Erqi Pollom

All Publications

• A Balancing Act With Adaptive Hypofractionation. International journal of radiation oncology, biology, physics Vitzthum, L. K., Pollom, E. 2024; 120 (4): 930

  View details for DOI 10.1016/j.ijrobp.2024.08.030

  View details for PubMedID 39424592

• Disparities in US retinoblastoma presentation, management and local recurrence in the National Cancer Database, 2004-2016. Ophthalmology. Retina So, J. Y., Pershing, S., Pollom, E. L., Hiniker, S. M., Afshar, A. R. 2024

  Abstract

  To investigate patient-level differences in retinoblastoma presentation, treatments, and outcomes within the United States.Retrospective registry-based analysis.1,404 retinoblastoma cases in the National Cancer Database, 2004-2016, a US-based cancer registry.Patient characteristics and treatments were investigated over time. Primary treatment was classified as enucleation, local tumor destruction, chemotherapy, and/or radiation. Multivariable logistic regression models evaluated extraocular disease at presentation, treatment, and local recurrence following primary globe-sparing therapy.Odds ratios for extraocular disease at presentation; primary treatment modality; local recurrence after primary globe-sparing therapy.Extraocular disease affected 13% of patients at presentation (N=178). All-cause mortality among the entire cohort was 3.1% (n=44) at last follow-up Those who were non-white, uninsured or had government-funded insurance, or with non-metropolitan residence had significantly greater odds of extraocular disease (OR 2.21-3.64 for non-white vs. white non-Hispanic patients, OR 2.05-2.95 for uninsured or Medicaid/Medicare/government-funded vs. private/commercial insurance, and OR 1.80 for non-metropolitan vs. metropolitan residence). Between 2004-2016, utilization of chemotherapy (55% to 73%) and local tumor destruction (17% to 27%) increased. Enucleations remained over-represented among Hispanic patients (63% received enucleation in 2016, vs. 35% non-Hispanic patients; OR=1.83, (95% CI 1.22-2.75) for enucleation among Hispanic vs. white, non-Hispanic patients). Patients with Medicaid/Medicare/government insurance and non-metropolitan residence also had higher odds of enucleation, and non-metropolitan patients had higher odds of local recurrence after primary globe-sparing therapy.Despite overall decline in enucleation and increase in globe-sparing therapy between 2004-2016, Hispanic, Medicaid/Medicare/government-insured, and non-metropolitan patients continued to have higher odds of extraocular disease at presentation and higher odds of undergoing enucleation as primary therapy. This suggests limitations in access to care and that shifts towards globe-sparing treatment (chemotherapy and local tumor destruction) did not occur equally across all patient groups. Further investigations into these disparities is warranted.

  View details for DOI 10.1016/j.oret.2024.11.005

  View details for PubMedID 39536804

• Green Horizons in Oncology: A Blueprint for Environmentally Sustainable Radiation Therapy Facilities. Seminars in radiation oncology Baniel, C. C., Sabol, R. A., Nieto, R., Scholey, J., Witztum, A., Chuter, R., Pollom, E., Gandhi, S., Wang, K., Mishra, K. K., Lichter, K. E., Park, C. 2024; 34 (4): 426-432

  View details for DOI 10.1016/j.semradonc.2024.07.004

  View details for PubMedID 39271277

• Safety of pelvic and abdominal radiation therapy for patients with inflammatory bowel disease: a dosimetric analysis of acute bowel toxicity. International journal of radiation oncology, biology, physics Hall, J. C., Hall, A. K., Lozko, Y., Hui, C., Baniel, C. C., Jackson, S., Vitzthum, L. K., Chang, D. T., Rahimy, E., Pollom, E. L. 2024

  Abstract

  OBJECTIVES: Inflammatory bowel disease (IBD) has been considered a relative contraindication to radiation therapy (RT) due to the potential greater risk of RT-induced toxicities. This study aims to assess acute toxicity outcomes in patients with IBD treated with abdominal/pelvic RT.METHODS: After institutional review board approval, patients with IBD who received RT to the abdomen/pelvis were identified from an institutional research repository and their electronic medical records were reviewed. The IBD cohort was matched 1:1 with controls according to all of the following: radiotherapy, gender, disease site, age, and year of RT. Acute toxicity was defined as toxicity occurring within 3 months of RT. Primary outcomes were assessed via univariable logistic regression models and predicted probability of acute toxicity and acute gastrointestinal (GI) toxicity were plotted for the most significant covariates. IBD and control control cohorts were compared on demographic and toxicity variables using chi-square/Fisher's exact tests and Kruskal-Wallis tests where appropriate.RESULTS: We identified 62 patients with median age of 64 years (interquartile range [IQR] 54-70) who received RT from 2006-2022. Patients were treated with intensity-modulated RT (38; 61.3%), 3-dimensional conformal RT (12; 19.4%), and stereotactic body RT/brachytherapy (12; 19.4%). After RT, 28 (45.2%) and 23 (37.1%) patients experienced grade ≥2 acute (any) and acute GI toxicity, respectively. Higher overall RT dose and RT dose to small bowel were found to be signicantly associated with increased risk of grade ≥2 acute toxicities (OR=1.041 per unit Gy, 95% CI 1.005-1.084, p=0.034 and OR=1.046, 95% CI 1.018-1.082, p=0.003, respectively). Between IBD and control cohorts, there were no significant differences in grade ≥2 acute (any) and acute GI toxicities (p=0.710 and p=0.704, respectively).CONCLUSION: In patients with IBD treated with abdominal/pelvic RT for malignancy, RT was effective and well-tolerated. RT treatment planning should carefully consider the location(s) of IBD inflammation and dose to bowel structures, in particular, dose to small bowel.

  View details for DOI 10.1016/j.ijrobp.2024.09.005

  View details for PubMedID 39270827

• Cultural and social barriers to hope in gastrointestinal cancer patients. Journal of gastrointestinal oncology Qu, V., Hui, C., Fang, Z., Jackson, S., Vitzthum, L., Rahimy, E., Hall, J., Pollom, E. L. 2024; 15 (4): 1487-1496

  Abstract

  Hope is correlated with quality of life and overall survivorship among patients with cancer. We aimed to identify sociodemographic and clinical determinants of hope among patients with gastrointestinal (GI) cancer.Patients with GI cancer seen in radiation oncology between 10/2022 and 6/2023 were surveyed with the Adult Hope Scale (AHS) questionnaire, which assesses hope based on goal-setting and goal-striving beliefs. Linear regression and Pearson's/Spearman's correlation coefficients were used to evaluate associations between AHS scores and demographic or disease variables.One-hundred and forty-five (71.1% response rate) patients were included in the analysis. Most (75%) patients were symptomatic from disease, and Asian American and Pacific Islander (AAPI) patients accounted for 30.3% of our cohort. Identifying as AAPI or needing an interpreter for clinic visits was significantly associated with lower AHS scores, and more AAPI patients required interpreter assistance compared to non-AAPI patients (P=0.04). Being divorced, unemployed, or female was also linked to less hope. No other differences in hope were found.Sociodemographic rather than prognostic clinical factors were predictive of hope among patients with GI cancer. Interventions to contextualize psychosocial risk factors have the potential to improve quality of life and oncologic outcomes.

  View details for DOI 10.21037/jgo-23-938

  View details for PubMedID 39279929

  View details for PubMedCentralID PMC11399820

• Stereotactic body radiotherapy for painful spinal metastases: a decade of experience at a single institution. Journal of neurosurgery. Spine Chou, K. N., Park, D. J., Hori, Y. S., Persad, A. R., Chuang, C. F., Emrich, S. C., Ustrzynski, L., Tayag, A., Kumar, K. A., Usoz, M., Mendoza, M., Rahimy, E., Pollom, E., Soltys, S. G., Lo, C. H., Chang, S. D. 2024: 1-9

  Abstract

  This study aimed to retrospectively evaluate the efficacy of stereotactic body radiotherapy (SBRT) for pain relief in patients with painful spinal bone metastases (SBMs) and to identify key factors contributing to treatment outcomes.The authors conducted a retrospective analysis of adult patients who underwent SBRT for painful solid tumor SBMs between March 2012 and January 2023. During this period, SBRT was performed adhering to the International Spine Radiosurgery Consortium guidelines and international consensus recommendations for target volume delineation. To be included, patients needed to experience persistent pain directly associated with SBMs, warranting regular opioid treatment. Positive pain relief post-SBRT was defined by three criteria: 1) a decrease in the severity of pain; 2) reduction in opioid dosage; and 3) concurrent improvement in daily activities. The revised Tokuhashi score and Spine Instability Neoplastic Score were used to identify crucial factors influencing treatment outcomes.This study included 377 patients, covering 576 lesions across 759 vertebrae. Of these, 332 lesions showed significant pain relief within 3 months following SBRT. Lower pain relief rates were observed in patients with a revised Tokuhashi score of 0-8 or in patients with diabetes mellitus. In contrast, higher relief rates were linked to treating a single painful SBM in 1 SBRT course, and greater contouring of the involved sectors according to International Spine Radiosurgery Consortium guidelines and international consensus recommendations. The highest pain relief rate was observed in patients with prostate cancer (73.8%), whereas the lowest rate was observed in patients with hepatocellular carcinoma (36.4%). The presence of pre-SBRT vertebral fractures, the dosage and fraction of SBRT, and the use of concurrent systemic cancer therapies or antiresorptive agents, including bisphosphonates and denosumab, did not notably influence the pain relief efficacy of SBRT. Comprehensive medical records 6 months after SBRT treatment were available for only 362 lesions. The overall rate of pain relief observed was 32.6%.SBRT is an effective treatment approach for managing painful SBMs, achieving a pain relief rate of 57.6% within 3 months and maintaining a rate of 32.6% at 6 months after treatment. The transition to osteoblastic lesions may potentially improve the stability of SBMs, indicated by lower Spine Instability Neoplastic Score, which in turn could extend pain relief management.

  View details for DOI 10.3171/2024.5.SPINE231326

  View details for PubMedID 39126716

• Racial Disparities in Cancer Stage at Diagnosis and Survival for Adolescents and Young Adults. JAMA network open Taparra, K., Kekumano, K., Benavente, R., Roberto, L., Gimmen, M., Shontell, R., Cakobau, H., Deo, N., Kinslow, C. J., Betof Warner, A., Deville, C., Shing, J. Z., Vo, J. B., Patel, M. I., Pollom, E. 2024; 7 (8): e2430975

  Abstract

  There are limited studies assessing stage at diagnosis and risk of death among all 5 federally defined races in the US among adolescent and young adult (AYA) patients with cancer.To identify racial disparities in stage at diagnosis and survival among AYA patients with cancer.This retrospective cohort study used data from a US national hospital-based oncology database on AYA patients, aged 15 to 39 years, with the 10 deadliest cancers among AYA patients who received a diagnosis from January 1, 2004, to December 31, 2017, with 6 months or more of follow-up. Analyses by race were categorized by the 5 federally defined races in the US: American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and non-Hispanic White (hereafter, White). White patients served as the majority reference group. Statistical analysis was performed from November 2022 to September 2023.The primary end points were late stage at diagnosis (logistic regression with adjusted odds ratios [AORs] and 95% CIs) and overall survival (log-rank tests and Cox proportional hazards regression with adjusted hazard ratios [AHRs] and 95% CIs).A total of 291 899 AYA patients (median age, 33 years [IQR, 28-37 years]; 186 549 female patients [64%]; 189 812 [65%] with stage I or II cancers) were evaluated. The cohort included 1457 American Indian or Alaska Native patients (1%), 8412 Asian patients (3%), 40 851 Black patients (14%), 987 Native Hawaiian or Other Pacific Islander patients (0.3%), and 240 192 White patients (82%). Cancers included breast (n = 79 195 [27%]), lymphoma (n = 45 500 [16%]), melanoma (n = 36 724 [13%]), testis (n = 31 413 [11%]), central nervous system (n = 26 070 [9%]), colon or rectum (n = 22 545 [8%]), cervix (n = 20 923 [7%]), sarcoma (n = 14 951 [5%]), ovary (n = 8982 [3%]), and lung (n = 5596 [2%]). Risk of late-stage diagnosis was higher for Asian (AOR, 1.20; 95% CI, 1.14-1.26), Black (AOR, 1.40; 95% CI, 1.36-1.43), and Native Hawaiian or Other Pacific Islander (AOR, 1.34; 95% CI, 1.16-1.55) patients compared with White patients. Overall survival differed by race for all cancer sites, except cancers of the central nervous system and ovary. Risk of death was higher for American Indian or Alaska Native (AHR, 1.15; 95% CI, 1.02-1.30), Black (AHR, 1.22; 95% CI, 1.19-1.26), and Native Hawaiian or Other Pacific Islander (AHR, 1.25; 95% CI, 1.09-1.44) patients but lower for Asian patients (AHR, 0.90; 95% CI, 0.85-0.95) compared with White patients.This cohort study of AYA patients suggests that stage at diagnosis and survival varied across races for the 10 deadliest AYA cancers. These results support the need for tailored interventions and informed public policy to achieve cancer care equity for all races.

  View details for DOI 10.1001/jamanetworkopen.2024.30975

  View details for PubMedID 39212989

  View details for PubMedCentralID PMC11365006

• Tyrosine Kinase Inhibitors With and Without Up-Front Stereotactic Radiosurgery for Brain Metastases FromEGFRandALKOncogene-Driven Non-Small Cell Lung Cancer (TURBO-NSCLC). Journal of clinical oncology : official journal of the American Society of Clinical Oncology Pike, L. R., Miao, E., Boe, L. A., Patil, T., Imber, B. S., Myall, N. J., Pollom, E. L., Hui, C., Qu, V., Langston, J., Chiang, V., Grant, M., Goldberg, S. B., Palmer, J. D., Prasad, R. N., Wang, T. J., Lee, A., Shu, C. A., Chen, L. N., Thomas, N. J., Braunstein, S. E., Kavanagh, B. D., Camidge, D. R., Rusthoven, C. G. 2024: JCO2302668

  Abstract

  PURPOSE: Newer-generation tyrosine kinase inhibitors (TKIs) for non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements have demonstrated high CNS activity. The optimal use of up-front stereotactic radiosurgery (SRS) for brain metastases (BM) in patients eligible for CNS-penetrant TKIs is controversial, and data to guide patient management are limited.MATERIALS AND METHODS: Data on TKI-naive patients with EGFR- and ALK-driven NSCLC with BM treated with CNS-penetrant TKIs with and without up-front SRS were retrospectively collected from seven academic centers in the United States. Time-to-CNS progression and overall survival (OS) were analyzed, with multivariable adjustment in Fine & Gray and Cox proportional hazards models for clinically relevant factors.RESULTS: From 2013 to 2022, 317 patients were identified (200 TKI-only and 117 TKI + SRS). Two hundred fifty (79%) and 61 (19%) patients received osimertinib and alectinib, respectively. Patients receiving TKI + SRS were more likely to have BM ≥1 cm (P < .001) and neurologic symptoms (P < .001) at presentation. Median OS was similar between the TKI and TKI + SRS groups (median 41 v 40 months, respectively; P = .5). On multivariable analysis, TKI + SRS was associated with a significant improvement in time-to-CNS progression (hazard ratio [HR], 0.63 [95% CI, 0.42 to 0.96]; P = .033). Local CNS control was significantly improved with TKI + SRS (HR, 0.30 [95% CI, 0.16 to 0.55]; P < .001), whereas no significant differences were observed in distant CNS control. Subgroup analyses demonstrated a greater benefit from TKI + SRS in patients with BM ≥1 cm in diameter for time-to-CNS progression and CNS progression-free survival.CONCLUSION: The addition of up-front SRS to CNS-penetrant TKI improved time-to-CNS progression and local CNS control, but not OS, in patients with BM from EGFR- and ALK-driven NSCLC. Patients with larger BM (≥1 cm) may benefit the most from up-front SRS.

  View details for DOI 10.1200/JCO.23.02668

  View details for PubMedID 39047224

• Nonoperative Management for Rectal Cancer. Cancer journal (Sudbury, Mass.) Pollom, E. L., Sheth, V. R., Dawes, A. J., Holden, T. 2024; 30 (4): 238-244

  Abstract

  The treatment paradigm for rectal cancer has been shifting toward de-escalated approaches to preserve patient quality of life. Historically, the standard treatment in the United States for locally advanced rectal cancer has standardly comprised preoperative chemoradiotherapy coupled with total mesorectal excision. Recent data challenge this "one-size-fits-all" strategy, supporting the possibility of omitting surgery for certain patients who achieve a clinical complete response to neoadjuvant therapy. Consequently, patients and their physicians must navigate diverse neoadjuvant options, often in the context of pursuing organ preservation. Total neoadjuvant therapy, involving the administration of all chemotherapy and radiation before total mesorectal excision, is associated with the highest rates of clinical complete response. However, questions persist regarding the optimal sequencing of radiation and chemotherapy and the choice between short-course and long-course radiation. Additionally, meticulous response assessment and surveillance are critical for selecting patients for nonoperative management without compromising the excellent cure rates associated with trimodality therapy. As nonoperative management becomes increasingly recognized as a standard-of-care treatment option for patients with rectal cancer, ongoing research in patient selection and monitoring as well as patient-reported outcomes is critical to guide personalized rectal cancer management within a patient-centered framework.

  View details for DOI 10.1097/PPO.0000000000000727

  View details for PubMedID 39042774

• Stereotactic Radiosurgery for Residual, Recurrent, and Metastatic Hemangiopericytomas: A Single-Institution Retrospective Experience. Neurosurgery Yoo, K. H., Park, D. J., Veeravagu, A., Persad, A., Lee, M., Marianayagam, N. J., Zamarud, A., Gu, X., Pollom, E. L., Soltys, S. G., Meola, A., Chang, S. D. 2024

  Abstract

  BACKGROUND AND OBJECTIVES: Hemangiopericytomas are infrequent vascular tumors originating from Zimmermann pericytes. The conventional treatment involves gross total resection, followed by adjuvant radiotherapy. Nevertheless, their tendency to infiltrate dural sinuses, high vascularity, and anatomic complexity pose challenges for radical resection, leading to a significant risk of recurrence. Stereotactic radiosurgery (SRS) has emerged as a promising adjuvant therapy to address these challenges. Our study provides the largest single-institutional retrospective, aiming to evaluate the effectiveness and safety of SRS as a treatment modality for residual, recurrent, and metastatic hemangiopericytomas.METHODS: From 1998 to 2023, 27 patients with 101 tumors underwent CyberKnife SRS at Stanford University Medical Center. The median age was 51 years at the time of treatment. The median follow-up period from SRS was 103 months (range: 6-250). All patients underwent upfront surgical resection. The median tumor volume was 1.5 cc. The median single-fraction equivalent dose was 19 Gy. The SRS was administered at the 76% of the median isodose line (range: 64-89).RESULTS: Of the 101 treated tumors, 24 (23.8%) progressed with a median time to recurrence of 30 months. At 10 years, the rates of local tumor control (LTC), overall survival (OS), and progression-free survival (PFS) were 74.3%, 80.8%, and 67%, respectively. In patients with metastatic lesions, the LTC rates were significantly greater when compared with those with residual or recurrent tumors. There was no significant difference between patients with residual, recurrent, and metastatic hemangiopericytomas in OS and PFS. Notably, no cases of radiation-induced adverse events were detected.CONCLUSION: SRS leads to excellent LTC, PFS, and OS at 10 years with negligible risk for adverse events. Therefore, it is an effective and safe management modality for patients with residual, recurrent, and metastatic hemangiopericytomas.

  View details for DOI 10.1227/neu.0000000000003114

  View details for PubMedID 39028180

• The Assistant Clinical Research Coordinator Program: A Pathway for Recruitment in Radiation Oncology. Advances in radiation oncology Aboytes, M., Cody, M., Laseinde, E., Hall, J., Soltys, S., Beadle, B., Kidd, E., Qian, Y., Koong, A. C., Chang, D., Le, Q., Pollom, E. L. 2024; 9 (7): 101504

  Abstract

  Purpose: Recruiting prospective physicians to radiation oncology can be challenging, because of limited familiarity with the field. The Assistant Clinical Research Coordinator (ACRC) program can help provide trainees early exposure to radiation oncology.Methods and Materials: The ACRC program involves hiring a college graduate to provide administrative and research support for faculty members. The program was developed with our institution's clinical trials office, which provided guidance on regulatory compliance and training. A structured selection process identifies top candidates, and a rigorous onboarding process ensures smooth transitions between ACRCs. We report characteristics and outcomes of ACRC employees and surveyed them to assess their program experience using a Likert scale.Results: From 2005 to 2023, the ACRC program paired 73 ACRCs with faculty. Most faculty (68%) are currently supported by ACRCs. In 2023, 113 applications were received for 4 positions. ACRCs have contributed to research publications (293 as coauthors and 43 as first authors) and taken on leadership roles in the department. Most program alumni have attended medical school (34 of 64 program graduates; 53%). Eight have chosen to specialize in radiation oncology (13%; 2 applying into radiation oncology, 1 in residency, and 5 attendings). Of the 25% of alumni who responded to our survey, 77% responded that the mentorship provided by the ACRC program was very or extremely effective in guiding their academic development. All respondents rated the research opportunities as good or excellent, and 77% rated the clinical experience opportunities as good or excellent. Most (77%) reported that the ACRC program had substantial or significant influence on their choice of career path.Conclusions: The ACRC program provides an opportunity to address recruitment challenges in radiation oncology by offering early exposure to the field, clinical research skills, and mentorship. With the strong interest in our job posting this year, there is potential to expand this program to other institutions.

  View details for DOI 10.1016/j.adro.2024.101504

  View details for PubMedID 38846487

• Advancing Clinical Trial Equity through Integration of Telehealth and Decentralized Treatment. JNCI cancer spectrum Brown, E., Albert Fisher, G., Shelton, A., Chang, D. T., Pollom, E. 2024

  Abstract

  Innovative strategies to increase clinical trial accessibility and equity are needed. We conducted a retrospective review of a phase II investigator-initiated trial to determine whether the modification of clinical trial design to decentralize study treatment can improve trial accessibility among underrepresented groups. Sociodemographic characteristics including area deprivation indices as well as study site travel distance, time, and costs were compared between those enrolled participants who received chemotherapy locally and those who did not. Participants who received chemotherapy locally lived significantly farther from the study site (median 95.90 vs 25.20 miles, p = .004), faced a greater time burden traveling to the study site (median 115.00 vs 34.00 minutes, p = .002), and had higher travel-related costs for a single trip to the study site (median 62.81 vs 16.51 dollars, p = .004). This study highlights opportunities for alleviating financial and time toxicities associated with clinical trial participation, promoting equity in clinical research.

  View details for DOI 10.1093/jncics/pkae050

  View details for PubMedID 38902952

• The Role of CyberKnife Stereotactic Radiosurgery in Recurrent Cranial Medulloblastomas across Pediatric and Adult Populations. Journal of clinical medicine Yoo, K. H., Marianayagam, N. J., Park, D. J., Zamarud, A., Gu, X., Pollom, E., Soltys, S. G., Meola, A., Chang, S. D. 2024; 13 (12)

  Abstract

  Background/Objectives: Medulloblastoma is the most common malignant brain tumor in children. In recent decades, the therapeutic landscape has undergone significant changes, with stereotactic radiosurgery (SRS) emerging as a promising treatment for recurrent cases. Our study provides a comprehensive analysis of the long-term efficacy and safety of SRS in recurrent medulloblastomas across both pediatric and adult patients at a single institution. Methods: We retrospectively reviewed the clinical and radiological records of patients who underwent CyberKnife SRS for recurrent cranial medulloblastomas at our institution between 1998 and 2023. Follow-up data were available for 15 medulloblastomas in 10 patients. The cohort comprised eight pediatric patients (ages 3-18) and two adult patients (ages 19-75). The median age at the time of SRS was 13 years, the median tumor volume accounted for 1.9 cc, the median biologically equivalent dose (BED) was 126 Gy, and the single-fraction equivalent dose (SFED) was 18 Gy. The SRS was administered at 75% of the median isodose line. Results: Following a median follow-up of 39 months (range: 6-78), 53.3% of the medulloblastomas progressed, 13.3% regressed, and 33.3% remained stable. The 3-year local tumor control (LTC) rate for all medulloblastomas was 65%, with lower rates observed in the adult cohort (50%) and higher rates in pediatric patients (67%). The 3-year overall survival (OS) rate was 70%, with significantly higher rates in pediatric patients (75%) compared to adult patients (50%). The 3-year progression-free survival (PFS) rate was 58.3%, with higher rates in pediatric patients (60%) compared to adult patients (50%). Two pediatric patients developed radiation-induced edema, while two adult patients experienced radiation necrosis at the latest follow-up, with both adult patients passing away. Conclusions: Our study provides a complex perspective on the efficacy and safety of CyberKnife SRS in treating recurrent cranial medulloblastomas across pediatric and adult populations. The rarity of adverse radiation events (AREs) underscores the safety profile of SRS, reinforcing its role in enhancing treatment outcomes. The intricacies of symptomatic outcomes, intertwined with factors such as age, tumor location, and prior surgeries, emphasize the need for personalized treatment approaches. Our findings underscore the imperative for ongoing research and the development of more refined treatment strategies for recurrent medulloblastomas. Given the observed disparities in treatment outcomes, a more meticulous tailoring of treatment approaches becomes crucial.

  View details for DOI 10.3390/jcm13123592

  View details for PubMedID 38930121

• Tyrosine kinase inhibitors with and without upfront CNS radiation for brain metastases in oncogene-driven non-small cell lung cancer (TURBO-NSCLC). Miao, E., Pike, L. G., Boe, L. A., Patil, T., Myall, N., Hui, C., Pollom, E. L., Qu, V., Langston, J., Grant, M. J., Goldberg, S. B., Palmer, J., Prasad, R., Wang, T. C., Lee, A., Shu, C. A., Chen, L., Thomas, N. J., Camidge, D., Rusthoven, C. G., TURBO NSCLC LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557400381

• Evaluating disparities in receptor status, overall survival, and time to hormone therapy among women with breast cancer Taparra, K. A., DeVille, N. V., Melendez-Ramos, A., Blanco-Portillo, J., Ioannidis, A., Patel, M. I., Pollom, E. L., Horst, K. C. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557402568

• Phase II trial of organ preservation program using short-course radiation and FOLFOXIRI for rectal cancer (SHORT-FOX). Pollom, E. L., Fisher, G. A., Shelton, A., Johnson, T., Chen, C., Jackson, S., Shaheen, S., Holden, T., Bien, J., King, D., Morris, A. M., Kin, C., Dawes, A., Kirilcuk, N., Gahagan, J., Vitzthum, L., Sheth, V., Brown, E., Pratapneni, A., Chang, D. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557400852

• Disparities in stereotactic radiosurgery practice patterns for treatment of brain metastases: A large national cancer database study Taparra, K. A., Shih, J., Patel, M. I., Pollom, E. L. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557402566

• Primary Stereotactic Body Radiotherapy for Spinal Bone Metastases From Lung Adenocarcinoma. Clinical lung cancer Chou, K. N., Park, D. J., Hori, Y. S., Persad, A. R., Chuang, C., Emrish, S. C., Ustrzynski, L., Tayag, A., Kumar, K., Usoz, M., Mendoza, M., Rahimy, E., Pollom, E., Soltys, S. G., Lai, S. W., Chang, S. D. 2024

  Abstract

  This study aimed to assess the results of primary stereotactic body radiotherapy (SBRT) for spinal bone metastases (SBM) originating from lung adenocarcinoma (ADC). We considered the revised Tokuhashi score (rTS), Spinal Instability Neoplastic Score (SINS), and genetic characteristics.We examined adult patients with lung ADC who underwent primary SBRT (using the CyberKnife System) for SBM between March 2012 and January 2023.We analyzed data from 99 patients, covering 152 SBM across 194 vertebrae. The overall local control (LC) rate was 77.6% for SBM from lung ADC, with a LC rate of 90.7% at 1 year. The median period for local progression (LP) occurrence was recorded at 10.0 (3-52) months. Additionally, Asian patients demonstrated higher LC rates than White patients. Utilizing the rTS and SINS as predictive tools, we revealed that a poor survival prognosis and an unstable spinal structure were associated with increased rates of LP. Furthermore, the presence of osteolytic bone destructions and pain complaints were significantly correlated with the occurrence of LP. In the cohort of this study, 108 SBM underwent analysis to determine the expression levels of programmed cell death ligand 1 (PD-L1). Additionally, within this group, 60 showed mutations in the epidermal growth factor receptor (EGFR) alongside PD-L1 expression. Nevertheless, these genetic differences did not result in statistically significant differences in the LC rate.The one-year LC rate for primary SBRT targeting SBM from lung ADC stood at 90.7%, particularly with the use of the CyberKnife System. Patients achieving LC exhibited significantly longer survival times compared to those with LP.

