External Beam Research Articles

Allogeneic stem cell transplantation in patients with a prior history of prostate cancer.

A retrospective analysis of 25 patients with a history of prostate cancer (PC) who subsequently underwent allogeneic hematopoietic cell transplantation (HCT) for treatment of a hematologic malignancy was performed. Median patient age was 66.7years. Median duration from the diagnosis of PC to HCT was 4.2years. Twenty-three patients had Gleason group 1 or 2 disease. Therapy included prostatectomy (n = 13) and external beam or brachytherapy (n = 9). Hematologic diagnoses included both myeloid (n = 15) and lymphoid neoplasms (n = 10). Twenty-four patients received either a nonmyeloablative or reduced intensity conditioning regimen. GVHD prophylaxis included a calcineurin inhibitor and mycophenolate mofetil ± sirolimus. Twenty patients had HLA-matched sibling or HLA-matched unrelated donors; five patients had HLA-mismatched donors. Eleven patients are alive, and 14 have died. Median survival was 2.5years (range, .02-12.6years). The major cause of death was hematologic relapse. Only one patient had evidence of recurrent PC, occurring 1.5years posttransplant. In carefully selected patients with a prior history of PC, there was no evidence of rapid recurrence of the solid tumor (ST) after HCT. PC patients who are in remission from their ST or have control of their disease on therapy should be considered eligible for HCT.

Importance of Radiographic Tumor Regression during Radiotherapy in Squamous Cell vs. Adenocarcinoma of the Uterine Cervix as Assessed by MRI, CT and Conebeam CT

<h3>Purpose/Objective(s)</h3> The purpose of this study was to evaluate the kinetics of tumor regression in cervical SCC and AC across the different imaging modalities used for patients undergoing radiotherapy, and to evaluate locoregional relapse (LRR), progression-free survival (PFS) and overall survival (OS) of each cohort and correlate these data with rate of regression of the primary tumor during treatment, and the percent of residual tumor after external beam. <h3>Materials/Methods</h3> Thirty-two patients with stage IB2-IVA cervical cancer were selected with all 3 imaging modalities from an institutional database with a 2:1 ratio of squamous cell carcinoma to adenocarcinoma. All available CT (113 scans), on-treatment weekly conebeam CT (CBCT; 100 scans) and MRIs (MRI₁ at diagnosis and MRI₂ prior to brachytherapy; 48 scans) were imported into planning software and tumor GTV volumes contoured (CT and MRI), or largest two-dimensional area of tumor delineated (CBCT). Volume regression over time curves were generated, and size and rate of regression, and the percent of residual tumor were correlated to disease progression and disease-specific survival (DSS), with receiver-operator curves and machine learning algorithms used to identify thresholds. Kaplan-Meier estimators were used for survival analysis. Fine-Grey analysis was used to estimate cumulative incidence of progression, using a competing risk of death. <h3>Results</h3> With a median follow-up of 2.9 years (yrs), 32 patients were included, 22 (69%) with SCC and 10 (31%) with AC. All were treated with concurrent chemoradiation with 45 Gy in 25 fractions with weekly cisplatin, followed by brachytherapy. The majority received 5 brachytherapy fractions (59%). 2/22 (9%) with SCC and 1/10 (10%) with AC had local progression. The 1- and 2-yr cumulative incidence (CI) of local progression for both SCC and AC was 10% at both time points. Distant progression was higher in AC (60%, 6/10) compared with SCC (9%, 2/22) For SCC vs AC, the 2-yr CI of distant progression was 9% vs 57% (p=0.02). Ten of 32 patients died (31%), 3/22 (14%) with SCC and 7/10 (70%) with AC. For SCC patients, 2-yr DSS was 90%, versus 60 % for AC. Extent and rate of regression on CT and CBCT data were not correlated with progression or survival in this cohort; however, these data showed consistent rates of tumor regression. A threshold of >20% residual on MRI₂ was identified and was correlated with worse 2-yr PFS (50% vs 90%, p=0.013) and 1-yr DSS (83% vs 100%, p<0.001). Median residual volume on MRI₂ trended toward significant between SCC and AC (55% vs 16%, p=0.052). <h3>Conclusion</h3> This study showed cervical AC is associated with higher rates of distant progression and worse overall survival than SCC. Cervical AC tends to have a higher residual tumor burden. Our identified threshold of >20% residual tumor on MRI₂ correlating with worse PFS and distant progression may help identify escalation of systemic therapy in select patients.

