Received Radiation Therapy Research Articles

Arginine Vasopressin Deficiency in Children with Craniopharyngioma and Cerebral Germ Cell Tumour: Two Sides of the Same Coin – Clinical and Radiological Features

Introduction: Paediatric brain tumours in the sellar-suprasellar region are often associated with arginine vasopressin peptide deficiency (AVPD), either at diagnosis caused by the tumour itself or during follow-up as a consequence of treatments. The purpose of this research was to retrospectively describe the neuroradiological characteristics and the timing of AVPD development in a cohort of paediatric patients with craniopharyngioma (CP) or germ cell tumours (GCTs). Methods: We evaluated brain MRI at tumour diagnosis and at the onset of AVPD, as well as recorded clinical, endocrinological, and histopathological data, treatments, and outcome. Results: Seventy-two patients with AVPD were included: 46 CPs (M:F = 25:21) and 26 GCTs (M:F = 18:8). CPs were suprasellar (63%), sellar (4%), or both (33%). GCTs were suprasellar (65%), pineal (24%), or bifocal (11%). No statistically significant differences were noted in tumour size between CP and GCT. Posterior pituitary bright spot absence was reported at diagnosis or at follow-up (as surgery consequence) in all patients with AVPD, indicating that the absence of hyper-intensity is a cardinal feature of AVPD. When measurable, pituitary stalk was thickened in most GCT patients (61.5%). At AVPD diagnosis in GCT, the mean age was 11.9 years; 18 (69%) patients had AVPD at the time of tumour diagnosis, 5 (19.3%) before the diagnosis with a latency of 24.4 months (range 4–48), and 3 (11.5%) during follow-up (mean 24 months, range 4–60) due to tumour recurrence. GCT patients presented with severe endocrinological manifestations (18/26), headache and vomiting (10/26), visual impairment (5/26), and behavioural changes with fatigue (1/26). In CP, the mean age at AVPD diagnosis was 10.3 years; 7 (15.2%) patients had AVPD at time of tumour diagnosis, 37 (80.5%) developed it shortly after neurosurgery, and 2 patients (4.3%) after 2 and 4 months from surgery, respectively. Clinically, headache and visual abnormalities were the most frequent clinical symptoms at diagnosis of CP (39/46, 84.8%), with hydrocephalus (16/46, 35%) and displacement of optic chiasm (29/46, 63%) at the initial MRI. While the vast majority of CP patients (93%) received only surgery, all GCT patients received radiation therapy in addition to or instead of surgery. Conclusion: An early differential diagnosis in children with AVPD and brain tumours is supported by a good understanding of the clinical features and imaging findings. Expert follow-up is necessary.

Adult head and neck rhabdomyosarcoma: radiotherapy- based treatment, outcomes, and predictors of survival

BackgroundAdult head and neck rhabdomyosarcoma (HNRMS) is an exceptionally rare malignancy, and there is a paucity of data and research dedicated to understanding its characteristics and management in adult populations. This study aimed to assess the outcomes and identify survival predictors in adult HNRMS.MethodsWe retrospectively evaluated 42 adult patients (> 16 years) with HNRMS who received radiotherapy (RT)-based treatment at our institute between 2008 and 2022. We analysed the clinical characteristics and prognosis of these patients, including the locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS), using the Kaplan–Meier method. The chi-square and Fisher’s exact tests were used to analyse differences between groups for dichotomous and categorical variables, respectively. Survival rates were calculated using the Kaplan–Meier method. Prognostic variables were assessed through univariate Cox analyses.ResultsThe median patient age was 28 years (range, 16–82 years). Alveolar RMS was the most common histological type, observed in 21 patients (50.0%), followed by embryonal in 16 patients (38.1%). The anatomic sites of origin were orbital in one (2.4%), parameningeal in 26 (61.9%), and non-orbital/non-parameningeal in 15 (35.7%) patients. Nineteen patients (45.2%) had regional lymph node metastasis, and five patients (11.9%) presented with distant metastatic disease. Distant metastasis (n = 17) was the primary cause of treatment failure. At a median follow-up of 47.0 months, the 5-year LRFS, PFS, and OS rates were 69.0%, 39.7%, and 41.0%, respectively. Univariate analysis revealed that tumour size, lymph node involvement, and the local treatment pattern (surgery and RT vs. RT alone) were significant predictors of survival.ConclusionsThe main failure pattern in patients with HNRMS receiving RT-based treatment was distant metastasis. Tumour size > 5 cm and lymph node involvement were predictors of worse LRFS. Multimodality local treatment, combining surgery and RT, is effective and provides survival benefits.

Thyroid Functionsand Thyroid Lesions in Children with Hodgkin Lymphoma and Central Nervous System Tumors Who Received Radiotherapy to the Head and Neck Region

Objective: The aim of this study was to assess thyroid function and lesions after radiotherapy to the head and neck region in children with Hodgkin lymphoma (HL) or central nervous system (CNS) tumors. Material and Methods: The study included children diagnosed with HL or CNS tumors who were in complete remission at least one year after completion of chemotherapy (CT) and who had all received radiotherapy (RT) to the head and/or neck. All patients were requested to undergo thyroid function tests and thyroid ultrasonography (USG). Results: A total of 37 patients were included. The mean age was 13.7±3.8 years. The mean follow-up time was 5.09±2.5 years. All patients had CT and RT. Seven (18.9%) patients had subclinical hypothyroidism, and 7 (18.9%) had thyroid USG abnormalities. None of the patients had thyroid malignancy. Age under 10 years at diagnosis, follow-up time of 3 years or more, and an RT dose of 25 Gy or more were found as effective factors for subclinical hypothyroidism development. Only an RT dose of 25 Gy or more was found to be related to thyroid USG abnormalities. Conclusion: Thyroid function tests and thyroid imaging should be routinely examined in any patient who has been treated for cancer to evaluate thyroid dysfunction regardless of clinical findings and the follow-up of these patients should be lifelong.

Enhancing radiosensitivity in triple-negative breast cancer through targeting ELOB.

Enhancing radiotherapy sensitivity is crucial for improving treatment outcomes in triple-negative breast cancer (TNBC) patients. In this study, we investigated the potential of targeting Elongin B (ELOB) to enhance radiotherapy efficacy in TNBC. Analysis of TNBC patient cohorts revealed a significant association between high ELOB expression and poor prognosis in patients who received radiation therapy. Mechanistically, we found that ELOB plays a pivotal role in regulating mitochondrial function via modulating mitochondrial DNA expression and activities of respiratory chain complexes. Targeting ELOB effectively modulated mitochondrial function, leading to enhanced radiosensitivity in TNBC cells. Our findings highlight the importance of ELOB as a potential therapeutic target for improving radiotherapy outcomes in TNBC. Further exploration of ELOB's role in enhancing radiotherapy efficacy may provide valuable insights for developing novel treatment strategies for TNBC patients.

Treatment Outcomes of Patients with Ependymoma Receiving Radiotherapy: A Single Institution Experience

Introduction: This study explored the failure pattern and clinical outcomes in patients with ependymoma undergoing radiotherapy. Methods: Between January 2004 and June 2022, we included 32 patients with ependymoma who underwent radiotherapy as part of the multimodality treatment at our institution. Of these, 27 (84.4%) underwent adjuvant radiotherapy, four received radiotherapy after local recurrence, and one received definitive CyberKnife radiotherapy (21 Gy in three fractions). The median prescribed dose was 54 Gy in patients who received conventional radiotherapy. We analyzed the local progression-free survival (LPFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), overall survival (OS), and potential prognostic factors. Results: The median age was 29.8 years. Approximately 28.1% were pediatric patients. Fifteen tumors (46.9%) were World Health Organization (WHO) grade II, 10 (31.3%) were WHO grade III, and seven (22.8%) were WHO grade I. Among them, 15 patients (46.9%) had posterior fossa tumors, 10 (31.3%) had supratentorial tumors, and seven (22.8%) had spinal tumors. Of the 31 patients who underwent upfront surgical resection, 19 (61.3%) underwent gross total resection or near-total resection. Seventeen of 19 patients with first failures (89.5%) had isolated local recurrences. Of the 19 patients with disease progression, 11 (57.9%) were disease free or had stable disease after salvage therapy, and five (26.3%) had disease-related mortality. Most of the first local recurrences after radiotherapy occurred infield (13 of 16, 81.3%). The 5-year LPFS, DMFS, PFS, and OS rates were 48.5%, 89.6%, 45.1%, and 88.4%, respectively, at a median follow-up of 6.25 years. Subtotal resection was associated with poorer LPFS and PFS in patients with intracranial ependymoma (hazard ratio = 3.69, p = 0.018, for LPFS; hazard ratio = 3.20, p = 0.029, for PFS). Conclusion: Incorporating radiotherapy into multimodal treatment has led to favorable outcomes in patients with ependymoma, and the extent of resection is a prognostic factor for the local control of intracranial ependymoma.

