No abstract

In recent years, patient survival and physicians' ability to predict survival in NSCLC with brain metastases has improved significantly. The updated Lung-molGPA incorporating gene alteration data into the DS-GPA is a user-friendly tool that may facilitate clinical decision making and appropriate stratification of future clinical trials.

Neoplasms of the central nervous system (CNS) are the most frequently encountered solid tumors of childhood, but are less common in adolescents and young adults (AYA), aged 15–39 years. Gliomas account for 29%–35% of the CNS tumors in AYA, with approximately two-thirds being low-grade glioma (LGG) and the remaining being high-grade glioma (HGG). We review the epidemiology, work-up, and management of LGG and HGG, focusing on the particular issues faced by the AYA population relative to pediatric and adult populations. Visual pathway glioma and brainstem glioma, which represent unique clinical entities, are only briefly discussed. As a general management approach for both LGG and HGG, maximal safe resection should be attempted. AYA with LGG who undergo gross total resection (GTR) may be safely observed. As age increases and the risk factors for recurrence accumulate, adjuvant therapy should be more strongly considered with a strong consideration of advanced radiation techniques such as proton beam therapy to reduce long-term radiation-related toxicity. Recent results also suggest survival advantage for adult patients with the use of adjuvant chemotherapy when radiation is indicated. Whenever possible, AYA patients with HGG should be enrolled in a clinical trial for the benefit of centralized genetic and molecular prognostic review and best clinical care. Chemoradiation should be offered to all World Health Organization grade IV patients with concurrent and adjuvant chemotherapy after maximal safe resection. Younger adolescents with GTR of grade III lesions may consider radiotherapy alone or sequential radiotherapy and chemotherapy if unable to tolerate concurrent treatment. A more comprehensive classification of gliomas integrating pathology and molecular data is emerging, and this integrative strategy offers the potential to be more accurate and reproducible in guiding diagnostic, prognostic, and management decisions.

Purpose Lung cancer remains the most common cause of both cancer mortality and brain metastases (BM). The purpose of this study was to assess the effect of gene alterations and tyrosine kinase inhibition (TKI) on median survival (MS) and cause of death (CoD) in patients with BM from lung adenocarcinoma (L-adeno). Methods A multi-institutional retrospective database of patients with L-adeno and newly diagnosed BM between 2006 and 2014 was created. Demographics, gene alterations, treatment, MS, and CoD were analyzed. The treatment patterns and outcomes were compared with those in prior trials. Results Of 1521 L-adeno patients, 816 (54%) had known alteration status. The gene alteration rates were 29%, 10%, and 26% for EGFR, ALK, and KRAS, respectively. The time from primary diagnosis to BM for EGFR−/+ was 10/15 months (P=.02) and for ALK−/+ was 10/20 months (P<.01), respectively. The MS for the group overall (n=1521) was 15 months. The MS from first treatment for BM for EGFR and ALK−, EGFR+, ALK+ were 14, 23 (P<.01), and 45 (P<.0001) months, respectively. The MS after BM for EGFR+ patients who did/did not receive TKI before BM was 17/30 months (P<.01), respectively, but the risk of death was not statistically different between TKI-naïve patients who did/did not receive TKI after the diagnosis of BM (EGFR/ALK hazard ratios: 1.06 [P=.84]/1.60 [P=.45], respectively). The CoD was nonneurologic in 82% of patients with known CoD. Conclusion EGFR and ALK gene alterations are associated with delayed onset of BM and longer MS relative to patients without these alterations. The CoD was overwhelmingly nonneurologic in patients with known CoD.

We investigated clinical and treatment-related factors as predictors of pleural effusion in esophageal cancer patients after concurrent chemoradiation therapy (CCR). Materials/Methods: Consecutive primary esophageal cancer patients treated with CCR between 2001 and 2010 were retrospectively reviewed from our treatment record. Inclusion criteria were as follows: newly diagnosed and first treatment for esophageal cancer except for EMR; disease including thoracic esophagus; follow-up 6 months; conventional fractionation and irradiated 50 Gy; World Health Organization (WHO) performance status 2; available CT data to analyze dose volume of pericardium and lungs; intact of malignant pleural disease. Adverse events were graded according to the CTCAE version 4.0. Symptomatic effusion was defined as effusion grade2. Radiation treatment planning performed by two-dimensional planning was reconstructed to three-dimensional treatment planning to analyze dose-volume parameters without modification. Pleural effusion was reviewed on follow-up chest computed tomography. Percent volume irradiated 5 to 60 Gy (V5-V60) and mean dose of pericardium and both lungs were evaluated by dose volume histogram. The following clinical factors were investigated for associations with the risk of pleural effusion: age, gender, performance status, main tumor location, clinical stage, histology, smoking, hypertension, alcohol, cardiovascular disease, and diabetes. Treatment-related factors including radiation dose, treatment planning method, CCR regimen, neoadjuvant chemotherapy, salvage surgery, mean dose of the lungs and mean dose of the pericardium. Associating clinical and treatment-related risk factors for pleural effusion were detected by univariate and multivariate analyses. Results: Overall 157 patients were met the criteria. The median follow up was 29 (ranged 6 to 121) months. Pleural effusion in any grade was observed in 58 (37%). Symptomatic pleural effusion developed in 12 (8 %) patients. Onset of pleural effusion ranged 1 to 94 months. Dosimetric analyses revealed the value of V5 to V60 of pericardium and mean dose of pericardium were significantly higher in patients with symptomatic pleural effusion than those with asymptomatic pleural effusion and without pleural effusion. Multivariate analysis identified mean pericardial dose as the strongest risk factor for both pleural effusion in any grade and symptomatic effusion. Clinical stage was also detected as significant risk factor. Conclusion: Pleural effusion after CCR for esophageal cancer is relatively common adverse event. Pericardial dose-volume relationship has a large impact on any patient, irrespective of whether pleural effusion is present or absent, symptomatic or asymptomatic.

