A.L. Holtzman

Knowledge and Attitudes toward Hookah Usage among University Students.

Abstract Objective: Hookah smoking is a popular form of tobacco use on university campuses. This study documented use, attitudes, and knowledge of hookah smoking among college students. Participants: The sample included 943 university students recruited between February 2009 and January 2010. Respondents (M age = 20.02) included 376 males, 533 females, and 34 who did not report sex. Methods: An anonymous online questionnaire was completed by respondents. Results: In this sample, 42.9% of college students had tried hookah, and 40% of those individuals had used it in the past 30 days. Students perceived fewer negative consequences of hookah smoking compared with cigarette smoking. Age, sex, racial background, marijuana/cigarette use, and perceptions of side effects were significantly associated with hookah use. Conclusions: University students are misinformed regarding the health consequences of hookah smoking. Programs aimed at education, prevention, and intervention for hookah use are needed to address this growing public health concern.

Proton therapy in a pediatric patient with stage III Hodgkin lymphoma

Standard of care treatment for pediatric patients with stage III Hodgkin lymphoma (HL) is chemotherapy with involved-fi eld radiotherapy (IFRT) reserved for patients receiving less-intensive chemotherapy regimens or with incomplete or slow responses to chemotherapy [1]. Unfortunately, HL survivors are at a very high risk of long-term side effects from their defi nitive treatment [2 – 9]. As these sequelae are a function of exposure to both chemotherapy and radiotherapy, investigators seek ways to reduce damage to normal tissue [1,9,10]. Although researchers have demonstrated the dosimetric advantages of using intensity-modulated radiation therapy (IMRT) and proton therapy (PT) in patients with stage I/II HL [6], to our knowledge, no study has evaluated their use in patients with advanced-stage HL. The present presentation investigates dose reduction to the organs at risk (OAR) with IMRT and PT in a pediatric patient with stage III HL treated at the University of Florida Proton Therapy Institute (UFPTI).

Proton therapy to the subdiaphragmatic region in the management of patients with Hodgkin lymphoma.

Abstract Twelve consecutive patients with classical Hodgkin lymphoma (HL) involving diaphragmatic or subdiaphragmatic regions were treated on an institutional review board-approved outcomes tracking protocol. All patients underwent treatment with proton therapy following chemotherapy and had comparative three-dimensional conformal photon radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) plans to evaluate differences in dose to organs at risk (OARs). Among the cohort, stomach doses with 3DCRT, IMRT and proton therapy were 21 Gy (median), 14 Gy and 6 Gy, respectively. Median dose reductions with proton therapy compared with 3DCRT and IMRT were 13 Gy (p = 0.0022) and 8 Gy (p = 0.0022) for the stomach. Additionally, there was significant dose reduction using proton therapy for the liver, pancreas, bowel, left kidney and right kidney. Proton therapy reduces the dose to the stomach, liver, pancreas, small bowel and kidneys compared with 3DCRT or IMRT in patients with HL requiring abdominal radiotherapy. These dose reductions are expected to translate into lower risks of secondary cancers and other late toxicities in survivors of HL.

Advancing the Therapeutic Index in Stage III/IV Pediatric Hodgkin Lymphoma with Proton Therapy

Abstract Purpose: Hodgkin lymphoma (HL) survivors are susceptible to long-term side effects from definitive treatment with combination chemotherapy and radiation therapy (RT). Because late effects from RT correlate to radiation treatment volume, stage III/IV pediatric HL requiring large radiation fields are at greater risk for late complications. This study investigates the dosimetric impact of proton therapy (PT) to spare the organs at risk (OARs) in stage III and IV HL. Patients and Methods: From October 2011 through January 2014, 7 pediatric patients with stage III or IV HL involving both supradiaphragmatic and infradiaphragmatic underwent treatment planning with 3-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), and PT to a dose of 21 Gy after ABVE-PC chemotherapy. Plans were normalized to meet treatment parameters including target coverage and dose to OARs. Results: All 7 patients were treated with PT. PT had the lowest integral body dose (101 J; range, 5...

Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or High-Intensity Focused Ultrasound

PURPOSE Local recurrence of prostate cancer after cryosurgery (CS) and high-intensity focused ultrasound (HIFU) is an emerging problem for which optimal management is unknown. Proton therapy (PT) may offer advantages over other local therapeutic options. This article reviews a single institutions experience using PT for salvage of local recurrent disease after HIFU or CS. METHODS AND MATERIALS We reviewed the medical records of 21 consecutive patients treated with salvage PT following a local recurrence of prostate cancer after CS (n=12) or HIFU (n=9) between January 2007 and July 2014. Patients were treated to a median dose of 74 Gy(relative biological effectiveness [RBE]; range: 74-82 Gy[RBE]) and 8 patients received androgen deprivation therapy with radiation therapy. Patients were evaluated for quality of life (QOL) by using the Expanded Prostate Index Composite questionnaire and toxicity by using Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment, every 6 months for 2 years after treatment, and then annually. RESULTS Median follow-up was 37 months (range: 6-95 months). The 3-year biochemical progression-free survival (bPFS) rate was 77%. The 3-year grade 3 toxicity rate was 17%; however, 2 of these patients had pre-existing grade 3 GU toxicities from their HIFU/CRYO prior to PT. At 1 year, bowel summary, urinary incontinence, and urinary obstructive QOL scores declined, but only the bowel QOL score at 12 months met the minimally important difference threshold. CONCLUSIONS PT achieved a high rate of bPFS with acceptable toxicity and minimal changes in QOL scores compared with baseline pre-PT functions. Although most patients have done fairly well, the study size is small, follow-up is short, and early results suggest that outcomes with PT for salvage after HIFU or CS failure are inferior to outcomes with PT given in the de novo setting with respect to disease control, toxicity, and QOL.

Outcomes after primary or adjuvant radiotherapy for salivary gland carcinoma

Abstract Background: We report long-term outcomes of patients treated with primary radiotherapy (RT) or surgery and adjuvant RT for salivary gland malignancies. Materials and methods: From 1964 to 2012, 291 patients received primary RT (n = 67) or RT combined with surgery (n = 224). Results: The 5-, 10-, and 15-year local control, local-regional control, distant metastasis-free survival, cause-specific survival and overall survival rates were 82%, 77% and 73%; 77%, 72% and 67%; 74%, 70% and 70%; 70%, 59% and 54%; and 63%, 47% and 38%, respectively. Per multivariate analysis, combined surgery and RT and T stage impacted local control; overall stage and combined surgery and RT impacted local-regional control; overall stage impacted distant metastasis-free survival; and overall stage, node positivity, clinical nerve invasion, and surgery and RT impacted cause-specific and overall survival. Five percent of patients experienced grade 3 or worse toxicity. Conclusion: Combined surgery and RT improves local control, local-regional control, and cause-specific survival compared with primary RT for salivary tumors.

Implementation of depression and anxiety screening in patients undergoing radiotherapy

Anxiety and depression are disabling, underdiagnosed issues that affect the management of oncology patients. Until recently, there has been no standard protocol for screening and treating these ailments at our cancer centre. The purpose of this institutional review board-approved study was to analyse the implementation of a screening tool in our clinical workflow with the aim of screening over 90% of patients and increasing referrals to mental health services by 50%.

Letter to the Editor in response to Hopper et al, “Salvage therapy for locally recurrent prostate cancer after radiation”

We read with great interest the article by Hopper et al on salvage image guided radiation therapy after failure of cryotherapy among 8 patients with prostate cancer with no acute grade 2 toxicities. As the authors note, radiation therapy for salvage of a local recurrence after cryotherapy yields acceptable disease control rates and relatively low toxicity or additional morbidity. However, even though salvage radiation therapy may provide minimal increased toxicity, cryotherapy followed by radiation therapy can result in more toxicity and worse disease control than upfront curative-intent radiation therapy. In our experience, patients who received upfront cryotherapy suffered higher rates of grade 3 toxicities that were directly attributable to the cryosurgical procedure and lower rates of biochemical control compared with patients who received upfront radiation therapy. Among >1000 men with prostate cancer who were treated with upfront radiation therapy at our institution, the cumulative incidence for all grade 3 toxicities was 5%, compared with a toxicity rate approaching 17% in patients who had received either cryosurgery or high-intensity focal ultrasound before image guided radiation therapy. Rather than debate or focus on the role of advancing technology, we should consider the toxicities that result from cryotherapy in addition to those after radiation therapy. Although salvage radiation therapy provides acceptable biochemical control rates and minimal additional toxicity, it is important to remember that primary radiation therapy provides excellent oncologic control without the morbidity associated with cyrotherapy.