Patients Receiving Radiation Therapy Research Articles

Potential Benefits of Aloe vera and Raphanus sativus var. longipinnatus Gel for Prevention of Radiation-Induced Dermatitis in Head and Neck Cancer Patients.

The main therapy for head and neck cancer is radiation, and one of the toxic effects of radiation is radiation dermatitis. Aloe vera is a species of succulent plant of the genus Aloe, widely used in cosmetic and skin care products, as well as daikon (Raphanus sativus var. longipinnatus), which is high in antioxidants. The present study aims to evaluate the potential benefits of Aloe vera and daikon gel combination in head and neck cancer patients to prevent radiation-induced dermatitis. A cohort study was conducted with eligible subjects, all head and neck cancer patients receiving radiation therapy selected in consecutive sampling. Samples were divided into two groups; either received Aloe vera and daikon combination gel (study group) or baby oil (control induced dermatitis (RID) were observed. A total of 44 patients were grouped into intervention (Aloe vera-daikon gel) and control (baby oil) groups. After ten radiotherapies (RT) sessions, the intervention group had a lower percentage of grade 1 RID (35% vs. 91.7%, control: 65% grade 2 RID, P < 0.001). After 20 RT sessions, 40% had no dermatitis, while all patients had RID in the control group (P = 0.061). After 30 RT sessions, the intervention group had a lower RID grade overall (gr 0: 5%, gr 1: 85%, gr 2: 10%) compared to the control group (gr 1: 33.3%, gr 2: 54.3%, gr 3: 8.3%, P = 0.002). After 35 RT sessions, the intervention group also had a lower RID grade overall (gr 0: 5%, gr 1: 65%, gr 2: 20%, gr 3: 10%) compared to the control group (gr 1: 8.3%, gr 2: 37.5%, gr 3: 45.8%, gr 4: 8.3%, P < 0.001). The combination of Aloe vera and daikon gel showed promising results in reducing the severity of radiation-induced dermatitis for head and neck cancer patients.

Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients.

Risk of incident cardiovascular disease (CVD) in head and neck squamous cell carcinoma (HNSCC) patients is under-reported. We assessed the association of HNSCC-related factors and traditional risk factors with 1- and 5-year CVD risk in HNSCC patients without prevalent CVD at cancer diagnosis. A clinical cohort of 1,829 HNSCC patients diagnosed between 2012 and 2018, at a National Cancer Institute (NCI)-designated cancer center was included. Information on HNSCC-related factors [HNSCC anatomical subsite, stage at diagnosis, treatment, and tumor human papillomavirus (HPV) status] were extracted from the tumor registry. Data on traditional risk factors (hypertension, dyslipidemia, diabetes, tobacco smoking status, and obesity) were extracted from the electronic health records system (EHR) at baseline (HNSCC diagnosis). A composite of ischemic heart disease, heart failure, and ischemic stroke was the outcome of interest in time to event analysis. Hazard ratio (HR) (95% CI) were reported with death as a competing risk. In patients diagnosed with HNSCC, 10.61% developed incident CVD events by 1-year post cancer diagnosis. One-year CVD risk was lower in patients using antihypertensive medications at baseline, compared to patients without baseline hypertension [HR (95% CI): 0.41 (0.24-0.61)]. One-year CVD risk was high in patients receiving HNSCC surgery. Patients receiving radiation therapy had a higher 5-year CVD risk than surgery patients [HR (95% CI): 2.17 (1.31-3.04)]. Patients using antihypertensive medications had a lower 5-year CVD risk than patients without baseline hypertension [HR (95% CI): 0.45 (0.22-0.75)]. Older age and diabetes were associated with increased 1- and 5-year CVD risk. HPV-negative patients were older (p 0.006) and had a higher 5-year cumulative incidence of CVD (p 0.013) than HPV-positive patients. Traditional risk factors and cancer-related factors are associated with CVD risk in HNSCC patients. Future research should investigate the role of antihypertensive medications in reducing CVD risk in HNSCC patients.

Application of individualized multimodal radiotherapy combined with immunotherapy in metastatic tumors.

Radiotherapy is one of the mainstays of cancer treatment. More than half of cancer patients receive radiation therapy. In addition to the well-known direct tumoricidal effect, radiotherapy has immunomodulatory properties. When combined with immunotherapy, radiotherapy, especially high-dose radiotherapy (HDRT), exert superior systemic effects on distal and unirradiated tumors, which is called abscopal effect. However, these effects are not always effective for cancer patients. Therefore, many studies have focused on exploring the optimized radiotherapy regimens to further enhance the antitumor immunity of HDRT and reduce its immunosuppressive effect. Several studies have shown that low-dose radiotherapy (LDRT) can effectively reprogram the tumor microenvironment, thereby potentially overcoming the immunosuppressive stroma induced by HDRT. However, bridging the gap between preclinical commitment and effective clinical delivery is challenging. In this review, we summarized the existing studies supporting the combined use of HDRT and LDRT to synergistically enhance antitumor immunity, and provided ideas for the individualized clinical application of multimodal radiotherapy (HDRT+LDRT) combined with immunotherapy.

