Radiotherapy-treated Patients Research Articles

Efficacy of Auricular Acupressure Combined With Positive Psychological Techniques on Sleep Quality in Cancer Patients Undergoing Radiotherapy: A Randomized Controlled Trial.

Auricular acupressure (AA) and positive psychological intervention (PPI) are promising sleep improvement methods. To assess and compare the efficacies of combined intervention (CI [AA + PPI]), AA, and PPI in sleep quality enhancement and their potential effects in alleviating negative psychological states in radiotherapy-treated patients with cancer. This study was a 4-arm, placebo-controlled randomized trial. We randomly assigned 120 eligible patients into 4 groups (30 patients per group). The main outcomes included subjective sleep quality, psychological distress, and fear of cancer recurrence, which were measured at baseline, immediate postintervention, and 4 weeks postintervention. Objective sleep quality was measured using Fitbit Charge 3 at baseline and immediate postintervention. The intervention effects were estimated using the linear mixed model. The 4 groups demonstrated significant differences in subjective sleep quality (P < .001), psychological distress (P = .004), and fear of cancer recurrence (P < .001). CI, AA, and PPI had different degrees of positive effects on subjective sleep quality compared with sham control; CI was more effective than AA and PPI, whereas AA was more effective than PPI. CI and PPI showed significant and comparable effects on psychological distress and fear of cancer recurrence reduction. Only CI and AA significantly improved the objective sleep quality. CI, AA, and PPI are recommended as complementary therapies to improve the sleep quality of patients with cancer. In future clinical practice, healthcare workers should assess patients' sleep quality and psychological status and select appropriate interventions.

Neoadjuvant SHR-1701 with or without chemotherapy in unresectable stage III non-small-cell lung cancer: A proof-of-concept, phase 2 trial

We conducted a proof-of-concept, phase 2 trial to assess neoadjuvant SHR-1701 with or without chemotherapy, followed by surgery or radiotherapy, and then consolidation SHR-1701 in unresectable stage III non-small-cell lung cancer (NSCLC). In the primary cohort of patients receiving neoadjuvant combination therapy (n= 97), both primary endpoints were met, with a post-induction objective response rate of 58% (95% confidence interval [CI] 47-68) and an 18-month event-free survival (EFS) rate of 56.6% (95% CI 45.2-66.5). Overall, 27 (25%) patients underwent surgery; all achieved R0 resection. Among them, 12 (44%) major pathological responses and seven (26%) pathological complete responses were recorded. The 18-month EFS rate was 74.1% (95% CI 53.2-86.7) in surgical patients and 57.3% (43.0-69.3) in radiotherapy-treated patients. Neoadjuvant SHR-1701 with chemotherapy, followed by surgery or radiotherapy, showed promising efficacy with a tolerable safety profile in unresectable stage III NSCLC. Surgical conversion was feasible in a notable proportion of patients and associated with better survival outcomes.

Prediction of toxicity outcomes following radiotherapy using deep learning-based models: A systematic review

PurposeThis study aims to perform a comprehensive systematic review of deep learning (DL) models in predicting RT-induced toxicity. Materials and methodsA literature review was performed following the PRISMA guidelines. Systematic searches were performed in PubMed, Scopus, Cochrane and Embase databases from the earliest record up to September 2022. Related studies on deep learning models for radiotherapy toxicity prediction were selected based on predefined PICOS criteria. ResultsFourteen studies of radiotherapy-treated patients on different types of cancer [prostate (n=2), HNC (n=4), liver (n=2), lung (n=4), cervical (n=1), and oesophagus (n=1)] were eligible for inclusion in the systematic review. Information regarding patient characteristics and model development was summarized. Several approaches, such as ensemble learning, data augmentation, and transfer learning, that were utilized by selected studies were discussed. ConclusionDeep learning techniques are able to produce a consistent performance for toxicity prediction. Future research using large and diverse datasets and standardization of the study methodologies are required to improve the consistency of the research output.