Prostate brachytherapy utilization in the COVID-19 era: A cross-sectional study of radiation oncologists in the United States

PURPOSEDespite advantages such as abbreviated treatment course, brachytherapy (BT) utilization rates for prostate cancer (PC) in the United States (US) are declining. We surveyed practicing US radiation oncologists (ROs) to determine the proportion who offer BT for PC and whether the COVID-19 pandemic influenced practice patterns. MATERIALS AND METHODSFrom July-October 2021, we surveyed practicing US ROs. Provider demographic and practice characteristics were collected. Questions assessing utilization of BT and external beam (EBRT) for patients of varying risk groups and the effect of the pandemic on practice patterns were administered. Descriptive statistics were reported. The bivariate relationships between provider characteristics and likelihood of offering BT were assessed using the Chi-square test (α < 0.05). RESULTSSix percent of surveyed ROs responded, with 203 meeting inclusion criteria (72% male, 72% white, 53% non-academic, 69% >10 years in practice) and 156 (77%) treating PC. For low-risk, fewer providers offered BT (41% total; 25% low dose rate [LDR], 10% high dose rate [HDR], 6% both) than stereotactic body (SBRT) (54%) and moderately hypofractionated radiation therapy (MHFRT) (83%). For favorable intermediate risk, fewer offered BT (37% total; 21% LDR, 10% HDR, 6% both) than SBRT (48%), MHFRT (87%), and conventionally fractionated EBRT (38%). For high (44%) and very-high (37%) risk, fewer offered EBRT+BT than EBRT alone. For every risk group, academic ROs were significantly more likely to offer BT (all p-values<0.05). <1% of respondents reported increased pandemic-related BT usage. CONCLUSIONSUS ROs, particularly in non-academic settings, do not routinely offer BT monotherapy or boost (<50%). Practice patterns were unaffected by COVID-19. Retraining may be critical to increasing utilization.

Structural assessment of the pedestrian bridge accessing Civita di Bagnoregio, Italy

The paper presents the results of the vibration tests carried out on the pedestrian bridge accessing Civita di Bagnoregio, Italy. The structure was in bad health condition. The external beams were damaged due to deterioration exacerbated by the combined actions of rain and wind. The circular piers were also damaged with several cracks where the concrete cover was spliced and the reinforcement bars were exposed. The analysis presented in the paper focuses on the highest five piers, which seemed to show an irregular behavior during a preliminary experimental campaign. The results of the experimental campaign presented in this paper showed that the structural behavior of the bridge was qualitatively similar to the expected one. The reduced stiffness, due to the observed widespread damage state, amplified the vibrations uniformly along the structure. The Italian Guidelines for the risk and safety assessment of bridges and viaducts, issued in 2020, have been applied and tested in this study and the results are presented in the paper.

The Prognostic Value of Tumor Size, Volume and Tumor Volume Reduction Rate During Concurrent Chemoradiotherapy in Patients With Cervical Cancer.

ObjectiveThis study aimed to investigate the relationship between prognostic and tumor parameters of cervical cancer patients, such as tumor size (TS), tumor volume (TV), and tumor volume reduction rate (TVRR) after external beam radiotherapy.MethodsA total of 217 patients with advanced cervical cancer, classified as Federation of Gynecology and Obstetrics (FIGO) IIa–IVa, were enrolled in the study. Pre- and mid-RT pelvic magnetic resonance imaging (MRI) were performed twice, during RT and just before brachytherapy.ResultsThe median follow-up time was 51 months (range, 7–111 months). The 5-year overall survival (OS), progression-free survival (PFS), and local failure-free survival (LFFS) rates were 81.3, 85.1, and 92.9%, respectively. Multivariate analysis revealed that tumor parameters including FIGO stage >II (Hazard Ratio, 2.377 and 95% confidence interval [CI], 1.091–5.182; P = 0.029), pre-RT TV >61.6 cm3 (HR, 0.417 and 95% CI, 0.188–0.926; P = 0.032), and mid-RT TV >11.38 cm3 (HR, 3.192 and 95% CI, 1.094–9.316; P = 0.034) were observably associated with OS. Univariate analysis showed that the tumor volume reduction rate (TVRR) was dramatically associated with overall survival (HR, 0.204 and 95% CI 0.033–1.282; P <0.001) and local failure-free survival (P = 0.050).ConclusionsIn this retrospective study, TVRR and mid-radiotherapy tumor volume are independent and strong prognostic parameters for patients with local advanced cervical cancer receiving CCRT.

Abstract 1289: Systemic immune response of prostate cancer patients to alpha-emitting radiotherapy