Long-Term Subjective Functional Outcomes of Prostate Cancer: Prostatectomy vs Radiation.

Long-term subjective outcomes of prostate cancer are relatively unknown. The Oregon Urology Institute (OUI) has been collecting subjective functional outcome data to help determine the long-term subjective outcomes of prostatectomy vs radiation therapy. Patients treated at OUI completed interval post-treatment questionnaires that assessed: urinary, bowel, sexual, and hormonal function, and overall treatment satisfaction. Two cohorts were established: prostatectomy vs radiation. Results from each cohort were compared and analyzed with a linear mixed effect model. Our longitudinal dataset includes a prostatectomy cohort of 410 patients and radiation therapy cohort of 416 patients surveyed at the 3-month interval, but the number of patients decreased after each time interval (ie 3, 6, 9, and 12months and then annually for up till 14years post-treatment). Urinary and sexual functional scores decreased by 4% and 8% after radiation, whereas prostatectomy had a 5% and 13% increase over time post-treatment, respectively. Over time, patients treated with prostatectomy were found to be more satisfied with the outcome of their treatment than patients receiving radiation therapy. Prostatectomy and radiation therapy had impacts on quality of life measurements that emphasize the importance of making the best-informed decision in each unique situation.

Abstract B087: Disparities in pediatric patients receiving proton therapy during the COVID-19 pandemic - A single institutional experience

Abstract Introduction: Our institution cares for a largely underserved urban population, treating about 120 children annually with radiation therapy; roughly 10% are referred for proton therapy elsewhere. COVID-19 led to some decreases in medical care due to uncertainties regarding the state of public health. The purpose of this study is to evaluate existing socioeconomic disparities using the University of Wisconsin Area Deprivation Index (ADI) and whether the pandemic impacted this referral pattern. Methods: Over the last twenty years, approximately 2,275 children have presented to our institution for radiation treatment. A retrospective chart review was conducted and a patient database of demographic and clinical information was created. We used demographic data to obtain the ADI, and compared relative disparity rankings between proton therapy recipients and a random sample of patients from the 25 most common zip codes (representative of over 20% of the total cohort). We compared the number of patients treated only at the closest proton facility before and after the onset of the pandemic. Results: The demographic make-up of our patient population is approximately 53.7% Latino, 22.6% White, 9.5% African American, 9.2% Asian, and 5% Other. Of these patients, about 500 had diagnoses typically referred for proton therapy (such as brain tumors, neuroblastoma, sarcomas, and Hodgkin lymphoma). At baseline, we found a statistically significant difference in the median state ADI decile of 3 and 7 for protons and photons, respectively, reflecting lower socioeconomic disadvantage in the proton group. There was a difference in the median household income (based on zip code) of $102,028 and $70,479 between the proton and photon groups (p &amp;lt; 0.0001). There was also a difference in median household income of $57,871 and $76,808 between Latino and Non-Latino patients (p &amp;lt; 0.0001). Demographic data for the proton therapy cohort showed that 46.2% of these patients were White, 15.4% were Latino, 15.4% were African American, 7.7% were Asian, and 15.4% were Other. At the closest proton facility, between 2014-2019, 16 of our patients received radiation therapy. Since the beginning of pandemic associated restrictions in March 2020, 19 patients have received proton therapy at this center. Conclusions: Disparities preventing patients from receiving proton therapy have been described. Our work adds granular census block data and uses the ADI which takes into account median family income, unemployment rate, households without access to a vehicle, English language proficiency and more. Those with lower ADI risk rankings were overrepresented in the proton therapy group. Despite the pandemic and added referral challenges, the number of patients able to receive proton therapy did not decrease which we hypothesize may be due to many factors, including the unanticipated flexibility of remote work amongst those with lower ADI rankings. Latinos were least likely to have proton therapy, and further research is needed to ameliorate the disparities and barriers to care which they face. Citation Format: Samuel P. McKinnon, Zara I. Kazmierczak, Arthur J. Olch, Daniel Roh, Ethan Nguyen, Kristen Pang, Iain J. MacEwan, Kenneth K. Wong. Disparities in pediatric patients receiving proton therapy during the COVID-19 pandemic - A single institutional experience [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B087.

