Initial Cancer Treatment Research Articles

An evaluation of RAS testing among metastatic colorectal cancer patients in the USA.

Background: Data on RAS testing practices prior to metastatic colorectal cancer (mCRC) treatment initiation are lacking in the USA. Materials & methods: Flatiron data were utilized for patients diagnosed with mCRC between 2011 and 2017. Flatiron is a longitudinal, demographically and geographically diverse database representing data from over 1.5 million active US patients treated at 255 community and hospital-affiliated oncology clinics. Results: Among 17,387 mCRC patients 69% were RAS tested and 31% were never tested. Timing of RAS testing was as follows: 23% were tested at the time of their initial CRC diagnosis, 60% following mCRC diagnosis but prior to first line of treatment, 3% prior to third line, the remaining 14% were tested following third line. Conclusion: Athird (31%) of patients failed to receive RAS testing, therefore all treatment options were unavailable to them. These data highlight how universal testing has not been achieved.

Abstract PS7-88: Effect of the COVID-19 pandemic on the initial treatment of breast cancer in the Netherlands: A population-based study

Abstract PS7-88: Effect of the COVID-19 pandemic on the initial treatment of breast cancer in the Netherlands: A population-based study

Cultural, social, and healthcare access factors associated with delays in gastric cancer presentation, diagnosis, and treatment: A cross-sectional study

BackgroundThe aim of this study was to identify the time intervals between the demand for health services and the initiation of cancer treatment, and to explore the associated factors, in gastric cancer patients being treated in an oncology hospital in northern Brazil. MethodsThis cross-sectional study. Gastric cancer patients receiving treatment in a northern Brazil reference hospital were interviewed. A Mann-Whitney test was used to verify associations between the time intervals of access to treatment and socioeconomic factors, clinical variables, and patient difficulties, adopting a 0.05 significance level. ResultsThe average time intervals were 471.3 days between symptom onset and primary health service request and 180.9 days between diagnosis and treatment. The average time between the onset of symptoms and the treatment of gastric cancer was 747.8 days. Patients using herbal home remedies showed the longest times before seeking primary health care (p = 0.04). Delays between diagnosis and treatment were associated with unemployment (p = 0.03). High average times until oncologist appointments were related to the absence of comorbidities (p = 0.004). Personal difficulties and a lack of hospital beds were associated with long time intervals to specialist appointments and between diagnosis and treatment. Personal difficulties were associated with long time intervals between the onset of symptoms and the treatment of gastric cancer. ConclusionGastric cancer patients faced delays and healthcare access barriers in a region with high mortality for this disease. Appropriate interventions are necessary to reduce delays and better control the disease. Policy SummaryIn this paper we have explored the barriers to access to diagnosis and treatment for patients with gastric cancer in a major cancer centre in Northern Brazil. The results will inform strategies for improving timely access to critical cancer services.

Longitudinal Trends of Financial Toxicity in Patients With Lung Cancer: A Prospective Cohort Study.

Cancer therapy is associated with severe financial burden. However, the magnitude and longitudinal patient relationship with financial toxicity (FT) in the initial course of therapy is unclear. Patients with stage II-IV lung cancer were recruited in a prospective longitudinal study between July 2018 and March 2020. FT was measured via the validated COmprehensive Score for financial Toxicity (COST) at the time of cancer diagnosis and at 6-month follow-up (6MFU). 6MFU data were compared with corresponding baseline data. A lower COST score indicates increased financial hardship. At the time of analysis, 215 agreed to participate. Subsequently, 112 patients completed 6MFU. On average, slightly more FT was observed at diagnosis compared with 6MFU (median COSTbase 25 v COST6M 27; P < .001); however, individual patients experienced large changes in FT. At 6MFU, 27.7% of patients had made financial sacrifices to pay for treatment but only 4.5% refused medical care based on cost. Median reported out-of-pocket (OOP) costs for the initial 6 months of cancer treatment was $2,496 (range, $0-25,900). Risk factors for FT at diagnosis were unique from risk factors at 6MFU. Actual OOP expenses were not correlated with FT; however, inability to predict upcoming treatment expenses resulted in higher FT at 6MFU. FT is a pervasive challenge during the initiation of lung cancer treatment. Few patients are willing to sacrifice medical care regardless of the cost. Risk factors for FT evolve, resulting in unique interventional targets throughout therapy.