Abstract Targeted alpha therapy (TAT) is a type of radiotherapy (RT) that uses alpha-emitting radionuclides. These radionuclides have a natural affinity for areas of bone metastases (i.e., radium-223, Ra-223) or can label specific tumour targets (i.e., prostate-specific membrane antigen). Conventional photon irradiation (i.e., external beam) can activate or suppress immune responses. The resulting immune response is dictated by the release of soluble markers such as cytokines (i.e., IL-6) and damage associated molecular patterns, DAMPs (calreticulin). Less is known about the immune response induced by alpha-emitters. With increased interest in using TAT for cancer patients, it is important to gain a more in depth knowledge regarding the immune response of alpha emitters. Aim: Explore the systemic immune response of prostate cancer (PCa) patients to alpha-emitting RT by studying circulating cytokines, checkpoint molecules, matrix metalloproteinases (MMPs) and DAMPs. Methods: The cohort comprised of 43 patients with metastatic castration-resistant PCa treated with up to six four-weekly injections of the alpha emitter, Ra-223. We measured longitudinal changes in 61 plasma markers using the Luminex assay. The plasma markers included cytokines, checkpoint molecules and DAMPs. Results: Ra-223 induced longitudinal changes in 14 plasma markers over the course of treatment (T2-T6) compared with pre-treatment levels (T1). Most of the observed RT-induced changes occurred after four injections of Ra-223 (T5), where 9 of the 14 plasma markers changed significantly. The table summarises T5 findings (presented as mean concentration, pg/ml; statistical analysis using Wilcoxon matched-pairs signed rank test). Conclusion: Our data demonstrates that alpha-emitting RT induces systemic immune responses that can be measured in the plasma of patients. Given the diverse role of these markers, further study is needed to explore the biological implications of these systemic changes on patient outcome. Changes in plasma markers in patients treated with Ra-223 T1 T5 P value IL-8 6.7±0.9 9.7±1.3 0.0009 IL-2R 293.5±42.9 364.5±69.7 0.0247 IP-10 18.4±2.3 21.8±2.5 0.0243 RANTES 2668.8±173.4 2944.7±164.6 0.0455 BTLA 549.9±153.5 527.7±265.2 0.0319 CD137 49.6±8.9 39.1±13.5 0.0099 Calreticulin 7868±3514.9 9238.4±808.5 0.0386 RAGE 63.9±4.7 52.3±5.1 0.0014 MMP1 66.1±7.5 84.9±12.6 0.0245 Citation Format: Sapna Lunj, Hitesh Mistry, YeePei Song, Kamlesh Patel, Hannah Nightingale, Tim Smith, Peter Hoskin, Catharine West, Ananya Choudhury. Systemic immune response of prostate cancer patients to alpha-emitting radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1289.

The prognostic significance of pretreatment squamous cell carcinoma antigen levels in cervical cancer patients treated by concurrent chemoradiation therapy and a comparison of dosimetric outcomes and clinical toxicities between tomotherapy and volumetric modulated arc therapy

BackgroundTo analyze the prognostic factors associated with stage IB-IVA cervical cancer in patients who underwent concurrent chemoradiation therapy (CCRT) and to compare the clinical toxicities and dosimetric parameters of organs at risk between the different radiotherapy techniques.MethodsThis retrospective study enrolled 93 patients with stage IB-IVA cervical cancer who underwent definitive CCRT between April 2009 and December 2017. Nine patients (9.7%) received 3DCRT, 43 patients (46.2%) underwent VMAT, and 41 patients (44.1%) received tomotherapy, and all of them followed by brachytherapy using a 2D planning technique. The treatment outcomes and related prognostic factors were analyzed. We also compared the clinical toxicities and dosimetric parameters between the different techniques used for the last 30 patients.ResultsWith a median follow-up of 52.0 months, the 5-year overall survival (OS), progression-free survival (PFS), locoregional recurrence–free survival (LRRFS), and distant metastases–free survival (DMFS) were analyzed. In a Cox proportional hazards regression model, pretreatment SCC Ag > 10 ng/mL was a significant prognostic factor for PFS (hazard ratio [HR] 2.20; 95% confidence interval [CI] 1.03–4.70; P = 0.041), LRRFS (HR, 3.48; 95% CI 1.07–11.26; P = 0.038), and DMFS (HR 2.80; 95% CI 1.02–7.67; P = 0.045). Increasing the rectal volume receiving a radiation dose exceeding 30 Gy (V30 of rectum; odds ratio [OR] 1.15; 95% CI 1.10–1.30; P = 0.03) was associated with a higher possibility of ≥ Grade 2 acute radiation therapy (RT)-related diarrhea. The median rectal V30 values were 56.4%, 97.5%, and 86.5% for tomotherapy, 3-dimensional conformal radiation therapy (3DCRT), and volumetric modulated arc therapy (VMAT), respectively (P < 0.001). In addition, the chance of experiencing ≥ Grade 2 acute diarrhea were 10.0%, 66.7%, and 54.5% for tomotherapy, 3DCRT, and VMAT, respectively (P = 0.029).ConclusionsPatients with pretreatment SCC Ag ≤ 10 ng/mL have better PFS, LRRFS, and DMFS than those with pretreatment SCC Ag > 10 ng/mL. The rectal V30 is a significant predictor of severe acute diarrhea. Tomotherapy significantly decreased the rectal V30, reducing the severity of acute RT-related diarrhea during external beam RT.Trial registration This study was approved by the institutional review board at Kaohsiung Medical University Hospital. The registration number is KMUHIRB-E(I)-20190054 and retrospectively registered on 2019/3.

