vast majority durable · Future less aggressive surgery · ?? adjuvant vs salvage RT

BRAF–MEK Inhibition in Newly Diagnosed Papillary Craniopharyngiomas | NEJM

Craniopharyngiomas, primary brain tumors of the pituitary–hypothalamic axis, can cause clinically significant sequelae. Treatment with the use of surgery, radiation, or both is often associated wit...

www.nejm.org

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PDBrown

@PDBrownOnc

1 year

Good review of vestibulocochlear delineation & tips for contouring

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PDBrown

@PDBrownOnc

1 year

Does Pseudoprogression occur after spine met SBRT? Yes, 16% of time after SBRT · Transient ↑ signal abnl centered @ treated lesion followed by signal improvement on FU MR imaging not attributable to systemic therapy

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PDBrown

@PDBrownOnc

1 year

Progressive brain met after SRS, often resection is indicated Is risk recurrence high after GTR of progressive brain met? YES, 40% local failure even after GTR of tumor Adjuvant RT indicated following salvage resection even after GTR

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PDBrown

@PDBrownOnc

1 year

70 SCLC w/337 brain mets treated SRS One-year CNS control rate: · 39% 1-2 Brain mets · 28% 3-5 Brain mets · 0% > 5 Brain mets! Pertinent Ongoing Trial: NRG CC009 SCLC 1-10 brain met HA-WBRT vs SRS

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PDBrown

@PDBrownOnc

1 year

IDHm week 5/5 What is T2-FLAIR Mismatch Sign?

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PDBrown

@PDBrownOnc

8 months

Frankincense week 1/4 50 patients Gr1-3 RN after SRS for brain mets · Treated Boswellia Serrata 4.2-4.5g/day in divided doses · >50% response rate · 1/3 w/ symptomatic RN able to avoid steroids · 6% Gr1-2 GI (diarrhea)

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PDBrown

@PDBrownOnc

2 years

Congrats #NRGonc landmark trial RTOG 0539 •Grade 1 #meningioma S/P GTR or STR •Central review 10 yr Prog Rate after GTR 3%, STR 27% •Increasing tumor size assoc with worse PFS, OS •Typically no role adjuvant RT in this population #radonc #roedu

Low-risk meningioma: Initial outcomes from NRG Oncology/RTOG 0539

AbstractBackground. Three- and five-year progression-free survival (PFS) for low-risk meningioma managed with surgery and observation reportedly exceeds 90

academic.oup.com

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PDBrown

@PDBrownOnc

1 year

Review SBRT for spine metastases · Radiation Myositis 2% @ 1 yr · ↑↑ risk myositis w/ Single-fraction spine SBRT · If myositis occurs no established standard, many treat w/ 1-2 week course steroids

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PDBrown

@PDBrownOnc

1 year

Putting Indigo Trial PFS benefit in context: · EORTC 22845 different era · RTOG9802 control arm ACTIVE treatment (RT as opposed to placebo) · RTOG9802 Chemo&RT PFS benefit ↑ if exclude IDHwildtype · After Vorasidenib resistance is Salvage Chemo&RT less effective?

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PDBrown

@PDBrownOnc

1 year

RTOG 0631 Randomized Trial · Primary Endpoint Pain Response 3 mos favors EBRT61% vs SBRT 41% · Poor Pain Scale completion rates 63% @ 3 mos · NO diff QOL, adverse effects · 2 yr Vert compression fracture EBRT 22% vs 20% via @JAMAOnc part of @JAMANetwork

Radiosurgery of Spine Metastasis—NRG/RTOG 0631 RCT Final Results

This randomized clinical trial assesses whether patient-reported pain relief was improved with stereotactic radiosurgery compared with conventional external beam radiotherapy for patients with 1 to 3...

jamanetwork.com

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PDBrown

@PDBrownOnc

2 years

Interesting study RT margins 207 patients #GBM by Minniti et al •Replanned with reduced GTV-to-CTV margin 1cm •Compared to standard 2 cm margin similar pattern of failure and less RT normal brain, hippos •Link: #radonc #roedu

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PDBrown

@PDBrownOnc

1 year

Post element only spine met SBRT, do you need to include the vertebral body? 31 cases SBRT post elements only NO isolated vertebral body failures Supports SBRT Consensus Contouring Guidelines

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PDBrown

@PDBrownOnc

2 years

Landmark trial RTOG1205 reirradiation recurrent #GBM •Small GTVs 18 cc •80% 1st relapse •Significant PFS benefit, important clinically if options limited •No OS benefit possibly due to salvage RT on Bev alone arm •Link: #roedu

NRG Oncology/RTOG1205: A Randomized Phase II Trial of Concurrent Bevacizumab and Reirradiation...