  View details for DOI 10.1016/j.cllc.2024.05.007

  View details for PubMedID 38897849

• Where Does Auto-Segmentation for Brain Metastases Radiosurgery Stand Today? Bioengineering (Basel, Switzerland) Kim, M., Wang, J. Y., Lu, W., Jiang, H., Stojadinovic, S., Wardak, Z., Dan, T., Timmerman, R., Wang, L., Chuang, C., Szalkowski, G., Liu, L., Pollom, E., Rahimy, E., Soltys, S., Chen, M., Gu, X. 2024; 11 (5)

  Abstract

  Detection and segmentation of brain metastases (BMs) play a pivotal role in diagnosis, treatment planning, and follow-up evaluations for effective BM management. Given the rising prevalence of BM cases and its predominantly multiple onsets, automated segmentation is becoming necessary in stereotactic radiosurgery. It not only alleviates the clinician's manual workload and improves clinical workflow efficiency but also ensures treatment safety, ultimately improving patient care. Recent strides in machine learning, particularly in deep learning (DL), have revolutionized medical image segmentation, achieving state-of-the-art results. This review aims to analyze auto-segmentation strategies, characterize the utilized data, and assess the performance of cutting-edge BM segmentation methodologies. Additionally, we delve into the challenges confronting BM segmentation and share insights gleaned from our algorithmic and clinical implementation experiences.

  View details for DOI 10.3390/bioengineering11050454

  View details for PubMedID 38790322

• Combinatorial Approaches for Chemotherapies and Targeted Therapies with Radiation: United Efforts to Innovate in Patient Care. International journal of radiation oncology, biology, physics Jabbour, S. K., Kumar, R., Anderson, B., Chino, J. P., Jethwa, K. R., McDowell, L., Lo, A. C., Owen, D., Pollom, E. L., Tree, A. C., Tsang, D. S., Yom, S. S. 2024

  Abstract

  Combinatorial therapies consisting of radiation therapy with systemic therapies, particularly chemotherapy and targeted therapies, have moved the needle to augment disease control across nearly all disease sites for locally advanced disease. Evaluating these important combinations to incorporate more potent therapies with radiation therapy will help in our understanding toxicity and efficacy for patients. This article discusses multiple disease sites and includes a compilation of contributions from expert Red Journal editors from each disease site. Leveraging the improved systemic control with novel agents, we must continue efforts to study novel combinations with radiation therapy.

  View details for DOI 10.1016/j.ijrobp.2024.01.010

  View details for PubMedID 38216094

• Surgery and stereotactic radiosurgery for spinal leiomyosarcoma: a single-institution retrospective series and systematic review. Journal of neurosurgery. Spine Zamarud, A., Marianayagam, N. J., Sekar, V., Testa, S., Park, D. J., Yener, U., McCleary, T. L., Yoo, K. H., Emrich, S., Tayag, A., Ustrzynski, L., Pollom, E., Soltys, S., Wang, L., Charville, G., Ganjoo, K., Chang, S. D., Meola, A. 2023: 1-13

  Abstract

  Leiomyosarcoma (LMS) is a rare, aggressive soft-tissue sarcoma that seldom spreads to the bone. The spine can be either the site of LMS osseous metastases or the primary tumor site. The optimal treatment option for spinal LMS is still unclear. The authors present a cohort of patients with spinal LMS treated with either upfront surgery or upfront CyberKnife stereotactic radiosurgery (SRS).The authors retrospectively studied the clinical and radiological outcomes of 17 patients with spinal LMS treated at their institution between 2004 and 2020. Either surgery or SRS was used as the upfront treatment. The clinical and radiological outcomes were assessed. A systematic review of the literature was also conducted.Of the 17 patients (20 spinal lesions), 12 (70.6%) were female. The median patient age was 61 years (range 41-80 years). Ten patients had upfront surgery for their spinal lesions, and 7 had upfront CyberKnife radiosurgery. The median follow-up was 11 months (range 0.3-130 months). The median overall survival (OS) for the entire cohort was 13 months (range 0.3-97 months). In subgroup analysis, the median OS was lower for the surgical group (13 months, range 0.3-50 months), while the median OS for the SRS group was 15 months (range 5-97 months) (p = 0.5). Forty percent (n = 4) of those treated with surgery presented with local recurrence at a median of 6.7 months (range 0.3-36 months), while only 14% (n = 1) of those treated with CyberKnife radiosurgery had local recurrence after 5 months. Local tumor control (LTC) rates at the 6-, 12-, and 18-month follow-ups were 72%, 58%, and 43%, respectively, for the SRS group and 40%, 30%, and 20%, respectively, for the surgery group (p < 0.05). The literature review included 35 papers with 70 patients harboring spinal LMS; only 2 patients were treated with SRS. The literature review confirms the clinical and radiological outcomes of the surgical group, while data on SRS are anecdotal.The authors present the largest series in the literature of spinal LMS and the first on SRS for spinal LMS. This study shows that LTC is statistically significantly better in patients receiving upfront SRS instead of surgery. The OS does not appear different between the two groups.

  View details for DOI 10.3171/2023.10.SPINE23666

  View details for PubMedID 38157539

• Impact of language barriers and use of interpreters on hope among patients with Central Nervous System Malignancies and Bone Metastases. International journal of radiation oncology, biology, physics Hui, C., Hall, J., Fang, Z., Lefebvre, S., Hayden-Gephart, M., Li, G., Meola, A., Nagpal, S., Soltys, S., Pollom, E. 2023

  Abstract

  PURPOSE: Hope is important in serious illnesses, as it has been linked to patient quality of life. We aimed to determine factors associated with lower hope scores among patients with central nervous system (CNS) disease or bone metastases.METHODS: The Adult Dispositional Hope Scale (AHS) is a 12-item questionnaire that measures hope through two qualities: agency (goal-directed energy) and pathways (plan to meet goals). Total scores range from 8 to 64, with higher scores reflecting higher agency and pathways thinking. We prospectively collected scores from patients seen in two radiation oncology clinics at our institution from 10/2022 to 4/2023. The method of least squares to fit general linear models and Pearson's correlation coefficients (PCC) was used to determine relationships between AHS score and socioeconomic and disease factors.RESULTS: Of the 197 patients who responded, median age was 60.5 years (range 16.9-92.5 years), most patients were male (60.9%), white (59.4%), and had malignant disease (59.4%). Median overall AHS score was 54 (range 8-64), and median pathway and agency thinking scores were 27 (range 4-32) and 27 (range 4-32), respectively. Patients who needed an interpreter compared to those who did not had significantly lower overall AHS scores (mean score 45.4 versus 51.2, respectively; p=0.0493) and pathway thinking scores (mean score 21.5 versus 25.7, respectively; p=0.0085), and patients with poorer performance status had significantly worse overall AHS scores (PCC=-0.2703, p=0.0003).CONCLUSION: Patients with CNS disease or bone metastases requiring the use of an interpreter had lower AHS scores, highlighting the possible association of language barriers to hope. Addressing patient language barriers and further studies on the possible association of language barriers to hope may improve hope, quality of life and outcomes among these patients.

  View details for DOI 10.1016/j.ijrobp.2023.11.056

  View details for PubMedID 38056777

• Advancements without consensus: differing practice patterns highlight unanswered questions in the management of brain metastases from EGFR- and ALK-positive non-small cell lung cancer. Journal of thoracic disease Hui, C., Pollom, E. L., Li, G., Myall, N. J. 2023; 15 (11): 5877-5884

  View details for DOI 10.21037/jtd-23-1483

  View details for PubMedID 38090286

  View details for PubMedCentralID PMC10713290

• STEREOTACTIC RADIOSURGERY FOR RESIDUAL, RECURRENT, AND METASTATIC HEMANGIOPERICYTOMAS: A SINGLE INSTITUTION EXPERIENCE Yoo, K., Park, D., Veeravagu, A., Lee, M., Marianayagam, N., Zamarud, A., Gu, X., Pollom, E., Soltys, S., Chang, S., Meola, A. OXFORD UNIV PRESS INC. 2023

  View details for Web of Science ID 001115245400225

• STEREOTACTIC RADIOSURGERY FOR CYSTIC AND SOLID INTRACRANIAL HEMANGIOBLASTOMAS: A SINGLE-INSTITUTION RETROSPECTIVE SERIES Yoo, K., Park, D., Marianayagam, N., Pollom, E., Soltys, S., Meola, A., Chang, S. OXFORD UNIV PRESS INC. 2023

  View details for Web of Science ID 001115245400236

• Advancements without consensus: differing practice patterns highlight unanswered questions in the management of brain metastases from<i> EGFR-</i> and<i> ALK</i>-positive non-small cell lung cancer JOURNAL OF THORACIC DISEASE Hui, C., Pollom, E. L., Li, G., Myall, N. J. 2023

  View details for DOI 10.21037/jtd-23-1483

  View details for Web of Science ID 001096720900001

• Outcomes and Imaging Analysis in Hepatocellular Carcinoma Treated With Stereotactic Body Radiation Therapy. Practical radiation oncology Hui, C., Baclay, R., Lau, B., von Eyben, R., Vitzthum, L., Pollom, E., Chang, D. T. 2023; 13 (2): e139-e148

  Abstract

  Although arterial phase enhancement is commonly used to evaluate treatment response for hepatocellular carcinoma, it may not accurately describe response for lesions treated with stereotactic body radiation therapy (SBRT). We aimed to describe the post-SBRT imaging findings to better inform the optimal timing of salvage therapy after SBRT.We retrospectively reviewed patients with hepatocellular carcinoma treated with SBRT from 2006 to 2021 at a single institution with available imaging showing lesions with characteristic arterial enhancement and portal venous washout. Patients were then stratified into 3 groups based on treatment: (1) concurrent SBRT and transarterial chemoembolization, (2) SBRT only, and (3) SBRT followed by early salvage therapy due to persistent enhancement. Overall survival was analyzed with the Kaplan-Meier method, and cumulative incidences were calculated with competing risk analysis.We included 82 lesions in 73 patients. The median follow-up time was 22.3 months (range, 2.2-88.1 months). The median time to overall survival was 43.7 months (95% confidence interval, 28.1-57.6 months) and median progression-free survival was 10.5 months (95% confidence interval, 7.2-14.0 months). There were 10 (12.2%) lesions that experienced local progression and there was no difference in rates of local progression between the 3 groups (P = .32). In the SBRT-only group, the median time to resolution of arterial enhancement and washout was 5.3 months (range, 1.6-23.7 months). At 3, 6, 9, and 12 months, 82%, 41%, 13%, and 8% of lesions, respectively, continued to show arterial hyperenhancement.Tumors treated with SBRT may continue to exhibit persistence of arterial hyperenhancement. Without an increase in size of enhancement, continued surveillance may be appropriate for these patients.

  View details for DOI 10.1016/j.prro.2022.08.012

  View details for PubMedID 36868725

• ASO Visual Abstract: Patterns of Recurrence after Poor Response to Neoadjuvant Chemotherapy in Gastric Cancer and the Role for Adjuvant Radiation. Annals of surgical oncology Hui, C., Ewongwo, A., Lau, B., Fisher, G., Delitto, D., Poultsides, G., Ho, Q. A., Rahimy, E., Pollom, E., Chang, D. T., Vitzthum, L. K. 2023

  View details for DOI 10.1245/s10434-023-14475-3

  View details for PubMedID 37875741

• Stereotactic Radiosurgery for Cranial and Spinal Hemangioblastomas: A Single-Institution Retrospective Series. Neurosurgery Yoo, K. H., Park, D. J., Marianayagam, N. J., Gu, X., Pollom, E. L., Soltys, S. G., Chang, S. D., Meola, A. 2023

  Abstract

  Stereotactic radiosurgery (SRS) has been an attractive treatment modality for both cranial and spinal hemangioblastomas, especially for multiple lesions commonly associated with von Hippel-Lindau (VHL) disease. This study aims to provide the largest long-term analysis of treatment efficacy and adverse effects of SRS for cranial and spinal hemangioblastomas at a single institution.We evaluated the clinical and radiological outcomes of patients with hemangioblastomas treated with CyberKnife SRS at our institute from 1998 to 2022. The follow-up data were available for 135 hemangioblastomas in 35 patients. Twenty-eight patients had 123 hemangioblastomas associated with VHL, and 7 had 12 sporadic hemangioblastomas. The median age was 36 years, and the median tumor volume accounted for 0.4 cc. The SRS was administered with the median single-fraction equivalent dose of 18 Gy to the 77% median isodose line.At a median follow-up of 57 months (range: 3-260), only 20 (16.2%) of the VHL-associated and 1 (8.3%) sporadic hemangioblastomas progressed. The 5-year local tumor control rate was 91.3% for all hemangioblastomas, 91.7% among the sporadic lesions, and 92.9% in patients with VHL. SRS improved tumor-associated symptoms of 98 (74.8%) of 131 symptomatic hemangioblastomas, including headache, neck pain, dizziness, visual disturbances, dysesthesia, ataxia, motor impairment, seizures, and dysphagia. Two patients developed radiation necrosis (5.7%), and 1 of them required surgical resection.SRS is a safe and effective treatment option for patients with hemangioblastomas in critical locations, such as the brainstem, cervicomedullary junction, and spinal cord, and in patients with multiple hemangioblastomas associated with VHL disease.

  View details for DOI 10.1227/neu.0000000000002728

  View details for PubMedID 37967154

• Socio-economic disparities influence likelihood of post-operative radiation to resection cavities of metastatic brain tumors ACTA NEUROCHIRURGICA Haider, G., Dadey, D. A., Rodrigues, A., Pollom, E. L., Adler, J. R., Veeravagu, A. 2023

  View details for DOI 10.1007/s00701-023-05826

  View details for Web of Science ID 001087777900004

• Socio-economic disparities influence likelihood of post-operative radiation to resection cavities of metastatic brain tumors. Acta neurochirurgica Haider, G., Dadey, D. Y., Rodrigues, A., Pollom, E. L., Adler, J. R., Veeravagu, A. 2023

  Abstract

  PURPOSE: Irradiating the surgical bed of resected brain metastases improves local and distant disease control. Over time, stereotactic radiosurgery (SRS) has replaced whole brain radiotherapy (WBRT) as the treatment standard of care because it minimizes long-term damage to neuro-cognition. Despite this data and growing adoption, socio-economic disparities in clinical access can result in sub-standard care for some patient populations. We aimed to analyze the clinical and socio-economic characteristics of patients who did not receive radiation after surgical resection of brain metastasis.METHODS: Our sample was obtained from Clinformatics Data Mart Database and included all patients from 2004 to 2021 who did or did not receive radiation treatment within sixty days after resection of tumors metastatic to the brain. Regression analysis was done to identify factors responsible for loss to adjuvant radiation treatment.RESULTS: Of 8362 patients identified who had undergone craniotomy for resection of metastatic brain tumors, 3430 (41%) patients did not receive any radiation treatment. Compared to patients who did receive some form of radiation treatment (SRS or WBRT), patients who did not get any form of radiation were more likely to be older (p = 0.0189) and non-white (p = 0.008). Patients with Elixhauser Comorbidity Index ≥3 were less likely to receive radiation treatment (p < 0.01). Fewer patients with household income ≥ $75,000 did not receive radiation treatment (p < 0.01).CONCLUSION: Age, race, household income, and comorbidity status were associated with differential likelihood to receive post-operative radiation treatment.

  View details for DOI 10.1007/s00701-023-05826-w

  View details for PubMedID 37816918

• Treatment Planning Expansions in Glioblastoma: How Less Can Be More. International journal of radiation oncology, biology, physics Trifiletti, D. M., Milano, M. T., Redmond, K. J., Pollom, E. L., Hattangadi-Gluth, J. A., Kim, M. M. 2023; 117 (2): 293-296

  View details for DOI 10.1016/j.ijrobp.2023.03.062

  View details for PubMedID 37652602

• A Large National Study on Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Cancer Patients Who Refuse Radiation Therapy and Surgery. International journal of radiation oncology, biology, physics Lau, B., Vo, J., Shing, J., Pollom, E., Taparra, K. 2023; 117 (2S): e33

  Abstract

  PURPOSE/OBJECTIVE(S): Asian Americans (AAs) are the only race for whom cancer is the leading cause of death in the US. Despite radiation therapy (RT) and surgery being curative treatments, prior work demonstrated AAs refuse RT/surgery at a higher rate than other races. Given AAs are often aggregated with Native Hawaiians and other Pacific Islanders (NHPIs), rates of RT/surgery refusal within this community are poorly understood. We aimed to 1) assess RT/surgery refusal on overall survival (OS) using propensity-score (PS) matched groups, 2) identify AA and NHPI populations that refuse RT/surgery and 3) determine predictors of refusing RT/surgery.MATERIALS/METHODS: A US hospital-based retrospective cohort study of the National Cancer Database was conducted. Patients included were ≥18 years old, AA by ethnogeographic region (South AA, East AA, and Southeast AA) or NHPI race, with a confirmed diagnosis of 1 of the 10 most common US cancers during 2004-2017 who were recommended for RT/surgery. Cox proportional hazard models with adjusted Hazard Ratios (aHR) assessed propensity-score matched groups (1:10) based on age, race, cancer stage, comorbidity index, rurality, facility type, facility location, and year of diagnosis. Adjusted odds ratios (aOR) were calculated and 95% confidence intervals (95% CI) for treatment refusal using logistic regression. Population heterogeneity for treatment refusal by race was assessed with likelihood ratio tests (p-heterogeneity).RESULTS: The cohort of 147,685 patients who met the inclusion criteria were predominantly East AA (43%), diagnosed with breast cancer (42%), and had a <2 comorbidity index (99%). Median age was 61 years. Median follow-up was 58 months. Overall, 2,888 (5%) patients refused RT, and 1,073 (1%) refused surgery. RT refusal by race was 5.7% (East AA), 7.9% (NHPI), 4.6% (South AA), and 4.6% (Southeast AA). Surgery refusal rates were 1.5% (East AA), 1.9% (NHPI), 1.1% (South AA) and 1.2% (Southeast AA). RT refusal significantly predicted poorer OS (aHR = 1.15, 95% CI = 1.06-1.25) whereas surgery refusal did not. Compared to East AA, NHPIs had a higher risk of RT refusal (aOR = 1.44, 95% CI = 1.27-1.62), whereas South AA (aOR = 0.85, 95% CI = 0.75-0.95) and Southeast AA (aOR = 0.82, 95% CI = 0.75-0.90) had a significantly lower risk (p-heterogeneity<.0001). Predictors of RT refusal were older patient age, high comorbidity index, oral cavity cancer, urban-rural residence, Midwest or West US region, and diagnosis 2011-2017.CONCLUSION: Among AA and NHPI patients with cancers in the US, RT refusal predicted poorer OS. NHPI had the highest risk of RT refusal. Given AA and NHPI are not monolithic groups, data disaggregation is necessary to understand racial/ethnic disparities for treatment refusal. Sociocultural and historical contexts of AA and NHPI populations on treatment refusal are necessary to improve cancer outcomes among these populations.

  View details for DOI 10.1016/j.ijrobp.2023.06.720

  View details for PubMedID 37785166

• Patterns of Failure for Poor Response to Neoadjuvant Chemotherapy in Gastric Cancer. International journal of radiation oncology, biology, physics Hui, C., Ewongwo, A., Lau, B., Fisher, G. A., Poultsides, G., Rahimy, E., Pollom, E., Vitzthum, L. 2023; 117 (2S): e304

  Abstract

  PURPOSE/OBJECTIVE(S): Peri-operative chemotherapy has emerged as the standard of care in the treatment of locally advanced gastric cancer. Improved treatment strategies are needed for patients with a poor response to neoadjuvant chemotherapy and postoperative chemoradiation has been proposed as a potential method of treatment intensification. We aimed to describe the patterns of failure for patients with no or partial response (NR, PR) to pre-operative chemotherapy.MATERIALS/METHODS: We retrospectively reviewed charts of patients with locally advanced gastric cancer treated at our institution from 2008 to 2022 with pre-operative chemotherapy followed by surgery with a D2 resection. We excluded patients who received pre-operative or post-operative radiation therapy, or patients who had a complete response (CR) following neoadjuvant chemotherapy. Cumulative incidence of locoregional failure (LRF) and distant metastases (DM) were calculated from the time of diagnosis with competing risk analysis with death as a competing risk and censored at the last follow up. Overall survival (OS) was analyzed using Kaplan-Meier.RESULTS: A total of 57 patients were identified and 60% are male. Median follow-up time was 31.3 months (range 6.9-181.5 months), and the median age at diagnosis was 68 years old (range 30-86). The most used pre-operative chemotherapy regimen was FLOT (38.6%), followed by FOLFOX (29.8%), and ECF/ECX/EOX (19.3%), and a majority of patients (57.9%) received adjuvant chemotherapy. The most common histology was adenocarcinoma (85.9%), and 61.4% of patients had poorly differentiated disease. Thirty-three (57.9%), and 9 patients (15.8%) were characterized as PR and NR to neoadjuvant therapy by pathology, respectively. The distribution of pathologic stages following neoadjuvant chemotherapy were as follows: 17 patients (29.8%) with Stage IA-B, 12 patients (21.1%) with Stage IIA-B, 15 patients (26.3%) with Stage IIIA, 9 patients (15.8%) with Stage IIIB, and 3 patients (5.3%) with Stage IIIC disease. Two patients had positive lymph nodes with a T0 primary tumor. Median OS was 51.4 months (95% confidence interval [CI] 39.8-68.4) for the entire cohort, and 92.1 months (95% CI 34.6-73.0) versus 42.8 months (95% CI 23.1-88.0) for patients with a PR, and NR, respectively (p = 0.14). The 2-year cumulative incidence of LRF and DM was 7.4% (95% CI 0.4-14.3) and 36.3% (95% CI 23.6-49.1), respectively. Of the five patients who experienced LRF, three of the patients also eventually or concurrently developed DM. 60% of these patients would have had their first site of recurrence covered by standard post-operative radiation treatment volumes.CONCLUSION: Patients with locally advanced gastric cancer who do have less than a CR to chemotherapy have poor outcomes due to high rates of DM. Adjuvant locoregional therapy such as radiation is unlikely to affect survival while DM is the predominant pattern of progression. Further studies are needed to identify adjuvant therapies to improve distant control.

  View details for DOI 10.1016/j.ijrobp.2023.06.2324

  View details for PubMedID 37785108

• Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancers: A United States Cohort Study between 2004 and 2017. International journal of radiation oncology, biology, physics Taparra, K., Ing, B., Ewongwo, A., Vo, J., Shing, J., Gimmen, M., Keli'i, K. M., Pollom, E., Kidd, E. A. 2023; 117 (2S): e64

  Abstract

  PURPOSE/OBJECTIVE(S): Brachytherapy (BT) improves clinical outcomes among women with cervical and endometrial cancers. Recent trends found decreasing BT rates in the United States; however, racial/ethnic differences have not been investigated completely. Here we aim to analyze 1) variations in BT practice patterns, 2) racial differences of BT, and 3) predictors of BT by race among women with cervical and endometrial cancers in the United States.MATERIALS/METHODS: A retrospective cohort of women with endometrial and cervical cancers in the US was evaluated using the National Cancer Database, between 2004 and 2017. Primary endpoint was treatment with BT. Women ≥18 years of age were included for FIGO Stage IA-IVA, non-surgically treated cervical cancers and high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers. Racial groups were in accordance with federal guidelines including Asian, American Indian and Alaska Native (AIAN), Black, Native Hawaiian and other Pacific Islander (NHPI), and White. BT practice patterns and trends over time were evaluated by race. To identify predictors of BT by race, logistic regression calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) after assessing for multicollinearity.RESULTS: A total of 13,857 women with cervical cancer and 140,942 women with endometrial cancer were included. Median follow-up was 69 months. Median (IQR) age was 53 (43-63) years for cervical cancer and 64 (57-72) years for endometrial cancer. Most cervical cancers were Stage III (44%), squamous cell carcinoma (88%), and lymphovascular space invasion (LVSI) positive (49%). Most endometrial cancers were Stage IB (45%), endometrioid histology (82%), and LVSI-positive (50%). Between 2004 and 2017, endometrial cancer BT increased (34% to 57%). BT rates for cervical cancer ranged from 65% NHPI, 63% Asian, 62% White, 59% AIAN, and 57% Black. BT rates for endometrial cancer ranged from 26% Black, 25% White, 25% Asian, 21% AIAN, and 20% NHPI. By race, only Black women with cervical cancer were significantly less likely to receive BT (aOR = 0.8; 95% CI = 0.7-0.9), compared to White women. Only NHPI women with endometrial cancer were less likely to receive BT (aOR = 0.7; 95% CI = 0.5-1.0), compared to White women. Community cancer center treatment was the only factor associated with a decreased odds of BT for both Black women with cervical cancer (aOR = 0.7; 95% CI = 0.6-0.9) and NHPI women with endometrial cancer (aOR = 0.3; 95% CI = 0.1-0.8), compared to academic centers.CONCLUSION: In this study of women diagnosed with endometrial and cervical cancers with stages known to benefit from BT, NHPI women with endometrial cancer and Black women with cervical cancer were less likely to receive brachytherapy compared to White women. Community engagement is needed to increase BT access for patients treated at community cancer centers to ensure equitable gynecologic cancer care.

  View details for DOI 10.1016/j.ijrobp.2023.06.787

  View details for PubMedID 37785907

• Determining the Optimal Sequence of Immunotherapy and Lymph Node Irradiation among Patients with Cancer: A Propensity Score Matched Analysis. International journal of radiation oncology, biology, physics Taparra, K., Benevente, R., Gimmen, M., Kekumano, K., Pollom, E. 2023; 117 (2S): e629

  Abstract

  PURPOSE/OBJECTIVE(S): Immunotherapy (IT) and lymph node irradiation (LNI) are essential cancer treatment modalities. In combination, the optimal sequence to enhance tumor response is poorly understood. While LNI depletes radiosensitive IT-related immune cells, LNI also provides an immunostimulatory effect by shedding tumor neoantigens in the microenvironment. Here we aim to 1) assess IT and LNI sequence patterns among patients with common cancers, 2) evaluate propensity score (PS) matched overall survival (OS) between IT first and LNI first treatments, and 3) compare OS by cancer site.MATERIALS/METHODS: A PS matched retrospective cohort study was conducted using the National Cancer Database. The primary endpoint was OS (time from diagnosis to death). Patients age ≥18 years with breast, GI (pancreas, colorectal, liver), GU (prostate, kidney, bladder), lung, lymphoma, melanoma, and oral cavity cancers were included. All patients underwent both IT and LNI and those with incomplete treatment timing were excluded. IT followed by LNI (IT first) was compared to LNI followed by IT (LNI first). PS were performed with 1:1 matching and a standard mean difference cutoff of 0.1 for covariate balancing. PS matched age, stage, comorbidity index, facility type, and upfront lymph node surgery. Unadjusted Kaplan-Meier (KM) estimates with log-rank tests assessed OS. Multivariable Cox proportional hazard (CPH) models adjusted for patient demographics compared IT first versus LNI first with adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI). Models were stratified by cancer site.RESULTS: A total of 23,238 patients treated with IT and LNI were included, 88% of patients underwent IT first. Median (interquartile range [IQR]) age and follow-up were 57 (48-66) years and 39 (27-53) months, respectively. Cancers included 74% breast, 8% oral cavity, 6% GI, 5% lymphoma, 4% lung, 2% GU, and 1% melanoma. Median (IQR) weeks to treatment were 7 (4-13) for IT first and 8 (4-17) for LNI first. On unadjusted analysis, OS was significantly inferior with LNI first for overall (p<.0001), breast (p<.0001), GI (p = .004), lymphoma (p = .0003), and oral cavity cancer (p = .005). There were no significant differences in OS for GU, lung, and melanoma. On PS matched adjusted CPH analysis, LNI first had significantly higher risk of death overall (aHR = 3.2, 95% CI = 3.0-3.4), compared to IT first. PS matched cancer stratified analyses found OS was significantly inferior with LNI first for breast (aHR = 1.5, 95% CI = 1.2-1.8), GI (aHR = 1.2, 95% CI = 1.1-1.4), GU (aHR = 1.3, 95% CI = 1.0-1.8), lymphoma (aHR = 1.8, 95CI = 1.3-2.6), and oral cavity cancer (aOR = 1.3, 95% CI = 1.1-1.5).CONCLUSION: PS matched analyses revealed superior OS for patients receiving IT first then LNI for breast, GI, GU, lymphoma, and oral cavity cancers. These findings suggest the importance of an intact immune system prior to IT. Future prospective studies are warranted to validate these findings.

