5-year Cause-specific Survival Rates Research Articles

Dose-escalated Salvage Whole-pelvic Radiotherapy for Biochemical Recurrence After Radical Prostatectomy for High-risk Prostate Cancer.

To investigate the institutional experience of dose-escalated salvage whole-pelvic radiotherapy (WPRT) with the simultaneous integrated boost (SIB) technique in patients with biochemical recurrence (BCR) after radical prostatectomy for high-risk prostate cancer. This retrospective study included 21 patients with BCR who received radical prostatectomy for high-risk prostate cancer and underwent salvage RT. Clinical target volume (CTV) of the whole pelvis (CTV56) included the prostate bed, common iliac, external iliac, internal iliac, and obturator lymph node regions. The boost CTV (CTV66) included the prostate bed. Planning target volumes (PTV) were generated by adding a margin of 6-8 mm to CTV (PTV56 and PTV66). Doses of 56.1 and 66 Gy in 33 fractions were delivered to PTV56 and PTV66, respectively. The 5-year biochemical progression-free survival, overall survival, and cause-specific survival rates were 72%, 94%, and 94%, respectively. A grade 3 late genitourinary toxicity event of gross hematuria was observed in one patient (4%). Acute and late toxicities of grade ≥3, other than gross hematuria, were not observed in any patient. Dose-escalated salvage WPRT using the SIB technique provides appropriate tumor control without increasing the incident of significant toxicities.

Long-Term Outcomes Following Definitive or Adjuvant Proton Radiotherapy for Adenoid Cystic Carcinoma

PurposeAdenoid cystic carcinoma (ACC) is a rare malignancy accounting for 1% of all head and neck cancers. Treatment for ACC has its challenges and risks, yet few outcomes studies exist. We present long-term outcomes of patients with ACC of the head and neck treated with proton therapy (PT). Materials and MethodsUnder an institutional review board-approved, single-institutional prospective outcomes registry, we reviewed the records of 56 patients with de novo, nonmetastatic ACC of the head and neck treated with PT with definitive (n = 9) or adjuvant PT (n = 47) from June 2007 to December 2021. The median dose to the primary site was 72.6 gray relative biological equivalent (range, 64-74.4) delivered as either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received concurrent chemotherapy. Thirty-one patients received nodal radiation, 30 electively and 1 for nodal involvement. ResultsWith a median follow-up of 6.2 years (range, 0.9-14.7), the 5-year local-regional control (LRC), disease-free survival, cause-specific survival, and overall survival rates were 88%, 85%, 89%, and 89%, respectively. Intracranial extension (P = .003) and gross residual tumor (P = .0388) were factors associated with LRC rates. While the LRC rate for those with a gross total resection was 96%, those with subtotal resection or biopsy alone were 81% and 76%, respectively. The 5-year cumulative incidence of clinically significant grade ≥3 toxicity was 15%, and the crude incidence at the most recent follow-up was 23% (n = 13). ConclusionThis is the largest sample size with the longest median follow-up to date of patients with ACC treated with PT. PT can provide excellent disease control for ACC of the head and neck with acceptable toxicity. T4 disease, intracranial involvement, and gross residual disease at the time of PT following either biopsy or subtotal resection were significant prognostic features for worse outcomes.

Five-Year Survival Outcomes After Carbon-Ion Radiotherapy for Operable Stage I NSCLC: A Japanese National Registry Study (J-CROS-LUNG)