Improved Patients' Satisfaction Level of Radiation Therapy: The Effect of "Explainer Videos about Radiation Therapy", "Treatment of Breast Cancer Patients by Female Radiation Therapists" and "Treating Male Patients While Wearing Underwear in Pelvic Radiation Therapy"

The questionnaire survey investigated whether "Explainer videos about radiation therapy (RT-Video)", "Treatment of breast cancer patients by female radiation therapists (F-RTT)" and "Treating male patients while wearing underwear in pelvic radiation therapy (M-RTT)" can improve patient's satisfaction. The RT-Video survey included questions regarding the impression of radiation therapy, improving its understanding, and anxiety reduction (102 patients received radiation therapy). Fifty-one breast cancer patients were asked whether they preferred an F-RTT treatment. Subsequently, the patients treated with F-RTT (41 patients) and M-RTT (50 patients) were surveyed about their treatment satisfaction on a five-point scale. RT-Video improved the understanding of radiation therapy for 86 out of 102 patients (84%). In all, 68 out of 102 patients (68%) had a negative impression of radiotherapy; among them, watching the RT-Video reduced anxiety in 63% of patients. A total of 14 out of 51 breast cancer patients (28%) preferred the F-RTT treatment. The percentage of patients who received treatment satisfaction by F-RTT and M-RTT was 95% and 84%, respectively. RT-Video, F-RTT and M-RTT treatments improved patients' satisfaction.

The Gnarly Dilemma – To Launch or Not

Bill Lumbergh, the Sr. Director of Product Strategy for Initech, peered through the window in his office after finishing a design review meeting for the latest release of the company’s flagship software TPS SOLUTION. During this meeting, major product issues were revealed which could put the reputation of Initech at risk and, potentially, harm patients receiving radiation therapy. Bill and his software teams had embarked on a complete redesign of TPS SOLUTION’s architecture. The redesign, which had starved TPS SOLUTION’s customers of new features for the past 18 months (about 1 and a half years), was now behind schedule.

Clinical Outcomes and Treatment Patterns of Primary Central Nervous System Lymphoma: Multicenter Retrospective Analysis

Objectives: Primary central nervous system lymphoma (PCNSL) is a rare malignant disease with poor prognosis. Its low incidence leads to challenges in decision-making for treatment. As a matter of fact, there is still no consensus on the appropriate treatment modalities. In this context, the objective of this study is to investigate and comparatively assess the efficacies of several treatment modalities in the treatment of PCNSL. Methods: Thirty-four patients diagnosed with PCNSL at 5 different hematology centers between 2007 and 2021 were included in the study. Patients’ data from all five centers were collected retrospectively. Since ibrutinib is not approved for this indication in Turkey, consent for off-label use of ibrutinib is obtained from each patient. Ethics committee approval was obtained on June 9, 2021 with decision number 2021/18-05. Results: The median age of the patients was 59 (min.: 22, max.: 78) years. The male-to-female ratio was 1.26/1. Nineteen (55.9%) patients had Eastern Cooperative Oncology Group (ECOG) performance score of ?2. Fifteen (44.1%) patients had normal lactate dehydrogenase (LDH) levels and only 14.7% of the patients had B symptoms at the time of diagnosis. Magnetic resonance imaging (MRI) revealed a single mass lesion in 14 (41.2%) patients. As an induction therapy, methotrexate-based regimen was administered in 29 (85.3%) patients. Only 14 of the 34 patients received 4 or more cycles of high-dose methotrexate (MTX). About 32.4% of the patients received radiation therapy (RT) during follow-up as a part of induction therapy. Five patients received only RT due to poor performance status. Ibrutinib was administered in 5 patients for refractory disease. It was determined that four or more cycles of MTX treatment increased progression-free survival (PFS) (p=0.031) and overall survival (OS) (p=0.012). Moreover, RT improved PFS (p=0.023). Considering that the complete response achieved by induction therapy influences long-term survival, achievement of the best response to the treatment regimens administered in combination with new agents may prolong survival (PFS: p=0.01, OS: p=0.023). Conclusion: The findings of this study indicate that the initial response to treatment is crucial. Additionally, it was found that high-dose MTX treatment should be administered for 4 cycles or more in order to achieve the best results. Furthermore, it was determined that ibrutinib monotherapy was well-tolerated in our patients with relapsed/refractory disease, with excellent clinical benefits. In conclusion, a combination therapy consisting of high-dose MTX, ibrutinib, and rituximab appears to be a promising initial treatment approach in appropriate patients. Keywords: PCNSL, methotrexate, radiotherapy, ibrutinib

RISREAC Study: Assessment of Cutaneous Radiation Injury Through Clinical Documentation.