Incidence of Nonkeratinocyte Skin Cancer After Breast Cancer Radiation Therapy

Previous studies have suggested that radiation therapy may contribute to an increased risk of subsequent nonkeratinocyte (ie, not squamous and basal cell) skin cancers. To test the hypothesis that radiation therapy for breast cancer increases the risk of subsequent nonkeratinocyte skin cancers, particularly when these cancers are localized to the skin of the breast or trunk. This population-based cohort study used longitudinal data from the Surveillance, Epidemiology, and End Results (SEER) Program for January 1, 2000, to December 31, 2019. The SEER database includes population-based cohort data from 17 registries. Patients with newly diagnosed breast cancer were identified and were evaluated for subsequent nonkeratinocyte skin cancer development. Data analysis was performed from January to August 2023. Radiation therapy, chemotherapy, or surgery for breast cancer. The primary outcomes were standardized incidence ratios (SIRs) for subsequent nonkeratinocyte skin cancer development from 2000 to 2019 based on treatment type (radiation therapy, chemotherapy, or surgery), skin cancer site on the body, and skin cancer subtype. Among the 875 880 patients with newly diagnosed breast cancer included in this study, 99.3% were women, 51.6% were aged older than 60 years, and 50.3% received radiation therapy. A total of 11.2% patients identified as Hispanic, 10.1% identified as non-Hispanic Black, and 69.5% identified as non-Hispanic White. From 2000 to 2019, there were 3839 patients with nonkeratinocyte skin cancer, including melanoma (3419 [89.1%]), Merkel cell carcinoma (121 [3.2%]), hemangiosarcoma (104 [2.7%]), and 32 other nonkeratinocyte skin cancers (195 [5.1%]), documented to occur after breast cancer treatment. The risk of nonkeratinocyte skin cancer diagnosis after breast cancer treatment with radiation was 57% higher (SIR, 1.57 [95% CI, 1.45-1.7]) than that of the general population when considering the most relevant site: the skin of the breast or trunk. When risk at this site was stratified by skin cancer subtype, the SIRs for melanoma and hemangiosarcoma were both statistically significant at 1.37 (95% CI, 1.25-1.49) and 27.11 (95% CI, 21.6-33.61), respectively. Receipt of radiation therapy was associated with a greater risk of nonkeratinocyte skin cancer compared with chemotherapy and surgical interventions. In this study of patients with breast cancer, an increased risk of melanoma and hemangiosarcoma after breast cancer treatment with radiation therapy was observed. Although occurrences of nonkeratinocyte skin cancers are rare, physicians should be aware of this elevated risk to help inform follow-up care.

Bone loss over time and risk of osteoporosis in advanced pancreatic cancer.

Pancreatic cancer has a high risk of developing osteoporosis. However, the impact of osteoporosis has not been well-studied. This study aimed to evaluate bone loss over time and risk of osteoporosis in patients with advanced pancreatic cancer. We retrospectively examined consecutive patients with unresectable pancreatic cancer who had evaluable computed tomography before treatment and at 1-year follow-up. Bone mineral density at the first lumbar vertebra was measured on computed tomography, and osteoporosis was defined as bone mineral density <135 Hounsfield units. The prevalence and risk factors for osteoporosis, changes in bone mineral density over time and incidence of bone fractures were analyzed. Three hundred eighty patients were included. Osteoporosis was associated with older age, female sex, low body mass index and poor performance status at baseline. A consistent decrease in bone mineral density was observed over time regardless of age, sex or disease status, resulting in an increase in the prevalence of osteoporosis over time (47% at baseline, 79% at 1year, 88% at 2years, 89% at 3years, 95% at 4years and 100% at 5years). Changes in bone mineral density from baseline were greater in patients with locally-advanced pancreatic cancer, in those who received modified FOLFIRINOX or S-IROX for more than 3 months, and in those who received radiation therapy. Incident fractures developed in 45 patients (12%) during follow-up. Osteoporosis and osteoporotic fractures were highly prevalent in patients with advanced pancreatic cancer. This study highlights the importance of screening for osteoporosis in such patients.