Abstract A025: Elevated periprostatic fat is associated with high grade prostate cancer in radiotherapy-treated patients

Abstract Introduction Obesity is associated with poor prostate cancer-specific outcomes. Body mass index, a commonly used surrogate of obesity, does not adequately describe fat distribution, which can instead be assessed using medical imaging. Abdominal visceral obesity, a better indicator of metabolic health, has been associated with increased prostate cancer risk. Similarly, periprostatic adipose tissue (PPAT), a type of visceral fat in close proximity to the prostate has a postulated role in prostate cancer aggressiveness. We hypothesised that elevated quantities of visceral fat, both abdominal and periprostatic would be associated with increased disease aggressiveness. To gain insight into potential contributing mechanisms, we examined gene expression pathways differentially expressed in association with adiposity measures. Methods Abdominal adipose tissue, both subcutaneous and visceral (n=244), and PPAT (n=309) were quantified from the radiation planning computed tomography (CT) scans from prostate cancer patients treated with radiotherapy and ADT in the Northern Ireland Cancer Centre between 2005-2009. Abdominal fat was measured at L4/L5 and PPAT at the midpoint of pubic symphysis using a threshold of -190 to -30 Hounsfield Units to identify fat. Associations of adipose tissue quantity, categorised using tertiles of fat quantity, with Gleason score (≥4+3 versus ≤3+4) were assessed using univariable and multivariable logistic regression analysis. Associations between adipose tissue quantity and risk of biochemical recurrence and metastasis were examined using Cox regression. In a subset of patients with tumour biopsy transcriptomic data (n=183), an exploratory Gene Set Enrichment Analysis (GSEA) was performed to identify enriched gene pathways in the tumours of those with high versus low fat measures, defined using the median fat quantity. Results High PPAT was significantly associated with increased risk of high grade prostate cancer (Tertile 3 vs. Tertile 1; age adjusted OR 2.05; 95%CI 1.17-3.62; p=0.01). There was a trend for increased risk of high grade disease in those with high abdominal subcutaneous (T3 vs. T1; age adjusted OR 1.73; 95%CI 0.92-3.30) and visceral (T3 vs. T1; age adjusted OR 1.21; 95%CI 0.66-2.25) fat measures but this was not significant. In GSEA, those with high PPAT showed enrichment of the KEGG adipocytokine signalling pathway (nominal p-value=0.004) whilst those with high subcutaneous fat had enrichment of pathways involved in lipid and cholesterol metabolism. No adipose tissue measure was significantly associated with prostate cancer-specific outcomes following a median follow up of 10.1 years. Conclusions Elevated quantities of PPAT are associated with increased risk of high grade prostate cancer and enriched tumour adipocytokine signalling, suggesting a possible paracrine role of PPAT in prostate cancer aggressiveness. This is the first study to explore potential mechanisms of PPAT using tumour gene expression data. If confirmed, this may in part explain the link between obesity and aggressive prostate cancer. Citation Format: Sarah J. Winter, Suneil Jain, Gillian Prue, Conor K. McGarry, Alan R. Hounsell, Michelle Leech, Emma H. Allott. Elevated periprostatic fat is associated with high grade prostate cancer in radiotherapy-treated patients [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A025.

Salvage surgery in laryngeal cancer after radiotherapy and partial surgery - comparative results.

The study is a retrospective comparison of the usefulness of salvage surgery between a group of previously radiotherapy-treated patients (RTPs) and a group of patients who previously underwent partial surgery with both local and ± nodal recurrence. Retrospective study. Multi-center academic hospital. The former group was comprised 30 previously RTPs, whereas the latter group consisted of 20 patients after partial laryngeal surgery with optional subsequent adjuvant radiotherapy (PSPs). Treatment efficacy was compared in both groups in relation to overall survival (OS) and the locoregional control rate (LCR). Local and ± nodal recurrence was considered primary treatment failure. All patients underwent total laryngectomy. The updated 5-year OS in the PSPs was 31%, while the percentage of the updated 5-year LCR was 42%. In the RTPs the updated 5-year OS was 21%, and the percentage of 5-year LCR was 38%. No statistically significant differences were found in terms of the comparison of OS or the comparison of LCR results in both groups (P = 0.427, P = 0.704, respectively). Based on the analysis, it was found that irrespective of the initial treatment, salvage surgery was associated with decreased survival and cure rates (by 50%) compared to the group of patients with advanced laryngeal cancer who underwent primary total laryngectomy.

