Early Posttreatment Research Articles

The Effects of Photobiomodulation Therapy in Cubital Tunnel Syndrome, Clinical Trial.

Aim: We aimed to evaluate the effects of laser therapy together with rest splint and exercise on muscle strength, function, activities of daily living, and pain in individuals suffering from cubital tunnel syndrome (CuTS) by comparing it with placebo treatment. Materials and Methods: This prospective, single-blind, and randomized controlled study was conducted with 64 patients with CuTS in total. They were divided into two groups by randomization: Group 1 (n = 32) was provided with low-energy laser therapy + splint + exercise, and Group 2 (n = 32) was provided with low-energy sham laser therapy + splint + exercise. Patients in both groups received resting splints and nerve release exercises. Pretreatment and posttreatment (3rd week, 3rd month) evaluations were made with the Visual Analog Scale (VAS), the Quick Disability of Arm, Shoulder, and Hand Questionnaire, hand grip strength, fingertip grip strength, the Patient-Rated Ulnar Nerve Evaluation Scale (PRUNES), and Short Form-12. An electrophysiological evaluation was performed at baseline and at the 3rd month. Results: We observed significant improvements in both groups regarding pain, function, muscle strength, health profile, and quality of life in the early posttreatment (3rd week) stage and at the 3rd-month follow-up. When both groups were compared, a significant difference was determined between the VAS-Rest, VAS-Movement, PRUNES-Pain, PRUNES-Function, and PRUNES-Total parameters in the posttreatment (3rd week follow-ups), as well as PRUNES-Pain scores in the post-treatment (3rd month) stage, of the groups in favor of those in Group 1 (p < 0.05). Conclusion: The findings of our study have shown that in the treatment of CuTS, laser treatment is superior to placebo in the short term, but they have equivalent effects in the medium term. Further studies with large patient populations are needed to provide more diverse information about the therapeutic effectiveness of low-intensity laser therapy.

Prognostic Significance of Early Posttreatment Audiometry in Idiopathic Sudden Sensorineural Hearing Loss.

This study aimed to assess the prognostic value of early posttreatment initiation audiometry findings in patients with idiopathic sudden sensorineural hearing loss (ISSHL). A retrospective cohort study. The study was conducted at a single tertiary medical center. A review was conducted on 299 ISSHL patients treated between 2007 and 2023. Patients underwent audiometry on Days 2 to 3 and 5 to 7 posttreatment initiation. Data on demographics, medical history, audiometry results, and prognosis were collected. Prognosis was categorized based on hearing recovery at 1 year postdiagnosis. Older age, worse initial speech reception threshold (SRT), ischemic heart disease, cerebrovascular accidents/transient ischemic attacks, hypertension, and diabetes were associated with a poorer prognosis. Posttreatment initiation audiometry findings on Days 2 to 3 and 5 to 7 significantly correlated with prognosis. Patients with a ≥30% improvement had substantial or complete recovery in over 80% of cases, while those with <10% had <30% recovery. Multivariate analysis identified a significant improvement on days 5 to 7 as an independent predictor of complete recovery (odds ratio = 4.25 [95% confidence interval 1.96-9.23], P = .0002). Posttreatment initiation audiometry findings, particularly on Days 5 to 7, hold significant prognostic value in ISSHL patients. A substantial improvement during this timeframe is strongly associated with favorable outcomes. These findings emphasize the potential of posttreatment initiation audiometry as a valuable tool for clinicians in counseling patients with ISSHL.

Shifting Gears: Transitioning Healthy Lifestyle Education Into Early Post-Treatment Survivorship.

During cancer treatment, oncology nurses emphasize patient and family education about coping strategies to manage adverse events such as gastrointestinal effects and fatigue. However, information about how to return to health.

Diffusion-weighted imaging complements T2-weighted MRI for tumour response assessment in squamous anal carcinoma