  View details for DOI 10.1016/j.ijrobp.2023.06.2022

  View details for PubMedID 37785878

• A Technology-Informed Approach to Clinical Trial Equity. International journal of radiation oncology, biology, physics Brown, E., Jr, G. A., Shelton, A., Johnson, T., Chen, C., Shaheen, S., Holden, T. L., Dao, V. A., Bien, J. Y., King, D., Vitzthum, L., Kirilcuk, N., Morris, A., Kin, C., Dawes, A., Sheth, V., Chang, D. T., Pollom, E. 2023; 117 (2S): e8

  Abstract

  PURPOSE/OBJECTIVE(S): Despite efforts to increase participation of diverse communities in clinical trials, ethnic/racial minorities remain underrepresented. One such determinant may be lack of access to a comprehensive cancer center that conducts clinical research. Historically, our institution has had low accrual from rural regions further away from our cancer center, with Hispanic or Latino (HL) patients (pts) being especially underrepresented in our clinical research. In this study, we explored the impact of a clinical trial that allowed pts to receive chemotherapy (chemo) with their local oncologist. We hypothesize that allowing pts to receive chemo locally will lead to higher rates of enrollment from populations under-represented in clinical trials.MATERIALS/METHODS: We conducted a study for pts with rectal cancer to undergo short-course radiation followed by 4 months of chemo with the option to pursue watch and wait if pts achieve a clinical complete response. Radiation was administered at our institution while pts could receive standard-of-care chemo closer to home with their local oncologist. For pts who received chemo locally, the research coordinator and co-investigators held video visits with the pts prior to each chemo infusion to review adverse events (AE), labs, and chemo dosing. We compared demographic data of pts on this trial with that of pts enrolled across all adult therapeutic oncologic clinical trials over the same time period at our institution. Distance to our institution was calculated based on pts' primary residence zip code. Protocol compliance with AE reporting for pts who received chemo locally was assessed by chart review.RESULTS: Between May 2020 and January 2023, 24/35 enrolled pts completed both radiation and chemo on trial. 13/24 pts (54%) received chemo locally. Of the 24 pts, 16 were White (67%), 7 Asian (29%), 1 Native Hawaiian/ Pacific Islander (4%). Of all enrolled patients, 4 were HL (16.7%), compared to our institutional average of 16.5%. All enrolled HL pts received their chemo locally. The average distance traveled by non-HL pts from their home to our institution was 87.7 miles (range 5.1 - 308). In contrast, HL pts traveled an average of 147.8 miles (range 110 - 249), 68% further than their non-HL counterparts. There was 100% compliance with AE reporting among those pts who received their chemo locally.CONCLUSION: Although the percentage of HL participation in our study was consistent with our institutional average, all HL pts enrolled on the trial received treatment locally and lived substantially further from our institution than non-HL. By allowing pts to receive this part of treatment locally, we provided pts who live further away an opportunity to engage in clinical research without the associated financial and time toxicities related with traveling for treatment. By decentralizing clinical trials and leveraging telemedicine, we can promote the participation of under-represented groups in clinical trials.

  View details for DOI 10.1016/j.ijrobp.2023.06.664

  View details for PubMedID 37786184

• Safety of Radiation Therapy for Treatment of Malignancy in Patients with Inflammatory Bowel Disease. International journal of radiation oncology, biology, physics Hall, J. C., Lozko, Y., Hui, C., Baniel, C. C., Snyder, J. M., Vitzthum, L., Chang, D. T., Rahimy, E., Pollom, E. 2023; 117 (2S): e300

  Abstract

  PURPOSE/OBJECTIVE(S): Inflammatory bowel disease (IBD) has been considered a relative contraindication to radiation therapy (RT) due to the potential greater risk of RT-induced toxicities, however, there is limited toxicity data using modern RT techniques. This study aims to assess toxicity outcomes in patients with IBD treated with abdominal or pelvic RT.MATERIALS/METHODS: After institutional review board approval, patients with IBD who received RT to the abdomen or pelvis were filtered from an institutional research repository and their electronic medical records were reviewed. Acute toxicity was defined as that occurring within 3 months of RT. Toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Univariable Cox proportional hazards regression was used to assess rates of grade ≥2 toxicity-free survival.RESULTS: We identified 62 patients with median age of 69 years (interquartile range [IQR] 62-77) who received RT from 2006-2022. Median follow up was 15 months (IQR 4-33). Most patients were male (42; 68%) and had a diagnosis of ulcerative colitis (44; 71%). The most common primary malignancy was colorectal/anal (26; 42%). Intensity-modulated RT (IMRT) was most frequently used (38; 61%) followed by 3-dimensional conformal RT (3D-CRT) (12; 19%) and stereotactic body RT (SBRT)/brachytherapy (12; 19%). For IMRT/3D-CRT, median dose delivered was 50 Gy (IQR 49-59) in 25 fractions (IQR 25-30), and median maximum dose (Dmax) to bowel was 48 Gy (IQR 43-52); whereas for SBRT/brachytherapy, the median dose was 32 Gy (IQR 27-40) in 3 fractions (IQR 2-5) and median bowel Dmax was 32 Gy (IQR 20-37). The median biologically effective dose delivered with an assumed alpha/beta ratio of 10 (BED10) across all RT modalities was 63 Gy (IQR 60-72). After initiation of RT, 31 patients (50%) and 14 patients (23%) experienced grade ≥2 acute and late toxicity, respectively. Thirteen patients (21%) and 7 patients (11%) experienced grade 3 acute and late toxicity, respectively. No patients experienced grade >3 toxicity. Acute toxicity resulted in interruption to RT for 5 patients (8%), 2 of which did not resume RT. Four patients (6%) required adjustment to chemotherapy or IBD medication dosage as a result of their acute toxicity. Median time from RT start to acute toxicity onset was 41 days (IQR 32-46), whereas median time to onset of late toxicity was 9 months (IQR 5-15). The most common acute and late toxicities were diarrhea (21; 34%) and bowel obstruction/perforation/fistula (4; 6%), respectively. Rates of grade ≥2 toxicity-free survival overtime were not significantly associated with IBD status (active vs quiescent), delivered BED10, or bowel Dmax BED3.CONCLUSION: In patients with IBD treated with abdominal or pelvic RT for malignancy, RT was feasible with acceptable rates of toxicity and active versus quiescent IBD status did not impact toxicity outcomes. Future research is needed to elucidate specific dose constraints when treating patients with IBD.

  View details for DOI 10.1016/j.ijrobp.2023.06.2314

  View details for PubMedID 37785098

• Impact of Employment and Insurance Status on Hope Among Patients Treated within Radiation Oncology. International journal of radiation oncology, biology, physics Hui, C., Hall, J. C., Snyder, J. M., Lefebvre, S., Soltys, S. G., Pollom, E. 2023; 117 (2S): e237-e238

  Abstract

  PURPOSE/OBJECTIVE(S): Hope is important in serious illnesses including cancer, as it has been linked to patient well-being and quality of life. We assessed hope among patients seen in radiation oncology and aimed to determine associated socioeconomic and disease factors. We hypothesized that patients who may have less resources to cope with their illness would have lower hope scores.MATERIALS/METHODS: The Adult Dispositional Hope Scale (AHS) is a questionnaire that aims to measures an individual's determination to accomplish goals and planning strategies to accomplish goals. We prospectively collected AHS survey scores from patients with benign or malignant disease seen in 2 radiation oncology clinics at our institution from 10/2022 to 1/2023. The AHS survey contains 12 items to measure hope through two qualities: agency (goal-directed energy) and pathways (plan to meet goals). Each item is answered using an 8-point scale. There are 4 items each for the Agency and Pathway subscales with 4 filler items for total scores ranging from 8 to 64, with higher scores reflecting higher agency and pathways thinking. Kruskal-Wallis H test and Kendall's Tau Rank Correlation were used to determine differences between categorical and continuous variables on AHS scores, respectively.RESULTS: We included 228 patients with a median age of 62 years (range 16.9-92.6). Half were male (51%), 56% were white, and 77% had malignant disease. The primary disease subsite was CNS, GI and other in 76 (34%), 70 (31%), and 81 (36%) patients, respectively. Of patients with known occupation and insurance information, 32 (14%), 67 (29%), and 49 (22%) were not employed, employed, and retired, respectively, and 115 (50%), 85 (37%), and 20 (9%) had private insurance, Medicare, and Medical, respectively. Median agency, pathway, and total hope scores were 27 (interquartile range [IQR] 24-29), 28 (IQR 24-30), and 55 (IQR 48-58), respectively. Higher total hope scores were associated with being employed (p = 0.02), having private insurance (p<0.02), and higher ECOG scores (p<0.01). After excluding those who are not employed because they are retired (n = 99), lack of employment was significantly associated with hope (p<0.01). Characteristics such as race/ethnicity, gender, marital status, pain, symptoms from disease, malignant or benign disease, stage of disease, and treatment modalities were not associated with AHS scores.CONCLUSION: In our study, patients with non-private insurance and being currently unemployed had lower AHS scores. The lower hope scores suggest that these patients may have fewer resources to cope with their treatments and diagnoses and may benefit from further inquiry about the need to mitigate cancer-related financial burden to improve hope levels. Further studies are needed to evaluate whether financial toxicity, which has been shown to negatively impact patient outcomes, is correlated to coping and hope.

  View details for DOI 10.1016/j.ijrobp.2023.06.1161

  View details for PubMedID 37784941

• CNS Control after First-Line Osimertinib in Patients with Metastatic EGFR-Mutant NSCLC. International journal of radiation oncology, biology, physics Hui, C., Wakelee, H. A., Neal, J. W., Ramchandran, K. J., Das, M., Nagpal, S., Roy, M., Huang, J., Pollom, E., Myall, N. 2023; 117 (2S): e110

  Abstract

  Although osimertinib (osi) has excellent intracranial activity in EGFR-mutant metastatic non-small cell lung cancer (NSCLC), there is no consensus regarding whether to continue osi for central nervous system (CNS) control with second-line chemotherapy (chemo) at the time of systemic progression. We aimed to compare CNS outcomes after first-line osi in patients receiving second-line chemo with or without continuation of osi.We retrospectively reviewed patients with EGFR-mutant NSCLC with brain metastases (BrM) at the time of initiating first-line osi who experienced progression and started second-line chemo. Cumulative incidence of local and distant CNS progression, and extracranial (EC) progression was calculated from time of second-line chemo initiation with death as a competing risk. Overall survival (OS) was analyzed using Kaplan-Meier.We included 52 patients with a median follow up of 9.6 months (range 0.4-36.4). Median OS and CNS progression-free survival (PFS) from the time of starting second-line chemo was 12.5 months (95% CI 8.1-16.9), and 5.3 months (95% CI 3.35-7.26), respectively. The 1-year cumulative incidence of local, distant CNS progression, any CNS progression, and EC progression was 14.4% (95% CI 4.5-24.2), 42.8% (95% CI 22.8-56.8), 42.8% (95% CI 22.8-56.8) and 66.8% (95% CI 53.5-80.2), respectively. After progression on first-line osi, 25 (48.1%) and 27 patients (51.9%) continued and discontinued osi, respectively. Patients who continued osi had significantly higher BrM burden than those who did not, with 17 (68%), 3 (12%), and 5 (20%) versus 26 (96%), 0, and 1 (3.7%) patient having <10 or >11 parenchymal brain lesions, or leptomeningeal disease (LMD) at the time of second line therapy, respectively (p<0.01). In those who continued osi vs those who did not, median OS (10.8 vs 12.5 months; p = 0.37), median intracranial PFS (5.3 vs 4.8 months; p = 0.99), 1-year cumulative incidence of local (8.4% versus 20 % p = 0.26), and 1-year distant CNS progression (24.8% vs 60%; p = 0.08) was not significantly different. CNS complications such as symptomatic, hospitalizations, and steroid initiation for CNS disease, and progression of LMD were not significantly different between the two groups. Eventually, 10 patients underwent salvage RT post first-line osi and median time to salvage RT was 7.8 months (range 2-9.4). Of patients who underwent salvage RT, 2 patients (20%) had continued osi with second-line chemo. Twelve patients (44.4%) who did not continue osi eventually re-started osi for progressive disease.Patients who continued osi had significantly higher BrM tumor burden. Despite these patients being at higher risk for CNS progression, time to CNS progression and incidence of CNS complications were not significantly different in the two cohorts. Patients who discontinued osi were more likely to undergo salvage RT. Continuation of osi may allow patients to defer salvage RT.

  View details for DOI 10.1016/j.ijrobp.2023.06.888

  View details for PubMedID 37784648

• Role of Fractionation in Local Control of Spinal Metastases Treated with Stereotactic Radiosurgery. International journal of radiation oncology, biology, physics Klebaner, D., Pollom, E., Mendoza, M., Kumar, K. A., Gibbs, I. C., Chang, S. D., Hancock, S. L., Soltys, S. G. 2023; 117 (2S): e117-e118

  Abstract

  Optimal fractionation of spinal stereotactic radiosurgery (SRS) for spine metastases remains unknown. Retrospective data suggest decreased local failure (LF) with fractionated SRS of brain metastases. We evaluated our institutional outcomes of spinal SRS with the hypothesis that fractionation improves the rate of local failure compared to single-fraction treatment.This IRB-approved, retrospective analysis included patients with spine metastases treated with spinal SRS between October 2002 and November 2014 with evaluable follow-up imaging and no prior irradiation to the given segment. The exposure of interest was single- or multi-fraction SRS with a primary endpoint of the cumulative incidence of LF with death as a competing risk. We assessed bivariate associations between fractionation and single-fraction equivalent dose (SFED in Gy10) as well as high-risk features, defined as epidural extension (Bilsky Scale), paraspinous extension, and gastrointestinal (GI) vs non-GI primary. We calculated the rates of LF and vertebral body compression fracture (VCF) at 1-year, and assessed LF by fractionation when limited only to courses receiving SFED>18 Gy. We analyzed the association between fractionation and LF using subdistribution hazard ratios (SHR) estimated from competing risks regression with death as a competing risk and adjusting for lesion-specific characteristics as well as SFED to determine contribution of these variables to the estimated effect of fraction number on LF. We calculated relative attenuation for the contribution of SFED to this association, defined as [SHRfractions-SHRfractions+SFED] ÷ [SHRSFED-1].In 293 patients with 516 spinal segments, lesions treated with single fraction compared to multi-fraction SRS had less epidural (19% vs 36%, p<0.001) and paraspinous (20% vs 35%, p<0.001) extension, more GI histology (17% vs 10%, p = 0.039), received a higher mean SFED (18.3 Gy vs. 16.6 Gy, p<0.001), and had a lower 1-year LF (8% vs 14%, p = 0.02), with no difference in VCF (7% vs. 5%, p = 0.38). After adjusting for high-risk features, single fraction SRS was associated with lower LF (SHR = 0.45, 95% CI 0.24-0.84, p = 0.02). After adjustment for SFED, this association of fractionation was attenuated by 53% and became insignificant (SHR = 0.78, 95% CI 0.44-1.37, p = 0.38). Overall, 1-year LF for SFED>18 Gy was 6% compared to 15% for <18 Gy (p<0.001). When limited to courses with SFED>18 Gy (n = 261), single fraction SRS had no improvement in 1-year LF compared to multi-fraction (6.6% vs 4.6%, p = 0.77).Single fraction SRS was associated with better local control compared to multi-fraction; however, much of this association was attenuated by SFED but not by high-risk features of treated lesions. To clarify the role of fractionation, we have initiated a prospective, randomized trial of single vs. multi-fraction SRS utilizing the same SFED.

  View details for DOI 10.1016/j.ijrobp.2023.06.903

  View details for PubMedID 37784661

• Patterns of Recurrence After Poor Response to Neoadjuvant Chemotherapy in Gastric Cancer and the Role for Adjuvant Radiation. Annals of surgical oncology Hui, C., Ewongwo, A., Lau, B., Fisher, G., Delitto, D., Poultsides, G., Ho, Q., Rahimy, E., Pollom, E., Chang, D. T., Vitzthum, L. K. 2023

  Abstract

  BACKGROUND: Improved treatment strategies are needed for patients with locally advanced gastric cancer with poor response to neoadjuvant chemotherapy. We aimed to describe patterns of failure for patients with no or partial response (NR, PR) to preoperative chemotherapy.PATIENTS AND METHODS: We analyzed patients with locally advanced gastric cancer treated from 2008 to 2022 with preoperative chemotherapy followed by surgery with D2 resection. We excluded patients who received radiation. Cumulative incidence of locoregional failure (LRF) and distant metastases (DM) were calculated. For patients with recurrent abdominal disease, hypothetical radiation clinical treatment volumes (CTV) were contoured on postoperative scans and compared with patterns of recurrence.RESULTS: A total of 60 patients were identified. The most used preoperative chemotherapy was FLOT (38.6%), followed by FOLFOX (30%) and ECF/ECX/EOX (23.3%). Four (6.7%), 40 (66.7%), and 9 patients (15%) had a complete pathologic response (CR), PR, and NR to neoadjuvant therapy, respectively. Among patients without a CR, 3-year overall and progression-free survival rates were 62.3% (95% CI 48-76.6%) and 51.3% (95% CI 36.9-65.7%), respectively. Three-year cumulative incidence of LRF and DM were 8.4% (95% CI 0.4-16.4%) and 41.0% (95% CI 26.3-55.4%), respectively. Absolute rates of patients having the first site of recurrence encompassed by a postoperative radiation CTV was 2.0% for patients without a CR and 0% for patients with NR.CONCLUSIONS: Patients with locally advanced gastric cancer with less than a CR to chemotherapy have poor outcomes due to high rates of DM. Adjuvant locoregional therapy such as radiation is unlikely to affect survival.

  View details for DOI 10.1245/s10434-023-14350-1

  View details for PubMedID 37755563

• Practical Guideline for Prevention of Patchy Hair Loss following CyberKnife Stereotactic Radiosurgery for Calvarial or Scalp Tumors: Retrospective Analysis of a Single Institution Experience. Stereotactic and functional neurosurgery Park, D. J., Marianayagam, N. J., Yener, U., Tayag, A., Ustrzynski, L., Emrich, S. C., Pollom, E., Soltys, S., Meola, A., Chang, S. D. 2023: 1-7

  Abstract

  Patchy alopecia is a common adverse effect of stereotactic radiosurgery (SRS) on the calvarium and/or scalp, yet no guidelines exist for its prevention. This study aims to investigate the incidence and outcomes of patchy alopecia following SRS for patients with calvarial or scalp lesions and establish preventive guidelines.The study included 20 patients who underwent CyberKnife SRS for calvarial or scalp lesions, resulting in a total of 30 treated lesions. SRS was administered as a single fraction for 8 lesions and hypofractionated for 22 lesions. The median SRS target volume was 9.85 cc (range: 0.81-110.7 cc), and the median prescription dose was 27 Gy (range: 16-40 Gy), delivered in 1-5 fractions (median: 3). The median follow-up was 15 months.Among the 30 treated lesions, 11 led to patchy alopecia, while 19 did not. All cases of alopecia resolved within 12 months, and no patients experienced other adverse radiation effects. Lesions resulting in alopecia exhibited significantly higher biologically effective dose (BED) and single-fraction equivalent dose (SFED) on the overlying scalp compared to those without alopecia. Patients with BED and SFED exceeding 60 Gy and 20 Gy, respectively, were 9.3 times more likely to experience patchy alopecia than those with lower doses. The 1-year local tumor control rate for the treated lesions was 93.3%. Chemotherapy was administered for 26 lesions, with 11 lesions receiving radiosensitizing agents. However, no statistically significant difference was found.In summary, SRS is a safe and effective treatment for patients with calvarial/scalp masses regarding patchy alopecia near the treated area. Limiting the BED under 60 Gy and SFED under 20 Gy for the overlying scalp can help prevent patchy alopecia during SRS treatment of the calvarial/scalp mass. Clinicians can use this information to inform patients about the risk of alopecia and the contributing factors.

  View details for DOI 10.1159/000533555

  View details for PubMedID 37699370

• STEREOTACTIC RADIOSURGERY FOR RECURRENT MEDULLOBLASTOMA IN PEDIATRIC AND ADULT PATIENTS: A SINGLE-INSTITUTION EXPERIENCE Yoo, K. H., Marianayagam, N. J., Park, D. J., Gu, X., Pollom, E. L., Soltys, S. G., Chang, S. D., Meola, A. OXFORD UNIV PRESS INC. 2023

  View details for DOI 10.1093/neuonc/noad137.284

  View details for Web of Science ID 001300535600285

• STEREOTACTIC RADIOSURGERY FOR EPENDYMOMA IN PEDIATRIC AND ADULT PATIENTS: A SINGLE-INSTITUTION EXPERIENCE Yoo, K. H., Marianayagam, N. J., Park, D. J., Zamarud, A., Gu, X., Pollom, E. L., Soltys, S. G., Chang, S. D., Meola, A. OXFORD UNIV PRESS INC. 2023

  View details for DOI 10.1093/neuonc/noad137.282

  View details for Web of Science ID 001300535600283

• STEREOTACTIC RADIOSURGERY FOR CRANIAL AND SPINAL HEMANGIOBLASTOMAS: A SINGLE-INSTITUTION SERIES Yoo, K. H., Park, D. J., Marianayagam, N. J., Gu, X., Pollom, E. L., Soltys, S. G., Chang, S. D., Meola, A. OXFORD UNIV PRESS INC. 2023: 85

  View details for DOI 10.1093/neuonc/noad137.283

  View details for Web of Science ID 001300535600284

• Racial Disparities in 30-day Readmissions after Surgery for Head and Neck Cancer. The Laryngoscope Huang, A. E., Shih, J. J., Sunwoo, J. B., Pollom, E., Taparra, K. 2023

  Abstract

  Native Hawaiians and other Pacific Islanders (NHPI) patients with head and neck cancer are often aggregated with Asian individuals despite evidence of heterogeneous health outcomes and mortality. The aim of this study was to determine the association of race with unplanned 30-day hospital readmission rate after head and neck surgery across the five federally recognized racial categories.This retrospective cohort study used a national hospital-based database and included patients ≥18 years old with diagnostically confirmed, nonmetastatic head and neck cancer of any subsite treated surgically between 2004 and 2017. The primary endpoint was unplanned readmission within 30 days of discharge after primary surgery.A total of 365,834 patients were included who were predominantly White (87%), treated at academic cancer centers (47%), lower income (63%), with early-stage disease (60%), and with thyroid (47%) or oral cavity (23%) cancers. Median follow-up duration was 47 months. Of the 10,717 (3%) readmissions, 5,845 (1.6%) were unplanned. Adjusted for confounders and compared with White patients, NHPI patients had the highest likelihood of unplanned (aOR 2.07, 95%CI 1.16-3.40, p = 0.008) readmissions. Within the NHPI group, patients with lower income (aOR 4.27, 95%CI 1.28-20.4, p = 0.035) and those residing in an urban or rural area (aOR 7.42, 95%CI 1.14-49.5, p = 0.034) were more likely to be readmitted.NHPI patients with head and neck cancers experience significantly higher 30-day readmissions following definitive surgical treatment. These results highlight the importance of racial disaggregation in clinical studies.4 Laryngoscope, 2023.

  View details for DOI 10.1002/lary.30997

  View details for PubMedID 37610178

• Stereotactic radiosurgery for sarcoma metastases to the brain: a single-institution experience. Neurosurgical focus Zamarud, A., Park, D. J., Dadey, D. Y., Yoo, K. H., Marianayagam, N. J., Yener, U., Szalkowski, G. A., Pollom, E., Soltys, S., Chang, S. D., Meola, A. 2023; 55 (2): E7

  Abstract

  Brain metastases (BMs) secondary to sarcoma are rare, and their incidence ranges from 1% to 8% of all bone and soft tissue sarcomas. Although stereotactic radiosurgery (SRS) is widely used for BMs, only a few papers have reported on SRS for sarcoma metastasizing to the brain. The purpose of this study was to evaluate the safety and effectiveness of SRS for sarcoma BM.The authors retrospectively reviewed the clinical and radiological outcomes of patients with BM secondary to histopathologically confirmed sarcoma treated with SRS, either as primary treatment or as adjuvant therapy after surgery, at their institution between January 2005 and September 2022. They also compared the outcomes of patients with hemorrhagic lesions and of those without.Twenty-three patients (9 females) with 150 BMs secondary to sarcoma were treated with CyberKnife SRS. Median age at the time of treatment was 48.22 years (range 4-76 years). The most common primary tumor sites were the heart, lungs, uterus, upper extremities, chest wall, and head and neck. The median Karnofsky Performance Status on presentation was 73.28 (range 40-100). Eight patients underwent SRS as a primary treatment and 15 as adjuvant therapy to the resection cavity. The median tumor volume was 24.1 cm3 (range 0.1-150.3 cm3), the median marginal dose was 24 Gy (range 18-30 Gy) delivered in a median of 1 fraction (range 1-5) to a median isodose line of 76%. The median follow-up was 8 months (range 2-40 months). Median progression-free survival and overall survival were 5.3 months (range 0.4-32 months) and 8.2 months (range 0.1-40), respectively. The 3-, 6-, and 12-month local tumor control (LTC) rates for all lesions were respectively 78%, 52%, and 30%. There were no radiation-induced adverse effects. LTC at the 3-, 6-, and 12-month follow-ups was better in patients without hemorrhagic lesions (100%, 70%, and 40%, respectively) than in those with hemorrhagic lesions (68%, 38%, and 23%, respectively).SRS, both as a primary treatment and as adjuvant therapy to the resection cavity after surgery, is a safe and relatively effective treatment modality for sarcoma BMs. Nonhemorrhagic lesions show better LTC than hemorrhagic lesions. Larger studies aiming to validate these results are encouraged.

  View details for DOI 10.3171/2023.5.FOCUS23168

  View details for PubMedID 37527671

• Stereotactic radiosurgery for distant brain metastases secondary to esthesioneuroblastoma: a single-institution series. Neurosurgical focus Zamarud, A., Yener, U., Yoo, K. H., Park, D. J., Marianayagam, N. J., Ho, Q. A., Pollom, E., Soltys, S., Wang, L., Chang, S. D., Meola, A. 2023; 55 (2): E6

  Abstract

  Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare, malignant tumor of neuroectodermal origin that arises from the olfactory neuroepithelium. In this study the authors present the first series in the literature on distant brain metastases (BMs) secondary to ENB that were treated with stereotactic radiosurgery (SRS), to evaluate the safety and effectiveness of SRS for this indication.A retrospective analysis of clinical and radiological outcomes of patients with ENB who underwent CyberKnife (CK) SRS at a single center was conducted. The clinical and radiological outcomes of patients, including progression-free survival, overall survival, and local tumor control (LTC) were reported.Between 2003 and 2022, 32 distant BMs in 8 patients were treated with CK SRS at Stanford University. The median patient age at BM diagnosis was 62 years (range 47-75 years). Among 32 lesions, 2 (6%) had previously been treated with surgery, whereas for all other lesions (30 [94%]), CK SRS was used as their primary treatment modality. The median target volume was 1.5 cm3 (range 0.09-21.54 cm3). CK SRS was delivered by a median marginal dose of 23 Gy (range 15-30 Gy) and a median of 3 fractions (range 1-5 fractions) to a median isodose line of 77% (range 70%-88%). The median biologically effective dose was 48 Gy (range 21-99.9 Gy) and the median follow-up was 30 months (range 3-95 months). The LTC at 1-, 2-, and 3-year follow-up was 86%, 65%, and 50%, respectively. The median progression-free survival and overall survival were 29 months (range 11-79 months) and 51 months (range 15-79 months), respectively. None of the patients presented adverse radiation effects.In the authors' experience, SRS provided excellent LTC without any adverse radiation effects for BMs secondary to ENB.