Abstract A032: Preliminary evaluation of sleep-related patient-reported outcomes (pros), morningness-eveningness chronotype, &amp; objective sleep measures using smart wearables in a primary brain tumor patient population

Abstract Introduction: Sleep is vitally important for the improvement of cancer outcomes, but evaluation of sleep in the primary brain tumor (PBT) population is limited. This analysis aims to provide preliminary data on the consistency/reliability of sleep-related patient-reported outcomes (PROs) and to assess sleep symptom severity with both PROs and objective sleep measurements. Methods: PBT patients ³ 18 years wore a Fitbit smart-wearable device for 4 weeks, which captured objective sleep measures (total sleep time, sleep latency, nap odds/number/duration, and wake after sleep onset (WASO)). The Morningness-Eveningness Questionnaire (MEQ) was completed at baseline, PROMIS Sleep-Related Impairment (SRI) and Sleep Disturbance (SD) Short-Forms were completed at baseline and at the end of the study, and daily sleep diaries were done during the final week. Descriptive statistics were used to describe patient demographics/clinical characteristics, Cronbach’s alpha to test consistency, McNemar’s tests for change in PRO severity, and Pearson’s correlations for relationships between PROs and objective sleep measures at week 1 and week 4. Results: 54 patients (median 46 years (24-71), 56% male, 85% white non-Hispanic, 81% KPS ≥ 90) completed the study. Most had anaplastic astrocytoma (20%) or glioblastoma (17%), had received radiation therapy (83%), had prior tumor recurrence (32%), and were not on active treatment (80%) during the study. PROMIS SRI/SD and MEQ were all consistent and reliable (Cronbach’s alpha 0.74-0.92). Fifty-six percent of patients had an intermediate sleep chronotype, 35% moderate-morning, 4% definite-morning, and only 6% moderate-evening (0% definite-evening). Moderate-severe SD and SRI were reported in 13% and 17% at baseline, and 4% (p=0.06) and 13% (p=0.69) at study exit. Co-occurrence of SD and SRI decreased from 11% to 2% (p=0.06). Fitbit-recorded measures showed a correlation at week 4 between WASO and SD (r=0.35, p=0.009), and a trend with SRI (r=0.24, p=0.08). Conclusions: This investigation shows initial evidence that sleep-related PROs are consistent and reliable in PBT patients, &amp;gt;10% of participants had significant SD and SRI, and the majority had intermediate and morningness chronotypes. Surprisingly, significant improvement in SD was reported during the study, which may be related to increased awareness of sleep patterns by the participants. Lack of sleep improvement (high SD/SRI) was associated with increased WASO, suggesting greater sleep fragmentation and potentially greater circadian vs. homeostatic sleep drive dysregulation in this population, warranting further investigation. Citation Format: Maeve M. Pascoe, Elizabeth Vera, Hope Miller, Alex Wollet, Dorela Shuboni-Mulligan, Amanda L. King, Terri S. Armstrong. Preliminary evaluation of sleep-related patient-reported outcomes (pros), morningness-eveningness chronotype, &amp; objective sleep measures using smart wearables in a primary brain tumor patient population [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A032.

Cervical Cancer With The Active And Stable PI3K/MTOR/AKT Pathway In Azerbaijan Patients

Among the reproductive cancers cervical cancer has special place, because the second most frequent cause of cancer-related death among women worldwide. The studies suggested that the PI3K/mTOR/AKT signaling pathway is associated with certain reproductive tumors. A lot of research is ongoing for understanding this pathway evidence of its role in promoting tumorigenesis and recent progress in the development of therapeutic agents that targeted PI3K/AKT. In this a single-arm study included 34 Azerbaijan population woman with HPV-negative cervical tumors. The core genes of PAM signaling pathway were analyzed using RT-PCR method. Our preliminary results suggested that tumorgenesis of HPV-negative cervical cancer patients approximately 25% associated with dysregulation of PAM signaling pathway reason which are core genes alteration. The overall survival times in the PAM-active and PAM-stable patients were not significantly varies. However, the main factor for overall survival times were treatment strategy: both PAM-active and PAM-stable patients who received radiation therapy alone had a shorter overall survival than patients who received radiation plus chemotherapy. The patients with alteration of ATK1 and mTOR genes in PAM signaling pathway had poor prognosis then patients with PIK3CA and PTEN mutation

Effectiveness of glutamine for the treatment of radiodermatitis in cancer patients: a meta-analysis of randomized controlled trials.

