Patients Underwent Radiation Therapy Research Articles

Double Dissociation of Cognitive Varies under Unilateral Radiation Exposure on the Hippocampus

Although the key position of the hippocampus (HP) in memory processes is not in doubt, the specifics of its participation in cognitive processes are far from being established. At the same time, the role of the HP in differentiating the novelty of impressions is often discussed in the context of adult HP neurogenesis. Radiation exposure to the HP, which inhibits the processes of neurogenesis, can serve as a model for studying this relationship. A homogeneous sample of 28 patients with meningiomas of the chiasmal-sellar area adjacent to the HP was studied. 15 patients were diagnosed with a left-sided location of the tumor and 13 patients with a right-sided one. The two groups were comparable in terms of demographic, clinical and morphometric characteristics. In order to stop the growth of the tumor, the patients underwent radiation therapy (RT), in which the HP on the side of the pathological process was forced to receive a dose comparable to the dose in the tumor. The study using the original technique was carried out before the start of RT, immediately after its completion, 6 and 12 months after the end of RT. Data were obtained on earlier changes in memory characteristics mediated by the right hippocampal region, but at the same time — more pronounced long-term cognitive consequences of ionizing effects on the HP of the left hemisphere.

Local Disease-Free Survival and Disease-Free Survival in Locally Advanced Cervical Cancer Diagnosed and Treated in Bihor County, Romania.

Cervical cancer is the fourth most dangerous malignancy worldwide in women and is diagnosed at the advanced stages in most cases. Oncological and surgical modalities when precisely employed together can prove to be helpful for determining the proper diagnosis and treatment strategies. Neoadjuvant chemotherapy (NACT) has been found to have a role in reducing tumor size and has evolved as a treatment regimen for locally advanced cervical cancer (LACC). The present study aimed to analyze the treatment strategies either with neoadjuvant platinum-based chemotherapy (NACT) administration or not and pathological responses in patients with LACC. We reviewed 100 patients of LACC from October 2018 to December 2022 at Bihor County Emergency Clinical Hospital. About 43 patients underwent radiation therapy in addition to NACT administration (NACT+/other) and 57 underwent other treatment regimens without neoadjuvant treatment (NACT-/ other). Various demographic parameters, FIGO staging, histological status, surgical interventions, and survival rate (local disease-free survival (LDFS) and disease-free survival (DFS)) were accessed in both groups. Statistical analysis was performed to analyze the significance of various parameters studied. The mean age range of the studied sample was 57.05 ± 12.51 in NACT+/other and 60.4±12.32 in NACT-/other. Among 100 patients, 90 cases of squamous carcinoma, eight of adenocarcinoma, and two cases of adenosquamous carcinoma were analyzed and treated. At stage IIIC1, 11 patients were accessed while 15 patients were at clinical stage IIIC2, and among these, 25.58% received neoadjuvant oncological treatment and very limited mediastinal disease. DFS rates are greater in the patients who have undergone surgery in the NACT+/other group, while in the LDFS, there is better survival in the case of surgery without any NACT treatment (NACT-/other). The effect of NACT can be suggested as another important treatment strategy and result in a good response in terms of DFS and LDFS in patients with LACC. This approach aims to reduce tumor size preoperatively, facilitating surgical removal and potentially improving patient outcomes compared to other treatment modalities. Thus, it can be concluded that NACT may be considered an important strategy to be opted for the treatment of LACC.

THU077 Differences In Clinicopathological Features Of Acidophil Stem Cell Adenomas Compared To Other Subtypes Of Acromegaly: A Retrospective Study