PURPOSE To assess whether reirradiation (re-RT) and concurrent bevacizumab (BEV) improve overall survival (OS) and/or progression-free survival (PFS), compared with BEV alone in recurrent glioblast...

ascopubs.org

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PDBrown

@PDBrownOnc

6 months

Paraganglioma week 1/6 Case based reviews In my practice: · rarely/never biopsy (bleed risk) · SRS (15 Gy) for smaller lesions, large lesions 45-50.4 Gy · Surgery consider if already CN deficits/low risk

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PDBrown

@PDBrownOnc

10 months

Bone Met week 4/5 Any benefit RT for asymptomatic high-risk bone mets? Randomized Trial Prophylactic RT less skeletal events/hospitalizations (& improved OS) compared to standard of care (SOC)

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PDBrown

@PDBrownOnc

10 months

Physicians & other overachievers always thinking about next task, not living in moment, WAKE UP or you will miss life

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PDBrown

@PDBrownOnc

10 months

Bone Met week 2/5 Post-op RT after surgical stabilization, should you treat entire hardware? YES

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PDBrown

@PDBrownOnc

2 years

Interesting study from #MDACC I use this regimen for radioresistant osseous #metastases too extensive for #spine #SBRT #IMRT #roedu #radonc

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PDBrown

@PDBrownOnc

1 year

Reminder for IDHmutant glioma homozygous deletion CDKN2A/B makes it grade 4 (WHO CNS-5)

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PDBrown

@PDBrownOnc

1 year

Meta-analysis T-DM1 w/RT · 17% Gr3+ brain radionecrosis w/SRS & T-DM1 · Risk seems to be increased if concurrent (e.g. w/in 1 week)

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PDBrown

@PDBrownOnc

1 year

Does molecular GBM have better prog compared to histologic GBM? NO, according to this Dutch study Compared histologically&imagingGr2/3 but molecular GBM to histologic GBM

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PDBrown

@PDBrownOnc

1 year

In GBM is there a role for “supramaximal” resection of FLAIR/T2 tumor beyond contrast enhancing tumor? · RANO resect group study would suggest YES · Thought provoking study difficult to tease out inherent selection bias (favorable location, smaller tumor)

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PDBrown

@PDBrownOnc

1 year

Is there tumor control benefit adjuvant RT compared to salvage RT after GTR Grade 2 Meningioma? Large Canadian Study Yes

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PDBrown

@PDBrownOnc

1 year

Excellent editorial on thoughtful use of smaller margins for GBM @DanTrifMD @MichaelTMilano @KristinRedmond2 Dr. Pollum @JHGLab @MichelleMKimMD

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PDBrown

@PDBrownOnc

8 months

Does MGMT status predict outcome for Gr2/3 Astrocytoma? YES for IDHwt NO for IDHm

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PDBrown

@PDBrownOnc

1 year

Incidental meningioma high risk features: · Lack of calcification · Hyperintense T2 signal · Edema · Large tumor (>10 cc)

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PDBrown

@PDBrownOnc

7 months

In modern era does PCI improve OS in Small Cell Lung Cancer? YES in both limited & extensive stage in this meta-analysis In subset of trials w/MRI screening pre-PCI, Suggestion OS benefit in limited stage

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PDBrown

@PDBrownOnc

1 year

Meta-analysis Tumor Treating Fields (TTF) 9 studies, 1430 pts GBM · Median OS 23mos w/TTF vs 17 mos w/o · Usage rate ≥75% associated ↑OS

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PDBrown

@PDBrownOnc

2 years

#RCT GK vs. Linac #SRS #brain #metastasis NO diff LC, DBF, OS Surprisingly no diff #radiation #necrosis despite higher doses & target volumes 7x larger due to PTV on Linac arm Many use SIMT now for Linac SRS

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PDBrown

@PDBrownOnc

1 year

Excellent review SRS for Functional Disorders · Epilepsy · Tremor · Trigeminal neuralgia · OCD · Intractable pain · hypothalamic hamartoma associated epilepsy median 17 Gy

Safety and efficacy of Gamma Knife radiosurgery in hypothalamic hamartomas with severe epilepsies:...

