Limited Disease Research Articles

Surgical management of non–small cell lung cancer with limited metastatic disease involving only the brain

ObjectiveThe optimal primary site treatment modality for non–small cell lung cancer with brain oligometastases is not well established. This study sought to evaluate the long-term survival of patients with non–small cell lung cancer with isolated brain metastases undergoing multimodal therapy with or without thoracic surgery. MethodsPatients with cT1-3, N0-1, M1b-c non–small cell lung cancer with synchronous limited metastatic disease involving only the brain treated with brain stereotactic radiosurgery or neurosurgical resection in the National Cancer Database (2010-2017) were included. Long-term overall survival of patients who underwent multimodal therapy including thoracic surgery (“Thoracic Surgery”) versus systemic therapy with or without radiation to the lung (“No Thoracic Surgery”) was evaluated using Kaplan–Meier analysis, Cox proportional hazards modeling, and propensity score matching. ResultsOf the 1240 patients with non–small cell lung cancer with brain-only metastases who received brain stereotactic radiosurgery or neurosurgery and met study inclusion criteria, 270 (21.8%) received primary site resection. The Thoracic Surgery group had improved overall survival compared with the No Thoracic Surgery group in Kaplan–Meier analysis (P < .001) and after multivariable-adjusted Cox proportional hazards modeling (P < .001). In a propensity score–matched analysis of 175 patients each in the Thoracic Surgery and No Thoracic Surgery groups, matching on 13 common prognostic variables, thoracic surgery was associated with better survival (P = .012). ConclusionsIn this national analysis, patients with cT1-3, N0-1, M1b-c non–small cell lung cancer with isolated limited brain metastases had better overall survival after multimodal therapy including thoracic surgery compared with systemic therapy without surgery. Multimodal thoracic treatment including surgery can be considered for carefully selected patients with non–small cell lung cancer and limited brain metastases.

Exploring Knowledge and Awareness of HCV Infection and Screening Test: A Cross-Sectional Survey Among an Italian Sample

Addressing HCV represents a public health priority, especially in Italy, which has the highest HCV prevalence in Europe. This study primarily aimed to explore knowledge about the HCV infection and awareness of the existence of the HCV screening test in Italy, before the implementation of awareness campaigns in 2022. An online cross-sectional survey was conducted (December 2021–January 2022). The primary outcomes were: Disease Knowledge Score (DKS), Prevention and Transmission Knowledge Score (PTKS) (for both: scoring from 0 to 100%, higher scores corresponded to higher knowledge), and being unaware of the existence of the HCV screening. The final sample consisted of 813 participants. The median DKS was 75% (IQR = 66.7–83.3), the median PTKS was 46.2% (IQR = 38.5–53.8), and 23.2% of participants were unaware of HCV screening. Higher education, health-related study or profession, history of accidental injuries, being affected by HCV and having actively searched for information on HCV had positive associations with DKS. LGBT males showed significantly lower DKS. Considering PTKS, participants affected by HCV the disease had a negative association with this score. Having a postgraduate education reduced the likelihood of not knowing about the HCV screening test, while having at least one family member affected by hepatitis C increased this probability. This study highlighted a concerning lack of knowledge about prevention and transmission, indicating a need for targeted education campaigns. The findings emphasized the importance of information and motivation and identified male LGBT + individuals as a vulnerable group with limited disease knowledge. Future research should concern the effectiveness of awareness campaigns.

Pruritic crusted lesions in an 89‐year‐old woman

Pruritic crusted lesions in an 89‐year‐old woman

Person-Centered Navigator Program for People with Parkinson's Disease: A Pilot Study.

There are limited Parkinson's disease (PD)-specific navigator programs, although PD is chronic and requires life-long comprehensive care. As most patient navigation literature focuses on oncology and is based in the West, this study aimed to develop a person-centered navigator program for PD and evaluate its preliminary outcomes and feasibility in the Korean context. The program was developed using the "analysis, design, development, implementation, and evaluation" model, and "professional navigation framework." Initially, 28 participants were recruited to participate in an 8-week navigator program. The retention rate was 82%. Social function was significantly improved 12 weeks after baseline. Participants reported high satisfaction with the program, suggesting that it was well-accepted. This study systematically developed a navigator program based on PD-specific needs and the Korean context. Future models should focus on personal and participatory attributes. Navigator programs for people with PD represent appropriate and evolving healthcare interventions.