  View details for DOI 10.3171/2023.5.FOCUS23216

  View details for PubMedID 37527675

• Stereotactic Radiosurgery for Contrast-Enhancing Satellite Nodules in Recurrent Glioblastoma: A Rare Case Series From a Single Institution. Cureus Park, D. J., Persad, A. R., Yoo, K. H., Marianayagam, N. J., Yener, U., Tayag, A., Ustrzynski, L., Emrich, S. C., Chuang, C., Pollom, E., Soltys, S. G., Meola, A., Chang, S. D. 2023; 15 (8): e44455

  Abstract

  Introduction Glioblastoma (GBM) is the most common malignant adult brain tumor and is invariably fatal. The standard treatment for GBM involves resection where possible, followed by chemoradiation per Stupp's protocol. We frequently use stereotactic radiosurgery (SRS) as a single-fraction treatment for small (volume ≤ 1cc) nodular recurrent GBM to the contrast-enhancing target on T1 MRI scan. In this paper, we aimed to evaluate the safety and efficacy of SRS for patients with contrast-enhancing satellite nodules in recurrent GBM. Methods This retrospective study analyzed the clinical and radiological outcomes of five patients who underwent CyberKnife (Accuray Inc., Sunnyvale, California) SRS at the institute between 2013 and 2022. Results From 96 patients receiving SRS for GBM, five (four males, one female; median age 53) had nine distinct new satellite lesions on MRI, separate from their primary tumor beds. Those nine lesions were treated with a median margin dose of 20 Gy in a single fraction. The three-, six, and 12-month local tumor control rates were 77.8%, 66.7%, and 26.7%, respectively. Median progression-free survival (PFS) was seven months, median overall survival following SRS was 10 months, and median overall survival (OS) was 35 months. Interestingly, the only lesion that did not show radiological progression was separate from the T2-fluid attenuated inversion recovery (FLAIR) signal of the main tumor. Conclusion Our SRS treatment outcomes for recurrent GBM satellite lesions are consistent with existing findings. However, in a unique case, a satellite nodule distinct from the primary tumor's T2-FLAIR signal and treated with an enlarged target volume showed promising control until the patient's demise. This observation suggests potential research avenues, given the limited strategies for 'multicentric' GBM lesions.

  View details for DOI 10.7759/cureus.44455

  View details for PubMedID 37664337

  View details for PubMedCentralID PMC10470661

• CyberKnife radiosurgery for treatment of residual or recurrent Grade 1 choroid plexus papilloma: A single institution experience. World neurosurgery Zhang, M., Park, D. J., Marianayagam, N. J., Yener, U., Soltys, S. G., Pollom, E., Chang, S. D., Meola, A. 2023

  Abstract

  Choroid plexus papillomas (CPP) are rare intraventricular brain tumors derived from the epithelium of the choroid plexus. Gross total resection has traditionally been considered curative, but residual tumor or recurrence remains possible. SRS has become particularly more important strategy for subtotally resectied and recurrent tumors. The evidence-based rationale of SRS treatment for residual or recurrent CPP in adult patients is still lacking due to its rarity.We retrospectively reviewed histopathologically confirmed cases of residual or recurrent CPP treated with SRS at our institute in the adult population between 2005 and 2022. Three patients, with five lesions, were identified with a median age of 63 years. Patients presented initially with hydrocephalus-related symptoms, although ventriculomegaly was noted only in one patient radiographically. The tumor locations were most common in 4th ventricle or along foramen of Luschka. Treatment was delivered in a single fraction in 4 lesions and in 3 fractions in 1 patient. The median follow-up was 26 months.The local tumor control rate for the lesions was 80%. One patient developed a new lesion outside the SRS field, and one lesion developed progression without need for subsequent treatment. There were no significant shrinkage of the lesions radiographically. None of the patients revealed radiation-related adverse events. No patients required surgical management after SRS treatment at our institution. Based on the literature review, our case series was the second largest retrospective series from a single institution on SRS for recurrent or residual CPP.SRS for patients with recurrent or residual CPP was a safe and effective treatment modality in this case series. Larger studies are encouraged to validate the role of SRS in the treatment of recurrent or residual CPP.

  View details for DOI 10.1016/j.wneu.2023.07.003

  View details for PubMedID 37423336

• Diverging Roads in the Management of Metastatic EGFR Mutated Non Small Cell Lung Cancer: Ablate All, None, or Some? International journal of radiation oncology, biology, physics Vitzthum, L. K., Pollom, E. L. 2023; 116 (3): 479-480

  View details for DOI 10.1016/j.ijrobp.2022.12.043

  View details for PubMedID 37270242

• Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery. Cancers Lau, B., Tominez, P., Shing, J. Z., Vo, J. B., Pollom, E., Taparra, K. 2023; 15 (13)

  Abstract

  Despite radiation therapy (RT) and surgery being the curative treatments, prior work demonstrated that the aggregated Asian American (AA) and Native Hawaiian and Other Pacific Islanders (NHPI) population refuse RT and surgery at a higher rates than other races. Given that AA and NHPI are distinct groups, data disaggregation is necessary to understand racial and ethnic disparities for treatment refusal. We aimed to (1) compare RT and surgery refusal rates between AA and NHPI populations, (2) assess RT and surgery refusal on overall mortality, and (3) determine predictors of refusing RT and surgery using the United States (U.S.) National Cancer Database. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for treatment refusal were calculated using logistic regression. Adjusted hazard ratios (aHR) were calculated for overall survival using Cox proportional hazard models among propensity score-matched groups. The overall rate of RT refusal was 4.8% and surgery refusal was 0.8%. Compared to East AA patients, NHPI patients had the highest risk of both RT refusal (aOR = 1.38, 95%CI = 1.21-1.61) and surgery refusal (aOR = 1.28, 95%CI = 1.00-1.61). RT refusal significantly predicted higher mortality (aHR = 1.17, 95%CI = 1.08-1.27), whereas surgery refusal did not. Predictors of RT and surgery refusal were older patient age, high comorbidity index, and cancer diagnosis between 2011-2017. The results show heterogenous treatment refusal patterns among AA and NHPI populations, suggesting areas for targeted intervention.

  View details for DOI 10.3390/cancers15133358

  View details for PubMedID 37444468

• Society for Women in Radiation Oncology Consensus Statement on Family and Medical Leave. International journal of radiation oncology, biology, physics Baniel, C. C., Ponce, S. B., Lichter, K. E., Peters, G. W., Small, C., Seldon, C., Nguyen, K. T., Khan, A. F., Thomas, C. R., Small, W., Kahn, J. M., Olivier, K. R., Masters, A. H., Barry, P. N., Pollom, E. L., Jagsi, R. 2023; 116 (2): 270-275

  View details for DOI 10.1016/j.ijrobp.2022.12.027

  View details for PubMedID 37179087

• Racial disparities in survival and stage at diagnosis among adolescent and young adult patients with cancer Taparra, K. A., Kekumano, K., Benevente, R., Gimmen, M. Y., Kinslow, C., Deville, C., Pollom, E. L. LIPPINCOTT WILLIAMS & WILKINS. 2023

  View details for Web of Science ID 001053772003334

• Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancer in the United States. Cancers Taparra, K., Ing, B. I., Ewongwo, A., Vo, J. B., Shing, J. Z., Gimmen, M. Y., Keli'i, K. M., Uilelea, J., Pollom, E., Kidd, E. 2023; 15 (9)

  Abstract

  Brachytherapy improves clinical outcomes among women diagnosed with cervical and endometrial cancers. Recent evidence demonstrates that declining brachytherapy boosts for women with cervical cancer were associated with higher mortality. In this retrospective cohort study, women diagnosed with endometrial or cervical cancer in the United States between 2004 and 2017 were selected from the National Cancer Database for evaluation. Women ≥18 years of age were included for high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers and FIGO Stage IA-IVA-non-surgically treated cervical cancers. The aims were to (1) evaluate brachytherapy treatment practice patterns for cervical and endometrial cancers in the United States; (2) calculate rates of brachytherapy treatment by race; and (3) determine factors associated with not receiving brachytherapy. Treatment practice patterns were evaluated over time and by race. Multivariable logistic regression assessed predictors of brachytherapy. The data show increasing rates of brachytherapy for endometrial cancers. Compared to non-Hispanic White women; Native Hawaiian and other Pacific Islander (NHPI) women with endometrial cancer and Black women with cervical cancer were significantly less likely to receive brachytherapy. For both NHPI and Black women, treatment at community cancer centers was associated with a decreased likelihood of brachytherapy. The data suggest racial disparities among Black women with cervical cancer and NHPI women with endometrial cancer and emphasize an unmet need for brachytherapy access within community hospitals.

  View details for DOI 10.3390/cancers15092571

  View details for PubMedID 37174037

• Effect of Radiation Schedule on Transportation-Related Carbon Emissions: A Case Study in Rectal Cancer. Advances in radiation oncology Frick, M. A., Baniel, C. C., Qu, V., Hui, C., Brown, E., Chang, D. T., Pollom, E. L. 2023; 8 (5): 101253

  Abstract

  The health care sector is a major contributor of worldwide greenhouse gas (GHG) emissions. Indirect emissions, including those associated with transportation, make up 82% of the US health care sector's environmental footprint. Radiation therapy (RT) treatment regimens present an opportunity for environmental health care-based stewardship owing to the high incidence of cancer diagnosis, significant utilization of RT, and myriad treatment days required for curative regimens. Because the use of short-course RT (SCRT) in the treatment of rectal cancer has demonstrated noninferior clinical outcomes compared with conventional, long-course RT (LCRT), we investigate the environmental and health equity-related outcomes.Patients treated with curative, preoperative RT for newly diagnosed rectal cancer at our institution between 2004 and 2022 and living in-state were included. Travel distance was estimated using patients' reported home address. Associated GHG emissions were calculated and reported in carbon dioxide equivalents (CO2e).Of 334 patients included, the total distance traveled for the treatment course was significantly greater in patients treated with LCRT versus SCRT (median, 1417 vs 319 miles; P < .001). Total CO2e emissions for those undergoing LCRT (n = 261) and SCRT (n = 73) were 665.3 kg CO2e and 149.9 kg CO2e, respectively, per treatment course (P < .001), with a net difference of 515.4 kg CO2e. Relatively, this suggests that LCRT is associated with 4.5 times greater GHG emissions from patient transportation.Using treatment of rectal cancer as proof-of-principle, we advocate for the inclusion of environmental considerations in the creation of climate-resilient oncologic RT practices, especially in the context of equivocal clinical outcomes between RT fractionation schedules.

  View details for DOI 10.1016/j.adro.2023.101253

  View details for PubMedID 37250284

  View details for PubMedCentralID PMC10209481

• Stratified assessment of an FDA-cleared deep learning algorithm for automated detection and contouring of metastatic brain tumors in stereotactic radiosurgery. Radiation oncology (London, England) Wang, J. Y., Qu, V., Hui, C., Sandhu, N., Mendoza, M. G., Panjwani, N., Chang, Y. C., Liang, C. H., Lu, J. T., Wang, L., Kovalchuk, N., Gensheimer, M. F., Soltys, S. G., Pollom, E. L. 2023; 18 (1): 61

  Abstract

  Artificial intelligence-based tools can be leveraged to improve detection and segmentation of brain metastases for stereotactic radiosurgery (SRS). VBrain by Vysioneer Inc. is a deep learning algorithm with recent FDA clearance to assist in brain tumor contouring. We aimed to assess the performance of this tool by various demographic and clinical characteristics among patients with brain metastases treated with SRS.We randomly selected 100 patients with brain metastases who underwent initial SRS on the CyberKnife from 2017 to 2020 at a single institution. Cases with resection cavities were excluded from the analysis. Computed tomography (CT) and axial T1-weighted post-contrast magnetic resonance (MR) image data were extracted for each patient and uploaded to VBrain. A brain metastasis was considered "detected" when the VBrain- "predicted" contours overlapped with the corresponding physician contours ("ground-truth" contours). We evaluated performance of VBrain against ground-truth contours using the following metrics: lesion-wise Dice similarity coefficient (DSC), lesion-wise average Hausdorff distance (AVD), false positive count (FP), and lesion-wise sensitivity (%). Kruskal-Wallis tests were performed to assess the relationships between patient characteristics including sex, race, primary histology, age, and size and number of brain metastases, and performance metrics such as DSC, AVD, FP, and sensitivity.We analyzed 100 patients with 435 intact brain metastases treated with SRS. Our cohort consisted of patients with a median number of 2 brain metastases (range: 1 to 52), median age of 69 (range: 19 to 91), and 50% male and 50% female patients. The primary site breakdown was 56% lung, 10% melanoma, 9% breast, 8% gynecological, 5% renal, 4% gastrointestinal, 2% sarcoma, and 6% other, while the race breakdown was 60% White, 18% Asian, 3% Black/African American, 2% Native Hawaiian or other Pacific Islander, and 17% other/unknown/not reported. The median tumor size was 0.112 c.c. (range: 0.010-26.475 c.c.). We found mean lesion-wise DSC to be 0.723, mean lesion-wise AVD to be 7.34% of lesion size (0.704 mm), mean FP count to be 0.72 tumors per case, and lesion-wise sensitivity to be 89.30% for all lesions. Moreover, mean sensitivity was found to be 99.07%, 97.59%, and 96.23% for lesions with diameter equal to and greater than 10 mm, 7.5 mm, and 5 mm, respectively. No other significant differences in performance metrics were observed across demographic or clinical characteristic groups.In this study, a commercial deep learning algorithm showed promising results in segmenting brain metastases, with 96.23% sensitivity for metastases with diameters of 5 mm or higher. As the software is an assistive AI, future work of VBrain integration into the clinical workflow can provide further clinical and research insights.

  View details for DOI 10.1186/s13014-023-02246-z

  View details for PubMedID 37016416

  View details for PubMedCentralID 7174761

• Stereotactic Radiosurgery for Brain Metastases in Patients With a Heterozygous Germline Ataxia Telangiectasia Mutated Gene. Cureus Hall, J. C., Chang, S. D., Gephart, M. H., Pollom, E., Butler, S. 2023; 15 (4): e37712

  Abstract

  Germline mutations in the ataxia telangiectasia mutated (ATM) gene are associated with increased radiation sensitivity. Present literature lacks consensus on whether patients with heterozygous germline ATM mutations may be at greater risk of radiation-associated toxicities when treated with radiation therapy (RT), and there is little data considering more modern and conformal RT techniques such as stereotactic radiosurgery (SRS). Our report presents two cases of patients with heterozygous germline ATM mutations treated with SRS for brain metastases. One patient developed grade 3 radiation necrosis (RN) of an irradiated 16.3 cm3 resection cavity, but did not develop RN at other sites of punctate brain metastases treated with SRS. Similarly, the second report describes a patient who did not develop RN at any of the 31 irradiated sites of sub-centimeter (all ≤5 mm) brain metastases. The described cases demonstrate that some patients with germline ATM variants can safely undergo SRS for smaller brain metastases; however, clinical caution should be considered for patients with larger targets or a history of prior radiation toxicity. Given these findings and the lingering uncertainty surrounding the degree of radiosensitivity across ATM variants, future research is needed to determine whether more conservative dose-volume limits would potentially mitigate the risk of RN when treating larger brain metastases in this radiosensitive population.

  View details for DOI 10.7759/cureus.37712

  View details for PubMedID 37206490

  View details for PubMedCentralID PMC10191388

• Clinical consensus guideline on the management of phaeochromocytoma and paraganglioma in patients harbouring germline SDHD pathogenic variants. The lancet. Diabetes & endocrinology Taïeb, D., Wanna, G. B., Ahmad, M., Lussey-Lepoutre, C., Perrier, N. D., Nölting, S., Amar, L., Timmers, H. J., Schwam, Z. G., Estrera, A. L., Lim, M., Pollom, E. L., Vitzthum, L., Bourdeau, I., Casey, R. T., Castinetti, F., Clifton-Bligh, R., Corssmit, E. P., de Krijger, R. R., Del Rivero, J., Eisenhofer, G., Ghayee, H. K., Gimenez-Roqueplo, A. P., Grossman, A., Imperiale, A., Jansen, J. C., Jha, A., Kerstens, M. N., Kunst, H. P., Liu, J. K., Maher, E. R., Marchioni, D., Mercado-Asis, L. B., Mete, O., Naruse, M., Nilubol, N., Pandit-Taskar, N., Sebag, F., Tanabe, A., Widimsky, J., Meuter, L., Lenders, J. W., Pacak, K. 2023

  Abstract

  Patients with germline SDHD pathogenic variants (encoding succinate dehydrogenase subunit D; ie, paraganglioma 1 syndrome) are predominantly affected by head and neck paragangliomas, which, in almost 20% of patients, might coexist with paragangliomas arising from other locations (eg, adrenal medulla, para-aortic, cardiac or thoracic, and pelvic). Given the higher risk of tumour multifocality and bilaterality for phaeochromocytomas and paragangliomas (PPGLs) because of SDHD pathogenic variants than for their sporadic and other genotypic counterparts, the management of patients with SDHD PPGLs is clinically complex in terms of imaging, treatment, and management options. Furthermore, locally aggressive disease can be discovered at a young age or late in the disease course, which presents challenges in balancing surgical intervention with various medical and radiotherapeutic approaches. The axiom-first, do no harm-should always be considered and an initial period of observation (ie, watchful waiting) is often appropriate to characterise tumour behaviour in patients with these pathogenic variants. These patients should be referred to specialised high-volume medical centres. This consensus guideline aims to help physicians with the clinical decision-making process when caring for patients with SDHD PPGLs.

  View details for DOI 10.1016/S2213-8587(23)00038-4

  View details for PubMedID 37011647

• Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging. Frontiers in oncology Alhusaini, S., Lanman, T. A., Ko, R. B., Therkelsen, K. E., Eyben, R. V., Diehn, M., Soltys, S. G., Pollom, E. L., Chin, A., Vitzthum, L., Wakelee, H. A., Padda, S. K., Ramchandran, K., Loo, B. W., Neal, J. W., Nagpal, S. 2023; 13: 1139940

  Abstract

  The 2-year incidence of brain metastases (BrMs) in stage III non-small lung cell cancer (NSCLC) has been estimated to be around 30%. However, recent clinical trials have demonstrated considerably lower BrMs rates in this patient population. In this study, we aimed to review the real-world incidence, surveillance, and treatment patterns of BrMs in stage III NSCLC.Using a retrospective single-center study design, we identified patients with stage III NSCLC who received radiation with curative intent over a 10-year period. Outcome variables included BrMs incidence, overall survival (OS), and survival from date of BrMs. Additionally, we assessed patterns of BrMs surveillance in stage III NSCLC and treatment.We identified a total of 279 stage III NSCLC patients, of which 160 with adequate records were included in the final analyses [adenocarcinoma (n = 96), squamous cell carcinoma (n = 53), other histology subtype (n = 11)]. The median OS for the entire cohort was 41 months (95% CI, 28-53), while the median time from BrMs to death was 19 months (95% CI, 9-21). Twenty-three patients (14.4%) received planned surveillance brain MRIs at 6, 12, and 24 months after completion of treatment. The remaining 137 patients (85.6%) received brain MRIs at systemic recurrence (restaging) or when neurologically symptomatic. A total of 37 patients (23%) developed BrMs, with a 2-year cumulative BrMs incidence of 17% (95% CI, 11-23). A higher incidence of BrMs was identified in patients with adenocarcinoma relative to those with squamous cell carcinoma (p < 0.01). Similarly, a higher 2-year BrMs incidence was observed in patients who received planned surveillance brain MRI relative to those who did not, although statistical significance was not reached. Stereotactic radiosurgery (SRS) treated 29 of BrMs patients (78.4%) and was preferred over WBRT, which treated only 3 patients (8.1%).At our center, BrMs incidence in stage III NSCLC patients was lower than historically reported but notably higher than the incidence described in recent clinical trials. Routine BrMs surveillance potentially allows earlier detection of asymptomatic BrMs. However, asymptomatic BrMs were mostly detected on restaging MRI at the time of recurrence.

  View details for DOI 10.3389/fonc.2023.1139940

  View details for PubMedID 37035171

  View details for PubMedCentralID PMC10080021

• SUPPORT: SUrvey of Parental Leave POlicies of RadiaTion Oncology Programs and Residency Applicants. Advances in radiation oncology Baniel, C. C., Qu, V., Ponce, S. B., Taparra, K., Beadle, B., Currey, A., Lichter, K. E., Frank, J., Bagshaw, H., Soltys, S., Pollom, E. 2023; 8 (4): 101207

  Abstract

  Recruitment to radiation oncology training programs has recently declined, and gender inequities persist in radiation oncology. Policies that promote inclusivity, such as the updated American College of Graduate Medical Education parental leave policy establishing minimum parental leave requirements, may support recruitment to radiation oncology.We surveyed 2021-2022 radiation oncology residency applicants and program directors (PDs) about program-specific parental leave policies, transparency of parental leave information during the residency application and interview process, and perceptions of the effect of parenthood on residency training, career advancement, and well-being.Of 89 radiation oncology PDs, 29 (33%) completed the survey. Of 154 residency applicants (current fourth-year medical students, international applicants, or postdoctoral fellows) surveyed, 62 (40%) completed the survey. Most applicants planned to start a family during residency (53%) and reported perceived flexibility to start a family influenced their decision to pursue radiation oncology over other career specialties (55%). Many applicants viewed time in residency (nonresearch, 22%), in research (33%), and as early career faculty (24%) as the best time to start a family. A small number of applicants used program-specific parental leave policy information in determining their rank list (11%), and many applicants sought information regarding fertility health care benefits (55%). Many applicants obtained parental leave information verbally, despite expressing a preference for objective means (slide deck, 63%; website, 50%; or handout, 42%) of information sharing. PDs were all supportive of a 6-week maternity leave policy (100% agree or strongly agree with the policy) and did not feel parental leave would negatively affect a resident's ability to pursue an academic (100%) or private practice career (100%).Many radiation oncology residency applicants plan to start families during training, seek and value program-specific parental leave information and health benefits, and prefer objective means of information sharing. These findings likely reflect those who have strong views of parental leave policies.

  View details for DOI 10.1016/j.adro.2023.101207

  View details for PubMedID 37124316

  View details for PubMedCentralID PMC10130339

• Validation of a Resectability Scoring System for Prediction of Pancreatic Adenocarcinoma Surgical Outcomes. Annals of surgical oncology Toesca, D. A., Susko, M., von Eyben, R., Baclay, J. R., Pollom, E. L., Jeffrey, R. B., Poullos, P. D., Poultsides, G. A., Fisher, G. A., Visser, B. C., Koong, A. C., Feng, M., Chang, D. T. 2023

  Abstract

  BACKGROUND: The most used pancreatic cancer (PC) resectability criteria are descriptive in nature or based solely on dichotomous degree of involvement (<180° or >180°) of vessels, which allows for a high degree of subjectivity and inconsistency.METHODS: Radiographic measurements of the circumferential degree and length of tumor contact with major peripancreatic vessels were retrospectively obtained from pre-treatment multi-detector computed tomography (MDCT) images from PC patients treated between 2001 and 2015 at two large academic institutions. Arterial and venous scores were calculated for each patient, then tested for a correlation with tumor resection and R0 resection.RESULTS: The analysis included 466 patients. Arterial and venous scores were highly predictive of resection and R0 resection in both the training (n=294) and validation (n=172) cohorts. A recursive partitioning tree based on arterial and venous score cutoffs developed with the training cohort was able to stratify patients of the validation cohort into discrete groups with distinct resectability probabilities. A refined recursive partitioning tree composed of three resectability groups was generated, with probabilities of resection and R0 resection of respectively 94 and 73% for group A, 61 and 35% for group B, and 4 and 2% for group C. This resectability scoring system (RSS) was highly prognostic, predicting median overall survival times of 27, 18.9, and 13.5 months respectively for patients in RSS groups A, B, and C (p<0.001).CONCLUSIONS: The proposed RSS was highly predictive of resection, R0 resection, and prognosis for patients with PC when tested against an external dataset.

  View details for DOI 10.1245/s10434-023-13120-3

  View details for PubMedID 36792768

• A National Cancer Disparities Analysis of Predictors for Radiation Therapy Refusal by Race. International journal of radiation oncology, biology, physics Taparra, K., Qu, V., Lau, B., Pollom, E. 2023

  Abstract

  PURPOSE: Radiation therapy (RT) refusal by patients with cancer is infrequent but is significant because it portends poor outcomes. No prior study has evaluated all five federally defined racial categories with respects to RT refusal. Here we use a large nationally representative population with cancer to determine: 1) which race of patients refuse RT the most and 2) predictive factors for RT refusal by race.MATERIALS/METHODS: A retrospective study included patients ≥18 years old with diagnostically confirmed cancer between 2004-2017, using the National Cancer Database. All patients included were offered RT for first course treatment. Multivariable logistic regression assessed RT refusal (adjusted odds ratio [aOR]) with 95% confidence intervals (95%CI). Analyses were adjusted for patient factors (age, rurality, income, education, and comorbidities) and cancer characteristics (stage, cancer type, facility type, year of diagnosis, and region). Median overall survival was calculated using the Kaplan-Meier method.RESULTS: Of 11,609,044 patients, 2,759,753 patients were included and recommended for RT by the treating physician. Median follow-up was 50 months. RT was refused by 139,383 patients (5.0%), varying by race: 416 NHPI (7.2%), 489 AIAN (5.8%), 118,186 Non-Hispanic White (5.0%), 17,427 Black (4.8%), and 2,865 Asian (4.8%) patients. The rates of annual RT refusal were increasing, especially among NHPI patients. The populations with the highest likelihood of refusing RT were NHPI (aOR=1.53, 95%CI=1.36-1.71), AIAN (aOR=1.24, 95%CI=1.12-1.37), and Black (aOR=1.11, 95%CI=1.09-1.14) patients, compared to Non-Hispanic White patients. Older age and higher comorbidity burden predicted RT refusal across all races. Median overall survival was 81 months and 144 months for patients who refused RT and received RT, respectively.CONCLUSION: Indigenous and Black patients are more likely to refuse RT, which may contribute to inferior cancer outcomes. Understanding NHPI and AIAN patient perspectives and perceptions may elucidate interventions to mitigate these disparities.