Surgery versus radiotherapy in octogenarians with stage Ia non‑small cell lung cancer: propensity score matching analysis of the SEER database

ObjectivesTo compare overall survival (OS) and cancer-specific survival (CSS) outcomes of surgery with radiotherapy in octogenarians with stage Ia non-small cell lung cancer (NSCLC).Materials and methodsPatients aged ≥ 80 years with clinical stage Ia (T1N0M0) NSCLC between 2012 and 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned into surgery and radiotherapy groups. Multivariate Cox regression analysis was used to identify survival-associated factors. Treatment groups were adjusted by propensity score matching (PSM) analysis while OS and CSS outcomes were compared among groups by Kaplan–Meier analysis.ResultsA total of 1641 patients were identified, with 46.0% in the surgical group and 54.0% in the radiotherapy group. Compared to surgery, radiotherapy-treated patients were older, later diagnosed, had more often unmarried, more squamous cell carcinoma, more unknown grade and increased tumor sizes. Radiotherapy was associated with a significantly worse OS, compared to surgery (hazard ratio 2.426; 95% CI 2.003–2.939; P < .001). After PSM, OS (P < 0.001) and CSS (P < 0.001) were higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgical and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgical and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. There were no survival differences between the matched surgery without lymph node examination (LNE) and radiotherapy group, as well as between the matched surgery and radiotherapy who were recommended but refused surgery group.ConclusionsIn octogenarians with stage Ia NSCLC, surgery with lymph node dissection offers better OS and CSS outcomes than radiotherapy.

Electronic Health Record Patient Portal Use in Radiotherapy Treated Patients in the Era of COVID-19; Who's Getting Left Behind?

Purpose/Objective(s)COVID-19 has accelerated the utility of electronic health record (EHR) patient portal (PP) as a method for patients to communicate with oncology teams and improve the quality of care. This study examines the relationship between several sociodemographic characteristics with activation and use of PP system at an academic center by patients who underwent radiotherapy (RT). Use of PP among patients for up-to-date information on their care and to enhance their ability to manage their healthcare are linked with more favorable outcomes and quality of life. With the rapid integration of PP in oncologic management, differences in sociodemographic could account for disparities seen in PP use highlighting patients that should be receiving targeted efforts.Materials/MethodsEHR data were retrospectively analyzed regarding PP activation and use in all patients who underwent RT between the start of COVID-19 (March 2020) until February 2022 at an academic center. Summary statistics and odds ratios were used to examine the study cohort demographic characteristics regarding the outcome of PP activation.ResultsThere was a 10.4% increase in RT treated patients’ activation of PP from 69.8% before the COVID-19 pandemic (November 2017-March 2020) to 80.2% after the start of the pandemic. Concurrently, telemedicine use (requiring PP activation) among patients increased from 0.8% pre-pandemic to 40.2%. During the study period of interest, PP activation rate was 84.3% among White patients, 67.8% in Black/African American, 76.5% in Asians; 82.9% activation rate in Hispanics compared to 76.2% in non-Hispanics. Non-Hispanic White female was the group most likely to activate PP (OR 2.2; 95% CI 1.7-2.8), whereas non-Hispanic Black male was the least likely (OR 0.5; 95% CI 0.3-0.7). English speakers were significantly more likely to activate their PP (OR 3.7; 95% CI 2.1-6.5) compared to non-English speakers (OR 0.3; 95% CI 0.1-0.5). The highest activated PP by age range was amongst 20-30 years old (89.6%). PP activation was slightly lower in ages 30-40 (80.7%), and then recovered to 85.9% in 40-50 years old, after which there was a gradual decrease each subsequent decade reaching a low of 75.8% in ≥ 80 years. Breast cancer had the highest activation rate (92.7%) followed by head and neck (84%), prostate (81.3%), and lung cancer (66.5%). Married or divorced patients in comparison to single or widowed were more likely to activate PP. There was no correlation with having activated PP with a “no show” status for RT treatment.ConclusionOverall, activation of PP has increased in RT treated patients since the start of the pandemic. There are disparities in respect to race, speaking English, sex, and age. At the time of this study, the PP system was only available in English. The lower rate of activation identified in specific sex, race and age should prompt exploration of creative opportunities to increase patient activation and engagement in populations facing health disparities.

