Multimodality Management Research Articles

Outcomes of Gamma Knife radiosurgery for skull base chondrosarcomas: a multi-institutional retrospective study.

Radiotherapy has an essential role in the management of skull base chondrosarcomas (SBCs) after resection. This multi-institutional study evaluated the outcomes of Gamma Knife radiosurgery (GKRS) for histopathologically proven SBCs. Data of patients who underwent GKRS for SBCs at Gamma Knife centers in Japan were retrospectively collected. Patients without a histopathological diagnosis and those who had intracranial metastases from extracranial chondrosarcomas were excluded. Histologically, grade III and some nonconventional variants were identified as aggressive types. The cumulative local control rates (LCRs) and disease-specific survival (DSS) rates were calculated using the Kaplan-Meier method. Factors potentially affecting the LCR were evaluated using the Cox proportional hazards model for bivariate and multivariate analyses. The incidence of radiation-induced adverse effects (RAEs) was calculated as crude rates, and factors associated with RAEs were examined using Fisher's exact test. Fifty-one patients were enrolled, with a median age of 38 years. Thirty patients (59%) were treated with upfront GKRS for residual SBCs after resection (n = 27) or biopsy (n = 3), and 21 (41%) underwent GKRS as a salvage treatment for recurrence. The median tumor volume was 8 cm3. The overall LCRs were 87% at 3 years, 78% at 5 years, and 67% at 10 years after GKRS. A better LCR was associated with a higher prescription dose (p = 0.039) and no history of repeated recurrence before GKRS (p = 0.024). The LCRs among patients with the nonaggressive histological type and treatment with ≥ 16 Gy were 88% at 3 years, 83% at 5 years, and 83% at 10 years. The overall survival rates after GKRS were 96% at 5 years and 83% at 10 years. Although RAEs were observed in 3 patients (6%), no severe RAEs with Common Terminology Criteria for Adverse Events grade 3 or higher were identified. No significant factor was associated with RAEs. GKRS for SBCs has a favorably low risk of RAEs and could be a reasonable therapeutic option for SBC in multimodality management. A sufficient GKRS prescription dose is necessary for higher LCRs. Histological grading and subtype evaluations are important for excluding exceptional SBCs. Patients with conventional SBCs have a long life expectancy and should be observed for life after treatment.

Esophageal Cancer: Whether and What Before or After Surgery?

Esophageal cancer is the eighth most common cancer and the sixth most common cause of cancer-related mortality worldwide. Surgery has been the mainstay of the treatment of esophageal cancer. However, given the dismal survival with surgery alone, other modalities, e.g., chemotherapy (CT) and radiotherapy (RT), have been used for the management of these cancers. This review aims to look at the evolution of multi-modality management of esophageal cancer and tries to answer certain questions pertaining to the management of these cancers.

P03.08.B Proton Therapy and recurrent Lower Grade Glioma: clinical and radiological aspects, intraoperative findings and histo-pathological features

Abstract Background Radiation therapy (RT) plays a central role in management of central nervous system disease, in particular in the multimodality management of low(er) and high-grade CNS gliomas. New strategy that involved Proton Therapy (PT) have been experienced in the last years. No data are available about re-surgery of lesion irradiated with protons. Material and Methods We reviewed our single Unit experience of re-surgery of Lower-Grade Glioma patients that received, in their neuro-oncological history, a treatment with PT. We collect clinical data, intra-operative findings, histopathological features and oncological and clinical outcome after surgery. Results We collected three cases of young with an IDH1-mutated tumor that underwent to Proton Therapy (PT). In two cases PT was performed due to progression of disease, in one case as adjuvant therapy after first surgical treatment. In all cases we performed surgery within three years after PT. All patients complained drug resistant epilepsy after PT with symptom relief after surgery and one patient complained a spine fracture due to corticosteroids intake to control radionecrosis’s symptoms after PT. In the pre-operative work-up all patient performed a 11-C-Methionin PET scan that revealed an increase of tracer uptake in the suspected area of tumor progression. In one case advanced MRI protocol with PWI was performed to further distinguish and sample area of pseudoprogression and tumor progression. In two patients area of gliosis and necrosis was find at the histological examination. Conclusion Our experience, although limited to three case, provided a clinical and radiological example of the small cohort of patients that performed surgery after a Prothon Radiotherapy. Clinical presentation was heterogenous except a poor seizure control. Despite time elapsed since PT, areas of radionecrosis were found in the histopathological samples of 2/3 of patients. Moreover, we need to collect more data to draw a complete picture in this complex field.