ObjectivesA published tumour regression grade (TRG) score for squamous anal carcinoma treated with definitive chemoradiotherapy based on T2-weighted MRI yields a high proportion of indeterminate responses (TRG-3). We investigate whether the addition of diffusion-weighted imaging (DWI) improves tumour response assessment in the early post treatment period.Materials and methodsThis retrospective observational study included squamous anal carcinoma patients undergoing MRI before and within 3 months of completing chemoradiotherapy from 2009 to 2020. Four independent radiologists (1–20 years’ experience) scored MRI studies using a 5-point TRG system (1 = complete response; 5 = no response) based on T2-weighted sequences alone, and then after a 12-week washout period, using a 5-point DWI-TRG system based on T2-weighted and DWI. Scoring confidence was recorded on a 5-point scale (1 = low; 5 = high) for each reading and compared using the Wilcoxon test. Indeterminate scores (TRG-3) from each reading session were compared using the McNemar test. Interobserver agreement was assessed using kappa statistics.ResultsEighty-five patients were included (mean age, 59 years ± 12 [SD]; 55 women). T2-weighted TRG-3 scores from all readers combined halved from 24% (82/340) to 12% (41/340) with DWI (p < 0.001). TRG-3 scores changed most frequently (41%, 34/82) to DWI-TRG-2 (excellent response). Complete tumour response was recorded clinically in 77/85 patients (91%). Scoring confidence increased using DWI (p < 0.001), with scores of 4 or 5 in 84% (287/340). Interobserver agreement remained fair to moderate (kappa range, 0.28–0.58).ConclusionDWI complements T2-weighted MRI by reducing the number of indeterminate tumour responses (TRG-3). DWI increases radiologist’s scoring confidence.Clinical relevance statementDiffusion-weighted imaging improves T2-weighted tumour response assessment in squamous anal cancer, halving the number of indeterminate responses in the early post treatment period, and increases radiologists’ confidence.Key PointsTumour response based on T2-weighted MRI is often indeterminate in squamous anal carcinoma.Diffusion-weighted imaging alongside T2-weighted MRI halved indeterminate tumour regression grade scores assigned by four radiologists from 24 to 12%.Scoring confidence of expert and non-expert radiologists increased with the inclusion of diffusion-weighted imaging.

Facilitating the transition to posttreatment survivorship for adolescent and young adults: A randomized waitlist control trial of a virtual mind-body intervention.

12132 Background: Adolescent and young adults (AYAs) with cancer experience chronic stress and poor quality of life, particularly in early posttreatment as AYAs grapple with a “new normal.” Mind-body programs introduced early posttreatment hold promise for providing AYAs with skills to mitigate the adverse psychosocial and physiological effects of stress. Methods: We adapted and piloted an 8-session virtual, mind-body stress management and resilience group program for AYAs (3RP-AYA) to support the posttreatment transition. AYAs were randomized to receive the 3RP-AYA immediately (intervention group; IG) or after 3 months (waitlist control; WC). Data were collected at baseline (T0), 3 (T1) and 6 months (T2). We assessed feasibility by examining 3RP-AYA participation and survey completion rates. Paired-samples t-tests evaluated within-group effects of the 3RP-AYA on coping, distress (worry, depression, uncertainty intolerance), and resilience from T0-T1 (intervention period for IG, waitlist period for WC). Independent-samples t-tests of T0-T1 change scores for each group tested between-group differences in strength of change. Cohen’s d characterized strength of within- and between- group differences. Acceptability (i.e., content satisfaction and perceived helpfulness) was assessed at progam end (T1 for IG, T2 for WC). Results: From 05/19-09/20, 72 AYAs (77% participation rate; Mage = 23.8; 73.6% female; mean 18-months posttreatment; 59.7% non-Hispanic white; 20.8% Hispanic; 25% international) were randomized to IG (n = 35) or WC (n = 37); 85.9% completed 6/8 sessions (median = 7), and 87.5% completed the T1 survey. At enrollment, AYAs presented with elevated worry (M = 52.5, SD = 12.2) and uncertainty intolerance (M = 33.8, SD = 8.7), resembling patients with generalized anxiety. From T0-T1, the IG demonstrated moderate-to-large improvements in coping (d= 0.78, P &lt; .001), worry ( d =0.45, p = .04), depression ( d= .31, p = .11), tolerance of uncertainty ( d = .37, p = .06 ) and resilience ( d =.34, p = .09). When examining between-group differences, the IG showed significantly greater improvement in coping (d = 0.72, p = .01), with non-significantly greater change in worry, depression, tolerance of uncertainty, and resilience (ds = 0.27-0.49, ps &gt; .09) relative to WC. Notably, 96.6% of participants reported overall content satisfaction, and 91.7% reported the 3RP-AYA was helpful. Conclusions: A virtual mind-body program is feasible, acceptable and shows promising efficacy in improving coping and distress among posttreatment AYAs. Findings offer a paradigm shift in the way survivorship care is delivered, suggesting that integrating a mind-body program into early posttreatment survivorship care can facilitate adjustment to life after treatment. This can have downstream effects on the long-term emotional and physical health of AYAs. Clinical trial information: NCT03768336 .