Changes in serum transforming growth factor-beta concentration as a predictive factor for radiation-induced lung injury onset in radiotherapy-treated patients with locally advanced lung cancer.

BackgroundRadiation-induced lung injury (RILI) occurs after chest radiation therapy, which ranges from acute radiation pneumonia to subsequent radiation pulmonary fibrosis. However, they are difficult to predict. The study aimed to examine the predictive utility of serum levels of transforming growth factor-beta (TGF-β) for radiation-induced lung injury.MethodsThis single-center prospective observational study enrolled 21 patients with locally advanced lung cancer who underwent chest radiation therapy. We measured the serum levels of TGF-β, Krebs von Denlungen-6, and granulocyte colony-stimulating factor (GCSF) eight times immediately before irradiation.ResultsSeven, four, eight, and one patient had Grade 0, 1, 2, and 3 radiation-induced lung injury, respectively. Compared with the Grade 0 and 1 RILI groups (RP− group), the Grade 2 and 3 RILI groups (RP+ group) had a significantly higher relative ratio of TGF-β values from immediately before irradiation to the time of 30–48 Gy irradiation (P=0.011). The cut-off value of the TGF-β relative ratio of the RP+ group measured from the receiver operating characteristic curve was 1.31; moreover, the sensitivity, specificity, and positive predictive value were 75%, 100%, and 75%, respectively. There was no significant between-group difference in the levels of the other cytokines.ConclusionsFor patients undergoing radiation therapy for locally advanced lung cancer, the ratio of TGF-β levels before and after 30–48 Gy irradiation may predict the onset of RILI. Our findings may facilitate the identification of predictors of the onset of radiation-induced lung injury.

Survival Comparison Between Squamous Cell Carcinoma and Adenocarcinoma for Radiotherapy-Treated Patients with Stage IIB-IVA Cervical Cancer.

ObjectiveTo compare the prognostic significance of adenocarcinoma (AC) with squamous cell carcinoma (SCC) on overall survival (OS) in patients with stage IIB-IVA cervical cancer (CC) treated by external beam radiotherapy (EBRT) and brachytherapy (BRT) with/without chemotherapy registered in the Surveillance, Epidemiology, and End Results database.MethodsData of eligible patients were extracted between 2004 and 2016. A univariate analysis was conducted using the cumulative incidence function (CIF) by considering competing events and compared using Gray’s test. The significant variables in univariate analysis were further evaluated in a multivariate analysis performed with the Fine-Gray regression model. Propensity score matching (PSM) analysis was also employed to reconfirm the results found in the present study.ResultsA total of 2,243 patients with SCC and 176 patients with AC were extracted from the database. The 5-year OS rates were 57.8% in the SCC group and 52.8% in the AC group. 149 patients died of causes other than CC—considered as competing events. Compared with the SCC group, patients diagnosed with AC had statistically significant worse 5-year OS rate before and after PSM. In the multivariate Fine-Gray regression model, the histological subtype of AC was proven as an independent prognostic factor associated with poorer OS before [hazard ratio (HR) = 1.340; 95% confidence interval (CI): 1.081-1.660; P = 0.007] and after [HR = 1.376; 95% CI: 1.107-1.711; P = 0.004] PSM.ConclusionsThe histological subtype of AC is significantly correlated with impaired OS as an independent prognostic variable in patients with stage IIB-IVA CC who received EBRT and BRT compared to patients with SCC. Future studies should incorporate effective and individualized treatment strategies into clinical decision-making to improve the unsatisfactory survival outcomes for patients with AC.

Methyltransferase 1 is required for nonhomologous end-joining repair and renders hepatocellular carcinoma resistant to radiotherapy.

