Ronica H. Nanda

Stereotactic body radiation therapy versus no treatment for early stage non–small cell lung cancer in medically inoperable elderly patients: A National Cancer Data Base analysis

Stereotactic body radiation therapy (SBRT) has demonstrated high rates of local control with low morbidity and has now emerged as the standard of care for medically inoperable, early stage non–small cell lung cancer (NSCLC). However, the impact of lung SBRT on survival in the elderly population is less clear given competing comorbid conditions. An analysis of the National Cancer Data Base (NCDB) was undertaken to determine whether definitive SBRT improves survival relative to observation alone patients ages 70 years and older.

Neoadjuvant modified FOLFIRINOX and chemoradiation therapy for locally advanced pancreatic cancer improves resectability

Though necessary for improved outcomes, surgical resection is often limited in patients with locally advanced pancreatic cancers (LAPCs). We evaluated the efficacy of the approach adopted by our institution of using modified FOLFIRINOX chemotherapy followed by radiation with concurrent gemcitabine or capecitabine for patients with LAPCs, in an effort to enhance resectability while improving the toxicity profile compared with similar treatment regimens.

The Effect of Transition Clinics on Knowledge of Diagnosis and Perception of Risk in Young Adult Survivors of Childhood Cancer

Background: Improved treatment for pediatric cancers has ensured an evergrowing population of patients surviving into adulthood. The current study evaluated the impact of previous engagement in survivor care on patient knowledge and awareness of health risks as young adults. Procedure: Young adult survivors of childhood cancers (N=93, M age=23.63 y) were recruited during their annual survivor clinic visit. Participants completed self-reported measures of demographics, treatment knowledge, perception of future health risks, participation in previous survivor care, and neurocognitive functioning. Results: In total, 82% of patients (N=76/93) reported previously participating in survivorship care. These patients were more likely to have knowledge of their radiation treatment (P=0.034) and more likely to recognize risk for future health effects from their treatment (P=0.019). Income between

Correlation of Acute and Late Brainstem Toxicities With Dose-Volume Data for Pediatric Patients With Posterior Fossa Malignancies

10,000 and

Factors Influencing Pulmonary Toxicity in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in the Setting of Total Body Irradiation-Based Myeloablative Conditioning

24,999 (odds ratio=0.168; 95% confidence interval, 0.046-0.616; P=0.031) was associated with decreased patient knowledge regarding diagnosis. Male sex (odds ratio=0.324; 95% confidence interval, 0.135-0.777; P=0.012) was associated with less knowledge of future health risks. Patients with self-reported difficulties on the CCSS-NCQ were more likely to regard their cancer treatment as a future health risk. Conclusion: Participation in survivor care plays an important role in imparting information to young adult survivors of pediatric cancer regarding their disease history and risk for future health problems.

The feasibility of frameless stereotactic radiosurgery in the management of pediatric central nervous system tumors

PURPOSEnRadiation-induced brainstem toxicity after treatment of pediatric posterior fossa malignancies is incompletely understood, especially in the era of intensity modulated radiation therapy (IMRT). The rates of, and predictive factors for, brainstem toxicity after photon RT for posterior fossa tumors were examined.nnnMETHODS AND MATERIALSnAfter institutional review board approval, 60 pediatric patients treated at our institution for nonmetastatic infratentorial ependymoma and medulloblastoma with IMRT were included in the present analysis. Dosimetric variables, including the mean and maximum dose to the brainstem, the dose to 10% to 90% of the brainstem (in 10% increments), and the volume of the brainstem receiving 40, 45, 50, and 55xa0Gy were recorded for each patient. Acute (onset within 3xa0months) and late (>3xa0months of RT completion) RT-induced brainstem toxicities with clinical and radiographic correlates were scored using Common Terminology Criteria for Adverse Events, version 4.0.nnnRESULTSnPatients aged 1.4 to 21.8xa0years underwent IMRT or volumetric arc therapy postoperatively to the posterior fossa or tumor bed. At a median clinical follow-up period of 2.8xa0years, 14 patients had developed symptomatic brainstem toxicity (crude incidence 23.3%). No correlation was found between the dosimetric variables examined and brainstem toxicity. Vascular injury or ischemia showed a strong trend toward predicting brainstem toxicity (P=.054). Patients with grade 3 to 5 brainstem toxicity had undergone treatment to significant volumes of the posterior fossa.nnnCONCLUSIONnThe results of the present series demonstrate a low, but not negligible, risk of brainstem radiation necrosis for pediatric patients with posterior fossa malignancies treated with IMRT. No specific dose-volume correlations were identified; however, modern treatment volumes might help limit the incidence of severe toxicity. Additional work investigating inherent biologic sensitivity might also provide further insight into this clinical problem.