Abstract Disclosure: K.C. Yuen: Advisory Board Member; Self; Novo Nordisk, Ascendis, Corcept Therapeutics, Ipsen, Amryt, Strongbridge, Crinetics, Recordati, Xeris. Grant Recipient; Self; Corcept Therapeutics, Crinetics, Ascendis, Amryt. Speaker; Self; Corcept Therapeutics, Novo Nordisk, Recordati. E. Smith: None. F. Bernabe: None. J.M. Eschbacher: None. M. Rodriguez: None. A.S. Little: None. Background: Acidophil stem cell adenomas (ASCAs) are tumors derived from a precursor of somatotrophs and lactotrophs. Often presenting clinically like prolactinomas that respond to dopamine agonist therapy, some may also present with subtle clinical symptoms and biochemical features of acromegaly. Because ASCAs are so rare, their clinicopathological features have not been well-studied. Aims: Clinicopathological features of ASCAs were analyzed and compared with mixed somatotroph-lactotroph adenomas (MSLAs), mammosomatotroph adenomas (MSAs) and pure somatotroph adenomas (PSAs). Methods: We retrospectively reviewed the medical records of acromegaly patients from a single institution presenting from 2001 to 2022. All growth hormone-secreting adenomas were categorized into ASCAs, MSLAs, MSAs and PSAs based on their histopathological findings in surgically treated patients, and their pre- (preop) and post-operative (postop) clinical data were analyzed. Results: Among 135 patients within this cohort, ASCAs, MLSAs, MSAs and PSAs accounted for 21 (15.5%), 11 (8.1%), 59 (43.7%) and 44 (32.6%) cases, respectively. ASCA patients were younger (mean age ASCA: 48.6 vs MLSA 56.5, MSA 59.0, PSA 63.4 years; P < 0.05), had higher preop prolactin levels (ASCA: 1190 ± 639.0 vs MSLA: 44.9 ± 23.2, MSA: 39.7 ± 6.8, PSA: 23.8 ± 5.5 µg/L; P < 0.01), had higher rates of MIB-1 labeling indices (ASCA 76.2% vs MSLA 39.0%, MSA 45.5%, PSA 43.2%; P < 0.05) and preop visual field defect (VFD) (ASCA 32.3% vs MSLA 13.6%, MSA 27.3%, PSA 29.6%; P < 0.05), and had lower rates of preop hypertension (HTN) (ASCA 14.3% vs MSLA 52.5%, MSA 36.4%, PSA 31.8%; P < 0.05) and diabetes mellitus (DM) (ASCA 14.3% vs MSLA 27.2%, MSA 54.5%, PSA 20.5%; P < 0.05). ASCA tumors were larger than MSAs (2.3 ± 1.0 vs 1.6 ± 0.7 cm; P < 0.01), but comparable to MSLAs and PSAs. Rates of cavernous sinus invasion and preop GH levels were similar between groups. Postop GH levels were higher in ASCA (8.6 ± 5.3 µg/L) compared to MSLAs (2.4 ± 0.5 µg/L) and MSAs (1.1 ± 0.7 µg/L) (P < 0.05). ASCA preop IGF-I levels were lower than PSA (ASCA: 466.7 ± 118.5 vs PSA: 803.7 ± 56.5 µg/L; P < 0.05), while postop IGF-I levels were comparable to MLSAs, MSAs and PSAs. ASCAs also had lower postop remission rates compared to MLSAs, MSAs and PSAs (ASCA 19.0% vs MLSA 45.5%, MSA 38.6% and PSA 54.2%; P < 0.05). Most ASCA (85.7%), MLSA (81.4%), MSA (100%) and PSA (77.2%) patients underwent one surgery and more ASCA (23.8%), MLSA (25.4%) and PSA (22.7%) patients underwent radiation therapy than MSA (9.1%) patients. Conclusions: Our data demonstrated important insights into the differences of clinicopathological features of ASCAs compared to other acromegaly subtypes. Notably, ASCAs occurred in younger patients, had larger and more aggressive tumors, had lower postop remission rates and had higher VFD rates. In addition, ASCAs had higher rates of preop hyperprolactinemia and lower rates of preop HTN and DM. Presentation: Thursday, June 15, 2023

The role of localised prostate cancer treatment in renal transplant patients: A systematic review.

To systematically review and critically appraise all treatment options for localised prostate cancer in renal transplant candidates and recipients. A systematic review was conducted adhering to PRISMA guidelines. Searches were performed in the Cochrane Library, Embase, Medline, the Transplant Library and Trip database for studies published up to September 2022. Risk of bias was assessed with the Cochrane Risk of Bias in Non-Randomised Studies of Interventions for non-randomised studies tool. A total of 60 studies were identified describing 525 patients. The majority of studies were either retrospective non-randomised comparative or case series/reports of poor quality. The vast majority of studies were focussed on prostate cancer after renal transplantation. Overall, 410 (78%) patients underwent surgery, 93 (18%) patients underwent radiation therapy or brachytherapy, one patient underwent focal therapy (high-intensity frequency ultrasound) and 21 patients were placed on active surveillance. The mean age was 61 years old, the mean PSA level at diagnosis was 9.6ng/mL and the mean follow-up time was 31 months. The majority of patients had low-risk disease with 261 patients having Gleason 6 prostate cancer (50%), followed by 220 Gleason 7 patients (42%). All prostate cancer mortality cases were in high-risk prostate cancer (≥Gleason 8). The cancer-specific survival results were similar between surgery and radiotherapy at 1 and 3years. Localised prostate cancer treatment in renal transplant patients should be risk stratified. Surgery and radiation treatment for localised prostate cancer in renal transplant patients appear equally efficacious. Given the limitations of this study, future research should concentrate on developing a multicentre RCT with long-term registry follow-up.