Epilepsies associated with hypothalamic hamartomas (HHs) are frequently drug resistant with severe psychiatric and cognitive comorbidities. We performed a prospective trial to evaluate the safety...

onlinelibrary.wiley.com

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PDBrown

@PDBrownOnc

5 months

Review Hypofrac SRS Brain Mets

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PDBrown

@PDBrownOnc

11 months

ASTRO ( #264 ) Randomized Trial Different RT Techniques High Grade Glioma · No Diff PFS, OS, Toxicity · Would be most interested in cognitive testing if prospectively acquired

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PDBrown

@PDBrownOnc

1 year

Multicenter RCT Dose Escalation MR Spec for GBM · No OS, PFS benefit, or increased toxicity

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PDBrown

@PDBrownOnc

2 years

Incredibly thoughtful editorial balancing tumor control and risks The Art of Radiation Therapy: The Necessary Risk of Radiation Necrosis for Durable Control of Brain Metastases #roedu #brainmet #radiosurgery

The Art of Radiation Therapy: The Necessary Risk of Radiation Necrosis for Durable Control of Brain...

One of the greatest challenges in radiation oncology is selecting the “optimal” radiation dose and weighing the benefits and risks of our choices. Higher doses generally increase both tumor control...

www.redjournal.org

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PDBrown

@PDBrownOnc

8 months

Melanoma Brain Mets: Reminder T1 WITHOUT contrast often helpful to identify mets

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PDBrown

@PDBrownOnc

1 year

Do osteolytic spine mets "stabilize" after RT?

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PDBrown

@PDBrownOnc

1 year

Randomized Trial Vestibular Schwannoma -No diff outcomes hearing, QOL, equilibrium between SRS or observe arm

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PDBrown

@PDBrownOnc

7 months

RT treatment LMD · CSF tumor cell count # Before & After RT prognostic · CSF tumor cell count # ↑↑ after focal RT & ↓↓after proton CSI Pertinent trial in development:

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PDBrown

@PDBrownOnc

11 months

ASTRO Late-Breaking Abstract (LBA13): Randomized Trial fSRS vs WBRT Resected Brain Met · Excellent Surg Bed Control w/fSRS · LMD rate w/fSRS similar to post-op single frac SRS

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PDBrown

@PDBrownOnc

2 years

MetaAnalysis #SBRT vs CRT #bone #metastasis SBRT better pain relief, less benefit w/ elevation BED Local Control (primary reason for SBRT) best assessed by CCTG SC.24

Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy in Pain Relief for Bone...

This study aimed to investigate the difference in pain relief between stereotactic body radiation therapy (SBRT) and conventional radiation therapy (cRT) for patients with bone metastases.

www.redjournal.org

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PDBrown

@PDBrownOnc

1 year

What are the cognitive outcomes for glioma w/ modern focal RT? · Prospective Study F/U up to 11 years! · Stable w/some improvement · Despite more aggressive tumors outcomes comparable to Watchful-Waiting cohort

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PDBrown

@PDBrownOnc

1 year

Cross-FIRE study 6,500+ patients brain mets 1st-line SRS SCLC vs SRS in NSCLC · SCLC worse Median OS · SCLC earlier 1st CNS progression Pertinent Ongoing Trial: NRG CC009 SCLC 1-10 brain met HA-WBRT vs SRS

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PDBrown

@PDBrownOnc

1 year

Large cranial targets should fSRS be used? Duke study 445 patients brain met 5 fraction SRS 25-30Gy Median diameter dominant lesion 3 cm intact & 4.6 cm resected 1 yr LC 86% Gr 2+ radionecrosis 8%

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PDBrown

@PDBrownOnc

1 year

Indigo RCT first breakthrough LGG since RTOG9802 · Crossover allowed so prob won’t be survival benefit · Vorasidenib can delay RT&Chemo · Would upfront Vorasidenib with RT & Chemo improve outcomes?

