Myxopapillary ependymoma (MPE) is an exceedingly rare tumor histology. While surgery is clearly the treatment of choice, controversy exists regarding the role of adjuvant radiotherapy (RT). Using the Surveillence, epidemiology, and end results (SEER) database, we aimed to determine the epidemiology, prognostic factors, and treatment-related outcomes for MPE. A total of 773 cases were found in the SEER database. The incidence in the American population was found to be 1.00 per million person-years. On multivariate analysis, receipt of surgery (HR = 0.14, CI = 0.06-0.35, p < 0.001), receipt of RT (HR = 4.06, CI = 1.87-8.81, p < 0.001), age less than 30 (HR = 0.24, CI = 0.08-0.72, p = 0.01), and Caucasian race (HR = 0.37, CI = 0.13-0.996, p = 0.049) were statistically significant prognostic factors. The mean tumor size among those receiving RT (4.6 cm) was significantly larger than among those not receiving RT (3.2 cm, p = 0.0002). Those who lived in metropolitan areas were more likely to receive RT than those who did not. Given multiple previous studies show that RT improves PFS and the discrepancy in tumor size, selection bias is likely a significant contributor to the apparent negative impact of RT on OS. Regardless, surgery remains the most crucial aspect in the care of patients with MPE.

Background The Penn Parkinson's Daily Activities Questionnaire‐15 (PDAQ‐15) assesses cognition‐related instrumental activities of daily living (IADL) in Parkinson's disease (PD). Objectives To assess the degree and predictors of disagreement between patients (PT) and knowledgeable informants (KI) on the PDAQ‐15. Methods We recruited 254 PT and KI pairs (PT‐KI), determined predictors of agreement, and compared scores to a performance‐based functional measure (Direct Assessment of Functional Status [DAFS]; N = 61). Results PT and KI total score (intraclass correlation = 0.57) and individual item (Cohen's kappa = 0.46–0.62) agreement were moderate. Patient depression, global cognition, and caregiver burden (all P < 0.05), predicted PT‐KI discrepancy. PT‐KI discrepancy was highest in patients with a dementia diagnosis, followed by mild cognitive impairment and then normal cognition (all P < 0.01), with PT rating themselves relatively more functionally intact as cognition worsened. DAFS performance was more highly correlated with KI (r = 0.82; P < 0.001) than PT (r = 0.62; P < 0.001) PDAQ‐15 score. Conclusions Our results support using KI as proxies when assessing cognitive IADLs in PD PTs, particularly in cases of more advanced cognitive decline.

Purpose/objectives: Patients with lung cancer sometimes present with multiple primary lung cancers (MPLCs), either simultaneously (synchronous) or after treatment of an initial lesion (metachronous). Although open surgery remains a treatment mainstay for patients with stage I-II non-small-cell lung cancer (NSCLC), stereotactic body radiation therapy (SBRT) is an acceptable alternative for patients who are medically unfit for or who refuse surgery. In this study, we retrospectively examine the outcome among patients with early-stage MPLCs treated at our institution with SBRT. Materials/methods: Patients at our institution receiving SBRT for MPLC between June 2011 and March 2020 were reviewed retrospectively. Prior to undergoing definitive SBRT, the imaging, and pathology for every patient were reviewed in a multi-disciplinary thoracic/pulmonary tumor board. Dose and fractionation varied with the most common prescriptions being 50 Gy/5 fractions, 56 Gy/4 fractions, and 55 Gy/5 fractions. Results: A total of 38 patients with a total of 80 MPLCs were treated, among which 68 were T1 lesions and 12 were T2 lesions. Median follow-up was 25.9 months, with local control (LC) rates calculated per lesion to be 98.6%, 93.3%, and 88.2% at one, two, and three years. Median overall survival (OS) was 43.5 months; 83.6%, 67.8%, and 52.3% at one, two, and three years, respectively. Sixty-two of the 80 (77.5%) treated lesions were not associated with any subsequent acute or late toxicity. The 18 (22.5%) lesions associated with toxicity included nine acute and nine late events. All toxicity was either grade 1 (13 of 18) or grade 2 (five of 18). Conclusions: SBRT for early-stage MPLC achieves high control rates with limited toxicity. MPLC patients deemed unfit for open surgical management should be considered for definitive SBRT.