Male breast cancer. Clinical experience of the Russian Scientific Center of Roentgenradiology of the Ministry of Health of Russia

Interest in male breast cancer is increasing every year due to the increase in the spread of this disease. However, the lack of randomized trials in male breast cancer draws the attention of specialists to this problem. Male breast cancer is 100 times less common than female. Over the past decades, there has been an increase in the disease up to 26 %. Low awareness of general practitioners, as well as the male part of the population, untimely access to specialized specialists are the reasons for the late diagnosis of the disease. Recommendations for the treatment of male breast cancer are based on the results of studies conducted in female with a similar diagnosis.In the period from January 2015 to September 2022, 13 patients diagnosed with male breast cancer were examined and treated in the Department of Oncology and Reconstructive Plastic Surgery of the Breast of the Russian Scientific Center of Roentgenradiology, Ministry of Health of Russia. The age of patients at the time of treatment ranged from 58 to 75 years, with a mean age of 63 years. In 2 patients (15 %), stage 0 was established, in 4 (31 %) – stage Ia, in 4 (31 %) – stage IIa, in 1 (7.6 %) – stage IIb, in 1 (7.7 %) – stage IIIb, in 1 (7.6 %) – stage IIIc. Two (15 %) patients underwent neoadjuvant polychemotherapy, 6 (46 %) patients underwent adjuvant polychemotherapy. In 7 (54 %) patients, surgical treatment was performed without further adjuvant polychemotherapy. Six (46 %) patients underwent radiation therapy. Hormone therapy was prescribed to all 13 (100 %) patients. When contacting the clinic, the most frequent complaints would be the appearance of a seal behind the nipple, discharge from the nipple.When diagnosing male breast cancer, the same methods are used as female. Tactics of treatment is determined individually. Early diagnosis of the disease and timely prescribed therapy lead to many years of remission.

The Free Superficially Based Low-Abdominal Mini Flap for Oncoplastic Breast Reconstruction.

Volume replacement in oncoplastic breast reconstruction most commonly uses pedicled flaps. In thin patients with small breasts, free-tissue transfer may be better suited to preserve breast size. Evidence on microvascular oncoplastic reconstruction is limited, and reconstruction has often required sacrifice of potential future donor sites. The free superficially based low-abdominal mini (SLAM) flap uses a narrow strip of lower abdominal tissue based on superficial perfusion of the abdominal wall that is anastomosed to chest wall perforators to preserve the ability to perform future abdominally based autologous breast reconstruction. Five patients underwent reconstruction with SLAM flaps for immediate oncoplastic reconstruction. Their mean age was 49.8 years, and their mean body mass index was 23.5. Tumor location was most commonly in the lower outer quadrant (40%). Average lumpectomy weight was 30 g. Two flaps were based on the superficial inferior epigastric artery, and three, on the superficial circumflex iliac artery. Recipient vessels included internal mammary perforators (40%), serratus branch (20%), lateral thoracic vessel branch (20%), and lateral intercostal perforators (20%). All patients underwent radiation therapy without delay and maintained volume, symmetry, and contour at an average period of 11.7 months after surgery. There were no cases of flap loss, fat necrosis, or delayed wound healing. The free SLAM flap allows for immediate oncoplastic breast reconstruction in thin, small-breasted patients with limited regional tissue without sacrificing future potential donor sites for autologous breast reconstruction. Therapeutic, IV.

Abstract P2-14-10: Axillary Reverse Mapping Aids in Reducing the Rates of BCRL in Underserved Ethnically Diverse Population