MP55-14 SALVAGE ROBOTIC RADICAL PROSTATECTOMY AFTER FOCAL THERAPY VERSUS RADIATION: A 10-YEAR EXPERIENCE

You have accessJournal of UrologyCME1 May 2022MP55-14 SALVAGE ROBOTIC RADICAL PROSTATECTOMY AFTER FOCAL THERAPY VERSUS RADIATION: A 10-YEAR EXPERIENCE Alireza Ghoreifi, Masatomo Kaneko, Hooman Djaladat, Andrew Hung, Rene Sotelo, Andre Berger, Mihir Desai, Inderbir Gill, Monish Aron, and Andre Luis Abreu Alireza GhoreifiAlireza Ghoreifi More articles by this author , Masatomo KanekoMasatomo Kaneko More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Andrew HungAndrew Hung More articles by this author , Rene SoteloRene Sotelo More articles by this author , Andre BergerAndre Berger More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Monish AronMonish Aron More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002634.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage robotic radical prostatectomy (sRRP) has gained acceptance in the management of patients with recurrent prostate cancer. Limited data is available regarding the outcomes of this procedure, especially in the setting of primary focal therapy (FT). The aim of this study is to evaluate the outcomes of sRRP after primary FT versus radiation therapy (RT). METHODS: Using our IRB-approved prostate cancer database, we reviewed the records of patients who underwent sRRP following primary local therapy for prostate cancer between Jan 2010 to July 2021. Patients with concomitant procedures, including fistula repair and urethroplasty were excluded. Perioperative findings and long-term outcomes were recorded and compared between FT and RT groups. RESULTS: A total of 100 patients with a median (IQR) age of 68 (63-74) years were included in the final analysis. Of these, 75 received RT (brachy=24, external beam=48, both=3) and 25 FT (Cryo=15, HIFU=8, both=1, focal laser ablation=1) as primary treatment. Median (IQR) time between primary treatment and sRRP was 66 (37-108) months (RT = 82 vs FT = 38M, p=0.0002). The median pre-sRRP PSA in RT vs. FT was 7.6 and 4.95 ng/mL, respectively (p=0.04). Pre-sRRP biopsy showed significantly higher rate of high-grade (GG ≥4) cancer in RT compared to FT (33% vs. 20%, p=0.02). Perioperative and pathology findings are reported in the Table. There was 1 rectal injury in the RT group. 90-day complications were significantly higher in RT vs. FT patients (32% vs. 8%, p=0.02). 6-month, but not 12-month continence (defined as no pad usage) was higher in FT compared to RT (53% vs. 21%, p=0.02 and 67% vs. 35%, p=0.13). A total of 24 patients underwent artificial urethral sphincter (AUS) placement, all of whom were in the RT group. In a median (IQR) follow-up of 24 (5-52) months (RT = 24M vs. FT = 9M; p=0.30), 14 patients developed biochemical recurrence (PSA >0.2 ng/mL), as follows: RT=15% vs. FT=12.5%. On multivariable analysis, history of RT was associated with higher rate of 90-day complications (Odds Ratio=4.9, 95% CI 1.06-23.02, p=0.04). CONCLUSIONS: Salvage robotic radical prostatectomy in patients with recurrent prostate cancer following focal therapy is safe. It is associated with lower 90-day complications and earlier urinary continence compared to the patients who received primary radiotherapy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e943 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Masatomo Kaneko More articles by this author Hooman Djaladat More articles by this author Andrew Hung More articles by this author Rene Sotelo More articles by this author Andre Berger More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement PDF DownloadLoading ...

Extensile Anterior and Posterior Knee Exposure for Complete Synovectomy of Diffuse Tenosynovial Giant Cell Tumor (Pigmented Villonodular Synovitis).

Extensile Anterior and Posterior Knee Exposure for Complete Synovectomy of Diffuse Tenosynovial Giant Cell Tumor (Pigmented Villonodular Synovitis).

Factors associated with late local failure and its influence on survival in men undergoing prostate brachytherapy

BACKGROUND AND PURPOSETo determine the factors associated with a positive post-treatment prostate biopsy (PB) and the effects of local failure on biochemical control and cause-specific survival (CSS) in men receiving prostate brachytherapy. METHODS AND MATERIALSOf 545 men with post-implant PB, 484 were routine (median 24 months) while 61 (median 55 months) were for cause. 114 had a repeat PB for rising PSA. Initial mean PSA was 10.5 ng/ml (±13.9) while 244 (44.8%), 202 (37.1%) and 99 (18.2%) had low, intermediate or high-risk disease. Treatments were implant only in 287 (52.7%), and implant with androgen deprivation therapy (ADT) ± external beam in 258. Radiation doses were converted to the biologically equivalent dose (BED). Final biopsy results were the last biopsy performed on that patient. Associations for the first and final biopsies with PSA, clinical stage (CS), Gleason grade group, time on hormone therapy (ADT) and BED were determined by ANOVA, chi-square and binary linear regression. Freedom from Phoenix failure (FFPF) and cause-specific survival were estimated by Kaplan Meier method and Cox proportions hazards. RESULTSAfter a median of 11.4 years the first and final biopsy were positive in 10.8% and 8.8%, respectively. Significant linear regression associations with first positive PB were ADT (p = 0.005), CS (p = 0.044) and BED (p = 0.030) while only BED (p < 0.001) was significant for the final PB. Positive biopsy occurred in 21/112 (18.8%), 16/230 (7.0%) and 3/182 (1.6%) for BED ≤150, >150–200 and >200 Gy (p < 0.001), and in 29/261 (11.1%) for BED (median) ≤185 Gy vs. 5/263 (1.9%) for > 185 Gy (OR 4.2, p < 0.001). 15-year FFPF was 75.6 vs. 17.5% and cause-specific survival was 94.2 vs. 75.5% for negative vs. positive biopsy. CONCLUSIONSHigher radiation doses are associated with 1.9% late local failure following prostate brachytherapy. A negative post-implant PB is associated with superior FFPF and decreased prostate cancer mortality.