Radiation dermatitis (RD) occurs in 95% of patients receiving radiation therapy (RT) for cancer treatment, affecting 800 million patients annually. We aimed to demonstrate the feasibility of developing a historical RD cohort, Radiation Induced Skin Reactions (RISREAC) cohort. This retrospective study evaluated RD-related clinical documentation for 245 breast cancer patients who received RT at the University of Rochester Medical Center, to understand the RD progression, scoring, and management. All statistical analyses were performed at 0.05 level of significance. Clinician-documented RD severity was observed for 169 (69%) patients with a mean severity of 1.57 [1.46, 1.68]. The mean descriptor-based severity score of 2.31 [2.18, 2.45] moderately correlated (r = 0.532, P < 0.0001) with documented RD grade. Most patients (91.8%) received skin care treatment during RT, with 66.7% receiving more than 2 modalities. The RISREAC cohort is the first retrospective cohort established from clinical documentation of radiation-induced skin changes for the study of RD and cutaneous radiation injury (CRI). RD symptom descriptors were more reliably documented and suitable for all skin types compared to Radiation Therapy Oncology Group (RTOG) or Common Toxicity Criteria for Adverse Events (CTCAE) grades. A new descriptor-based scoring tool would be useful for RD and CRI.

Use of a Novel Network-Based Linchpin Score to Characterize Accessibility to the Oncology Physician Workforce in the United States

Physician headcounts provide useful information about the cancer care delivery workforce; however, efforts to track the oncology workforce would benefit from new measures that capture how essential a physician is for meeting the multidisciplinary cancer care needs of the region. Physicians are considered linchpins when fewer of their peers are connected to other physicians of the same specialty as the focal physician. Because they are locally unique for their specialty, these physicians' networks may be particularly vulnerable to their removal from the network (eg, through relocation or retirement). To examine a novel network-based physician linchpin score within nationwide cancer patient-sharing networks and explore variation in network vulnerability across hospital referral regions (HRRs). This cross-sectional study analyzed fee-for-service Medicare claims and included Medicare beneficiaries with an incident diagnosis of breast, colorectal, or lung cancer from 2016 to 2018 and their treating physicians. Data were analyzed from March 2022 to October 2022. Physician characteristics assessed were specialty, rurality, and Census region. HRR variables assessed include sociodemographic and socioeconomic characteristics and use of cancer services. Oncologist linchpin score, which examined the extent to which a physician's peers were connected to other physicians of the same specialty as the focal physician. Network vulnerability, which distinguished HRRs with more linchpin oncologists than expected based on oncologist density. χ2 and Fisher exact tests were used to examine relationships between oncologist characteristics and linchpin score. Spearman rank correlation coefficient (ρ) was used to measure the strength and direction of relationships between HRR network vulnerability, oncologist density, population sociodemographic and socioeconomic characteristics, and cancer service use. The study cohort comprised 308 714 patients with breast, colorectal, or lung cancer. The study cohort of 308 714 patients included 161 206 (52.2%) patients with breast cancer, 76 604 (24.8%) patients with colorectal cancer, and 70 904 (23.0%) patients with lung cancer. In our sample, 272 425 patients (88%) were White, and 238 603 patients (77%) lived in metropolitan areas. The cancer patient-sharing network included 7221 medical oncologists and 3573 radiation oncologists. HRRs with more vulnerable networks for medical oncology had a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.19; 95% CI, 0.08 to 0.29). HRRs with more vulnerable networks for radiation oncology had a higher percentage of beneficiaries living in poverty (ρ, 0.17; 95% CI, 0.06 to 0.27), and a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.21; 95% CI, 0.09 to 0.31), and lower rates of cohort patients receiving radiation therapy (ρ, -0.18; 95% CI, -0.28 to -0.06; P = .003). The was no association between network vulnerability for medical oncology and percent of cohort patients receiving chemotherapy (ρ, -0.03; 95% CI, -0.15 to 0.08). This study found that patient-sharing network vulnerability was associated with poverty and lower rates of radiation therapy. Health policy strategies for addressing network vulnerability may improve access to interdisciplinary care and reduce treatment disparities.

Treatment patterns of glioma in Pakistan: An epidemiological perspective.

