Oncology Vol 29 No 4_Suppl_1

Achieving NED status correlates strongly with outcome in MBC, making this a potentially valuable short-term clinical trial endpoint akin to pathologic complete response. MBC patients who attain NED have prolonged survival, with perhaps up to one-third achieving complete remission.

Exposure to chemotherapy or RT disrupts the formation and establishment of proper synaptic connections by causing significant alterations in neuronal structure that compromise neurotransmission and cognition.

We present a survival prediction model that has identified patient subgroups with poor (Group 4) to excellent (Group 1) prognoses. In addition, pretreatment symptoms were predictive of survival and correlated with the prediction of the model. If validated, we believe that this model, possibly in conjunction with patient symptoms, may aid in determining optimal treatment strategies.

Repeat SRS represents a potential salvage therapy for patients with locally recurrent brain metastases, providing additional tumor control with acceptable toxicity, even in the setting of prior SRS, surgical resection, and/or WBRT. Repeat SRS may also be reasonable to use to either avoid or delay the treatment of WBRT.

Neurocognitive-preservation strategies for WBRT are not cost-effective from a societal perspective, though they may be effective for patients who are cognitively intact at baseline and have a long expected survival.

A numerical method for computing a DIR transformation according to a target ventilation image was used to generate a ventilation image that correlates precisely with the dose distribution while maintaining high DIR spatial accuracy. Thus, by employing this approach, the focus of future CT ventilation studies that are designed to assess radiation dose response is reduced to assessing the physical feasibility of the DIR transformation that generates the ventilation image predicted by the dose-response model.

Early surveillance imaging with diffusion-weighted MRI at 6–8 weeks following definitive treatment with radiotherapy is feasible and may be predictive of early nodal failure. Further validation in a prospective cohort is warranted.

Our preliminary results suggest that the use of temozolomide in the management of low-grade glioma is neither deleterious nor beneficial in terms of PFS. In comparison with the PFS reported by the EORTC 22844/22845 and RTOG 9802 trials, our PFS is markedly worse. This finding is likely attributable to the high median age of our patient population, which is noticeably older and thus assumed to have a poorer prognosis.

This is the largest retrospective review with the longest outcome to specifically evaluate pediatric Hodgkin lymphoma patients. Furthermore, this is the first analysis to find that AA patients have inferior OS when compared with whites and Hispanics. These differences remained significant over the course of 30 years, indicating that modern treatment modalities have not improved this racial disparity.

Selected patients who are initially deemed unresectable may now undergo resection after receiving neoadjuvant induction chemotherapy and SBRT. Furthermore, improved surgical outcomes are observed with neoadjuvant SBRT in comparison with neoadjuvant chemotherapy alone. Longer follow-up is needed to validate its impact on survival.

A novel method for monitoring CIEDs during radiotherapy is presented, which we report as effective, easy, and lacking adverse side effects. This simple technique is a cost-effective alternative to frequent device interrogations during the course of radiotherapy and allows for consistent daily monitoring.

MRI-guided EBRT using the ViewRay system is a novel approach to deliver APBI. ViewRay APBI is noninvasive yet maintains a high degree of precision by using prefraction MR imaging, thus allowing a reduction in the PTV margin. The resultant decrease in the ipsilateral breast dose may reduce acute skin toxicity and improve cosmetic outcomes. Thus, the ViewRay system is an attractive alternative to existing APBI techniques.

For patients with tumors greater than 5 cm, survival in the Medicare population remains similar between breast conservation and mastectomy, as it does for smaller primaries. Despite the exclusion from prospective randomized trials, breast conservation should remain a standard option for women with larger tumors when deemed clinically and cosmetically amenable to resection.

In this prospectively followed cohort of breast cancer patients receiving RT to the intact breast, novel predictors for more severe skin toxicity were identified, including PR-negative status, invasive ductal histology, and receipt of chemotherapy, as well as known risk factors, including BMI and fractionation scheme.

The percentage of DCIS patients receiving postlumpectomy RT increased between 1999 and 2008. Younger patients with higher grade, medium-sized tumors, and fewer comorbidities were more likely to receive postlumpectomy RT.

For early-stage breast cancer cases with ER+ and PR+ status, histology was not associated with a difference in BCSS. Alternatively, ILC cases that were ER− or PR− had an increased BCSS compared with receptor-matched IDC cases. These findings add to the growing evidence supporting ILC as a more favorable histology, which is important for guiding treatment and prognostication.

