Ashley Albert

Upcoming imaging concepts and their impact on treatment planning and treatment response in radiation oncology

For 2018, the American Cancer Society estimated that there would be approximately 1.7 million new diagnoses of cancer and about 609,640 cancer-related deaths in the United States. By 2030 these numbers are anticipated to exceed a staggering 21 million annual diagnoses and 13 million cancer-related deaths. The three primary therapeutic modalities for cancer treatments are surgery, chemotherapy, and radiation therapy. Individually or in combination, these treatment modalities have provided and continue to provide curative and palliative care to the myriad victims of cancer.Today, CT-based treatment planning is the primary means through which conventional photon radiation therapy is planned. Although CT remains the primary treatment planning modality, the field of radiation oncology is moving beyond the sole use of CT scans to define treatment targets and organs at risk. Complementary tissue scans, such as magnetic resonance imaging (MRI) and positron electron emission (PET) scans, have all improved a physician’s ability to more specifically identify target tissues, and in some cases, international guidelines have even been issued. Moreover, efforts to combine PET and MR to define solid tumors for radiotherapy planning and treatment evaluation are also gaining traction.Keeping these advances in mind, we present brief overviews of other up-and-coming key imaging concepts that appear promising for initial treatment target definition or treatment response from radiation therapy.

Racial disparities in tumor features and outcomes of patients with squamous cell carcinoma of the tonsil: Racial Disparities in Tonsillar Cancer

To identify differences in 3‐year overall survival (OS) and disease‐free survival (DFS) based on race in patients with tonsillar squamous cell carcinoma.

Impact of age on receipt of curative treatment for cervical cancer: an analysis of patterns of care and survival in a large, national cohort

PURPOSEnDisparities in the receipt of standard of care based on age have been identified for several types of cancer including cervical cancer. The purpose of this study is to analyze patterns of care and survival for older patients receiving definitive treatment in a large, national cohort.nnnMATERIALS AND METHODSnThe National Cancer Database was queried for patients with FIGO/AJCC IB2-IVA cervical cancer diagnosed from 2004 to 2014 who underwent definitive radiation or concurrent chemoradiation. Standard of care was defined as concurrent chemotherapy with external beam radiation and brachytherapy to a total dose ≥70u202fGy. Multivariable logistic regression was used to determine factors associated with the receipt of standard of care. Multivariable Cox regression was used to determine covariables associated with differences in overall survival.nnnRESULTSn24,126 patients met inclusion criteria including 4052 women 61-70u202fyears old, 2471 women 71-80u202fyears old, and 1325 women over 80u202fyears old. A smaller percentage of patients over age 60 received standard of care compared to younger aged patients. On multivariable analysis, older patients were less likely to be treated with standard of care. On multivariable Cox regression, ages 71-80 (HR 1.25, 95% CI-1.16-1.36, pu202f<u202f.001) and ageu202f>u202f80 (HR 1.90, 95% CI 1.73-2.07, Pu202f<u202f.001) were associated with decreased overall survival. On subgroup analysis for patients with significant comorbidities, treatment with standard of care resulted in increased 5-year OS as compared to incomplete treatment.nnnCONCLUSIONSnAge was found to be an independent predictor for the receipt of standard of care treatment for cervical cancer.

Saving the hand: role of multimodality therapy for Ewing's sarcoma family tumor of the palm

The Ewing’s sarcoma family of tumors (EFTs) are a rare subtype of tumor that include primitive neuroectodermal tumors (PNETs), typical Ewing’s sarcoma, and atypical Ewing sarcoma. EFTs of the hand are extremely rare, and none have been reported to our knowledge beyond the fifth decade of life. EFTs present most frequently in the second decade of life and have a male predominance. Multimodality therapy is typically used to treat patients. We present a case that is unique for several reasons. First, this patient presented in the sixth decade of life, which is later than most cases. Second, treatment included an amputation-sparing resection followed by adjuvant radiation therapy with electron beams. The patient was left with complete functionality of the hand and remained free of recurrent disease 4 years later.

Adjuvant treatment of meningioma with stereotactic radiation surgery and hypofractionated stereotactic radiation surgery: Patterns of care and survival in a large, hospital database

Objectives Stereotactic radiation surgery (SRS) and hypofractionated stereotactic radiation surgery (HF-SRS) have become an alternative to external beam radiation therapy (EBRT) in the adjuvant treatment of meningiomas. The purpose of this study was to identify national treatment patterns and survival outcomes for meningiomas on the basis of radiation treatment modality in the adjuvant setting. Methods and materials The National Cancer Database was queried for patients with meningioma diagnosed between 2010 and 2012. World Health Organization grade I disease with subtotal resection and all cases of grade II disease regardless of the extent of the resection were included. Logistic regression was used to determine factors that were associated with receipt of SRS/HF-SRS compared with EBRT. Cox regression was used to determine covariables associated with differences in overall survival (OS). Results A total of 802 patients met the inclusion criteria of which 173 patients received SRS/HF-SRS (22%) and 629 patients (78%) received EBRT. The 3-year OS rate was 97.3% for the SRS/HF-SRS group and 93.4% for the EBRT group (Pu2009=u2009.018). On subgroup analysis by grade, for grade I the 3-year OS rate was 98.3% for the SRS/HF-SRS group versus 96.7% for the EBRT group (Pu2009=u2009.117). For grade II disease, the 3-year OS rate was 94.4% in the SRS/HF-SRS group versus 92.4% in the EBRT group (Pu2009=u2009.199). On multivariable analysis, World Health Organization grade II histology (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.21-0.56; Pu2009<u2009.001) and gross total resection (OR: 0.29; 95% CI, 0.15-0.57; Pu2009<u2009.001) were associated with a decreased likelihood of receiving SRS/HF-SRS but private insurance (OR: 8.89; 95% CI, 1.15-68.47; Pu2009=u2009.036) and Medicare (OR: 10.03; 95% CI, 1.28-78.69; Pu2009=u2009.028) were associated with an increased likelihood of receiving SRS/HF-SRS. Year of diagnosis was not associated with receipt of SRS/HF-SRS. The multivariable Cox regression demonstrated a trend toward improved OS for treatment with SRS/HF-SRS (hazard ratio: 0.24; 95% CI, 0.06-1.03; Pu2009=u2009.055). Conclusions SRS and HF-SRS are associated with similar survival as EBRT; however, SRS/HF-SRS is used infrequently and usage has not increased over time.

Pneumocephalus after the Treatment of an Inoperable Superior Sulcus Tumor with Chemoradiation

Background Pneumocephalus is a rare phenomenon that can occur as a complication after operations involving the thoracic discs, following thoracotomy for tumor resection, and after an intracranial operation or cranial trauma. This complication frequently occurs when a tumor is located in the costovertebral angle and an operative intervention creates a tear in the dura resulting in a pleural-dural fistula. Case Presentation We describe the case of a 58-year-old man with an inoperable superior sulcus tumor who developed pneumocephalus after the initiation of chemoradiation secondary to a pleural-dural fistula. Conclusions Although a rare occurrence, pneumocephalus should be considered when patients with tumors in the superior sulcus treated with radiation develop neurologic symptoms characteristic of increased intracranial pressure.