  View details for DOI 10.1016/j.ijrobp.2023.01.033

  View details for PubMedID 36764491

• Patterns of Progression in Patients with Newly Diagnosed Glioblastoma Treated with 5 mm Margins on a Phase I/II Trial of 5 Fraction Stereotactic Radiosurgery with Concurrent and Adjuvant Temozolomide. Practical radiation oncology Mendoza, M. G., Azoulay, M., Chang, S. D., Gibbs, I. C., Hancock, S. L., Pollom, E. L., Adler, J. R., Harraher, C., Li, G., Gephart, M. H., Nagpal, S., Thomas, R. P., Recht, L. D., Jacobs, L. R., Modlin, L. A., Wynne, J., Seiger, K., Fujimoto, D., Usoz, M., von Eyben, R., Choi, C. Y., Soltys, S. G. 2023

  Abstract

  BACKGROUND: In patients with newly diagnosed glioblastoma (GBM), tumor margins of at least 20 mm are the standard of care. We sought to determine the pattern of tumor progression in patients treated with 5 fraction stereotactic radiosurgery (SRS) with 5 mm margins.METHODS: Thirty adult patients with newly diagnosed GBM were treated with 5 fraction SRS in escalated doses from 25 Gy to 40 Gy with a 5 mm total treatment margin. Progression was scored as 'in-field' if the recurrent tumor was within or contiguous with the 5 mm margin, 'marginal' if between 5 and 20 mm, and 'distant' if entirely occurring greater than 20 mm. As geometric patterns of progression do not reflect the biologic dose received, we calculated the minimum equieffective dose in 2 Gy per day (EQD2) at the site of tumor recurrence. Progression was 'dosimetrically in-field' if covered by a minimum EQD2 of 48 Gy10.RESULTS: From 2010 to 2016, 27 patients had progressed. Progression was in-field in 17 (63%), marginal in 3 (11%) and distant in 7 (26%) patients. In the 3 patients with marginal progression, the minimum EQD2 to recurrent tumor were 48 Gy10, 56 Gy10 (both considered dosimetrically in-field) and 7 Gy10 (i.e., dosimetrically out-of-field). Median overall survival (OS) was 12.1 months for in-field (95%CI 8.9-17.6), 15.1 months (95%CI 10.1-not achieved) for marginal and 21.4 months (95%CI 11.2-33.5) for distant progression. Patients with radiation necrosis were less likely to have in-field progression (1 of 7; 14%) compared to those without radiation necrosis (16 of 20; 80%; p = 0.003); those with necrosis had a median overall survival of 27.2 months (95%CI 11.2-48.3) compared to 11.7 months (95%CI 8.9-17.6) for patients with no necrosis (p = 0.077).CONCLUSION: In patients with newly diagnosed GBM treated with a 5 mm CTV margin, 3 patients (11%) had marginal progression within 5-20 mm; only 1 patient (4%) may have dosimetrically benefitted from conventional 20 mm margins. Radiation necrosis was associated with in-field tumor control.

  View details for DOI 10.1016/j.prro.2023.01.008

  View details for PubMedID 36736621

• Stereotactic radiosurgery for localized cranial Langerhans cell histiocytosis: A single institution experience and review of literature. World neurosurgery Park, D. J., Marianayagam, N. J., Yener, U., Wang, L., Soltys, S. G., Pollom, E., Chang, S. D., Meola, A. 2023

  Abstract

  Langerhans cell histiocytosis (LCH) is a rare idiopathic disease characterized by the clonal proliferation of Langerhans histiocytes in various parts of the body and capable of leading to organ damage and tumor formation. Reports of cranial LCH in the adult population are extremely rare. Although surgery remains the preferred option for localized LCH lesions, the role of stereotactic radiosurgery (SRS) is emerging as well.To retrospectively review a rare case series to determine the safety and effectiveness of SRS for patients with localized cranial LCH.We retrospectively reviewed histopathologically confirmed cases of localized cranial LCH treated with SRS at our institute in the adult population between January 2005 and September 2022. Five patients were identified with a median age of 34 years (19-54 years). The tumor location was in the pituitary stalk in three patients, the orbit in one patient, and the parietal skull in one patient. The median target volume was 2.8 cc (range: 0.37-6.11). Treatment was delivered in a single fraction in 4 patients (median margin dose of 8 Gy (range: 7-10 Gy) and in 3 fractions (22.5 Gy) in 1 patient. The median follow-up was 12 years (range: 4-17). None of the patients required craniotomy for tumor debulking before or after SRS.The local tumor control rate for the lesions was 100%. All three patients with LCH in the pituitary stalk had diabetes insipidus at the initial presentation and developed panhypopituitarism after SRS. Diabetes insipidus was not improved after SRS. The other two patients presented no adverse radiation effects. Based on the literature review, our case series was the largest retrospective series on SRS for localized cranial LCH, with the longest median follow-up.SRS for patients with localized cranial LCH was a safe and effective treatment modality in this case series. Larger studies are encouraged to validate the role of SRS in the treatment of localized cranial LCH.

  View details for DOI 10.1016/j.wneu.2023.01.053

  View details for PubMedID 36681322

• Reflections on the 2021 Accreditation Council for Graduate Medical Education and American Board of Radiology Family and Medical Leave of Absence Policies: An Opportunity to Increase Structural Support for Physicians. International journal of radiation oncology, biology, physics Baniel, C. C., Klebaner, D., Beadle, B. M., Ponce, S. E., Takiar, V., Gibbs, I. C., Soltys, S. G., Bagshaw, H. P., Chang, D. T., Le, Q. T., Pollom, E. L. 2023; 115 (1): 19-22

  View details for DOI 10.1016/j.ijrobp.2022.07.1837

  View details for PubMedID 36526381

• Characterizing Metastatic Non-Small Cell Lung Cancer Presenting to an Academic Medical Center in an Era of Changing Treatment Paradigms Raja, N., No, H. J., Von Eyben, R., Das, M., Roy, M., Myall, N., Chin, A. L., Diehn, M., Loo, B. W., Chang, D. T., Pollom, E., Vitzthum, L. ELSEVIER SCIENCE INC. 2022: E407

  View details for Web of Science ID 000892639301234

• Assessing Cancer Disparities among Pacific Islanders with Metastatic Cancer for Survival, Time-to-Metastasis, and Time-to-Radiotherapy Using a Novel Informatics Consult Approach Taparra, K., Gombar, S., Pollom, E. ELSEVIER SCIENCE INC. 2022: E139-E140

  View details for Web of Science ID 000892639300297

• Local Control of Brain Metastases with Osimertinib Alone in Patients with EGFR-Mutant Non-Small Cell Lung Cancer Hui, C., Qu, V., Wang, J. Y., Von Eyben, R., Chang, Y. C., Chiang, P. L., Liang, C. H., Lin, J. Y., Lu, J. T., Li, G., Hayden, M., Myall, N., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2022: E54-E55

  View details for Web of Science ID 000892639300120

• A National Cancer Disparities Analysis of Pacific Islanders Who Decline Radiation Therapy and Impacts on Overall Survival Taparra, K., Pollom, E. ELSEVIER SCIENCE INC. 2022: E139

  View details for Web of Science ID 000892639300296

• Implementation and Case Study of a Clinical Research Data Warehouse in Radiation Oncology Qu, V., Wood, D. J., Henry, A. S., Brain, S., Noakes, C., Baniel, C. C., Frick, M. A., Buyyounouski, M., Bagshaw, H. P., Horst, K. C., Marquez, C. M., Vitzthum, L., Pollom, E. ELSEVIER SCIENCE INC. 2022: E109

  View details for Web of Science ID 000892639300233

• Outcomes and Imaging Analysis in Hepatocellular Carcinoma Treated with Stereotactic Body Radiation Therapy Hui, C., Baclay, J. R., Lau, B., Von Eyben, R., Vitzthum, L., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2022: E174-E175

  View details for Web of Science ID 000892639300376

• Stratified Assessment of a Commercial Deep Learning Algorithm for Automated Detection and Contouring of Metastatic Brain Tumors in Stereotactic Radiosurgery Wang, J. Y., Qu, V., Hui, C., Sandhu, N., Mendoza, M., Panjwani, N., Lin, J. Y., Chang, Y. C., Liang, C. H., Lu, J. T., Wang, L., Kovalchuk, N., Gensheimer, M., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2022: E557

  View details for Web of Science ID 000892639301565

• Stereotactic Radiosurgery for Trigeminal Neuralgia Secondary to Tumor: A Single Institutional Retrospective Series Hall, J. C., Ung, T. H., McCleary, T. L., Chuang, C. F., Gibbs, I. C., Soltys, S. G., Hayden, M., Li, G., Pollom, E., Chang, S. D., Meola, A. ELSEVIER SCIENCE INC. 2022: E83

  View details for Web of Science ID 000892639300180

• Stereotactic radiosurgery for recurrent pediatric brain tumors: clinical outcomes and toxicity. Neurosurgical focus Wang, E., Gutkin, P. M., Oh, J., Pollom, E., Soltys, S. G., Grant, G. A., Prolo, L. M., Chang, S., Li, G., Fisher, P. G., Partap, S., Campen, C. J., Gibbs, I. C., Hiniker, S. M. 2022; 53 (5): E2

  Abstract

  Recurrence of brain tumors in children after the initial course of treatment remains a problem. This study evaluated the efficacy and safety of reirradiation using stereotactic radiosurgery (SRS) in patients with recurrent pediatric primary brain tumors.This IRB-approved retrospective review included pediatric patients with recurrent primary brain tumors treated at Stanford University from 2000 to 2019 using frameless SRS. Time to local failure (LF) and distant intracranial failure (DIF) were measured from the date of SRS and analyzed using competing risk analysis. Overall survival (OS) and progression-free survival (PFS) were analyzed with the Kaplan-Meier method.In total, 37 patients aged 2-24 years (median age 11 years at recurrence) were treated for 48 intracranial tumors. Ependymoma (38%) and medulloblastoma (22%) were the most common tumor types. The median (range) single fraction equivalent dose of SRS was 16.4 (12-24) Gy. The median (range) follow-up time was 22.9 (1.5-190) months. The median OS of all patients was 36.8 months. Eight of 40 (20%) lesions with follow-up imaging locally recurred. The 2-year cumulative incidence of LF after reirradiation with SRS was 12.8% (95% CI 4.6%-25.4%). The 2-year cumulative incidence of DIF was 25.3% (95% CI 12.9%-39.8%). The median PFS was 18 months (95% CI 8.9-44). Five (10.4%) patients developed toxicities potentially attributed to SRS, including cognitive effects and necrosis.Reirradiation using SRS for recurrent pediatric brain tumors appears safe with good local control. Innovations that improve overall disease control should continue because survival outcomes after relapse remain poor.

  View details for DOI 10.3171/2022.8.FOCUS22361

  View details for PubMedID 36321285

• Stereotactic radiosurgery for trigeminal neuralgia secondary to tumor: a single-institution retrospective series. Neurosurgical focus Hall, J. C., Ung, T. H., McCleary, T. L., Chuang, C., Gibbs, I. C., Soltys, S. G., Hayden Gephart, M., Li, G., Pollom, E. L., Chang, S. D., Meola, A. 2022; 53 (5): E3

  Abstract

  Trigeminal neuralgia (TN) secondary to tumor represents a rare and diverse entity, and treatment for secondary TN remains controversial. This report reviews a single institution's experience in treating secondary TN with stereotactic radiosurgery (SRS) and focuses on the durability of pain relief with respect to various treatment targets, i.e., the trigeminal nerve, offending tumor, or both.Between the years 2009 and 2021, 21 patients with TN secondary to benign (n = 13) or malignant (n = 8) tumors underwent SRS. Barrow Neurological Institute (BNI) pain intensity scale scores were collected from patient electronic medical records at baseline, initial follow-up, and 1 and 3 years post-SRS. The interval change in BNI scale score (ΔBNI) at the various follow-up time points was also calculated to assess the durability of pain relief following SRS.The median follow-up period was 24 (range 0.5-155) months. Five patients (24%) received treatment to the trigeminal nerve only, 10 (48%) received treatment to the tumor only, and 6 (29%) had treatment to both the nerve and tumor. The overall radiation dosage ranged from 14 to 60 Gy delivered in 1-5 fractions, with a median overall dose of 26 Gy. The median dose to the tumor was 22.5 (range 14-35) Gy, delivered in 1-5 fractions. Of the treatments targeting the tumor, 25% were delivered in a single fraction with doses ranging from 14 to 20 Gy, 60% were delivered in 3 fractions with doses ranging from 18 to 27 Gy, and 15% were delivered in 5 fractions with doses ranging from 25 to 35 Gy. The most common dose regimen for tumor treatment was 24 Gy in 3 fractions. The median biologically effective dose (with an assumed alpha/beta ratio of 10 [BED10]) for tumor treatments was 43.1 (range 13.3-60.0) Gy. There was a significant difference in the proportion of patients with recurrent pain (ΔBNI score ≥ 0) at the time of last follow-up across the differing SRS treatment targets: trigeminal nerve only, tumor only, or both (p = 0.04). At the time of last follow-up, the median ΔBNI score after SRS to the nerve only was -1, 0 after SRS to tumor only, and -2 after SRS to both targets.SRS offers clinical symptomatic benefit to patients with TN secondary to tumor. For optimal pain relief and response durability, treatment targeting both the tumor and the trigeminal nerve appears to be most advantageous.

  View details for DOI 10.3171/2022.8.FOCUS22381

  View details for PubMedID 36321284

• Intracranial Control With Combination BRAF and MEK Inhibitor Therapy in Patients With Metastatic Melanoma. Cureus Hui, C., Wu, Y. F., Liu, K., Sandhu, N., Blomain, E., Binkley, M. S., Gephart, M. H., Chang, S. D., Li, G. H., Reddy, S. A., Soltys, S. G., Pollom, E. 2022; 14 (11): e31838

  Abstract

  Purpose/Objectives Combination BRAF (vemurafenib, dabrafenib, or encorafenib) plus MEK (trametinib, cobimetinib, or binimetinib) inhibitor therapy is now widely used in the treatment of metastatic melanoma. However, data for intracranial response to these drugs are limited. We aimed to evaluate the intracranial efficacy of BRAF plus MEK inhibitors in patients with BRAF-mutant melanoma with brain metastases (BM) and to determine patterns of failure of these new agents to inform optimal integration of local intracranial therapy. Materials and methods We retrospectively reviewed charts of patients with BRAF-mutant melanoma with metastasis to the brain with at least one untreated brain metastasis at the time of initiation of BRAF plus MEK inhibitors at our institution from 2006 to 2020. We collected per-patient and per-lesion data on demographics, treatment modality, and outcomes. The cumulative incidence of local (LF), distant intracranial (DF), and extracranial failure (EF) were calculated with competing risk analysis with death as a competing risk and censored at the last brain MRI follow-up. LF was calculated on a per-lesion basis while DF and EF were calculated on a per-patient basis. DF was defined as any new intracranial lesions. Overall survival (OS) was analyzed using Kaplan-Meier. Logistic regression was used to identify predictors for LF. Results We identified 10 patients with 63 untreated brain metastases. The median age was 50.5 years. The median sum of the diameters of the five largest untreated brain metastases per patient was 20 mm (interquartile range 15-39 mm) and the median diameter for all measurable lesions was 4 mm. Median follow-up time was 9.0 months (range 1.4 months-46.2 months). Median OS was 13.6 months. The one-year cumulative incidence of LF, DF, and EF was 17.1%, 88.6, and 71.4%, respectively. The median time to LF, DF, and EF from the start of BRAF plus MEK inhibitors was 9.0 months, 4.7 months, and 7.0 months, respectively. The larger size of the BM was associated with LF on univariate analysis (odds ratio 1.13 per 1 mm increase in diameter, 95% confidence interval 1.019 to 1.308, p<0.02). Two (20%) patients eventually received stereotactic radiosurgery, and 2 (20%) received whole-brain radiotherapy for intracranial progression. Conclusion Although patients with BRAF-mutant melanoma with BM had fair local control on BRAF plus MEK inhibitors, the competing risk of death and distant intracranial and extracranial progression was high. Patients with larger brain metastases may benefit from local therapy.

  View details for DOI 10.7759/cureus.31838

  View details for PubMedID 36579260

  View details for PubMedCentralID PMC9788920

• Clinically Consistent Prostate Cancer Outcome Prediction Models with Machine Learning Vallon, J. J., Panjwani, N., Ling, X., Vij, S., Pollom, E., Bagshaw, H. P., Srinivas, S., Leppert, J., Bayati, M., Buyyounouski, M. K. ELSEVIER SCIENCE INC. 2022: E126-E127

  View details for Web of Science ID 000892639300269

• Local control of brain metastases with osimertinib alone in patients with EGFR-mutant non-small cell lung cancer. Journal of neuro-oncology Hui, C., Qu, V., Wang, J. Y., von Eyben, R., Chang, Y. C., Chiang, P. L., Liang, C. H., Lu, J. T., Li, G., Hayden-Gephart, M., Wakelee, H., Neal, J., Ramchandran, K., Das, M., Nagpal, S., Soltys, S., Myall, N., Pollom, E. 2022

  Abstract

  Although osimertinib has excellent intracranial activity in metastatic non-small cell lung cancer (NSCLC) with exon 19 deletion or L858R EGFR alterations, measures of local control of brain metastases are less well-reported. We describe lesion-level outcomes of brain metastases treated with osimertinib alone.We retrospectively reviewed patients with EGFR-mutant NSCLC with untreated brain metastasis measuring ≥ 5 mm at the time of initiating osimertinib. Cumulative incidence of local recurrence in brain (LRiB) was calculated with death as a competing risk, and univariable and multivariable analyses were conducted to identify factors associated with LRiB.We included 284 brain metastases from 37 patients. Median follow-up was 20.1 months. On initial MRI after starting osimertinib, patient-level response was complete response (CR) in 11 (15%), partial response (PR) in 33 (45%), stable disease (SD) in 18 (25%) and progressive disease (PD) in 11 (15%). The 1-year cumulative incidence of LRiB was 14% (95% CI 9.9-17.9) and was significantly different in patients with a CR (0%), PR (4%), and SD (11%; p = 0.02). Uncontrolled primary tumor (adjusted hazard ratio [aHR] 3.78, 95% CI 1.87-7.66; p < 0.001), increasing number of prior systemic therapies (aHR 2.12, 95% CI 1.49-3.04; p < 0.001), and higher ECOG score (aHR 7.8, 95% CI 1.99-31.81; p = 0.003) were associated with LRiB.Although 1-year cumulative incidence of LRiB is < 4% with a CR or PR, 1-year cumulative incidence of LRiB is over 10% for patients with less than a PR to osimertinib on initial MRI. These patients should be followed closely for need for additional treatment such as stereotactic radiosurgery.

  View details for DOI 10.1007/s11060-022-04145-x

  View details for PubMedID 36227422

• Radiation Oncology Virtual Education Rotation (ROVER) 2.0 for Residents: Implementation and Outcomes. Journal of cancer education : the official journal of the American Association for Cancer Education Sandhu, N. K., Rahimy, E., Hutten, R., Shukla, U., Rajkumar-Calkins, A., Miller, J. A., Von Eyben, R., Deig, C. R., Obeid, J., Jimenez, R. B., Fields, E. C., Pollom, E. L., Kahn, J. M. 2022

  Abstract

  The COVID-19 pandemic catalyzed the integration of a virtual education curriculum to support radiation oncologists in training. We report outcomes from Radiation Oncology Virtual Education Rotation (ROVER) 2.0, a supplementary virtual educational curriculum created for radiation oncology residents globally. A prospective cohort of residents completed surveys before and after the live virtual webinar sessions (pre- and post-surveys, respectively). Live sessions were structured as complex gray-zone cases across various core disease sites. Resident demographics and responses were summarized using means, standard deviations, and proportions. Nine ROVER sessions were held from October 2020 to June 2021. A total of 1487 registered residents completed the pre-survey, of which 786 attended the live case discussion and 223 completed post-surveys. A total of 479 unique radiation oncology residents (of which 95, n=19.8%, were international attendees) from 147 institutions (national, n=81, 55.1%; international, n=66, 44.9%) participated in the sessions. There was similar participation across post-graduate year (PGY) 2 through 5 (range n=86 to n=105). Of the 122 unique resident post-surveys, nearly all reported learning through the virtual structure as "very easy" or "easy" (97.5%, n=119). A majority rated the ROVER 2.0 educational sessions to be "valuable or "very valuable" (99.2%, n=121), and the panelists-attendee interaction as "appropriate" (97.5%, n=119). Virtual live didactics aimed at radiation oncology residents are feasible. These results suggest that the adoption of the ROVER 2.0 curricula may help improve radiation oncology resident education.

  View details for DOI 10.1007/s13187-022-02216-1

  View details for PubMedID 36083458

• Brain Metastases from Gynecologic Primary Cancers: Prognostic Factors for Local Control and Overall Survival Mendoza, M., Janchenko, L., von Eyben, R., Kidd, E., Pollom, E., Chang, S., Li, G., Kapp, D., Hayden, M., Soltys, S. LIPPINCOTT WILLIAMS & WILKINS. 2022: S34

  View details for Web of Science ID 000847787800072

• Risk of Tumor Upstaging With Prostate-Specific Membrane Antigen Positron Emission Tomography in Patients With High-Risk Prostate Cancer. JAMA network open Brant, A., Lewicki, P., Xiang, M., Zhu, A., Kishan, A. U., Pollom, E. L., Shoag, J. E. 2022; 5 (9): e2231101

  View details for DOI 10.1001/jamanetworkopen.2022.31101

  View details for PubMedID 36094506

• Intracranial and Metastatic Solitary Fibrous Tumors Treated with Radiotherapy and Radiosurgery Mendoza, M., Hui, C., von Eyben, R., Pollom, E., Loo, B., Soltys, S. LIPPINCOTT WILLIAMS & WILKINS. 2022: S34

  View details for Web of Science ID 000847787800071

• Posttreatment FDG-PET/CT Hopkins criteria predict locoregional recurrence after definitive radiotherapy for oropharyngeal squamous cell carcinoma. Head & neck Miller, J. A., Moradi, F., Sundaram, V., Liang, R., Zhang, C., Nguyen, N. K., Akhtar, F., Liu, Y., Ren, Y., Harandi, N., Weng, Y., Pollom, E. L., Colevas, A. D., Divi, V., Holsinger, F. C., Beadle, B. M., Le, Q., Gensheimer, M. F. 2022

  Abstract

  BACKGROUND: Metabolic response assessment for oropharyngeal squamous cell carcinoma (OPSCC) aids in identifying locoregional persistence/recurrence (LRR). The Hopkins Criteria are a standardized qualitative response assessment system using posttreatment FDG-PET/CT.METHODS: We conducted a retrospective cohort study of patients with node-positive OPSCC treated with definitive (chemo)radiotherapy. We assessed Hopkins Criteria performance for LRR, then developed and validated a competing-risks model.RESULTS: Between 2004 and 2018, 259 patients were included with median follow-up of 43months. The Hopkins Criteria sensitivity, specificity, negative predictive value, and accuracy were 68%, 88%, 95%, and 85%. The 36-month cumulative incidence of LRR was greater with positive scores (45% vs. 5%, HR 12.60, p<0.001). PET/CTs performed ≤10weeks after radiotherapy were associated with a four-fold increase in pathologically negative biopsies/surgeries (36% vs. 9%, p=0.03). The AUC for LRR was 0.89 using a model integrating the Hopkins score.CONCLUSIONS: The Hopkins Criteria predict LRR with high accuracy for OPSCC response assessment.

  View details for DOI 10.1002/hed.27160

  View details for PubMedID 35920790

• Disparities in Survival and Comorbidity Burden Between Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer. JAMA network open Taparra, K., Qu, V., Pollom, E. 2022; 5 (8): e2226327

  Abstract

  Improper aggregation of Native Hawaiian and other Pacific Islander individuals with Asian individuals can mask Native Hawaiian and other Pacific Islander patient outcomes. A comprehensive assessment of cancer disparities comparing Asian with Native Hawaiian and other Pacific Islander populations is lacking.To compare comorbidity burden and survival among East Asian, Native Hawaiian and other Pacific Islander, South Asian, and Southeast Asian individuals with non-Hispanic White individuals with cancer.This retrospective cohort study used a national hospital-based oncology database enriched with Native Hawaiian and other Pacific Islander and Asian populations. Asian, Native Hawaiian and other Pacific Islander, and White individuals diagnosed with the most common cancers who received treatment from January 1, 2004, to December 31, 2017, were included. Patients younger than 18 years, without pathologic confirmation of cancer, or with metastatic disease were excluded. Data were analyzed from January to May 2022.The primary end points were comorbidity burden by Charlson-Deyo Comorbidity Index and overall survival (OS).In total, 5 955 550 patients were assessed, including 60 047 East Asian, 11 512 Native Hawaiian and other Pacific Islander, 25 966 South Asian, 42 815 Southeast Asian, and 5 815 210 White patients. The median (IQR) age was 65 (56-74) years, median (IQR) follow-up was 58 (30-96) months, and 3 384 960 (57%) were women. Patients were predominantly from metropolitan areas (4 834 457 patients [84%]) and the Southern United States (1 987 506 patients [34%]), with above median education (3 576 460 patients [65%]), and without comorbidities (4 603 386 patients [77%]). Cancers included breast (1 895 351 patients [32%]), prostate (948 583 patients [16%]), kidney or bladder (689 187 patients [12%]), lung (665 622 patients [11%]), colorectal (659 165 patients [11%]), melanoma (459 904 patients [8%]), endometrial (307 401 patients [5%]), lymphoma (245 003 patients [4%]), and oral cavity (85 334 patients [1%]) malignant neoplasms. Native Hawaiian and other Pacific Islander patients had the highest comorbidity burden (adjusted odds ratio [aOR], 1.70; 95% CI, 1.47-1.94) compared with Asian and White groups. Asian patients had superior OS compared with White patients for most cancers; only Southeast Asian patients with lymphoma had inferior survival (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.16-1.37). In contrast, Native Hawaiian and other Pacific Islander patients demonstrated inferior OS compared with Asian and White patients for oral cavity cancer (aHR, 1.56; 95% CI, 1.14-2.13), lymphoma (aHR, 1.35; 95% CI, 1.11-1.63), endometrial cancer (aHR, 1.30; 95% CI, 1.12-1.50), prostate cancer (aHR, 1.29; 95% CI, 1.14-1.46), and breast cancer (aHR, 1.09; 95% CI, 1.00-1.18). No cancers among Native Hawaiian and other Pacific Islander patients had superior OS compared with White patients.In this cohort study, compared with White patients with the most common cancers, Asian patients had superior survival outcomes while Native Hawaiian and other Pacific Islander patients had inferior survival outcomes. Native Hawaiian and other Pacific Islander patients had significantly greater comorbidity burden compared with Asian and White patients, but this alone did not explain the poor survival outcomes. These results support the disaggregation of these groups in cancer studies.

  View details for DOI 10.1001/jamanetworkopen.2022.26327

  View details for PubMedID 35960520

• Examining Associations Among Sexual Health, Unmet Care Needs, and Distress in Breast and Gynecologic Cancer Survivors. Seminars in oncology nursing Benedict, C., Fisher, S., Kumar, D., Pollom, E., Schapira, L., Kurian, A. W., Berek, J. S., Palesh, O. 2022: 151316

  Abstract

  This study evaluated breast and gynecologic cancer patients' sexual function, unmet needs related to sexuality, and distress.Secondary analyses of a cross-sectional survey study evaluated measures of sexual function (Female Sexual Function Index [FSFI]), unmet needs (Supportive Care Needs Scale), and distress (Patient Health Questionnaire). χ2 test, t tests, and analysis of variances (ANOVAs) tested bivariate relationships. Subgroup comparisons were made based on the Female Sexual Function Index sexual dysfunction diagnostic cut-off score (<26.55; lower scores indicate greater dysfunction). A regression model tested associations between sexual function and unmet needs with distress as the outcome variable.Clinically significant sexual dysfunction was common in this cohort of women. In multivariate modeling, worse sexual function and greater unmet sexuality needs related to greater distress. Future work should explore reasons behind the high levels of sexual dysfunction and unmet needs in female survivors.It is important to routinely screen for sexual health concerns among female cancer survivors at all phases of the cancer trajectory including years posttreatment.

