Common Histology Research Articles

Validation of the Prognostic Index for Spine Metastasis (PRISM) Score for Stratifying Survival in Patients Treated with Spinal Stereotactic Radiosurgery

Stereotactic spinal radiosurgery (SSRS) has been increasingly utilized as a first-line treatment for the management of spine metastases due to its ability to prolong survival and improve symptom control. Studies have shown that SSRS is helpful for select patients; however, there is no universal scoring system utilized to predict patient response to treatment. The Prognostic Index for Spinal Metastases (PRISM) score was shown to predict the likelihood of patients benefiting from SSRS. We sought to further demonstrate its generalizability by performing validation with a large dataset from a second high-volume institution. We performed a retrospective review from 2017-2019 of 424 patients treated with SSRS at a single institution. Patients were stratified on the previously described PRISM criteria: Female sex (+2), solitary bone disease (+3), performance status (0 through +3.5), prior surgery at the SSRS site (+1), number of other metastatic sites (-N), prior radiation at the SSRS site (-1), and latency to treatment ≥ 5 months (+3). Patients were grouped based on PRISM scores: >7, Group 1; 4-7, Group 2; 1-3, Group 3; <1 Group 4. There were 89, 188, 88, and 59 patients in Groups 1, 2, 3, and 4, respectively. Most patients were male (70%) with a performance status of 0 (53%). The most common tumor histologies were prostate (34%), renal (18%), and lung (11%). The median biological effective dose (BED10) was 60 Gy (interquartile range [IQR], 60-82). We performed Cox proportional hazards analysis on overall survival (OS) based on PRISM score and patient and tumor characteristics. Concordance indices created from PRISM criteria and the multivariate Cox proportional analysis were compared. The median follow-up time was 50.5 months (95% confidence interval [CI], 45.8-54.7) with a median overall survival of 30.3 months (95% CI, 27.3-38.4). The median overall survivals for PRISM Groups 1, 2, 3, and 4 were 57.1, 37, 23.7, and 8.8 months, respectively. There were significant differences in overall survival among PRISM groups with hazard ratios of 0.49 (95% CI, 0.35-0.69; P<0.001) for Group 1, 0.71 (95% CI, 0.55-0.91); P<0.007) for Group 2, 1,45 (95% CI, 1.08-1.94); P = 0.010) for Group 3, and 3.47 (95% CI, 2.56-4.70; P<0.001) for Group 4. Multivariable Cox analysis for patient and tumor characteristics revealed only the number of organs involved and performance status as significant clinicopathologic prognostic attributes. However, the C-index using the PRISM criteria was 0.76, which was superior to the C-index when using the significant clinicopathologic attributes by themselves (0.71). These data demonstrate robust validation of the PRISM score to stratify OS in patients treated with SSRS and may help guide optimal treatment selection in prospective trials and clinical settings.

Functional Outcomes and Toxicities Associated with SBRT to Bone Metastases Involving the Joint Space

Metastatic spread to bone is a common occurrence in advanced malignancies. Stereotactic Body Radiation Therapy (SBRT) is increasingly used for management of bone metastases in both the palliative and oligometastatic settings, especially for radioresistant histologies. Historically, therapeutic radiation to joints has been avoided whenever possible to minimize toxicities such as joint fibrosis and stiffness. Very little data exists to guide the treatment of bone metastases involving or adjacent to the joint space using SBRT. The purpose of this study is to report functional outcomes and toxicities associated with SBRT to metastatic bone lesions involving the joint space. Patients with solid tumor bone metastases involving the joints of long bones who were treated with SBRT (≥500 cGy/fraction; BED10 ≥37.5) who had ≥30 days follow up were identified from our institutional electronic health record using an IRB approved protocol. Pre-treatment and post-treatment pain assessments and toxicities were collected and scored retrospectively. Toxicities were categorized as acute (≤30 days post treatment) or late (>30 days post-treatment). Weidentified 40 evaluable patients with 54 lesions treated with SBRT. Lesions treated included those involving the hip (29/54, 54%), shoulder (11/54, 20%), elbow (8/54, 14%), and knee (6/54, 11%). The most common patient histology treated was renal cell carcinoma (13/40, 33%), followed by prostate adenocarcinoma (7/40, 18%), non-small cell lung cancer (4/40, 10%), and breast cancer (4/40, 10%). The remainder (12/40) had other histologies. Median follow up time was 7.7 months (range = 1.3-55.0). Median prescribed dose was 650 cGy/fraction (range = 500-1300 cGy) and most lesions received 4000 cGy in 5 fractions (18/54, 33%). At >30 days, of the 42 sites where pain was reported pre-treatment, 30/42 (71%) had complete or partial pain relief, while 10/42 (24%) experienced no pain relief during available follow up. Patients reported worsening pain after SBRT in 2/54 (3.7%) of treated lesions. Seven of 54 (14.0%) treated lesions led to complaints of joint stiffness requiring physical therapy. A minority of patients developed insufficiency fractures or treatment failures after SBRT requiring surgery (4/54, 7.4%). Three of 54 patients (5.6%) developed symptomatic radiation myositis confirmed on imaging. Toour knowledge, this is the first study to report functional and toxicity outcomes of SBRT to lesions involving the joints of long bones. While SBRT appears to have acceptable toxicities at the doses reported in this analysis, further study is warranted to identify pre-treatment factors predictive of toxicity. Limitations of the study include its small sample size, retrospective nature, and single institution design. Future studies will focus on dosimetric and clinical factors associated with toxicities which may allow for more personalized treatments and assist with informed consent.

