S. Gallotto

Left hippocampal dosimetry correlates with visual and verbal memory outcomes in survivors of pediatric brain tumors: Hippocampal Dosimetry and Memory Post-RT

Radiotherapy (RT) in the pediatric brain tumor population causes late neurocognitive effects. In the current study, the authors investigated associations between clinical and dosimetric risk factors and memory outcomes in a cohort of patients treated with proton radiotherapy (PRT).

An update from the Pediatric Proton Consortium Registry

Background/objectives The Pediatric Proton Consortium Registry (PPCR) was established to expedite proton outcomes research in the pediatric population requiring radiotherapy. Here, we introduce the PPCR as a resource to the oncology community and provide an overview of the data available for further study and collaboration. Design/methods A multi-institutional registry of integrated clinical, dosimetric, radiographic, and patient-reported data for patients undergoing proton radiation therapy was conceived in May 2010. Massachusetts General Hospital began enrollment in July of 2012. Subsequently, 12 other institutions joined the PPCR and activated patient accrual, with the latest joining in 2017. An optional patient-reported quality of life (QoL) survey is currently implemented at six institutions. Baseline health status, symptoms, medications, neurocognitive status, audiogram findings, and neuroendocrine testing are collected. Treatment details of surgery, chemotherapy, and radiation therapy are documented and radiation plans are archived. Follow-up is collected annually. Data were analyzed 25 September, 2017. Results A total of 1,854 patients have consented and enrolled in the PPCR from October 2012 until September 2017. The cohort is 55% male, 70% Caucasian, and comprised of 79% United States residents. Central nervous system (CNS) tumors comprise 61% of the cohort. The most common CNS histologies are as follows: medulloblastoma (n = 276), ependymoma (n = 214), glioma/astrocytoma (n = 195), craniopharyngioma (n = 153), and germ cell tumors (n = 108). The most common non-CNS tumors diagnoses are as follows: rhabdomyosarcoma (n = 191), Ewing sarcoma (n = 105), Hodgkin lymphoma (n = 66), and neuroblastoma (n = 55). The median follow-up is 1.5 years with a range of 0.14 to 4.6 years. Conclusion A large prospective population of children irradiated with proton therapy has reached a critical milestone to facilitate long-awaited clinical outcomes research in the modern era. This is an important resource for investigators both in the consortium and for those who wish to access the data for academic research pursuits.

Very low-dose versus standard dose radiation therapy for indolent primary cutaneous B-cell lymphomas: A retrospective study

Limitations include the fact that roughly 90% of US allopathic dermatologists are members of the American Academy of Dermatology; our results may underestimate provider counts. Our ideal dermatologist:population ratio of 3.5 per 100,000 people is somewhat arbitrary, given that an appropriate ratio has never been validated. Patients in rural, poor, and high-minority areas lack an acceptable level of access to dermatologists. Minority physicians are more likely to care for patients of their own race and practice in underserved areas. Sadly, only 3% and 4.1% of US dermatologists are African American and Latin American, respectively. Physicians with rural backgrounds and clinical experience are more likely to practice in those areas, as evidenced by Michigan State University’s Rural Physician Program. Initiatives to train more dermatologists from rural, poor, or high-minority areas, and methods to incentivize practice in these areas, such as loan forgiveness, should be considered. The AccessDerm teledermatology initiative has expanded access to dermatologic care by helping patients unable to receive in-person consultation. However, teledermatology alone without access to definitive treatments, including obtaining biopsy specimens, surgical services, and medication monitoring, will not adequately serve the needs of these populations. In addition, dermatologists often serve as advocates in their communities for skin health education. Residency-trained dermatologists are leaders of important public health initiativeswhen they are active participants in the communities they serve.