To define the landscape of treatment patterns and current epidemiological data regarding gliomas in Pakistan. As part of the Pakistan Brain Tumour Epidemiology Study (PBTES), data were collected from 32 neurosurgical centres across the country. Our retrospective study looked at patients who underwent surgical procedures for gliomas in 2019 in neurosurgical centres. The data was collated and analysed using STATA version 15. A total of 781 patients with gliomas were identified 479(61.8%) in public sector hospitals, 302(39.1%) in the private sector). The most common histopathological subtypes were glioblastoma 262 (33.5%), followed by astrocytoma 147(18.8%) and oligodendroglioma 93(11.9%). Gender distribution was skewed towards men 508(65%). Private institution hospitals performed surgical biopsies as the first surgical procedure 75(23%) more often than public hospitals 38(9%). Chemotherapy was given to 115(29.8%) patients, and there was no data regarding 467(53%) of patients. Similarly, only 202(43.9%) patients received radiation therapy, and there was no data for 469(60%) of patients. For high-grade gliomas specifically, only 95(31.8%) patients with HGG have a record of receiving radiation therapy, and only 57(18.9%) had a record of being started on chemotherapy. Our study highlighted gaps in glioma management within Pakistan, with only around half of our patients receiving chemotherapy and radiotherapy, despite it being indicated. In our experience, high-grade tumours were diagnosed at a younger age than in high-income countries, but overall, glioblastoma was a smaller constituent of our tumour sample than expected.

Adipose-Derived Stromal Cell-Based Therapies for Radiation-Induced Fibrosis.

Significance: Half of all cancer patients receive radiation therapy as a component of their treatment regimen, and the most common resulting complication is radiation-induced fibrosis (RIF) of the skin and soft tissue. This thickening of the dermis paired with decreased vascularity results in functional limitations and esthetic concerns and poses unique challenges when considering surgical exploration or reconstruction. Existing therapeutic options for RIF of the skin are limited both in scope and efficacy. Cell-based therapies have emerged as a promising means of utilizing regenerative cell populations to improve both functional and esthetic outcomes, and even as prophylaxis for RIF. Recent Advances: As one of the leading areas of cell-based therapy research, adipose-derived stromal cells (ADSCs) demonstrate significant therapeutic potential in the treatment of RIF. The introduction of the ADSC-augmented fat graft has shown clinical utility. Recent research dedicated to characterizing specific ADSC subpopulations points toward further granularity in understanding of the mechanisms driving the well-established clinical outcomes seen with fat grafting therapy. Critical Issues: Various animal models of RIF demonstrated improved clinical outcomes following treatment with cell-based therapies, but the cellular and molecular basis underlying these effects remains poorly understood. Future Directions: Recent literature has focused on improving the efficacy of cell-based therapies, most notably through (1) augmentation of fat grafts with platelet-rich plasma and (2) the modification of expressed RNA through epitranscriptomics. For the latter, new and promising gene targets continue to be identified which have the potential to reverse the effects of fibrosis by increasing angiogenesis, decreasing inflammation, and promoting adipogenesis.

IMT-1 PROS AND CONS OF SURGICAL INTERVENTION FOR DIFFUSE MIDLINE GLIOMA AIMED AT DENDRITIC CELL IMMUNOTHERAPY

Abstract Since a diffuse midline glioma (DMG) has no effective therapy, it is an urgent need to develop new therapeutic strategy. We performed immunotherapy using fusions of autologous dendritic cells (DC) with tumor cells in DMG cases in which tumor tissue was collected by surgery aimed at biopsy, and evaluate the effectiveness and examine the pros and cons of surgical intervention against DMG. Among the patients with basal ganglia or brain stem tumors received surgery at our hospital, 5 adult cases of DMG with H3K27M gene mutation were registered. All patients received radiation therapy and temozolomide chemotherapy. 4 cases received bevacizumab chemotherapy when the patients had recurrence or progression of the disease. The tumor-fused DCs (TFDC) were made by DCs induced from autologous peripheral blood mononuclear cells and tumor cells established from surgical specimens. They were injected subcutaneously into the neck 3 ~ 6 times in a 14 ~ 28 day cycle as the immunotherapy. The adverse events, PFS, and OS were evaluated. A transient complication of facial numbness was observed in one case on right after surgery. Although two patients had CR in those therapies, both of them died of disease (OS at 18 and 32 months, respectively). Since the remaining three cases were registered very recently, adverse event or treatment efficacy judgment have not been determined at the time of submission of the abstract. Serious surgical complications have not been observed in the presented cases. Surgery may be acceptable for DMG as long as the surgery is performed by sufficiently experienced surgeon in an appropriate environment. The TFDC immunotherapy, which can be performed only by collecting a small amount of tumor tissue, expects to be a novel treatment for MDG. In this presentation, the pros and cons of surgical intervention aimed at TFDC immunotherapy for DMG will be examined.