Adverse events and oncologic outcomes with combination lenvatinib and pembrolizumab for the treatment of recurrent endometrial cancer

ObjectiveTo evaluate adverse events (AEs) of combination lenvatinib plus pembrolizumab for the treatment of recurrent endometrial cancer (EC) and to assess outcomes by lenvatinib starting dose. MethodsWe retrospectively reviewed patients with recurrent EC treated with lenvatinib plus pembrolizumab at our institution between 10/1/2019–11/30/2021. Starting dose of lenvatinib was defined as standard (20 mg) or reduced (10 mg/14 mg). AEs were manually extracted through chart review and graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. PFS, overall survival (OS), and duration of response (DOR) were analyzed. ResultsForty-three patients were identified; median age was 67 years (range, 54–85). The most common histologies were serous (35%), endometrioid (23%), and carcinosarcoma (21%). Starting lenvatinib doses were 10 mg (n = 10), 14 mg (n = 10), and 20 mg (n = 23). Median number of cycles received was 8 (range, 1–42). Twenty-four patients (56%) required ≥1 lenvatinib dose reduction; 3 (7%) discontinued lenvatinib, and 1 (2%) discontinued pembrolizumab for intolerance or AE. Thirty-six patients (84%) experienced grade ≥ 3 AEs; hypertension, weight loss, anemia, fatigue, and thrombocytopenia were most common. The standard dose group experienced significantly shorter observed PFS vs the reduced dose group (P = .02). There was no difference in DOR (P = .09) or OS (P = .27) between the groups. ConclusionIn clinical practice, AEs associated with combination lenvatinib plus pembrolizumab were common and comparable to Study 309/KEYNOTE-775 findings. AEs were similar regardless of starting lenvatinib dose. Further dose optimization studies of lenvatinib plus pembrolizumab may be indicated in recurrent EC. Clinical trial data remain the gold standard to guide starting lenvatinib dosing.

SIX YEARS OF NEURO-NAVIGATION ASSISTED BRAIN TUMOUR SURGERY: PROGRESS AND CHALLENGES

Abstract AIMS To report a six-year experience with computerized neuro-navigation assistance in our neuro-oncology surgeries and services. METHOD Retrospective review of all consecutive cases involving computer-assisted neuro-navigation diagnostic and resective brain tumour operation over a six-year period (January 2016-December 2021). Main study parameters: Clinical diagnostic procedures, operations, histological diagnosis, adjuvant treatments. Data were analysed using simple descriptive statistics, and results were presented accordingly. RESULTS Total number of cases 111, Males 70 and Females 41 (M: F = 1.7:1). Age ranges from 8 months to 80 years. The commonest presentation was headache, nausea, and vomiting. Pre-op diagnosis: Intra axial tumours 70/111 (63%), Extra axial tumours 41/111 (36%). Operations: Resection/Debulking of tumour 86/111(77,4%), with complete EOR of 65/86 (75%). Diagnostic Biopsy 68/111(61%) with target precision of 100%. Common Histology were Gliomas 50/111(45%), Meningiomas 41/111 (36.9%), and Metastatic 15/111 (13.5%). Adjuvant treatments and follow-ups were advised accordingly. CONCLUSIONS With computerized neuro-navigation assistance, a wider spectrum of brain tumours were more confidently operated, and adjuvant treatments were easily deployed in line with a precise histological diagnosis for improved neuro-oncology services. But this success was at a huge cost of adopting measures to overcome some inevitable challenges.

Genomic profiling and sites of metastasis in non-small cell lung cancer.