Radiotherapy is an increasingly essential therapeutic strategy in the management of hepatocellular carcinoma (HCC). Nevertheless, resistance to radiotherapy is one of the primary obstacles to successful treatment outcomes. Hence, we aim to elucidate the mechanisms underlying radioresistance and identify reliable biotargets that would be inhibited to enhance the efficacy of radiotherapy in HCC. From a label-free quantitative proteome screening, we identified transfer RNA (tRNA; guanine- N [7]-) methyltransferase 1 (METTL1), a key enzyme for N7-methylguanosine (m 7 G) tRNA modification, as an essential driver for HCC cells radioresistance. We reveal that METTL1 promotes DNA double-strand break (DSB) repair and renders HCC cells resistant to ionizing radiation (IR) using loss-of-function and gain-of-function assays in vitro and in vivo. Mechanistically, METTL1-mediated m 7 G tRNA modification selectively regulates the translation of DNA-dependent protein kinase catalytic subunit or DNA ligase IV with higher frequencies of m 7 G-related codons after IR treatment, thereby resulting in the enhancement of nonhomologous end-joining (NHEJ)-mediated DNA DSB repair efficiency. Clinically, high METTL1 expression in tumor tissue is significantly correlated with poor prognosis in radiotherapy-treated patients with HCC. Our findings show that METTL1 is a critical enhancer for HCC cell NHEJ-based DNA repair following IR therapy. These findings give insight into the role of tRNA modification in messenger RNA translation control in HCC radioresistance.

Comprehensive Analysis of the Butyrate-Metabolism-Related Gene Signature in Tumor Microenvironment-Infiltrating Immune Cells in Clear Cell Renal Cell Carcinoma.

A wealth of experimental evidence has validated that butyrate is capable of inhibiting tumorigenesis, while the potential role of butyrate metabolism in the tumor immune microenvironment (TIME) has been rarely explored. This study aims to explore the potential of butyrate-metabolism-related genes as prognostic biomarkers and their correlations with immune infiltrates in clear cell renal cell carcinoma (ccRCC) patients. Based on The Cancer Genome Atlas dataset (TCGA; n = 539), a total of 22 differentially expressed genes (DEGs) related with butyrate metabolism in ccRCC and normal samples were identified. Among them, a prognostic signature involving six butyrate-metabolism-related genes was created (Bu-Meta-GPS) in the training set (n = 271) and validation set (n = 268), and risk scores were calculated based on them. ccRCC patients with high-risk scores exhibited an unfavorable prognosis, high immunoscore, upregulated immuno-oncological targets (PD1, PD-L1, CTLA4, and CD19), and distinct immune-cell infiltration than those with low-risk scores. High-risk ccRCC patients without radiotherapy had a better survival rate than radiotherapy-treated patients. The negative regulation of cytokine production and cytokine-mediated signaling pathways was remarkably enriched in ccRCC patients with high-risk scores. A nomogram was then formulated to assess the overall survival (OS) of ccRCC patients. In summary, we illuminated the key role of butyrate metabolism in ccRCC TIME. The developed Bu-Meta-GPS was a sensitive predictive biomarker for the prognosis of ccRCC, which also provided new perspectives in improving immunotherapeutic efficacy.

PO-1828 Predictive biomarkers, side effects and tumor control in radiotherapy-treated male cancer patients

PO-1828 Predictive biomarkers, side effects and tumor control in radiotherapy-treated male cancer patients

Is Thoracic Radiotherapy an Absolute Contraindication for Treatment of Lung Cancer Patients With Interstitial Lung Disease? A Systematic Review