An Overview of the Role of Radiotherapy in the Treatment of Small Cell Lung Cancer – A Mainstay of Treatment or a Modality in Decline?

AimsSmall cell lung cancer (SCLC) accounts for about 15% of all lung cancers. Chemotherapy, immunotherapy and radiotherapy all play important roles in the management of SCLC. The aim of this study was to provide a comprehensive overview of the role and evidence of radiotherapy in the cure and palliation of SCLC. Materials and methodsThe search strategy included a search of the PubMed database, hand searches, reference lists of relevant review articles and relevant published abstracts. ClinicalTrials.gov was also queried for relevant trials. ResultsThoracic radiotherapy improves overall survival in limited stage SCLC, but the timing and dose remain controversial. The role of thoracic radiotherapy in extensive stage SCLC with immunotherapy is the subject of several ongoing trials. Current evidence supports the use of prophylactic cranial irradiation (PCI) for limited stage SCLC but the evidence is equivocal in extensive stage SCLC. Whole brain radiotherapy is well established for the treatment of brain metastases but evidence is rapidly accumulating for the use of stereotactic radiosurgery. Further studies will define the role of PCI, whole brain radiotherapy and hippocampal avoidant PCI in the immunotherapy era. ConclusionRadiotherapy is an essential component in the multimodality management of SCLC. Technological advances have allowed safer delivery of radiotherapy with reduced toxicities. Discussion at multidisciplinary team meetings is important to ensure radiotherapy is considered and offered in appropriate patients.

EP05.02-006 Neoadjuvant DS-8201 for Stage III Non-small Cell Lung Cancer with HER2 20ins

Stage III-N2 non-small cell lung cancer (NSCLC) represents a highly heterogeneous disease and requires multimodality management. Neoadjuvant therapy is indicated when upfront surgery is difficult with the aim of tumor shrinkage. Trastuzumab deruxtecan (i.e., DS-8201) is an emerging antibody-drug conjugate (ADC) which four topoisomerase I inhibitors are linked to a HER2-targeting antibody. Prior study has shown a 55% objective response rate (ORR) in previous treated metastatic HER2-mutant NSCLC with durable effect.

Observational Study to Determine the Involvement of Level III Lymph Nodes in Case of Clinically Positive Level II Nodes in Carcinoma Breast.

Management of breast cancer has gradually shifted from era of radical surgery to present days of multimodality management and conservatism. Management of carcinoma breast is primarily multimodality of which surgery is one of the important roles to play. Our study is a prospective observational study to determine the involvement of level III axillary lymph nodes in clinically involved axilla with grossly involved lower-level axillary nodes. Underestimation of a number of involved nodes at level III shall result in inaccuracy of subset risk stratification leading to substandard prognostication. The enigma of not addressing presumably involved nodes thereby altering the staging vs acquired morbidity has always been a contentious issue. Mean lymph node harvest at the lower level (I and II) was 17.9 ± 6.3 (range: 6-32) while positive lower-level axillary lymph node involvement was 6.5 ± 6.5 (range: 1-27). The mean ± SD for level III positive lymph node involvement was 1.46 ± 1.69 (range: 0-8). Our prospective observational study though limited by the number and years of follow-up has demonstrated that the presence of more than three positive LN at a lower level increases the risk for higher nodal involvement substantially. It is also evident in our study that PNI, ECE, and LVI increased the probability of stage up-gradation. LVI was found to be a significant prognostic factor for apical LN involvement in multivariate analysis. On multivariate logistic regression > 3 pathological positive lymph nodes at the level I and II and LVI involvement elevated the risk of involvement at level III by 11 and 46 times, respectively. It is recommended that patients who have a positive pathological surrogate marker of aggressiveness should be evaluated perioperatively for level III involvement, especially in the setting of visible grossly involved nodes. The patient should be counseled and informed decision to perform complete axillary lymph node dissection with the added risk of morbidity should be contemplated.