We investigated the biological predisposition to site of metastasis in patients with NSCLC based on their molecular profiling and program death ligand PD-L1 status. We sought to identify any association between metastatic site and molecular profile in NSCLC patients. This was a retrospective analysis of patients with stage IV NSCLC who were newly diagnosed from January 2014 to June 2022. Clinical characteristics, pathology, molecular reports, and imaging were retrieved and analyzed. A total of 143 patients were included in the study. Median age was 65 years, with an equal number of men (n=71) and women (n=72). The most common histology was adenocarcinoma (81.8%). At least one genetic mutation was discovered in 100 patients. Mutations with a targetable drug were found in 86 patients. The most common mutations were TP53 (25.2%), EGFR (24.5%), KRAS/NRAS (20.3%), and CDKN2A/2B (7.7%). Patients with any mutation were significantly more likely to have metastatic disease to the brain (57% vs. 37%, p=0.03), but there was no difference in metastatic disease to bone (34% vs. 26%, p=0.32). Patients without a discoverable mutation were significantly more likely to have metastatic disease to other sites (e.g., adrenal gland 91% vs. liver 66%, p=0.002). There was no difference in progression-free survival (PFS) or overall survival (OS) between those with versus without mutations. Median PFS and OS were significantly longer in patients with an EGFR mutation than those with KRAS/NRAS or TP53 mutations. Patients with PD-L1 >1% or TP53 were significantly more likely to have metastatic disease to organs other than bone or brain (p=0.047 and p=0.023, respectively). We identified four prognostic groups in metastatic NSCLC. Patients with PD-L1 <1% and no actionable mutations have the poorest prognosis, with median survival of around 20 months. Patients with mutations discoverable on NGS are more likely to have metastatic disease to the brain. KRAS/NRAS in particular has a predilection to metastasize to the brain and bone. PD-L1 expression and a TP53 mutation, on the other hand, tend to lead to metastasis of NSCLC to organs other than brain or bone. These results need to be corroborated in larger prospective studies.

Neighborhood-Level Socioeconomic Disadvantage Predicts Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves survival in select patients with peritoneal metastases (PM), but the impact of social determinants of health on CRS/HIPEC outcomes remains unclear. A retrospective review was conducted of a multi-institutional database of patients with PM who underwent CRS/HIPEC in the USA between 2000 and 2017. The area deprivation index (ADI) was linked to the patient's residential address. Patients were categorized as living in low (1-49) or high (50-100) ADI residences, with increasing scores indicating higher socioeconomic disadvantage. The primary outcome was overall survival (OS). Secondary outcomes included perioperative complications, hospital/intensive care unit (ICU) length of stay (LOS), and disease-free survival (DFS). Among 1675 patients 1061 (63.3%) resided in low ADI areas and 614 (36.7%) high ADI areas. Appendiceal tumors (n = 1102, 65.8%) and colon cancer (n = 322, 19.2%) were the most common histologies. On multivariate analysis, high ADI was not associated with increased perioperative complications, hospital/ICU LOS, or DFS. High ADI was associated with worse OS (median not reached versus 49 months; 5 year OS 61.0% versus 28.2%, P < 0.0001). On multivariate Cox-regression analysis, high ADI (HR, 2.26; 95% CI 1.13-4.50; P < 0.001), cancer recurrence (HR, 2.26; 95% CI 1.61-3.20; P < 0.0001), increases in peritoneal carcinomatosis index (HR, 1.03; 95% CI 1.01-1.05; P < 0.001), and incomplete cytoreduction (HR, 4.48; 95% CI 3.01-6.53; P < 0.0001) were associated with worse OS. Even after controlling for cancer-specific variables, adverse outcomes persisted in association with neighborhood-level socioeconomic disadvantage. The individual and structural-level factors leading to these cancer disparities warrant further investigation to improve outcomes for all patients with peritoneal malignancies.

Spatial proteomics enables identification of prognostic biomarkers in papillary renal cell carcinoma

Abstract Background Papillary renal cell carcinoma (PRCC) is the second most common adult kidney cancer histology, constituting 15-20% of cases. While some patients may have indolent PRCC tumors that grow slowly, other tumors rapidly metastasize. Some PRCC tumors respond to immune checkpoint inhibitors. Thus, understanding the immune tumor microenvironment and how it correlates with patient outcomes in this relatively rare disease is a critical need. Spatial interrogation of patient samples has the potential to offer novel insights into the tumor-immune axis and provide avenues for enhanced diagnosis and treatment. Addressing questions of spatial arrangement within tumors has remained a technical and biological challenge, but emerging spatial biology technologies provide molecular data at single cell resolution. We hypothesized that the spatial interaction of immune, stromal and tumor cells would be prognostic for PRCC patients. Methods A tissue microarray was assembled from an archive of ~100 patients presenting with PRCC. This dataset was assayed with PhenoCycler/CODEX (Akoya Biosciences) using a 31-antibody panel with immune- and cancer-related proteins. We have developed methodology and novel algorithms to perform signal normalization, cell segmentation, and cell typing. We computed neighborhoods for each of 2.5 million cells and performed network analysis to identify spatial clusters. This method allowed us to identify clusters consistently present across multiple TMA spots from the same patient and across multiple patients. Results Using spatial neighborhood analysis, we have identified diverse spatial clusters of potential clinical relevance, including five distinct M2 macrophage spatial clusters. We have described one of the clusters as being physically associated with helper T cells, which is visualized on a PRCC spot and shows co-occurence of M2-macrophages (CD163) and helper T cells (CD4). This pattern was replicated in additional TMA spots from the same patient. In contrast, other clusters of M2-macrophages (M2-M2 spatial cluster and M2-M1 macrophages) are visualized to show vastly different cellular neighborhoods. Clinical associations show that the patients with presence of the M2-T helper cluster have a poor cancer-associated survival (p=0.005). In comparison, the total proportion of M2 macrophages is not associated with survival (p=0.4), highlighting the importance of characterizing spatial interactions beyond cell type quantitation. Conclusions In summary, we highlight the utility of spatial biology to explain the heterogeneity in patients’ tumors and to uncover novel correlates of clinical phenotypes, establishing a platform for future discovery in this field and the identification of additional spatial correlates of patient outcome and clinical response. CDMRP DOD Funding: yes