IntroductionThe standard therapy for stage I NSCLC is surgery, but some operable patients refuse this option and instead undergo radiotherapy. Carbon-ion radiotherapy (CIRT) is a type of radiotherapy. The Japanese prospective nationwide registry study on CIRT began in 2016. Here, we analyzed real-world clinical outcomes of CIRT for operable patients with stage I NSCLC. MethodsAll patients with operable stage I NSCLC treated with CIRT in Japan between 2016 and 2018 were enrolled. The dose fractionations for CIRT were selected from several options approved by the Japanese Society for Radiation Oncology. CIRT was delivered to the primary tumor, not to lymph nodes. ResultsThe median follow-up period was 56 months. Among 136 patients, 117 (86%) had clinical stage IA NSCLC and 19 (14%) had clinical stage IB NSCLC. There were 50 patients (37%) diagnosed clinically without having been diagnosed histologically. Most tumors (97%) were located in the periphery. The 5-year overall survival, cause-specific survival, progression-free survival, and local control rate were 81.8% (95% confidence interval [CI]: 75.1–89.2), 91.2% (95% CI: 86.0–96.8), 65.9% (95% CI: 58.2–74.6), and 95.8% (95% CI: 92.3–99.5), respectively. Multivariate analysis identified age as a significant factor for overall survival (p = 0.018), whereas age and consolidation/tumor ratio (p = 0.010 and p = 0.004) were significant factors for progression-free survival. There was no grade 4 or higher toxicity. Grade 3 radiation pneumonitis occurred in one patient. ConclusionsThis study reports the long-term outcomes of CIRT for operable NSCLC in the real world. CIRT for operable patients has been found to have favorable outcomes, with tolerable toxicity.

230. SURVIVAL OUTCOMES OF ROBOT-ASSISTED TRANS-MEDIASTIONAL ESOPHAGECTOMY IN PATIENTS WITH CT1N0 ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background We have developed a robot-assisted trans-mediastinal esophagectomy (RATME) to reduce the surgical invasiveness of open trans-thoracic esophagectomy (oTTE). However, the long-term outcome of esophageal cancer patients who underwent RATME remains unclear. Methods Patients who underwent RATME or oTTE for clinical T1N0 esophageal squamous cell carcinoma were enrolled in this study. The clinicopathological and surgical details, overall survival (OS), disease-free survival (DFS), and cause-specific survival (CSS) were compared between the RATME and oTTE groups. Results Forty-three and 47 patients who underwent RATME and oTTE, respectively, were included in this analysis. The RATME group included more male patients and had a significantly lower comorbidity index. There was no significant difference in age, tumor location, preoperative ESD rates, and pathological TNM factors between the two groups. The RATME group showed a longer operation time, less blood loss, low incidence of pneumonia, and shorter hospital stays. The OS and DFS rates in the RATME tended to be higher than in the oTTE group; The 5-year OS rates were 88.4 vs 71.5%, and the 5-year DFS rates were 81.4 vs 62.8% (RATME vs oTTE group, p = 0.09 and p = 0.11). The CSS in both groups were equivalent; The 5-year CSS rates were 93.7 vs 92.4% in the RATME and oTTE groups respectively. The RATME group had significantly fewer deaths than the oTTE group (p = 0.032). Conclusions The RATME group tended to show better OS and DFS than the oTTE group. The OS of the RATME group was equivalent to that of the comprehensive registry data in Japan, indicating that RATME radicality is guaranteed.

Outcome of Hypofractionated Radiotherapy for Localized Gastric Mucosa-associated Lymphoid Tissue Lymphoma.

With the prevalence of COVID-19, the importance of short-course radiotherapy (RT) in many cancers has been discussed. The aim of this study was to evaluate the results of hypofractionated schedule RT for localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma. We assessed 45 patients with localized gastric MALT lymphoma who underwent RT between 2005 and 2019. The total RT dose ranged from 24-36 Gy in 10-18 fractions (median of 28 Gy/14 fractions). Patients were divided into three groups according to the dose fractionation: Group A, 30-36 Gy in 15-18 fractions; Group B, 26-28 Gy in 13-14 fractions; and Group C, 24-25 Gy in 10 fractions. All the patients achieved complete remission without local recurrence. The 5-year overall, cause-specific, and progression-free survival rates were 97.5%, 100%, and 97.5%, respectively, with a median follow-up period of 82 months. Among the dose fractionation groups, there were no statistically significant differences in local control or incidence of grade 2 or worse adverse events. Results of RT for localized gastric MALT lymphoma showed excellent local control and survival with no serious adverse events, regardless of dose fractionation. In situations where short-term RT is required, a hypofractionated RT schedule of 24-25 Gy in 10 fractions could be an option for RT schedules.

Incidence, epidemiological characteristics, and cause-specific survival analysis of ampullary carcinoma using the SEER database.