Interfraction dose deviation and catheter position in cervical interstitial and intracavitary image guided HDR brachytherapy.

Interstitial and intracavitary gynecological HDR brachytherapy involve precise, localized delivery to targets with high dose gradients, sparing adjacent organs at risk (OAR). Due to the proximity of the rectum, bowel and bladder to the target, deviations in the applicator or catheter with respect to patient anatomy can significantly increase dose to OAR. The magnitude and direction of applicator and catheter migration at each fraction was assessed for template interstitial and tandem and ring (T&R) cohorts. The cohort included twelve gynecological patients with intact cervical lesions treated with external beam and brachytherapy. Pre-treatment CT images were registered to the simulation CT with respect to the target. Treatment catheter positions transformed into the planning CT coordinate system to evaluate localized catheter displacement and dose distributions calculated at each fraction. Dose was evaluated on the planning CT with planning contours and dwell locations at treatment position. Absolute deviation, depth and deflection angle for all patients were 4.6 ± 4.2 mm, -1.4 ± 4.0 mm, and 3.1 ± 2.3° respectively (n = 516 catheter positions for all treatment fractions and patients, mean ± SD). Absolute catheter deviation and deflection magnitude for interstitial treatments increased overall with each subsequent fraction with an overall increase of catheter retraction at each fraction (p < 0.005, n = 492 catheters, Kruskal-Wallis). A target EQD2 D90 reduction of 10 ± 10% and 7.7 ± 8.7% of the planned dose for interstitial and T&R cohorts respectively. There was an overall increase in bladder and rectal doses at each fraction. Catheter tracking in interstitial and intracavitary gynecological treatments with CT imaging revealed significant changes in catheter positioning with respect to the target volume. Overall deviations increased in magnitude with each subsequent fraction in the interstitial treatments. This caused patient dosimetry deviations, including target dose reduction and adjacent OAR doses changes.

Covid-19's impact on radiotherapy in the Republic of Srpska

Background/Aim. Coronavirus disease 2019 (COVID-19) significantly affects patients with any type of chronic disease, especially the ones with neoplasm. The aim of this study was to investigate the impact of the COVID-19 pandemic on the weekly number of external beam (EB) radiotherapy (RT) (EBRT) fractions and monthly brachytherapy (BT) applications without intentional hypofractionation. We also investigated how the pandemic affected the number of EBRT patients younger or older than 70 years. Methods. The Affidea Radiotherapy Center, Banja Luka (BL RT Center), provides RT to the population (1.15 million) of the Republic of Srpska (Bosnia and Herzegovina). We analyzed the period of 14 months before the onset and the same period during COVID-19. Results. The average weekly number of EBRT fractions from January 2019 to the end of February 2020 was 680.5 [standard deviation (SD) 67.4], and from March 2020 to the end of April 2021, it was 617.1 (SD 96.4). During April 2020, the weekly number of the EBRT de-creased by 67.9% compared to the same period in 2019, while in March 2021, it fell by 42.4%. Paired samples t-test showed that the occurrence of the COVID-19 pandemic had a statistically significant effect [t(60) = 4.627, p &lt; 0.05] on the reduction in the number of weekly EBRT fractions in the BL RT Center. When comparing number of EBRT patients over 70 years old to those fewer than 70 years old, the decrease was 16.3% vs. 1.6%, respectively. The Wilcoxon signed-rank test revealed that the COVID-19 pandemic had a statistically significant effect (Z = -2.42, p = 0.016) on reducing the number of monthly BT applications. Conclusion. A statistically significant decline in EBRT and BT was observed in BL RT Center for the first fourteen months of the pandemic. The "waves" of the pandemic "closed" the medical wards needed for the diagnosis and therapy of oncology patients and converted them into COVID-19 wards. Therefore, some oncology patients who would have had an indication for RT never received

Design and Physical Detection of Bridge Tower and Externally Prestressing Cable for Existing Bridge Strengthened by A Cable-Stayed System

With the continuous development of economy, the increasing traffic volume has brought greater burden to highway bridges. In this paper, a Yellow River Bridge is taken as an example. The cracking and deflection of the box girder of the main bridge have affected the structural performance requirements of the bridge operation. Based on this situation, the cable-stayed system is used to reinforce the bridge, and the construction process of bridge tower, cable saddle, steel anchor box and external beam is described in detail. The theoretical calculation and practice show that this method can effectively strengthen the bridge structure, and the cable-stayed system reinforcement method, as a mature, reasonable and operable construction technology, provides relevant reference for the reinforcement research of similar bridges.

