Tiffany M. Morgan

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

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

Fractionated Radiotherapy is Associated with Lower Rates of Treatment-Related Edema than Stereotactic Radiosurgery in MRI-Defined Meningiomas

OBJECTIVEnBoth stereotactic radiosurgery (SRS) and fractionated radiation therapy (FRT) techniques are used for treatment of intracranial meningiomas with excellent local control (LC) rates. Although SRS techniques are convenient, toxicity including treatment-related edema can significantly impact patient quality of life. The long-term clinical outcomes of patients with magnetic resonance imaging (MRI)-defined meningiomas treated with radiation therapy (RT) alone are reported.nnnMETHODSnThe charts of 211 patients with meningiomas diagnosed by contrast-enhanced MRI treated with either SRS or FRT between 1991 and 2012 at a single institution were reviewed. Actuarial rates for LC and development of treatment-related radiographic edema (TRE) were determined by the Kaplan-Meier method.nnnRESULTSnThere were 211 patients who received radiation therapy for 223 lesions. Median follow-up was 5.7 years. Eleven patients experienced a local failure; of these, 2 were ultimately found to have pathologically proven metastatic carcinoma. Two- and 5-year LC was 97.8% and 94.6%, respectively, with no significant difference based on modality of therapy. Actuarial rate for development of TRE at 1 and 2 years was 30.1% and 34.6% for the SRS group and 1.6% and 2.5% for the FRT group, respectively (P < 0.001).nnnCONCLUSIONSnRT alone using a limited margin is an effective treatment option for MRI-defined meningiomas and should be considered even without biopsy if surgery will present significant morbidity. Although LC with SRS versus FRT was comparable, FRT was associated with a significantly decreased risk of TRE.

Does size matter? Investigating the optimal planning target volume margin for postoperative stereotactic radiosurgery to resected brain metastases

OBJECTIVEThe optimal margin size in postoperative stereotactic radiosurgery (SRS) for brain metastases is unknown. Herein, the authors investigated the effect of SRS planning target volume (PTV) margin on local recurrence and symptomatic radiation necrosis postoperatively.METHODSRecords of patients who received postoperative LINAC-based SRS for brain metastases between 2006 and 2016 were reviewed and stratified based on PTV margin size (1.0 or > 1.0 mm). Patients were treated using frameless and framed SRS techniques, and both single-fraction and hypofractionated dosing were used based on lesion size. Kaplan-Meier and cumulative incidence models were used to estimate survival and intracranial outcomes, respectively. Multivariate analyses were also performed.RESULTSA total of 133 patients with 139 cavities were identified; 36 patients (27.1%) and 35 lesions (25.2%) were in the 1.0-mm group, and 97 patients (72.9%) and 104 lesions (74.8%) were in the > 1.0-mm group. Patient characteristics were balanced, except the 1.0-mm cohort had a better Eastern Cooperative Group Performance Status (grade 0: 36.1% vs 19.6%), higher mean number of brain metastases (1.75 vs 1.31), lower prescription isodose line (80% vs 95%), and lower median single fraction-equivalent dose (15.0 vs 17.5 Gy) (all p < 0.05). The median survival and follow-up for all patients were 15.6 months and 17.7 months, respectively. No significant difference in local recurrence was noted between the cohorts. An increased 1-year rate of symptomatic radionecrosis was seen in the larger margin group (20.9% vs 6.0%, p = 0.028). On multivariate analyses, margin size > 1.0 mm was associated with an increased risk for symptomatic radionecrosis (HR 3.07, 95% CI 1.13-8.34; p = 0.028), while multifraction SRS emerged as a protective factor for symptomatic radionecrosis (HR 0.13, 95% CI 0.02-0.76; p = 0.023).CONCLUSIONSExpanding the PTV margin beyond 1.0 mm is not associated with improved local recurrence but appears to increase the risk of symptomatic radionecrosis after postoperative SRS.

Hypofractionated external beam radiation therapy in combination with HDR boost for localized prostate cancer: patient reported quality of life outcomes

Purpose There is limited data to support the use of hypofractionated external beam radiation (HypoF) in combination with high-dose-rate brachytherapy (HDR). We report our quality of life (QOL) outcomes when treating intermediate and high-risk prostate cancer patients with external beam radiation (EBRT) plus HDR. Material and methods The charts of 54 patients with localized adenocarcinoma of the prostate treated with standard fractionation (SF) or HypoF EBRT plus HDR boost at a single institution between 2012 and 2015 were reviewed. All patients completed the American Urological Association Symptom Score (AUASS) and Expanded Prostate Index for Prostate Cancer – Clinical Practice (EPIC-CP) quality of life assessments prior to treatment and completed at least one follow-up survey. Linear mixed models were performed to test for significant changes and differences in each outcome over time. Results There was no significant difference in AUA score (p = 0.98), incontinence (urge) and urinary irritation/obstruction scores (p = 0.81 and p = 0.62, respectively), and bowel QOL (p = 0.97) between the two dosing groups over time or at any discrete time point. For both groups, AUA scores peaked at 0-2 months before improving. Likewise, sexual function, vitality score, and QOL scores were also not significantly different between the dose groups over time (p = 0.59, p = 0.37, and p = 0.71, respectively). All QOL categories, except sexual function, trended toward baseline with increasing time from intervention. Conclusions Our study suggests HypoF EBRT can be delivered in combination with HDR for patients with ntermediate-risk and high-risk adenocarcinoma of the prostate without increasing toxicity compared to SF with an HDR boost.