The effect of hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine on ­self-­assessment of depression manifestations in women receiving radiotherapy after surgical ­treatment of uterine cancer

Background. The detection of cancer and its subsequent treatment contribute to the development of depression. This circumstance illustrates the need for proactive prevention of affective status disorders in cancer patients, its dynamic control and timely correction.&#x0D; Aim. Comparative analysis of the effect of hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine (methylethylpyridinol, ethylmethylhydroxypyridine malate, ethylmethylhydroxypyridine succinate) on the dynamics of self-assessment of depression manifestations in women recieving radiation therapy after surgical treatment of uterine cancer.&#x0D; Material and methods. A short-term, prospective, simple blind, placebo-controlled, randomized study of the effect of methylethylpyridinol, ethylmethylhydroxypyridine malate and ethylmethylhydroxypyridine succinate on the severity of depression symptoms in patients receiving radiation therapy after extended extirpation of the uterus with appendages was performed. The study was completed by 96 patients. Course two-week administration of drugs in almost equimolar single doses (0.830.88 mmol) was started simultaneously with radiation therapy. The treatment effectiveness was assessed using the Beck Depression Inventory 2 and 4 weeks after the start of the study. Statistical comparison of related samples was carried out using the Friedman test and post hoc analysis using the paired Wilcoxon test with the Bonferroni correction. Independent samples were compared using the KruskalWallis test with a post hoc analysis using the DanBonferroni test.&#x0D; Results. Radiation therapy was found to cause a clinically significant increase in the severity of depressive symptoms in 14 and 28 days after the start of the study (p 0.010). Two-week administration of methylethylpyridinol, ethylmethylhydroxypyridine malate, and ethylmethylhydroxypyridine succinate reduced the severity of depressive symptoms to the normal level (p 0.001), mainly due to a decrease in the severity of symptoms of the cognitive-affective cluster (p 0.001). The studied drugs with equal severity prevented the escalation of depression symptoms according to the Beck Depression Inventory (p ˃0.05).&#x0D; Conclusion. Hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine are equally effective in preventing the development of depression during postoperative radiation treatment of patients with ute-rine cancer.

Association of Surgical Margin Status with Oncologic Outcome in Patients Treated with Breast-Conserving Surgery

We aimed to compare the prognosis of patients with close resection margins after breast-conserving surgery (BCS) with that of patients with negative margins and identified predictors of residual disease. A total of 542 patients with breast cancer who underwent BCS between 2003 and 2019 were selected and divided into the close margin (114 patients) and negative margin (428 patients) groups. The median follow-up period was 72 (interquartile range, 42-113) months. Most patients received radiation therapy (RTx) and systemic therapy according to their stage and molecular subtype. The 10-year locoregional recurrence-free survival rates of the close and negative margin groups were 88.2% and 95.5%, respectively (p = 0.001). Multivariable analysis showed that adjuvant RTx and margin status after definitive surgery were significantly associated with locoregional recurrence. Of the 57 patients who underwent re-excision, 34 (59.6%) had residual disease. Multivariable analysis revealed that a histological type of positive or close margins and multifocality were independent predictive factors for residual disease. Although the current guidelines suggest that no ink on tumor is an adequate margin after BCS, a close resection margin may be associated with locoregional failure. The treatment strategy for close resection margins after BCS should be based on individual clinicopathological features.