Management of postoperative pain among health professionals working in governmental hospitals in South Wollo Zone, Northeast Ethiopia. Prospective cross sectional study

IntroductionPain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components. Inadequate postoperative pain management leads to negative clinical outcomes such as extended hospitalization, poor recovery, diminished and decreases the quality of life, increased healthcare costs and utilization, higher morbidity and mortality, and the development of chronic pain. The study was used for the hospitals administrations, health professionals, committee that develop the pain management guideline, researcher, and governmental health institutions regarding the practice of postoperative pain management. The aim of this study was to assess the management of postoperative pain among health professionals working in governmental hospitals in South Wollo Zone, Ethiopia. Methods and materialsA hospital-based prospective cross-sectional study was conducted from February 20, 2022 to March 25, 2022. The study population was selected from South Wollo Zone governmental hospitals and 386 samples were collected using a self-administered questionnaire and verified, coded and entered into Epidata software version 3.1 and it exported to SPSS version 23 for analyze. To summarize descriptive statistics frequencies, percentages, and mean were used and presented with tables, charts, and figures. Result386 participants were involved and making up 95.8% of the response rate. Among the respondents, 97.9% of the respondents had used pharmacological management. 51.3% applied non-pharmacological and 66.1% applied multimodality management of postoperative pain. Among pharmacological management, 48.7% of systemic analgesics technique, 26.3% of regional analgesics technique, and 25.0% of patient-controlled epidural analgesics, whereas in non-pharmacological management 40.4% of cold and heat application followed by 32.3% of immobilization was applied to the management of postoperative pain. Conclusion and recommendationThe overall level of pharmacological, non-pharmacological and multimodality approach of post-operative pain management among health professionals in the study area was more than ninety, half and more than half of the participants, respectively. Postoperative pain management found in many key areas of postoperative pain management has an impact on the provision of effective pain management and optimal care given to surgical patients. This study provided an opportunity for health professionals working in hospitals, to evaluate themselves in the area of postoperative related to pain management.

Outcomes of Surgical Treatment in Spinal Metastasis

With increase in the elderly population and improved survival among patients with malignancies, the rates of patients presenting with metastatic involvement of the spine is on the rise. Surgical management of spinal metastasis requires a multidisciplinary approach and surgery is a key component of multimodality management of metastatic spinal lesions. A PubMed search of relevant articles was performed and a narrative review of available pertinent literature in English language is presented.