After receiving radiation therapy, 60%-95% of patients with cancer develop radiodermatitis, which causes pain, wound infection, and poor quality of life. Glutamine is a popular nutritional supplement for patients with cancer. Several studies examined the usefulness of glutamine for reducing radiodermatitis. However, there is still no consolidated evidence for clinical use. We searched PubMed, Embase, Cochrane Library, CINAHL PLUS, and the China Knowledge Resource Integrated Database for the relevant literature published up to March 2023, without language restrictions. Two reviewers screened, filtered, and appraised these articles independently, and their data were pooled using a random-effects model. Five randomized controlled trials (RCTs) with 218 participants were analyzed. The incidence of radiodermatitis in the glutamine group (89/110) was significantly lower than in the placebo group (99/108; risk ratio [RR], 0.90; 95% CI, 0.81-1.00; p = 0.05; I2 = 7%). The incidence of moderate to severe radiodermatitis was significantly lower in the glutamine group than in the placebo group (RR, 0.49; 95% CI, 0.32-0.76; p = 0.001; I2 = 52%). Moreover, subgroup analysis demonstrated heterogeneity (I2 = 52%) for moderate to severe radiodermatitis, the risk of which might be significantly reduced by a glutamine dose of 20-30g/day (RR, 0.60; 95% CI, 0.41-0.87; I2 = 0%). The meta-analysis indicate that glutamine might lead to a lower incidence of radiodermatitis, and that a glutamine dose of 20-30g/day might decrease the incidence of moderate to severe dermatitis. Thus, the serious impact of radiodermatitis on treatment follow-up makes the clinical use of glutamine even more important. PROSPERO number: CRD42021254394.

Primary central nervous system tumors survival in children in ten Colombian cities: a VIGICANCER report.

Primary central nervous system (CNS) tumors are the second most common cancer in children and adolescents, leading to premature death and disability. Population-based survival estimates aid decision-making in cancer control, however data on survival for primary CNS tumors in Latin America is lacking. We describe survival rates for children with primary CNS tumors treated in ten Colombian cities. We analyzed data from children and adolescents newly diagnosed with cancer between 2012 and 2021, participating in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) in ten cities in Colombia. VIGICANCER collects information on clinical outcomes from twenty-seven pediatric oncology units and conducts active follow-up every three months. VIGICANCER does not register craniopharyngiomas; we excluded intracranial germ cell tumors for this report. We used the Kaplan-Meier method to estimate the overall survival probability, stratified by sociodemographic variables, topography, WHO grading, receipt of radiation therapy, and type of surgical resection. We analyzed the prognostic capacity of variables using multivariate proportional Cox's regression, stratified by city and year of diagnosis. During the study period, VIGICANCER included 989 primary CNS tumors in 879 children and 110 adolescents. The cohort median age was 9 years; 53% of patients were males, and 8% were Afro-descendants. Most common tumors were supratentorial astrocytomas (47%), astrocytic tumors (35%), medulloblastomas (20%), ependymomas (11%), and mixed and unspecified gliomas (10%). Five-year overall survival of the entire cohort was 54% (95% CI, 51-58); for supratentorial gliomas, WHO grade I was 77%, II was 62%, III-IV was 27%, respectively, and for medulloblastoma was 61%. The adjusted hazard rate ratio for patients with WHO grade III and IV, for those with subtotal resection, for brainstem location, and for those not receiving radiation therapy was 7.4 (95% CI, 4.7-11.8), 6.4 (95% CI, 4.2-9.8), 2.8 (95% 2.1-3.8), 2.0 (95% CI, 1.3-2.8) and 2.3 (95% CI, 1.7-3.0), respectively. We found that half of Colombia's children and adolescents with primary CNS tumors survive five years, compared to 70% to 80% in high-income countries. In addition to tumor biology and location, gross total resection was crucial for improved survival in this cohort. Systematic monitoring of survival and its determinants provides empirical data for guiding cancer control policies.

Clinical analysis of 94 cases of ocular adnexal lymphomas

AbstractTo investigate the imaging manifestations and pathological features of ocular adnexal lymphoma (OALs) in order to provide relevant information for ophthalmologists. A total of 94 patients with OALs were pathologically confirmed between August 2018 and July 2023, and their demographics, location, subtype, treatment, and prognosis were retrospectively studied. 94 patients with OALs were included in this study, of whom 28 were female (29.79%) and 66 were male (70.21%). The age of the patients ranged from 21 to 80 years, with a predominance of 50–60 years (60/94); monocular onset was common (90/94), and the most site of onset was orbital (74/94), followed by conjunctiva (12/94), eyelids (4/94), vitreous (3/94), and lacrimal gland (1/94). CT and MRI can show the involvement and extent of the lesions, and the pathology of the disease is characterized by mucosa‐associated lymphoid tissue marginal zone B‐cell lymphoma (72/94), diffuse large B‐cell lymphoma (10/94), T‐cell lymphoma (4/94), mantle cell lymphoma (2/94), Burkitt's lymphoma (2/94), small lymphocytic lymphoma (2/94), and follicular lymphoma (1/94). All patients received surgical treatment, 42 patients received local radiation therapy, 35 patients received chemotherapy, 13 patients received radiation therapy and chemotherapy successively, and 3 patients received comprehensive treatment. During the follow‐up, three patients relapsed, four died, one was lost to follow‐up, and the remaining patients had stable conditions. The majority of OALs are mucosa‐associated lymphoid tissue marginal zone B‐cell lymphomas (MALT) with an excellent prognosis. It mostly occurs in people over 50 years of age and most site of the onset is orbital.