Ability of the ash dieback pathogen to reproduce and to induce damage on its host are controlled by different environmental parameters.

Ash dieback, induced by an invasive ascomycete, Hymenoscyphus fraxineus, has emerged in the late 1990s as a severe disease threatening ash populations in Europe. Future prospects for ash are improved by the existence of individuals with natural genetic resistance or tolerance to the disease and by limited disease impact in many environmental conditions where ash is common. Nevertheless, it was suggested that, even in those conditions, ash trees are infected and enable pathogen transmission. We studied the influence of climate and local environment on the ability of H. fraxineus to infect, be transmitted and cause damage on its host. We showed that healthy carriers, i.e. individuals showing no dieback but carrying H. fraxineus, exist and may play a significant role in ash dieback epidemiology. The environment strongly influenced H. fraxineus with different parameters being important depending on the life cycle stage. The ability of H. fraxineus to establish on ash leaves and to reproduce on the leaf debris in the litter (rachises) mainly depended on total precipitation in July-August and was not influenced by local tree cover. By contrast, damage to the host, and in particular shoot mortality was significantly reduced by high summer temperature in July-August and by high autumn average temperature. As a consequence, in many situations, ash trees are infected and enable H. fraxineus transmission while showing limited or even no damage. We also observed a decreasing trend of severity (leaf necrosis and shoot mortality probability) with the time of disease presence in a plot that could be significant for the future of ash dieback.

Factors associated with overall survival, progression-free survival and toxicity in patients with small cell lung cancer and thoracic irradiation in a clinical real-world setting

BackgroundSmall-cell lung cancer (SCLC) is a malignant tumor known for its poor prognosis. In addition to chemotherapy and immunotherapy irradiation plays a big role especially in inoperability. This study evaluated prognostic factors in patients with SCLC, receiving chemotherapy and thoracic irradiation, that may affect overall survival (OS), progression-free survival (PFS) and toxicity.MethodsPatients with limited disease (LD) SCLC (n = 57) and extensive disease (ED) SCLC (n = 69) who received thoracic radiotherapy were analyzed retrospectively. The prognostic factors sex, age, Karnofsky performance status (KPS), tumor-, nodal-stage and timepoint of start of irradiation in relation to the first cycle of chemotherapy were evaluated. Start of irradiation was stratified as early (le 2 cycles of chemotherapy), late (3 or 4 cycles) and very late (ge 5 cycles). Results were analyzed by Cox univariate and multivariate as well as logistic regression analysis.ResultsThe median OS of LD-SCLC patients was 23.7 months in early, and 22.0 months in late start of irradiation. In very late start, median OS was not reached. PFS was 11.8, 15.2 and 47.9 months, respectively. In patients with ED-SCLC OS was 4.3 months in early, 13.0 months in late and 12.2 months in very late start of irradiation. PFS was 6.7, 13.0 and 12.2 months, respectively. Prognosis of patients with LD- or ED-SCLC receiving late or very late start of irradiation was significantly prolonged in OS and PFS compared to an early start (p < 0.05). KPS ge 80 shows a significant increase of OS and PFS in ED-SCLC. Female sex and smaller mean lung dose were associated with lower risk of toxicity.ConclusionLate or very late start of irradiation is a prognosis-enhancing factor in LD-SCLC and ED-SCLC for OS and PFS. KPS ge 80 increases prognosis of OS and PFS in ED-SCLC as well. Toxicity is less common in female sex and patients with low mean lung dose in LD-SCLC.

Abstract CT144: Randomized phase II trial of preoperative fulvestrant with or without enzalutamide for ER+/Her2- breast cancer

Abstract Background: Most estrogen receptor alpha positive (ER+) breast cancers (BCs) express androgen receptor (AR) protein, but its function is unclear. High AR relative to ER is associated with endocrine resistance. This randomized phase II trial of neoadjuvant fulvestrant (F) with or without the anti-androgen enzalutamide (E) was designed to determine if the addition of E to F in women with ≥T2 ER+/Her2- primary BC would increase the % patients (pts) with limited residual disease at time of surgery as measured by modified preoperative endocrine predictive index (PEPI). Methods: 4 months of therapy was given prior to surgery (F 500 mg IM weeks 1, 3, 5, 9, and 13) and pts were randomized to receive E 160 mg po daily for 16 weeks, stratified by node status and T-stage. Tumor biopsies were required at study entry and after 4 weeks on therapy (Wk5). PEPI score at time of surgery was the primary endpoint for efficacy. The minimax two-stage design had 80% power with type I error rate of 0.08. Reverse phase phosphoprotein array (RPPA), IHC for ER/PR/AR/GR/Ki67, and Polaris multiplex immunofluorescence (IF) panel for myeloid lineage immune cells were performed. Average signal levels were compared across arms, PEPI score (0, &amp;gt;0), PEPI by arm, and Ki67 (&amp;lt;10%, ≥10%). Comparisons at both baseline and with treatment were considered. Significance was assessed with empirical Bayes moderated t-statistics. Since exploratory, p-values were not adjusted for multiple testing. Results: 69 pts consented; 59 evaluable. 95% completed surgery. PEPI=0 observed in 10 (17%). Of 33 pts on FE arm, 21 had T3/T4 tumors, 91% ER+/PR+, median AR expression 80%, Ki67 15%. Of 26 patients on F arm, 19% had T3/T4 tumors, 96% ER+/PR+, median AR expression 85%, Ki67 10%. PEPI=0 was achieved more frequently on the FE arm (8, 24%) than the F arm (2, 8%) (p=0.16). Toxicity was as expected with endocrine therapy. IHC of baseline vs Wk5 biopsies showed decreased ER, PR, and Ki67 levels by Wk5 that remained decreased at time of surgery. AR and GR were significantly decreased only in the FE arm at the time of surgery. RPPA revealed that baseline EGFR (Y1604 and Y992) was higher in tumors with PEPI=0 tumors, whereas the average baseline mTOR activation was higher among pts with PEPI&amp;gt;0. Significant changes detected by RPPA upon treatment included a significant decrease in AR. Myeloid-derived suppressor cells (MDSC) were significantly reduced by treatment only in the FE arm. Conclusions: The combination FE had manageable side effects. PEPI=0 was achieved more frequently on the FE arm (8/33) than the F arm (2/26). Activated EGFR was higher pretreatment in tumors achieving PEPI=0. mTOR pathway was elevated pretreatment in PEPI&amp;gt;0 tumors (also observed with resistance to FE in ER+/HER2- metastatic disease (SABCS 2021). When comparing pretreatment tumor to Wk5, total AR by RPPA was the most differentially decreased protein in PEPI=0 tumors. AR signaling is known to support immunosuppressive cells and we observed a marked decrease in MDSCs with treatment only on the FE arm. Citation Format: Anthony D. Elias, Alyse Staley, Monica Fornier, Gregory A. Vidal, Sharon Sams, Nicole Spoelstra, Peter Kabos, Jennifer R. Diamond, Elena Shagisultanova, Rosa I. Gallagher, Julia Wulfkuhle, Emanuel Petricoin, Kathryn Zolman, Stephanie Biller, Vida Alami, Tessa McSpadden, Virginia Borges, Lyndsey S. Crump, Dexiang Gao, Jennifer K. Richer. Randomized phase II trial of preoperative fulvestrant with or without enzalutamide for ER+/Her2- breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT144.

A Study to Assess the Effectiveness of STP Regarding Knowledge of Preventive Measures on COPD Among Old Age People in Selected Village Rohtas Bihar

INTRODUCTION: COPD is a chronic airway limited disease as characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The more familiar terms ‘chronic bronchitis’ and ‘emphysema’ are no longer used, but are now included within the COPD diagnosis. COPD is not simply a “smoker’s cough” but an under-diagnosed, life-threatening lung disease. According to WHO report that the 3.29 million of people suffer with the COPD death, in nearly 90% of COPD death in those under 70 years of age occur in developing countries. The most cause of COPD the including environmental exposure to tobacco, smoke, indoor air pollution and occupational dusts, fumes, and chemicals are important risk. The early is most common treatment of COPD economic preventable management is quite smoking, and is needed to slow the progression of symptoms. AIM: To assess the effectiveness of STP on knowledge of preventive measures on COPD among old age people. METHODOLOGY: The pre-experimental one group pre-test and post-test design was conducted at Takiya, Sasaram, Rohtas, Bihar from 6/2/23 to 10/2/23. The conceptual framework utilized in this study was based on General System theory of “Ludwig von Bertalanffy”. A self-structured questionnaire method was used to assess the pre-test level of knowledge of preventive measures on COPD among old age people in selected village Rohtas Bihar by adopting probability random sampling technique. Immediately after pre-test STP was implemented just after the implementation post-test was conducted by using same questionnaire method. The result was analyzed. RESULTS: Before implementation of STP the knowledge level of old age people, (32) had poor knowledge, (28) had average knowledge and none of them had good knowledge of preventive measures on COPD among old age people in selected village Rohtas Bihar and the pre-test mean knowledge score was. After implementation of STP the knowledge level of old age people, none of them had poor knowledge, (31) had average level of knowledge and (29) had good knowledge of preventive measures on COPD among old age people in selected village Rohtas Bihar. The post-test mean score (14.72) of knowledge of preventive measures on COPD among old age people were comparatively more than their pre-test mean knowledge score (7.98). It confirms that, there was increase in knowledge of preventive measures on COPD among old age people after the administration of STP. CONCLUSION: At last, as a researchers, we concluded that there is increase in knowledge of preventive measures on COPD among old age people after implementation of STP and there is no association between variable and sociodemographic variables.

171 - The end of an era? Reduction in the use of prophylactic cranial irradiation (PCI) in limited disease small cell lung cancer (LD SCLC)

171 - The end of an era? Reduction in the use of prophylactic cranial irradiation (PCI) in limited disease small cell lung cancer (LD SCLC)

Mediastinal teratoma with double malignant transformation

We report a case of a 65-year-old woman with retrosternal discomfort, dyspnea, and weight loss in whom the computed tomography showed a multicystic mass with fat content and calcified wall in the anterior mediastinum. After surgical resection, pathological examination revealed synchronous primary colorectal adenocarcinoma and primary carcinoid tumor arising in a mediastinal mature cystic teratoma. Treatment with oxaliplatin and capecitabine was instituted, and subsequent checkups showed no evidence of recurrence. Malignant transformation of mature cystic teratoma is a rare complication that occurs in 1–3% of these tumors and consists of a nongerm cell malignant tumor arising from a preexisting mature teratoma. Any of the constituent tissues of a teratoma has the potential to undergo malignant transformation. In case of limited disease, treatment should be surgical. There is no consensus regarding adjuvant treatment, and the existence of a double neoplastic lineage may complicate the choice of chemotherapy treatment.

Limited Granulomatosis With Polyangiitis of Nose and Paranasal Sinuses - a Case Report.

Granulomatosis with polyangiitis is a rare disease with involvement of multiple organ system. It classically affects the upper respiratory tract, lower respiratory tract and kidneys. 90% of patients present with upper respiratory diseases like rhinosinusitis, nasal polyposis, nasal septal perforation, serous otitis media, impaired hearing and stridor due to subglottic stenosis. Disease manifests in two forms as limited disease i.e. without renal involvement and generalized disease i.e. with renal involvement. It needs to be differentiated from chronic granulomatous diseases like tuberculosis and delay in the treatment should be prevented. Here we present a case with disease limited to Nose and Paranasal sinuses.

A new prognostic marker in small cell lung cancer: red cell distribution width ratio of hemoglobin

Aim: The ratio of hemoglobin (Hb) to red cell distribution width (RDW) (HRR) has been defined as an effective prognostic factor in various cancer types. The aim of this study is to investigate the prognostic role of HRR value in small cell lung cancer (SCLC). Material and Method: A total of 1039 patients diagnosed with SCLC between 2010-2021 were included in the study. After exclusion of 199 patients without positron emission tomography-computerized tomography (PET-CT), age, gender, additional disease histories, smoking history, pathological stages, survival status, disease progression times, treatments applied, first hemoglobin obtained after diagnosis, red cell distribution width and ratios, and other laboratory parameters of 840 patients were recorded. The log-rank test and the Cox proportional hazards model were used to identify predictors of mortality. Results: A total of 840 patients were included in the study. The median overall survival (OS) and the progression-free survival (PS) times of the patients were 9 months, and 7 months, respectively. The cut-off value for HRR was determined 0.580 (sensitivity 78.73%, specificity 37.88%). In this study, each one-unit increase in HRR reduces death and survival by 1.6 times detected, and it was revealed that HRR had a statistically significant effect on OS and PS. When the patients were divided into two as limited and extensive disease, there was a statistically significant difference between the groups in terms of OS (12-6 months) and PS (10-6 months), but no significant difference was found in terms of HRR between these two groups. Conclusion: HRR is an easily accessible, inexpensive parameter that can be used as a prognostic marker in patients with SCLC.