Conventional Radiological Profile of Metastatic Bone Disease Based on Its Histopathological Results: A 3-Year Experience

Highlights:1. The incidence of MBD tends to be more frequent in older ages and in female patients.2. The radiological appearance of a lesion tends to differ depending on its primary tumor.3. Pathological fracture was present in 55.37% of the cases. AbstractIntroduction: Metastasis commonly occurs in the bone, termed metastatic bone disease (MBD). Early diagnosis and intervention are important to prolong and increase the quality of life. Although conventional radiology is less sensitive for diagnosing this disease, it remains the most cost and time-efficient screening method. This study aimed to describe the radiological profile of patients diagnosed with MBD based on its histopathological result.Methods: This was a descriptive retrospective study using medical records and digital radiological data of patients diagnosed with MBD from 2019-2021 in Dr. Soetomo General Academic Hospital, Surabaya. Variables in this study include gender, age, histopathological result, location of metastases, number of lesions, lesion density, and pathological fracture.Results: 51 patients were diagnosed with MBD during the period of the study and sorted into 121 cases based on metastases location. MBD is more frequent in older female patients, where lesion mostly originates from the breast, thyroid, and lungs, with adenocarcinoma as the most common histology. Vertebrae were the most common location of metastases. Most lesion tends to be multiple and osteolytic. However, certain lesions from different primary tumor had different predilections. Pathological fracture was present in 55.37% of cases.Conclusion: MBD needs to be suspected in patients with cancer from the breast, thyroid, and lungs as its incidence is higher. More studies about MBD profiles on a larger scale should be conducted to better represent this disease in the general population.

SPCR-11 DEMOGRAPHIC DISPARITIES AND PROGNOSTIC FACTORS IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA: A SEER DATABASE ANALYSIS

Abstract Accounting for 3-4% of all central nervous system malignancies, primary CNS lymphoma (PCNSL) is a rare but aggressive form of extranodal non-Hodgkin lymphoma. Although recent studies have demonstrated an overall decline in the incidence, certain demographics are known to be more affected than others. We reviewed the queried Surveillance, Epidemiology, and End Results (SEER) database, 17 registries, Nov 2021 sub (2000-2019) for lymphoid neoplasm recode 2021 revision with primary site codes C69.1-69.4, C69.9-70.1, C70.9-72.5, C72.8-72.9. Patients of unknown race, ethnicity, and stage of the disease were excluded. We used Cox proportional hazard regression to assess the determinants of overall survival (OS) and cause-specific survival (CSS). Significance level was set to 0.05. Our search included 5910 patients. The mean age at diagnosis was 61.8 ± 15.8 years. Males accounted for 53.67% of the patients. Racial demographics showed a predominance of Whites (66.1%), followed by Hispanics (15.6%), Asian/pacific islanders (10.3%), Blacks (7.4%), and American Indians/Alaska Natives (0.45%). Most common histology was diffuse large B-cell lymphoma (67.74%). Most patients were diagnosed at stage I (76.5%), followed by stage IV (19.7%) of the disease. Older patients had worse OS (HR 1.03 [1.027;1.032]) and CSS (HR 1.021 [1.018;1.024]). Females had better OS 0.853 [0.803;0.9059]) and CSS (HR 0.8871 [0.8145;0.966]) compared to males. Indolent (follicular and marginal zone) lymphomas were associated with better OS (HR 0.3169 [0.2647-0.3759]) and CSS (HR 0.4265 [0.3494-0.5152]) compared to large B-cell lymphoma. Black patients had worse OS (1.608 [1.421-1.813]) and CSS (HR 1.385 [1.165-1.635]). While Hispanic ethnicity did not influence OS, it was associated with worse CSS (1.158 [1.025;1.304]). Stage at diagnosis did not have a statistically significant association with survival. These results suggest a need for additional research targeting high-risk demographics to develop tailored treatments, enhance care accessibility, and address possible inequities in the management of PCNSL.

Risk factors and predictors of tumor recurrence among breast cancer patients in a tertiary government hospital in the Philippines.