A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis.

As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster. We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline's quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale. Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as "recommended," and three guidelines were evaluated as "recommended with modifications." Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn't recommend iliac bone graft and three guidelines recommended PMMA bone cement. Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.

Oncological Safety of Skipping Axillary Lymph Node Dissection in Patients with Clinical N0, Sentinel Node-Positive Breast Cancer Undergoing Total Mastectomy

ObjectiveThis study aimed to determine whether sentinel lymph node biopsy (SLNB) alone could afford oncological outcomes comparable with axillary lymph node dissection (ALND) in patients with early breast cancer without palpable lymphadenopathy who underwent total mastectomy (TM) and were SLN-positive.MethodsThis study analyzed clinical data of 6747 patients with breast cancer who underwent TM between 2014 and 2018 in two tertiary hospitals in Korea. Overall, 643 clinical stage T1-3 N0 patients who did not receive neoadjuvant therapy and had one to two metastatic SLNs at the time of surgery were included. Propensity score matching was performed between the SLNB alone and ALND groups, adjusting for clinical T stage and number of metastatic SLNs. In total, 237 patients were allocated to each group.ResultsMean number of metastatic SLNs was 1.2 for the SLNB group and 1.6 for the ALND group. With a median follow-up of 65.0 months, 5 year disease-free survival was 90.8% for the SLNB group and 93.9% for the ALND group (hazard ratio [HR] 1.35, 95% confidence interval [CI] 0.70–2.58; p = 0.36). 5 year ipsilateral locoregional recurrence-free survival (LRRFS) was not significantly different between the two groups (95.1% and 98.3% for the SLNB and ALND groups, respectively) [HR 1.86, 95% CI 0.69–5.04; p = 0.21]. In the SLNB group, patients who received radiation therapy (RT) showed superior 5 year LRRFS than patients who did not receive RT (100% vs. 92.9%; p = 0.02).ConclusionCollectively, our findings suggest that SLNB could afford comparable outcomes to ALND in patients with early breast cancer and one to two metastatic SLNs who underwent TM. Importantly, RT could decrease locoregional recurrence in patients who underwent SLNB alone.

Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States.

Medicaid expansion (ME) impacted patients when assessed at a national level. However, of the 32 states in which Medicaid expansion occurred, only 3 were Southern states. Whether results apply to Southern states that share similar geopolitical perspectives remains elusive. We aimed to assess the impact of ME on pancreatic ductal adenocarcinoma (PDAC) treatment in eight Southern states in the USA. We identified uninsured or Medicaid patients (age 40-64 years) diagnosed with PDAC between 2011 and 2018 in Southern states from the North American Association of Central Cancer Registries-Cancer in North America (NAACCR-CiNA) research dataset. Medicaid-expanded states (MES; Louisiana, Kentucky, and Arkansas) were compared with non-MES (NMES; Tennessee, Alabama, Mississippi, Texas, and Oklahoma) using multivariate logistic regression. P < 0.05 was considered statistically significant. Among 3036 patients, MES significantly increased odds of Medicaid insurance by 36%, and increased proportions of insured Black patients by 3.7%, rural patients by 3.8%, and impoverished patients by 18.4%. After adjusting for age, race, rural-urban status, poverty status, and summary stage, the odds of receiving radiation therapy decreased by 26% for each year of expansion in expanded states (P = 0.01). Last, ME did not result in a significant difference between MES and NMES in diagnosing early stage disease (P = 0.98) nor in receipt of chemotherapy or surgery (P = 0.23 and P = 0.63, respectively). ME in Southern states increased insurance access to traditionally underserved groups. Interestingly, ME decreased the odds of receiving radiation therapy yearly and had no significant impact on receipt of chemotherapy or surgery.