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PDBrown

@PDBrownOnc

5 months

METIS positive randomized trial! Met Primary Endpoint Tumor Treatment fields significantly delay time to intracranial progression

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PDBrown

@PDBrownOnc

9 months

Review LDRT osteoarthritis

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PDBrown

@PDBrownOnc

11 months

Definitive Single Frac SBRT Spine Chordoma & Chondrosarc · 5 Yr LC 90% · Small series (22 lesions) · Alternative for selected cases?

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PDBrown

@PDBrownOnc

11 months

Prospective registry meningioma 68Ga-DOTATATE PET · 60 pts · Early F/U median 20 mos · 2 of 3 local failures had PET-avid disease post-op & had elected observation · 5 pts no PET uptake & observed no recurrences

A Prospective Registry Study of 68Ga-DOTATATE PET/CT Incorporation Into Treatment Planning of...

The current standard for meningioma treatment planning involves magnetic resonance imaging–based guidance. Somatostatin receptor ligands such as 68Ga-DOTATATE are being explored for meningioma...

www.redjournal.org

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PDBrown

@PDBrownOnc

10 months

Bone Met week 3/5 Post-op RT after surgical stabilization long bones, should you treat entire hardware? YES

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PDBrown

@PDBrownOnc

2 years

Dosimetric predictor cognitive decline #Cross Cancer Institute #randomized trial #GBM •Significant decline #MMSE if Mean Dose L Hippo >30Gy Conventional or >25Gy Hypofrac •Sparing L hippo may be particularly important #radonc #roedu #Hippocampal

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PDBrown

@PDBrownOnc

10 months

Bone Met week 1/5 Is there benefit for post-op RT after stabilization of pathologic fractures? YES

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PDBrown

@PDBrownOnc

1 year

95% papillary craniopharyngiomas have BRAF V600E mutations Vemurafenib/cobimetinib BRAF/MEK inhibitor 7 patients had no local consolidation after BRAF/MEK inhibitor therapy, 6 of them have not progressed

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PDBrown

@PDBrownOnc

1 year

#ASCO23 PLENARY: Indigo RCT Improved PFS w/ Vorasidenib for IDHmutant low-grade glioma!

Vorasidenib in IDH1- or IDH2-Mutant Low-Grade Glioma | NEJM

Isocitrate dehydrogenase (IDH)–mutant grade 2 gliomas are malignant brain tumors that cause considerable disability and premature death. Vorasidenib, an oral brain-penetrant inhibitor of mutant IDH...

www.nejm.org

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PDBrown

@PDBrownOnc

1 year

New (RANO) surgical classification system based on resection of BOTH contrast enhancing & FLAIR/T2 predicts survival · Inherent selection bias between classes · Prognostic value RANO classes retained in multivariate model

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PDBrown

@PDBrownOnc

1 year

Meningioma ANOCEF guidelines: For All grades IMRT or SRS GTV includes: · Nodular dural enhancement · Thickened meninges · Invaded bone 1/4

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PDBrown

@PDBrownOnc

1 year

Is fractionated SRS as good as single frac SRS for meningiomas? Possibly Yes. Meta‑analysis No diff in 5 yr LC (93-94%) or Complication rate despite FSRS signif larger volumes 24 cc vs 6 cc #radonc

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PDBrown

@PDBrownOnc

1 year

Meningioma cognitive outcomes • #BTSM mean dose hippocampus correlates w/hippo volume loss •Signif atrophy if mean >40Gy but NOT if low dose (<10Gy) #radonc

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PDBrown

@PDBrownOnc

1 year

Is concurrent ICI & SRS safe? 657 pts w/ brain mets SRS & concurrent OR nonconcurrent ICI · SRS + concurrent immuno NO increase risk RN · V12 predictive RN

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PDBrown

@PDBrownOnc

2 years

Insightful review recurrent #GBM Drs. Knisely & Fine •Provides clinical context landmark trial #NRGonc RTOG1205 •Table 1 good guidance reRT/no RT •In select cases I reRT only prog tumor & exclude tumor that has been stable on several serial MRIs

Reirradiation for Recurrent Glioblastoma: What We Know and What We Do Not | Journal of Clinical...