Whole lung irradiation in stage IV Wilms tumor patients: Thyroid dosimetry and outcomes

PURPOSEnThis study evaluated factors associated with increased risk of pulmonary toxicity (PT) from any cause in pediatric patients after myeloablative conditioning, using total body irradiation (TBI), followed by allogeneic hematopoietic stem cell transplantation (HSCT).nnnMETHODS AND MATERIALSnThe records of 129 consecutive pediatric patients (range: 1-21 years of age) who underwent TBI-based myeloablative conditioning for hematologic malignancies at our institution between January 2003 and May 2014 were reviewed. Although total TBI doses ranged from 10.5 to 14 Gy, lung doses were limited to 10 Gy with partial transmission blocks. TBI dose rates ranged from 5.6 cGy/min to 20.9 cGy/min. PT was classified using clinical symptoms, radiographic evidence, and ventilatory defects on pulmonary function tests. Noninfectious (idiopathic) pneumonia syndrome (IPS) was characterized by patients exhibiting PT while demonstrating no signs of infection throughout the follow-up period.nnnRESULTSnPT from any cause developed in 70.5% of patients and was significantly associated with increased transplantation-related mortality (TRM) (P=.03) and decreased overall survival (OS) (P=.02). IPS developed in 23.3% of patients but was not associated with increased TRM (P=.6) or decreased OS (P=.5). Acute graft-versus-host disease (GVHD) significantly affected PT (P=.001) but did not significantly influence the development of IPS (P=.4). Infection was a leading cause of PT (75.8%). TBI dose rate significantly affected development of overall PT (P=.02) and was the sole factor to significantly influence the incidence of IPS (P=.002). TBI total dose, dose per fraction, disease type, transplantation chemotherapy, age of patient, sex, and donor type did not significantly impact overall PT or IPS.nnnCONCLUSIONSnA high incidence of PT was noted in this large series of homogeneously treated pediatric patients undergoing TBI for allogeneic HSCT. TBI dose rates affected overall PT and strongly influenced IPS. TBI dose rate is a contributing factor influencing pulmonary toxicity and rates less than 15 cGy/min should be considered to decrease the risk of IPS.

Health Care Disparities Among Octogenarians and Nonagenarians With Stage III Lung Cancer

Recurrent malignant primary and metastatic central nervous system (CNS) tumors in pediatric patients are devastating, and efforts to improve outcomes for these patients have been disappointing. Conventional re-irradiation in these patients increases the risk of significant toxicity. We therefore evaluated feasibility and outcomes using frameless radiosurgery (FRS) in children with recurrent primary and metastatic brain tumors. We reviewed five cases of recurrent primary and metastatic brain tumors treated with frameless radiosurgery between 2008 and 2013. We analyzed safety and feasibility, dosimetric data, local control, and adverse effects. Five patients were treated with frameless radiosurgery for palliation. Fifteen target volumes were treated using our institutional FRS system. The volumes of targets ranged from 0.08 to 51.67xa0cm3 with doses ranging from 15 to 21xa0Gy. Radiosurgery was well tolerated, decreased the need for large-volume CNS irradiation, and allowed for effective palliation in this small cohort. Frameless radiosurgery is feasible in this patient population. Frameless radiosurgery should be considered in management of select patients with recurrent primary or metastatic brain tumors.

Impact of lymph node evaluation in adjuvant and neoadjuvant chemotherapy settings on survival outcomes in Wilms tumour: a review of 185 cases from a single institution

To report the thyroid dosimetry and long‐term follow‐up of childhood cancer survivors treated with whole lung irradiation (WLI) for Wilms tumor.

Outcomes After Radiation Therapy to Metastatic Sites in Patients With Stage 4 Neuroblastoma

To the authors knowledge, the practice patterns for patients aged more than 80 years with stage III non–small cell lung cancer (NSCLC) is not well known. The purpose of the current study was to investigate factors predictive of and the impact on overall survival (OS) after concurrent chemoradiation (CRT) among patients aged ≥80 years with American Joint Committee on Cancer stage III NSCLC in the National Cancer Data Base (NCDB).