Abstract 2991: Survival reliability of Glioblastoma on CD38

Abstract Glioblastoma (GBM) is a fatal malignancy of the brain. Unfortunately, the current multimodality management approach does not lead to long term survival benefits. Several prognostic factors such as Blood Brain Barrier (BBB) & Blood Tumor Barrier (BTB), Glioma Stem-like Cells (GSCs), an immunosuppressive tumor microenvironment (TME) and genetic heterogeneity promotes GBM progression. To improve treatment efficacy, these factors should be addressed in a rational manner. Our pre-clinical investigations indicate that maintenance of CD38 expression, a type II transmembrane glycoprotein, is vital to GBM survival. CD38 could be an ideal biologically relevant target as it is homogeneously expressed on tumor cells and its TME elements. Furthermore, accessibility of FDA approved anti-CD38 therapies, non-overlapping toxicities and potential to cross the BBB has granted approval of our phase I study using Radiation/Temozolomide and Immunotherapy with Daratumumab to Improve Antitumor Efficacy in newly diagnosed Glioblastoma (PRIDE) (NCT04922723). In brief, we performed Western blot (WB), RT-qPCR, and flow cytometry to examine CD38 expression on human GBM cell lines and microglia (LN229, T98G, DI-321, SA21 and HMC3) including CD38 transfected cells. We used trans well assays to analyze changes in CD38 expression in several environments. MTS viability assay was used to study the viability of Temozolomide on GBM cells. Basal expression of CD38 on GBM cells was assessed, showing that CD38 expression varies amongst cell lines and components of its TME. CD38 negative (flow sorted) cells regain CD38 expression around Day 4 after sorting, indicating that CD38 is crucial for GBM survival. We then sorted cells into CD38 negative and positive and performed trans well experiments with overexpressing and knock down cells, revealing that CD38 expression changes based upon surrounding cells in its environment. Cells transfected with shRNA against CD38 have a slower proliferative rate compared to wild-type and CD38 overexpressing cells. We also saw that LN229 Temozolomide (TMZ) resistant (LN229-TR) cells also have a slower proliferative rate and show an increase in CD38 expression. We also observed that CD133, SOX2 and Nestin are significantly over expressed in LN229-TR compared to LN229 CD38 WT, while sharing similar CD38 expression as GSCs and malignant GBM cells. IC50 of TMZ on CD38 overexpressing cells was significantly higher than CD38 WT GBM cells suggesting that CD38 expression contributes towards treatment resistance. All experiments were performed in triplicate and p values less than 0.05 were considered significant. Our preliminary data suggests that CD38 is regulating the proliferation rate as well as stem cell like features of GBM cells. Moreover, overexpression of CD38 is leading to TMZ resistance in pre-clinical models. Our ongoing in vitro and in vivo gene deletion experiments will further solidify the biological importance of CD38 in GBM. Citation Format: Leland Earp, Srishti Kala, Sonikpreet Aulakh. Survival reliability of Glioblastoma on CD38 [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 2991.

High-dose salvage re-irradiation in recurrent/progressive adult diffuse gliomas: development of a novel prognostic scoring system

PurposeOver the past two decades, high-dose salvage re-irradiation (re-RT) has been used increasingly in the multimodality management of adults with recurrent/progressive diffuse glioma. Several factors that determine outcomes following re-RT have been incorporated into prognostic models to guide patient selection. We aimed to develop a novel four-tiered prognostic model incorporating relevant molecular markers from our single-institutional cohort of patients treated with high-dose salvage re-RT for recurrent/progressive diffuse glioma. Material and methodsVarious patient, disease, and treatment-related factors impacting upon survival following salvage re-RT were identified through univariate analysis. Each of these prognostic factors was further subdivided and assigned scores of 0 (low-risk), 1 (intermediate-risk), or 2 (high-risk). Scores from individual prognostic factors were added to derive the cumulative score (ranging from 0 to 16), with increasing scores indicating worsening prognosis. ResultsA total of 111 adults with recurrent/progressive diffuse glioma treated with salvage high-dose re-RT were included. We could assign patients into four prognostic subgroups (A=15 patients, score 0–3); (B=50 patients, score 4–7); (C=33 patients, score 8–10); and (D=13 patients, score 11–16) with completely non-overlapping survival curves suggesting the good discriminatory ability. Post-re-RT survival was significantly higher in Group A compared to groups B, C, and D, respectively (stratified log-rank p-value <0.0001). ConclusionThere exists a lack of universally acceptable ‘standard-of-care’ salvage therapy for recurrent/progressive diffuse glioma. A novel four-tiered prognostic scoring system incorporating traditional factors as well as relevant molecular markers is proposed for selecting patients appropriately for high-dose salvage re-RT that warrants validation in a non-overlapping cohort.