ИССЛЕДОВАНИЕ РЕМИНЕРАЛИЗАЦИИ ТВЕРДЫХ ТКАНЕЙ ЗУБОВ У ПАЦИЕНТОВ ПОСЛЕ ЛУЧЕВОЙ ТЕРАПИИ ПО ПОВОДУ НОВООБРАЗОВАНИЙ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ МЕТОДОМ РАМАН-ФЛЮОРЕСЦЕНЦИИ

Subject. Mineralization of hard dental tissues and its correction in patients after radiation therapy for malignant neoplasms.&#x0D; Objectives. To develop a method for remineralization of hard dental tissues in patients after radiation therapy for neoplasms of the maxillofacial area using Raman fluorescence spectroscopy.&#x0D; Methodology. The study was conducted on a group of people who had previously received radiation therapy for malignant neoplasms of the head and neck, matched by gender and age, who voluntarily agreed to take part in it. The main group consisted of 20 people who underwent the proposed remineralization complex. Comparison group – without using the proposed complex. A study of Raman fluorescence of teeth was carried out using the InSpectrum computer in three areas (neck, equator, incisal edge) in patients before and after correction.&#x0D; Results. Raman fluorescence diagnostics of the tooth surface made it possible to clearly see the difference in mineralization in digitized indicators. The data for patients in the main group after correction of mineralization (y = 304, x = 963 cm-1) are higher than for patients in the comparison group (y = 287, x = 963 cm-1).&#x0D; Conclusion. In different areas of the tooth surface, the level of mineralization of hard tissues differs: neck (216 ± 0.019, x = 963 cm-1), equator (389 ± 0.024, x = 963 cm-1), cutting edge (282 ± 0.016, x = 963 cm-1). The Raman fluorescence diagnostic method allows you to monitor changes in mineralization. &#x0D; The developed method of remineralization of hard dental tissues in patients after radiation therapy for neoplasms of the maxillofacial area using Raman fluorescence spectroscopy makes it possible to influence mineralization and is recommended for further research to prevent the development of radiation caries

Clinical Characteristics of Primary Thyroid Lymphoma

Background and Objectives Primary thyroid lymphoma is rare in thyroid cancer and also in extranodal lymphoma. As such, there has been only a few studies done on this rare disease, and this study evaluated its clinical characteristics and prognosis.Subjects and Method A retrospective review was conducted on 18 patients who were treated for primary thyroid lymphoma between January 2006 and December 2021. We investigated clinical, radiologic, pathologic findings, treatment modalities and prognosis.Results The study involved 18 patients, all of whom were confirmed through histopathological assessments via thyroidectomy (5/18), core needle biopsy (12/18), and incisional biopsy (1/18). Among these, three patients were male, while 15 were female, with a mean age of 66.4±8.78 (49-82). The most common symptom was a palpable neck mass (8/18). The most common pathologic type was diffuse large B cell lymphoma (9 patients), followed by mucosaassociated lymphoid tissue lymphoma (6 patients). At the time of diagnosis, 3 (20.0%) 8 (53.3%), 0, and 4 (26.7%) number of patients were found in Stage I, II, III and IV, respectively. Twelve patients received chemotherapy and three patients received radiation therapy. Three patients were lost to follow-up without treatment.Conclusion Primary thyroid lymphoma should be included in differential diagnosis when making a diagnosis for rapid growing thyroid nodule. Core needle biopsy is considered as first line pathologic diagnostic tool due to limitation of fine needle cytology.

Clinical Profile and Outcome of Adult Classical Hodgkin's Lymphoma: Real World Single Centre Experience.

Hodgkin's lymphoma treatment outcomes have been the true success story of modern medicine. Various data from western as well as Indian studies are available for classical Hodgkin's lymphoma (cHL). Here we report treatment outcomes from a tertiary cancer care centre in Karnataka over a 5year period. This was a retrospective review of cHL cases aged 15years and above diagnosed between January 2015 and December 2019 at Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India. The case files of the patients were retrieved and relevant data was collected. Two hundred patients of cHL were included in this study. Median age was 28years with male to female ratio of 1.56:1. B symptoms were present in 58% cases. Mixed cellularity (46.5%) was the most common histological subtype. Majority patients had advanced stage at presentation (stage III/IV) (62.5%). Extranodal disease was present in 19.5% cases. GHSG early-favourable cases were 15.5%, early-unfavourable cases were 22.0%, while 62.5% were advanced cases. The most common chemotherapy regimen used was ABVD. Eighty-three (41.5%) patients received radiation therapy. Median follow-up was 34.2months (range 4.1-67.8). The rates for complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) were 84.5%, 8.5%, 5.0% and 2.0% respectively. PFS and OS rate at 6years were 69.5% and 84.1% respectively. HL is one of the malignancies with high cure rate. The treatment outcome at our centre is comparable to western data and data from other tertiary centres from India.