Thoracic radiotherapy decisions in patients with interstitial lung disease (ILD) are complex due to concerns about severe or even fatal radiation pneumonitis. This systematic review analysed the published evidence regarding the incidence of radiation pneumonitis and mortality after thoracic radiotherapy and investigated clinical and dosimetric predictors of radiation pneumonitis in lung cancer patients with ILD. A systematic search was carried out in PubMed, Medline, Embase and the Cochrane database for articles published between January 2000 and April 2021. Two authors independently screened eligible studies that met our predefined criteria. Studies were assessed for design and quality and a qualitative data synthesis was carried out. The search strategy resulted in 1750 articles. After two rounds of screening, 24 publications were included. The median overall incidence of grade ≥3 radiation pneumonitis was 19.7% (range 8–46%). The incidence was greater in conventional radical radiotherapy-treated patients (median 31.8%) compared with particle beam therapy- or stereotactic ablative radiotherapy-treated patients (median 12.5%). The median rate of grade 5 radiation pneumonitis was 11.9% (range 0–60%). The presence of ILD was an independent predictor of severe radiation pneumonitis. Severe radiation pneumonitis was more common in the presence of usual interstitial pneumonia (UIP) pattern or idiopathic pulmonary fibrosis (IPF) than non-UIP or non-IPF subtype. Several other clinical predictors were reported in the literature. V5, V10, V20 and mean lung dose were the most common dosimetric predictors for severe radiation pneumonitis, often with stricter dose constraints than conventionally used. Patients with lung cancer associated with ILD had a poorer overall survival compared with patients without ILD. In conclusion, patients with lung cancer associated with ILD have a poor prognosis. They are at high risk of severe and even fatal radiation pneumonitis. Careful patient selection is necessary, appropriate high-risk consenting and strict lung dose-volume constraints should be used, if these patients are to be treated with thoracic radiotherapy.

Multimodal assessment of acute cardiac toxicity induced by thoracic radiotherapy in cancer patients. Study protocol

BackgroundToday, cancer ranks as one of the leading causes of death. Despite the large number of novel available therapies, radiotherapy (RT) remains as the most effective non-surgical method to cure cancer patients. In fact, approximately 50% of all cancer patients receive some type of RT and among these 60% receive RT-treatment with a curative intent. However, as occurs with any other oncological therapy, RT treated patients may experience toxicity side effects that range from moderate to severe. Among these, cardiotoxicity represents a significant threat for premature death. Current methods evaluate cardiotoxic damage based on volumetric changes in the Left Ventricle Ejected Fraction (LVEF). Indeed, a 10% drop in LVEF is commonly used as indicator of cardiotoxicity. More recently, a number of novel techniques have been developed that significantly improve specificity and sensitivity of heart’s volumetric changes and early detection of cardiotoxicity even in asymptomatic patients. Among these, the Strain by Speckle Tracking (SST) is a technique based on echocardiographic analysis that accurately evaluates myocardial deformation during the cardiac cycle (ventricular and atrial function). Studies also suggest that Magnetic Resonance Imaging (MRI) is a high-resolution technique that enables a better visualization of acute cardiac damage.MethodologyThis protocol will evaluate changes in SST and MRI in cancer patients that received thoracic RT. Concomitantly, we will assess changes in serum biomarkers of cardiac damage in these patients, including: high-sensitivity cardiac Troponin-T (hscTnT), N-Terminal pro-Brain Natriuretic Peptide (NTproBNP) and Circulating Endothelial Cells (CECs), a marker of endothelial dysfunction and vascular damage.DiscussionThe presented protocol is to our knowledge the first to prospectively and with a multimodal approach, study serological and image biomarkers off early cardiac damage due to radiotherapy.With a practical clinical approach we will seek early changes that could potentially be in the future be linked to clinical mayor events with consequences for cancer survivors.

Abstract 162: Cholesterol metabolism gene expression and prostate cancer-specific outcomes in radiotherapy-treated patients