7 Background: This study aims to identify the risk factors and predictors of tumor recurrence of breast cancer patients using the local data available in the Breast Care Center in East Avenue Medical Center, Quezon City, Philippines. Methods: A chart review of 529 charts was done at the Breast Care Center between 2011–2017, and 474 charts were included. Demographics and Clinicopathologic features were gathered from the chart. Cox-proportional hazard regression was used to compute hazard ratios [95% confidence interval] of the different variables to compare the recurrence rates. Results: Breast cancer subtypes are as follows: 246 (52%) patients were HR+/Her2-, 52 (11%) were HR-/Her2+, 81 (17%) were HR+/Her2+, and 95 (20%) were HR-/Her2-. The mean age at diagnosis was 50 years old. The median BMI was 25 kg/m2. Most have hypertension (HTN) (21.7%) and diabetes mellitus (DM) (7%). The most common histology was invasive carcinoma NOS (92.6%), and 42.5% had a lymphovascular invasion. Only 6.7% received neoadjuvant systemic therapy, the rest had adjuvant systemic therapy. Mostly underwent modified radical mastectomy (92.8%). The most common cytotoxic agent used were cyclophosphamide (96.14%), doxorubicin (87.13%), docetaxel (53.37%), and 5-fluorouracil (37.87%). In the her2+ subtype, only 19.54% received trastuzumab. Among breast cancer subtypes, HR-/Her2+ has the highest tumor recurrence (15.38%), and HR+/Her2-, HR+/Her2+, and HR-/Her2- had 8.54%, 7.41%, and 11.96% had tumor recurrence, respectively. The median time to recurrence was 47, 24, 39.5, and 47 months with HR+/Her2-, HR-/Her2+, HR+/Her2+, and HR-/Her2-, respectively. The most common site of recurrence were bone (39%) and local recurrence (32.37%). Contralateral breast recurrence occurred in 2 patients with HR-/Her2+. In univariate analysis, HTN (HR 0.34 [0.13, 0.85], p=0.022), DM (HR 2.55 [1.19, 5.48], p=0.016), stage IIIA (HR 3.78 [1.04, 13.73], p=0.044), IIIB (HR 9.11 [2.46, 33.68] p=0.001), IIIC (HR 12.59 [3.50, 45.22], p&lt;0.001), positive lymph nodes (HR 1.07 [1.02, 1.12] p=0.002), and patients who received doxorubicin (HR 0.44[0.23, 0.86], p=0.015) were statistically significant for tumor recurrence. In multivariate analysis, HTN (HR 0.32 [0.11, 0.94], p=0.038) and doxorubicin (HR 0.30 [0.13, 0.70], p=0.005) have the strongest effect for decreasing recurrence rate and DM (HR 7.45 [2.85, 19.46] p&lt;0.001) and locally advanced stage (IIIB) (HR 10.97 [2.51, 48.06], p=0.001) were associated with greater risk of recurrence. Conclusions: In this study, we determined the risk factors and predictors of breast cancer tumor recurrence in a tertiary government hospital in a third-world country like the Philippines. Certain co-morbidities (HTN and DM), locally advanced stage at diagnosis, and systemic treatment received (doxorubicin) significantly affected tumor recurrences with breast cancer in our setting.

Chromophobe renal cell carcinoma

Chromophobe renal cell carcinoma (ChRCC) is the second most common variant histology (non-clear cell) RCC. ChRCC is distinct from clear cell RCC (ccRCC) in terms of genetics, genomics, metabolism, cell of origin, and response to targeted and immune therapies. The pathogenesis of ChRCC remains unclear, but current data suggest two potential mechanisms: mTORC1 hyperactivation through PTEN pathway mutations and mitochondrial dysfunction leading to oxidative stress. There are no specific approved treatments for ChRCC, although some responses to tyrosine kinase and mTOR inhibitors have been observed. Response to immunotherapy is generally limited. Targetable pathways involving innate lymphoid cells/IL-15 and cysteine homeostasis/ferroptosis have recently been identified.

A Genomic Analysis of Esophageal Squamous Cell Carcinoma in Eastern Africa.

Esophageal squamous cell carcinoma (ESCC) comprises 90% of all esophageal cancer cases globally and is the most common histology in low-resource settings. Eastern Africa has a disproportionately high incidence of ESCC. We describe the genomic profiles of 61 ESCC cases from Tanzania and compare them to profiles from an existing cohort of ESCC cases from Malawi. We also provide a comparison to ESCC tumors in The Cancer Genome Atlas. We observed substantial transcriptional overlap with other squamous histologies via comparison with The Cancer Genome Atlas (TCGA) PanCan dataset. DNA analysis revealed known mutational patterns, both genome-wide as well as in genes known to be commonly mutated in ESCC. TP53 mutations were the most common somatic mutation in tumors from both Tanzania and Malawi but were detected at lower frequencies than previously reported in ESCC cases from other settings. In a combined analysis, two unique transcriptional clusters were identified: a proliferative/epithelial cluster and an invasive/migrative/mesenchymal cluster. Mutational signature analysis of the Tanzanian cohort revealed common signatures associated with aging and cytidine deaminase activity (APOBEC) and an absence of signature 29, which was previously reported in the Malawi cohort. This study defines the molecular characteristics of ESCC in Tanzania, and enriches the Eastern African dataset, with findings of overall similarities but also some heterogeneity across two unique sites. Despite a high burden of ESCC in Eastern Africa, genomic investigations in this region are nascent. This represents the largest comprehensive genomic analysis ESCC from sub-Saharan Africa to date.

Clinical characteristics and treatment outcomes of invasive ductal and lobular carcinoma: analyses of 54,832 taiwan cancer registry index cases.

Invasive lobular cancer (ILC) is the second most common histology type of breast cancer followed by invasive ductal carcinoma (IDC). This study aimed to investigate the characteristic, treatment strategies, and clinical outcomes of ILC based on a national population-based cancer registry. This study recruited 2671 ILC and 52,215 IDC patients diagnosed between 2011 and 2017 using the Taiwan Cancer Registry (TCR). Correlations between ILC and IDC subgroups were assessed using 1:4 propensity score matching and compared using the χ2 test. Disease free survival(DFS) and overall survival(OS) were estimated using the Kaplan-Meier method with the log-rank test. The risk of disease relapse and mortality were assessed using Cox proportional hazards model. ILC patients had larger tumor sizes, more positive axillary lymph node involvement, lower tumor grade, and higher cancer stage than IDC patients. After matching, ILC patients had a significantly higher rate of receiving mastectomy (58.93% and 53.85%) and positive surgical margin regardless of surgery type. ILC exhibited a significantly higher rate of distant metastasis than IDC(3.67% and 2.93%), but no difference in local recurrence rate, DFS or OS between the two groups. Higher cancer stage, higher grade, and mastectomy were risk factors for disease relapse and cancer-specific mortality. The hormone receptor-positive and HER2 over-expression subtypes were found to be associated with a reduced risk of disease relapse, while only PR positivity was associated with a decreased risk of mortality. (all P-values < 0.05). ILC patients had a higher mastectomy rate, higher surgical margin rate and distant metastasis rate than IDC patients. There is no significant difference in DFS or OS between ILC and IDC patients. Mastectomy was associated with poor outcomes regardless of ILC or IDC.

A FIRST REPORT ON OUTCOMES OF STEREOTACTIC BODY RADIOTHERAPY FOR POSTERIOR ELEMENT ONLY SPINAL METASTASES AND VALIDATION OF RECOMMENDED CLINICAL TARGET VOLUME DELINEATION PRACTICE

Abstract Spine stereotactic body radiotherapy (SBRT) improves local control and pain response compared to conventional external beam radiotherapy. Consensus stipulates MRI-based delineation of the clinical target volume (CTV) and is based on spine segment sector involvement. The applicability to metastases limited to the posterior elements remains to be validated. We aimed to determine the patterns of failure and safety of treating posterior element metastases when the vertebral body (VB) was intentionally excluded from the CTV. METHODS AND MATERIALS: A retrospective review of a prospectively maintained database of 605 patients and 1412 spine segments treated with spine SBRT was performed. Only treated segments involving the posterior elements alone were included. The primary outcome was local failure and secondary outcomes included patterns of failure, toxicities. RESULTS: 24/605 patients and 31/1412 segments were treated to the posterior elements only. Local failure occurred in 11/31 segments. The cumulative rate of local recurrence was 9.7% at 12 months and 30.8% at 24 months. Amongst local failures, the most common histologies were renal cell carcinoma (36.4%) and non-small cell lung cancer (36.4%) and 73% had baseline paraspinal disease extension. 6/11 (54.5%) failed exclusively within treated CTV sectors and 5/11 (45.5%) with both treated and adjacent untreated sectors. 4/5 cases had recurrent disease extending into the VB, but no failure was observed exclusively within the VB. CONCLUSIONS: Posterior element alone metastases are rare. Our analyses support SBRT consensus contouring guidelines such that the VB can be excluded from CTV in spinal metastases confined to the posterior elements.