Healthy lifestyle behaviors among a diverse population of early posttreatment adolescent and young adult (AYA) survivors participating in a virtual stress management program.

e24048 Background: Adolescent and young adults (AYA) cancer survivors have worse long-term physical health than survivors of adult cancers. Healthy lifestyle behaviors can maximize physical health and enhance quality of life. The National Comprehensive Cancer Network (NCCN) publishes survivorship guidelines for healthy behaviors; however, it is unclear if AYA survivors follow these recommendations. Methods: This is a secondary analysis of a waitlist-controlled trial of an adapted mind body stress management group program for AYA survivors recruited between 03/2019-09/2020. Participants completed self-report questionnaires assessing tobacco use, e-cigarette use, alcohol use, physical activity, and sleep quality both before and after completing the 8-week group program. Descriptive statistics were used to characterize the proportions of survivors meeting NCCN guidelines at time of enrollment. Results: Seventy-two AYA survivors participated in this study (mean age 24, 74% female, 60% Non-Hispanic White, 21% Hispanic, 4% Black, 53% hematologic malignancy, mean 1.6 years post-treatment).Table 1 summarizes NCCN guidelines and concordant behavior at enrollment. Most participants met guidelines for tobacco and e-cigarette use at study entry, with the majority reporting they abstained from using tobacco (85%) and e-cigarettes (90%). Only 28% reported abstaining from any alcohol use. Of those who consumed alcohol, most reported consuming &lt; 3 drinks per day (83%), but 65% endorsed at least occasional binge drinking behavior ( &gt; 5 drinks). Only 52% met guidelines for vigorous- or moderate- intensity activity (i.e. 75 and 150 minutes weekly, respectively). Specifically, participants reported a median of 47.5 minutes/week (IQR 0-120 min/week) of vigorous-intensity activity and 60 minutes/week (IQR 30-140) of moderate-intensity activity. Many experienced sleep concerns, with only 30% reporting good or very good sleep (i.e. &gt; 4 on a 1 (very poor)-5 (very good) Likert scale). Conclusions: In a racially/ethnically diverse sample of AYA survivors, NCCN survivorship guideline concordance for healthy lifestyle was mixed. Of concern was that AYA survivors’ use of tobacco and e-cigs was similar to the general population. Furthermore, alcohol and physical activity recommendations were mostly not followed, and reported sleep quality was poor. These results highlight the need to better understand barriers and promote healthy lifestyles to optimize post-treatment outcomes. [Table: see text]

Taming Glioblastoma in "Real Time": Integrating Multimodal Advanced Neuroimaging/AI Tools Towards Creating a Robust and Therapy Agnostic Model for Response Assessment in Neuro-Oncology.

The highly aggressive nature of glioblastoma carries a dismal prognosis despite aggressive multimodal therapy. Alternative treatment regimens, such as immunotherapies, are known to intensify the inflammatory response in the treatment field. Follow-up imaging in these scenarios often mimics disease progression on conventional MRI, making accurate evaluation extremely challenging. To this end, revised criteria for assessment of treatment response in high-grade gliomas were successfully proposed by the RANO Working Group to distinguish pseudoprogression from true progression, with intrinsic constraints related to the postcontrast T1-weighted MRI sequence. To address these existing limitations, our group proposes a more objective and quantifiable "treatment agnostic" model, integrating into the RANO criteria advanced multimodal neuroimaging techniques, such as diffusion tensor imaging (DTI), dynamic susceptibility contrast-perfusion weighted imaging (DSC-PWI), dynamic contrast enhanced (DCE)-MRI, MR spectroscopy, and amino acid-based positron emission tomography (PET) imaging tracers, along with artificial intelligence (AI) tools (radiomics, radiogenomics, and radiopathomics) and molecular information to address this complex issue of treatment-related changes versus tumor progression in "real-time", particularly in the early posttreatment window. Our perspective delineates the potential of incorporating multimodal neuroimaging techniques to improve consistency and automation for the assessment of early treatment response in neuro-oncology.

MR-Guided Transurethral Ultrasound Ablation of Prostate Cancer: Initial Experience of Monitoring Tumor Response by Dynamic Apparent Diffusion Coefficient Measurements at 3.0 T

Introduction: Diffusion-weighted imaging (DWI) as part of multiparametric magnetic resonance imaging (mpMRI) is an important sequence for the detection of prostate cancer (PCa). The objective of this retrospective analysis was to evaluate changes in apparent diffusion coefficient (ADC) measurements in biopsy-proven PCa undergoing TULSA-PRO (MR-guided transurethral ultrasound ablation of the prostate) at 3.0 T after 1, 3, and 6–12 months posttreatment. Methods: Nineteen patients underwent follow-up examinations after 1, 3, and 6–12 months including mpMRI at 3.0 T and urological-clinical examinations with quantitative analysis of ADCs. Results: In PCa, a significant increase of ADC values after 6–12 months was measured after TULSA-PRO treatment by 29.1% (pre-TULSA: 0.79 ± 0.16 × 10−3 mm2/s, 6–12 months: 1.02 ± 0.35 × 10−3 mm2/s), while the corresponding value in the reference tissue decreased by 48.5% (pre-TULSA: 1.20 ± 0.15 × 10−3 mm2/s, 6–12 months: 0.91 ± 0.29 × 10−3 mm2/s). The mean ADC values in the early follow-up groups at 1 and 3 months did not change significantly. Conclusion: DWI with ADC as part of mpMRI can serve as a biomarker to dynamically monitor the follow-up after TULSA after 6–12 months. For early posttreatment progression, it is not suitable due to too many confounding variables.

