Services added lung cancer screening with low-dose computed tomography (LDCT) as a Medicare preventive service benefit in 2015 following findings from the National Lung Screening Trial (NLST) that showed a 16% reduction in lung cancer mortality associated with LDCT. A challenge in developing and promoting a national lung cancer screening program is the high false-positive rate of LDCT because abnormal findings from thoracic imaging often trigger subsequent invasive diagnostic procedures and could lead to postprocedural complications. OBJECTIVE To determine the complication rates and downstream medical costs associated with invasive diagnostic procedures performed for identification of lung abnormalities in the community setting. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of non-protocol-driven community practices captured in MarketScan Commercial Claims & Encounters and Medicare supplemental databases was conducted. A nationally representative sample of 344 510 patients aged 55 to 77 years who underwent invasive diagnostic procedures between 2008 and 2013 was included. MAIN OUTCOMES AND MEASURES One-year complication rates were calculated for 4 groups of invasive diagnostic procedures. The complication rates and costs were further stratified by age group. RESULTS Of the 344 510 individuals aged 55 to 77 years included in the study, 174 702 comprised the study group (109 363 [62.6%] women) and 169 808 served as the control group (106 007 [62.4%] women). The estimated complication rate was 22.2% (95% CI, 21.7%-22.7%) for individuals in the young age group and 23.8% (95% CI, 23.0%-24.6%) for those in the Medicare group; the rates were approximately twice as high as those reported in the NLST (9.

Purpose Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIEDs) (28 pacemakers and 14 cardioverter-defillibrators) underwent 42 courses of PBT for thoracic (23 [55%]), prostate (15 [36%]), liver (3[7%]), or base of skull (1 [2%]) tumors at a single institution. The median prescribed dose was 74 Gy(RBE) [range 46.8–87.5 Gy(RBE)], and the median distance from the treatment field to the CIED was 10 cm (range 0.8–40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13–21 Gy) and 346 Sv (range 11–1100 mSv). Six CIED malfunctions occurred in five patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and one patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator (ERI) after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9–8 cm), and the mean maximum neutron dose was 655 mSv (range 330–1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the ERI message was replaced uneventfully after treatment. Conclusions The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving thoracic PBT be followed closely.

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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.