Fertility preservation for cancer patients: treatment gaps and considerations in patients' choices.

Women with cancer may desire fertility preservation (FP) prior to initiating cancer treatment, but undergoing FP may result in treatment delays. This study sought to determine whether such delays existed in our population and which factors were associated with patients' decision to proceed with FP. This was a historical cohort study performed at Montefiore Medical Center's Institute for Reproductive Medicine and Health. Reproductive age women diagnosed with cancer and consulted for FP were included. The main outcome measure wasthe number of days between FP consultation and cancer treatment initiation. Factors associated with patients' decisions to proceed with FP were also analyzed. Thirty out of 51 women in our study underwent FP including embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation (OTC), both oocyte and embryo cryopreservation, or GnRH agonist treatment. The majority of women who underwent FP chose embryo cryopreservation (36.7%), followed by oocyte cryopreservation (33.3%). Of the 20 patients with partners who underwent FP, 13 (65%) froze embryos. Only 4 of the 30 women who underwent FP had all, or a portion of their services, covered by insurance. The mean treatment delay was 18days (p = 0.007), with a mean consultation to oncologic treatment gap of 23 ± 16.8 and 41.4 ± 25.9days in the non-FP and FP groups, respectively. Women with cancer diagnosis who underwent FP prior to initiating cancer treatment experienced a statistically significant delay in initiating cancer treatment. However, the clinical significance of this finding is unknown since FP treatments have not been associated with increased recurrence or mortality.

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

PurposesThe incidence of thyroid cancer has increased annually, and has a heavy psychological and economic burden on society and individuals. Based thyroid cancer data from patients treated in Liaocheng People's Hospital from 2015 to 2018, with Chinese national and regional characteristics, in this study, we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective.MethodsClinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, there were 1001 cases who underwent open operation with total thyroidectomy + central lymph node dissection; meanwhile, 1107 cases were treated with neck lateral lymph node dissection at the same time.ResultsThe overall metastasis rate of all patients was 57.23%. Even the lymph node metastasis of papillary thyroid microcarcinoma (PTMC) was as high as 48.97%. When the mass rose above 2 cm, the proportion of metastasis increased to 77.22%. When the tumor was complicated with bilateral and multiple high‐risk factors, the proportion of metastasis was 65.27% and 72.21%, respectively. When the tumor breaks through the capsule, the metastasis rate was 67.08%. With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54% to 73.33%, which showed positive correlation. 49.32% of patients had lymph node metastasis in the lateral cervical region. When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases.ConclusionThe degree of malignancy of thyroid cancer depends on tumor genome evolution. Rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life. When the tumor diameter exceeds 1 cm, the risk of cervical lymph node metastasis is high, and we recommended lateral lymph node dissection.

Determinants of delay from cancer diagnosis to treatment initiation in a cohort of brazilian women with breast cancer.

This objective this study was to identify the time interval between breast cancer (BC) diagnosis and treatment initiation and delay-associated factors. This is a prospective cohort study that followed breast cancer patients, enrolled and treated at the cancer center in Rio de Janeiro (RJ) - Brazil, from October 02, 2014 to April 30, 2015. Participants were interviewed at the first consultation. Treatment-related information was collected six months after recruitment. The median and interquartile range (IQR) were calculated. The interval between breast cancer diagnosis and treatment initiation of more than 60days was considered the delay, according to the maximum term determined by Brazilian law. The association between independent variables and the outcome was performed using the crude odds ratios (OR). Variables presenting p<.20 in the univariate analysis were included in the multiple logistic regression model by the stepwise forward method, and those with p<.05 were retained in the final model. A total of 470 patients were included in the study. The median time was of 127days (IQR: 85- 174). Delay was observed in 89.1% of the cases. After adjustment, the variables associated with delay were age≥60years (OR: 2.48; 95% CI 1.22-5.06), initial clinical staging (<2B) (OR: 2.01; 95% CI 1.05-3.86) and residence outside the city of Rio de Janeiro (OR: 2.75; 95% CI 1.38-5.51). Delays in starting treatment were associated with sociodemographic and clinical factors. Improving patient quality of care and restructuring the health service can minimise delays.

Principles of qualification and surgical treatment of the nose and paranasal sinuses in the era of COVID-19

The COVID-19 pandemic is one of the greatest challenges in modern medicine. Despite the implemented social and economic restrictions, the epidemiological situation is still dynamic. Otolaryngologists (especially rhinologists), are a group of doctors particularly exposed to SARS-CoV-2 infection. In order to limit the spread of the virus, it is necessary to implement procedures that minimize the risk of infection of medical personnel and patients. Due to the location of the virus, it is very important in relation to rhinological procedures and operations. The authors reviewed the literature on this topic and presented effective methods to reduce the likelihood of virus transmission during nasal and paranasal sinus surgery used in our center. It is important that pandemic limitations do not affect the duration of diagnosis and initiation of cancer treatment. Neoplasms of the nasal region and paranasal sinuses are detected relatively late due to the time of symptom onset, and further delays in the onset of the therapeutic process are extremely unfavorable. We are of the opinion that rhinological procedures, especially in patients with unknown epidemiological status, should be limited to the necessary minimum - life-threatening conditions and resection of malignant neoplasms. Even in these cases, however, strict adherence to procedures is necessary to reduce the risk of virus transmission. We hope that the implementation of the guidelines presented in the following paper will help in the fight against the current pandemic and its subsequent waves.

Determinants of Guideline-Discordant Breast Cancer Care

Evidence-based breast cancer treatment guidelines recommend the most appropriate course of therapy based on tumor characteristics and extent of disease. Evaluating the multilevel factors associated with guideline discordance is critical to identifying strategies to eliminate breast cancer survival disparities. We identified females diagnosed with a first primary, stage I-III breast cancer between the ages of 20-69 years of age from the population-based Seattle-Puget Sound Surveillance, Epidemiology, and End Results registry. Participants completed a survey about social support, utilization of patient support services, hypothesized barriers to care, and initiation of breast cancer treatment. We used logistic regression to estimate odds ratios and 95% confidence intervals (CI). Among 1,390 participants, 10% reported guideline-discordant care. In analyses adjusted for patient-level sociodemographic factors, individuals who did not have someone to go with them to appointments or drive them home (OR 1.96; 95% CI, 1.09-3.59) and those who had problems talking to their doctors or their staff (OR 2.03; 95% CI, 1.13-3.64) were more likely to be guideline discordant than those with social support or without such problems, respectively. Use of patient support services was associated with a 43% lower odds of guideline discordance (OR 0.57; 95% CI, 0.36-0.88). Although guideline discordance in this cohort of early-stage breast cancer survivors diagnosed <70 years of age was low, instrumental social support, patient support services, and communication with doctors and their staff emerged as potential multilevel intervention targets for improving breast cancer care delivery. This study supports extending the reach of interventions designed to improve guideline concordance.

Breast cancer detection using active contour and classification by deep belief network

The abnormal modifications in tissues or cells of the body and growth beyond normal grow and control is called cancer. Breast cancer is one of the kinds of cancer. The existence level of patient suffering from breast cancer can be improved through Prognosis detection of breast cancer. The cancer diagnosis and detection accuracy have upgraded with the machine learning techniques, and the improvement of expertise. A computer-aided diagnosis (CAD) system is used for the mammograms to enable initial breast Cancer recognition, analysis, and treatment. For existing CAD system the accuracy is unacceptable. This research work explores a breast CAD scheme established on feature fusion through Convolution Neural Network deep features. The outcome shows that the random forest algorithm contributes the maximum accuracy (97.51%) with the lowest error rate than CNN classifier (95.65%). The abnormality of the breast images is scrutinized through Deep Belief Network (DBN). The offered work practices active contour segmentation to distinct the abnormal image and it can be categorized by Deep Belief Network. The recommended algorithm is used to eradicate the properties of the point spread function in the method of low-dose medical CT image restoration and recovers the reconstructed image quality. The efficiency and speed of the segmentation process are increased through sparse transform. Our mentioned method is used to afford the enhanced performance, offer a good implementation of the results, evaluated the accuracy and the processing time.

Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment

Obstetrician-gynecologists frequently are consulted either before the initiation of cancer treatment to request menstrual suppression or during an episode of severe heavy bleeding to stop bleeding emergently. Adolescents presenting emergently with severe uterine bleeding usually require only medical management; surgical management rarely is required. Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management. When used continuously, combined hormonal contraceptives are effective for producing amenorrhea, although complete amenorrhea cannot be guaranteed. The risk of venous thromboembolism in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the risk-benefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.

Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: ACOG Committee Opinion, Number 817.

Obstetrician-gynecologists frequently are consulted either before the initiation of cancer treatment to request menstrual suppression or during an episode of severe heavy bleeding to stop bleeding emergently. Adolescents presenting emergently with severe uterine bleeding usually require only medical management; surgical management rarely is required. Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management. When used continuously, combined hormonal contraceptives are effective for producing amenorrhea, although complete amenorrhea cannot be guaranteed. The risk of venous thromboembolism in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the risk-benefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.

Validation of an oncology-specific opioid risk calculator in cancer survivors.

Clinical guidelines recommend that providers risk-stratify patients with cancer before prescribing opioids. Prior research has demonstrated that a simple cancer opioid risk score might help identify to patients with cancer at the time of diagnosis with a high likelihood of long-term posttreatment opioid use. This current project validates this cancer opioid risk score in a generalizable, population-based cohort of elderly cancer survivors. This study identified 44,932 Medicare beneficiaries with cancer who had received local therapy. Longitudinal opioid use was ascertained from Medicare Part D data. A risk score was calculated for each patient, and patients were categorized into low-, moderate-, and high-risk groups on the basis of the predicted probability of persistent opioid use. Model discrimination was assessed with receiver operating characteristic curves. In the study cohort, 5.2% of the patients were chronic opioid users 1 to 2years after the initiation of cancer treatment. The majority of the patients (64%) were at low risk and had a 1.2% probability of long-term opioid use. Moderate-risk patients (33% of the cohort) had a 5.6% probability of long-term opioid use. High-risk patients (3.5% of the cohort) had a 75% probability of long-term opioid use. The opioid risk score had an area under the receiver operating characteristic curve of 0.869. This study found that a cancer opioid risk score could accurately identify individuals with a high likelihood of long-term opioid use in a large, generalizable cohort of cancer survivors. Future research should focus on the implementation of these scores into clinical practice and how this could affect prescriber behavior and patient outcomes. A novel 5-question clinical decision tool allows physicians treating patients with cancer to accurately predict which patients will persistently be using opioid medications after completing therapy.

Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial.

BackgroundBreast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits.ObjectiveThe overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes.MethodsWe will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties.ResultsWe have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years.ConclusionsThe results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management.International Registered Report Identifier (IRRID)PRR1-10.2196/23414

Challenges faced by cancer patients in Uganda: Implications for health systems strengthening in resource limited settings

BackgroundUganda Cancer Institute (UCI), the only comprehensive cancer treatment center in Uganda, registers about 4000 new cancer patients a year. However, many cancer patients in Uganda never receive treatment due to a variety of challenges. We therefore conducted a study to identify and assess the challenges faced by cancer patients in Uganda. MethodsA cross-sectional study conducted in April-May 2017 among adult cancer patients. 359 participants participated in an interviewer-administered survey. We used stratified random sampling to select the study participants. Data was analyzed in SPSS Statistics 24. Results35 % of the patients delayed initiating cancer treatment and 41 % missed medical appointments along their care journey. Delayed and missed appointments were mainly due to lack of money for cancer medicines, transportation and accommodation. Patients also expressed challenges with side effects of cancer treatment: 52 % sought help from health workers when they experienced side effects; 14 % used alternative medicine; and 21 % did not inform anyone. In addition, 55 % of the participants had limited knowledge about their disease and treatment. Other challenges when at UCI included: being hungry and thirsty throughout the day, long waiting hours, not having a resting place, not understanding what comes next, and having their records lost by hospital staff. ConclusionChallenges faced by cancer patients in Uganda result in enormous delays in initiation and continuation of cancer treatment. These challenges are often a result of the poor social-economic status of the patients; inadequate infrastructure for cancer care; and inefficiencies in the health care system. Policy SummaryTo improve the experience of patients, the National Cancer Control Plan should consider establishing regional cancer centers; creating a reliable supply of cancer medicines; and integrating navigation programmes into cancer care. Strengthening the whole health system, in relation to cancer service delivery, should remain a top priority for Uganda and other resource limited settings.