  View details for DOI 10.1016/j.soncn.2022.151316

  View details for PubMedID 35902337

• Rectosigmoid Cancer-Rectal Cancer or Sigmoid Cancer? American journal of clinical oncology Hui, C., Baclay, R., Liu, K., Sandhu, N., Loo, P., von Eyben, R., Chen, C., Sheth, V., Vitzthum, L., Chang, D., Pollom, E. 2022

  Abstract

  OBJECTIVES: We aimed to determine the optimal treatment for patients with locally advanced rectosigmoid cancers, and to determine whether this can be guided by distance from anal verge (AV) and/or anatomic landmarks such as the sacral promontory and peritoneal reflection (PR).MATERIALS AND METHODS: We retrospectively reviewed patients with T3-T4 and/or node-positive rectosigmoid cancers who underwent surgery from 2006 to 2018 with available pelvic imaging. We included tumors at 9 to 20cm from the AV on either staging imaging, or colonoscopy. Patients were stratified into those who received neoadjuvant therapy, and those who underwent upfront surgery. Comparisons of characteristics were performed using chi2 test and Fischer exact test. Locoregional failure (LRF) and overall survival were compared using Cox regressions and Kaplan-Meier analysis.RESULTS: One hundred sixty-one patients were included. Ninety-seven patients had neoadjuvant therapy, and 64 patients had upfront surgery. Median follow-up time was 45.1 months. Patients who had neoadjuvant therapy had tumors that were higher cT stage (P<0.01) with more positive/close circumferential resection margins seen on imaging by radiologists (28.9% vs. 1.6%, P=0.015). The 2-year rate of LRF, distant metastases, or overall survival was not significantly different between the 2 groups. None of 15 patients with tumors below the PR treated with neoadjuvant therapy had LRF, but 1 (25%) of 4 patients with tumors below the PR treated with adjuvant therapy experienced LRF (P=0.05).CONCLUSIONS: Patients with tumors below the PR may benefit more from neoadjuvant therapy. The PR on imaging may be a reliable landmark in addition to the distance from the AV to determine the most appropriate treatment option.

  View details for DOI 10.1097/COC.0000000000000931

  View details for PubMedID 35848736

• Neoadjuvant therapy in the post-German rectal trial era: making sense in the absence of consensus. Practical radiation oncology Hui, C., Vitzthum, L. K., Chang, D. T., Pollom, E. L. 2022

  Abstract

  Trimodality therapy per the German Rectal trial has led to excellent locoregional outcomes for locally advanced rectal cancer. Recent efforts have shifted towards improving distant control and health-related quality of life in this disease. To this end, total neoadjuvant therapy has become an increasingly used approach where most, if not all, chemotherapy is delivered prior to surgery to improve compliance and to address micrometastases early. To avoid surgical morbidity, a "watch-and-wait" approach, in which total mesorectal excision is deferred, has also been studied for patients who achieve a clinical complete response after chemoradiation. These two concurrent treatment trends have raised many points of uncertainty in what used to be a relatively straightforward neoadjuvant treatment paradigm. We discuss here our approach to neoadjuvant therapy for locally advanced rectal cancer, based on the data we currently have and through shared decision-making with patients to help them select the treatment that best aligns with their preferences and values.

  View details for DOI 10.1016/j.prro.2022.06.010

  View details for PubMedID 35803535

• Characterization of Metastatic Non-Small Cell Lung Cancer and Oligometastatic Incidence in an Era of Changing Treatment Paradigms. International journal of radiation oncology, biology, physics No, H. J., Raja, N., Von Eyben, R., Das, M., Roy, M., Myall, N., Neal, J., Wakelee, H., Chin, A., Diehn, M., Loo, B. W., Chang, D. T., Pollom, E. L., Vitzthum, L. K. 2022

  Abstract

  Due to the limitations of current staging systems and evolving definitions, there are limited data on oligometastatic non-small cell lung cancer (NSCLC) epidemiology. The purpose of this study is to evaluate metastatic disease burden and the incidence of oligometastatic disease using recent clinical trial edibility criteria.A cohort of patients with metastatic NSCLC, diagnosed from 2016 to 2019, were randomly sampled from a curated tumor registry. Definitions for oligometastatic disease were obtained from relevant clinical trials. The Stanford Cancer Institute Research Database (SCIRDB) was used to identify baseline patient factors, systemic and local therapy, extent and location of metastatic lesions, and survival outcomes.Among 120 patients presenting with metastatic NSCLC, the majority had de novo metastatic disease (75%) with a median of 4 metastatic lesions involving 3 organ systems. 37.5% would have been eligible for at least one oligometastatic trial with 28.3% meeting criteria for MDACC, 20.0% for NRG-LU002, 6.7% for SINDAS and 16.7% for SABR-COMET. By adding malignant pleural effusions (MPE) and early progression as exclusionary criteria, only 54.1% of patients with ≤3 synchronous metastases were eligible for consideration of local therapy. Early progression on systemic therapy was associated with worse survival (10.0 vs. 42.4 months, p < 0.001), whereas presence of MPE was not. Of those tumors identified as oligometastatic, 44.4% received local therapy and 28.9% underwent ablative therapy to all sites. There was a trend towards greater overall survival (44.4 vs 24.9 months, p=0.055) and progression free survival (8.0 vs. 5.4 months, p=0.06) in patients meeting eligibility for at least one oligometastatic trial.Around 48% of patients with metastatic NSCLC had ≤3 metastases at presentation and 28% met clinical trial criteria for oligometastatic disease. Future research is needed to better define the oligometastatic state and identify patients most likely to benefit from local therapy.

  View details for DOI 10.1016/j.ijrobp.2022.04.050

  View details for PubMedID 35654305

• Impact of socio-economic factors on radiation treatment after resection of metastatic brain tumors: trends from a private insurance database. Journal of neuro-oncology Dadey, D. Y., Rodrigues, A., Haider, G., Pollom, E. L., Adler, J. R., Veeravagu, A. 2022

  Abstract

  BACKGROUND: Stereotactic radiosurgery (SRS) to the surgical bed of resected brain metastases is now considered the standard of care due to its advantages over whole brain radiation therapy (WBRT). Despite the upward trend in SRS adoption since the 2000s, disparities have been reported suggesting that socio-economic factors can influence SRS utilization.OBJECTIVE: To analyze recent trends in SRS use and identify factors that influence treatment.METHODS: We conducted a retrospective cohort study with the Optum Commercial Claims and Encounters Database and included all patients from 2004 to 2021 who received SRS or WBRT within 60days after resection of tumors metastatic to the brain.RESULTS: A total of 3495 patients met the inclusion and exclusion criteria. There were 1998 patients in the SRS group and 1497 patients in the WBRT group. SRS use now supersedes WBRT by a wide margin. Lung, breast and colon were the most common sites of primary tumor. Although we found no significant differences based on race among the treatment groups, patients with annual household income greater than $75,000 and those with some college or higher education are significantly more likely to receive SRS (OR 1.44 and 1.30; 95% CI 1.18-1.76 and 1.08-1.56; P=0.001 and 0.005, respective). Patients with Elixhauser Comorbidity Index of three or more were significantly more likely to receive SRS treatment.CONCLUSION: The use of post-surgical SRS for brain metastasis has increased significantly over time, however education and income were associated with differential SRS utilization.

  View details for DOI 10.1007/s11060-022-04031-6

  View details for PubMedID 35596873

• Post-operative Stereotactic Radiosurgery of Malignant Melanotic Schwannoma. Cureus Hall, J. C., Chang, S. D., Wilson, T. J., Ganjoo, K. N., Toland, A., Vogel, H., Pollom, E. L., Rahimy, E. 2022; 14 (3): e22849

  Abstract

  Melanotic schwannoma is an extremely rare schwannoma variant with malignant potential, demonstrating high local and distant recurrence. Given the paucity of data, recommended treatment with localized disease is radical resection, with the unclear benefit of adjuvant therapy.We present a case of an 18-year-old female with no past medical history or genetic syndromeswho underwent margin-positive resection of an S1 nerve root melanotic schwannoma followed by adjuvant stereotactic radiosurgery (SRS). SRS was delivered without acute or late toxicity by 2.5 years post-treatment. She remains without evidence of recurrent disease, although longer follow-up is needed given the risk of late recurrence. Our case adds to the limited literature documenting the efficacy of adjuvant radiotherapy in melanotic schwannoma and is the first to describe the successful use of SRS for this rare disease.

  View details for DOI 10.7759/cureus.22849

  View details for PubMedID 35399431

• Radiotherapy for brain metastases from thyroid cancer: an institutional and national retrospective cohort study. Thyroid : official journal of the American Thyroid Association Blomain, E. S., Berta, S., Hug, N. F., Giao, D. M., Meola, A., Binkley, M. S., Hui, C., Churilla, T., Shahsavari, N., Desai, K., Chang, S. D., Soltys, S., Pollom, E. L. 2022

  Abstract

  BACKGROUND: Stereotactic radiosurgery (SRS) is the standard of care for patients with a limited number of brain metastases. Despite the fact that the seminal studies regarding SRS for brain metastases were largely tissue agnostic, several current national guidelines do not uniformly recommend SRS in thyroid cancer. We therefore investigated oncologic outcomes in a cohort of patients with brain metastases from thyroid cancer who received radiotherapy at our institution as well as those in a nationally representative cancer cohort, the national cancer database (NCDB).METHODS: We identified patients with thyroid cancer and brain metastases treated with radiotherapy at our institution from 2002 through 2020. For the NCDB cohort, the national database of patients with thyroid cancer was screened on the basis of brain-directed radiotherapy or brain metastases. For the institutional cohort, the cumulative risk of local failure, distant intracranial failure and radiation necrosis were calculated, adjusted for the competing risk of death. Overall survival (OS) in both cohorts was analyzed using Kaplan-Meier method. Univariate analysis was accomplished via clustered competing risks regression.RESULTS: For the institutional cohort, we identified 33 patients with 212 treated brain metastases. Overall survival was 6.6 months. The 1-year cumulative incidences of local failure and distant intracranial failures were 7.0% and 38%, respectively. The 1-year risk of radiation necrosis was 3.3%. In the NCDB cohort, there were 289 patients and median survival was 10.2 months. NCDB national practice patterns analysis showed an increasing use of SRS over time in both the entire cohort and the subset of anaplastic patients. Univariate analysis was performed for overall survival, risk of local failure, risk of regional intracranial failure and risk of radiation necrosis.CONCLUSIONS: SRS is a safe, effective and increasingly-utilized treatment for thyroid cancer brain metastases of any histology and should be the standard of care treatment.

  View details for DOI 10.1089/thy.2021.0628

  View details for PubMedID 35229625

• In Response to: "Comparing Addition of Radiotherapy in EGFR- and ALK-Positive NSCLC With Brain Metastases: Are We Evaluating the Optimal Endpoint?" Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer Thomas, N. J., Myall, N. J., Sun, F., Patil, T., Mushtaq, R., Yu, C., Sinha, S., Pollom, E. L., Nagpal, S., Camidge, D. R., Rusthoven, C. G., Braunstein, S. E., Wakelee, H. A., McCoach, C. E. 1800; 17 (2): e12-e14

  View details for DOI 10.1016/j.jtho.2021.11.017

  View details for PubMedID 35074229

• Phase II trial of organ preservation program using short-course radiation and folfoxiri for rectal cancer (SHORT-FOX) Pollom, E. L., Shelton, A., Fisher, G. A., Bien, J., King, D., Johnson, T., Chen, C., Shaheen, S., Chong, C., Vitzthum, L., Kirilcuk, N., Morris, A. M., Kin, C., Dawes, A., Sheth, V., Sundaram, V., Brown, E., Chang, D. LIPPINCOTT WILLIAMS & WILKINS. 2022

  View details for DOI 10.1200/JCO.2022.40.4_suppl.TPS218

  View details for Web of Science ID 000770995900213

• Landscape of mortality during and within thirty days after non-palliative radiotherapy across eleven major cancer types. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Xiang, M., Raldow, A. C., Pollom, E. L., Steinberg, M. L., Kishan, A. U. 1800

  Abstract

  BACKGROUND AND PURPOSE: Peri-RT mortality (death during or within 30 days of non-palliative radiotherapy) has been historically overlooked, and rates and risk factors are unclear.MATERIALS AND METHODS: Patients with non-metastatic cancer, treated with non-palliative external beam radiation (RT) 2004-2016, were identified in the National Cancer Database for 11 cancer types: breast, prostate, non-prostate genitourinary, bone/soft tissue, gynecological, head/neck, lymphoma, gastrointestinal (GI), small cell lung, non-small cell lung, and central nervous system (CNS). Multivariable logistic regression was used to identify predictors of peri-RT mortality controlled for 17 covariates, including patient, tumor, and treatment factors.RESULTS: Approximately 1.53 million patients were identified. Peri-RT mortality was 2.46% overall, spanning two orders of magnitude from 0.14% for breast to 8.52% for CNS. Peri-RT mortality steadily improved from 3.13% in 2004 to 1.78% in 2016 (P < .0001). Major predictors of peri-RT mortality included age, baseline comorbidity, male sex, and stage (P < .0001). Conversely, higher patient volume at the treating facility and use of more conformal RT planning techniques were moderately protective (P < .0001). Racial disparities varied based on disease site, as Black patients had increased peri-RT mortality for breast, lymphoma, and GI cancers, but not for other cancer types. Lack of private insurance was associated with substantially increased peri-RT mortality regardless of cancer type.CONCLUSION: Peri-RT mortality varied considerably according to multiple factors. Sociodemographic differences highlight areas of health disparities and opportunities for quality improvement. Early recognition of patients at increased risk may facilitate implementation of closer monitoring or other preventive measures.

  View details for DOI 10.1016/j.radonc.2022.01.008

  View details for PubMedID 35033605

• DSC perfusion MRI-derived fractional tumor burden and relative CBV differentiate tumor progression and radiation necrosis in brain metastases treated with stereotactic radiosurgery. American Journal of Neuroradiology ‡Kuo, F., ‡Ng, N. N., Nagpal, S., Pollom, E. L., Soltys, S., Hayden-Gephart, M., Li, G., Born, D. E., Iv, M. 2022; 43 (5): 689-695

  View details for DOI 10.3174/ajnr.A7501

• Editorial: Atypical and malignant meningioma: Advances in pathophysiology, imaging and treatment. Frontiers in neurology Ahmad, M., Meola, A., Pollom, E. 2022; 13: 970394

  View details for DOI 10.3389/fneur.2022.970394

  View details for PubMedID 36051220

• Progression Versus Radiation Treatment Changes After Stereotactic Ablative Radiation Therapy of a Liver Metastasis PRACTICAL RADIATION ONCOLOGY No, H. J., Negrete, L. M., Pollom, E. L., Wakelee, H. A., Chang, D. T., Vitzthum, L. K. 2022; 12 (1): 1-2

  View details for DOI 10.1016/j.prro.2021.06.013

  View details for Web of Science ID 000740674400002

• Performance of a Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography-Derived Risk-Stratification Tool for High-risk and Very High-risk Prostate Cancer. JAMA network open Xiang, M., Ma, T. M., Savjani, R., Pollom, E. L., Karnes, R. J., Grogan, T., Wong, J. K., Motterle, G., Tosoian, J. J., Trock, B. J., Klein, E. A., Stish, B. J., Dess, R. T., Spratt, D. E., Pilar, A., Reddy, C., Levin-Epstein, R., Wedde, T. B., Lilleby, W. A., Fiano, R., Merrick, G. S., Stock, R. G., Demanes, D. J., Moran, B. J., Huland, H., Tran, P. T., Martin, S., Martinez-Monge, R., Krauss, D. J., Abu-Isa, E. I., Alam, R., Schwen, Z., Pisansky, T. M., Choo, C. R., Song, D. Y., Greco, S., Deville, C., McNutt, T., DeWeese, T. L., Ross, A. E., Ciezki, J. P., Boutros, P. C., Nickols, N. G., Bhat, P., Shabsovich, D., Juarez, J. E., Chong, N., Kupelian, P. A., Rettig, M. B., Zaorsky, N. G., Berlin, A., Tward, J. D., Davis, B. J., Reiter, R. E., Steinberg, M. L., Elashoff, D., Horwitz, E. M., Tendulkar, R. D., Tilki, D., Czernin, J., Gafita, A., Romero, T., Calais, J., Kishan, A. U. 1800; 4 (12): e2138550

  Abstract

  Importance: Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) can detect low-volume, nonlocalized (ie, regional or metastatic) prostate cancer that was occult on conventional imaging. However, the long-term clinical implications of PSMA PET/CT upstaging remain unclear.Objectives: To evaluate the prognostic significance of a nomogram that models an individual's risk of nonlocalized upstaging on PSMA PET/CT and to compare its performance with existing risk-stratification tools.Design, Setting, and Participants: This cohort study included patients diagnosed with high-risk or very high-risk prostate cancer (ie, prostate-specific antigen [PSA] level >20 ng/mL, Gleason score 8-10, and/or clinical stage T3-T4, without evidence of nodal or metastatic disease by conventional workup) from April 1995 to August 2018. This multinational study was conducted at 15 centers. Data were analyzed from December 2020 to March 2021.Exposures: Curative-intent radical prostatectomy (RP), external beam radiotherapy (EBRT), or EBRT plus brachytherapy (BT), with or without androgen deprivation therapy.Main Outcomes and Measures: PSMA upstage probability was calculated from a nomogram using the biopsy Gleason score, percentage positive systematic biopsy cores, clinical T category, and PSA level. Biochemical recurrence (BCR), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall survival (OS) were analyzed using Fine-Gray and Cox regressions. Model performance was quantified with the concordance (C) index.Results: Of 5275 patients, the median (IQR) age was 66 (60-72) years; 2883 (55%) were treated with RP, 1669 (32%) with EBRT, and 723 (14%) with EBRT plus BT; median (IQR) PSA level was 10.5 (5.9-23.2) ng/mL; 3987 (76%) had Gleason grade 8 to 10 disease; and 750 (14%) had stage T3 to T4 disease. Median (IQR) follow-up was 5.1 (3.1-7.9) years; 1221 (23%) were followed up for at least 8 years. Overall, 1895 (36%) had BCR, 851 (16%) developed DM, and 242 (5%) died of prostate cancer. PSMA upstage probability was significantly prognostic of all clinical end points, with 8-year C indices of 0.63 (95% CI, 0.61-0.65) for BCR, 0.69 (95% CI, 0.66-0.71) for DM, 0.71 (95% CI, 0.67-0.75) for PCSM, and 0.60 (95% CI, 0.57-0.62) for PCSM (P<.001). The PSMA nomogram outperformed existing risk-stratification tools, except for similar performance to Staging Collaboration for Cancer of the Prostate (STAR-CAP) for PCSM (eg, DM: PSMA, 0.69 [95% CI, 0.66-0.71] vs STAR-CAP, 0.65 [95% CI, 0.62-0.68]; P<.001; Memorial Sloan Kettering Cancer Center nomogram, 0.57 [95% CI, 0.54-0.60]; P<.001; Cancer of the Prostate Risk Assessment groups, 0.53 [95% CI, 0.51-0.56]; P<.001). Results were validated in secondary cohorts from the Surveillance, Epidemiology, and End Results database and the National Cancer Database.Conclusions and Relevance: These findings suggest that PSMA upstage probability is associated with long-term, clinically meaningful end points. Furthermore, PSMA upstaging had superior risk discrimination compared with existing tools. Formerly occult, PSMA PET/CT-detectable nonlocalized disease may be the main driver of outcomes in high-risk patients.

  View details for DOI 10.1001/jamanetworkopen.2021.38550

  View details for PubMedID 34902034

• Trends and Predictors of Hypofractionated and Intensity-Modulated Radiotherapy for Organ Preservation in Bladder Cancer. Clinical genitourinary cancer Xiang, M., Chang, A. J., Chamie, K., Drakaki, A., Pollom, E. L., Steinberg, M. L., Kishan, A. U. 2021

  Abstract

  INTRODUCTION: Use of hypofractionated radiation (HFRT) and intensity-modulated radiation (IMRT) for organ preservation in bladder cancer is controversial and highly variable. We investigated practice patterns, trends, and predictors of HFRT and IMRT.PATIENTS AND METHODS: The National Cancer Database was queried for patients with muscle-invasive, non-metastatic urothelial bladder cancer, treated with definitive (chemo)radiotherapy between 2004 and 2017. HFRT was defined as 50 to 60 Gy at >2 Gy/fraction. Multivariable logistic regression was used to identify predictors of receiving HFRT or IMRT. Multivariable Cox regression was used to model overall survival (OS), adjusting for potential confounders such as age, comorbidity, and chemotherapy.RESULTS: Of 5132 patients identified, 490 (9.5%) received HFRT, and only 334 (6.5%) received ≥2.5 Gy/fraction. HFRT patients were significantly older, less fit, and less likely to receive chemotherapy relative to CFRT, even after controlling for age and comorbidity (adjusted odds ratio 0.36, 95% confidence interval [CI] 0.29-0.45, P < .0001). Utilization of HFRT and IMRT increased over time (P < .0001), reaching 22.5% and 47.7%, respectively, by 2017. Among patients treated with CFRT, OS was similar with or without IMRT (P=.46). Among patients treated with HFRT, IMRT was associated with increased survival (3-year OS 35% vs. 24%, P=.03), which persisted in multivariable analysis (adjusted hazard ratio 0.71, 95% CI 0.52-0.98, P=.04).CONCLUSION: HFRT is largely underutilized, being primarily reserved for older, frailer patients. Chemotherapy is significantly underused with HFRT relative to CFRT. IMRT is used frequently and was associated with equivalent or modestly increased overall survival.

  View details for DOI 10.1016/j.clgc.2021.11.002

  View details for PubMedID 34866018

• Management of brain metastases in lung cancer: evolving roles for radiation and systemic treatment in the era of targeted and immune therapies. Neuro-oncology advances Myall, N. J., Yu, H., Soltys, S. G., Wakelee, H. A., Pollom, E. 2021; 3 (Suppl 5): v52-v62

  Abstract

  Brain metastases are a common occurrence in both non-small cell and small cell lung cancer with the potential to affect quality of life and prognosis. Due to concerns about the accessibility of the central nervous system by systemic chemotherapy agents, the management of brain metastases has historically relied on local therapies including surgery and radiation. However, novel targeted and immune therapies that improve overall outcomes in lung cancer have demonstrated effective intracranial activity. As a result, the management of brain metastases in lung cancer has evolved, with both local and systemic therapies now playing an important role. Factors such as tumor histology (non-small versus small cell), oncogenic driver mutations, and symptom burden from intracranial disease impact treatment decisions. Here, we review the current management of brain metastases in lung cancer, highlighting the roles of stereotactic radiosurgery and novel systemic therapies as well as the ongoing questions that remain under investigation.

  View details for DOI 10.1093/noajnl/vdab106

  View details for PubMedID 34859233

• Radiation Oncology Virtual Education Rotation 2.0 for Residents: Preliminary Results Pollom, E., Sandhu, N., Dieg, C., Miller, J. A., Obeid, J. P., Jimenez, R. B., Fields, E. C., Kahn, J. M. ELSEVIER SCIENCE INC. 2021: E184-E185

  View details for Web of Science ID 000715803800351

• Analysis of Pathologic Complete Response Rates Between Different Neoadjuvant Radiation Treatment Regimens for Rectal Cancer Koong, A., Baclay, J. M., Hui, C., Von Eyben, R., Minneci, M., Loo, P., Vitzthum, L., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2021: E52

  View details for Web of Science ID 000715803800057

• The Utility of Stereotactic Body Radiotherapy for Pelvic Recurrences After Prior Radiation Therapy Minneci, M., Baclay, J. M., Von Eyben, R., Vitzthum, L., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2021: E59-E60

  View details for Web of Science ID 000715803800074

• Pathologic Response and Locoregional Control After Preoperative Pancreatic Stereotactic Body Radiation Therapy Dworkin, M. L., Miller, J. A., Toesca, D. S., Baclay, J. R., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2021: E37

  View details for Web of Science ID 000715803800025

• A Crowdsourcing Challenge for the Development of Artificial Intelligence Algorithms for Automated Identification and Delineation of Pancreatic Cancer Primary Tumors Toesca, D. S., Bush, K., Baclay, J. M., Sergeev, R. A., Brougher, N., Godeny, B., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2021: E99

  View details for Web of Science ID 000715803800159

• Rectosigmoid Cancer - Rectal Cancer or Sigmoid Cancer? Hui, C., Baclay, J. M., Liu, K., Sandhu, N., Loo, P., Von Eyben, R., Chen, C., Sheth, V., Vitzthum, L., Chang, D. T., Pollom, E. ELSEVIER SCIENCE INC. 2021: E47

  View details for Web of Science ID 000715803800046

• Radiation Oncology Virtual Education Rotation 2.0 for Residents: Preliminary Results. International journal of radiation oncology, biology, physics Pollom, E., Sandhu, N., Dieg, C., Miller, J. A., Obeid, J. P., Jimenez, R. B., Fields, E. C., Kahn, J. M. 2021; 111 (3S): e184-e185

  Abstract

  PURPOSE/OBJECTIVE(S): Radiation Oncology Virtual Education Rotation (ROVER) is a virtual education platform developed to support radiation oncology education for medical students during COVID19 when away and in-person rotations were suspended. Due to the positive reception of ROVER, we created ROVER2.0 tailored to radiation oncology residents.MATERIALS/METHODS: ROVER2.0 comprises monthly case-based discussions on various topics with radiation oncology faculty from across the country and is tailored to radiation oncology residents. Sessions are 1 hour in duration and hosted over Zoom. Sessions were advertised on social media (Twitter) and on ARRO, ACRO, and ADROP mailing lists. Pre- and post-session surveys were used to explore resident perspectives on virtual education and assess the utility of virtual education as a modern learning platform.RESULTS: Five ROVER2.0 sessions have been held, led by 17 faculty from 16 institutions (3-4 faculty per session) with a total of 868 registrants (R), 445 attendees (A), and 152 post-survey respondents (P): gastrointestinal (R = 186, A = 103, P = 50), genitourinary (R = 159, A = 83, P = 29), central nervous system (R = 140, A = 58, P = 19), pediatrics (R = 177, A = 94, P = 27), and head and neck (R = 206, A = 107, P = 27). 43.5% of registrants were female, 6.1% were PGY-1, 37.3% were PGY-2/3, and 45% were PGY-4-5. Of all registrants, 82% signed up for ROVER2.0 for the "opportunity to hear from a diverse expert panel." At baseline, 73.5% reported that their home programs conducted mock oral exams and programs were reported to have a median of 5 hours/week of dedicated didactics. A third or fewer reported that COVID-19 negatively impacted residency didactics (22.8%), faculty engagement in teaching (30.8%), or access to faculty (33.9%). 24.2%, 37.3%, and 38.5% of respondents felt that virtual platforms are superior, equal, or inferior to in-person learning, respectively. 98.0% considered the sessions very valuable or valuable and that it was very easy or easy (94.1%) to learn through the virtual format. 83.6% strongly agreed or agreed that they felt more confident treating the disease site cancer as a result of the session. 84.2% reported that they had no difficulty attending sessions due to clinical responsibilities.CONCLUSION: ROVER2.0 case-based sessions can augment radiation oncology residency didactics by providing exposure to different practices across the country as an adjunct to in-person learning. Most respondents felt that COVID-19 did not negatively impact educational quality, and a rapid transition to virtual platforms likely served as an important buffer. ROVER2.0 was met with enthusiasm and considered an effective teaching tool by radiation oncology resident participants. This virtual and open-access resource can facilitate accessible and equitable education to those negatively impacted by in-person learning restrictions and allow broader dissemination of information about radiation oncology.