Comparison of Various Analgesic Protocols for Control of Postoperative Pain Following Anorectal Surgery

Background: Anorectal pathology is commonly perceived it and handled in common surgical practitioners’ fistula and abscess, hemorrhoids, fissures, condyloma, and other pathological conditions. Because of the strong sensory innervations of the canal of anal, patients endure severe discomfort during anorectal surgery. It is generally most severe in the first twenty-four hours especially after excisional hemorrhoidectomy. the aim of this study is a comparison between different analgesic protocols used to relieve pain postoperative anorectal surgery.&#x0D; Methods: PubMed, Embase, Medline, Science Gate, Scientific Report, Elsevier, Google Scholar, and Cochrane Evidence Based Medicine Reviews were used to conduct a review search. Review of newly released books and papers with regard to the topic, as well as manual searches (Comparison of various analgesic protocols for control of postoperative pain following anorectal surgery), was started at (May,2021). we searched the published studies from 2011 to the present date by the full text:(various analgesic protocols post anorectal surgery).&#x0D; Results: Anorectal surgery is marked by excruciating discomfort after the procedure. Using the new technique during anorectal surgery as hemorrhoidectomy to avoid more excision of anal mucosa and the skin, putting the suture nearest to the dentate line and away from the internal anal sphincter, and good hemostasis to avoid the inserting of the anal pack are the most essential methods to lessen pain postoperatively regardless of the type of anorectal surgery performed or the instrument to use during it. We found more protocols using multimodality pain management for the relief of pain, topical drugs that produce direct relaxation of the internal anal sphincter, topical intervention as a pudendal nerve block, a method of surgery as surgical sphincterotomy, and technical tips to reduce pain as ligasure.&#x0D; Conclusion: Multimodal pain treatment has been demonstrated to minimize pain intensity and opioid doses in various kinds of surgery. According to the highest degree of proof, using current technological procedures and tools as a ligasure with some topical agent as GTN glyceryl trinitrate ointment provided amazing excellent alleviation of postoperative pain following anorectal surgery.

Assessment of neurocognitive functions using ACE-III scale in patients with high-grade glioma receiving adjuvant chemoradiation.

e14030 Background: High Grade Gliomas (HGG) are aggressive CNS tumours with poor prognosis despite multimodality management with surgery, radiation and chemotherapy. During the course of the disease and treatment patients experience alterations in neurocognitive functions (NCF) &amp; QOL which is dependent on factors like size, location of tumour, type of surgery, chemo radiotherapy (CTRT) received &amp; disease recurrence. Assessment of change in pattern of NCF is important in optimising treatment and interventions like use of neuroprotectors and in guiding future clinical trials in those directions. Change in NCF significantly affects QOL of patients and their care givers. Most studies on NCF in brain tumours has been conducted on Low Grade Gliomas and various tools have been used in these studies. Addenbrooke Cognitive Examination tool (ACE III) has been used by some in the assessment of NCF in brain tumour. This study aims to assess change in NCF in postoperative HGG patients receiving adjuvant chemoradiation. Methods: 13 newly diagnosed post operative cases of Grade III &amp; IV gliomas were prospectively enrolled in the study. Enrolled patients received adjuvant radiotherapy (RT) (60Gy/30 fractions) using IMRT technique with concurrent Temozolomide (TMZ) 75mg/m2 over 6 weeks. Patients received adjuvant TMZ 150-200 mg/m2 up to six 4-weekly cycles. Pre-treatment Neurocognitive functions were assessed using ACE III scale before start of RT. Post-treatment assessment was done using ACE III at 6 months after completion of RT. The ACE-III scale consists of 5 domains namely Attention (Total Score-18), Memory (TS-26), Fluency (TS-14), Language (TS-26), Visuospatial Abilities (TS-16); the Total Score is given out of 100.The variable are described using mean (SD); Paired t test was used for statistical analysis and baseline data was compared with 6 months’ data. Results: The study group was homogenous with a median age of 42 years. Fronto-parietal region of the brain was most commonly involved. All patients had received concurrent TMZ, completed RT within 6 weeks and received adjuvant TMZ for a period of 6 months. On Comparing baseline to 6 months data; statistically significant improvement was noted in Memory(p-0.049), Language(p-0.031) &amp; the Total Score (p-0.048).There was improvement in total ACE III score in 84% of the patients at 6 months. Conclusions: Significant improvement noted in majority of the postoperative patients at 6 months’ post RT in both total ACE III score and specific domains except a few. Long term follow up needed to assess further change in NCF due to disease or long term treatment related effects.[Table: see text]

Molecular Subtypes As Emerging Predictors of Clinicopathological Response to Neoadjuvant Chemotherapy (NACT) in Locally Advanced Breast Cancer (LABC): A Single-Centre Experience in Western India.