4168 Background: Ampullary carcinomas (AC) are rare and comprise only 0.2% of gastrointestinal malignancies, and there is a paucity of studies analyzing them. We studied the incidence, demographics, tumor characteristics, and survival variables of patients with AC using the Survival, Epidemiology, and End Results [SEER] November 2021 database. Methods: We identified 3650 patients aged >18 with microscopically confirmed adenocarcinoma of the ampulla using ICD-O-3 site code C241 and histology codes (8140-8147, 8480, 8490, 8500). The epidemiological characteristics and the survival variables included were age, gender, ethnicity, and American Joint Committee on Cancer [AJCC] Staging. The overall 5-year survival (OS), cause-specific 5-year survival (CSS), and CSS plots across different strata were plotted using the Kaplan-Meier Method. The analysis was done using the Cox proportional hazard regression model (p<0.05). Results: The overall age-adjusted incidence of AC was 0.3 per 100,000 cases. The median age at diagnosis was 69 (Interquartile range - 59, 78). It was more common in males (56.03%) and Non-Hispanic White (58.96 %), with the most common stages at a presentation being stage 2B IIB (22.08%) and stage III (22.11%). The observed overall 5-year survival was 31%, and the cause-specific 5-year survival was 37.5%. The CSS was not significantly associated with gender (p=0.06). The estimated hazards of death attributed to AC increase by 13% (p < 0.0001) for every 10-year increase in age at diagnosis above 67 years. The CSS was also associated with race, with African Americans and Hispanics being associated with higher hazards of death attributed to AC when compared to Non-Hispanic Whites with HR of 1.5 (p<0.0001) and 1.12 (p=0.01), respectively. Conclusions: Ampullary carcinoma is more commonly seen in males and non-Hispanic Whites with a median age of 69 years. Patients are typically diagnosed in stages IIB and III. Lower CSS rates were associated with advancing age, African American, and Hispanic populations. We need further studies to determine whether these disparities between different races are due to socioeconomic, genetic, or biological factors. Additional studies investigating how different treatment options affect AC survival, especially in this population subset, can be explored. [Table: see text]

Migration of Risk Classification Between the JAES Versus ATA guidelines for Papillary Thyroid Carcinoma.

This study aimed to investigate outcomes in the same cohort of patients with papillary thyroid carcinoma (PTC) risk-stratified according to the Japan Association of Endocrine Surgery (JAES) and American Thyroid Association (ATA) guidelines. A total of 1044 patients with PTC who underwent initial thyroidectomy at Yokohama City University Medical Center between January 2000 and June 2022 were included. According to the JAES guidelines, 480 (46%), 386 (37%), and 178 (17%) patients were classified as low, intermediate, or high risk, respectively. Furthermore, according to the ATA guidelines, 590 (57%), 261 (25%), and 193 (18%) patients were reclassified as low, intermediate, or high risk, respectively. Among 1044 patients with PTC, the 10-year cause-specific survival (CSS) rates of patients with JAES low and intermediate risk were 99.7 and 98.6%, respectively, and there was no statistically difference (p = 0.096). However, the 10-year CSS rates of patients with ATA low and intermediate risk were 100 and 99.5%, respectively (p = 0.007). Among 1001 patients with M0 PTC, the 10-year distant metastasis-free survival (DMFS) rates of patients with JAES intermediate and high risk were 94.2, and 76.7%, respectively (p < 0.001). However, the 10-year DMFS rates of patients with ATA intermediate and high risk were 88.1 and 86.6%, respectively (p = 0.233), and there was no statistically difference. Both JAES and ATA risk classifications properly stratified the PTC patients. Furthermore, the ATA risk classification more precisely extracted patients with better and worse prognoses.

Long‑term prognosis and comprehensive endoscopic treatment strategy for esophageal cancer, including salvage endoscopic treatment after chemoradiation therapy.