  View details for DOI 10.1016/j.ijrobp.2021.07.684

  View details for PubMedID 34700866

• Analysis of Pathologic Complete Response Rates Between Different Neoadjuvant Radiation Treatment Regimens for Rectal Cancer. International journal of radiation oncology, biology, physics V, A. K., Baclay, J. R., Hui, C., Von Eyben, R., Minneci, M., Loo, P., Vitzthum, L., Pollom, E., Chang, D. T. 2021; 111 (3S): e52

  Abstract

  PURPOSE/OBJECTIVE(S): The standard of care for rectal cancer is either long or short course radiation followed by surgery with or without adjuvant chemotherapy. Recently, total neoadjuvant therapy, an approach consisting of giving all chemotherapy and radiotherapy prior to definitive surgery, has been a promising alternative. This study aims to assess the pathologic complete response (pCR) rates among different neoadjuvant treatment regimens and determine if neoadjuvant chemotherapy improves pCR rates.MATERIALS/METHODS: Electronic medical databases were queried to identify rectal cancer patients treated with neoadjuvant therapy at our institution from 2006-2019. Patients were grouped according to neoadjuvant therapy received: long-course chemoradiation (CRT), long-course chemoradiation with chemotherapy (CRT TNT), short-course radiation (SCRT), and short-course radiation with chemotherapy (SCRT TNT). Patients without follow-up data or surgical pathology reports were excluded. pCR was defined as no evidence of disease at surgery. pCR rates were determined and compared using Chi-square analysis.RESULTS: A total of 249 patients were analyzed. Table 1 shows treatment characteristics in each group. There were 200 (80.3%) patients who received CRT, 26 (10.4%) who received CRT TNT, 13 (5.2%) who received SCRT, and 10 (4%) who received SCRT TNT. Initial stage was different between groups, with metastatic patients more likely to receive SCRT TNT (P < 0.001). The median time to surgery were significantly different between groups (P < 0.001). Eleven (42.3%) and 6 (60%) patients received FOLFOX, and 13 (50%) and 4 (40%) of the patients received XELOX for CRT TNT and SCRT TNT, respectively. The remaining patients (7.7%) in the CRT TNT group received Capecitabine. For CRT, 53 (26.5%) patients achieved pCR, 3 (11.5%) in CRT TNT, 1 (7.7%) in SCRT, and 2 (20%) in SCRT TNT. None of these differences were statistically different (P = 0.19). On univariate analysis, age (P = 0.13), clinical T stage (P = 0.13), clinical N stage (P = 0.95), time to surgery (P = 0.82), and presence of chemotherapy in the neoadjuvant regimen (P = 0.22) were not significant predictors for pCR.CONCLUSION: Total neoadjuvant treatment for rectal cancer did not improve pCR rates over standard chemoradiation or short course radiation alone, which is contrary to what published series suggest. These results maybe be explained in part by the fact that chemotherapy was delivered first and the time from completing radiation to the time of surgery was not significantly different between groups. These data suggest that meaningful gains in pCR rates may be achieve by sequencing chemoradiation earlier in the TNT course. Future studies are needed to investigate this hypothesis.

  View details for DOI 10.1016/j.ijrobp.2021.07.388

  View details for PubMedID 34701649

• The Utility of Stereotactic Body Radiotherapy for Pelvic Recurrences After Prior Radiation Therapy. International journal of radiation oncology, biology, physics Minneci, M., Baclay, J. R., Von Eyben, R., Vitzthum, L., Pollom, E., Chang, D. T. 2021; 111 (3S): e59-e60

  Abstract

  PURPOSE/OBJECTIVE(S): Patients with locally recurrent colorectal cancer represent a particular clinical challenge as these patients often present with unresectable disease and a history of prior pelvic radiotherapy. While options are therefore limited, radiation is usually the only local therapy available. The purpose of this study was to analyze the efficacy and outcomes associated with treating recurrent colorectal cancer using stereotactic body radiation therapy (SBRT) in patients who have been previously irradiated to the pelvis.MATERIALS/METHODS: We identified 23 patients with recurrent rectal (n = 20, 87%) or colon (n = 3, 13%) adenocarcinoma who were treated with SBRT in the Department of Radiation Oncology at Stanford University from June 2009 to November 2019. In total, 11 males and 12 females were included in this study with a median age of 53 years old (range: 25-76). All 23 patients had a history of surgical resection and at least one course of radiation therapy to disease in the pelvis before SBRT treatment to the pelvis for recurrent cancer, of which 8 patients (35%) received two prior radiotherapy courses and 1 patient (4%) received three prior courses. Data collection included tumor staging and grading, radiation treatment details, and follow up information to determine toxicities and survival outcomes. Time to events were calculated from the completion of SBRT. Toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0.RESULTS: Median time to follow up was 91 months (range: 36-237). Median GTV and PTV volumes for tumor treated using SBRT were 79.9 and 136.5 cm3, respectively. Median SBRT dose was 40 Gy (range: 30 - 50). Median PTV mean dose was 41.8Gy. The median cumulative biological effective dose (BED) was 145 Gy (range: 72.0-254.4). Overall, 22 patients received 5 fractions of treatment and one patient received 4 of the 5 planned fractions due to deteriorating condition related to disease. Median time to overall survival (OS) was 125 months (range: 61-194) and median progression free survival (PFS) was 82 months (range: 57-142). The 3- and 5-year rate of local failure was 4.4% and 17.4%, respectively. Of the 23 patients in this cohort, there were 6 patients (26%) with grade 2 acute toxicities, including 3 patients (13%) with increased pain, and 6 patients (26%) with late grade 2 or 3 toxicities, including 3 patients (13%) with grade 3 neuropathy. There was no grade 3 or 4 acute, or grade 4 late toxicities reported. On univariate analysis, no factors were significantly predictive of OS, PFS, or toxicity.CONCLUSION: SBRT to previously irradiated areas of the pelvis was effective in controlling unresectable pelvic recurrences of colorectal cancer following previous radiation. While treatment was generally well-tolerated, pelvic pain was the most common acute toxicity, and neuropathy was the most common late toxicity. Further investigation is needed to improve the toxicity profile and optimize the therapeutic ratio.

  View details for DOI 10.1016/j.ijrobp.2021.07.405

  View details for PubMedID 34701819

• Pathologic Response and Locoregional Control After Preoperative Pancreatic Stereotactic Body Radiation Therapy. International journal of radiation oncology, biology, physics Dworkin, M. L., Miller, J. A., Toesca, D. A., Baclay, J. R., Pollom, E., Chang, D. T. 2021; 111 (3S): e37

  Abstract

  PURPOSE/OBJECTIVE(S): In light of ALLIANCE02150, the role of preoperative stereotactic body radiotherapy (SBRT) for pancreatic cancer is controversial. We studied patients who had surgery after preoperative SBRT to assess pathologic and clinical outcomes, and evaluate if elective nodal irradiation (ENI) decreases locoregional failure (LRF).MATERIALS/METHODS: Patients with pancreatic cancer who received SBRT at one center from 2007 to 2020 followed by oncologic surgery were reviewed. Local (primary tumor), regional (peripancreatic or perivascular per RTOG consensus), and distant failures were coded. Pathologic treatment response per College of American Pathologists was reviewed. Incidence of LRF with death as competing risk was assessed. Time to overall (OS) and progression-free survival (PFS) from date of pathologic diagnosis was assessed via Kaplan-Meier. Association testing via Cox analysis for OS/PFS and Gray test for LRF was performed.RESULTS: Twenty-eight patients were evaluable. Median (range) ECOG was 1 (0-2). Tumor stage was cT4 in 19 (67.9%) patients. Nodal stage was cN1 in 10 (35.7 %) patients. There were 7 and 21 patients with initially unresectable and borderline resectable disease respectively. Chemotherapy (CT) was given prior to SBRT in 27 (96.4%) patients, with FOLFIRINOX and gemcitabine-paclitaxel in 21 and 4 patients, respectively. Median (range) duration of CT was 5 (0-12) cycles. Median (range) dose, BED10, and fractionation were 40 Gy (25 - 50 Gy), 72 Gy (54.78 - 100 Gy), and 5 (1-5) respectively. The median (range) time between SBRT and surgery was 6.7 (2.6 - 21.9) weeks. Whipple, Appleby, and distal pancreatectomy was performed in 22, 4, and 2 patients respectively. The R0 rate was 23/28 (82.1%). Pathologic complete, near complete, partial, and poor/no treatment response was seen in 1 (3.6%), 10 (35.7%), 15 (53.6%), and 2 (7.1%) patients, respectively. The pN1 rate was 12/28 (42.3%). Median (range) follow up was 21.5 months (6.9 - 67.2 months). The 18-month (95% CI) overall survival (OS) and LRF were 66.6% (50.0 - 88.6%), and 7.8% (0.0 - 48.4%) respectively. Complete or near complete pathologic response was associated with improved OS (HR = 0.21, P = 0.022) and PFS (HR = 0.25, P = 0.021), but not LRC (P = 0.780). Longer (≥8 weeks) time between end of SBRT and surgery was associated with improved complete or near complete response rate (P = 0.024) but not OS, PFS, or LRF. BED10 did not predict for pathologic treatment response or margin status. Sixteen patients received ENI. There were no other statistically significant differences in the above baseline characteristics, OS, PFS, or pathology outcomes, with vs without ENI. The 18-month (95% CI) LRF with vs without ENI was 0.0% (0.0 - 0.0%) vs 12.8% (0.0 - 38.8%), P = 0.29.CONCLUSION: Our cohort of patients with pancreatic cancer treated with preoperative SBRT and surgery showed good pathologic response and R0 rate. ENI was associated with numerically lower LRF. Increased BED10 was not associated with improved pathologic treatment response.

  View details for DOI 10.1016/j.ijrobp.2021.07.356

  View details for PubMedID 34701293

• A Crowdsourcing Challenge for the Development of Artificial Intelligence Algorithms for Automated Identification and Delineation of Pancreatic Cancer Primary Tumors. International journal of radiation oncology, biology, physics Toesca, D. A., Bush, K., Baclay, J. R., Sergeev, R. A., Brougher, N., Godeny, B., Pollom, E., Chang, D. T. 2021; 111 (3S): e99

  Abstract

  PURPOSE/OBJECTIVE(S): To develop a crowdsourced artificial intelligence computational algorithm to accurately identify and delineate pancreatic cancer (PC) primary tumors and major peripancreatic vessels on high-resolution CT images.MATERIALS/METHODS: After IRB approval, a well-curated data set of 243 diagnostic pancreatic-protocol high-resolution CT scans of patients diagnosed with PC was prepared. A data science marathon competition was then hosted online by a third-party company between December 2020 and January 2021. The full data set was randomly partitioned into training, validation and hold-out (scoring) data sets. Contestants were provided a training dataset containing [de-identified files from a high-resolution IV contrast-enhanced CT DICOM image set; de-identified DICOM metadata; de-identified RT structure set file with contours of the tumor and superior mesenteric artery (SMA), celiac axis/common hepatic artery continuum (CA/CHA), and superior mesenteric vein/portal vein continuum (SMV/PV)], along with a smaller validation data set with CT scans without contours to test their trained algorithms. Provisional scores were assigned using the validation data set throughout the competition. Final scoring of submitted algorithms was based on the performance of the algorithms on a hold-out data set (unavailable for the contestants), matched against the expected ground truth data using an F1 scoring metric [2 * precision * recall / (precision + recall)], in which precision = TP / (TP + FP), and recall = TP / (TP + FN). TP is the area (measured in pixels) of the overlap of expected (ground truth delineation) and extracted (submitted algorithm) regions, FP is the area extracted but which does not belong to expected regions, FN is the area of the expected regions that is not covered by extracted regions. The above was calculated separately for the 4 structure types (tumor, SMA, CA/CHA, and SMV/PV), with a weighted average of the four F1 values, where the weight of the tumor was 7, and the weight of each of the vessels was 1. A final average for each contestant was scaled up to 0-100 range.RESULTS: In total, 337 algorithm solutions from 23 competitors were submitted. The winning algorithm achieved an average F1 score of 70.2. The F1 score ranged from 69.8 to 66.7 between the 2nd and 5th best solutions. The winning solution used a 3D-UNet model to develop a 3D semantic segmentation approach that was found to be significantly accurate on tumor and vessel delineation. A comparison between the winning solution and an ensemble between the 2nd to 5th place solutions showed that in 82% of cases, both the winning and the ensembled solution succeeded in achieving an F1 score > 60.CONCLUSION: A crowdsourced innovation challenge was successfully employed to generate artificial intelligence algorithms capable of accurately delineating pancreatic cancer on a diagnostic CT scan.

  View details for DOI 10.1016/j.ijrobp.2021.07.490

  View details for PubMedID 34702015

• Rectosigmoid Cancer - Rectal Cancer or Sigmoid Cancer? International journal of radiation oncology, biology, physics Hui, C., Baclay, J. R., Liu, K., Sandhu, N., Loo, P., Von Eyben, R., Chen, C., Sheth, V., Vitzthum, L., Chang, D. T., Pollom, E. 2021; 111 (3S): e47

  Abstract

  PURPOSE/OBJECTIVE(S): Locally advanced rectosigmoid adenocarcinomas are treated with either neoadjuvant (NA) chemoradiation or upfront surgery (sx). We determined outcomes with both treatment approaches and whether outcomes vary by anatomic landmarks.MATERIALS/METHODS: We identified 161 pts with non-metastatic T3-T4 and/or N+ rectosigmoid cancers who underwent sx. with NA (radiation with or without chemotherapy) or adjuvant (adj) therapy from 2006 to 2018 at our institution. We included pts with available imaging and with primary tumor located 9-20 cm from the anal verge (AV) on staging CT, MRI, or colonoscopy. We reviewed the relationship of the primary tumor to the peritoneal reflection (PR) and sacral promontory (SP). Comparisons between the NA and adj. groups were performed using Fisher's exact test. Cumulative incidence of locoregional failure (LRF), distant failure (DF), and overall survival (OS) were compared using Kaplan-Meier.RESULTS: Of the study cohort, 97 pts had NA therapy and 64 pts had upfront sx. Median follow-up was 45.1 months. Pts who had NA therapy were younger, had tumors that were lower and more likely below the PR and with threatened circumferential resection margins (CRM), fewer cycles of adj chemotherapy, and higher cT stage (Table 1). The 3-year OS was 97.5% in the NA group versus 93.7% for upfront sx 2-year cumulative incidence of LRF was 5.2% (NA) vs 5.6% (upfront sx), P = 0.91. 2-year cumulative incidence of DF was 9.2% (NA) vs 10.4% (upfront sx), P = 0.54. Of the 10 pts total with LRF, 8 and 6 occurred in pts with tumors straddling/above the PR and > 10 cm from AV on imaging, respectively. None of the 3 pts with tumors < 10 cm from AV (MRI) treated with NA had LRF, while 16.7% (1/6) of these pts who received upfront sx had LRF. None of the 15 pts with tumors below the PR treated with NA had LRF, while 25% (1/4) of these pts who received upfront sx had LRF. Outcomes did not vary by relationship to the SP.CONCLUSION: Pts with locally advanced rectosigmoid cancer treated with NA therapy had tumors closer to the AV and more advanced primaries. Despite these negative prognostic factors, they had cancer control outcomes similar to pts with higher, lower stage tumors treated with upfront sx. Pts with tumors below the PR or < 10 cm from AV may derive more benefit from NA therapy.

  View details for DOI 10.1016/j.ijrobp.2021.07.377

  View details for PubMedID 34701528

• RADIOTHERAPY FOR BRAIN METASTASES FROM THYROID CANCER: A RETROSPECTIVE COHORT STUDY Blomain, E., Berta, S., Hug, N., Giao, D., Meola, A., Binkley, M., Shahsavari, N., Desai, K., Chang, S., Soltys, S., Pollom, E. OXFORD UNIV PRESS INC. 2021: 42

  View details for Web of Science ID 000757356200166

• Intracranial Response to Combination BRAF and MEK Inhibitor Therapy in Patients with Metastatic Melanoma Hui, C., Wu, Y., Liu, K., Sandhu, N., Blomain, E., Binkley, M., Gephart, M., Chang, S., Li, G., Reddy, S., Gibbs, I., Soltys, S., Pollom, E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S48-S49

  View details for Web of Science ID 000701779700077

• Radiotherapy for Management of Brain Metastases from Thyroid Cancer: A National Cancer Database Study Blomain, E., Binkley, M., Giao, D., Churilla, T., Soltys, S., Pollom, E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S48

  View details for Web of Science ID 000701779700076

• Local Recurrence Outcomes of Colorectal Cancer Oligometastases Treated With Stereotactic Ablative Radiotherapy. American journal of clinical oncology Benson, K. R., Sandhu, N., Zhang, C., Ko, R., Toesca, D. A., Lee, P. E., Von Eyben, R., Diehn, M., Gensheimer, M., Maxim, P. G., Bush, K., Loo, B. W., Soltys, S. G., Pollom, E. L., Chang, D. T. 2021

  Abstract

  PURPOSE: The aim of this study was to report local failure (LF) outcomes and associated predictors in patients with oligometastatic colorectal cancer (CRC) treated with stereotactic ablative radiotherapy (SABR).MATERIALS AND METHODS: We retrospectively reviewed patients with CRC metastases to the brain, liver, spine, or lung treated with SABR between 2001 and 2016. Time to LF was summarized using cumulative incidence of LF curves with death as a competing risk.RESULTS: The analysis included a total of 130 patients and 256 lesions. Of the metastases treated, 129 (50%) were brain, 50 (20%) liver, 49 (19%) spine, and 28 (11%) lung. Median gross tumor volume was 24 mL for liver metastases, 2 mL for brain metastases, 4 mL for spine metastases, and 1 mL for lung metastases. The overall 1, 2, and 3-year cumulative incidence of LF rates were 21.6% (16.5, 27.1), 28.2% (22.3, 34.4), and 31.5% (25.2, 38.0), respectively. LF was highest among the liver metastases (1 y: 26.0%, 2 y: 38.5%), followed by spine (1 y: 25.1%, 2 y: 31.1%), brain (1 y: 20%, 2 y: 25.2%), and lung (1 y: 13.7%, 2 y: insufficient data). Metastases from right-sided primary CRC were significantly more likely to have LF (P=0.0146, HR=2.23). Biologically effective dose>70 Gy, defined using a standard linear quadratic model using alpha/beta ratio of 10 on the individual lesion level, and pre-SABR chemotherapy were also significant predictors of LF (P= 0.0009 and 0.018, respectively).CONCLUSIONS: CRC metastases treated with SABR had significantly higher rates of LF if they originated from right-sided primary CRC, compared with left-sided. Liver metastases had the highest rates of LF compared with other metastatic sites. Thus, CRC liver metastases and metastases from right-sided CRC may benefit from more aggressive radiotherapy.

  View details for DOI 10.1097/COC.0000000000000864

  View details for PubMedID 34534143

• Brain Metastases in EGFR- and ALK-positive Non-Small Cell Lung Cancer: Outcomes of CNS Penetrant Tyrosine Kinase Inhibitors (TKIs) Alone versus in Combination with Radiation. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer Thomas, N. J., Myall, N. J., Sun, F., Patil, T., Mushtaq, R., Yu, C., Sinha, S., Pollom, E. L., Nagpal, S., Camidge, D. R., Rusthoven, C. G., Braunstein, S. E., Wakelee, H. A., McCoach, C. E. 2021

  Abstract

  INTRODUCTION: Management of central nervous system (CNS) metastases in patients with driver-mutated non-small cell lung cancer (NSCLC) has traditionally incorporated both tyrosine kinase inhibitors (TKIs) and intracranial radiation. Whether next-generation, CNS-penetrant TKIs can be used alone without upfront radiation, however, remains unknown. This multi-institutional retrospective analysis aimed to compare outcomes in patients with EGFR- or ALK-positive NSCLC who received CNS-penetrant TKI therapy alone versus in combination with radiation for new or progressing intracranial metastases.METHODS: Data was retrospectively collected from 3 academic institutions. Two treatment groups (CNS-penetrant TKI alone vs TKI+CNS RT) were compared for both EGFR- and ALK-positive cohorts. Outcome variables included time to progression, time to intracranial progression, and time to treatment failure, measured from the date of initiation of CNS-penetrant TKI therapy.RESULTS: A total of 147 patients were included (EGFR n=94, ALK n=52, both n=1). In patients receiving radiation, larger metastases, neurological symptoms, and receipt of steroids were more common. There were no significant differences between TKI vs CNS RT+TKI groups for any of the study outcomes, including time to progression (8.5 vs 6.9 months, p=0.13 [EFGR] and 11.4 vs 13.4 months, p=0.98 [ALK]), time to intracranial progression (14.8 vs 20.5 months, p=0.51 [EGFR] and 18.1 vs 21.8 months, p=0.65 [ALK]), or time to treatment failure (13.8 vs 8.6 months, p=0.26 [EGFR] and 13.5 vs 23.2 months, p=0.95 [ALK]).CONCLUSION: These results provide preliminary evidence that intracranial activity of CNS-penetrant TKIs may enable local radiation to be deferred in appropriately selected patients without negatively impacting progression.

  View details for DOI 10.1016/j.jtho.2021.08.009

  View details for PubMedID 34455066

• Trimodality Versus Bimodality Therapy in Patients With Locally Advanced Esophageal Carcinoma: Commentary on the American Society of Clinical Oncology Practice Guidelines. Practical radiation oncology Vitzthum, L. K., Hui, C., Pollom, E. L., Chang, D. T. 2021

  Abstract

  In the recent guideline statement from the American Society of Clinical Oncology, experts reviewed relevant literature and provided treatment recommendations for multimodality treatment approaches. The guidelines recommend either preoperative concurrent neoadjuvant chemoradiotherapy (CRT) or perioperative chemotherapy for locally advanced adenocarcinoma and either preoperative CRT followed by esophagectomy or definitive CRT for squamous cell carcinoma. Whether radiation can be omitted in patients with adenocarcinoma or whether surgery can be omitted in patients with squamous cell carcinoma is a subject of ongoing debate and clinical trials.

  View details for DOI 10.1016/j.prro.2021.05.004

  View details for PubMedID 34353757

• Pancreatic Stereotactic Body Radiation Therapy with or without Hypofractionated Elective Nodal Irradiation. International journal of radiation oncology, biology, physics Miller, J. A., Toesca, D. A., Baclay, J. R., Vitzthum, L. K., Dubrowski, P., Pollom, E. L., Chang, D. T. 2021

  Abstract

  PURPOSE/OBJECTIVES: Pancreatic stereotactic body radiation therapy (SBRT) is limited to gross tumor without elective coverage for subclinical disease. Given a better understanding of recurrence patterns, we hypothesized that the addition of elective nodal irradiation (ENI) to pancreatic SBRT would be tolerable and would decrease locoregional progression.MATERIALS/METHODS: We conducted a retrospective 1:2 propensity-matched cohort study to compare toxicity and locoregional progression among patients treated with pancreatic SBRT with or without ENI. In the SBRT+ENI cohort, an elective target volume was delineated per RTOG guidelines and treated to 25 Gy in 5 fractions alongside 40 Gy in 5 fractions to gross disease. The primary outcome was the cumulative incidence of locoregional progression, with death as a competing risk.RESULTS: Among 135 candidate controls treated with SBRT alone, 100 were propensity-matched to 50 patients treated with SBRT+ENI. All patients completed SBRT. Median potential radiographic follow-up was 28 months. The incidence of late and serious acute toxicity were similar between matched cohorts. However, SBRT+ENI was associated with a statistically significant increase in acute grade 1-2 nausea (60% vs. 20%, p<0.001). The 24-month cumulative incidences of locoregional progression with and without ENI were 22.6% (95% confidence interval [CI]: 10.0-35.1%) vs. 44.6% (95% CI: 34.8-54.4%, multivariable-adjusted hazard ratio 0.39, 95% CI 0.18-0.87, p=0.021). This was stable in sensitivity analyses of uniform prescription dose, multiagent chemotherapy, and resectability. There were fewer peripancreatic (0% vs. 7%), porta hepatis (2% vs. 7%), and peri-aortic/aortocaval (5% vs. 12%) recurrences after SBRT+ENI, but no difference in survival.CONCLUSIONS: Pancreatic SBRT+ENI was tolerable and did not increase late or serious acute toxicity relative to a matched cohort undergoing SBRT alone, but did increase acute grade 1-2 nausea. The addition of ENI to SBRT was associated with decreased locoregional progression but not improved survival. Further studies are warranted to determine if ENI offers meaningful benefit.

  View details for DOI 10.1016/j.ijrobp.2021.07.1698

  View details for PubMedID 34348171

• #TrendingNow: Instagram versus Twitter Activity Among Radiation Oncology Patients and Providers. Practical radiation oncology Rahimy, E., Sandhu, N. K., Giao, D. M., Pollom, E. L. 2021

  Abstract

  PURPOSE: We aimed to evaluate recent Instagram and Twitter posts to identify the primary disseminators of information related to radiation therapy on social media (healthcare professionals versus patients), to characterize their influencer status, and to characterize the content of this information.METHODS: Using two commercial hashtag analytics platforms, 1,000 of the most recent eligible posts from each platform were evaluated for content, tone, and engagement, as well as user (poster) characteristics. Inclusion criteria were as follows: unique posts, written in English, relevant to human cancer treatment, and contains one of 11 predetermined hashtags (#radiation, #radiotherapy, #radiationtherapy, #radiationoncology, #radonc, #radiationtherapist #radiationtreatment, #medphys, #cyberknife, #radiosurgery, #protontherapy).RESULTS: Users of radiation oncology content on Instagram were primarily patients/caregivers (47%), specifically adult patients (94%) with breast cancer (53%). Patient/caregiver content was focused on patient experience (79%), with approximately half specific to radiation therapy (51%), and most patient/caregiver posts demonstrated a positive tone (86%). In contrast, Twitter content was dominated by health care professionals (53%), specifically within radiation oncology (90% of unique users). Health care professional content was focused on colleague education/research dissemination (53%), with a high proportion of posts specific to radiation therapy (95%).CONCLUSIONS: Given the disproportionate number of patients versus radiation oncology professionals active on Instagram versus Twitter, and the lack of radiation therapy-specific content on Instagram, there may be an opportunity to improve patient outreach and education by promoting presence of radiation oncologists within Instagram.

  View details for DOI 10.1016/j.prro.2021.06.008

  View details for PubMedID 34233217

• The landscape of mortality during or within 30 days after non-palliative radiotherapy across 11 major cancer types. Xiang, M., Raldow, A. C., Pollom, E. L., Steinberg, M. L., Kishan, A. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for DOI 10.1200/JCO.2021.39.15_suppl.6570

  View details for Web of Science ID 000708120604024

• Palliative care service utilization and advance care planning issues for adult glioblastoma patients: A systematic review. Wu, A., Colon, G., Aslakson, R., Pollom, E. L., Patel, C. B. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for DOI 10.1200/JCO.2021.39.15_suppl.2036

  View details for Web of Science ID 000708120600321

• Networking and Applying to Radiation Oncology During A Pandemic: Cross-Sectional Survey of Medical Student Concerns. Advances in radiation oncology Pollom, E. L., Sandhu, N., Deig, C. R., Obeid, J., Miller, J. A., Kahn, J. M. 2021; 6 (3): 100643

  Abstract

  Purpose: We assessed the effectiveness of a virtual networking session tailored for third- and fourth-year medical students interested in radiation oncology, and report students' concerns about applying to radiation oncology during the pandemic.Methods and Materials: A multi-institutional networking session was hosted on Zoom and included medical students, faculty, and residents from across the country. The breakout room feature was used to divide participants into smaller groups. Participants were randomly shuffled into new groups every 10 to 15 minutes. Students completed pre- and post-session surveys.Results: Among the 134 students who registered, 69 students participated in the session, and 53 students completed a post-session survey. Most students reported the session was valuable or very valuable (79%), and it was easy or very easy to network through the virtual format (66%). After the session, 18 (33.9%) students reported their interest in radiation oncology increased, and 34 (64.2%) reported their interest remained the same. Most students believed COVID-19 (55%) and virtual interviews and platforms (55%) negatively or somewhat negatively affected their ability to select a residency program. Most students (62%) were concerned they will be inaccurately evaluated as an interviewee on a virtual platform. Although 30% agreed or strongly agreed the cost-savings and convenience of virtual interviews outweigh potential downsides, 66% of students were planning to visit cities of interest in person before rank list submission.Conclusions: Medical students reported significant concerns with their ability to be accurately evaluated and to choose among residency programs on a virtual platform. Students found the networking session to be a valuable resource for most students, and programs could continue similar efforts during the residency application cycle to better represent their program while maintaining certain financial and geographic advantages of a virtual environment.