Introduction: Locally advanced breast cancer (LABC) is a subset of breast cancer characterized by the most advanced breast tumours in the absence of distant metastasis. Treatment of LABC has evolved from a single modality treatment to multimodality management. Neoadjuvant chemotherapy (NACT) is increasingly being used to treat patients with LABC. This study assessed tumour response after NACT using clinical changes, Response Evaluation Criteria in Solid Tumors (RECIST) criteria and pathological report.Methodology: This study was a prospective as well as retrospective observational study carried out in the department of general surgery, Dr. Sampurnanand Medical College, Jodhpur. All the patients admitted with stage III (IIIA, IIIB, IIIC) were included in the study after obtaining approval from the institutional ethical committee. Clinical response was assessed by RECIST criteria (clinical complete response (cCR), clinical partial response (cPR), clinical progressive disease (cPD), and clinical stable disease (cSD)) and pathological response by histopathological report (pCR). Response of various molecular subtypes was noted.Results: Among 31 patients included in the study, cCR observed in 22.58% cases, cPR observed in 61.29% cases while cPD and cSD seen in 3.22% and 12.90% cases, respectively. Pathological complete response (pCR) observed in 19.35% cases. Favourable response seen with human epidermal growth factor receptor 2 (HER2) overexpression (cCR = 50%, pCR = 37.50%) followed by triple negative (cCR = 25%, pCR = 25%) molecular subtypes.Conclusions: It can be concluded that molecular subtype determination helps in deciding treatment protocol in patients with LABC with HER2 overexpression and triple-negative breast cancers having a better clinicopathological response to NACT than luminal subtypes. NACT results in downstaging of tumours, thus, help in achieving surgically clear margins and elimination of micrometastases which decreases the recurrence rates and morbidity/mortality of patients.

Patterns of Multimodality Management of Gastric Cancer-Single Institutional Experience of 372 Cases From a Tertiary Care Center in North India.

IntroductionWorldwide gastric cancer is the 5th most commonly diagnosed cancer and the leading cause of gastrointestinal cancer-related deaths. Alone surgery provides long-term survival improvements in 20% of the patients with local advanced gastric cancer. The results can be improved considering multimodal management including chemotherapy and radiotherapy. However, in low middle-income countries like India, multimodal management is challenging. Herein, we evaluated the experience of multimodal management of gastric cancer and the long-term outcome.MethodsRetrospective analysis of the data of 372 patients was done from a prospectively maintained computerized database from 1994 to 2021. Records were analyzed for demographic details, treatment patterns, recurrences, and long-term outcomes (DFS and OS). Statistical analysis was done with the package SPSS version 26 (IBM Corp, Chicago, Illinois, USA).ResultsThis study included 372 patients. The mean age of the patients was 54.07. A total of 307 patients (82.5%) were operated upfront, 45 (12%) received NACT, and 20 (5.5%) underwent the palliative procedure. A total of 53.2% underwent curative resection. R0 resection rate was achieved in 95% of patients. A total of 72.58% of patients required adjuvant treatment, and the majority of the patients underwent chemoradiotherapy. The most common site of metastasis was the liver. Median follow-up was 50.16 months. The 3-year disease-free survival and overall survival were 36.28% and 67.8%, and the 5-year disease-free survival and overall survival were 30.15% and 37.7%, respectively.ConclusionOur study suggested that multimodal management is required in locally advanced gastric cancer to achieve good long-term outcomes. The treatment sequence can be tailored based on the available resources.

2D-DIGE-Based Proteomic Profiling with Validations Identifies Vimentin as a Secretory Biomarker Useful for Early Detection and Poor Prognosis in Oral Cancers.

