Radiation oncologist and researcher. @CompassOncology. Tweets are my own
Portland, OR
Joined November 2012
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Hiring a dosimetrist in my practice! Great opportunity in the PNW - Portland/Vancouver region. Love our team here and excited for the right person to join us. Happy to discuss with anyone interested. @CompassOncology #dosimetry #joboffer #radonclife
careers.usoncology.com/main/…
Tris Arscott, MD retweeted
Yesterday, I presented the @GETUG_Unicancer PEACE 2 trial at #ESTRO26 on the role of pelvic RT in very high risk #prostatecancer pts (staged with conventional imaging).
Twittorial below
Key conclusion: pelvic RT did not improve clinical outcomes (cPFS, MFS, PCSS, OS)...
1/n
Tris Arscott, MD retweeted
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)
Tris Arscott, MD retweeted
🚫 SUPREMO Trial: Why It Does NOT Change PMRT Practice Today?
🔍 What SUPREMO actually tested?
•Chest wall RT alone after mastectomy
•Treatment era: 2006–2013
•All node-positive pts → full axillary dissection
•Minimal regional nodal irradiation (RNI)
📉 Key findings
•❌ No OS benefit overall
•✅ Node-positive pts: lower locoregional recurrence with RT
•Very low-risk cohort:
•25% node-negative
•41% only 1 micro/macro node
•Just 3% chest-wall recurrence without RT
🎯 Why this doesn’t reflect 2025 practice?
Modern PMRT → Chest wall + SCF + IMN (full RNI)
SUPREMO → Chest wall only
Modern surgery → Sentinel node biopsy
SUPREMO → Full axillary dissection
Modern systemic therapy → Genomic + biologic risk-driven
SUPREMO → Older-era treatments
🧭 Real-world takeaway
PMRT with RNI remains SOC for most pts with 1–3 positive nodes
(ASTRO–ASCO–SSO 2024 guideline)
🧪 What’s coming next?
MA.39 / TAILOR RT will clarify if low-burden node-positive + low Oncotype pts can omit PMRT.
📌 Bottom line
SUPREMO ≠ Skip RT.
It reflects old surgery + inadequate RT volume in a low-risk population.
📚 Citation
Kunkler et al. NEJM. 2025.
DOI: doi.org/10.1056/NEJMoaSUPREM…
(ASTRO commentary: The ASCO Post, Nov 2025)
#OncoTwitter #MedTwitter #BreastCancer #RadiationOncology #PMRT #ASTRO #ASCO
@myESMO @esmo_open @ASCO @OncoAlert @ASTRO_org
🚨 NEJM SUPREMO Trial (2025): Do all mastectomy pts need chest-wall RT? 🧐
👩🔬 1,607 women with intermediate-risk breast cancer
(pT1N1, pT2N1, or pT3NO or stage pT2NO with a histologic grade 3 or LVSI) randomized to:
🟦 Chest-wall RT (40–50 Gy)
vs
🟩 No RT
📊 10-yr Results:
💀 OS: 81.4 % (RT) vs 81.9 % (No RT) → HR 1.04 🟰 NS
🧭 DFS: 76.2 % vs 75.5 % → NS
🧱 Chest-wall recurrence: 1.1 % vs 2.5 % (HR 0.45 ✅ ↓LRR)
⚡ Triple-negative: worse OS with RT (HR 1.9 ⚠️)
💬 Take-home:
Modern systemic therapy = ultra-low local relapse 💊
👉 Omission of PMRT in intermediate-risk pts is now safe & rational ✅
💡 Discuss this at your next Tumor Board!
🔖 Save + 📤 Share!
📚 Kunkler IH et al. N Engl J Med 2025
🔗 nejm.org/doi/full/10.1056/NE…
#OncoTwitter #BreastCancer #RadiationOncology #MedTwitter
@OncoAlert @myESMO @esmo_open @JCO_ASCO
Tris Arscott, MD retweeted
Presented at #ASCO25:
A 3-year structured exercise program after adjuvant chemotherapy for colon cancer improved disease-free and overall survival, physical functioning, and fitness, as compared with health education alone. Full CHALLENGE phase 3 trial results: nej.md/4mh5RPL
@ASCO
Encourage an active healthy lifestyle during and after cancer treatment, so great to see this
The most practice changing trial from #ASCO25 is now live on @NEJM .If this was a drug, this would be approved today. Globally relevant and low-cost intervention that is not only delaying relapse but actually improving survival.