Differential effects of anti-CD20 therapy on CD4 and CD8 T cells and implication of CD20-expressing CD8 T cells in MS disease activity

A small proportion of multiple sclerosis (MS) patients develop new disease activity soon after starting anti-CD20 therapy. This activity does not recur with further dosing, possibly reflecting deeper depletion of CD20-expressing cells with repeat infusions. We assessed cellular immune profiles and their association with transient disease activity following anti-CD20 initiation as a window into relapsing disease biology. Peripheral blood mononuclear cells from independent discovery and validation cohorts of MS patients initiating ocrelizumab were assessed for phenotypic and functional profiles using multiparametric flow cytometry. Pretreatment CD20-expressing T cells, especially CD20dimCD8+ T cells with a highly inflammatory and central nervous system (CNS)-homing phenotype, were significantly inversely correlated with pretreatment MRI gadolinium-lesion counts, and also predictive of early disease activity observed after anti-CD20 initiation. Direct removal of pretreatment proinflammatory CD20dimCD8+ T cells had a greater contribution to treatment-associated changes in the CD8+ T cell pool than was the case for CD4+ T cells. Early disease activity following anti-CD20 initiation was not associated with reconstituting CD20dimCD8+ T cells, which were less proinflammatory compared with pretreatment. Similarly, this disease activity did not correlate with early reconstituting B cells, which were predominantly transitional CD19+CD24highCD38high with a more anti-inflammatory profile. We provide insights into the mode-of-action of anti-CD20 and highlight a potential role for CD20dimCD8+ T cells in MS relapse biology; their strong inverse correlation with both pretreatment and early posttreatment disease activity suggests that CD20-expressing CD8+ T cells leaving the circulation (possibly to the CNS) play a particularly early role in the immune cascades involved in relapse development.

The Short-Term Outcome of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma with Mild Symptom: Case Series

A few reports have demonstrated the efficacy of middle meningeal artery embolization (MMAE) alone for mildly symptomatic chronic subdural hematoma (CSDH); however, the clinical course in the early posttreatment period remains unclear. The purpose of this study was to analyze the short-term outcomes of this technique at our center. This study was based on a retrospective analysis of a single-center consecutive case series. Patients with mildly symptomatic CSDH treated with MMAE alone between July 2020 and June 2022 were examined. Neurological examinations and head computed tomography scans were performed before treatment and 1, 7, 14, and 28days after treatment. The clinical course of the patients was analyzed. In particular, symptom improvement within 1week from treatment or rescue evacuation and the factors associated were evaluated. Fifteen patients were included in this study. No procedure-related complications occurred. Partial or complete recovery within the first week from treatment was observed in 10 cases (66.7%), and the symptoms resolved completely in a median of 26 (6.5-33.5) days. Rescue evacuation was needed in 3 cases (20.0%). The hematoma volume and midline shift gradually decreased from baseline, with a significant improvement within the first week (P= 0.030 and 0.0032, respectively). MMAE alone provides relatively early improvement in cases of mildly symptomatic CSDH and may be a potential alternative to surgical evacuation or medical therapy.

P570: REAL-WORLD EFFICACY OUTCOMES OF VENETOCLAX PLUS AZACITIDINE VS INTENSIVE CHEMOTHERAPY FOR INDUCTION THERAPY IN ADULT PATIENTS WITH ACUTE MYELOID LEUKEMIA