The Pattern of Progression to First-Line Treatment with Dabrafenib and Trametinib in Patients with Unresectable or Metastatic, BRAF-Mutated, Cutaneous Melanoma: Results of the Observational T-WIN Study.

In patients with B-RAF-mutated cutaneous melanoma, targeted therapies are the treatment of choice to achieve a rapid response. In this multicentric, prospective, observational study, patients with B-RAF-mutated cutaneous melanoma who were treated with dabrafenib and trametinib were categorized in two cohorts (cohort A: limited disease (n = 104) and cohort B: bulky disease (n = 97)) according to lactate dehydrogenase levels. The primary endpoint was the progression pattern; the secondary endpoints were overall survival (OS), progression-free survival (PFS), and safety data. From baseline to time of progression, there was a progression from nodal to other sites of disease in cohort A and from skin and nodal to other sites in cohort B. In both the cohorts, the number of involved organs and metastases at each location decreased. The median OS was 32.4 months (95% CI: 20.1 months (not estimable)) for cohort A, and 10.5 months (95% CI: 8.3-14.4 months) for cohort B; median PFS was 12.4 months (95% CI: 10.9-17.0 months) for cohort A, and 8.1 months (95% CI: 6.3-9.4 months) for cohort B. No new safety signals were reported. This study describes the patterns of first-line treatment progression with dabrafenib and trametinib in Italian clinical practice. The effectiveness and safety data were consistent with previous trials and extended to a real-world heterogeneous population.

Outcomes with optimal treatment in geriatric head and neck cancers – Tertiary cancer centre experience

ABSTRACT Aim: Older patients with locally advanced head and neck cancers (LA-HNC) are under-represented in clinical trials and denied standard treatment with concurrent chemo-radiation. Most are treated with radiotherapy (RT) alone. However, with the use of Intensity Modulated Radiation Therapy (IMRT) and good supportive care, even this cohort of patients can be considered for chemo-radiation. Methods and Materials: 69 patients with age &gt;65 years with LA-HNC treated between April 2015 and December 2019 in our Institute were prospectively evaluated for treatment compliance and outcomes. All patients were planned to receive 70 Gy in 33-35 fractions with IMRT and weekly Cisplatin at a dose of 40 mg/m2 (or Carboplatin-AUC-2). Loco-regional control (LRC), Overall survival (OS), and prognostic factors were evaluated. Results: Median age at presentation was 67 years (65-81). 54 were male. 64% had Karnofsky Performance Status of &gt;90. 42% had Oropharyngeal Primary. 17% had co-morbidities, 66% had T3 disease, 77% had Node positive disease, and 54% had Stage III disease. All patients completed 70 Gy and 81% patients received at least 5 (&gt;200 mg/m2) chemotherapy cycles. Acute grade-3 toxicity was seen in 20% of patients and 64% had complete response. With a median follow up of 23.6 months (3-71), OS was 53.5%. Estimated 2-year LRC was 60%; estimated 2- and 5-year OS was 53.5% and 34.3%, respectively. On univariate analysis, age &lt;70 years, Cisplatin use, limited nodal disease, Stage III, and complete response to treatment showed good OS (p &lt; 0.05). Conclusion: Definitive chemo-IMRT approach in older patients with LA-HNC is well tolerated with good clinical outcomes. Hence, older age should not be a barrier for standard treatment.

Multimodality liver directed treatment for colorectal liver metastasis: Array of complementary options can improve outcomes -A single centre experience from India.

