I learned this week that SABR-COMET patient #1 recently passed away, more than 12 years after enrollment, with no recurrence since his original SABR.
We initially treated him for a left adrenal met. It’s an interesting story… ⬇️⬇️⬇️
David Palma, MD, PhD
308 posts
David Palma, MD, PhD
@drdavidpalma
Radiation Oncologist | Researcher | Marathon runner and triathlete | Dad x 3 | Author, Taking Charge of Cancer | tweets = own opinions
Joined June 2025
- Here's a patient recently randomized on our ARREST2 phase 2/3 RCT. Sixteen pulmonary mets, 35 Gy in 5 fractions. Constraints: V13.5 Gy <37%, 1500 cc of lung <12.5 Gy
00:00 - Big news: the Anatomy and Radiology Contouring Bootcamp is now FREE! 🧵🧵🧵with photos of your attendings when they were residents... arcbootcamp.com
- Here's another neat plan from the PREVENT RCT. Instead of 20 Gy/5 for palliation, this patient is getting 35 Gy/5, prescribed🔥with max dose ~44 Gy/5. The esophagus (in mint-chocolate-chip green) is mostly outside the 20 Gy line.
- Our centre just launched a Rapid Palliative VMAT program, allowing us to quickly create & deliver highly conformal plans to improve symptoms. I've had 2 cases in 2 days. For this one, I did the contours at 10 AM and the plan was ready at 4 PM. 🧵
- I decided to rejoin X because there just isn't the same #radonc community on the other platforms. Over the next couple of days, I'll post some updates on some research and the ARC Bootcamp. Thanks @_ShankarSiva for the nudge to come back!
- Replying to @drdavidpalmaSome ask if patients with limited metastatic disease can be cured. The answer is clearly yes. We’ve known that since the 1930’s, and it was very clearly articulated in this book from the 1960s. In 2026 we’ll report the final outcomes from SABR-COMET, 10 years after closure.
- Great paper in @JAMAOnc assessing the time period for cure after for colon cancer. It's 6 years. "Cure" is defined as when the risk of recurrence is <0.5%. Very reasonable. jamanetwork.com/journals/jamao…
- Here's another new ARREST2 case - 10 lung lesions (also liver lesions treated by @TimkWin not shown). Most of these will receive 20 Gy in 1 fraction, the ones adjacent to important structures get 35/5.
GIF - Check out the SUNSET dosimetry study in @IJROBP. Key findings: - 73% treated without PTV compromise - PTV compromise not associated with local control - More overlap with central structures worse local control - Remember: IV contrast + 4D CT required, 5 mm PTV margins,
🚨In Press🚨SUNSET trial dosimetry accepted @IJROBP Hotspot 🔥 limited to 120% Location away from OARs🫀 ⬆️ COP👮♂️ (Central organ Overlapping PTV) volume portends ⬇️LC Doses within constraints have no relation with high toxicity ⚠️ Check out our study authors.elsevier.com/sd/article/S03… - If you are coming to #ASTRO25, come join our Extended Educational Session on Sunday at 2:30 PM Emerging Indications for Radiation in Poly-Metastatic Cancers
- Interesting case report in the Green Journal showing lung function changes after SBRT - you can see how the contralateral lung compensates. A similar effect was shown for locally advanced disease previously by Grace Parraga's team. #sparetheotherlung
- While I'm here, I'll just point out that RCTs of SABR don't show that radiation leads to more metastases...if anything the relationship is going the other way. Here's the data from Dan Gomez's oligomets RCT...
- Replying to @drdavidpalmaI followed the patient for 10 years with no recurrence before discharging him. Here's his last CT. This reminds us that behind every KM curve, there are individual people with individual stories who agree to join our studies.