Measurement of circulating tumor cells in squamous cell carcinoma of the head and neck and patient outcomes

ObjectivesWe report the outcomes of patients with squamous cell carcinoma of the head and neck (HNSCC) whose circulating tumor cells (CTCs) were quantified using surface-enhanced Raman scattering (SERS) nanotechnology.MethodsSERS tagged with EGF was used to directly measure targeted CTCs. Patient charts were retrospectively reviewed. An optimal cut point for CTCs in 7.5xa0ml of peripheral blood predictive of for distant metastasis-free survival (DMFS) was identified by maximizing the log-rank statistic. An ROC analysis was also performed.ResultsOf 82 patients, 13 experienced metastatic progression. The optimal cut point for DMFS was 675 CTCs (pu2009=u20090.047). For those with distant recurrence (nu2009=u200913) versus those without distant recurrence (nu2009=u200969), the CTC cut point which results in the largest combined sensitivity and specificity values is also 675 (sensitivityu2009=u200969%, specificityu2009=u200968%).ConclusionLiquid biopsy techniques in HNSCC show promise as a means of identifying patients at greater risk of disease progression.

Patient-reported health-related quality of life outcomes after HDR brachytherapy between small (<60 cc) and large (≥60 cc) prostate glands

PURPOSEnPatients with large prostate glands are underrepresented in clinical trials incorporating brachytherapy due to concerns for excessive toxicity. We sought to compare health-related quality of life (HRQOL) outcomes between small (<60xa0cc) and large (≥60xa0cc) prostates treated with high-dose-rate brachytherapy (HDR-B).nnnMETHODS AND MATERIALSnOne hundred thirty patients at Emory University were treated with HDR-B monotherapy (nxa0= 75) or HDR-B in combination with external beam radiation therapy (nxa0= 55). American Urologic Association Symptom Score (AUASS) and expanded prostate cancer index composite for clinical practice (EPIC-CP) scores were recorded. A linear mixed model was performed dichotomizing prostate volume (<60 and ≥xa060xa0cc) with AUASS, individual EPIC-CP domains (urinary incontinence, urinary irritation/obstruction [UIO], bowel function, sexual function, and vitality/hormonal function), and overall EPIC-CP HRQOL scores.nnnRESULTSnMedian followup was 22.6xa0months (range 2.2-55.8). The median gland volume for the entire cohort (nxa0= 130), <60xa0cc cohort (nxa0= 104), and ≥60xa0cc cohort (nxa0= 26) was 44xa0cc, 41.1xa0cc, and 68.0xa0cc, respectively. There were no baseline differences in HRQOL scores between cohorts. At 2 months, AUASS and UIO scores increased similarly between cohorts (AUASS pxa0= 0.807; UIO pxa0= 0.539), then decreased (longitudinal effect p < 0.001 and pxa0= 0.005, respectively) to remain not significantly different at 12 months (AUASS pxa0= 0.595; UIO pxa0= 0.673). Overall, prostate volume was not significantly associated with change in AUASS (pxa0= 0.403), urinary incontinence (pxa0= 0.322), UIO symptoms (pxa0= 0.779), bowel symptoms (pxa0= 0.757), vitality/hormonal symptoms (pxa0= 0.503), or overall HRQOL (pxa0= 0.382).nnnCONCLUSIONSnIn appropriately selected patients, HDR-B appears well tolerated in patients with ≥60xa0cc prostate glands without an increase in patient-reported toxicity. Volume should not be a strict contraindication in those with adequate baseline function.

S028) Measurement of Circulating Tumors Cells in Squamous Cell Carcinoma of the Head and Neck and Patient Outcomes

radiation treatment schedule remains unknown. The National Comprehensive Cancer Network (NCCN) guidelines recommend both hypofractionated radiotherapy (HFX) or CFX. We compared overall survival (OS) and treatment patterns among patients treated with HFX versus CFX for ESGC using a large national database. Materials/Methods: We identified patients diagnosed with stage I-II (cT12N0M0) glottic cancer from 2004-2013 in the National Cancer Data Base. Patients were treated with either HFX (2.25Gy/fraction to 63-65.25Gy) or CFX (2.0Gy/fraction to 66-70Gy). Multivariable logistic regression was used to determine factors associated with the receipt of HFX versus CFX. OS of patients receiving HFX versus CFX was compared using the logrank test, multivariable Cox proportional-hazards regression, and propensity-score matching. Results: 4,030 patients (39.5%) received HFX and 6,182 patients (60.5%) received CFX. Predictors for receipt of HFX included cT1 disease, recent year of diagnosis, and treatment at academic and highervolume centers (all P<0.001). Patients treated with HFX increased from 22.1% in 2004 to 58.0% in 2013. HFX was associated with improved OS compared with CFX on univariable (5-year OS, 77.0% vs 73.5%; logrank P<.001) and multivariable analysis (HR 0.89, PZ.01), a finding confirmed on propensity-score matching. On subset analyses, an improvement in OS was borderline significant for patients with cT1 disease (5-year OS, 78.2% vs 76.0%; log-rank PZ.053) and statistically significant for patients with cT2 disease (5-year OS, 70.8% vs 64.5%; log-rank PZ.02). Conclusions: HFX is associated with improved survival compared to CFX among patients treated with definitive radiotherapy for ESGC, particularly among patients with cT2 disease. HFX utilization increased over the study period; however, 40% of patients in our cohort did not receive HFX in the most recent year of our analysis.