Background The purpose of this study was to assess aspiration pneumonia (AsPn) rates and predictors after chemo-irradiation for head and neck cancer. Methods The was a prospective study of 72 patients with stage III to IV oropharyngeal cancer treated definitively with intensity-modulated radiotherapy (IMRT) concurrent with weekly carboplatin and paclitaxel. AsPn was recorded prospectively and dysphagia was evaluated longitudinally through 2 years posttherapy by observer-rated (Common Toxicity Criteria version [CTCAE]) scores, patient-reported scores, and videofluoroscopy. Results Sixteen patients (20%) developed AsPn. Predictive factors included T classification (p = .01), aspiration detected on videofluoroscopy (videofluoroscopy-asp; p = .0007), and patient-reported dysphagia (p = .02–.0003), but not observer-rated dysphagia (p = .4). Combining T classification, patient reported dysphagia, and videofluoroscopy-asp, provided the best predictive model. Conclusion AsPn continues to be an under-reported consequence of chemo-irradiation for head and neck cancer. These data support using patient-reported dysphagia to identify high-risk patients requiring videofluoroscopy evaluation for preventive measures. Reducing videofluoroscopy-asp rates, by reducing swallowing structures radiation doses and by trials reducing treatment intensity in patients predicted to do well, are likely to reduce AsPn rates.

PurposeThere is little known about how brain white matter structures differ in their response to radiation, which may have implications for radiation-induced neurocognitive impairment. We used diffusion tensor imaging (DTI) to examine regional variation in white matter changes following chemoradiotherapy.MethodsFourteen patients receiving two or three weeks of whole-brain radiation therapy (RT) ± chemotherapy underwent DTI pre-RT, at end-RT, and one month post-RT. Three diffusion indices were measured: fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). We determined significant individual voxel changes of diffusion indices using tract-based spatial statistics, and mean changes of the indices within fourteen white matter structures of interest.ResultsVoxels of significant FA decreases and RD increases were seen in all structures (p<0.05), with the largest changes (20–50%) in the fornix, cingula, and corpus callosum. There were highly significant between-structure differences in pre-RT to end-RT mean FA changes (p<0.001). The inferior cingula had a mean FA decrease from pre-RT to end-RT significantly greater than 11 of the 13 other structures (p<0.00385).ConclusionsBrain white matter structures varied greatly in their response to chemoradiotherapy as measured by DTI changes. Changes in FA and RD related to white matter demyelination were prominent in the cingula and fornix, structures relevant to radiation-induced neurocognitive impairment. Future research should evaluate DTI as a predictive biomarker of brain chemoradiotherapy adverse effects.

SBRT provides excellent local control for both primary and metastatic liver lesions with minimal toxicity. Future studies should focus on appropriate selection of patients and on careful assessment of liver function to maximize both the safety and efficacy of treatment.

Objectives Current pancreatic cancer diagnostics cannot reliably detect early disease or distinguish it from chronic pancreatitis. We test the hypothesis that optical spectroscopy can accurately differentiate cancer from chronic pancreatitis and normal pancreas. We developed and tested clinically-compatible multimodal optical spectroscopy technology to measure reflectance and endogenous fluorescence from human pancreatic tissues. Methods Freshly-excised pancreatic tissue specimens (39 normal, 34 chronic pancreatitis, 32 adenocarcinoma) from 18 patients were optically interrogated, with site-specific histopathology representing the gold standard. A multinomial logistic model using principal component analysis and generalized estimating equations provided statistically rigorous tissue classification. Results Optical spectroscopy distinguished pancreatic cancer from normal pancreas and chronic pancreatitis (sensitivity 91%, specificity 82%, positive predictive value 69%, negative predictive value 95%, area under receiver operating characteristic curve = 0.89). Reflectance alone provided essentially the same classification accuracy as reflectance and fluorescence combined, suggesting that a rapid, low-cost, reduced-footprint, reflectance-based device could be deployed without notable loss of diagnostic power. Conclusions Our novel, clinically-compatible, label-free optical diagnostic technology accurately characterizes pancreatic tissues. These data provide the scientific foundation demonstrating that optical spectroscopy can potentially improve diagnosis of pancreatic cancer and chronic pancreatitis.

158 Background: Radiofrequency ablation (RFA) is a widely used local therapy for small, unresectable liver tumors (LT). Stereotactic body radiotherapy (SBRT) has been used for similar patients, and has the advantage that it can be used when lesions are adjacent to blood vessels, are difficult to reach and cannot be imaged on ultrasound. We examined RFA and SBRT outcomes for treating primary and metastatic LT at our institution and identified predictive factors for local control. Methods: This study included 62 patients (pts) with 106 LT (69 metastatic, 37 primary) treated with SBRT and 127 pts with 206 LT (80 metastatic, 126 primary) treated with RFA from 2000 to 2010. 42 lesions were ablated intra-operatively while 164 were ablated percutaneously. Mean tumor size by maximum diameter was 2.2 cm (0.4-11) and 2.3 cm (0.6-6.2) for RFA- and SBRT-treated LT, respectively. Freedom from local progression (FFLP) for SBRT was defined as absence of progressive LT within or at the PTV margin while FFLP for RFA was defined as recurrence within or immediately adjacent to the ablation zone. Results: With a median follow-up of 29.4 months (0.46 to 120.8), 1- and 2-yr FFLP rates for all SBRT- vs RFA-treated LT were 93% and 84% vs 86% and 83%. There were 14 cases of residual LT after RFA, 6 of which were re-ablated; these were not counted as RFA failures. Significantly more pts in the SBRT group had received prior systemic therapy (54% vs 31%, p=0.0001) and had active extrahepatic disease at treatment start (36% vs 23%, p=0.01). For SBRT, neither LT size nor dose predicted for FFLP. For RFA, tumor size ≥3 cm had worse FFLP (HR: 5.3, p<0.0001) but an intraoperative approach had better FFLP (HR: −2.2, p=0.01). For tumors >3cm, SBRT had significantly better FFLP than percutaneous RFA (HR: 0.32, p=0.018). In the RFA group, there were 9 complications, including pneumothorax, hemothorax, and small bowel injury, 2 of which resulted in death. In the SBRT group, there was 1 case of radiation-induced liver disease in a Child-Pugh Class B pt but no other significant toxicities. Conclusions: SBRT is a safe alternative to RFA, can be used in a wider variety of patients, and may be more effective than percutaneous RFA at locally controlling larger liver tumors.

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