Background: Intensive chemotherapy (IC) is commonly used to achieve remission in patients with newly diagnosed acute myeloid leukemia (AML), although the relapse rate remains high. The combination of venetoclax, a BCL2 inhibitor, plus intravenous or subcutaneous azacitidine (ie, VEN-AZA), is FDA- and EMA-approved for the treatment of patients with newly diagnosed AML aged ≥ 75 years or with comorbidities that preclude the use of IC. Because of the challenging induction and maintenance decisions for some patients, it is important to understand the real-world patterns of use and outcomes of VEN-AZA vs IC. Aims: To compare US real-world outcomes for the use of VEN-AZA vs IC, particularly in older populations. Methods: This retrospective analysis was performed on a cohort of patients from the US-based Flatiron Health electronic health record-derived de-identified database, who had newly diagnosed AML and received induction therapy with VEN-AZA or IC between 21 Nov 2018 and 01 Jun 2021. Using an intention-to-treat analysis (including patients with less than 2 months of follow-up), patient groups were propensity score-matched in a 1:1 ratio using nearest neighbor matching with calipers set to 0.01 to reduce bias. Matched-patient assessments included morphological complete remission, overall survival (OS; defined as from first day of therapy to death), and relapse-free survival (RFS; from first day of therapy to relapse or death). Univariate analyses were used to investigate possible treatment-associated OS and RFS benefit in patient subgroups, including those with high-risk mutations. Results: Of 7484 patients in the Flatiron database with newly diagnosed AML, 1188 met the selection criteria and 436 were propensity score-matched resulting in 218 per treatment group. In the matched VEN-AZA vs IC cohorts, patients had a mean age of 69.9 vs 69.0 y and Charlson Comorbidity Index of 0.5 vs 0.7, respectively; 39% vs 38% were female. The rates of patients with complete remission (CR) and those with stem cell transplant (SCT) were significantly lower with VEN-AZA vs IC at 46% vs 62% (P=0.001) and 16% vs 31% (P<0.001), respectively. Fewer VEN-AZA– vs IC-treated patients received an early posttreatment bone marrow biopsy, with respective rates of 31% vs 69% (1 mo) and 57% vs 86% (2 mo). Median OS for VEN-AZA vs IC in the matched population was 13.0 vs 17.2 mo (P=0.263), respectively; it was 11.0 vs 15.6 mo (P=0.410) with censoring for SCT. Median RFS was numerically shorter for VEN-AZA than for IC (9.5 vs 11.0 mo; P=0.689); when including censoring for SCT, RFS was longer for VEN-AZA (7.5 vs 5.7 mo; P=0.027). Among subgroups, including those with high-risk mutations, no significant factor was found to be associated with OS in the matched patients (Figure). The frequency of known patients with high-risk mutations in RUNX1, ASXL1, and TP53 was similar for both treatment groups. Similar subgroup results were observed for RFS. Image:Summary/Conclusion: Rates of CR and SCT were significantly higher with IC. OS was nominally longer with IC vs VEN-AZA, with and without censoring for SCT; differences were not statistically significant. None of the subgroups tested, including patients with high-risk mutations, showed a significant OS association. Longer follow-up time may contribute to better characterized outcomes achieved with IC vs VEN-AZA in routine clinical practice. These data support more investigation on strategies to improve survival outcomes, including the impact of maintenance therapy.

Adherence to the American Cancer Society Head and Neck Cancer Survivorship Care Guideline According to Chart Review: A Nested Retrospective Cohort Pilot Study.

The purpose of this study was to explore adherence to the American Cancer Society (ACS) Head and Neck Cancer (HNC) Survivorship Care Guideline and their outlined 33 recommendations among posttreatment HNC survivors. A bi-institutional, retrospective, nested cohort study of mucosal or salivary gland HNC survivors diagnosed in 2018 was designed. Guideline adherence was assessed via retrospective chart review between 0 and 13 months after completion of oncologic treatment according to 4 categories: (1) problem assessed, (2) problem diagnosed, (3) management offered; (4) problem treated. Adherence was defined as meeting a recommendation subcategory at least once over the 13-month period. Among 60 randomly selected HNC survivors, a total of 38 were included in the final cohort after exclusion of individuals with ineligible cancers and those who died or were lost to follow-up over the study period. Approximately 95% of HNC survivors were assessed for HNC recurrence and screened for lung cancer. Certain common problems such as xerostomia, dysphagia, and hypothyroidism were screened for and managed in ≥70% of eligible survivors. Conversely, screening for other second primary cancers and assessment of a majority of other physical and psychosocial harms occurred in <70% of survivors, and in many cases none to a slim minority of survivors (eg, sleep apnea and sleep disturbance, body and self-image concerns). Only 5% of survivors received a survivorship care plan. Overall adherence to the ACS HNC Survivorship Care Guideline in early posttreatment survivors was suboptimal. Interventions are needed to better implement and operationalize these guideline recommendations.

Macular microcirculation changes after macula-off rhegmatogenous retinal detachment repair with silicone oil tamponade evaluated by OCT-A: preliminary results.