Development of a Big Data Radiation Oncology Dashboard

<h3>Purpose/Objective(s)</h3> Healthcare data often exist in silos and in unstructured formats that limit interoperability and require tedious manual extraction. Our institution has adopted a flexible and scalable big data platform built on Hadoop that integrates data from Epic/Clarity as well as Aria and allows users to leverage modern data science tools to facilitate access. We hypothesize that a data analytics and visualization dashboard can be built using open-source tools that will (1) allow non-technical users to explore de-identified clinical data within our institutional big data platform and (2) connect with repositories of molecular data to demonstrate potential methods of integrating clinical and basic science data. <h3>Materials/Methods</h3> De-identified patient-level radiation oncology data from the institutional big data platform (Hadoop) were extracted with the python packages pyodbc and pandas. For the purposes of this dashboard, radiation oncology specific clinical data elements were queried including the date of first radiation treatment, treatment location, treatment modality (SBRT, external beam, SRS, TBI, LDR/HDR brachytherapy), ICD10 codes, anatomic treatment site, number of fractions, treatment prescription, and dose per fraction. A python client connection with the publicly accessible instance of cBioPortal for Cancer Genomics was established using the Bravado library. Data transformation and cleaning was performed in python using panda's data frames. A web-based dashboard to facilitate user-defined visualizations was implemented using the Dash python library and interactive visualizations of subsets of extracted data were generated in real-time using the plotly plotting library. <h3>Results</h3> We developed a web-based dashboard that gives users without extensive programming expertise the ability to explore de-identified clinical data extracted from Hadoop. As proof of principle, the dashboard was used to visualize the clinical impact of the COVID-19 pandemic on radiation oncology patient volumes, revealing a significant decline in new radiation treatments in April and May of 2020 (-54% and -36% compared to 2019) during the initial COVID-19 surge. Furthermore, the dashboard allows users to interact with the cBioPortal for Cancer Genomics repository, which currently houses clinical and molecular data from 301 publicly available studies spanning 869 different cancer types. This interface with cBioPortal illustrates the potential for future integration of clinically meaningful sequencing results with clinical outcomes data. <h3>Conclusion</h3> We built an interactive web-based dashboard to enable general users' easy access to de-identified clinical data stored within the institutional big data platform. Additional data sources, including external molecular data can be connected to the dashboard allowing for future integration.

Comparison of Three Groups of Patients Having Low Dose Rate Prostate Brachytherapy: Prostate-Specific Antigen Failure and Overall Survival.

PurposeTo examine dosimetric and clinical outcomes for Cs-131 radioactive seed implant compared to Pd-103 and I-125. Background/SignificanceCs-131 is a novel isotope with relatively short half-life (9.7 days) that may have clinical advantages in seed implant treatments of prostate cancers. There may be a shorter duration of symptoms and increased PSA control rates.MethodsWe performed a retrospective study in which clinical and dosimetric outcomes were compared for 186 prostate implants performed over a ten-year time period at three different Ascension hospitals. Isotopes that were used included Cs-131 (n=66; half-life 9.7 days), I-125 (n=60; half-life 60 days), and Pd-103 (n=60; half-life 17 days)ResultsThe implants used standard radiation dosages. These were 145 Gy for I-125 alone or 109 Gy when combined with external beam radiation. In the case of Cs-131 used alone, the dose was 115 Gy or 85 Gy when combined with an external beam. For Pd-103, 125 Gy was used for monotherapy and 90 Gy when combined with an external beam. The Cs-131 dosimetry was found to be similar to I-125 and Pd-103 on a quantitative basis. However, there was better homogeneity, and the delivered activity per seed and the number of seeds employed were greater compared to other isotopes. We compared the corrected total source strengths (i.e. normalized to sample mean values) and were able to demonstrate similar distributions for the three isotopes. Dosimetric analysis also suggested there was superior homogeneity with Cs-131. The median PSA value at 60 months was 0.11 ng/ml. There were only a few PSA failures in the three groups of cases, nonetheless, the Cs-131 had the fewest. ConclusionsOne attractive option for men with early-stage prostate cancer is interstitial brachytherapy. The use of the shorter-acting Cs-131 isotope may be expected to have dose-related side effects that resolve more rapidly. This series suggests a trend for improved PSA control outcomes for Cs-131 patients compared with I-125 and Pd-103.