breast cancer. This population of patients presented with brain metastases was treated in the Institut Curie between 2014 and 2015 with TDM1 and concomitant (4) or sequential (8) radiosurgery with or without whole brain irradiation. We studied: local control (brain and target zone), clinical response and radiological (radio necrosis) the early and late side effects. Results: The mean age was 38 (23-53) years old at the time of diagnosis of breast cancer and 46 (28-61) years at the diagnosis brain metastatic evolution in good general condition's patients. In the concurrent group the response rate was 75% with one complete response, one partial response, one stable disease, and one local progression. Comparatively, in the sequential group the response rate was 85.7% with two complete responses, two partial responses, 8 stable diseases, and two local progressions. No patient experienced interruption of her irradiation for the reason of side effects. About 50% of the patients were asymptomatic after the treatment. The radio necrosis was observed in 50% in the concurrent group and 28.6% sequential group in the other with a similar rate of edema for the two groups (25% and 28.6%). Conclusion: In these very first series we found that association of T-DM1 and radiosurgery is feasible but can increase the radio necrosis without clinical translation. Larger prospective studies with longer follow-up are needed to evaluate this population of patients.

Purpose/Objective(s): Recent data show that overall survival after endoscopic mucosal resection (EMR) is similar to esophagectomy, however, limited data exists regarding the comparative efficacy of definitive radiotherapy (RT) for the treatment of T1N0 esophageal cancer. We sought to investigate the patterns of practice for the treatment of T1N0 esophageal cancer in the United States as well as to evaluate the comparative efficacy of esophagectomy vs EMR vs RT. Materials/Methods: Patients with clinical T1N0 esophageal carcinoma who underwent esophagectomy, EMR or RT (45 e 70 Gy) were identified from the National Cancer Database (NCDB) from 2004 to 2013. Univariate (UVA) and multivariable (MVA) effects of treatment type on survival were assessed using Cox proportional hazards regression. Overall survival (OS) was compared using Kaplan-Meier analysis and the log-rank test. Variables with p<0.001 were included in the MVA for OS. Results: 6,262 met criteria for inclusion in this study: 2,995 (48%) underwent esophagectomy, 2,130 (34%) underwent EMR and 1,137 (18%) underwent RT. Only 3 patients underwent esophageal brachytherapy. Median age was 68 years, and patients undergoing RT were older (72 y) compared to those undergoing esophagectomy (65 y) or EMR (70 y) (p<0.0001). In the esophagectomy, EMR and RT groups, 70%, 75% and 72% of patients had a Charlson score of 0, respectively. Median follow-up was 34 months. Median RT dose was 50.4 Gy and 78% underwent concurrent chemotherapy. 30 day mortality was 3.1% for esophagectomy and 0.6% for EMR. In recent years, EMR was more frequently utilized, rising from 23% to 43% whereas esophagectomy and RT were less frequently utilized in the same time period (p<0.0001). RT was more frequently utilized at non-academic centers than academic centers, 30.3% vs 9.3%, p<0.0001. Of the patients who underwent esophagectomy, 614 (21%) were upstaged. On MVA, patients with Charlson/Deyo score 1 (HR 1.2, pZ0.0003), older age (HR 1.03, p<0.001), Medicaid or no insurance (HR 1.5, pZ0.003), treatment at non-academic centers (HR 1.1, pZ0.009) and squamous histology (HR 1.3, p<0.001) were predictors of worse OS. There was no difference in OS between patients undergoing esophagectomy or EMR (pZ0.4) and this finding persisted when analysis was limited to T1a patients (pZ0.69). Patients requiring post-operative chemotherapy had a worse OS (HR 1.3, p<0.001). Patients who received definitive RT had a worse OS compared to patients who underwent esophagectomy or EMR (HR 1.8, p<0.001). Conclusion: EMR is increasingly utilized compared to esophagectomy and definitive RT for early esophageal cancer, whereas the utilization of esophageal brachytherapy was rare. Adoption of EMR in lieu of esophagectomy has not compromised survival. Patients undergoing esophagectomy and EMR had a superior OS compared to those who underwent definitive RT. Patients undergoing definitive RT appear to have unfavorable features likely affecting OS.

These results affirm that patients with OMCC have extended OS periods and that stereotactic body radiotherapy offers strong local control in these settings. We show that even in the oligometastatic setting those with right-sided primary tumors have worse outcomes relative to those with left-sided or rectal primary tumors. This suggests more aggressive treatment may be needed for those with oligometastatic right-sided colorectal cancer.

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