Abstract Background: Breast Cancer Related Lymphedema (BCRL), is a long-term side effect affecting the patient’s quality of life after lymph node surgery. Historically BCRL is seen in 5-7% and 15-40% of patients undergoing sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) respectively; with the risk increasing two-fold in low-income and ethnic minority groups. Axillary Reverse Mapping (ARM) is a novel technique to distinguish drainage pathways of the arm and breast, and prior studies have reported significantly lower rates of BCRL with ARM. Lymphatic re-approximation can prevent and/or reduce lymphedema rates in cases where crossover nodes are encountered. Furthermore, blue nodes can be preserved during ALND; however, if resected during ALND, lymphatic venous (LYMPHA) procedure can help to restore lymphatic flow. However, there is a paucity of literature looking at the utility of ARM in ethnically minority groups. Therefore, we aimed to evaluate the prevalence of lymphedema in our patient population with breast cancer undergoing SLNB and ALND using ARM and in turn compare these findings to historical controls. Materials & Methods: A retrospective study was carried out on patients who underwent axillary surgery with ARM from January 2019 to July 2021. Patient demographics such as age, BMI, gender, and ethnicity were recorded. Patients undergoing mastectomy vs breast conservation with SLNB ± ALND associated with ARM were monitored for lymphedema for a year at 3-month intervals using SOZO® scores, and then for another 2 years clinically. At each follow-up, SOZO® scores were computed using bioimpedance spectroscopy and compared to preoperative baseline scores. Results: A total of 142 patients’ data was evaluated, of which 83.8% belonged to the minority group (African American = 46, Hispanic = 63, Asian = 10). Mean BMI accounted for 29.1+5.31. Breast conservation surgery and mastectomy were performed in 71.8% (n=102) and 28.1% (n=40) of patients respectively. SLNB was performed on 88.7% (n=126) of the patients and ALND was carried out on 11.3% (n=16). Furthermore, 73.9% (n=105) of the patients underwent radiation therapy. Positive lymph nodes were identified in 24.6% (n=35) of patients. Blue nodes and blue lymphatics were encountered in 17.6% (n=25) and 32.4% (n=46) of patients respectively. Out of the blue nodes identified (n=25), 44% (n=11) were excised and 32% (n=8) were diagnosed as crossover nodes. All the crossover nodes were resected but none of them contributed to the development of lymphedema. Moreover, 90.9% of the patients with blue lymphatics underwent lymphatic re-approximation after excision of the blue nodes. Of the 142 patients, 59 had a three-month follow-up of which 2 patients (3.4%) developed clinical lymphedema diagnosed via SOZO® who had undergone SLNB which resolved by 6-month follow-up. Additionally, compared to the historical incidence of BCRL which accounts for up to 40.4% in ethnic minorities, we found a significantly lower incidence of lymphedema (p< 0.001) in our patient population. Moreover, in our study, ALND and radiation therapy did not contribute to lymphedema rates. Conclusion: ARM procedure can significantly lower BCRL even in ethnically minority groups. 3.4% of patients undergoing SLNB developed BCRL, which was significantly lower than historically reported data. Furthermore, in our study, no patients who underwent ALND developed lymphedema. Also, crossover nodes or radiation therapy did not contribute to the development of lymphedema after surgery demonstrating the effectiveness of ARM technique. Further studies with larger sample size and longer follow-up duration are necessary to better understand the utility of ARM technique in this population. Table 1 Baseline characteristics and follow-up data of the patients undergoing Axillary Reverse Mapping with SLNB ± ALND Citation Format: Fardeen Bhimani, Maureen McEvoy, Kelly Johnson, Sheldon Feldman. Axillary Reverse Mapping Aids in Reducing the Rates of BCRL in Underserved Ethnically Diverse Population [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-10.

The risks of radiation therapy and lymphedema in shoulder surgery

BackgroundRadiation therapy has proven efficacy for cancer treatment but is not without short- and long-term side effects, including radiation-induced lymphedema. There has been limited evidence on the secondary effects of prior radiation therapy on shoulder surgery. The purpose of this study is to evaluate the short-term outcomes of shoulder arthroplasty and rotator cuff repair (RCR) in patients who have undergone ipsilateral radiation therapy and/or have preoperative upper extremity lymphedema. MethodsDuke Enterprise Data Unified Content Explorer was used to query for patients who underwent RCR at our institution. Patients with radiation therapy for breast or lung cancer prior to ipsilateral RCR or shoulder arthroplasty were included. Patients with less than 2 years of follow-up were excluded. Data variables included primary tumor type, dates of cancer diagnoses, radiation treatment, axillary lymph node dissection (aLND), presence of lymphedema, index shoulder operations, most recent follow-up, and surgical and medical complications within the 90-day postoperative period. Additional oncologic variables included total Gray (Gy) delivered. ResultsTwenty-one patients underwent radiation therapy and subsequent shoulder arthroplasty or RCR (13 RCR, 3 total shoulder arthroplasty, 5 reverse shoulder arthroplasty). There were 20 females and 1 male with an average age of 65.6 years (47-82) and average clinical follow-up of 4.4 years (2.0-7.4). Oncologic diagnoses included lung (4.8%) and breast (95.2%) cancer. Average radiation dose delivered was 53.3 Gy (38.5-64) in the cohort. The average time from last external beam radiation therapy to shoulder surgery was 4.3 years (0.3-18.0). One of 13 (7.7%) 90-day postoperative complications was reported in the RCR cohort: a superficial vein thrombosis. One of 8 (12.5%) 90-day complications was reported in the arthroplasty cohort: a clinically suspected but radiographically absent acromial stress fracture in a reverse shoulder arthroplasty that did not require operative intervention. Overall, there were no revisions, reoperations, or shoulder-related unplanned inpatient 90-day readmissions. Among 10 patients with prior aLND, 3 (30%) (2 RCR, 1 arthroplasty) experienced new or worsening upper extremity lymphedema within the immediate postoperative period. ConclusionA minority of patients having undergone prior radiation therapy and aLND who subsequently underwent ipsilateral shoulder surgery experienced worsening subjective upper extremity lymphedema. Although 10% of these radiation therapy patients experienced minor complications within 90 days of their shoulder surgery, none were severe enough to merit inpatient admission or revision surgery.