Complimentary use of Liver directed therapies (LDTs) with systemic chemotherapy has improved oncologic outcomes in colorectal liver metastasis (CRLM). We analysed institutional results of multimodality management. Retrospective analysis of prospectively maintained database of CRLM patients managed with LDT including surgical resection, Ablation, Transarterial chemoembolization (TACE) or Transarterial radioembolization (TARE) between November 2011 to March 2020. Management plan was decided in multidisciplinary meeting. Resectable tumours underwent surgical resection or ablation or both in some cases. Borderline resectable or unresectable disease was treated with down staging chemotherapy or TACE/TARE followed by resection or ablation. All patients received adjuvant chemotherapy. Factors influencing survival were analysed. Out of total 375 patients, surgery alone was done in 191 (50.93%) patients while surgery with other LDT in 26 patients (6.93%). Ablation alone was done in 100 (26.66%) whereas TACE/TARE were done as standalone treatment in 21 (5.6%) and 7 (1.86%) patients respectively. TACE + ablation was done in 28 (7.46%) and TARE + ablation was done in 2(0.53%) patients.5-year Overall Survival(OS) was 49.8% while Event free survival(EFS) was 21.4%. The median OS and EFS for surgical group was significantly better than non-surgical group (78 V/s 39 months; p<0.05 and 20 V/s 15 months p <0.005). The resectable (78 months) group had better median OS as compared to borderline resectable and Unresectable group (39 months and 29 months). Male gender, resectable disease and surgical intervention were associated with improved OS. Although surgery remains the mainstay of treatment, complementary use of non-surgical LDT with systemic therapy offers possibility of good outcomes in advanced liver limited disease. Our experience highlights the impact of multidisciplinary care in optimizing CRLM treatment.

An update on long-term outcomes of pediatric follicular mucinosis over a 20-year period: a retrospective cohort study.

Follicular mucinosis (FM) is a rare disease characterized by mucin accumulation in the follicular unit. FM's etiology is still widely debated since its first description in 1957. Follicular mucinosis is usually reported to be benign in children, although reports of malignant transformation, most commonly mycosis fungoides, exist. The present project aims to demonstrate that children with a diagnosis of follicular mucinosis have positive long-term outcomes and do not develop mycosis fungoides. This is a retrospective cohort study where patients with a diagnosis of follicular mucinosis ages 22 years and below were identified. Data surrounding the patient's diagnosis of FM, differential diagnosis, treatments, and long-term outcomes were collected. Patients who were lost to follow-up were contacted by phone for an update on the status of their skin and overall health. Out of 14 patients with follow-up information, none developed subsequent mycosis fungoides or other hematologic malignancies. Pediatric patients with follicular mucinosis will likely present with limited disease and not experience malignant transformation.

Stereotactic Body Radiation Therapy for Sarcoma Pulmonary Metastases.

Lung metastases are the most common form of distant failure for patients diagnosed with sarcoma with metastasectomy considered for some patients with limited metastatic disease and good performance status. Alternatives to surgery such as stereotactic body radiation therapy (SBRT) can be considered, though data are limited. We present outcomes after SBRT for sarcoma lung metastases. Fifty sarcoma patients with 109 lung metastases were treated with SBRT between 2005 and 2021. Outcomes evaluated included local control (LC), overall survival (OS), and toxicity including lung pneumonitis/fibrosis, chest wall toxicity, dermatitis, brachial plexus, and esophageal toxicity. Systemic therapy receipt before and after SBRT was recorded. SBRT schedules were divided into 3 cohorts: 30 to 34Gy/1fx (n=10 [20%]), 48 to 50Gy/4 to 5fx (n=24[48%]), and 60Gy/5fx (n=16[32%]). With a median follow-up of 19.5 months, 1/3-year LC rates were 96%/88% and 1/3-year OS 77%/50%, respectively. There was no differences between the 3 regimens in terms of LC, OS, or toxicity. Size >4cm was a predictor of worse LC ( P =0.031) and worse OS ( P = 0.039) on univariate analysis. The primary pattern of failure was new metastases (64%) of which the majority were in the contralateral lung (52%). One-year chemotherapy-free survival was 85%. Overall, 76% of patients did not require chemotherapy initiation or change of chemotherapy regimen after lung SBRT. Toxicity was reported in 16% of patients overall, including 25%, 20%, and 14% in the 30 to 34Gy/1fx, 48 to 50Gy/4 to 5fx, and 60Gy/5fx cohorts, respectively. SBRT outcomes for lung metastases from sarcoma demonstrate high rates of LC and are similar with different dose/fractionation regimens. Lung SBRT is associated with prolonged chemotherapy-free survival. Prospective validation of these results is warranted.