Perfect case example of a #cancergroundshot trial.
nejm.org/doi/full/10.1056/NE…
Tris Arscott, MD retweeted
Can QUAD be used for thoracic tumours?
🟰YES!
➡️ 3 cycles of quad shot is safe and feasible with concurrent systemic therapy for centrally located thoracic tumours
➡️Limited grade 3 toxicities
➡️ Majority of patients experienced symptom relief as measured by PROs
#ASTRO24
Tris Arscott, MD retweeted
Are you a PGY4/5? We invite you to apply for our 300in10, 2-month fellowship program focusing on advancing #brachy. This is an opportunity to immerse yourself in a community committed to training competent brachytherapists. bit.ly/4all3Fk @AndrewFarach @daniel_petereit
Tris Arscott, MD retweeted
🎙️ OPRA updated analysis confirms the long-term organ preservation with total neoadjuvant therapy for #rectalcancer ‼️@OncoAlert @ASCO
📌Ph2 trial w/ 👥random to induction CTH followed by CRT (INCT-CRT) or vice versa
- Complete/near-complete responders were offered WW, incomplete responders ➡️🔪
🥇🎯: DFS. 🥈 🎯: TME-free survival
📊RESULTS
-324 👥, median FU 5.1 y
- 5-y DFS rates: INCT-CRT 71%, CRT-CNCT 69% (no sig)
- TME-free survival: INCT-CRT 39%, CRT-CNCT 54% (P = .012)
- 94% of regrowth within 2 y, 99% within 3 y
- DFS similar for TME post-restaging and WW followed by TME post-regrowth (both 64%, N🚫 sig)
#radonc ascopubs.org/doi/pdf/10.1200…
Tris Arscott, MD retweeted
Grateful for our work examining the success of peer-to-peer authorization strategies highlighting @NCCN guideline-cited Level 1 evidence in reversing insurance denials for spine #SBRT being published in @AJCOonline! #KillCancer #FixPriorAuth #SPORTSMEN
journals.lww.com/amjclinical…
Tris Arscott, MD retweeted
Happy and proud to discuss results from ARTO trial results during XXXIII SIURO congress! @siuroIT
Tris Arscott, MD retweeted
IMPORT 10y:
Late normal tissue effects at 10y ~5% in PBI arm vs ~30%(!!!!) in whole breast arm, and local control "better" with partial breast(!)
Frankly, whole breast radiotherapy is the *wrong* tx for older women w/ early, low risk #breastcancer
onclive.com/view/reduced-dos…
This is hugely important for our patients in making an informed decision about adjuvant treatments -- particularly as we enter #BreastCancerAwarenessMonth ! Fully agree RT alone (particularly #APBI) should be discussed alongside single modality endocrine therapy
This #ASTRO2023 presentation was one of the most important for our specialty. Tumor boards are recommending adjuvant endocrine therapy alone after surgery, but rarely RT-alone. Low-risk breast cancer is one of the most common things we treat. We need better advocacy for RT.
Treated our second #pluvicto patient today @CompassOncology ! Proud to offer #radiopharmaceutical tx to patients in the #PNW and those able to travel. Please reach out if need information. Thanks @NovartisMedical for helping get us up and running 💉☢️ #ProstateCancer #psma – at Portland, OR
Tris Arscott, MD retweeted
💥First plenary #ASTRO23 @vinaigondi presented PCI +/- hippocampal avoidance for small cell lung cancer. 🧠
⭐️HVLT-R no different (primary end point)
⭐️Did reduce first failure in any cognitive test (2nd endpoint)
⭐️No diff in intracranial failure 👏
Amazing to catch up with my #radonc residency program coordinator at #ASTRO23 - 4 decades of experience (!) and tireless commitment to @PennRadOnc trainees. Thank you! And so great to see you 🥰 @CBaffic #pennradonc #radonc4life
Tris Arscott, MD retweeted
#ASTRO2023
Hippocampal avoidance in PCI for SCLC, randomized phase III NRG C003
👉No increased risk of BM development
👉23% reduction risk to first cognitive failure
❓Durable effect
Little did I know a high school classmate and I would work in the same field (he’s at Naveris which does NavDx assay I use to evaluate/follow my H&N patients) - great way to learn about this useful clinical tool and ongoing developments/applications @NaverisDx @ASTRO_org #astro23