  View details for DOI 10.1016/j.adro.2021.100643

  View details for PubMedID 33748546

• Radiation Oncology Virtual Education Rotation (ROVER) for Medical Students. International journal of radiation oncology, biology, physics Kahn, J. M., Sandhu, N., von Eyben, R., Deig, C., Obeid, J., Miller, J. A., Pollom, E. 2021

  Abstract

  PURPOSE: We describe the implementation of a novel virtual educational program for medical students, Radiation Oncology Virtual Education Rotation (ROVER), and its impact on student interest and knowledge in radiation oncology.METHODS AND MATERIALS: ROVER comprised a series of virtual educational panels with case-based discussions across disease sites tailored to medical students. These were moderated by radiation oncology residents and included faculty panelists from academic radiation oncology programs across the country. Student pre- and post-session surveys were collected. Paired t-tests were used to compare the pre- and post-session assessment results.RESULTS: Six ROVER sessions were held from June 4, 2020 to August 20, 2020 with a total of 427 medical students registering for at least one session. Of these, 231 students attended at least one session, with 140 completing at least one post-session survey (60.6% response rate). Fourth-year medical students were the largest group represented among attendees (32.0%). Most attendees had exposure to radiation oncology (78.8%) prior to the sessions. Majority of students signed up for these sessions for education (90.6%). Some students signed up for the sessions to help with specialty selection (30.9%) and to network (30.4%). Medical students' understanding of the role of radiation oncology in each disease site (breast, sarcoma, central nervous system, pediatrics, gastrointestinal, genitourinary, gynecologic, lymphoma, lung, and head and neck) was improved by attending each session (pre- versus post-session, p <0.0001 for all disease sites). Over three-quarters of respondents stated they were considering applying or were likely to apply into radiation oncology both before and following the sessions.CONCLUSIONS: ROVER improved medical student perceived knowledge of radiation oncology across all disease sites covered. ROVER fulfills a need for a national medical student education platform for radiation oncology. Future work is warranted to augment virtual and open educational platforms to improve access to radiation oncology education.

  View details for DOI 10.1016/j.ijrobp.2021.03.057

  View details for PubMedID 33845145

• The Stanford stereotactic radiosurgery experience on 7000 patients over 2 decades (1999-2018): looking far beyond the scalpel. Journal of neurosurgery Fatima, N., Meola, A., Ding, V. Y., Pollom, E., Soltys, S. G., Chuang, C. F., Shahsavari, N., Hancock, S. L., Gibbs, I. C., Adler, J. R., Chang, S. D. 2021: 1–17

  Abstract

  OBJECTIVE: The CyberKnife (CK) has emerged as an effective frameless and noninvasive method for treating a myriad of neurosurgical conditions. Here, the authors conducted an extensive retrospective analysis and review of the literature to elucidate the trend for CK use in the management paradigm for common neurosurgical diseases at their institution.METHODS: A literature review (January 1990-June 2019) and clinical review (January 1999-December 2018) were performed using, respectively, online research databases and the Stanford Research Repository of patients with intracranial and spinal lesions treated with CK at Stanford. For each disease considered, the coefficient of determination (r2) was estimated as a measure of CK utilization over time. A change in treatment modality was assessed using a t-test, with statistical significance assessed at the 0.05 alpha level.RESULTS: In over 7000 patients treated with CK for various brain and spinal lesions over the past 20 years, a positive linear trend (r2 = 0.80) in the system's use was observed. CK gained prominence in the management of intracranial and spinal arteriovenous malformations (AVMs; r2 = 0.89 and 0.95, respectively); brain and spine metastases (r2 = 0.97 and 0.79, respectively); benign tumors such as meningioma (r2 = 0.85), vestibular schwannoma (r2 = 0.76), and glomus jugulare tumor (r2 = 0.89); glioblastoma (r2 = 0.54); and trigeminal neuralgia (r2 = 0.81). A statistically significant difference in the change in treatment modality to CK was observed in the management of intracranial and spinal AVMs (p < 0.05), and while the treatment of brain and spine metastases, meningioma, and glioblastoma trended toward the use of CK, the change in treatment modality for these lesions was not statistically significant.CONCLUSIONS: Evidence suggests the robust use of CK for treating a wide range of neurological conditions.

  View details for DOI 10.3171/2020.9.JNS201484

  View details for PubMedID 33799297

• A Histologic Low-Grade Glioma with 7 Gain, 10 Loss-A Wolf in Sheep's Clothing. International journal of radiation oncology, biology, physics Pollom, E. L., Soltys, S. G. 2021; 109 (5): 1137–38

  View details for DOI 10.1016/j.ijrobp.2019.11.018

  View details for PubMedID 33714521

• EXAMINING ASSOCIATIONS AMONG SEXUAL HEALTH, UNMET CARE NEEDS RELATED TO SEXUALITY, AND DISTRESS IN BREAST AND GYNECOLOGIC CANCER SURVIVORS Benedict, C., Fisher, S., Kuma, D., Pollom, E., Schapira, L., Kurian, A., Berek, J. S., Palesh, O. OXFORD UNIV PRESS INC. 2021: S605

  View details for Web of Science ID 000648922701433

• Time to First Progression in Patients with NSCLC with Brain Metastases Receiving 3rd Generation TKI alone vs TKI plus Brain Radiation Thomas, N., Myall, N., Sun, F., Patil, T., Mushtaq, R., Yu, C., Pollom, E., Nagpal, S., Camidge, R., Rusthoven, C., Braunstein, S., Wakelee, H. A., Mccoach, C. ELSEVIER SCIENCE INC. 2021: S591–S592

  View details for Web of Science ID 000631349601489

• Impact of mental illness on end-of-life emergency department use in elderly patients with gastrointestinal malignancies. Cancer medicine Kashyap, M., Harris, J. P., Chang, D. T., Pollom, E. L. 2021

  Abstract

  BACKGROUND: Elderly patients with gastrointestinal cancer and mental illness have significant comorbidities that can impact the quality of their care. We investigated the relationship between mental illness and frequent emergency department (ED) use in the last month of life, an indicator for poor end-of-life care quality, among elderly patients with gastrointestinal cancers.METHODS: We used SEER-Medicare data to identify decedents with gastrointestinal cancers who were diagnosed between 2004 and 2013 and were at least 66years old at time of diagnosis (median age: 80years, range: 66-117years). We evaluated the association between having a diagnosis of depression, bipolar disorders, psychotic disorders, anxiety, dementia, and/or substance use disorders and ED use in the last 30days of life using logistic regression models.RESULTS: Of 160,367 patients included, 54,661 (34.1%) had a mental illness diagnosis between one year prior to cancer diagnosis and death. Patients with mental illness were more likely to have>1 ED visit in the last 30days of life (15.6% vs. 13.3%, p<0.01). ED use was highest among patients with substance use (17.7%), bipolar (16.5%), and anxiety disorders (16.4%). Patients with mental illness who were male, younger, non-white, residing in lower income areas, and with higher comorbidity were more likely to have multiple end-of-life ED visits. Patients who received outpatient treatment from a mental health professional were less likely to have multiple end-of-life ED visits (adjusted odds ratio 0.82, 95% confidence interval 0.78-0.87).CONCLUSIONS: In elderly patients with gastrointestinal cancers, mental illness is associated with having multiple end-of-life ED visits. Increasing access to mental health services may improve quality of end-of-life care in this vulnerable population.

  View details for DOI 10.1002/cam4.3792

  View details for PubMedID 33621438

• In Regard to Odei etal. International journal of radiation oncology, biology, physics Kahn, J. M., Sandhu, N., Pollom, E. L. 2021; 109 (2): 639–40

  View details for DOI 10.1016/j.ijrobp.2020.08.067

  View details for PubMedID 33422277

• Type of fiducial marker and clinical outcomes in stereotactic body radiation therapy for pancreatic cancer. Baclay, R. J., Minneci, M., Abid, D., Toesca, D., von Eyben, R., Pollom, E. L., Chang, D. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for DOI 10.1200/JCO.2021.39.3_suppl.414

  View details for Web of Science ID 000636712800419

• Longitudinal Analysis of Mental Disorder Burden Among Elderly Patients With Gastrointestinal Malignancies. Journal of the National Comprehensive Cancer Network : JNCCN Harris, J. P., Kashyap, M., Humphreys, J. N., Chang, D. T., Pollom, E. L. 2021: 1–9

  Abstract

  BACKGROUND: Patients with cancer are at high risk for having mental disorders, resulting in widespread psychosocial screening efforts. However, there is a need for population-based and longitudinal studies of mental disorders among patients who have gastrointestinal cancer and particular among elderly patients.PATIENTS AND METHODS: We used the SEER-Medicare database to identify patients aged ≥65 years with colorectal, pancreatic, gastric, hepatic/biliary, esophageal, or anal cancer. Earlier (12 months before or up to 6 months after cancer diagnosis) and subsequent mental disorder diagnoses were identified.RESULTS: Of 112,283 patients, prevalence of an earlier mental disorder was 21%, 23%, 20%, 20%, 19%, and 26% for colorectal, pancreatic, gastric, hepatic/biliary, esophageal, and anal cancer, respectively. An increased odds of an earlier mental disorder was associated with pancreatic cancer (odds ratio [OR], 1.17; 95% CI, 1.11-1.23), esophageal cancer (OR, 1.10; 95% CI, 1.02-1.18), and anal cancer (OR, 1.17; 95% CI, 1.05-1.30) compared with colorectal cancer and with having regional versus local disease (OR, 1.09; 95% CI, 1.06-1.13). The cumulative incidence of a subsequent mental disorder at 5 years was 19%, 16%, 14%, 13%, 12%, and 10% for patients with anal, colorectal, esophageal, gastric, hepatic/biliary, and pancreatic cancer, respectively. There was an association with having regional disease (hazard ratio [HR], 1.08; 95% CI, 1.04-1.12) or distant disease (HR, 1.36; 95% CI, 1.28-1.45) compared with local disease and the development of a mental disorder. Although the development of a subsequent mental disorder was more common among patients with advanced cancers, there continued to be a significant number of patients with earlier-stage disease at risk.CONCLUSIONS: This study suggests a larger role for incorporating psychiatric symptom screening and management throughout oncologic care.

  View details for DOI 10.6004/jnccn.2020.7620

  View details for PubMedID 33401234

• Greater Financial Toxicity Relates to Greater Distress and Worse Quality of Life Among Breast and Gynecologic Cancer Survivors. Psycho-oncology Benedict, C., Fisher, S., Schapira, L., Chao, S., Sackeyfio, S., Sullivan, T., Pollom, E., Berek, J. S., Kurian, A. W., Palesh, O. 2021

  Abstract

  Financial toxicity includes distress and burden from cancer-related costs. Women are more likely to experience worse cancer-related financial outcomes than men. This study evaluated breast and gynecologic cancer patients' subjective experiences of financial toxicity and associations with distress and quality of life (QOL).A cross-sectional survey study included measures of financial toxicity (Comprehensive Score for financial Toxicity [COST] Version 2), distress (Patient Health Questionnaire [PHQ-4]), and QOL (Functional Assessment of Cancer Therapy [FACT-G]). Chi-square, t-tests, and ANOVAs examined bivariate relationships. Two regression models tested associations between financial toxicity and distress and QOL, controlling for covariates. Financial toxicity subgroups were compared based on a validated grading system.Participants (N=273; 74% breast cancer) averaged 54.65 years (SD=12.08), were 3.42 years (SD=4.20) post-diagnosis, and 33% reported cancer-related change in employment status. Financial toxicity was "mild" overall (COST M=26.11, SD=11.14); 32% worried about cancer-related financial problems (quite a bit/very much; item-level analysis). Worse financial toxicity related to younger age (p<.001), identifying as a non-Asian minority (p=.03) or Hispanic (p=.01), being single (p<.001), lower education (p=.004), lower income (p<.001), late-stage disease (p=.001), recurrent disease (p=.004), and active treatment (p<.001). In separate multivariable models, greater financial toxicity related to greater distress (β=-.45 p<.001) and worse QOL (β=.58, p<.001). Financial toxicity subgroups reported clinically significant differences in distress and QOL (p's<.05).Cancer-related financial burden is associated with pervasive negative effects and may impact subgroups differently. Future research should explore financial experiences across subgroups, aiming to better identify those at risk and build targeted interventions. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/pon.5763

  View details for PubMedID 34224603

• Phase I/II Dose-Escalation Trial of 3-Fraction Stereotactic Radiosurgery for Resection Cavities From Large Brain Metastases: Health-related Quality of Life Outcomes. American journal of clinical oncology Rahimy, E., Dudley, S. A., von Eyben, R., Pollom, E. L., Seiger, K., Modlin, L., Wynne, J., Fujimoto, D., Jacobs, L. R., Chang, S. D., Gibbs, I. C., Hancock, S. L., Adler, J. R., Li, G., Choi, C. Y., Soltys, S. G. 2021; 44 (11): 588-595

  Abstract

  We investigated differences in quality of life (QoL) in patients enrolled on a phase I/II dose-escalation study of 3-fraction resection cavity stereotactic radiosurgery (SRS) for large brain metastases.Eligible patients had 1 to 4 brain metastases, one of which was a resection cavity 4.2 to 33.5 cm3. European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires core-30 (QLQ-30) and brain cancer specific module (QLQ-BN20) were obtained before SRS and at each follow-up. Nine scales were analyzed (global health status; physical, social, and emotional functioning; motor dysfunction, communication deficit, fatigue, insomnia, and future uncertainty). QoL was assessed with mixed effects models. Differences ≥10 points with q-value (adjusted P-value to account for multiplicity of testing) <0.10 were considered significant.Between 2009 and 2014, 50 enrolled patients completed 277 QoL questionnaires. Median questionnaire follow-up was 11.8 months. After SRS, insomnia demonstrated significant improvement (q=0.032, -17.7 points at 15 mo post-SRS), and future uncertainty demonstrated significant worsening (q=0.018, +9.9 points at 15 mo post-SRS). Following intracranial progression and salvage SRS, there were no significant QoL changes. The impact of salvage whole brain radiotherapy could not be assessed because of limited data (n=4 patients). In the 28% of patients that had adverse radiation effect, QoL had significant worsening in 3 metrics (physical functioning, q=0.024, emotional functioning q=0.001, and future uncertainty, q=0.004).For patients treated with 3-fraction SRS for large brain metastasis cavities, 8 of 9 QoL metrics were unchanged or improved after initial SRS. Intracranial tumor progression and salvage SRS did not impact QoL. Adverse radiation effect may be associated with at least short-term QoL impairments, but requires further investigation.

  View details for DOI 10.1097/COC.0000000000000868

  View details for PubMedID 34670228

• Palliative Care Service Utilization and Advance Care Planning for Adult Glioblastoma Patients: A Systematic Review Cancers Wu, A., Ruiz Colón, G., Aslakson, R., Pollom, E., Patel, C. 2021; 13 (12)

  Abstract

  Glioblastoma (GBM) has a median overall survival of 16-21 months. As patients with GBM suffer concurrently from terminal cancer and a disease with progressive neurocognitive decline, advance care planning (ACP) and palliative care (PC) are critical. We conducted a systematic review exploring published literature on the prevalence of ACP, end-of-life (EOL) services utilization (including PC services), and experiences among adults with GBM. We searched from database inception until 20 December 2020. Preferred reporting items for systematic reviews guidelines were followed. Included studies were assessed for quality using the Newcastle-Ottawa Scale. The 16 articles were all nonrandomized studies conducted in six countries with all but two published in 2014 or later. ACP documentation varied from 4-55%, PC referral was pursued in 39-40% of cases, and hospice referrals were made for 66-76% of patients. Hospitalizations frequently occurred at the EOL with 20-56% of patients spending over 25% of their overall survival time hospitalized. Many GBM patients do not pursue ACP or have access to PC. There is a dearth of focused and high-quality studies on ACP, PC, and hospice use among adults with GBM. Prospective studies that address these and additional aspects related to EOL care, such as healthcare costs and inpatient supportive care needs, are needed.

  View details for DOI 10.3390/cancers13122867

  View details for PubMedCentralID PMC8228109

• Financial Toxicity in Patients with Brain and Spine Metastases. World neurosurgery Koenig, J. L., Sandhu, N. n., Sborov, K. n., Sabolch, A. n., Usoz, M. n., Li, G. n., Gephart, M. H., Chang, S. n., Hiniker, S. n., Soltys, S. G., Pollom, E. L. 2021

  Abstract

  Financial toxicity associated with cancer treatment has a deleterious impact on patient outcomes but has not been well-characterized among patients with metastatic cancers. We characterize the extent of financial toxicity among this population and identify factors associated with financial toxicity.We prospectively surveyed adult patients with brain and spine metastases who received radiosurgery at a large academic medical center between January 2018 and December 2019. Financial toxicity was measured with the Personal Financial Wellness (PFW) Scale.In total, 93 patients were included with a median survival of 17.7 months. Most patients had private insurance (47%) or Medicare with supplemental insurance (42%) while 11% of patients were uninsured or insured by Medicaid/Medicare/Veterans Affairs. 60% of patients were primary income earners of which 52% had dependents. The median PFW score was 7.0 (interquartile range, 5.1-9.1) with financial toxicity reported in 23 (25%) patients. After adjusting for age and education level, private insurance (OR 0.28; p=0.080) was associated with a lower likelihood of financial toxicity. At least one emergency department visit (OR 3.87; p=0.024) and a cancer-related change in employment status (OR 3.63; p=0.036) were associated with greater likelihood of reporting financial toxicity.Most poor prognosis cancer patients with brain and spine metastases treated at a tertiary center are primary income earners and experience financial toxicity. Further studies are warranted to assess the longitudinal impact of financial toxicity in patients with metastatic cancer, particularly those with at least one emergency department visit and a cancer-related change in employment status.

  View details for DOI 10.1016/j.wneu.2021.04.103

  View details for PubMedID 33940276

• Improved survival and disease control following pembrolizumab-induced immune-related adverse events in high PD-L1 expressing non-small cell lung cancer with brain metastases. Journal of neuro-oncology Zhang, M. n., Rodrigues, A. J., Pollom, E. L., Gibbs, I. C., Soltys, S. G., Hancock, S. L., Neal, J. W., Padda, S. K., Ramchandran, K. J., Wakelee, H. A., Chang, S. D., Lim, M. n., Hayden Gephart, M. n., Li, G. n. 2021

  Abstract

  Immune checkpoint inhibitors have become standard of care for many patients with non-small cell lung cancer (NSCLC). These agents often cause immune-related adverse events (IRAEs), which have been associated with increased overall survival (OS). Intracranial disease control and OS for patients experiencing IRAEs with metastatic NSCLC and brain metastases have not yet been described.We performed a single-institution, retrospective review of patients with NSCLC and existing diagnosis of brain metastasis, who underwent pembrolizumab treatment and developed any grade IRAE. The primary outcome of the study was intracranial time to treatment failure (TTF), defined from time of pembrolizumab initiation to new intracranial disease progression or death. Kaplan-Meier and Cox proportional hazard analyses were performed.A total of 63 patients with NSCLC brain metastasis were identified, and 24 developed IRAEs. Patients with any grade IRAEs had longer OS (21 vs. 10 months, p = 0.004), systemic TTF (15 vs. 4 months, p < 0.001) and intracranial TTF (14 vs. 5 months, p = 0.001), relative to patients without IRAEs. Presence of IRAEs and high PD-L1 (≥ 50%), but not absent/moderate PD-L1 (0-49%), had a positive association for OS, systemic TTF, and intracranial TTF. Following multivariable analysis, IRAE experienced on pembrolizumab was an independent predictor of OS, systemic TTF, and intracranial TTF.In our series of patients with NSCLC and brain metastases treated with pembrolizumab, IRAE presence was associated with a significant increase in OS, systemic TTF, and intracranial TTF. Future studies with increased cohorts will clarify how IRAEs should be interpreted among molecular subtypes.

  View details for DOI 10.1007/s11060-020-03686-3

  View details for PubMedID 33415659

• Postoperative Observation Versus Radiotherapy for Pathologic N1 Oral Cavity Squamous Cell Carcinoma. American journal of clinical oncology Xiang, M. n., Holsinger, F. C., Gensheimer, M. F., Divi, V. n., Pollom, E. L., Colevas, A. D., Le, Q. T., Beadle, B. M. 2021; Publish Ahead of Print

  Abstract

  To investigate the benefit of postoperative radiotherapy (PORT) for low-volume (pN1) nodal disease after resection of oral cavity squamous cell carcinoma.The National Cancer Database was queried for adults with nonmetastatic squamous cell carcinoma of the oral cavity treated by surgical resection with pathologic stage T1-2 N0-2 (American Joint Committee on Cancer 7th edition) and with the maximal exclusion of standard indications for PORT. Overall survival was compared within pN1 for observation versus PORT and then compared for pN1 versus pN0 and versus pN2 stratified by receipt of observation or PORT. Multivariable Cox regression was used to adjust for potential confounders between PORT and survival, including comorbidity and age.Overall 5017 pN0, 530 pN1, and 253 pN2 patients were identified, of whom 9%, 35%, and 64% received PORT, respectively. Within the pN1 cohort, PORT was associated with improved survival versus observation (adjusted hazard ratio, 0.66; 95% confidence interval, 0.46-0.97; P=0.03). Among observed patients, the prognosis of pN1 was equivalent to pN2 and inferior to pN0; in contrast, among patients treated with PORT, the prognosis of pN1 was equivalent to pN0 and superior to pN2. Without PORT, pN1 remained an adverse risk factor relative to pN0 regardless of the depth of invasion, lymph node size, lymph node location, and extent of lymph node dissection.PORT was associated with a survival benefit compared with observation. Notably, pN1 was an adverse risk factor relative to pN0 if, and only if, patients did not receive PORT, suggesting pN1 by itself may be an indication for PORT.

  View details for DOI 10.1097/COC.0000000000000792

  View details for PubMedID 33417322

• Impact of proton radiotherapy on treatment timing in pediatric and adult patients with CNS tumors. Neuro-oncology practice Jin, M. C., Shi, S., Wu, A., Sandhu, N., Xiang, M., Soltys, S. G., Hiniker, S., Li, G., Pollom, E. L. 2020; 7 (6): 626-635

  Abstract

  Despite putative benefits associated with proton radiotherapy in the setting of CNS tumors, numerous barriers limit treatment accessibility. Given these challenges, we explored the association of proton use with variations in treatment timing.Pediatric and adult patients with histologically confirmed CNS tumors were identified from the National Cancer Database (2004-2015). Univariable and multivariable regression models were constructed to assess factors impacting radiation timing. Multivariable Cox regression was used to evaluate the effect of treatment delay on survival.A total of 76 157 patients received photon or proton radiotherapy. Compared to photons, time to proton administration was longer in multiple pediatric (embryonal, ependymal, nonependymal glial, and other) and adult (ependymal, nonependymal glial, meningeal, other) tumor histologies. On adjusted analysis, proton radiotherapy was associated with longer delays in radiotherapy administration in pediatric embryonal tumors (+3.00 weeks, P = .024) and in all adult tumors (embryonal [+1.36 weeks, P = .018], ependymal [+3.15 weeks, P < .001], germ cell [+2.65 weeks, P = .024], glial [+2.15 weeks, P < .001], meningeal [+5.05 weeks, P < .001], and other [+3.06 weeks, P < .001]). In patients with high-risk tumors receiving protons, delays in adjuvant radiotherapy were independently associated with poorer survival (continuous [weeks], adjusted hazard ratio = 1.09, 95% CI = 1.02-1.16).Proton radiotherapy is associated with later radiation initiation in pediatric and adult patients with CNS tumors. In patients with high-risk CNS malignancies receiving protons, delayed adjuvant radiotherapy is associated with poorer survival. Further studies are needed to understand this discrepancy to maximize the potential of proton radiotherapy for CNS malignancies.

  View details for DOI 10.1093/nop/npaa034

  View details for PubMedID 33312677

  View details for PubMedCentralID PMC7716142

• Repeat Stereotactic Radiosurgery (SRS) For Brain Metastases Locally Recurrent Following Initial SRS Harandi, N. K., Modlin, L. A., Shi, S., Von Eyben, R., Pollom, E., Soltys, S. G. ELSEVIER SCIENCE INC. 2020: E733

  View details for Web of Science ID 000582521502446

• PREOPERATIVE SINGLE FRACTION RADIOSURGERY VERSUS POSTOPERATIVE FRACTIONATED RADIOSURGERY FOR RESECTED BRAIN METASTASES: A BI-INSTITUTIONAL ANALYSIS OF SAFETY AND CLINICAL OUTCOMES Prabhu, R., Shi, S., Dhakal, R., Soltys, S., Burri, S., Asher, A., Gephart, M., Ward, M., Li, G., Heinzerling, J., Pollom, E. OXFORD UNIV PRESS INC. 2020: 184

  View details for Web of Science ID 000590061300769

• Hematologic Toxicity Patterns In Patients Treated With Chemoradiation For Anal Squamous Cell Carcinoma Minneci, M., Baclay, J. M., Toesca, D. S., Von Eyben, R., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2020: E641–E642

  View details for Web of Science ID 000582521502233

• Feasibility and Acute Toxicity of Pancreatic Stereotactic Body Radiotherapy with or without Hypofractionated Elective Nodal Irradiation Miller, J. A., Toesca, D. S., Baclay, J. M., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2020: E580–E581

  View details for Web of Science ID 000582521502092

• Quality of End-of-Life Care Among Elderly Patients With Gastrointestinal Cancers and Comorbid Substance Use Disorders Kashyap, M., Harris, J. P., Chang, D. T., Pollom, E. ELSEVIER SCIENCE INC. 2020: E405–E406

  View details for Web of Science ID 000582521501380

• Patterns of Regional Failure in Patients with Pancreatic Cancer treated with Stereotactic Body Radiation Therapy Baclay, J. M., Toesca, D. S., Von Eyben, R., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2020: E584–E585

  View details for Web of Science ID 000582521502101

• Health-Related Quality of Life following Fractionated Stereotactic Radiosurgery for Large Brain Metastases Resection Cavities on a Phase I/II Trial Rahimy, E., Dudley, S. A., Von Eyben, R., Pollom, E., Soltys, S. G. ELSEVIER SCIENCE INC. 2020: S68–S69

  View details for Web of Science ID 000582521503339

• The clinical and financial cost of mental disorders among elderly patients with gastrointestinal malignancies. Cancer medicine Harris, J. P., Kashyap, M., Humphreys, J. N., Pollom, E. L., Chang, D. T. 2020

  Abstract

  The clinical and financial effects of mental disorders are largely unknown among gastrointestinal (GI) cancer patients. Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified patients whose first cancer was a primary colorectal, pancreatic, gastric, hepatic/biliary, esophageal, or anal cancer as well as those with coexisting depression, anxiety, psychotic, or bipolar disorder. Survival, chemotherapy use, total healthcare expenditures, and patient out-of-pocket expenditures were estimated and compared based on the presence of a mental disorder. We identified 112,283 patients, 23,726 (21%) of whom had a coexisting mental disorder. Median survival for patients without a mental disorder was 52months (95% CI 50-53months) and for patients with a mental disorder was 43months (95% CI 42-44months) (p<0.001). Subgroup analysis identified patients with colorectal, gastric, or anal cancer to have a significant association between survival and presence of a mental disorder. Chemotherapy use was lower among patients with a mental disorder within regional colorectal cancer (43% vs. 41%, p=0.01) or distant colorectal cancer subgroups (71% vs. 63%, p<0.0001). The mean total healthcare expenditures were higher for patients with a mental disorder in first year following the cancer diagnosis (increase of $16,823, 95% CI $15,777-$18,173), and mean patient out-of-pocket expenses were also higher (increase of $1,926, 95% CI $1753-$2091). There are a substantial number of GI cancer patients who have a coexisting mental disorder, which is associated with inferior survival, higher healthcare expenditures, and greater personal financial burden.

  View details for DOI 10.1002/cam4.3509

  View details for PubMedID 33022135

• Treatment Breaks During Definitive Head/Neck Radiotherapy: Survival Impact and Predisposing Factors Xiang, M., Gensheimer, M., Pollom, E., Holsinger, F., Colevas, A., Quynh-Thu Le, Beadle, B. ELSEVIER SCIENCE INC. 2020: E39

  View details for Web of Science ID 000579885400086

• Neoadjuvant chemotherapy (NACT) use and response in US patients with early-stage triple-negative breast cancer in the National Cancer Database (NCDB) Kashyap, M., Downer, M., Debiasi, M., Russell, K., