Oncology Vol 29 No 4_Suppl_1

Integrating uPSA into the immediate and continued frequent surveillance of RP patients with organ-confined cancer will improve postop RT outcomes by identifying failures sooner and promoting an early salvage strategy.

Patients with inadequate health insurance were more likely to receive mastectomy, omit RT following breast-conserving surgery, and receive PMRT. Differences in clinical presentation and demographics according to insurance status incompletely explain the variation in therapy. Further study is needed to validate and address these disparities and to evaluate the impact of health insurance legislative efforts in localized breast cancer.

Desmoplastic histologic subtype is a strong predictor of brain metastasis development and decreased 2-year BMFS in patients with metastatic melanoma. Patients with desmoplastic melanoma, particularly thick lesions involving the H&N, should be imaged frequently during the first year after the diagnosis of stage IV disease.

This is the first study to demonstrate the feasibility of genomic sequencing of FNAs from pancreatic tumors. We have been able to successfully identify unique genetic signatures in patients with LAPC; however, the small sample size limits our ability to identify generalizable patterns.

Disparities exist in PT utilization compared with IMRT by age, race, and SES and merit further investigation.

Re-irradiation for H&N cancers with IMRT and concurrent chemotherapy results in promising local control and survival outcomes in selected patients. Treatment-related toxicity continues to be significant despite improvements in systemic therapy and radiation dose conformality, warranting careful patient selection and target volume delineation.

Assessment of volumetric IGRT disease response for HNSCC that is treated with definitive CRT is valuable for predicting disease control. Patients with less than 70% volume reduction should be considered for early surgical intervention.

Although limited by small numbers, we found that there were more long-term survivors and less distant metastasis in the cetuximab group. This is the largest report of CSCC patients treated with cetuximab. In the absence of prospective data, we believe that these data reveal that the addition of cetuximab is well tolerated and reveal signs of efficacy in this typically poorly performing group of patients and should be pursued in clinical trials.

With similar 10-year follow-up, there is a trend for improved locoregional control if treated as of 1980. Our data suggest that overall survival is longer for patients treated with IMRT. The current study lends further support to the body of evidence suggesting that in contrast to squamous cell carcinoma of the larynx, overall survival is improving for patients with squamous cell carcinoma of the hypopharynx.

Metabolic response during radiotherapy predicts for survival in p16+ OPC patients and may help in risk stratification of these patients for potential treatment de-intensification.

Despite uncertainty regarding the anatomic resolution of PET, sequential use of contrast-enhanced CT, PET-CT, and/or MRI had no impact on treatment planning that was not accomplished by the use of PET alone. Future work should focus on determining the optimal pretreatment imaging for women with cervical cancer and developing guidelines to optimize outcomes while minimizing cost and radiation exposure.

Patients with higher nontarget lung FDG avidity appear to be at greater risk forradiation pneumonitisfollowing SABR.

Without the use of MC planning, target structures were substantially underdosed. Local failures were associated with PTVmicro undercoverage, which suggests that delivering a therapeutic dose to this expanded microscopic disease target volume is beneficial. MC dosimetry is preferable for lung SBRT, while the PB algorithm is adequate for predicting pulmonary toxicity.

SBRT is an effective treatment modality, achieving excellent local control with minimal toxicity for patients with adrenal metastases. The development of progressive distant metastasis is the predominant pattern of failure affecting patients’ survival outcomes.

Rates of symptomatic radiation necrosis appear to be higher for the BRAF inhibitor therapy group. Prospective studies investigating BRAF inhibitor therapy and SRS for melanoma brain metastases should consider incorporating methods to decrease potential radiation necrosis, including fractionating radiosurgery.

Almost half of current radiation oncology residents do not have a mentor. Of those with mentors, most established relationships early in their training, during PGY-2 or prior. Therefore, it is imperative to intervene early in the training process to produce successful mentorship experiences. Many residents require more than one active mentor, which enables multiple goals to be met, such as career development, increasing one’s research portfolio, networking, and coping with residency.

In the largest reported analysis of perioperative mortality evaluating the 15 most common surgically treated malignancies, those with Medicaid coverage or without insurance were more likely to die within 30 days of surgery.

The 1.5-T MF generated by MRL had no effect on the viability or radioresponses of NSCLC or HNSCC cell lines in vitro. These results suggest that MRL, as a novel cancer treatment technology, has the potential not to influence the radiotherapy outcome of patients. Considering the complicated in vivo microenvironment, further in vivo study is warranted.

Future analyses will seek to elaborate the functional implications of LCs and IR-sensitive DC IR-exposure as it relates to the priming and development of graft-versus-host disease (GVHD) and local antitumor immunity following radiation therapy.

The use of respiratory gating has resulted in small but statistically significant reductions in heart dose. Further studies are needed to understand the clinical implications of these differences.

VMAT planning for the delivery of APBI in this preliminary dosimetric evaluation has been shown to be a viable option for APBI. VMAT planning gives acceptable lung and heart doses and appears to deliver lower doses to the heart and ipsilateral lung than APBI delivered with the single-entry SAVI applicator.

Both 3DCRT and balloon HDR can achieve relatively low MHDs and result in minimal increases in the risk of additional major coronary events. In certain cases, compared with HDR brachytherapy, 3DCRT may result in lower MHDs and a lower risk of long-term cardiac toxicity.

We implemented an EDC system for routine clinical use in our breast RT service that resulted in significant time savings for clinical documentation and a prospective population of a database for future outcomes research. Additional follow-up is needed to determine how easily this system can be generalized to other RT disease sites and practices.

These early results demonstrate the feasibility of adjuvant breast cancer treatment with US PT on an IBL. Acute toxicity results appear acceptable. Longer follow-up is needed.

Our study showed that oligometastatic breast cancer patients have improved 5-year survival after metastases compared with non-oligometastatic patients. In patients with oligometastases and HER2-positive disease or without triple-negative disease, survival after metastases was superior. Further studies are needed to identify a favorable subset of patients with oligometastases who would benefit from aggressive therapy.

Patients without insurance were less than half as likely to receive MIS and more than twice as likely to receive EBRT compared with patients with private insurance in our national cohort. Our findings suggest that with expanding access to private insurance under the Affordable Care Act, there may be significant shifts in the selection of treatment modality for men with prostate cancer in the United States.

Greater intraprostatic heterogeneity was associated with late grade 2+ GU toxicity. Given the high correlation of prostate volume with toxicity, SBRT dose parameters should be individualized and risk-adapted based on normalized prostate volumes, including a V50 not to exceed 9% of the prostate. The urethra is an important organ at risk, and the 42-Gy dose-volume should be limited to 2 mL, while bladder dose-volumes appear to be poor predictors of GU grade 2+ toxicity.

In this young patient population, no definitive treatment was selected in 22.5% of men with LR disease. For those with HR disease, 25.5% did not undergo active treatment, indicating that these men appear to be receiving less aggressive therapy than recommended by NCCN guidelines. In addition, African-American race is also associated with a decreased likelihood for receipt of definitive therapy.

Patients tolerated proton therapy in this randomized trial well, with excellent QoL scores, persistent low IPSS, and no grade ≥ 3 AEs in either arm. Thus far, there is no apparent clinical difference in outcomes with hypofractionated proton beam therapy compared to standard fractionation.

This study demonstrates that even though most MRI-identified GTVs are located in close proximity to critical structures, dose escalation is achievable without exceeding rectal constraints in all cases, and bladder constraints in the majority of cases. These variations are in cases with small bladders encompassed in the CTV and are not associated with increased acute toxicity.