Background:Rhegmatogenous retinal detachment (RRD) with macular involvement is a sight-threatening condition. Silicone oil (SO) is efficacious for retinal tamponade, especially in complex cases. Whether macular detachment per se or the potential tamponading agent may affect macular microcirculation after RRD repair is a matter of research.Objectives:To investigate macular microcirculation changes using optical coherence tomography angiography (OCT-A) after pars plana vitrectomy (PPV) with intravitreal SO for RRD repair in the early posttreatment period.Design:Prospective comparative cross-sectional study.Data sources and Methods:Fourteen eyes of 14 patients were included in the study. All eyes underwent a single successful PPV with SO tamponade for macula-off RRD. OCT-A was performed to analyze macular microcirculation and visual outcomes at 1 month postoperatively. The fellow unaffected eye was used as control.Results:Vessel density (VD) in the superficial capillary plexus (SCP) was significantly lower at each macular region (fovea, parafovea, and perifovea) of SO-treated eyes compared with the fellow eyes (all p = 0.001). Similarly, perfusion density (PD) in the SCP was significantly lower at each macular region than the fellow eyes (all p = 0.001). There was enlargement of foveal avascular zone (FAZ) area and decrease of circularity at RRD eyes compared with the fellow ones (all p = 0.001). Postoperative logMAR visual acuity (VA) was significantly lower in treated eyes than fellow eyes and correlated inversely with foveal, parafoveal, and perifoveal VD and PD SCP (all p < 0.001). Postoperative VA had no correlation with FAZ parameters.Conclusion:Enlargement of FAZ SCP and decrease in VD and PD SCP during the short-term follow-up were possibly attributable to ischemic changes in the macular area after RRD repair with SO tamponade. In this preliminary study, the flow density in macular capillary plexus may represent an indicator of visual outcomes.

Utility of Early Posttreatment PET/CT Evaluation Using FDG or 18F-FCH to Predict Response to 90Y Radioembolization in Patients With Hepatocellular Carcinoma.

BACKGROUND. Assessment of hepatocellular carcinoma (HCC) treatment response after transarterial radioembolization (TARE) is challenging, because response by conventional imaging criteria may not become apparent until 6 months after treatment. Though HCC exhibits variable avidity for FDG, some cases of HCC without avidity for FDG show avidity for 18F-fluorocholine (18F-FCH). OBJECTIVE. The purpose of this study was to evaluate the utility of early posttreatment evaluation by PET/CT using FDG or 18F-FCH to predict 6-month treatment response and survival after TARE in patients with HCC. METHODS. This retrospective study included 37 patients (mean age, 67 years; 34 men, three women) with documented HCC treated by TARE who underwent both pre-treatment FDG PET/CT and 18F-FCH PET/CT and early FDG PET/CT and/or 18F-FCH PET/CT 4-8 weeks after treatment; FDG PET/CT and 18F-FCH PET/CT examinations were performed on separate dates. Only one of 73 initially identified potentially eligible patients was excluded because of lack of HCC avidity for both FDG and 18F-FCH. Response assessment by modified RECIST (mRECIST) on multiphase CT or MRI was performed at 1 month and 6 months in 23 patients. Early responses seen on PET/CT and 1-month mRECIST response were assessed as predictors of 6-month mRECIST response. Univariable and multivariable predictors of overall survival (OS) were identified. RESULTS. On pretreatment PET/CT, 28 (76%) patients were FDG-positive (showed visual uptake on FDG PET/CT and tumor-to-normal liver ratio > 1.15), 15 (41%) were FCH-positive (showed visual uptake on 18F-FCH PET/CT), and six (16%) were both FDG-positive and FCH-positive. Twelve of 28 FDG-positive HCCs exhibited early response by FDG PET/CT; seven of 15 FCH-positive HCCs exhibited early response by 18F-FCH PET/CT. Twelve (52%) patients exhibited 6-month mRECIST response. Response seen on early posttreatment PET/CT exhibited 100% (12/12) sensitivity and 100% (11/11) specificity for 6-month mRECIST response, whereas 1-month mRECIST response exhibited 67% (8/12) sensitivity and 100% (11/11) specificity for 6-month mRECIST response. Response seen on early posttreatment PET/CT was a significant independent predictor of OS on univariable (hazard ratio [HR], 0.4; 95% CI, 0.2-0.9; p = .03) and multivariable (HR, 0.2; 95% CI, 0.1-0.8; p = .01) analyses. CONCLUSION. Early evaluation after TARE by PET/CT using FDG or 18F-FCH may pre dict 6-month response and OS in patients with HCC. CLINICAL IMPACT. Early posttreatment evaluation with PET/CT could help more reliably identify true nonresponders after TARE, which in turn could prompt early response-adapted therapeutic management.

Prediction of Early Onset Cytokine Release Syndrome and Neurologic Events after Axicabtagene Ciloleucel in Large B-Cell Lymphoma Based on Machine Learning Algorithms

Prediction of Early Onset Cytokine Release Syndrome and Neurologic Events after Axicabtagene Ciloleucel in Large B-Cell Lymphoma Based on Machine Learning Algorithms

Comparison of two annular photorefractive intrastromal cross-linking protocols in high oxygen for low-grade myopia through 24-month follow-up.

