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Head and neck cancers radiotherapy (RT) is associated with inevitable injury to parotid glands and subsequent xerostomia. We investigated the utility of SUV derived from 18 FDG-PET to develop metabolic imaging biomarkers (MIBs) of RT-related parotid injury. Methods: Data for oropharyngeal cancer (OPC) patients treated with RT at our institution between 2005 and 2015 with available planning computed tomography (CT), dose grid, pre-& first post-RT 18 FDG-PET-CT scans, and physician-reported xerostomia assessment at 3-6 months post-RT (Xero 3-6 ms) per CTCAE, was retrieved, following an IRB approval. A CT-CT deformable image co-registration followed by voxel-by-voxel resampling of pre & post-RT 18 FDG activity and dose grid were performed. Ipsilateral (Ipsi) and contralateral (contra) parotid glands were sub-segmented based on the received dose in 5 Gy increments, i.e. 0-5 Gy, 5-10 Gy sub-volumes, etc. Median and dose-weighted SUV were extracted from whole parotid volumes and sub-volumes on pre-& post-RT PET scans, using in-house code that runs on MATLAB. Wilcoxon signed-rank and Kruskal-Wallis tests were used to test differences pre-and post-RT. Results: 432 parotid glands, belonging to 108 OPC patients treated with RT, were sub-segmented & analyzed. Xero 3-6 ms was reported as: non-severe (78.7%) and severe (21.3%). SUV-median values were significantly reduced post-RT, irrespective of laterality (p = 0.02). A similar pattern was observed in parotid sub-volumes, especially ipsi parotid gland sub-volumes receiving doses 10-50 Gy (p < 0.05). Kruskal-Wallis test showed a significantly higher mean RT dose in the contra parotid in the patients with more severe Xero 3-6mo (p = 0.03).

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Background Survivors of non‐Hodgkin lymphoma (NHL) have increased secondary malignancy (SM) risk. We quantified this risk by patient and treatment factors. Methods Standardized incidence ratios (SIR, observed‐to‐expected [O/E] ratio) were assessed in 142,637 NHL patients diagnosed from 1975 to 2016 in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Comparisons were made between subgroups in terms of their SIRs relative to respective endemic populations. Results In total, 15,979 patients developed SM, more than the endemic rate (O/E 1.29; p < 0.05). Compared with white patients, relative to respective endemic populations, ethnic minorities had a higher risk of SM (white O/E 1.27, 95% CI 1.25–1.29; black O/E 1.40, 95% CI 1.31–1.48; other O/E 1.59, 95% CI 1.49–1.70). Relative to respective endemic populations, patients who received radiotherapy had similar SM rates to those who did not (O/E 1.29 each), but irradiated patients had increased breast cancer ( p < 0.05). Patients who received chemotherapy had higher SM rates than those who did not (O/E 1.33 vs. 1.24, p < 0.05) including more leukemia, Kaposi sarcoma, kidney, pancreas, rectal, head and neck, and colon cancers ( p < 0.05). Conclusions This is the largest study to examine SM risk in NHL patients with the longest follow‐up. Treatment with radiotherapy did not increase overall SM risk, while chemotherapy was associated with a higher overall risk. However, certain subsites were associated with a higher risk of SM, and they varied by treatment, age group, race and time since treatment. These findings are helpful for informing screening and long‐term follow‐up in NHL survivors.

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Purpose Head and neck cancers (HNC) radiotherapy (RT) is associated with inevitable injury to parotid glands and subsequent xerostomia. We investigated the utility of standardized uptake values (SUV) derived from routinely performed 18-fluorodeoxygluocose positron-emission tomography (18FDG-PET) to develop metabolic imaging biomarkers (MIBs) of RT-related parotid injury. Methods Data for oropharyngeal cancer (OPC) patients treated with RT at our institution between 2005-2015 with available planning computed tomography (CT), dose grid, pre- & first post-RT 18FDG-PET-CT scans, and physician-reported xerostomia assessment at 3-6 months post-RT (Xero 3-6ms) per CTCAE, was retrieved, following an IRB approval. A CT-CT deformable image co-registration followed by voxel-by-voxel resampling of pre & post-RT 18FDG activity and dose grid were performed. Ipsilateral (Ipsi) and contralateral (contra) parotid glands were sub-segmented based on the received dose in 5 Gy increments, i.e. 0-5 Gy, 5-10 Gy sub-volumes, etc. Median and dose-weighted SUV were extracted from whole parotid volumes and sub-volumes on pre- & post-RT PET scans, using in-house code that runs on MATLAB. Wilcoxon signed-rank and Kruskal-Wallis tests were used to test differences pre- and post-RT. Results 432 parotid glands, belonging to 108 OPC patients treated with RT, were sub-segmented & analyzed. Xero 3-6ms was reported as: non-severe (78.7%) and severe (21.3%). SUV- median values were significantly reduced post-RT, irrespective of laterality (p=0.02). A similar pattern was observed in parotid sub-volumes, especially ipsi parotid gland sub-volumes receiving doses 10-50 Gy (p<0.05). A Kruskal-Wallis test showed a significantly higher mean planned RT dose in the contra parotid in the patients with more severe Xero 3-6mo (p= 0.03). Multiple logistic regression showed a combined clinical-dosimetric-metabolic imaging model could predict the severity of Xero 3-6mo; AUC=0.78 (95%CI:0.66-0.85;p<0.0001) Conclusion We sought to quantify pre- and post-RT 18FDG-PET metrics of parotid glands in patients with OPC. Temporal dynamics of PET-derived metrics can potentially serve as MIBs of RT-related xerostomia in concert with clinical and dosimetric variables. Keywords: Xerostomia; FDG-PET; radiotherapy; imaging biomarkers; predictive model; head and neck cancer

In total, 254 patients with AML or ALL were treated with TMLI at our institution between 2006 and 2018. 21 of these patients were identified as receiving at least one subsequent course of radiation. A total of 67 relapse sites (median = 2 sites/patient, range = 1-16) were treated (6 lymph node, 34 soft tissue, 23 bone, and 4 CNS). At time of transplant, median age was 31 yrs (21-61 years). The median follow-up from date of transplant of these patients was 32.2 mo (3.9-154.1 mo). Of the 21 patients, 17 had active disease (MRD+ and/or bone marrow+) at transplant and 6 had prior history of EM disease. 12 patients had EM relapse only without BM relapse, while 5 had prior BM relapse and 4 had simultaneous EM and BM relapse. 12 recurrences were treated with systemic therapy prior to RT. The median mean TMLI dose to these sites was 12.0 Gy (4.0-20.8 Gy). 1yr and 5-yr estimates of OS were 80.9% (95% CI = 56.9-92.4%) and 35.6% (95% CI = 13.8-58.3%), respectively. 1 and 2-yr OS following salvage RT to the first site of EM recurrence was 45.4% (95% CI = 23.1-65.3%) and 38.9% (95% CI = 17.7-59.8%), respectively. The median salvage RT dose was 24 Gy (6-30 Gy). Following RT, 86.6% of the sites had durable local control. Conclusion: To our knowledge, this is the largest analysis to date of patients treated with TMLI. Relapse incidence was as frequent in regions receiving ≥12 Gy as those receiving < 12 Gy, suggesting TMLI is not associated with an increased EM relapse risk. These patients did not have significantly different OS compared to historical controls. RT is an effective modality to treat EM relapse in patients with acute leukemia who were previously treated with TMLI.