Objective: Bevacizumab has been shown to be effective in the treatment of recurrent glioblastoma in combination with chemotherapy compared with historic controls but not in randomized trials. Methods:We conducted a retrospective analysis of patients treated for recurrent glioblastoma with bevacizumab vs a control group of patients, comparing progression-free survival (PFS) and overall survival (OS) between the two groups, and performed subgroup analysis based on age and performance status. Expression of vascular endothelial growth factor (VEGF) based on age was examined using DNA microarray analysis. We also evaluated the impact of bevacizumab on quality of life.

23.6%), and breast (11.6%). Eighty patients (33.2%) received palliative RT with a total of 241 treatment courses [median courses: 2 (range 1 − 21), median fractions: 5 (range 1 − 26)]. The most common sites of palliative RT were the brain (41%), spine (13.8%), and long bone (10%). Approximately half of patients (48.8%) received their first course of palliative RT before EP-CT enrollment versus 47.5% (n = 38) following completion of EP-CT and 3.7% (n = 3) during EP-CT. Median time on EP-CT by timing of first palliative RT treatment was 63 days (pre-EP-CT), 68.5 days (after EP-CT), and 156 days (during EP-CT). Among patients receiving palliative RT before or during EP-CT enrollment, there were fewer ED visits or hospitalizations versus patients who received palliative RT after EP-CT completion (30.1% vs 50.0%, P = 0.042). Conclusion:In a cohort of advanced cancer patients enrolled in EP-CTs, palliative RT was utilized in one-third of patients at some point during their care. Those who received palliative RT prior to or during EP-CT enrollment experienced fewer ED visits and hospitalizations compared to those who received it after EP-CT. While rare, those patients who received palliative RT while on EP-CT experienced a markedly longer time on trial, highlighting the potential benefits of EP-CT trial designs that allow for palliative RT while remaining on study. Additional research is warranted to characterize the impact of palliative RT on the EP-CT trial experience.

Purpose/Objective(s): Definitive Stereotactic Body Radiation Therapy (SBRT) has become a standard treatment option for men with low to intermediate risk prostate cancer. Several studies have characterized the importance of low PSA nadir for sustained disease control post radiation. Dose response parameters are well-established for low dose rate (LDR) brachytherapy, and remain emerging for prostate SBRT. Due to heterogeneity of treatment platforms and prescription nomenclature, it remains challenging to apply dose-response data with SBRT in an ecumenical fashion. This study assesses clinical and dosimetric factors associated with a low PSA nadir post prostate SBRT. Materials/Methods: 852 patients with NCCN low (39.0%), favorable intermediate (26.6%) and unfavorable intermediate (34.4%) risk disease were treated with, inhomogeneous non-coplanar SBRT, allowing for intraprostatic dose escalation. Treatment was delivered at an academic institution from June 21, 2006 to January 3, 2018 and consisted of a 5fraction regimen of 35.0-36.25 Gy. The mean age was 66.6 years (41-87). 77.9% of patients were Caucasian and 17.4% African American. The mean follow-up time was 46.3 months (24-155). In order to distill predictive correlates for post-treatment PSA decline, patients receiving ADT or who experienced biochemical failure were omitted a priori. Correlation analyses were performed using Pearson chi-square testing and odds ratios were assessed with binary logistic regression. Results: After a minimum of 24 months post SBRT monotherapy, the mean PSA nadir was 0.39ng/ml (0-2.72), with 56.0% of patients experiencing a nadir 0.3ng/ml. Patients with a nadir 0.3ng/ml were more likely to be age 65 years (68.1% vs. 52.8%, p<.001), and to be Caucasian (80.7% vs. 74.4%, p Z .007). They were more likely to have clinical T2b/T2c disease (11.6% vs. 6.7%, p Z .031) and less likely to have a pre-treatment PSA >10ng/ml (9.6% vs. 15.2%, p Z .014). They more often were treated with anti-coagulation medicine (12.0% vs. 6.5%, p Z .01). Those with a nadir 0.3ng/ml had no difference in overall NCCN risk grouping, use of 5-alpha reductase inhibitor, metformin, or statin medication use. Dosimetric parameters that portended for nadir 0.3ng/ml included CTV D70 37.75Gy (82.6% vs. 70.5%, p<.001), CTV D80 37.5Gy (70.0% vs. 57.8%, p Z .003), and CTV mean dose 38.5Gy (57.1% vs. 43.8%, p Z .002). On multivariate analysis, predictors for long-term PSA nadir 0.3ng/ml were age 65 (OR 1.78, CI 1.20-2.64, p Z .004) and CTV D70 37.75Gy (OR 2.52, CI 1.10-5.79, p Z .029). Conclusion: Patients with localized prostate cancer can experience low PSA nadirs post SBRT monotherapy. Consistent with previous studies, older age appears to correlate with lower nadir values. CTV D70 37.75Gy predicts for PSA nadir 0.3ng/ml. Longer follow-up is warranted to assess for durability of these findings and future inquiry should involve correlation between D70 and long-term disease-free endpoints.

Purpose/Objective(s): Collagen vascular disease (CVD) is considered a relative contra-indication to radiotherapy. We sought to determine rates of acute and late radiotherapy-associated toxicity in patients with CVD compared to matched controls. Materials/Methods: A systematic review was performed following PRISMA guidelines. PubMed was searched for articles from inception to February 2021. Search terms included collagen vascular disease and subtypes; radiotherapy; and cancer. Eligible studies included radiotherapyassociated toxicity rates for at least 10 patients with CVD and their matched controls. Data abstracted included number of patients with CVD; number of controls; median follow-up; treatment period; anatomic sites treated; types of CVD; acute toxicity and late toxicity. Primary endpoints were acute and late grade 3 or higher (3+) toxicity. Random effects metaanalyses of acute and late grade 3+ toxicity were performed using Comprehensive Meta-analysis software for patients with any CVD and their matched controls; patients with scleroderma and their matched controls; and patients with Lupus and their matched controls. Results: The search strategy identified 3573 studies. 17 articles were selected for full-text review and 7 were included for analysis for the primary endpoints. Patients received radiotherapy between 1964 and 2016. 353 patients with CVD were matched to 617 controls, including 19 patients with scleroderma matched to 40 controls and 48 patients with Lupus matched to 82 controls. The most common sites treated were head and neck (31%), breast (29%), and pelvis (11%). Criteria for propensity score included: age, sex, cancer diagnosis, radiotherapy technique, radiotherapy dose, year of radiotherapy and anatomical site of treatment. Patients with CVD had an increased rate of acute grade 3+ toxicity compared to controls (15% vs 9%, P < 0.01, OR = 2.0) and a trend toward an increased rate of late grade 3+ toxicity (11% vs 6%, P = 0.05, OR = 1.7). Patients with scleroderma had an especially high acute grade 3+ toxicity rate compared to controls (25% vs 6%, P = 0.03, OR = 4.1). There was no significant difference in late grade 3 + toxicity between scleroderma patients and their matched controls, and no significant difference in acute or late grade 3+ toxicity between Lupus patients and their matched controls. 5 patients with CVD and no matched controls had treatment-related death. Conclusion: Patients with CVD have a higher rate of acute grade 3+ radiotherapy toxicity compared to matched controls.