Cancer during Corona Pandemic: Plight of cancer patients when two evils join hands

In the unprecedented times of Corona Pandemic (CP), each individual is facing uncertainty and stress. Presence of cancer during these times compounds the troubles. The changing scenario of consultation and treatment during pandemic, logistic issues, dwindling finances and fear are making a negative impact on the mental health of cancer patients. In a qualitative analysis conducted in a tertiary oncology hospital from 1st June to 6th July on the recently diagnosed or under treatment cancer patients. The face to face interview was conducted using a semi structured questionnaire specific to Cancer amid CP, General Anxiety Disorder Item Scale 7 and Physical Health Questionnaire 9 (PHQ-9). There were total 294 patients, mean age around 51 years with a male female ratio of 3:2, 40% were suffering from head and neck malignancy. There was a delay initiating cancer treatment in 22.4% of patients and three fourths of them attributed it to CP. Almost 80% of patients perceived that pandemic has adversely affected their treatment and 50% thought they would have had a better chance of cure. Half of our cohort stated that due to social distancing and usage of masks, there is a communication gap between them and the doctors. They also felt that now, with decreased nonverbal communication; they felt lack of empathy. 14.9% patients were more concerned about corona pandemic as compared to malignancy. This study is about the challenges and perspective of cancer patients during the CP. It indicates a need for more systematic and patient friendly approach by the regulatory authorities, hospital management and staff. Timely intervention of those under stress is recommended more frequently during CP.

Left atrial function assessed by speckle tracking echocardiography in anthracycline-induced cardiotoxicity: a case report.

BackgroundThe onset prevention and early diagnosis in cardiotoxicity due to cancer chemotherapy are important, and it is important to detect cardiac dysfunction at an early stage and start treatment to enhance the therapeutic effect.Case summaryA 31-year-old female with breast cancer received chemotherapy with epirubicin (400 mg/m2) and cyclophosphamide followed by docetaxel. Two months after the initiation of her chemotherapy, the left ventricular (LV) ejection fraction (LVEF) determined by echocardiography fell to 41.2%, and she was diagnosed with cancer therapy-related cardiac dysfunction (CTRCD). Three months after the initiation of cancer treatment, the peak velocity of late diastolic transmitral Doppler flow (A wave) became undetectable. Peak longitudinal strain (LS) and peak LS rate, which reflect left atrium (LA) reservoir function, gradually declined like the LVEF and LV-global LS (GLS). Seven months after the initiation of cancer treatment, she was diagnosed with acute decompensated heart failure. The changes in peak LS and peak LS at the onset were greater than those in LVEF and LV-GLS.DiscussionThis is a case report suggesting that LA reservoir function might be a more sensitive indicator than LVEF or LV-GLS in detecting CTRCD and that LA booster function might be the earliest. Left atrium reservoir function might be a more sensitive than conventional LV pump function and optimal indicator in CTRCD.

Mortality due to cancer treatment delay: systematic review and meta-analysis

ObjectiveTo quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways.DesignSystematic review and meta-analysis.Data sourcesPublished studies in Medline from...

Trends And Disparities In The Diagnosis And Initial Management Of High-Risk Prostate Cancer In The United States

An increasing proportion of men are being diagnosed with high-risk prostate cancer. Standard of care for initial treatment of high-risk prostate cancer includes prostatectomy or radiotherapy with no randomized evidence comparing the modalities to guide decision-making. This study characterized US national trends associated with undergoing prostatectomy or radiotherapy for high-risk prostate cancer. This retrospective cohort study used data collected by the National Cancer Database (NCDB) to assess demographic, clinical and socioeconomic factors among 215,313 men diagnosed with high-risk prostate cancer from 2004 to 2016 and the trends in diagnosis rate and the use of prostatectomy or radiotherapy. Cochran-Armitage test was used to identify trends in prostatectomy or radiotherapy with time. Multivariable logistic regression was used to examine demographic and clinical factors associated with undergoing prostatectomy or radiotherapy. All tests were 2-sided and considered significant at an α level of .05. The rate of high-risk prostate cancer increased from 11.9% in 2004 to 20.4% in 2016. In total, 215,313 men diagnosed as having localized high-risk prostate cancer between 2004 and 2016 were identified. White men composed 81.2% of this cohort, whereas black men composed 16.1%. Government-issued insurance was used by 59.2% of men. More than 81.7% of men had a Charlson-Deyo Comorbidity Index score of 0 (range, 0 to ≥3, with lower numbers indicating fewer comorbidities). The proportion of men who underwent prostatectomy (a total of 76,606 men) compared to radiation therapy, androgen deprivation (ADT) alone, or no treatment, increased from 23.1% in 2004 to 40.9% in 2016 (p < .0001). The proportion of men who underwent radiotherapy as the first treatment (a total of 104,783 men) decreased from 59.7% in 2004 to 43.3% in 2016 (p < .0001). Men treated at an academic center, living in an urban area, or possessing higher incomes and those who were younger, healthier, white, or were diagnosed as having lower grade prostate cancer had higher odds of undergoing prostatectomy. This study found that rates of high-risk prostate cancer diagnosis have increased from 11.9% in 2004 to 20.4% in 2016. Prostatectomy rates for the initial treatment of high-risk prostate cancer increased by 17.8% from 2004 to 2016 and radiotherapy rates decreased by 16.4% in the same study period. Demographic, clinical and socioeconomic factors of high-risk cancer diagnosis and undergoing prostatectomy included age, race, income, Charlson-Deyo Comorbidity Index score, clinical stage and grade of disease, facility type and location, and year of diagnosis. These results are hypothesis generating; further studies evaluating potential disparities in the initial diagnosis and management of localized high-risk prostate cancer are warranted.

Long-term Outcomes of Six-Fraction Stereotactic Ablative Radiotherapy to Limited Lymph Node Metastases: An Institutional Case Series

Lymph node (LN) metastasis is one of the most common sites to develop disease recurrence or progression after initial cancer treatment. Aggressive local treatment such as surgery or radiotherapy might benefit selected patients with limited metastatic LN(s). Stereotactic ablative radiotherapy (SABR) has been shown to achieve high local control rates with limited toxicities, yet the efficacy and patterns of failure have not been well studied with long-term follow-up. Herein, we report institutional outcomes of patients receiving six-fraction-SABR to involved metastatic LN(s). Since 2012, patients with oligo-metastatic or oligo-progressive LN(s) referred for radical radiotherapy and underwent six-fraction SABR were enrolled for retrospective chart and image review. Response was assessed by RECIST 1.1. Failure patterns and toxicities were recorded. Progression-free survival and overall survival (OS) were estimated by Kaplan-Meier method and log-rank test was used for analysis of prognostic factors. Forty-two patients with forty-six irradiation nodal sites were treated with SABR in this retrospective study. The majority (23/42) were lung cancer patients and the most frequent treatment sites were mediastinum and hilum (26/46). The median SABR dose was 45 Gy (range 30-45 Gy). Only one patient experienced grade 3 gastrointestinal toxicity. With the median follow-up of 52.8 months, median OS is 26.7 months (range 3.3–73.9 months). In-field failure rate is less than 5% (n = 2), and five patients (10.9%) developed isolated recurrences at elective regional lymphatics. The One-year and two-year cumulative isolated regional failure rates are 8.7% and 10.9%, respectively. Patients received >40 Gy (BED10 66.6 Gy) had a significant superior OS compared to those treated with <40 Gy (median OS: 33.6 months versus 10.0 months, log-rank test p = 0.01). Radical treatment of oligo-metastatic or oligo-progressive involved LN(s) with SABR in six fractions seems to provide high local control rate with low-risk of treatment-related toxicities and is not associated with excessive recurrence rates at elective nodal regions after long-term follow-up. A prospective phase II trial to further evaluate the efficacy, safety and patterns of failure for SABR in limited LN metastases was ongoing. Table Failure Sites after LN(s) SABR (N = 46)Abstract 2418; TableVariableNumberWithin RT field2 (4.3%)Isolated elective field5 (10.9%)Distant field35 (76.1%) Open table in a new tab