Abstract PO-129: Influence of triple-negative versus Luminal A breast cancer subtype on choice of autologous versus implant based delayed-immediate breast reconstruction

Abstract Background: Triple-negative and luminal A breast cancer molecular subtypes have divergent clinical and prognostic characteristics for breast cancer patients. Our study aims to compare the reconstructive choice of these two groups from the time they receive a tissue expander to the time they complete autologous or implant-based breast reconstruction. Methods: 255 patients who underwent delayed-immediate breast reconstruction with tissue expander placement from 2013 to 2017 diagnosed with either TN (n = 73) or luminal A (n = 182) invasive breast cancer subtype seen by two surgeons at a single institution were identified. Preference of autologous and implant- based reconstruction was analyzed, along with tissue expander (TE) complications, race, age, BMI, smoking, adjuvant therapy, and comorbidities. Results: There was a significant difference in the choice of implant- or autologous-based reconstruction among these two groups (p < 0.05). A greater proportion of luminal A patients underwent implant-based reconstruction (63.47%) and a greater proportion of TN patients underwent autologous-based reconstruction (53.13%). With regard to TE outcomes, there was no significant difference between the two groups with regard to duration of TE placement by reconstructive type, or TE surgical complications. Significantly more TN patients underwent radiation therapy (p < 0.01) and neoadjuvant chemotherapy (p < 0.0001) than luminal A patients. BMI, comorbidities, radiation therapy and overall TE complications were identified as predictive factors of patients electing for autologous reconstruction over implants. Conclusion: TN breast cancer patients mostly chose autologous-based reconstruction, while luminal A patients chose implant-based reconstruction. Both patient groups carried their tissue expanders for similar duration with similar complication profile. Radiation therapy is likely a major factor in the decision for the type of delayed-immediate reconstruction among this population. Citation Format: Joshua Amaya, Ryan M. Dickey, Kaitlin Jones, Sumeet S. Teotia, Nicholas T. Haddock. Influence of triple-negative versus Luminal A breast cancer subtype on choice of autologous versus implant based delayed-immediate breast reconstruction [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-129.

The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction.

Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle. This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome. All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9months postoperative demonstrated successful reinnervation of the vastus lateralis muscle. This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip.

Influence of Triple-Negative versus Luminal A Breast Cancer Subtype on Choice of Autologous versus Implant-Based Delayed-Immediate Breast Reconstruction.

Triple-negative (TN) and luminal A breast cancer molecular subtypes have divergent clinical and prognostic characteristics for breast cancer patients. Our study aims to compare the reconstructive choice of these two groups from the time they receive a tissue expander (TE) to the time they complete autologous or implant-based breast reconstruction. A total of 255 patients who underwent delayed-immediate breast reconstruction with TE placement from 2013 to 2017 diagnosed with either TN (n = 73) or luminal A (n = 182) invasive breast cancer subtype seen by two surgeons at a single institution were identified. Preference of autologous and implant-based reconstruction was analyzed, along with TE complications, race, age, body mass index (BMI), smoking, adjuvant therapy, and comorbidities. There was a significant difference in the choice of implant- or autologous-based reconstruction among these two groups (p < 0.05). A greater proportion of luminal A patients underwent implant-based reconstruction (63.47%) and a greater proportion of TN patients underwent autologous-based reconstruction (53.13%). With regard to TE outcomes, there was no significant difference between the two groups with regard to duration of TE placement by reconstructive type or TE surgical complications. Significantly, more TN patients underwent radiation therapy (p < 0.01) and neoadjuvant chemotherapy (p < 0.0001) than luminal A patients. BMI, comorbidities, radiation therapy, and overall TE complications were identified as predictive factors of patients electing for autologous reconstruction over implants. TN breast cancer patients mostly chose autologous-based reconstruction, while luminal A patients chose implant-based reconstruction. Both patient groups carried their TEs for similar duration with similar complication profile. Radiation therapy is likely a major factor in the decision for the type of delayed-immediate reconstruction among this population.