Myeloid Sarcoma in Myelodysplastic Syndrome : Review

Introduction: Myeloid sarcoma (MS), Granulocytic sarcoma (GS), or Chloroma is defined in the World Health Organization (WHO) classification as a tumor mass consisting of myoblasts with or without maturation and involving any anatomic site other than the bone marrow. Myeloid sarcoma usually founds either concurrently or following a previously recognized (acute myeloid leukemia) AML. Common sites of occurrence are skin, sinuses, bone, and others. It rarely involves the central nervous system and Spinal cord involvement usually manifests as epidural mass causing cord compression. Methodology: A literature search was performed for English language articles using PubMed, Scopus, and Google Scholar, for any date up to June 2022. The following keywords were used "MDS and/or Myeloid sarcoma (granulocytic sarcoma) or Chloroma." Search results were initially reviewed by title and abstract, and articles were selected for more in-depth analysis if deemed relevant. Pertinent articles were examined in-depth for this report. Results: We reviewed 73 articles from the year 1981 to 2021. Males were almost twice the females, with 46 males and 24 females with aThe median age was 67 years. Median complete blood count (CBC) showed hemoglobin (Hgb) of 9.2 g/dL, white blood cells (WBC) of 7.45 x109/L, and platelets of 82 x109/L. The different subtypes of MDS reported were; 11 (15%) patients with CMML, 3 (4%) with del 5q-, and 1 patient had MDS with hypoblastic bone marrow. The most common site of involvement was the skin in 33 (45%) of the patients, followed by lymph nodes in 10 (13%) patients, spinal/para-spinal in 8 (10%) patients, face or ear-nose-throat (ENT) in 7 (9%) patients, Gastrointestinal area I in 6 (8%) patients. Other involved areas include prostate in three patients, bladder in three patients, breast in three patients, brain in two patients, and testicular, bronchial, mediastinum, and vaginal involvement in one patient each (some patients have more than one site involved). Twenty-six (35%) patients were treated with chemotherapy alone or in combination with surgery or radiotherapy, 14 (19%) patients underwent local surgical resection, while 12 (16%) patients received radiation therapy alone or in combination. In addition, two patients underwent an allogeneic bone marrow transplant. On the other hand, 17 (23%) patients did not receive any treatment. Eighteen (24%) patients progressed to acute myeloid leukemia (AML). For overall survival, 35 (47%) patients died. Conclusion: Myeloid sarcoma (MS) is rare with MDS. However, it should be thought of and kept in mind as a differential diagnosis with an initial investigation by imaging and biopsy. Multiple sites can be involved with or without the involvement of the bone marrow with a considerable number of patients progressing to to AML and die. There are no guidelines for treatment up to now. The use of new MDS risk stratification scores, along with cytogenetics and mutations profile, might help to predict who is at risk in the future. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Study of radiation enteritis in cervical cancer patients treated with definitive radiotherapy and adjuvant radiotherapy – A prospective study

The third most frequent type of cancer in the world is cervical cancer. Traditionally cervical cancer treatment is carried by either Radiation therapy alone and/or with chemotherapy. High doses of Radiation therapy can cause gastric enteritis. To study the incidence of radiation enteritis in cervical cancer patients of stage upto IIIA. A total of 94 patients receiving radiation therapy (RT) for cervical cancer treatment were enrolled for the study in our hospital from August 2018 to January 2020. The 94 patients were divided into definitive RT group (64 patients) and Adjuvant RT group (30 patients). The incidences of radiation enteritis were evaluated statistically.In all cervical cancer patients, early radiation enteritis (RE) observed in 68.08%, and late radiation enteritis observed in 21.1%. Patients treated with definitive RT showed more frequent radiation enteritis than in adjuvant RT. In the group treated with definitive RT, the occurrence of early (RE) is more in the Radical radiotherapy group (RRT), whereas late RE appeared more with concurrent chemoradiotherapy (CCRT) group. The late (RE) severe cases (Grade 3,4) observed more with the definitive RT group (only RRT) than in the adjuvant RT group. In the Definitive RT group, early and late RE occurrence is more than the Adjuvant RT group. The incidence of enteritis was correlated with the lengthening of total irradiation time. Methods to reduce small bowel intervention in RT and volume of irradiation will further decrease enteritis morbidity.

Primary S100 Negative Amelanotic Spindle Vaginal Melanoma

Abstract Introduction/Objective Vaginal melanoma is a rare malignancy composed of cells showing melanocytic differentiation and represents less than 3% of malignant vaginal tumors. It occurs in older women, typically in the distal third of the vagina. Outcomes are poor and median survival is less than 2 years. Macroscopically, 90% of these lesions are pigmented, polypoid and ulcerated. Microscopically they demonstrate diffuse, nested, trabecular, and/or fascicular patterns and are comprised of epithelioid cells with or without a spindle cell component. They are typically pigmented and S100 positive. Methods/Case Report Here we present a rare case of purely spindled amelanotic S100 negative vaginal melanoma. The patient is a 75 year old woman who presented with a 6 month history of vaginal discharge, and a one month history of new foul odor and vaginal bleeding, constipation, and unintentional weight loss. A large vaginal mass was palpated on physical exam. Subsequent computed tomography demonstrated a 8.2 x 8.2 x 9.4 cm mass occupying the vaginal vault with abutment of the urinary bladder anteriorly and the rectal and anal walls posteriorly. A biopsy was performed and a 3.8 x 2.2 x 1.2 cm aggregate of pink tan friable tissuse was obtained. Histopathologic examination showed a malignant neoplasm composed purely of spindled cells in a fasicular pattern. Tumor cells showed marked nuclear pleomorphism with inconspicuous nucleoli. Tumor necrosis was present. No pigment was seen. By immunohistochemistry, tumor was positive for SOX10, HMB45, and Melan A, and negative for S100, AE1/3, EMA, myogenin, desmin, smooth muscle actin, synaptophysin, chromogranin, Pax8, and GATA3. BRAF mutation analysis showed no mutations. Patient received radiation therapy with a good clinical reponse. Results (if a Case Study enter NA) NA. Conclusion Amelanotic S100 negative spindled vaginal melanoma is an unusual presenation of a rare tumor and should be considered in the workup of malignant vaginal tumors with a spindle cell morphology.