Endoscopic submucosal dissection (ESD) is the first treatment option for superficial squamous cell carcinoma of the esophagus (SSCE). Salvage endoscopic treatment for recurrent advanced esophageal cancer after chemoradiotherapy (CRT) has been reported. However, there are few reports on long-term prognosis after salvage endoscopic treatment in Japan. The present study investigated long-term treatment results after conventional ESD for SSCE and after salvage endoscopic treatment for locally recurrent lesions after CRT. Outcomes of esophageal ESD were retrospectively investigated at Nagasaki University Hospital and long-term prognosis after salvage endoscopic treatment for locally recurrence lesions after CRT was examined. The en-bloc curative resection rate was 89.5% (606/676) for conventional ESD. The 5-year cause-specific survival rate (CSS) was 98.5%. A total of 77 patients underwent salvage endoscopic treatment [ESD or photodynamic therapy (PDT)] for locally recurrent lesions after CRT. The 3-year CSS was 81.3 and 77.1% for salvage ESD and salvage PDT, respectively. SSCE management using ESD yielded high en-bloc curative resection and survival rates. Overall, establishing salvage endoscopic treatment made long-term control of the underlying disease possible, while also maintaining the quality of life for patients with recurrent advanced esophageal cancer deeper than patients with T1b who underwent CRT and patients with recurrence after additional CRT following ESD.

Multi-institutional study on the role of post-operative radiotherapy in elderly patients with endometrial cancer

ObjectiveTo investigate the prognostic factors for survival and toxicities in elderly (≥65 years) patients with endometrial cancer who underwent post-operative radiotherapy. Additionally, to compare the treatment outcomes between the older...

Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in the Remnant Stomach.

Endoscopic submucosal dissection (ESD) in patients with early gastric cancers (EGCs) in the remnant stomach is technically difficult, owing to the limited space and fibrosis under the suture lines and anastomoses. Conversely, ESD for patients with EGCs in the remnant stomach is less invasive and provides better quality of life than completion total gastrectomy. To clarify the effectiveness and safety of ESD, we reviewed the medical records of patients with EGCs in the remnant stomach who underwent ESD between July 2006 and October 2020 at our institution. All identified patients were included in the analysis. Of 25 patients with 27 lesions, the en bloc and R0 resection rates were 88.9% and 85.2%, respectively. Neither perforation nor postoperative bleeding was observed. During a median follow-up period of 48 (range, 5–162) months, the 5-year overall survival rate was 71.0%, whereas the 5-year cause-specific survival rate was 100%. No obvious differences in the outcomes of procedures with suture line involvement and without suture line or anastomosis involvement were noted. In conclusion, ESD was effective and safe in patients with EGCs in the remnant stomach despite the suture line involvement.

Therapeutic strategies following endoscopic submucosal dissection for T1a-MM/T1b-SM1 esophageal squamous cell carcinoma: comparisons of long-term outcomes with propensity score-matched analysis.

For esophageal squamous cell carcinoma (ESCC) invading the muscularis mucosa (T1a-MM) or upper submucosa (T1b-SM1, up to 200µm), the curative effectiveness of endoscopic submucosal dissection (ESD) and additional therapeutic strategies remain controversial. The present study aims to investigate the effectiveness of ESD followed by different therapeutic strategies in treating such patients. A total of 242 patients with T1a-MM/T1b-SM1 ESCCs were involved. Data on therapeutic outcomes and long-term survivals were collected for analysis. Propensity score-matched analysis was performed to compensate for selection bias between patients with no additional therapy (NAT group) and those with additional therapy (AT group). R0 resection rate was 83.1% and curative resection rate was 78.5%. After a mean follow-up period of 57.8 ± 27.3months, the cumulative recurrence rate was 7.9%. The 5-year overall survival (OS) and cause-specific survival (CSS) rate was 91.1% and 94.0%. In a matched cohort of 24 pairs, the 5-year OS and CSS rates showed no significant difference between NAT group (82.0% and 87.1%) and AT group (86.0% and 89.9%) (P > 0.05). In the subgroup of patients with noncurative ESD (n = 52), the 5-year OS and CSS rates were significantly higher in surgery group (90.2% and 95.2%) than that in NAT group (50.1% and 59.5%) and chemoradiotherapy group (51.4% and 60.0%) (P < 0.05). ESD with no additional therapy could achieve favorable long-term outcomes in treating T1a-MM/T1b-SM1 ESCCs. For patients with noncurative ESD, surgery ranks a prime recommendation over CRT.

The influence of marital status on survival in patients with nasopharyngeal carcinoma: A surveillance, epidemiology, and end results database analysis.