ImportanceHypofractionated radiation therapy (RT) for prostate cancer has been associated with greater acute grade 2 gastrointestinal (GI) toxic effects compared with conventionally fractionated RT.ObjectiveTo evaluate whether a hyaluronic acid rectal spacer could (1) improve rectal dosimetry and (2) affect acute grade 2 or higher GI toxic effects for hypofractionated RT.Design, Setting, and ParticipantsThis randomized clinical trial was conducted from March 2020 to June 2021 among 12 centers within the US, Australia, and Spain, with a 6-month follow-up. Adult patients with biopsy-proven, T1 to T2 prostate cancer with a Gleason score 7 or less and prostate-specific antigen level of 20 ng/mL or less (to convert to μg/L, multiply by 1) were blinded to the treatment arms. Of the 260 consented patients, 201 patients (77.3%) were randomized (2:1) to the presence or absence of the spacer. Patients were stratified by intended 4-month androgen deprivation therapy use and erectile quality.Main Outcomes and MeasuresFor the primary outcome, we hypothesized that more than 70% of patients in the spacer group would achieve a 25% or greater reduction in the rectal volume receiving 54 Gy (V54). For the secondary outcome, we hypothesized that the spacer group would have noninferior acute (within 3 months) grade 2 or higher GI toxic effects compared with the control group, with a margin of 10%.ResultsOf the 201 randomized patients, 8 (4.0%) were Asian, 26 (12.9%) Black, 42 (20.9%) Hispanic or Latino, and 153 (76.1%) White; the mean (SD) age for the spacer group was 68.6 (7.2) years and 68.4 (7.3) years for the control group. For the primary outcome, 131 of 133 (98.5%; 95% CI, 94.7%-99.8%) patients in the spacer group experienced a 25% or greater reduction in rectum V54, which was greater than the minimally acceptable 70% (P &amp;lt; .001). The mean (SD) reduction was 85.0% (20.9%). For the secondary outcome, 4 of 136 patients (2.9%) in the spacer group and 9 of 65 patients (13.8%) in the control group experienced acute grade 2 or higher GI toxic effects (difference, −10.9%; 95% 1-sided upper confidence limit, −3.5; P = .01).Conclusions and RelevanceThe trial results suggest that rectal spacing with hyaluronic acid improved rectal dosimetry and reduced acute grade 2 or higher GI toxic effects. Rectal spacing should potentially be considered for minimizing the risk of acute grade 2 or higher toxic effects for hypofractionated RT.Trial RegistrationClinicalTrials.gov Identifier: NCT04189913

reported symptoms, while negative scores indicated more severe physician reported symptoms. Descriptive statistics, chi-square test, and Wilcoxon rank-sum test examine factors associated with discordance. Results: There were 499 symptom surveys from 44 patients. Concordance between PRO-CTCAE and CTCAE was associated with symptom severity (as reported by patients) for all domains (P < .001). Average PRO-CTCAE/CTCAE concordance was 91% for no symptoms, 29% for mild symptoms, 21% for moderate symptoms, and 7% for severe symptoms. Symptom assessment concordance was high at baseline due to lack of symptoms and decreased 37e83% during treatment. Posttreatment concordance was high (50%e92%), with the exception of xerostomia (36%). The majority of discordance was attributable to physician underreporting. Physician underreporting of symptom severity was statistically significant for patients older than 65 and for African Americans (Table). Conclusion: There is significant under-ascertainment of symptom severity by physicians for patients receiving head and neck radiation therapy. Age 65 and African American race were associated with discordance of patient physician symptom assessment. Author Disclosure: A. Falchook: Training course tuition fee waived;

No abstract