Leukemic and Lymphomatous Optic Neuropathy: A Case Series.

Optic neuropathy in the context of leukemia and lymphoma raises concern for central nervous system involvement or relapse and warrants prompt evaluation and treatment. To date, a gold standard for the diagnosis and management of leukemic optic neuropathy has yet to be established. Case series and review of the literature. Two illustrative cases were selected to discuss their treatment course and outcome. We report 7 cases of patients with leukemia or lymphoma presenting with optic nerve infiltration. All patients received steroid therapy for presumed infiltrative optic neuropathy, and 4 patients underwent radiation therapy. Along with systemic chemotherapy, all patients received intrathecal chemotherapy except one. Three patients received chimeric antigen receptor T-cell therapy. Leukemic and lymphomatous optic neuropathy is difficult to diagnose and treat, and there is no gold standard for diagnosis or treatment in the current literature. We help clarify how this disease should be approached in a multidisciplinary fashion and on an individual basis to correctly diagnose and treat the vision loss, while considering the patient's long-term prognosis based on their systemic disease.

Study of the various cutaneous adverse reactions to radiotherapy

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Radiation-induced skin toxicity is a widely recorded toxicity of definitive radiation therapy with about half of patients experiencing grade 2 or higher skin reactions. Radiation-specific characteristics include total exposure, fractional dose, beam energy, field size, anatomic of radiation, and subsequent systemic therapy.&lt;strong&gt; &lt;/strong&gt;Aim of the study was to identify and grade the various cutaneous adverse reactions to radiotherapy.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;25 patients underwent radiation therapy for any type malignancies were included in the study.&lt;strong&gt; &lt;/strong&gt;Skin manifestations due to other systemic/ cutaneous diseases prior to radiotherapy. Detailed history was taken about disease course, cutaneous manifestations with emphasis on treatment (type of radiation, dosage and duration). General physical examination and dermatological examination were done.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study 60% of patients were male, the minimum dose of radiation was 30Gy in 13% patients, maximum dose of radiation was 70Gy in 33% patients, 88% of patients were in RTOG grade 2. Hyperpigmentation was the commonest findings 23 (92%), followed by dry desquamation 11 (44%), the next common was epilation 10 (40%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Radiation toxicity, generally occurring during or shortly after treatment can range from mild (hyperpigmentation, erythema) to severe (moist desquamation).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Validation of Hearing Loss Prediction Tool for Cisplatin Chemotherapy and Radiation in Head and Neck Cancer Treatment

Hearing loss affects up to 88% of patients undergoing head and neck cancer treatment; however, there are few validated models to predict this outcome. A predictive posttreatment model for hearing loss will allow clinicians and patients to make well-informed decisions about treatment with cisplatin-based chemotherapies and radiotherapy. To validate a previously created predictive model for objective hearing outcomes and to assess barriers to using the prediction nomogram in general practice for patients newly diagnosed with head and neck cancer. This cohort study includes an evaluation of 105 patients (208 ears) and interviews with 6 clinicians. The patients were treated at a high-volume tertiary care hospital. Patient participants were newly diagnosed with head and neck cancer and treated at Siteman Cancer Center from July 1, 2018, to December 31, 2019, with radiotherapy both with and without cisplatin-based chemotherapy. Additionally, the clinicians involved in the care of patients with head and neck cancer were interviewed to assess implementation strategies. Radiotherapy with and without cisplatin-based chemotherapy. Hearing defined by the audiometric pure-tone average of 1, 2, and 4 kHz. A total of 105 patients (208 ears; mean [SD] age, 61 [11] years; 82 men [78%]) were compared with the development cohort to assess the similarities and differences in case mix. All patients underwent radiation therapy, 50 (48%) received cisplatin-based chemotherapy, and 67 (64%) had a surgical resection. The mean (SD) cochlear dose of radiation was 13 (12) Gy, and the mean (SD) total cisplatin dose was 238 (83) mg/m2 for those undergoing cisplatin therapy. A calibration curve demonstrated that predicted and observed posttreatment pure-tone average were not significantly different. The model predicted a posttreatment pure-tone average greater than 35 dB (a common threshold for hearing aid consideration) with a sensitivity of 73% and specificity of 67% with an area under the curve of 0.71, showing good discrimination. Clinician interviews suggest the nomogram requires careful integration into patient counseling to clarify risks and benefits for treatment. The findings of this cohort study confirm this model's ability to predict posttreatment hearing outcomes in a unique population of patients. This model has the potential to inform pretreatment counseling and posttreatment hearing evaluations for this patient population.