Defining optimal adjuvant treatment for high-risk early-stage endometrial cancer

<h3>Objectives:</h3> There is a paucity of data to determine the optimal adjuvant treatment of early-stage, high-risk endometrial histologies. While many retrospective series focus on uterine serous cancer, the optimal treament for other high risk subtypes, including G3 endometrioid cancer, clear cell carcinoma or carcinosarcoma is not yet clear. We sought to determine patterns and outcomes of adjuvant treatment for early-stage high-risk endometrial cancers of multiple histologic subtypes. <h3>Methods:</h3> After Institutional Review Board approval, a retrospective review of patients at Montefiore Medical Center diagnosed with early stage high-risk endometrial cancer between 2006 and 2018 was conducted. Inclusion criteria included: 1) Stage I-II disease 2) Grade 3 endometrioid, carcinosarcoma, clear cell, serous, or mixed histologies. Demographic and clinical information pertaining to cancer treatment was collected. The primary outcome was recurrence-free survival. Univariate and multivariate analyses were performed and a Kaplan-Meier progression free survival curve was created using STATA 14.2. P-value <0.05 was considered statistically significant. <h3>Results:</h3> A total of 1208 patients with endometrial cancer were identified, 249 of which met inclusion criteria. Sixty-percent (149) of patients had serous, clear cell, or mixed histologies, 17% (43) had carcinosarcoma, 23% (57) had Grade 3 endometrioid histology. Most patients received adjuvant combination chemoradiotherapy (52%, N=131) whereas 20% (49) received radiation alone (brachytherapy or external beam), 7% (18) received chemotherapy alone, and 20% (50) received no adjuvant treatment. Of the 48 (19%) disease recurrences, 25 (45%) were distant metastases at the time of recurrence. Combined chemoradiotherapy was associated with increased recurrence-free survival compared with chemotherapy alone (p=0.026) or radiation alone (p=0.004). Compared to G3 endometrioid histology, the hazard ratios for recurrence were: 3.70 (CI 1.31-10.41, p=0.01) for serous histology, 1.37 (CI 0.15-12.21, p=0.78) for clear cell, 9.70 (CI 3.22-29.16, p<0.01) for carcinosarcoma, and 4.59 (CI 1.28-16.46, p=0.02) for mixed histology. Charlson Cormorbidity Index was also associated with cancer recurrence (HR 1.53, CI 1.28-1.82, p<0.01), as was age (HR 0.95, CI 0.92-0.99, p=0.01). <h3>Conclusions:</h3> Multimodal treatment with chemotherapy and radiation therapy is associated with increased recurrence free survival in patients with high-risk early-stage endometrial cancers, in comparison to radiation or chemotherapy alone after surgical staging. Histologic subtype, comorbid conditions, and age all significantly impact survival. Notably, recurrence in clear cell tumors were not significantly impacted by adjuvant treatment with chemotherapy and radiation therapy. Randomized trials are needed to determine the optimal treatment of high-risk histologic subtypes.

Adjuvant radiation in stage 1 endometrioid endometrial cancer (EC), a National Cancer Database (NCDB) study of clinical decision making in practice

<h3>Objectives:</h3> To compare the relative importance of prognostic factors, and their interactions with lymph node dissection (LND), on receipt of post-operative adjuvant radiation (RT) in patients with stage 1 EC. <h3>Methods:</h3> We queried the National Cancer Database for all EC patients with pathologic stage 1 EC who had total hysterectomy from 2012-16. Patients who received preoperative RT or any chemotherapy were excluded. Logistic regression of grade, myometrial invasion (MI), age, lymphovascular space invasion (LVSI) and LND including interaction terms of each of the prognostic factors with LND was conducted to model receipt of RT. We ranked the regression coefficients of individual prognostic factors (bfactor), and interactions with any LND (bfactorxLND) to compare the magnitude of associations with RT. Relative contribution of the interaction terms (% change=bfactorxLND/bfactor x 100%) were also compared. Findings were accepted as significant at p<0.10. <h3>Results:</h3> 53,265 patients comprised the study population. The majority of patients were years old (59%), had <50% MI (79%), grade 1 tumor (58%), and did not have lVSI (89%.) Most (72%) patients had LND (sentinel node dissection, or lymphadenectomy) and 20% of patients received adjuvant RT (external beam alone, vaginal brachytherapy alone or both). Multivariate logistic regression found >50% MI is independently associated with the highest probability of receiving RT, followed by poorly differentiated tumor, LVSI, moderately differentiated tumor and age 60 or greater, in that order. Although LND is independently associated with increased RT, documentation of uninvolved nodes reduces the magnitude if the association of RT with age >60, LVSI, grade 2 and >50% MI. LND was not found to modify the association of grade 3 disease with RT (Table 1). <h3>Conclusions:</h3> The positive association between any LND and increased receipt of postoperative RT has previously been reported by other investigators. Our findings suggest this finding may be due to confounding, since the interaction terms of LND with nearly all individual prognostic factors are negative, indicating that documentation of negative nodes decreases the frequency of RT associated with nearly all high risk prognostic factors. The range of bfactor's, suggests that, in practice, there is a hierarchy of concern for recurrence associated with the individual prognostic factors. Future investigations that more precisely identify the independent risk for recurrence associated with each factor, as well as confounders associated with both LND and RT, may help refine the decision making process.

