Cure rates for primary mediastinal large B-cell lymphoma (PMBCL) have improved with the integration of rituximab. However, the type of primary therapy and role of radiotherapy (RT) remains ill-defined. Herein, we evaluated the outcome of PMBCL primarily treated with R-CHOP and the impact of an end-of-treatment (EOT) FDG-PET scan to guide consolidative RT. Patients ≥18 years of age with PMBCL treated with curative intent R-chemotherapy were identified. Prior to 2005, patients were recommended to receive R-CHOP +RT (RT era). Beginning in 2005, EOT PET was used to guide RT and only those with a PET-positive scan received RT (PET era). In total, 159 patients were identified, 94% were treated with R-CHOP and 44% received RT - 78% in RT era, 28% in PET era. The 5-year time to progression (TTP) and OS for the entire cohort were 80% and 89%, respectively, similar across treatment eras. Overall, 10% had refractory disease. In total, 113 patients had an EOT PET scan: 63% negative and 37% positive with a 5-year TTP of 90% vs 71% and 5-year OS of 97% vs 88%, respectively. For those with Deauville (D) scored PET scans (n=103), the 5-year TTP for PET-negative cases by Deauville criteria (D1-D3,DX) was 91%, with inferior outcomes for D5 vs D4 (5-year TTP 33% vs 87%, p=0.0002). Outcomes for R-CHOP treated PMBCL patients treated with R-CHOP are favorable and use of a PET-adapted approach reduces RT in the majority of patients. A small proportion have refractory disease and may benefit from an alternate treatment.

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ObjectiveTo estimate the association between occupational polycyclic aromatic hydrocarbon (PAH) exposure and female breast cancer.MethodsLifetime work histories for 1130 cases and 1169 controls from British Columbia and Ontario (Canada) were assessed for PAH exposure using a job-exposure matrix based on compliance measurements obtained during US Occupational Safety and Health Administration workplace safety inspections.ResultsExposure to any level of PAHs was associated with an increased risk of breast cancer (OR=1.32, 95% CI: 1.10 to 1.59), as was duration at high PAH exposure (for >7.4 years: OR=1.45, 95% CI: 1.10 to 1.91; ptrend=0.01), compared with women who were never exposed. Increased risk of breast cancer was most strongly associated with prolonged duration at high occupational PAH exposure among women with a family history of breast cancer (for >7.4 years: OR=2.79, 95% CI: 1.25 to 6.24; ptrend<0.01).ConclusionsOur study suggests that prolonged occupational exposure to PAH may increase breast cancer risk, especially among women with a family history of breast cancer.

Summary A novel prognostic score (IPS‐3), comprised of only three of the seven IPS‐7 indicators (age ≥45, stage IV, haemoglobin <105 g/l), was recently proposed as a simplified model for advanced‐stage classic Hodgkin lymphoma (cHL). We aimed to validate this model in advanced‐stage cHL patients treated with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) in British Columbia. The estimated five‐year freedom from progression (FFP) for scores of 0, 1, 2 and 3 were very similar to the original report at 84%, 76%, 72% and 68% respectively. The IPS‐3 score is highly reproducible in this independent dataset and its simplicity makes it appealing for everyday clinical practice.

Polycyclic aromatic hydrocarbons (PAHs) are a group of pollutants with multiple variants classified as carcinogenic. The Occupational Safety and Health Administration (OSHA) provided access to two PAH exposure databanks of United States workplace compliance testing data collected between 1979 and 2010. Mixed-effects logistic models were used to predict the exceedance fraction (EF), i.e., the probability of exceeding OSHA's Permissible Exposure Limit (PEL = 0.2 mg/m3) for PAHs based on industry and occupation. Measurements of coal tar pitch volatiles were used as a surrogate for PAHs. Time, databank, occupation, and industry were included as fixed-effects while an identifier for the compliance inspection number was included as a random effect. Analyses involved 2,509 full-shift personal measurements. Results showed that the majority of industries had an estimated EF < 0.5, although several industries, including Standardized Industry Classification codes 1623 (Water, Sewer, Pipeline, and Communication and Powerline Construction), 1711 (Plumbing, Heating, and Air-Conditioning), 2824 (Manmade Organic Fibres), 3496 (Misc. Fabricated Wire products), and 5812 (Eating Places), and Major group's 13 (Oil and Gas Extraction) and 30 (Rubber and Miscellaneous Plastic Products), were estimated to have more than an 80% likelihood of exceeding the PEL. There was an inverse temporal trend of exceeding the PEL, with lower risk in most recent years, albeit not statistically significant. Similar results were shown when incorporating occupation, but varied depending on the occupation as the majority of industries predicted at the administrative level, e.g., managers, had an estimated EF < 0.5 while at the minimally skilled/laborer level there was a substantial increase in the estimated EF. These statistical models allow the prediction of PAH exposure risk through individual occupational histories and will be used to create a job-exposure matrix for use in a population-based case-control study exploring PAH exposure and breast cancer risk.