Long-Term Follow-Up of Bridging Therapies Prior to CAR T-Cell Therapy for Relapsed/Refractory Large B Cell Lymphoma.

Bridging therapy (BT) with systemic therapy (ST), radiation therapy (RT), or combined-modality therapy (CMT) is increasingly being utilized prior to chimeric antigen receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL). We report the long-term outcomes of the patients who received commercial CAR T-cell therapy with or without BT. The patients with LBCL who underwent infusion of a commercial CD19 CAR T product were eligible. The radiation was stratified as comprehensive or focal. The efficacy outcomes and toxicity were analyzed. In total, 156 patients were included and, of them, 52.5% of the patients received BT. The median progression-free survival (PFS) was 0.65 years in the BT cohort compared to 1.45 years in the non-BT cohort. The median overall survival (OS) was 3.16 years in the BT cohort and was not reached in the non-BT cohort. The patients who received comprehensive radiation (versus focal) had significantly improved PFS and OS, achieving a 1-year PFS of 100% vs. 9.1% and 1-year OS of 100% vs. 45.5%. There was no difference in the severe toxicity between any of the nonbridging or BT cohorts. BT did not appear to compromise outcomes with respect to response rates, disease control, survival, and toxicity. The patients with limited disease treated with RT had favorable outcomes.

Shared features of metaplasia and the development of adenocarcinoma in the stomach and esophagus.

Introduction: Plasticity is an inherent property of the normal gastrointestinal tract allowing for appropriate response to injury and healing. However, the aberrancy of adaptable responses is also beginning to be recognized as a driver during cancer development and progression. Gastric and esophageal malignancies remain leading causes of cancer-related death globally as there are limited early disease diagnostic tools and paucity of new effective treatments. Gastric and esophageal adenocarcinomas share intestinal metaplasia as a key precancerous precursor lesion. Methods: Here, we utilize an upper GI tract patient-derived tissue microarray that encompasses the sequential development of cancer from normal tissues to illustrate the expression of a set of metaplastic markers. Results: We report that in contrast to gastric intestinal metaplasia, which has traits of both incomplete and complete intestinal metaplasia, Barrett's esophagus (i.e., esophageal intestinal metaplasia) demonstrates hallmarks of incomplete intestinal metaplasia. Specifically, this prevalent incomplete intestinal metaplasia seen in Barrett's esophagus manifests as concurrent development and expression of both gastric and intestinal traits. Additionally, many gastric and esophageal cancers display a loss of or a decrease in these characteristic differentiated cell properties, demonstrating the plasticity of molecular pathways associated with the development of these cancers. Discussion: Further understanding of the commonalities and differences governing the development of upper GI tract intestinal metaplasias and their progression to cancer will lead to improved diagnostic and therapeutic avenues.

Dermoscopy of genodermatoses

Genodermatoses are agroup of inherited skin diseases whose diagnosis is challenging due to their rarity as well as their clinical and genetic diversity. The majority of genodermatoses are autosomal or X‑linked inherited, but mosaic forms are also observed. Genodermatoses comprise various phenotypes ranging from limited cutaneous disease to severe cutaneous and extracutaneous involvement and may also be early warning signs of amultisystemic disorder. Despite recent advances in genetic technology and skin imaging modalities, dermoscopy can be useful for screening, diagnosis, and treatment follow-up. In ectopic mineralization and lysosomal storage disorders (pseudoxanthoma elasticum and Fabry disease, respectively), cutaneous manifestations may indicate involvement of other organs. In keratinization diseases (e.g., ichthyoses) and acantholytic skin fragility disorders (e.g., Darier and Hailey-Hailey disease), dermoscopy may help to assess treatment response by visualizing background erythema, hyperkeratosis, and interkeratinocyte space prominence. Dermoscopy is anoninvasive, easily accessible, useful, invivo assessment tool that is well established in dermatology to recognize characteristic features of genodermatoses.