Oral tongue squamous cell carcinoma (OTSCC) is an aggressive cancer with high morbidity and mortality rates, despite multimodality management. There are currently no clinically relevant molecular markers that identify patients at higher risk of recurrence and failure. We undertook 2D-DIGE proteomic profiling to study the differentially expressed proteins in OTSCC evaluating their role in prognosis. 2D-DIGE coupled with tandem mass spectrometry was performed on tissues obtained from early staged OTSCC along with its paired apparently adjacent normal tissue samples (n = 10). Top upregulated protein was validated using immunohistochemistry (n = 345), comprising of retrospective early stage OTSCC (n = 150) and prospective series of oral precancers, normal, and oral cancers (n = 195). Saliva samples collected from oral cancer and precancer samples were analyzed by ELISA (n = 146). We found statistically significant differential expression in 151 proteins out of 700 proteins quantified. Top ten differentially regulated proteins were identified using mass spectrometry analysis. We found vimentin, the mesenchymal protein, to be the most upregulated protein in tongue tumor tissues compared to adjacent apparent normal tissues. Vimentin was found to be significantly overexpressed in oral precancers along with cancers compared to normal tissues. The vimentin expression correlated significantly with differentiated states of oral precancers and cancers. Vimentin was also detected at significantly higher levels in saliva collected from oral precancer and cancer patients compared to normal healthy volunteers. Validation of vimentin in an independent series of retrospective early staged OTSCC showed that the vimentin expression is significantly associated with treatment failures and poorer DFS. The vimentin expression is useful as both poor prognostic and early detection marker in oral cancer. Vimentin detection in saliva can be a diagnostic test to detect oral precancers that may have malignant potential, needing closer follow-up, and disease monitoring.

Reappraisal of multimodality imaging for improved Radiation Therapy (RT) target volume determination of recurrent Oral Squamous Cell Carcinoma (OSCC): An original article

Objective: Head and Neck Squamous Cell Carcinoma (HNSCC) is one of the most frequent cancer sites around the globe. Within the heterogeneous group of HNSCC, Oral Squamous Cell Carcinoma (OSCC) deserves the utmost attention as an important subsite. Despite multimodality management, recurrence of OSCC is not uncommon. RT may play an integral role as part of initial management or as adjunctive therapy, or for treatment of recurrent disease. In this study, we evaluate multimodality imaging-based RT treatment volume definition for irradiation of recurrent OSCC. Materials and methods: Multimodality imaging-based RT treatment volume definition for radiotherapeutic management of recurrent OSCC was assessed. RT target volume determination by incorporation of Magnetic Resonance Imaging (MRI) or by Computed Tomography (CT)-simulation images only has been evaluated and comparative analysis has been performed for patients receiving salvage RT for recurrent OSCC. Results: Ground truth target volume has been found to be identical with treatment volume definition by CT-MR fusion-based imaging. Conclusion: Incorporation of MRI in target and treatment volume definition may improve target and treatment volume definition for recurrent OSCC.

The Use of Intraoperative Radiation Therapy (IORT) in Multimodality Management of Cancer Patients: a Single Institution Experience.

Intraoperative radiation therapy (IORT) is a highly conformal type of radiation therapy given at time of surgery aiming for better tumor local control. It increases the tumor radiation dose without exceeding normal tissues tolerance doses. To assess the feasibility of IORT and short-term toxicities in patients with different cancer sites treated with multidisciplinary protocol including IORT. Medical records of cancer patients who received IORT as a part of their multidisciplinary treatment at King Faisal Specialized Hospital and Research center (KFSH&RC), Riyadh, Saudi Arabia, from January 2013 until December 2017 were retrospectively reviewed. A total of 188 patients with 210 IORT applications were analyzed. Twenty-two patients had two applications at the same time. One hundred sixteen patients were males. Median age at time of diagnosis was 49.5years (19-77). One hundred thirty-four patients had primary, while 54 cases had recurrent disease. Gastroesophageal cancer and soft tissue sarcoma were the most frequent diagnosis in 49 patients followed by colorectal cancer in 35 patients. Major surgeries with curative intent done in 183 patients (97.3%). Hyperthermic intraperitoneal chemotherapy (HIPEC) was performed in 118 (62.8%) patients. The 30-day postoperative mortality rate was 3.2%. Fifty-four (28.7%) patients develop grades III-IV complications according to Clavien-Dindo grading system. The data presented discusses using of IORT treatment for different malignant tumors as a part of multimodality treatment. IORT seems safe and feasible; however, a longer follow-up period is needed for proper evaluation and to define the role of IORT in a tailored multimodality approach.

