Andrew Farach

Treatment Outcomes and Prognostic Factors in Male Patients With Stage IV Breast Cancer: A Population-based Study

Micro‐Abstract Male breast cancer is a rare disease, and limited data exists regarding metastatic male breast cancer. To better characterize this population, we used the Surveillance, Epidemiology, and End Results database to examine prognostic factors that affected survival outcomes. On multivariate analysis, patients with progesterone receptor‐positive disease, younger age (≤ 65 years), tumor size ≤ 2 cm, or who had undergone surgery of the primary tumor had better overall survival and cause‐specific survival. Purpose: Male breast cancer (MBC) represents < 1% of breast cancer patients, and limited data exists regarding metastatic MBC. To better characterize this patient subset, we performed a population‐based study examining prognostic factors among patients with stage IV MBC. Methods: Patients with stage IV MBC diagnosed between 1988 and 2012 were selected from the Surveillance, Epidemiology, and End Results database. Prognostic factors for overall survival (OS) and cause‐specific survival (CSS) were evaluated. Results: Overall, 394 patients had metastatic disease meeting inclusion criteria. The median follow‐up was 21 months. The 5‐year OS and CSS rates were 21.1% and 38.3%, respectively. Of those with known progesterone receptor (PR) status, 52% were PR‐positive, which was associated with better OS (P < .001) and CSS (P = .003). Overall, 197 patients (50%) received surgery for the primary tumor, and 197 (50%) did not. Patients undergoing surgery had longer median CSS than those who did not (36 vs. 21 months; P < .001). Additional factors that correlated with prolonged OS and CSS were smaller tumor size (≤ 2 cm; P < .05) and younger age (≤ 65 years; P < .05). In multivariate analysis, smaller tumor size, PR‐positivity, younger age, and resection of the primary tumor were associated with longer OS and CSS (P < .05). Conclusions: Although stage IV MBC has poor OS and CSS, patients with PR‐positive disease, younger age (≤ 65 years), tumor size ≤ 2 cm, or who undergo surgery of the primary tumor have better OS and CSS. This is the largest study of stage IV MBC to date, and these findings address some of the questions regarding this rare presentation of breast cancer.

Stereotactic body radiation therapy versus conventionally fractionated radiation therapy for early stage non-small cell lung cancer

PURPOSE To date, no published randomized trials have shown stereotactic body radiation therapy (SBRT) to offer superior outcomes to conventionally fractionated radiation therapy (CFRT) for early-stage non-small cell lung cancer (NSCLC). The largest study to date, this investigation of a contemporary national database sought to evaluate practice patterns and survival between CFRT and SBRT. METHODS The National Cancer Database was queried (2004-2015) for histologically-confirmed cT1-2aN0M0 NSCLC undergoing definitive CFRT or SBRT. Multivariable logistic regression ascertained factors associated with SBRT administration. Kaplan-Meier analysis evaluated overall survival (OS) before and following propensity matching. Cox proportional hazards modeling determined variables associated with OS. RESULTS Of 23,088 patients, 2286 (10%) patients received CFRT and 20,802 (90%) SBRT. SBRT was less often delivered in African-Americans, patients with lower incomes, urban location, greater comorbidities, at non-academic centers, in larger tumors, and squamous histology (p < 0.05 for all). Patients treated with SBRT had a higher median OS (38.8 months vs. 28.1 months, p < 0.001). At median follow-up of 44.6 months, the median OS for the SBRT group was 38.8 months, versus 28.1 months for CFRT (p < 0.001). These findings persisted following propensity matching. Subgroup analyses demonstrated improved OS in multiple subcohorts (T2, Charlson comorbidity score 2-3, squamous histology). SBRT was also independently associated with OS on Cox multivariate analysis (p < 0.001). CONCLUSIONS The largest such study to date (comprising of over 23,000 patients), this investigation demonstrates the survival benefit to ablative radiotherapy for early-stage NSCLC. Maturation of comparative prospective trials is eagerly awaited.

A rare presentation of choroidal metastasis from primary esophageal adenocarcinoma successfully treated with intensity-modulated radiation therapy

Purpose In this case report, we present a case of choroidal metastasis from a primary esophageal adenocarcinoma that was treated successfully with intensity-modulated radiation therapy. Observations A 65-year-old male with known stage IV esophageal adenocarcinoma presented with a central scotoma in his left eye and was ultimately found to have a large choroidal metastatic lesion with overlying subretinal fluid. IMRT was administered over the course of four weeks, resulting in restoration of the patients vision, regression of the metastatic lesion, and resolution of the subretinal fluid. As of 16 months following completion of radiation, there remains no evidence of choroidal recurrence or radiation-associated ocular complications. Conclusions and Importance: To our knowledge, this is the first published case report of a choroidal metastasis from esophageal cancer responding durably to IMRT. IMRT should therefore be considered a viable treatment option for this rare disease.

The Role of Combined Radiation and Immunotherapy in Breast Cancer Treatment

BackgroundInterest in harnessing the power of the host immune system to combat breast cancer recently has gained significant momentum. A growing body of evidence suggests that combined radiation therapy (RT) and immunotherapy synergistically activate a systemic immune response.MethodsA review of original research, pre-clinical, retrospective, and prospective clinical studies was performed to assess the existing evidence to support a role for combined immunoradiotherapy in the treatment of breast cancer.ResultsSubstantial evidence supports a synergism in combined immunoradiotherapy approaches. In this role, RT serves not only as a potent mediator of local control but also as an important component of systemic disease control. Actively accruing clinical trials aim to further define the clinical impact of immunoradiotherapeutic approaches in breast cancer.ConclusionsThis review provides an overview of the interplay between RT and emerging oncoimmunotherapy strategies and provides a biological explanation for their synergy in the treatment of breast cancer. More robust nationally funded studies are indicated.