LGG-29. TREATMENT FOR RECURRENT OPTIC PATHWAY PILOCYTIC ASTROCYTOMA

Chemotherapy after biopsy or partial resection of the tumor is widely accepted as first-line therapy for optic pathway pilocytic astrocytoma. However, there is no standard of care for recurred tumors. We investigated our cases which showed recurrence after initial therapy. Retrospective analysis of four recurrent optic pathway pilocytic astrocytoma cases was performed. All patients underwent partial resection or biopsy of the tumor, and all received carboplatin and etoposide- based chemotherapy as initial treatment. Mean age at first therapy was 2.3 years old, and mean time from initial therapy to recurrence of the tumor was 5.6 years. Two patients were totally blind at the time of recurrence, and other two had partial visual field losses. One patient underwent total resection of the tumor, and other three patients underwent partial resection followed by chemotherapy. Visual function in patients with visual acuity did not deteriorate after removal of the recurrent tumor. There was no recurrence of the tumor who underwent total resection. All of the three patients who had partial resection followed by chemotherapy recurred. Mean time from first recurrence to second recurrence was 1.8 years. After second recurrence, all patients underwent radiation therapy. One patient died due to malignant transformation of the tumor. For recurrent optic pathway pilocytic astrocytoma, prognosis may be better if total resection of the tumor without deteriorating the vision is possible.

Significance of Paneth cell–like differentiation in prostatic adenocarcinoma: a retrospective cohort study of 80 cases

The grading and prognosis of prostatic adenocarcinoma with Paneth cell-like differentiation (PanEC) is controversial with limited available data. We identified 80 cases, not previously published, of PanEC first identified on biopsy (n=69), transurethral resection of the prostate (n=1), and radical prostatectomy (RP) (n=10). Of 69 biopsies, 22 did not have a grade assigned. In the remaining 47 biopsies, the Grade Groups (GGs) of the associated usual prostatic adenocarcinoma were GG1-2 (n=34) and GG3-5 (n=13). Of 10 RPs, the GGs were as follows: GG1-2 (n=8), GG4 (n=1), and no grade due to treatment effect (n=1); pathological stages were pT2 (n=8)and pT3a (n=2), all with negative lymph nodes. We analyzed 19 cases with available follow-up only associated with GG1-2 conventional cancer; 9 underwent RP, and GGs at RP were as follows: GG1-2 (n=7), no grade due to treatment effect (n=1), and missing data (n=1); pathologic stages were pT2 (n=6) and pT3a (n=3); there were no positive regional lymph nodes; 3 were managed with active surveillance, without follow-up progression; 5 patients underwent radiation therapy with or without hormone therapy; none showed follow-up progression; 2 (10.5%) patients were recommended to undergo radiotherapy, with no further follow-up. Of the cases with available follow-up, 9 were not associated with conventional adenocarcinoma; the majority of these cases were treated with radiation therapy or active surveillance without evidence of progression. In summary, although a minority of PanECs are associated with conventional higher grade adenocarcinoma and have progression after treatment, the majority have favorable findings, justifying the consideration of them as more indolent tumors despite cases in which PanEC resembles Gleason pattern 5 adenocarcinoma.

Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels: Technique, Safety, and Outcomes after 250 Flaps.

The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. In bilateral cases, both flaps are often anastomosed to the internal mammary vessels on either side of the sternum. The authors propose a method in which both flaps are anastomosed to only the right side internal mammary artery and vein. Between November of 2009 and March of 2018, 125 patients underwent bilateral DIEP flap breast reconstruction with this technique. One flap is perfused by the anterograde proximal internal mammary artery and the second one by the retrograde distal internal mammary artery after presternal tunneling. Patient demographics and operative details were reviewed retrospectively. Two hundred fifty flaps were performed. One hundred fifty-two flaps were prophylactic or primary reconstructions (60.8 percent), 70 were secondary reconstructions (28 percent), and 28 were tertiary reconstructions (11.2 percent). Mean patient age was 46 years, and the mean body mass index was 25 kg/m. Sixty patients underwent radiation therapy or chemotherapy (48 percent). The authors encountered one significant partial failure (0.4 percent) and nine complete flap failures (3.6 percent). The authors did not see a statistically significant predisposition for failure comparing the retrograde with the anterograde flow flaps, nor when comparing the tunneled with the nontunneled flaps. The authors' results show that anastomosing both DIEP flaps to a single set of mammary vessels is safe and reliable. The authors conclude that the retrograde flow through the distal internal mammary artery is sufficient for free flap perfusion and that subcutaneous tunneling of a free flap pedicle does not predispose to flap failure. Therapeutic, IV.