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management...

ascopubs.org

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PDBrown

@PDBrownOnc

8 months

Frankincense Week 4/4 3 patients S/P SRS tx’d steroids, pentoxifylline, Vit E w/recurrent symptoms & worse imaging · Treated 5-Loxin-AKBA Boswellia Extract 150 mg BID w/fatty snack · All resolution symptoms/imaging changes & D/C steroids

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PDBrown

@PDBrownOnc

1 year

In MRI era, is there survival benefit w/ PCI for LS-SCLC? 327 patients CR/PR after chemo RT w/brain MRI 32% refuse PCI Better OS & Brain Met Free w/PCI Pertinent ONGOING trial MAVERICK (S1827) MRI surveillance +/- PCI

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PDBrown

@PDBrownOnc

1 year

If asked Med Oncs to name 5 most famous living radoncs they couldn’t do it & likely would not recognize the names. Prob best ticket to being well known is NOT good clinical care/scientific achievement but is large social media presence w/ good content & controversial comments.

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PDBrown

@PDBrownOnc

7 months

Case based review SRSbrain metastases · 1st case multiple brain mets (7)SRS 20 Gy · Rec’d total met volume <15cc · Pertinent ongoing trial mult brain mets CE.7 SRS vs. HA-WBRT+memantine

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PDBrown

@PDBrownOnc

2 years

T2-FLAIR Mismatch Sign for IDHmutant #Astrocytoma Gr2+3 (noncodel) •T2 homogenous hyperintense signal; FLAIR decreased core signal vs hyperintense rim •Highly Specific IDHm (nearly 100% in ADULTS) •Low sensitivity • #radonc

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PDBrown

@PDBrownOnc

11 months

What is role resection Elderly GBM? Trial closed due to futility No diff OS, resection small improvement PFS, improved KPS

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PDBrown

@PDBrownOnc

10 months

Bone Met week 5/5 Any benefit RT for Asymptomatic bone mets? · Median time to Mod/Severe pain or SRE: 81 mos EBRT vs 25 mos SOC

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PDBrown

@PDBrownOnc

2 years

Inspired to review ROSE trial by @DanTrifMD et al •Seizure control with #SRS takes 1-3 yrs, immediate with #lobectomy •Overtime worse verbal #memory with lobectomy 57% vs 36% • #radonc #epilepsy

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PDBrown

@PDBrownOnc

8 months

Frankincense week 2/4 Radiation Brain Edema RCT

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PDBrown

@PDBrownOnc

1 year

5 patients Early Alzheimer’s dementia Low Dose WBRT 10Gy/5 4/5 improved/stable MMSE-2 Tscores @ 1 yr 3 patients w/improved MMSE-2 Tscores ↑ to average range Other cognitive assessments broadly stable or mildly declined over time

Low-Dose Whole Brain Radiation Therapy for Alzheimer's Dementia: Results From a Pilot Trial in...

We report neurocognitive, imaging, ophthalmologic, and safety outcomes following low-dose whole brain radiation therapy (LD-WBRT) for patients with early Alzheimer dementia (eAD) treated in a pilot...

www.redjournal.org

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PDBrown

@PDBrownOnc

1 year

PCI & ESSCLC Canadian consensus recommendations: If Respond to concurrent chemo-immunotherapy should: · Undergo restaging brain MRI · RadOnc consult · If good PS consider PCI Pertinent ONGOING trial MAVERICK (S1827) MRI surveillance +/- PCI

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PDBrown

@PDBrownOnc

2 years

Phase 2 trial large or critical-site 178 grade 1 #meningioma #SRS 25Gy/5 +0mm margin (Milan) •Median volume 10.5cc •53 mo F/U •5yr LC 97% •55% improvement #cranial #nerve deficit •Link: I may start using this regimen

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PDBrown

@PDBrownOnc

1 year

Review SCLC • Chemo responsive ESSCLC, brain MRI before PCI 16% have brain met! • Immuno may reduce brain met rate (CASPIAN, IMpower133) • Pertinent ONGOING trial MAVERICK(S1827) MRI surveillance +/-PCI