Adaptive Lung Radiation Therapy in the Era of Immunotherapy: A Single-Center Retrospective Study

Treatment for locally advanced non-small cell lung cancer consists of concurrent chemoradiation followed by immunotherapy. Though this combination has been shown to have a benefit in both progression-free survival and overall survival, treatment is often limited by the development of pneumonitis. One way to mitigate toxicity is through adaptive radiation therapy, which does not currently have a standardized implementation in clinical practice. A single-center retrospective review of patients with locally advanced stage III or oligometastatic stage IV non-small cell lung cancer who were treated with chemoradiation with concurrent or subsequent immunotherapy from 2015 to 2020 was performed. Patients were stratified based on having 1 or more offline adapted plan. The aim of this study was to evaluate the association between dose-volume histogram values and common toxicities experienced during this treatment, including pneumonitis and esophagitis. Twenty-five patients were included in the final analysis: 10 with adapted plans (AP), and 15 with nonadapted plans (NAP). Mean age at onset was 74 years. The most common histology was adenocarcinoma (N=13). Five patients experienced pneumonitis: 2 in AP and 3 in NAP. Mann-Whitney U test of gross tumor volume sizes between AP (346.2 ± 269.7 cm3) and NAP (153.1 ± 99.6 cm3) was significant (P=.019). Multiple linear regression analysis with adjustment for covariates of pneumonitis versus plan adaptation (P=.106) and esophagitis versus plan adaptation (P=.59) did not demonstrate a significant difference in toxicity between the adapted and nonadaptive patients. Despite similar toxicities in both groups, the gross tumor volume size in the AP was more than double compared with NAP, suggesting that adaptive techniques provide a method for patients with larger target volumes to be treated without an observed difference in pneumonitis rates. These results suggest adaptive radiation therapy may have a role in mitigating toxicity experience from chemoradiation and immunotherapy and warrants further investigation.

Assessment of the clinicodemographic parameters and treatment outcomes of locally advanced and metastatic lung cancer cases – A retrospective study from northeast India

Background: There are many lacunae in our current understanding of the shifting epidemiological trends of lung cancer as well as lack of data among Northeast Indian patients. Aims and Objectives: This study tried to assess the clinicodemographic and treatment outcomes of advanced lung cancer cases. Materials and Methods: This was a retrospective hospital-based study. Patients with histopathologically confirmed locally advanced and metastatic lung cancer and were registered at Dr. Bhubaneswar Borooah Cancer Institute between January and December 2017 who were included in the study. A record was made of patient demographic-, clinical-, and treatment-related parameters. Kaplan–Meier survival curves were obtained. A two-tailed P&lt;0.05 was considered statistically significant. Results: Majority of the patients were elderly males (median=60 years), with a history of smoking in three quarter of them. Non-small-cell lung carcinoma (94%) type was the most common histology. About 93% of patients presented with TNM stage IV disease. The most common palliative chemotherapy (CT) regimen used was taxanes and platinum doublet (n=24, 35%). With a median follow-up of 6 months (range 0–37), the median progression-free survival and overall survival were 8 months and 10 months, respectively. The median survival was significantly longer in patients younger than 60 years. (13 months; P=0.021) and in those with non-small-cell histology (10 months). Conclusion: In this audit of resource-limited population with advanced lung cancer, palliative CT remains the mainstay of treatment. There is a further need to improve the survival of these advanced cases in a cost-effective manner.

Six Years of Neuro-Navigation Assisted Brain Tumor Surgery North Central Nigeria: Progress and Challenges

Introduction: Cranial operations in general have been historically driven by sound anatomical navigation with tremendous success. However, due to the unending desire for perfection, computerized neuro-navigation-assisted cranial surgery has found global usefulness, especially in neuro-oncological services. Our initial experience and challenges with this technology was already published three years ago but it becomes expedient for an update. Aims and Objectives: To report a six-year experience with computerized neuro-navigation assistance in our neuro-oncology surgeries and services. Methodology: Retrospective review of all consecutive cases involving computer-assisted neuro-navigation diagnostic and resective brain tumor operation over a six-year period (January 2016-December 2021). Main study parameters: Clinical diagnostic procedures, operations, histological diagnosis, adjuvant treatments. Data were analyzed using simple descriptive statistics, and results were presented accordingly. Results: Total number of cases 111, Males 70 and Females 41 (M: F = 1.7:1). Age ranges from 8 months to 80 years. The commonest presentation was headache, nausea, and vomiting. Pre-op diagnosis: Intra axial tumors 70/111 (63%), Extra axial tumors 41/111 (36%). Operations: Resection/Debulking of tumor 86/111 (77,4%), with complete EOR of 65/86 (75%). Diagnostic Biopsy 68/111 (61%) with target precision of 100%. Common Histology were Gliomas 50/111 (45%), Meningiomas 41/111 (36.9%), and Metastatic 15/111 (13.5%). Adjuvant treatments and follow-ups were advised accordingly. Conclusions: With computerized neuro-navigation assistance, a wider spectrum of brain tumors were more confidently operated, and adjuvant treatments were easily deployed in line with a precise histological diagnosis for improved neuro-oncology services. But this success was at a huge cost of adopting measures to overcome some inevitable challenges.