To compare two annular epithelium-on (epi-on) high oxygen photorefractive intrastromal cross-linking (PiXL) illuminations protocols for treatment of low-grade myopia. In this randomized, single-masked, intra-individually comparative study, healthy individuals with bilateral low-grade myopia (manifest refractive spherical equivalent (MRSE) -0.75 diopters (D) to -2.50 D) were treated with high oxygen epi-on PiXL. One eye was randomized to receive pulsed accelerated 365-nm ultraviolet-A illumination in a central annular zone of 4.0 mm (1 second on, 1 second off; 30 mW/cm2 ), and the fellow eye in a 3.5 mm annular zone (0.5 second on, 1 second off; 45 mW/cm2 ). Uncorrected distance visual acuity (UDVA), MRSE, low-contrast visual acuity (LCVA), best spectacle corrected visual acuity (BSCVA), endothelial cell count (ECC) and Scheimpflug light scattering depths were assessed through 24-month follow-up. Twenty-seven participants (54 eyes) were included. The 3.5 mm protocol rendered less subjective ocular discomfort posttreatment and a larger improvement than the 4.0 mm protocol in UDVA: -0.52 (-0.72, -0.32) logMAR (medians and interquartile ranges, IQR) and -0.38 (-0.50, -0.22), p = 0.003 and MRSE: +1.25 D (0.75, 1.50) and +1.0 (0.75, 1.0), p = 0.037. The transient reduction in LCVA was larger with the 3.5 mm protocol (p < 0.01). No adverse events, and no reductions in ECC or BSCVA were noted. Epi-on PiXL in high oxygen reduces myopia in healthy eyes. A larger reduction of myopia and less early posttreatment subjective ocular discomfort can be seen with a smaller treatment zone, but likely at the expense of a transient decrease in low-contrast visual acuity.

Brain growth after surgical treatment for infant postinfectious hydrocephalus in Sub-Saharan Africa: 2-year results of a randomized trial.

Hydrocephalus in infants, particularly that with a postinfectious etiology, is a major public health burden in Sub-Saharan Africa. The authors of this study aimed to determine whether surgical treatment of infant postinfectious hydrocephalus in Uganda results in sustained, long-term brain growth and improved cognitive outcome. The authors performed a trial at a single center in Mbale, Uganda, involving infants (age < 180 days old) with postinfectious hydrocephalus randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV+CPC; n = 51) or ventriculoperitoneal shunt (VPS; n = 49). After 2 years, they assessed developmental outcome with the Bayley Scales of Infant Development, Third Edition (BSID-III), and brain volume (raw and normalized for age and sex) with CT scans. Eighty-nine infants were assessed for 2-year outcome. There were no significant differences between the two surgical treatment arms in terms of BSID-III cognitive score (p = 0.17) or brain volume (p = 0.36), so they were analyzed together. Raw brain volumes increased between baseline and 2 years (p < 0.001), but this increase occurred almost exclusively in the 1st year (p < 0.001). The fraction of patients with a normal brain volume increased from 15.2% at baseline to 50.0% at 1 year but then declined to 17.8% at 2 years. Substantial normalized brain volume loss was seen in 21.3% patients between baseline and year 2 and in 76.7% between years 1 and 2. The extent of brain growth in the 1st year was not associated with the extent of brain volume changes in the 2nd year. There were significant positive correlations between 2-year brain volume and all BSID-III scores and BSID-III changes from baseline. In Sub-Saharan Africa, even after successful surgical treatment of infant postinfectious hydrocephalus, early posttreatment brain growth stagnates in the 2nd year. While the reasons for this finding are unclear, it further emphasizes the importance of primary infection prevention and mitigation strategies along with optimizing the child's environment to maximize brain growth potential.

Pretreatment ADC predicts tumor control after Gamma Knife radiosurgery in solid vestibular schwannomas.

Radiosurgery is a well-established treatment for vestibular schwannomas (VSs), but it is often difficult to identify which tumors will respond to treatment. We sought to determine whether pretreatment or posttreatment tumor apparent diffusion coefficient (ADC) values could predict tumor control in patients undergoing Gamma Knife radiosurgery (GKRS) and whether these values could differentiate between cases of pseudoprogression and cases of true progression in the early posttreatment period. We retrospectively identified patients who underwent GKRS for solid VSs between June 2008 and November 2016 and who had a minimum follow-up of 36 months. Pretreatment and posttreatment minimum, mean, and maximum ADC values were measured for the whole tumor volume and were compared between patients with tumor control and those with tumor progression. In patients with early posttreatment tumor enlargement, ADC values were compared between patients with pseudoprogression and those with true progression. Of the 44 study patients, 34 (77.3%) demonstrated tumor control at final follow-up. Patients with tumor control had higher pretreatment minimum (1.35 vs 1.09; p = 0.008), mean (1.80 vs 1.45; p = 0.004), and maximum (2.41 vs 1.91; p = 0.011) ADC values than patients with tumor progression. ADC values did not differ between patients with pseudoprogression and those with true progression at early posttreatment follow-up. ADC values may be helpful in predicting response to GKRS in patients with solid VSs but cannot predict which tumors will undergo pseudoprogression. Patients with higher pretreatment ADC values may be more likely to demonstrate posttreatment tumor control.