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PDBrown

@PDBrownOnc

1 year

Local failure after spine SBRT, can you use conventional re-irradiation for salvage? #radonc

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PDBrown

@PDBrownOnc

1 year

IDH Wildtype Astrocytoma, does isolated TERT Promoter Mutation in histologic Grade 2 equate to GBM prognosis? Probably NOT, isolated TERT have better prognosis

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PDBrown

@PDBrownOnc

1 year

DOTATATE PET PostOp Meningioma altered treatment plans 5/12 patients

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PDBrown

@PDBrownOnc

1 year

ASCO 2023: Elderly patients GBM 18F-DOPA PET Targeted Proton Dose Escalation w/TMZ · Primary endpoint met median PFS/OS 7/13mos · 13% Gr3 radiation necrosis · PET volume more predictive OS than MRI volume · QOL outcomes compare fav to other elderly GBM trials

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PDBrown

@PDBrownOnc

1 year

@NataliyaMedPhys LOL you are too kind, thank you. Prob the only renown CNS rad onc is Minesh. My family likes & loves me, I have good relationships w/most my colleagues, and I take good care of patients that is all that really matters

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PDBrown

@PDBrownOnc

2 years

Concise review #Glioma Vaccines Tcells DO home to CNS •Think #immuno & brain mets Antigen clonality & function matter •EGFRvIII subclonal & vaccines failed to date •IDH clonal & being tested •SurVaxM (survivin) promising Phase II @BrainTumorDoc

Vaccines Targeting Gliomas: Antigens Matter | Journal of Clinical Oncology

ascopubs.org

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PDBrown

@PDBrownOnc

2 years

Thoughtful review single vs. multi fraction #SBRT •SF potential better LC radioresis, less financial toxicity •MF potential immunogenicity, less geographic miss, OARs • #MSKCC trial not reviewed

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PDBrown

@PDBrownOnc

11 months

On topic of Rad Onc Locums, Why is the daily pay in 2023 the same as in the 90s?

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PDBrown

@PDBrownOnc

1 year

#SRS treatment option Vestibular #Schwannoma in #NF2 Tumor control lower than Sporadic (i.e. >90%) •Possibly due to lower dose? Each Gy increase 21% ↓ risk prog •BUT each Gy increase 1.5-fold ↑ risk hearing loss #radonc

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PDBrown

@PDBrownOnc

1 year

Randomized Phase 2 Dose Escalation GBM

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PDBrown

@PDBrownOnc

2 years

Kudos Dr. McGovern and team #prospective trial conventional fractionation re-RT #brain tumor •Essentially keep max dose non-target brain composite plan approx. <EQD2 of 100 Gy •Table 1 good reference dose constraints #radonc #roedu

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PDBrown

@PDBrownOnc

1 year

DYK any meningioma w/ TERT promoter mutation and/or CDKN2A/B homozygous deletion is a WHO grade 3 (WHOCNS5)

The 2021 WHO Classification of Tumors of the Central Nervous System: a summary

Abstract. The fifth edition of the WHO Classification of Tumors of the Central Nervous System (CNS), published in 2021, is the sixth version of the interna

academic.oup.com

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PDBrown

@PDBrownOnc

10 months

When spending time w/family are you present? Or occupied w/clinic, projects, meetings?

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PDBrown

@PDBrownOnc

2 years

Research letter #Leptomeningeal #Metastases •Reviewed 244 phase 3 trial mets breast, lung, melanoma •Only 3% explicitly allowed #LMD enrollment •Need to improve outcomes •Encourage inclusion LMD in clinical trials via @JAMAOnc part of @JAMANetwork

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PDBrown

@PDBrownOnc

1 year

Dr. Sujay Vora presenting at #ASCO23 Phase II 18F-DOPA-PET/MRI 5 or 10 fraction proton beam w/TMZ elderly patients newly diagnosed GBM. Abstract #2002

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PDBrown

@PDBrownOnc

1 year

Is Myelogram required to delineate cord for spine SBRT? Maybe not if visualization cord feasible w/MRI 75% had hardware Mean diff btwn Myelogram & fused T2 axials only 0.06cc T2 may slightly overestimate cord at cord-CTV interface #radonc

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