To assess the influence of marital status on the survival of patients with nasopharyngeal carcinoma (NPC), we used the Surveillance, Epidemiology, and End Results (SEER) database to analyze 5477 patients who were diagnosed with NPC from 2004 to 2016. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to analyze the influence of marital status on cause-specific survival (CSS) and overall survival (OS). Subgroup analyses was used to assess the influence of marital status on CSS based on different factors. For the 5477 patients, 61.5%, 22.4%, and 16.1% were married, single/unmarried, and separated/widowed/divorced, respectively. The separated/widowed/divorced group was more likely to be female (P < .001), had the highest proportion of elderly subjects (P < .001), were mostly Caucasian (P < .001), had pathological grade I/II (P < .001), were likely to undergo surgery (P = .032), and were registered in the northeast, north-central, and south (P < .001) regions. The 5-year CSS rates were 92.6%, 92.4%, and 85.1% in the married, single/unmarried, and separated/widowed/divorced groups, respectively (P < .001), and the 5-year OS rates were 60.7%, 54.6%, and 40.1%, respectively (P < .001). Marital status is an independent prognostic factor of NPC. Separated/widowed/divorced patients had a significantly increased risk of NPC-related death (hazard ratio [HR] = 2.180, 95% confidence interval [CI] 1.721-2.757, P < .001) compared to married patients. The single/unmarried (P = .355) group had a CSS similar to that of the unmarried group. Marital status is an independent prognostic factor of survival in NPC patients. Separated/widowed/divorced status increases the risk of NPC mortality.

The benefit of concurrent chemotherapy with radiotherapy for esophageal cancer is limited in Asian patients aged 80years or older: a SEER database analysis.

To evaluate the benefit of concurrent chemotherapy with radiotherapy (RT) for esophageal cancer in Asian patients aged ≥ 80years using the Surveillance, Epidemiology, and End Results (SEER) database. Among more than 7000 patients with squamous cell carcinoma or adenocarcinoma who were treated by RT without surgery for esophageal cancer in the SEER database, 2047 patients aged ≥ 80years were analyzed. Patients who received chemoradiotherapy (CRT group) and patients who received RT alone (RT alone group) were matched with a propensity score. The median observation period for survivors was 57months. The 3-year and 5-year overall survival rates in all patients were 15.2% and 8.5%, respectively. The 3-year and 5-year cause-specific survival rates in all patients were 20.8% and 14.5%, respectively. After propensity score matching, the overall survival rate in the CRT group was significantly higher than that in the RT alone group (5-year overall survival rates: 11.9% and 3.2%, respectively, p < 0.001). In 108 Asian or Pacific Islander patients, there was no significant difference (5-year overall survival rates: 13.5% and 0%, respectively, p = 0.291), although the overall survival rate in the CRT group was significantly higher than that in the RT alone group in any other race. It is controversial whether CRT is beneficial for Asian or Pacific Islander patients aged 80years or older with esophageal cancer based on Analysis of data in SEER database.

Disparities in All-cancer and Lung Cancer Survival by Social, Behavioral, and Health Status Characteristics in the United States: A Longitudinal Follow-up of the 1997-2015 National Health Interview Survey-National Death Index Record Linkage Study

Most research on cancer patient survival uses registry-based (e.g., SEER) incidence and survival data that have limited socioeconomic status and health-risk information. In this study, we used the 1997-2015 National Health Interview Survey-National Death Index prospectively-linked pooled cohort database (n = 40,291 cancer patients) to examine disparities in patient survival by a broad range of social determinants, including race/ethnicity, nativity, educational attainment, income/poverty level, occupation, housing tenure, physical and mental health status, smoking, physical activity, body mass index, and alcohol consumption. We used Cox proportional hazards models to estimate mortality hazard ratios and cause-specific 1-year, 5-year, and 10-year survival rates for all-cancer and lung cancer. During 1997-2015, the 10-year age-adjusted (all-cause) survival rate for cancer patients with professional and managerial occupations was 89.66%, significantly higher than the survival rate of 83.17% for laborers or 83.66% for the unemployed. Cancer patients with renting house had significantly lower age-adjusted survival rates than those owning house (82.65% vs. 85.80%). The 10-year age-adjusted survival rates were significantly greater among cancer patients with regular physical activity than those without regular physical activity (90.18% vs. 83.24%). Age-adjusted survival rates were significantly reduced for cancer patients with lower income and education, poor health, and serious psychological distress, and among current and former smokers. The gap in survival narrowed with additional sociodemographic, health, or behavioral adjustment. Similarly large differentials were found in lung cancer survival. Marked disparities in all-cancer and lung cancer survival were found by a wide range of sociodemographic and health characteristics.