Efficacy of Imiflex, Zest, and Assure II on Green Foxtail Control

Grass weeds pose a serious management challenge in grain sorghum. Recent development of three herbicide-tolerant grain sorghum technologies such as Inzen, Igrowth, and DoubleTeam will provide the opportunity for producers to use nicosulfuron (Zest), imazamox (Imiflex), and quizalofop-p-ethyl (FirstAct) for grass weed control, respectively. The main objectives of this research were to (1) determine the effectiveness of Imiflex applied preemergence (PRE) on green foxtail control in comparison to commonly used group 15 herbicides; (2) compare the efficacy of Zest, Imiflex, and Assure II applied early- or late-POST at two different rates; and (3) determine the tank-mix compatibility of Zest, Imiflex, Assure II, and Select Max (clethodim) with 2,4-D (Weedar 64) and dicamba (Clarity) on green foxtail control. Field experiments were conducted in fallow ground with a natural infestation of green foxtail at Kansas State University Agricultural Research Center in Hays, KS. PRE herbicide programs, including Imiflex, Dual II Magnum, Warrant, and Outlook were tested. Imiflex, Zest, and Assure II were tested in early- or late-postemergence (POST) timings. The early POST treatments of Imiflex, Assure II, Zest, and Select Max alone or in tank-mixture with Weedar 64 and/or Clarity were also tested in a separate study. Among PRE programs, Imiflex tested at both rates provided an excellent control (89 to 94%) of green foxtail up to 50 days after PRE (DAPRE), whereas control did not exceed more than 51% with any of the group 15 herbicides. Among early POST programs, Assure II at 10 fl oz/a provided 95% green foxtail control at 28 days after early POST (DAEPOST). Green foxtail control with early POST treatments of Imiflex, Zest, and Assure II (6 oz/a) was moderate and ranged from 77 to 83% at 28 DAEPOST. Green foxtail control with late POST treatments of Imiflex, Zest, and Assure II was inadequate and ranged from 14 to 31% at 21 days after late POST (DALPOST). In a separate study, tank-mixing Weedar 64 or Clarity with Assure II reduced the efficacy by >50% on green foxtail control compared to Assure II alone treatment. These results suggest that PRE applied Imiflex (6 or 9 oz/a) can provide excellent residual activity for early season control of green foxtail. Furthermore, Assure II applied early POST at a higher rate can provide effective control of green foxtail; however, the efficacy will significantly decline if Assure II is tank-mixed with Weedar 64 or Clarity.

Early posttherapy clearance of human papillomavirus and treatment response in cervical carcinoma.

Among patients with cervical cancer, little is known about the significance of persistent human papillomavirus (HPV) expression after chemoradiation (CRT). This study evaluated associations between early posttreatment HPV clearance and patient outcomes with an added focus on the value of posttherapy positron emission tomography (PET) imaging. Included patients underwent pretreatment testing indicating a high-risk HPV infection and posttreatment testing with a messenger RNA (mRNA)-based genital swab after CRT. Posttherapy responses were stratified on the basis of HPV mRNA detection into an early clearance (EC) group (no mRNA) and a persistent expression (PE) group (detectable mRNA) on the basis of an evaluation at a median of 6weeks after therapy. The Kaplan-Meier method was used to compare outcomes, and multivariable analysis was used to identify predictors of outcomes. Seventy-two of the 97 eligible patients (74.2%) had EC. The mean follow-up time was 25months (range, 4-56months), and 2-year pelvic control (76.9% vs 50.2%; P=.01) and overall survival (OS; 80.9% vs 52.2%; P<.01) were superior among EC patients. In the multivariable analysis, EC predicted for improved survival (hazard ratio [HR] for mortality, 0.46; 95% confidence interval [CI], 0.21-0.96; P=.047), as did a complete response (CR) on posttherapy PET (HR for less than a CR on PET, 6.17; 95% CI, 2.58-14.72; P<.01). In a subset analysis of patients with a posttherapy PET CR, HPV clearance retained prognostic significance (2-year OS, 95.6% with EC vs 66.7% with PE; P=.04), whereas PE patients without a PET CR had the worst survival (35.9%; P<.01 for trend). Early posttherapy clearance of HPV is associated with improved survival in cervical cancer. Evaluating HPV expression at this 6-week time point provides prognostic information beyond posttherapy PET imaging and may aid in risk stratification and decisions for treatment escalation.