Impact of surgical para-aortic lymph node staging for patients with advanced-stage cervical carcinoma undergoing definitive chemoradiation

<h3>Objectives:</h3> Evaluate the utilization and impact of surgical para-aortic surgical staging on the survival of patients with locally advanced-stage cervical carcinoma receiving definitive chemoradiation. <h3>Methods:</h3> Patients diagnosed between 2004-2015 with advanced stage (IIA-IVA) squamous, adenocarcinoma, adenosquamous carcinoma of the cervix with no distant metastases who did not undergo hysterectomy and received primary chemoradiation (external beam with or without brachytherapy) with at least one month of follow-up were identified in the National Cancer Database. Two groups were formed based on the assessment method of the para-aortic lymph node status; radiologic assessment versus surgical lymphadenectomy (PaLND). Overall survival was compared with the log-rank test following generation of Kaplan-Meier curves and a Cox multivariate model was constructed to control for a priori selected confounders. <h3>Results:</h3> A total of 3610 patients who met the inclusion criteria were identified. Surgical para-aortic staging was performed for 287 (8%) patients. Patients who had PaLND were younger (median 49 vs 53 years, p<0.001) more likely to have private insurance (49.1% vs 35.2%, p<0.001), or stage II disease (63.4% vs 56.3%, p=0.019), and receive brachytherapy (74.2% vs 66.9%, p<0.001). Patients who underwent PaLND were also more likely to have LNs categorized as positive (16.1% vs 11.2%, p=0.014). There was no difference in OS between patients who underwent primary radiologic vs primary surgical para-aortic LN assessment, p=0.42; 5-year OS rates were 55.6% for both groups. After controlling for patient age, race, insurance status, stage, histology, presence of comorbidities, history of another tumor, and receipt of brachytherapy, performance of PaLND was not associated with a survival benefit (HR: 1.05, 95% CI: 0.86, 1.29). <h3>Conclusions:</h3> In a large cohort of patients with locally advanced stage cervical carcinoma, undergoing primary chemoradiation, staging PaLND was rarely performed and not associated with a survival benefit.

A multi-centre analysis of adjuvant contact X-ray brachytherapy (CXB) in rectal cancer patients treated with local excision – Preliminary results of the CONTEM1 study

IntroductionEarly rectal cancers are increasingly diagnosed through screening programmes and are often treated using local excision (LE). In the case of adverse pathological features completion total mesorectal excision surgery (TME) is the standard recommendation. The morbidity and mortality risks of TME have stimulated the use of adjunctive treatments following LE to achieve organ preservation. Material and methodsPatients treated with adjuvant CXB following local excision between 2004 and 2017 in three centres were identified (Clatterbridge, Hull, Nice). All patients had adverse pathological features including: lymphovacular invasion, Sm2-3 Kikuchi level, tumour budding, pT2, positive resection margins (R1). CXB was performed with the Papillon50 tm machine to a dose of 40–60 Gy in 2 or 3 fractions over 2–4 weeks preceding/following external beam chemo/radiotherapy. Kaplan Meier survival estimates were used for outcomes measures. Results194 patients were identified. Median age was 70 years. pT staging was: pT1:143, pT2:45, pT3:6. CXB alone was given in 24 pts and combined with EBRT in 170. Median follow-up time was 77 months (range 7–122 months). Local relapse rate was 8% and distant metastases 9%. Organ preservation was achieved in 95%. 6 year local recurrence free and overall survival was 91% and 81% respectively. Cancer specific survival was 97%. No treatment related mortality was seen. ConclusionThis large multi-centre cohort study using adjuvant CXB following local excision suggests excellent oncological outcomes for these patients without completion TME. This treatment approach can be considered as an alternative for selective patients compliant with long term follow up.

Impact of the Radiation Oncology Alternative Payment Model on Brachytherapy Reimbursement

PURPOSEThe Radiation Oncology Alternative Payment Model (RO Model) will test prospective radiotherapy episode-based payments for 16 common disease sites. We created an automated analytics platform to calculate the impact of the RO Model vs historical fee-for-service episode reimbursements for brachytherapy treatments within five community oncology practices for prostate, uterine, and cervical cancer. METHODS AND MATERIALSClaims data between January 1, 2017 and October 2, 2019 for prostate, uterine, and cervical cancer were analyzed as per the RO Model Final Rule methodology. Expected professional and technical component (PC and TC) reimbursements were compared for episodes that utilized brachytherapy alone vs combination modality (external beam and brachytherapy) in the RO Model vs historical reimbursements. RESULTS6,022 RO Model-defined episodes (60% prostate, 28% uterine, 13% cervical) were generated. Brachytherapy monotherapy episodes (14%) would have an average positive reimbursement in the RO Model (+$2,163 for prostate, +$711 for uterine, +$533 for cervical for the PC; +$12,168 for prostate, +$8,181 for uterine, +$11,322 for cervical for the TC), while combination modality episodes (15%) would have an average negative reimbursement in the RO Model (-$183 for prostate, -$1,701 for uterine, -$2,195 for cervical for the PC; -$374 for prostate, -$5,026 for uterine, -$2,801 for cervical for the TC). CONCLUSIONSBrachytherapy monotherapy episodes for prostate, uterine, and cervical cancer will benefit from an increase in payment, whereas combination modality episodes will receive lower reimbursement. Large shifts in episodic payment may be related to practice-wide adjustments and pricing based on partial episodes of care that may ultimately limit access to care for vulnerable patient populations with cancer.