Multimodality Treatment of Brain Arteriovenous Malformations with One-Staged Hybrid Operation: Clinical Characteristics and Long-Term Prognosis.

Objective We aimed to evaluate the clinical characteristics and long-term prognosis of brain arteriovenous malformations (bAVMs) treated with multimodality management of one-staged hybrid operation. Methods We identified bAVM patients treated with one-staged hybrid operation from a multicenter prospective cohort study (NCT03774017) between January 2016 and June 2020. Patients were divided into unruptured and ruptured groups by the hemorrhagic presentation. Long-term (>12 months) neurological disability, postoperative complications of stroke, and nidus obliteration were evaluated and compared between groups. Prognostic predictors associated with outcomes were analyzed. Results A total of 130 patients were identified in the study receiving one-staged hybrid operations, including 61 unruptured cases and 69 ruptured cases. Mean age was 29.1 years old, with 78 (60.0%) being male. Patients included in the study were followed up for a mean period of 37.4 (11.07) months. The annual hemorrhagic risk was 4.2% per year. Thirteen postoperative stroke events were detected in 11 patients (8.5%). Long-term disability occurred in 6.9% of cases, and 86.2% of patients experienced an unchanged or improved neurological status at the last follow-up. All patients achieved complete obliteration on follow-up angiographies. Increased AVM volume was associated with a higher risk of postoperative stroke (odds ratio (OR) 1.021, 95% confidence interval (CI) 1.006-1.037, and P = 0.006). Poor neurological status (OR 6.461, 95% CI 1.309-31.889, and P = 0.022) and infratentorial location (OR 5.618, 95% CI 1.158-27.246, and P = 0.032) were independent predictors for long-term disability. Conclusions One-staged hybrid operation of embolization combined microsurgical resection can be performed as a safe and effective strategy for bAVM treatments. Long-term prognosis of complete obliteration with low rates of morbidity and mortality can be achieved. Unruptured and ruptured bAVMs acquired similar favorable outcomes after the multimodality treatment.

Optimal timing of thoracic irradiation for limited stage small cell lung cancer: Current evidence and future prospects.

Lung cancer is a global health concern as the leading cause of cancer related mortality worldwide. Small cell lung cancer (SCLC) poses a formidable challenge to the treating physicians with the worst prognosis among all lung cancers. However, limited stage SCLC (LS-SCLC) has a relatively better outcome with multimodality management. Efforts have been focused on optimal integration of treatment modalities to achieve an improved therapeutic ratio for patients with LS-SCLC. While chemotherapy and thoracic radiation therapy (TRT) are primary components of initial management for LS-SCLC, there is no consensus on optimal timing of TRT. Within this context, we herein provide a concise overview of current evidence and future prospects regarding the optimal timing of thoracic irradiation for LS-SCLC in light of the literature.

Gynecologic Oncology: On the Shoulders of Giants

AbstractGynecologic oncology is considered a new field, but its roots are buried deep in the past. As with other tumors, the earliest progress in modern times started with anesthesia and surgery. This was followed by landmark achievements in pathology, cytology, radiotherapy, chemotherapy, tumor virology, generation of high-quality evidence, and, more recently, genetics and genomics. Some of the most notable progresses in gynecologic cancers have been made by integrating the expertise of various specialties in multimodality management approaches. In this article we review the most important milestones in the history of gynecologic oncology and acknowledge the contributions of pioneers who made these possible.