MRI substantially improves the visibility and accuracy of lumpectomy cavity definition as compared with CT. Although the LC and PTV volumes that are delineated from an individual MRI sequence are generally smaller as compared with those from CT, the volumes, shapes, and locations for the PTV-MRI, defined by the union of T1, T2, and STIR, were comparable with PTV-CT for most of the cases studied. It is feasible to use MRI to replace CT in RT simulations for breast-conserving RT.

Similar to other reported series, the majority of our patients had triple-negative disease, and our patient population did not express the HER2/neu oncoprotein. Our predominant histology was squamous differentiation, whereas heterogeneity in histology is described in the literature. Despite high-grade disease, the outcomes in our study are favorable in comparison with previously reported series, although the follow-up is short.

Patients with Medicaid coverage or without insurance are more likely to not receive radiation after lumpectomy.

The standard patterns of care for breast conservation therapy include A-RT with a boost to the surgical bed. For the PubMed and Medline articles, 71% of the 1,180 patients without clips and clear margins did not receive a boost. These results correspond with the ROs’ survey, which showed that 65.4% of them did not give a boost to the patients systematically. While OBS was perceived by the surgeons as a technique to remove more tissue and improve cosmesis, our review demonstrated that it negatively impacts radiotherapy techniques that are proven to achieve adequate local control. OBS is clearly changing patterns of delivery of adjuvant RT, without long-term outcomes supporting its safety.

Currently, low-grade glioma is commonly treated in the community setting by RT alone. A relatively high rate of local failure is noted (28%), and long-term survival appears to be shorter than might be expected. A number of patients are treated based on imaging alone without a detriment to survival. Low-grade glioma appears to be a more aggressive disease than usually considered, and efforts to improve the outcome would be served through clinical trials.

Surgical resection with 125I brachytherapy is an effective strategy for local control of brain metastases. Although metastasis volume significantly influences resection cavity size and remodeling, volumetric parameters do not appear to influence local control or necrosis.

Large-volume PT re-irradiation for recurrent glioma is safe and associated with promising OS outcomes, particularly in the setting of bevacizumab-refractory tumors.

Craniopharyngioma-related death represents the most common cause of early deaths in both pediatric and adult patients. GTR and adjuvant RT do not appear to have a significant impact on OS within 5 years of diagnosis. Older age, black race, and adamantinomatous/papillary histologies are significant prognostic factors for early deaths after the diagnosis.

Utilization of adjuvant XRT and SRS remained stable between 2000 and 2010. Male sex, young age, marriage, partial resection, grade II/III tumors, and large tumors predicted for use of adjuvant therapy. For all patients, SRS improved survival compared with craniotomy alone. For patients with incomplete resection, SRS improved survival compared with craniotomy alone and adjuvant XRT. Randomized, prospective clinical trials are needed to better define the role of adjuvant XRT or SRS.

Median survival of multifocal GBM is incredibly short, even compared with the already short median survival of single-lesion GBM. The majority of our patients had biopsy alone, likely due to the nature of multifocal GBM. This most likely contributes to a worse MS.

Our results establish that WBRT + SRS produces leukoencephalopathy at a much higher rate than SRS alone. Surprisingly, an SRS integral dose of over only 3 J predicts for leukoencephalopathy in patients treated with SRS alone. Our data define a dosimetric threshold at which radiation-induced leukoencephalopathy is likely to occur following SRS. As the survival of patients with CNS metastases increases and as the neurotoxicity of chemotherapeutic and targeted agents becomes established, the threshold of 3 J may influence the therapeutic management of patients with multiple brain metastases.

The use of antiepileptic HDACi drugs during RT for GBM did not significantly improve outcomes or RT response in this retrospective analysis. Further study of the concomitant use of HDACis and TMZ is necessary to elucidate clinically relevant results.

SRS appears to be a reasonable treatment option for focally persistent or recurrent PCNSL in select patients, especially in the setting of focal neurologic deficits. As a radiosensitive entity, all PCNSL lesions had a substantial volumetric reduction with at least 14 Gy, and all patients with a focal neurologic deficit at treatment experienced symptomatic improvement with SRS. Further investigation should be completed regarding the benefits of SRS for focally appearing PCNSL as a potential way to avoid neurotoxicity and improve symptoms in selected patients.

SRS is both safe and efficacious for PTN. Additionally, prior to treatment, PTN patients who characterize their facial pain as dull and not exacerbated by daily activities are more likely to receive therapeutic benefit, with a mean response time of 1 month.