L.A. McGee

Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer

PURPOSE This study evaluates acute toxicity outcomes in breast cancer patients treated with adjuvant proton beam therapy (PBT). METHODS From 2011 to 2016, 91 patients (93 cancers) were treated with adjuvant PBT targeting the intact breast/chest wall and comprehensive regional nodes including the axilla, supraclavicular fossa, and internal mammary lymph nodes. Toxicity was recorded weekly during treatment, one month following treatment, and then every 6months according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Charts were retrospectively reviewed to verify toxicities, patient parameters, disease and treatment characteristics, and disease-related outcomes. RESULTS Median follow-up was 15.5months. Median PBT dose was 50.4 Gray relative biological effectiveness (GyRBE), with subsequent boost as clinically indicated (N=61, median 10 GyRBE). Chemotherapy, when administered, was given adjuvantly (N=42) or neoadjuvantly (N=46). Grades 1, 2, and 3 dermatitis occurred in 23%, 72%, and 5%, respectively. Eight percent required treatment breaks owing to dermatitis. Median time to resolution of dermatitis was 32days. Grades 1, 2, and 3 esophagitis developed in 31%, 33%, and 0%, respectively. CONCLUSIONS PBT displays acceptable toxicity in the setting of comprehensive regional nodal irradiation.

Consolidative proton therapy after chemotherapy for patients with Hodgkin lymphoma

Abstract Background We investigated early outcomes for patients receiving chemotherapy followed by consolidative proton therapy (PT) for the treatment of Hodgkin lymphoma (HL). Patients and methods From June 2008 through August 2015, 138 patients with HL enrolled on either IRB-approved outcomes tracking protocols or registry studies received consolidative PT. Patients were excluded due to relapsed or refractory disease. Involved-site radiotherapy field designs were used for all patients. Pediatric patients received a median dose of 21 Gy(RBE) [range 15–36 Gy(RBE)]; adult patients received a median dose of 30.6 Gy(RBE) [range, 20–45 Gy(RBE)]. Patients receiving PT were young (median age, 20 years; range 6–57). Overall, 42% were pediatric (≤18 years) and 93% were under the age of 40 years. Thirty-eight percent of patients were male and 62% female. Stage distribution included 73% with I/II and 27% with III/IV disease. Patients predominantly had mediastinal involvement (96%) and bulky disease (57%), whereas 37% had B symptoms. The median follow-up was 32 months (range, 5–92 months). Results The 3-year relapse-free survival rate was 92% for all patients; it was 96% for adults and 87% for pediatric patients (P = 0.18). When evaluated by positron emission tomography/computed tomography scan response at the end of chemotherapy, patients with a partial response had worse 3-year progression-free survival compared with other patients (78% versus 94%; P = 0.0034). No grade 3 radiation-related toxicities have occurred to date. Conclusion Consolidative PT following standard chemotherapy in HL is primarily used in young patients with mediastinal and bulky disease. Early relapse-free survival rates are similar to those reported with photon radiation treatment, and no early grade 3 toxicities have been observed. Continued follow-up to assess late effects is critical.

Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee

Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee Yolanda D. Tseng, MD,* David J. Cutter, MD, DPhil, FRCR,y John P. Plastaras, MD, PhD,z Rahul R. Parikh, MD,x Oren Cahlon, MD,k Michael D. Chuong, MD,{ Katerina Dedeckova, MD, Mohammad K. Khan, MD, PhD,** Shinn-Yn Lin, MD,yy Lisa A. McGee, MD,zz Eric Yi-Liang Shen, MD,yy Stephanie A. Terezakis, MD,xx ShahedN. Badiyan,MD,kk YouliaM. Kirova,MD,{{ Richard T. Hoppe,MD, Nancy P. Mendenhall, MD,***,yyy Mark Pankuch, PhD,zzz Stella Flampouri, PhD,***,yyy Umberto Ricardi, MD,xxx and Bradford S. Hoppe, MD, MPH***,yyy

Treatment outcomes of squamous cell carcinoma of the oral cavity in young adults

OBJECTIVES The natural history of squamous cell carcinoma (SCC) of the oral cavity (OC) in young adults is unknown. We sought to provide an updated report on treatment outcomes of patients with OC SCC who were 40 years or younger. MATERIALS AND METHODS We performed a retrospective analysis of 124 consecutive patients with primary OC SCC treated at Mayo Clinic (1980-2014). Patient and tumor characteristics and treatment approach were abstracted from patient charts. RESULTS Median patient age was 35 years (range, 19-40 years). The most common primary site was oral tongue (107 patients; 86.3%). Most patients (101; 81.5%) underwent wide local excision. Surgery alone was curative in 77 patients (62.1%); 47 (37.9%) received radiotherapy, and 26 (21%) received chemotherapy. Five-year overall survival (OS) was 78.1%; 10-year OS was 76.9%. Five-year disease-free survival (DFS) was 66.6%; 5-year local control was 87.6%; and 5-year locoregional control was 78.5%. On multivariable analysis, factors associated with worse OS and DFS were higher pathologic T stage (P = .008), lymph node positivity (P < .001), and disease recurrence (P < .001). CONCLUSION Young adults with primary OC SCC may be treated with a similar treatment approach as older adults.

Outcomes and patterns of failure of sarcomatoid carcinoma of the larynx: The Mayo Clinic experience

Sarcomatoid carcinoma is a rare variant of squamous cell carcinoma of the head and neck. No consensus exists on its management. Our aim was to present our outcomes.

First report of proton beam therapy for breast angiosarcoma from the prospective PCG registry

the cumulative number of chemotherapy cycles [1,2]. Even though nail and skin toxicity are not life threatening, effective management to ameliorate the symptoms is a necessity to allow patients to continue their chemotherapy regimen. In some cases, patients may require dose adjustment, as was the case in a series of three patients with PATEO syndrome described by Rodriguez-Lomba et al. [3] Despite development of PATEO syndrome, our patient was able to continue her chemotherapy regimen with use of a potent topical corticosteroid and cooling her hands in ice baths during subsequent paclitaxel infusions, an approach similar to Scott e et al’s [4,5] frozen glove therapy that was found to significantly reduce nail and skin toxicity associated with taxane-based chemotherapy. We present this case to heighten awareness of this unique manifestation of handfoot syndrome specific to taxane chemotherapy and share a successful approach towards management.