Six Years of Neuro-Navigation Assisted Brain Tumor Surgery North Central Nigeria: Progress and Challenges

Introduction: Cranial operations in general have been historically driven by sound anatomical navigation with tremendous success. However, due to the unending desire for perfection, computerized neuro-navigation-assisted cranial surgery has found global usefulness, especially in neuro-oncological services. Our initial experience and challenges with this technology was already published three years ago but it becomes expedient for an update. Aims and Objectives: To report a six-year experience with computerized neuro-navigation assistance in our neuro-oncology surgeries and services. Methodology: Retrospective review of all consecutive cases involving computer-assisted neuro-navigation diagnostic and resective brain tumor operation over a six-year period (January 2016-December 2021). Main study parameters: Clinical diagnostic procedures, operations, histological diagnosis, adjuvant treatments. Data were analyzed using simple descriptive statistics, and results were presented accordingly. Results: Total number of cases 111, Males 70 and Females 41 (M: F = 1.7:1). Age ranges from 8 months to 80 years. The commonest presentation was headache, nausea, and vomiting. Pre-op diagnosis: Intra axial tumors 70/111 (63%), Extra axial tumors 41/111 (36%). Operations: Resection/Debulking of tumor 86/111 (77,4%), with complete EOR of 65/86 (75%). Diagnostic Biopsy 68/111 (61%) with target precision of 100%. Common Histology were Gliomas 50/111 (45%), Meningiomas 41/111 (36.9%), and Metastatic 15/111 (13.5%). Adjuvant treatments and follow-ups were advised accordingly. Conclusions: With computerized neuro-navigation assistance, a wider spectrum of brain tumors were more confidently operated, and adjuvant treatments were easily deployed in line with a precise histological diagnosis for improved neuro-oncology services. But this success was at a huge cost of adopting measures to overcome some inevitable challenges.

Long-term results of postoperative and definitive (chemo)radiotherapy in sinonasal carcinoma. Adult Comorbidity Evaluation 27 score as a predictor of survival.

The objective was to evaluate the efficacy and toxicity of curative radiotherapy in patients with sinonasal carcinoma and to identify prognostic factors influencing treatment outcomes. The authors conducted a retrospective study of 61 consecutive patients treated with postoperative or definitive radiotherapy from 2002 to 2018 (median age 59 years, current/former smokers 71%, maxillary sinus 67%, nasal cavity 26%). The majority of patients were diagnosed with locally advanced disease (85% clinical stage ≥ III). Regional cervical metastases were initially diagnosed in 23% of patients. The most common histology was squamous cell carcinoma (61%). Radiation therapy was preceded by radical surgery in 64% of patients. 29 patients received chemotherapy (48%). The median follow-up was 53 months. The median total dose of radiotherapy achieved was 70 Gy. The 5- and 10-year locoregional control, distant control, overall survival, and disease-free survival were 74% and 64%, 90% and 90%, 51% and 35%, and 38% and 25%, respectively. Severe acute toxicity occurred in 36%, severe late toxicity in 23% of patients. Severe unilateral visual impairment occurred in 6 patients, temporal lobe necrosis in 1 patient, and osteoradionecrosis requiring surgery in 2 patients. The results of the study demonstrated the high effectiveness of curative treatment in patients with sinonasal carcinoma with long-term locoregional and distant control. The multivariate analysis indicated that N-staging, age, comorbidity score [as assessed by Adult Comorbidity Evaluation 27 (ACE-27)] and initial response to treatment were the strongest prognostic factors.

Practical Management of Adult Ultra-Rare Primary Retroperitoneal Soft Tissue Sarcoma: A Focus on Perivascular Epithelioid Tumours and Extraosseous Ewing Sarcoma.

With the exception of well-differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, solitary fibrous tumour, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma, the majority of the ≈70 histologic subtypes of retroperitoneal sarcoma are defined as 'ultra-rare' sarcomas, with an incidence of ≤1-5/1,000,000 persons/year. For most of these ultra-rare RPS subtypes, diagnosis and treatment follows international guidelines for the management of more common RPS histologies, with en bloc surgical resection as the mainstay of curative treatment, and enrolment in clinical trials where possible. Because the treatment of RPS is heavily driven by histology, the surgeon must be familiar with specific issues related to the diagnosis and management of ultra-rare sarcoma subtypes. Expert radiological and surgeon reviews are required to differentiate similarly presenting tumours where surgery can be avoided (e.g., angiomyolipoma), or where upfront systemic therapy is indicated (e.g., extraosseous Ewing's sarcoma). Thus, the management of all retroperitoneal sarcomas should occur at a sarcoma referral centre, with a multidisciplinary team of experts dedicated to the surgical and medical management of these rare tumours. In this focused review, we highlight how diagnosis and management of the ultra-rare primary RPS histologies of malignant perivascular epithelioid cell tumour (PEComa), extraosseous Ewing sarcoma (EES), extraosseous osteosarcoma (EOS), and rhabdomyosarcoma (RMS) critically diverge from the management of more common RPS subtypes.