John A. Cox

Current modalities of accelerated partial breast irradiation

The benefits of adjuvant whole-breast irradiation (WBI) after breast-conserving surgery are well established and WBI is a standard of care. In selected patients with early stage breast cancer, accelerated partial breast irradiation (APBI) has emerged as an alternative treatment option to WBI. Early trials of APBI have demonstrated an excellent local control rate and an associated good-to-excellent cosmetic outcome. APBI can reduce both the treatment volume and overall treatment time of adjuvant radiation therapy, which potentially overcomes logistical barriers associated with WBI that have previously prevented eligible women from pursuing breast-conserving therapy. Likewise, the addition of new modalities for APBI delivery has increased the number of patients who might be eligible for this adjuvant treatment—in the setting of breast-conserving surgery—despite the limited availability of long-term data on APBI outcomes compared to historical WBI outcomes. Ongoing phase III trials aim to compare APBI with WBI and also point the practitioner to the appropriate APBI patient selection criteria. Here, we review available modalities, patient selection criteria and consensus guideline recommendations, and current controversies in APBI.

Cost analysis of adjuvant management strategies in early stage (stage I) testicular seminoma

Background Acceptable post-orchiectomy adjuvant therapy strategies for stage I seminoma patients include surveillance, para-aortic radiation therapy (RT), dog-leg RT, and a single cycle of carboplatin. The required follow-up recommendations were amended by the National Comprehensive Cancer Network (NCCN) in 2012. Given a cause-specific survival of nearly 100%, a closer analysis of the reimbursement for each treatment strategy is warranted. Methods NCCN guidelines were used to design treatment plans for each acceptable adjuvant treatment strategy. Follow-up charges were generated for 10 years based on 2012 (version 1.2012; unchanged in current version 1.2013) and 2011 NCCN (version 2.2011) surveillance recommendations. The 2012 Medicare reimbursement rates were used to calculate each treatment strategy and incremental cost-effectiveness ratios to compare the treatment options. Results Under the current NCCN follow-up recommendations, the total reimbursements generated over 10 years of surveillance, para-aortic RT, dog-leg RT, and carboplatin were

Single-fraction radiotherapy for palliation of myelofibrosis-related extremity pain syndrome.

10,643,

Cost analysis of adjuvant management strategies in early-stage testicular seminoma.

11,678,

Pleomorphic Lobular Carcinoma of the Breast: A Review of 35 Cases at a Single Institution

9,662, and

Multimodality treatment of locally advanced penile cancer: A contemporary dosimetric comparison and case presentation.

10,405, respectively. This is compared with the reimbursements as per the 2011 NCCN recommendations:

Improved human observer performance in digital reconstructed radiograph verification in head and neck cancer radiotherapy.

20,986,

Accelerated Partial Breast Irradiation Using the Strut-Adjusted Volume Implant: A Single-Institution Review of Toxicity and Cosmetic Outcome

11,517,

Cost Analysis of Alternative Treatment Modalities Utilized in the Management of Early-Stage Testicular Seminoma

9,394, and

Do We Need Intensity-Modulated Radiation Therapy (IMRT) Routinely in the Preoperative Setting for Rectal Cancer?

20,365 respectively. Factoring the rates of relapse into a salvage model, observation was found to be more costly and less effective (