Abstract Introduction Dysregulated lipid metabolism is a hallmark of prostate cancer. Furthermore, use of the cholesterol lowering statin drugs has been linked to a reduced risk of lethal prostate cancer. To understand the molecular pathways implicated in this relationship, we examined the association between differential expression of genes involved in intratumoral cholesterol metabolism in prostate tumor biopsies and prostate cancer-specific outcomes. Methods Tumor biopsy gene expression data from 242 men diagnosed with localized/locally advanced prostate cancer and treated with radiotherapy and androgen deprivation therapy was analyzed. A total of 71 genes involved in cholesterol transport, biosynthesis and regulation were selected from the Reactome pathway database, with additional genes involved in cholesterol metabolism extracted from literature. For each gene, expression levels were dichotomized by median expression level. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations of gene expression with biochemical recurrence and metastasis. Models were adjusted for age at diagnosis and Gleason score. Multiple-testing correction was performed using the Bonferroni correction method. Results During a median follow-up of 10.4 years, 72 (30%) patients experienced biochemical recurrence and 32 (13%) developed metastatic disease. Differential expression of several genes was found to be associated with risk of biochemical recurrence and metastasis, though none remained statistically significant following Bonferroni correction. However, several genes showed similar patterns of association with risk of biochemical recurrence and of metastasis, an association which remained similar following adjustment for age and Gleason score. Low (below median) expression of FDFT1, a gene encoding squalene synthase, a key enzyme in cholesterol biosynthesis, was associated with an increased risk of biochemical recurrence (HR 1.87; 95% CI, 1.15-3.01) and metastasis (HR 3.52; 95% CI, 1.52-8.16). High (above median) expression of SLCO1B3, a gene encoding an organic anion transporting polypeptide transporting a variety of small molecules including statins, was associated with higher risk of biochemical recurrence (HR 2.14; 95% CI, 1.31-3.49) and metastasis (HR 2.70; 95% CI, 1.25-5.90). Conclusion These hypothesis-generating results point to a potential role for altered intratumoral cholesterol metabolism in prostate cancer-specific outcomes. Our findings highlighting differential expression of FDFT1 and SLCO1B3, genes involved in cholesterol biosynthesis and anion transport, respectively, in association with risk of biochemical recurrence and metastasis may provide clues as to the mechanistic pathways of most importance. Validation in other prostate cancer gene expression datasets is required. Citation Format: Sarah J. Winter, Sophia Halliday, Konrad H. Stopsack, Sarah O. Osman, Alan R. Hounsell, Gillian Prue, Suneil Jain, Emma H. Allott. Cholesterol metabolism gene expression and prostate cancer-specific outcomes in radiotherapy-treated patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 162.

Impact of the 2019 Novel Coronavirus Disease (COVID-19) Epidemic on Radiotherapy-Treated Patients with Cancer: A Single-Center Descriptive Study.

IntroductionThe present study investigated hospitalization data of patients receiving radiotherapy at Anhui Cancer Hospital during the COVID-19 epidemic and analyzed the impact of the epidemic on the clinical data of radiotherapy patients to provide references for the feasibility and safety of radiotherapy at other medical institutions.MethodsThe present study performed a retrospective analysis of hospitalization data of patients undergoing radiotherapy at the Radiation Department (from January 5 to March 19, 2020 according to the Chinese lunar calendar), who were defined as the epidemic group. Hospitalization data for patients undergoing radiotherapy during the same period in 2019 were used as the control group for comparison with the epidemic group in terms of sex, age, distribution of various cancer types, hospitalization costs, average length of stay, completion rate of radiotherapy, treatment mode, and purpose of radiotherapy.ResultsA total of 79 and 115 patients received radiotherapy in the epidemic group and control group, respectively. The number of patients who received radiotherapy declined 31.3% during the epidemic period. The number of head and neck cancer patients who received radiotherapy was 36 (45.57%) in the epidemic group and 32 (27.83%) in the control group, which was a significant difference (χ2=6.476, P=0.011). The proportions of patients with other types of cancer decreased, with no significant difference between the two groups (P>0.05). No significant differences between the two groups were found in terms of other hospitalization data (P>0.05).ConclusionThe total number of patients who received radiotherapy decreased during the epidemic period, but the proportion of head and neck cancer increased. The epidemic had no significant effect on other hospitalization data. While strengthening prevention and control measures, we should actively perform radiotherapy to ensure that cancer patients receive timely and safe treatment.

Outcomes in Radiotherapy-Treated Patients With Cancer During the COVID-19 Outbreak in Wuhan, China

This case series evaluated the delivery of radiotherapy in 209 patients with cancer during the COVID-19 outbreak in Wuhan, China.

Prevalence of carotid plaque stenosis after head and neck radiotherapy - an observational study of 156 survivors.

