A.M. Chhabra

Utilization of hypofractionated whole-breast radiation therapy in patients receiving chemotherapy: a National Cancer Database analysis

PurposeResults from four major hypofractionated whole-breast radiotherapy (HF-WBRT) trials have demonstrated equivalence in select patients with early-stage breast cancer when compared with conventionally fractionated WBRT (CF-WBRT). Because relatively little data were available on patients receiving neoadjuvant or adjuvant chemotherapy, consensus guidelines published in 2011 did not endorse the use of HF-WBRT in this population. Our goal is to evaluate trends in utilization of HF-WBRT in patients receiving chemotherapy.Methods and materialsWe retrospectively analyzed data from 2004 to 2013 in the National Cancer DataBase on breast cancer patients treated with HF-WBRT who met the clinical criteria proposed by consensus guidelines (i.e., agexa0>0xa0years, T1-2N0, and breast-conserving surgery), regardless of receipt of chemotherapy. We employed logistic regression to delineate and compare clinical and demographic factors associated with utilization of HF-WBRT and CF-WBRT.ResultsA total of 56,836 women were treated with chemotherapy and WBRT (without regional nodal irradiation) from 2004 to 2013; 9.0% (nxa0=xa05093) were treated with HF-WBRT. Utilization of HF-WBRT increased from 4.6% in 2004 to 18.2% in 2013 (odds ratio [OR] 1.21/year; Pxa0<xa00.001). Among patients receiving chemotherapy, factors most dramatically associated with increased odds of receiving HF-WBRT on multivariate analysis were academic facilities (OR 2.07; Pxa0<xa00.001), agexa0>80 (OR 2.58; Pxa0<xa00.001), west region (OR 1.91; Pxa0<xa00.001), and distancexa0>50 miles from cancer reporting facility (OR 1.43; Pxa0<xa00.001). Factors associated with decreased odds of receiving HF-WBRT included white race, incomexa0<

The expanding role of stereotactic body radiation therapy for pancreatic cancer: a review of the literature

48,000, lack of private insurance, T2 versus T1, and higher grade (all Pxa0<xa00.02).ConclusionsDespite the absence of consensus guideline recommendations, the use of HF-WBRT in patients receiving chemotherapy has increased fourfold (absolutexa0=xa013.6%) over the last decade. Increased utilization of HF-WBRT should result in institutional reports verifying its safety and efficacy.

Long-term outcomes analysis of low-dose-rate brachytherapy in clinically T3 high-risk prostate cancer

Pancreatic cancer is an aggressive malignancy for which surgical resection with negative margins provides the only chance of long-term survival. Unfortunately, fewer than 20% of newly diagnosed pancreatic cancer patients are eligible for surgery due to advanced local and/or distant disease. Historically, patients ineligible for surgery have received chemotherapy with or without conventionally fractionated external beam radiation therapy (RT). Stereotactic body radiation therapy (SBRT) has emerged as a viable alternative strategy for locally advanced pancreatic cancer (LAPC) based on multiple institutional reports showing enhanced local control rates, minimal toxicity, and reduced treatment times. The use of SBRT for borderline resectable and postoperative patients is promising and deserves further prospective evaluation.

Improving Outcomes through Immune System Modulation in the Treatment ofGynecological Malignancies

PURPOSEnThe available data demonstrating that superiority of LDR brachytherapy (LDR-BT) boost in high-risk prostate cancer patients under represents patients with extracapsular extension (T3a) and/or seminal vesicle invasion (T3b) have been limited. We report long-term clinical outcomes data for patients with cT3a/b disease receiving LDR-BT.nnnMETHODS AND MATERIALSnNinety-nine men (median age: 69.4xa0years) with cT3a/bN0M0 high-risk prostate adenocarcinoma received definitive LDR-BT or LDR-BT boost after external beam radiation therapy (EBRT) at a single institution between 1998 and 2007. About 86% of patients received androgen deprivation therapy. Freedom from biochemical failure (FFBF), prostate cancer-specific survival (PCSS), and overall survival (OS) was calculated using the Kaplan-Meier method with the Phoenix definition used as definition of failure. Cox regression analysis was used to compare outcomes between clinical stage, initial PSA, Gleason Score, and percent core positive rate.nnnRESULTSnWith a median followup of 7xa0years, 7-year rate of FFBF, PCSS, and OS for the entire cohort was 65.2% (±5.6%), 90.1% (±3.6%), and 77.9% (±4.7%), respectively. LDR-BT boost patients achieved a 7-year FFBF rate of 73.5 (±6.5%). No significant difference in outcomes was present between T3a or T3b disease, Gleason score, iPSA stratification and percent core positive rates.nnnCONCLUSIONSnLDR-BT, primarily as a boost in conjunction with ADT and EBRT, is not only feasible, but also highly effective in men with cT3a and cT3b high-risk prostate cancer resulting in excellent biochemical control and survival outcomes. LDR-BT boost implantation of patients should be strongly considered for cT3 patients given the merits of trimodality care.

The Downstream “Halo” Effect of a Proton Therapy Center on an Academic Medical Center

The treatment of gynecological cancers continues to evolve with combination of different therapies. There has been a significant effort to induce stimulation of the immune system through treatment with interferons and interleukins in the past. More recently, the remarkable results of clinical trials demonstrating efficacy of checkpoint inhibitor immunotherapies in multiple cancer types has generated considerable interest within the gynecological community. Here, we review the findings of efforts to augment the humoral immune system and review the pre-clinical and clinical evidence for checkpoint inhibitors. The Abscopal effect, a phenomenon whereby localized radiation therapy results in immune mediated tumor regression in distant sites is currently also discussed in the context of gynecological cancers. The combination of various immunotherapies in gynecological cancer and emerging clinical evidence for the combinations may lead to improved treatment outcomes.