Clinical outcomes of iodine-125 low-dose-rate brachytherapy for localized prostate cancer: a single-institution review in Japan.

PurposeTo evaluate the oncological outcomes and genitourinary and gastrointestinal adverse events in acute and late-phases of iodine-125 low-dose-rate brachytherapy for localized prostate cancer.Material and methodsWe retrospectively evaluated 334 patients treated for localized prostate cancer with low-dose-rate brachytherapy. Bio-chemical relapse-free survival, cause-specific survival, and overall survival were evaluated using Kaplan-Meier method and log-rank test. Incidence of adverse events was calculated using National Cancer Institute common terminology criteria for adverse events, version 5. Logistic regression was used to identify independent predictors of acute and late-phase genitourinary and gastrointestinal adverse events.ResultsNational Comprehensive Cancer Network’s low-, intermediate-, and high-risk groups included 133 (39.8%), 163 (48.8%), and 38 (11.3%) patients, respectively. The 5-year cause-specific survival rate was 100%. The 5-year bio-chemical relapse-free survival rates for the low-, intermediate-, and high-risk groups were 98.3%, 95.8%, and 100%, respectively. One patient had a ≥ grade 3 acute adverse event. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 genitourinary adverse event rates were 27.9%, 14.4%, and 0.5%, respectively. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 gastrointestinal adverse event rates were 3.1%, 1.5%, and 0.5%, respectively. A high pre-treatment international prostate symptom score and non-use of α1-blockers were associated with an increased risk of acute genitourinary adverse events.ConclusionsLow-dose-rate brachytherapy had good oncological outcomes, with acceptable adverse event rates. Pre-treatment urinary function and use of α1-blockers may be useful in predicting and preventing acute genitourinary adverse events.

Significance of histology and nodal status on the survival of women with early-stage cervical cancer: validation of the 2018 FIGO cervical cancer staging system.

ObjectiveTo assess the efficacy of the FIGO 2018 classification system for nodal-specific classifications for early-stage cervical cancer; specifically, to examine the impact of nodal metastasis on survival and the effect of postoperative treatments, according to histological subtypes.MethodsThis society-based retrospective observational study in Japan examined 16,539 women with the 2009 FIGO stage IB1 cervical cancer who underwent primary surgical treatment from 2004 to 2015. Associations of cause-specific survival (CSS) with nodal metastasis and postoperative adjuvant therapy were examined according to histology type (squamous cell carcinoma [SCC], n=10,315; and non-SCC, n=6,224).ResultsThe nodal metastasis rate for SCC was higher than that for non-SCC (10.7% vs. 8.3%, p<0.001). In multivariable analysis, the impact of nodal metastasis on CSS was greater for non-SCC tumors (adjusted-hazard ratio [HR], 3.11; 95% confidence interval [CI], 2.40–4.02) than for SCC tumors (adjusted-HR, 2.20; 95% CI, 1.70–2.84; p<0.001). Propensity score matching analysis showed significantly lower CSS rates for women with pelvic nodal metastasis from non-SCC tumors than from SCC tumors (5-year CSS rate, 75.4% vs. 90.3%, p<0.001). The CSS rates for women with nodal metastasis in SCC histology were similar between the postoperative concurrent chemoradiotherapy/radiotherapy and chemotherapy groups (89.2% vs. 86.1%, p=0.42), whereas those in non-SCC histology who received postoperative chemotherapy improved the CSS (74.1% vs. 67.7%, p=0.043).ConclusionThe node-specific staging system in the 2018 FIGO cervical cancer classification is applicable to both non-SCC tumors and SCC tumors; however, the prognostic significance of nodal metastases and efficacy of postoperative therapies vary according to histology.