Background: Radiotherapy for head and neck cancer (HNC) represents a well-known predisposing factor for asymptomatic carotid artery lesions and acute cerebrovascular accidents. Our aim is to provide contemporary estimates on the prevalence, severity, and characteristics of carotid artery lesions in HNC survivors. Patients and methods: We prospectively included HNC patients who underwent radiotherapy and were free from the disease at the time of duplex ultrasound evaluation. Patients were re-contacted telephonically and those who agreed to participate were invited for an ambulatory visit when the investigators collected clinical information and performed duplex ultrasound examination based on a predefined protocol. Results: A total of 156 patients were included and underwent duplex ultrasound examination after a mean of 65.2 months from the last session of radiotherapy. A total of 36 patients (23.1%) had normal carotid arteries; mild, non-stenotic lesions were observed in 49.4% (n=77) of patients; severe stenotic plaques were found in 27.5% (n=43) of patients. One patient found with an asymptomatic occlusion of the left ICA. The prevalence of major cardiovascular risk factors and high radiation dose increased proportionally with plaque severity. Low echogenicity plaque was found in 59 (37.8%) patients on the right side and 57 (36.5%) on the left side; long segment plaque in 49 (31.4%) patients on the right side and in 47 (30.1%) on the left side; an atypical location of the lesions in 42 (26.9%) patients on the right side and in 48 (30.8%) on the left side. Conclusions: The prevalence of occlusion and severe stenosis after radiotherapy for HNC was very low in our study population. Low echogenicity plaque, long segment plaque, and an atypical location were common findings. Classic cardiovascular risk factors appear to have had a causative role: a routine screening of radiotherapy-treated patients might be necessary only in patients with concomitant cardiovascular risk factors or exposed to high-dose neck radiation.

Ovarian cancer-derived copy number alterations signatures are prognostic in chemoradiotherapy-treated head and neck squamous cell carcinoma.

DNA copy number alterations (CNAs) are frequent in cancer, and recently developed CNA signatures revealed their value in molecular tumor stratification for patient prognosis and platinum resistance prediction in ovarian cancer. Head and neck squamous cell carcinoma (HNSCC) is also characterized by high CNAs. In this study, we determined CNA in 173 human papilloma virus‐negative HNSCC from a Dutch multicenter cohort by low‐coverage whole genome sequencing and tested the prognostic value of seven cancer‐derived CNA signatures for these cisplatin‐ and radiotherapy‐treated patients. We find that a high CNA signature 1 (s1) score is associated with low values for all other signatures and better patient outcomes in the Dutch cohorts and The Cancer Genome Atlas HNSCC data set. High s5 and s7 scores are associated with increased distant metastasis rates and high s6 scores with poor overall survival. High cumulative cisplatin doses result in improved outcomes in chemoradiotherapy‐treated HNSCC patients. Here we find that tumors high in s1 or low in s6 are most responsive to a change in cisplatin dose. High s5 values, however, significantly increase the risk for metastasis in patients with low cumulative cisplatin doses. Together this suggests that the processes causing these CNA signatures affect cisplatin response in HNSCC. In conclusion, CNA signatures derived from a different cancer type were prognostic and associated with cisplatin response in HNSCC, suggesting they represent underlying molecular processes that define patient outcome.

Risk of Meningioma in European Patients Treated With Growth Hormone in Childhood: Results From the SAGhE Cohort.

ContextThere has been concern that GH treatment of children might increase meningioma risk. Results of published studies have been inconsistent and limited.ObjectiveTo examine meningioma risks in relation to GH treatment.DesignCohort study with follow-up via cancer registries and other registers.Setting Population-based.PatientsA cohort of 10,403 patients treated in childhood with recombinant GH in five European countries since this treatment was first used in 1984. Expected rates from national cancer registration statistics.Main Outcome MeasuresRisk of meningioma incidence.ResultsDuring follow-up, 38 meningiomas occurred. Meningioma risk was greatly raised in the cohort overall [standardized incidence ratio (SIR) = 75.4; 95% CI: 54.9 to 103.6], as a consequence of high risk in subjects who had received radiotherapy for underlying malignancy (SIR = 658.4; 95% CI: 460.4 to 941.7). Risk was not significantly raised in patients who did not receive radiotherapy. Risk in radiotherapy-treated patients was not significantly related to mean daily dose of GH, duration of GH treatment, or cumulative dose of GH.ConclusionsOur data add to evidence of very high risk of meningioma in patients treated in childhood with GH after cranial radiotherapy, but suggest that GH may not affect radiotherapy-related risk, and that there is no material raised risk of meningioma in GH-treated patients who did not receive radiotherapy.