Rahul Tendulkar, MD

@RTendulkarMD

Clinical director, Vice Chair of education, Professor of Radiation Oncology @ Cleveland Clinic. Tweets mine.

Cleveland, OH Joined September 2015

2.2K Following 5.6K Followers 6K Posts

Latest posts 5

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Rahul Tendulkar, MD @RTendulkarMD Jul 4, 2024

Burnout & moral injury in medicine have affected so many health care workers. As a mid-career physician, here’s what I’ve learned to combat it - I hope others find it to be helpful.
In Search of Joy and Meaning in Modern Medicine @JCOOP_ASCO ascopubs.org/doi/pdf/10.120…

Rahul Tendulkar, MD @RTendulkarMD Nov 9, 2025

Unlike previous post-mastectomy RT trials which included regional nodal irradiation (BC, Danish, etc), SUPREMO primarily tested chest wall RT only. Let’s compare to 4 other studies which found that RNI for LN+ after ALND can reduce DM. 1/

Rahul Tendulkar, MD @RTendulkarMD Nov 8, 2025

Great thread on the limitations of SUPREMO. In short, chest wall radiation without regional nodal RT is not how PMRT was done on nearly every previous trial. Lack of RNI likely a major factor in this being a negative trial. More on this later…

Brian Lawenda MD @BLawenda Nov 8, 2025

When the New England Journal of Medicine published the SUPREMO trial this week, social media lit up with headlines like:
“Radiotherapy after mastectomy can be avoided, study finds”
It’s an appealing headline, but dangerously incomplete.
brianlawenda.substack.com/p/why-the-supr…
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Rahul Tendulkar, MD @RTendulkarMD Nov 6, 2025

Patients on SUPREMO had median 14 lymph nodes removed, so PMRT adds little value for pT1-2N1 after ALND. If ALND not done for SLN+, PMRT still indicated since >30% have risk of additional LN+ per AMAROS & SENOMAC. ASCO guidelines summarize nicely: ascopubs.org/doi/10.1200/JC…

ascopubs.org Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Update ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO...

Dr Rishabh Jain Verified account @DrRishabhOnco Nov 6, 2025

🚨 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/10.10…

#OncoTwitter #BreastCancer #RadiationOncology #MedTwitter
@OncoAlert @myESMO @esmo_open @JCO_ASCO

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Rahul Tendulkar, MD @RTendulkarMD Oct 23, 2025

I don’t think @JoeBiden could have found a better doctor to take care of him than @NehaVapiwala @PennMedicine. The best of the best! 👏

Neha Vapiwala Verified account @NehaVapiwala Oct 23, 2025

It was the honor of a lifetime to contribute to the care of @JoeBiden. Every cancer patient deserves respect. Every cancer patient matters. 2/2
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