Prognostic factors in patients receiving surgery and radiation therapy for retroperitoneal sarcoma: A machine-learning analysis

BackgroundThe addition of radiation therapy to surgery for retroperitoneal sarcoma remains controversial. Improved patient selection may help identify optimal candidates for multimodality treatment. The aim of this analysis was to define prognostic factors among patients who receive radiation therapy and surgery to aid in patient selection for multimodal therapy. MethodsPatients who received radiation therapy and underwent curative-intent resection for retroperitoneal sarcoma between 2004 and 2016 were identified from a national cohort in the United States (National Cancer Database). A machine-based classification and regression tree model was used to generate similar groups of patients relative to overall survival based on preoperative factors. ResultsA total of 1,443 patients received radiation therapy in addition to surgery. Median age was 61 years old and 55.0% were female. Most patients (66%) received care at an academic or integrated network cancer program. With a median follow-up of 84 months, receipt of radiation therapy was not associated with improved overall survival (P = .81). Classification and regression tree analysis revealed a significant association between overall survival and American Joint Committee on Cancer stage group, age, tumor histology, and Charlson comorbidity score. Application of these parameters via machine learning stratified patients into 5 cohorts with distinct survival outcomes. In the most favorable cohort (Cohort 1: American Joint Committee on Cancer stage group ≤II, age ≤61, histology including fibrosarcoma, well differentiated liposarcoma, myxoid liposarcoma, and leiomyosarcoma), the 5-year overall survival was 81.7% and median overall survival was not reached; in the least favorable cohort (Cohort 6: American Joint Committee on Cancer stage group >II, age >68) where the 5-year survival was 41.3% and median overall survival was 45.2 months (P < .001 versus Cohort 1). ConclusionIn the absence of a defined survival benefit, patients with advanced American Joint Committee on Cancer stage group, older age, and medical comorbidities have relatively unfavorable overall survival after combined modality therapy and therefore stand the least to gain from the addition of radiation therapy to surgery. In contrast, younger patients with good performance status and retroperitoneal sarcoma histologies with a higher propensity for local recurrence may have the greatest opportunity to benefit from radiation therapy.

PSUN27 Largest Cohort of Cervical Spine Metastases of Pheochromocytoma/Paraganglioma in the Setting of SDHB Mutation

Abstract Background Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors arising from chromaffin cells in adrenal or extra-adrenal locations, respectively. Overall, 10 to 20% of PPGLs are metastatic, with higher metastatic potential observed in succinate dehydrogenase subunit B (SDHB)-related tumors (up to 90%). Metastatic PPGLs are diagnosed based on the presence of tumor cells of chromaffin origin in a location outside the site of normal development (adrenal medulla and the sympathetic chain) in the bones and lymphatic nodes per 2017 WHO guidelines. Studies evaluating both metastatic pheochromocytomas and extra-adrenal PGLs have reported bone to be the most common site of metastasis. Clinical Case We reviewed the metastatic patients in our PPGL cohort and found 40 (29.85%) out of 134 patients with SDHB-related metastatic PPGLs developing metastatic lesions in the cervical spine. The related descriptive analyses were as follows: 25 (62.5%) were males, 15 (37.5%) females. Fourteen patients (35%) have died due to metastatic PPGL complications. The average age of patients at the time of the primary tumor diagnosis was 30.3 ± 35 years and the age at the initial metastatic tumor diagnosis was 34 ± 33 years. The average time interval to metastatic disease was 7.4 ± 38 years. At their initial presentation, there were 25 (62.5%) patients with solitary tumors; 1 (2.5%) with multiple primary tumors; and 14 (35%) with metastatic tumors. All the patients either developed or had metastatic lesions in the cervical vertebrae. Nine (22.5%) patients required surgical fusions of the vertebrae to manage their pathological fractures and another 9 (22.5%) patients received radiation therapy. Conclusion Genetic testing is recommended for all patients with PPGLs. Genetic analysis, especially finding a SDHB mutation may be helpful in determining metastatic potential. Most patients with spinal metastatic lesions are asymptomatic, but when clinical symptoms arise, the most common clinical symptom involves pain and neurological deficit. Metastasis to the spine is an important complication that can lead to significant pain and disability and requires surgical interventions or radiotherapy. Awareness for such spinal tumors is essential for offering the correct treatment to the patients. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.