TCa Day 23
BEP for advanced seminoma works like a charm... Mostly.
Occasionally CVS toxicity rears it's ugly head.
50y had acute MI post 1# BEP.
Mass down from 8 cm to 3cm.
Rest polished off by 36Gy. NED 3y on.
We have a small series now. 😊
Anyone else faced this?

Excellent Summary video Guncha. What's better than a bit of Red #redjournal IJROBP - The Red Journal to beat the blues.

Huge congratulations for the work and everything else. 😊

Vedang Murthy UK will launch a randomized trial which includes PLND/pelvic RT based on data driven by Indian POP-RT trial.
How about join hands or do similar. After all, we are world's PSMA capital! Clinical trials need a dose of steroids with Indian volumes
Hashim U. Ahmed

pradeep reddy Filippo Alongi Sean Collins Prostate SBRT@Georgetown University Journal of Clinical Oncology Sushil You are right. We should go by vascular anatomy. That works well for superior extent of nodes. For inferior extent, vessels become blurry and many end up contouring too low. This can increase dose to trigone and neck with toxicity

Hence this work to standardise lower border. 😊

Vedang Murthy Priyamvada Maitre 💙alison birtle Robert Huddart💙 Couldn't agree more, although a positive biopsy with seminoma would have been nicer. One issue about 'fear with 30 Gy IFRT' may be volumes. In the past, these pts often received the full hockey-stick, just like the urologists would do 'the full RPLND'. I'd treat just the node.

💙alison birtle Robert Huddart💙 That SUVmax will entail an approx 35pc risk of relapse.

2nd line chemo for those unfortunate to relapse not a cakewalk you will agree. 😊 And percentage of cure falls.

IMO the fear with 30 Gy IFRT is exaggerated and unfounded.

Maneesh Singh Vedang Murthy Priyamvada Maitre Rishika Mody TMC Radiation Oncology Clinical Oncology Reshape our pelvic target 🎯

What will you do?

Angela Jia Alison Tree 💙🇺🇦 Angela Jia

POPRT adding nodes Vedang Murthy

RTOG0534 QOL

Overall some added toxicity and QOL decline, but less than we say from 1990s trials.

🚨The Lancet Commission on #prostatecancer 🚨

🗝️ Takeaways from this huge effort (among many)

✨ Incidence will >2x 📈1.4mill (2020) to 2.9mill (2040)
✨ Recs for screening and outreach
✨ Minimize overtreatment in high-income countries
✨ Improve access in low- & middle-income

Alexandros Papachristofilou Vedang Murthy Ryan Hutten, MD Igor Migowski (MD) silke gillessen Christian D. Fankhauser NCCN released an update on March 15, 2024 but 1c Carbo de-escalation and RT de-escalation is still missing from the picture for IIA/IIB. #SAKK0110 #SAKK0118

Bijoy Telivala

Bijoy Telivala Jeff Ryckman Vedang Murthy Ryan Hutten, MD Igor Migowski (MD) silke gillessen Christian D. Fankhauser Indeed, primary endpoint narrowly missed.
On the other hand, RPLND trials have even less follow up & three times higher recurrence rates. The largest RPLND trial had half the size of SAKK 01/10. Yet RPLND now in NCCN guidelines? No RCT ever conducted in Stage IIA/B seminoma.

Michiel Strijbos Not an expert on this but Dosimetric and modelling studies do show benefit. Our first patient on our proton facility at TMC Radiation Oncology was a seminoma! Maybe John Christodouleas can help.

Vedang Murthy Alexandros Papachristofilou Ryan Hutten, MD Igor Migowski (MD) silke gillessen Christian D. Fankhauser Here you go Vedang Murthy

Alexandros Papachristofilou Ryan Hutten, MD Igor Migowski (MD) silke gillessen Christian D. Fankhauser There you go. From the man himself!
Alex it will be great if you can update us on the next SAKK seminoma trial status!

Not a bad idea if available. BUT Carbo ➕ IFRT (even with protons) has a certain elegance. 😊

TCa D8
Seminoma with a small RP node. Stage 2a-b
Classical Rx has been overkill.
Dog leg RT 😕
3x BEP 😭😭
The folks at SAKK have made it so elegant. Alexandros Papachristofilou
silke gillessen
Christian D. Fankhauser
1x Carboplatin and IFRT 😊
Very cool and very effective.

1. Necrosis in the RP does not necessarily mean necrosis at the other sites

2. Discordance rate is around 27%… hence cannot reliably not treat the extra-RP site

3. Always address the Extra-RP disease if feasible. May do it in a second sitting