Hematologic malignancies of the larynx: A single institution review.

Primary hematologic malignancies of the larynx are rare diagnoses, accounting for less than 1% of all laryngeal tumors. They most commonly present as submucosal masses of the supraglottis, with symptoms including hoarseness, dysphagia, dyspnea and rarely cervical lymphadenopathy. METHODS: Retrospective case series of patients in a tertiary academic laryngeal practice with hematologic malignancy of the larynx presenting over a 10 year period; charts were reviewed for diagnosis, symptoms, treatment, and outcomes. 12 patients were found to have primary presentation of a hematologic malignancy within the larynx between 2009 and 2019. A submucosal mass was the most common finding, and hoarseness was the most common symptom. Local control of disease was high. Airway obstruction was managed with tracheostomy. Several patients required tube feeding prior to disease control. Most patients underwent radiation therapy and chemotherapy, although surgery alone was effective in patients with isolated disease. Hematologic malignancies of the larynx are rare but treatable. Biopsy is the mainstay of diagnosis, and imaging may be helpful to exclude diseases with a similar physical presentation (i.e., laryngocele). Prognosis depends on diagnosis but is generally favorable.

Anchored Transponder Guided Lung Radiation Therapy

PurposeThe Calypso Beacon transponder has been modified by the addition of a nitinol anchor feature to allow for positional stability when implanted bronchoscopically into the lung. The purpose of this study was to confirm the feasibility and safety of anchored transponder placement and feasibility of lung target localization and tracking. Methods and MaterialsThis study enrolled patients with histologically confirmed cancer in the lung (primary or metastatic) who were scheduled to receive external beam radiation therapy. Three anchored transponders were implanted via flexible bronchoscopy into small (approximately 2- to 2.5-mm diameter) airways. Patient alignment at each radiation fraction was performed with the Calypso system, and anchored transponder position was tracked during radiation delivery. The primary endpoint was defined as the ability to localize at least 85% of the patients during the first week of treatment. Four follow-up visits were specified including a posttreatment assessment and every 3 months up to 1 year. ResultsA total of 69 patients underwent anchored transponder placement, and all 207 implanted anchored transponders were visible on the treatment-planning simulation computed tomography scan. Sixty-seven patients underwent radiation therapy, and localization was successful in 66 cases (98.5%). With 1 failure in 67 cases, the P value for rejecting the null hypothesis was <.001 and the primary objective of the study met. Five adverse events in 5 patients were potentially attributed to the study device or implantation procedure, consisting of pneumonia (2 cases), pleural abscess (1 case), and pneumothorax (2 cases). Two serious events (cardiac arrest and acute hypotension) were attributed to anesthesia during the implantation procedure. ConclusionsThis study strongly supports that anchored transponders are safe, positionally stable, and useful for lung tumor localization and monitoring.

Association Between Pretreatment Dietary Preference and Weight Loss after Radiation Therapy in Head and Neck Cancer Patients: A Pilot Study

Weight loss is common in cancer patients underwent radiation therapy. However, the impact of pretreatment behavior on postradiation nutritional status was unknown. This prospective observational study was conducted in 31 Thai head and neck cancer patients to investigate the association between pretreatment dietary preference and weight change after radiotherapy. Pretreatment preferences on sweet, salty, sour, bitter, umami, spicy, and fatty food were evaluated using a validated questionnaire, TASTE26. Body weights were monitored at baseline, 1,000–2,000, 2,800–3,400, 4,000–4,400, and 5,000–7,000 cGy of radiations and 2 month-follow up after radiotherapy. The energy intakes were analyzed by using 3 day-dietary record and INMUCAL software. Spicy food preference was the only factor found positively correlated with weight loss after radiation (r = 0.64, P = 0.007). Consistently, strong spicy lovers had more pronounced reduction of energy intake and body weight, and higher needs of tube feeding than those of mild or moderate lovers (P < 0.05). This study suggested that stronger preference on spicy food may be associated with less energy intake and more severe weight loss after radiation therapy. A large-scale study is warranted to confirm such findings. Then, preradiation screening for spicy preference may be useful to predict weight loss during radiation therapy.