Abstract PO-082: Improving adherence to hormone therapy among breast cancer patients through a mobile app and patient navigation: Preliminary results

Abstract Background: The successful use of hormone therapy (HT) has contributed to improved 5-year cause-specific breast cancer survival rates, and evidence shows that long-term use produces a larger reduction in recurrence and mortality, with nearly 50% reduction in breast cancer mortality during the second decade after diagnosis. Despite the proven benefits, hormone therapy adherence is suboptimal (less than 80% of daily doses taken), and about 33% of women who are prescribed HT do not take their medication as prescribed and are at increased risk of disease recurrence and increased mortality. Smartphone ownership has increased substantially over the past decade, providing an extraordinary opportunity for innovation in the delivery of tailored interventions to improve patients' adherence to hormonal therapy. Purpose: We present preliminary results of a pilot study that involves a theory-based, culturally tailored, interactive mobile app + patient navigation to improve adherence to HT among breast cancer patients attending the breast clinic at the Mays Cancer Center (MCC). Methods: This is a 2-group parallel, randomized control trial that is currently recruiting 120 breast cancer patients and randomly assigning them to the intervention (60) or the control (60) group. The intervention group receives two components: 1) the HT Helper phone app; and 2) assistance from a patient navigator who will provide educational, psychosocial support and reinforcement, address common barriers, and facilitate the interaction with the medical team as needed. The control group receives the usual care and information provided by the MCC's breast clinic to patients undergoing HT. The app and navigation support are based in Social Cognitive Theory and principles of motivational interviewing. Results: Due to the COVID-19 pandemic, we were forced to suspend the start of the intervention until May 2021. We have recruited 27 patients and will present a general description of participants and preliminary results of the 3-month follow-up. This theory-based intervention will empower patients' self-monitoring and management. It will facilitate patient education, identification/reporting of side effects, delivery of self-care advice, and simplify communication between the patient and the oncology team. Conclusions: The anticipated outcome is a scalable, evidence-based, and easily disseminated intervention with potentially broad use to patients using HT and other oral anticancer agents. The ultimate goal of this innovative multi-communication intervention is to improve overall survival and life expectancy, enhance quality of life, reduce recurrence, and decrease healthcare costs. Citation Format: Patricia Chalela, Edgar Muñoz, Vivian Cortez, Armida Flores, Pramod Sukumaran, Cliff Despres, Devasena Inupakutika, David Akopian, Amelie G. Ramirez. Improving adherence to hormone therapy among breast cancer patients through a mobile app and patient navigation: Preliminary results [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-082.

Reirradiation in Conservative Salvage of Recurrent Soft-tissue Sarcoma: An Analysis of Treatment Efficacy and Toxicities.

Compared with radical resection alone, perioperative radiation therapy (RT) combined with neurovascular preserving surgery is the standard for the management of virgin soft-tissue sarcomas. Yet, the optimal management of a local recurrence remains unclear. We report outcomes of patients with locally recurrent soft-tissue sarcoma treated with resection and reirradiation at the University of Florida. We reviewed the records of patients treated with primary conservative surgery and radiation for soft-tissue sarcoma followed by salvage resection and reirradiation for a local recurrence at our institution. We analyzed 23 patients treated between 1976 and 2014 (median follow-up, 46 mo). Tumor sites included: proximal extremity, 11 patients; trunk, 6; distal extremity, 5; and head and neck, 1. All patients had conservative gross total resection of their recurrent tumor, without amputation. For reirradiation, 16 patients received external-beam RT alone, 6 received external-beam RT and brachytherapy, and 1 received brachytherapy alone. Two patients received chemotherapy. After retreatment, the 5-year overall survival, cause-specific survival, local control, and distant control rates were 39%, 42%, 46%, and 60%, respectively. Ten patients experienced local recurrences, 1 experienced regional recurrence, and 9 developed distant metastases. Retreatment-related complications ranged from delayed wound healing to limb amputation; 8 patients required amputation. Only 3 patients remained disease-free at last follow-up. No statistically significant associations were found between treatment factors (eg, RT dose) and local control. Achieving local control of recurrent soft-tissue sarcoma is challenging. Treatment with reoperation and reirradiation can lead to debilitating complications affecting function and quality of life.

