Hi everyone! Been a while, but back today with a teaching video on palliative RT for GI cancers. IMO palliative RT can be v effective, but is underutilized. Here is 13 min on indications, regimens, common q's re: palliative RT by GI site. Slides & full video link below 🧵1/5.

Link to whole video is here 2/5.

General principles for GI cancers, followed by palliative RT basics for upper GI & liver tumors. For esophagus, stent vs. RT? For liver, whole vs. partial liver? Note palliative RT for liver tumors supported by Ph3 RCT (@ldawsonmd). Just 1 fx improved pain in 67% pts! 3/5

Pancreas & pelvic (rectal, anal) tumors next. For pancreas, I like 24Gy/3fx (PAINPANC), also discuss celiac SRS w link to our e-contour. For lower GI, note Quad Shot/SHARON regimens which are BID over 2 days (4 fx total) – convenient & effective for most. 4/5

Hope this is helpful. Let me know feedback, obviously variation in how folks practice, regimens, etc. & thank you to @AnkerUVMRadOnc for reviewing & for expert insight! Done 5/5

Forgot to mention our PULSAR strategy! We haven’t published our data yet in pall GI setting, but idea is high dose/fx to tumor alone (~8Gy) w each fx separated by wks. Plan up to 3-5 fx. Less toxicity (useful for re-RT), can adapt to tumor change, & possible synergize w IO.

My father age 89 was dxed with a GEJ cancer, poorly differentiated, causing GI bleeding. A few weeks of palliative radiation resolved his symptoms entirely with virtually no adverse effects, internal or dermatological. He died 1-1-2 yrs later of unrelated causes. (I was amazed.)

T/t a patient of distal stomach Ca with tumour bleed & pt has had symptomatic resolution of his symptoms. I will agree 💯 that palliative RT represents a feasible alternative for rapid relief of oncological symptoms, especially in LMIC & awareness is key for adequate utilization.

Super helpful !

great job

Totally agree

@cristiph3