Five-Year Mortality Outcomes for Eating As Treatment (EAT), a Health Behavior Change Intervention to Improve Nutrition in Patients With Head and Neck Cancer: A Stepped-Wedge, Randomized Controlled Trial

BackgroundMalnutrition affects up to 80% of patients with head and neck cancer (HNC), and is associated with higher burden of disease, poorer treatment outcomes, and greater mortality. The Eating As Treatment (EAT) intervention is a behavioural intervention, previously demonstrated to be effective for improved nutritional status, depression and quality of life, in patients with HNC. This paper examines the impacts of the EAT intervention on five-year mortality among participants. MethodsA multi-centre stepped-wedge randomised controlled trial was conducted in five Australian hospitals. Dietitians were trained to deliver EAT, a combination of motivational interviewing and cognitive behaviour therapy strategies, to patients with HNC receiving radiation therapy. This paper describes secondary analyses of survival benefit on an intention to treat basis. Differences in proportions of 5-year all-cause mortality between control and EAT intervention arms were analysed using multivariable logistic regression and 5-year survival rates were analysed using Cox proportional hazard regression. Analyses controlled for temporal effects (study time), hospital site (clustering), and baseline nutritional status differences. ResultsOverall, there were 64 deaths in the 5 years following enrolment; 36 (24%) among those assigned to the control condition and 28 (18%) among those assigned to EAT. Logistic regression showed statistically significant reduced odds in favour of EAT (OR= 0.33, 95%CI 0.11-0.96), with an absolute risk reduction of 17%(0.01 to 0.33%), a relative risk reduction of 55% (0.22-0.92), resulting in the number needed to treat of 6 (4 -13). Survival analysis found that risk of death was significantly reduced by the EAT intervention (Hazard Ratio 0.39, 0.16-0.96). ConclusionsEAT showed a statistical and clinically meaningful survival benefit, probably via improved nutrition during radiotherapy. This survival benefit strengthens the finding of the main trial showing that a behavioural intervention focussed on nutrition could improve HNC outcomes. Replication studies using stepped-wedge designs for implementation into clinical practice may be warranted.

Abstract TP229: Stroke Rate and Associated Factors in Individuals With Primary Brain Gliomas and Brain Radiation Therapy: A Retrospective Cohort Study

Background/Objectives: The risk of stroke in individuals with brain gliomas may be increased due to several possible factors including chemotherapy, radiation-induced toxicity, and concomitant vascular risks. We report on the stroke rate and associated factors following brain tumor diagnosis and radiation therapy. Design: This is a retrospective cohort study, from a single tertiary academic brain tumor center, of patients with brain gliomas diagnosed between 2004-2021 who received brain radiation therapy during their treatment. Chi-square test was used to calculate the odds ratios. Results: Among a total of 912 patients with primary gliomas who received radiation therapy, stroke subsequently occurred in 93 patients (10.2%). Strokes were ischemic in 72.0% (N=67), intracerebral hemorrhage (ICH) in 25.8% (N=24), and subarachnoid hemorrhage in 2.2% (N=2). Individuals who sustained a stroke were 44.1% female and had a mean age of 54.2 years (range 21-84) at the time of stroke diagnosis. Of those who had a stroke, 64.5% (N=60) were also taking bevacizumab at the time of stroke. Median time from initiation of radiation therapy to stroke was 653 days (range 0-3788). Median radiation dose was 5940 cGy (range 1800-6000). The following factors were associated with a higher odd of having a stroke: radiation necrosis (OR 4.51; 95% CI 1.98-10.29, P=0.0003); hypertension (OR 1.82; 95% CI 1.17-2.82, P=0.008); hyperlipidemia (OR 5.50; 95% CI 3.45-8.78, P&lt;0.0001); and diabetes (OR 2.19; 95% CI 1.25-3.84, P=0.007). Among stroke patients, 80.6% had strokes on the same side as radiation therapy. Those who were taking bevacizumab were more likely to have an ICH (31.7% vs. 15.1%, OR 2.60, 95% CI 0.87-7.77, P=0.09) as compared to other stroke types. Conclusions: Individuals with primary brain gliomas undergoing radiation therapy who were subsequently diagnosed with a stroke had higher rates of comorbid vascular risk factors and radiation necrosis.