Background A significant fraction of OPSCCA cases is associated with traditional carcinogens; in these patients treatment response and clinical outcomes remain poor. Methods We evaluated patient, tumor and treatment characteristics for 200 veterans with OPSCCA treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) between 2000 and 2012. Results Most patients (77%) were white and heavy smokers. Twenty seven patients required tracheostomy and 63 required gastrostomy placement during treatment. Overall survival at 5 years was 40%.. Survival was impacted by T stage, treatment intensity, completion of treatment and p16 tumor status. Almost 30% of patients were unable to complete a treatment regimen consistent with NCCN guidelines. Conclusions OPSCCA in veterans is associated with traditional carcinogens and poor clinical outcomes. Despite heavy smoking exposure, p16 tumor status significantly impacts survival. Careful consideration must be given to improving treatment paradigms for this cohort given their limited tolerance for treatment escalation.

Survival of early-stage NSCLC patients is associated with the number of LNs removed. The surgical management of early-stage NSCLC should include thoracic lymphadenectomy of at least 10 nodes.

Substantial proportions of patients documented in a major US cancer registry did not receive radiation therapy or chemotherapy as part of initial treatment for limited-stage SCLC, which, in turn, was associated with poor survival. Lack of radiation therapy delivery was uniquely associated with government insurance coverage, suggesting a need for targeted access improvement in this population. Additional work will be necessary to conclusively define exact population patterns, specific treatment deficiencies, and causative factors leading to heterogeneous care delivery.

Background We assessed the outcomes of patients with unresected anaplastic thyroid carcinoma (ATC) in the National Cancer Data Base (NCDB) and explored potential relationships between radiation therapy (RT) dose and overall survival (OS). Methods The study group was composed of patients who received either no surgery or grossly incomplete resection. Correlates of OS were explored using univariate and multivariable analysis (MVA) analyses. Results A total of 1,288 patients were analyzed. Mean age was 70.2 years; 59.7% were female; and 47.6% received neck RT. Median OS was 2.27 months, with 11% alive at one year. A positive RT dose-survival relationship was seen for the entire study cohort, for those who received systemic therapy, and for those with stage IVA/IVB and IVC disease. On MVA, older age (HR: 1.317, CI: 1.137–1.526), ≥1 comorbidity (HR: 1.587, CI: 1.379–1.827), distant metastasis (HR: 1.385, CI: 1.216 –1.578), receipt of systemic therapy (HR: 0.637, CI: 0.547–0.742), and receipt of RT as compared with no RT (HR <45 Gy: 0.843, CI: 0.718–0.988; HR 45-59.9 Gy: 0.596, CI: 0.479–0.743; HR 60-75 Gy: 0.419, CI: 0.339 – 0.517) correlated with OS. The RT dose-survival relationship for those who received higher (60-75 Gy) vs. lower (45-59.9 Gy) therapeutic dose was confirmed by propensity score matching. Conclusions Survival was poor in this cohort of patients with unresected ATC and more effective therapies are needed. However, the association of RT dose with OS highlights the importance of identifying patients with unresected ATC who may still yet benefit from multi-modal local-regional treatment incorporating higher dose RT.

IMPORTANCE Historical data suggest that there is an overall survival benefit associated with prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC). However, as the fidelity of magnetic resonance imaging (MRI) of the brain continues to improve, this idea is now being questioned, with recent research showing no survival benefit associated with PCI in extensive-stage SCLC; however, the role for PCI is not clear in patients with limited-stage SCLC (LS-SCLC).OBJECTIVE To report the overall survival and rates of intracranial control for patients with LS-SCLC, all staged with MRI, who either did or did not undergo PCI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 297 patients with LS-SCLC at alarge US academic cancer center. Patients were treated with thoracic radiation; 205 also underwent PCI and 92 did not. All patients underwent at least baseline MRI, with restaging brain MRI and/or computed tomography; they did not have disease progression after thoracic radiation treatment. A propensity score-matching analysis was undertaken in an attempt to adjust for potential bias. Of the 297 patients who met the inclusion criteria, the propensity score was calculated for 295 patients, using patient, tumor, and treatment characteristics. Data were analyzed in October 2019. INTERVENTION Prophylactic cranial irradiation in patients with LS-SCLC. MAIN OUTCOMES AND MEASURESThe rate of overall survival and intracranial control. RESULTSOf the 297 patients, 162 (54.5%) were men. The median age was 62.2 years (range, 27.0-85.0 years) for patients who underwent PCI and 68.6 years (range, 40.0-86.0 years) for those who did not undergo PCI. The 3-year cumulative incidence rate of brain metastases was higher in the no-PCI group vs the PCI group, when counting death as a competing risk, but the difference was not statistically significant (20.40% [95% CI, 12.45%-29.67%] vs 11.20% [95% CI, 5.40%-19.20%]; P = .10). The use of PCI was not associated with a difference in overall survival between the patient groups (hazard ratio, 0.844; 95% CI, 0.604-1.180; P = .32). CONCLUSIONS AND RELEVANCEThese findings suggest that patients with LS-SCLC staged with MRI who undergo PCI after thoracic radiation treatment were not associated with a decreased risk of developing new brain metastases compared with patients who do not undergo PCI. The use of PCI was not associated with an overall survival benefit for such patients. 17. Ozawa Y, Omae M, Fujii M, et al. Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer. BMC Cancer. 2015;15(587):589.