Abstract PS9-38: Improving adherence to hormone therapy among breast cancer patients through a mobile app and patient navigation: App development and testing

Abstract Background: The successful use of hormone therapy (HT) has contributed to improved 5-year cause-specific breast cancer survival rates and evidence shows that long-term use produces a larger reduction in recurrence and mortality, with nearly 50% reduction in breast cancer mortality during the second decade after diagnosis. Despite the proven benefits, hormone therapy adherence is suboptimal (less than 80% of daily doses taken) and about 33% of women who are prescribed HT do not take their medication as prescribed and are at increased risk of disease recurrence and increased mortality. Smartphone ownership has increased substantially over the past decade, providing an extraordinary opportunity for innovation in the delivery of tailored interventions to improve patients’ adherence to hormonal therapy. Purpose: We present the design and development process of a theory-based, culturally tailored, interactive mobile app to improve adherence to HT among breast cancer patients to be used in combination with patient navigation in a two-group randomized clinical trial study at the Mays Cancer Center. The intervention group (n= 60) will receive the phone app + patient navigation and the control or usual care group (n=60) will receive the information oncologists provide to patients prescribed HT. Methods: Four focus groups (n=21) were conducted with breast cancer patients and personal semi-structured interviews (n=8) with oncologists, nurses, and patient navigators from the Mays Cancer Center, to assess barriers and facilitators to hormone therapy adherence, key symptoms, app content, and features. Qualitative data informed the initial design and development of app mock-ups; these were assessed with two additional focus groups (n=10). Based on formative research, a functional phone app prototype was developed and beta-tested with five breast cancer patients, minor refinements were made, and the app is ready for recruitment. Results: Inputs from patients and healthcare team members helped to identify specific app content and features. Key themes included the importance of increasing patient education, enhancing self-efficacy, facilitating communication with the medical team and helping patients develop self-care skills to promote optimal adherence to hormone therapy. Specific app features included notification pop-ups, reminders, motivational messages, symptom tracking and management tips, educational content, social networking among patients, communication with a patient navigator, local resources and support groups, and technical support. In addition to colors, background and icon preferences, patients emphasize the need for a user-friendly app that is easy to navigate with clear educational content. Beta-testers found the app easy to use, credible and trustworthy, and their reactions were very positive about app appearance, content, purpose, and usability. Minor technical issues were fixed, and the study app was refined and finalized. Conclusions: An iterative and patient-centered design process was followed to develop a bilingual and interactive mobile app prototype to be used in a randomized control trial. The anticipated outcome is a scalable, evidence-based and easily disseminated intervention with potentially broad use to patients using HT and other oral anticancer agents. Citation Format: Patricia Chalela, Edgar Munoz, Cliff Despres, Pramod Sukumaran, Illeana Tiemann, Victoria Paz, Bianca Gutierrez, Devasena Inupakutika, Sahak Kaghyan, David Akopian. Improving adherence to hormone therapy among breast cancer patients through a mobile app and patient navigation: App development and testing [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-38.

Prognostic nomograms for patients undergoing radical operation for stage I-III appendiceal adenocarcinoma: A surveillance, epidemiology, and end results database analysis.

To develop nomograms for effective prediction of cause-specific survival (CSS) and overall survival (OS) of patients who underwent radical operation for stage I-III appendiceal adenocarcinoma. Clinical information from the surveillance, epidemiology, and end results database was retrieved from 2004 to 2015 and subjected to multivariate analysis to explore variables that affect the OS and CSS. Results were used to construct nomograms to assess the 1-, 3-, and 5-year OS and CSS rates, then their calibration accuracy and discriminative power were examined using Kaplan-Meier curves, calibration plots, and C statistics. Overall, 1,241 patients were included in the analysis. We found 7 and 5 factors that could independently alter the prognosis, then used for creating nomograms for evaluating the OS and CSS, respectively, with respective C-index values of 0.741 (95% confidence interval [CI]: 0.729-0.754) and 0.747 (95% CI: 0.733-0.762). Calibration and receiver operating characteristic curves further revealed excellent predictive performance. We successfully built highly accurate nomograms for evaluating the 1-, 3-, and 5-year CSS and OS rates in subjects who underwent radical operation for stage I-III appendiceal adenocarcinoma. Further studies, involving prospective validations, are required to validate these nomograms.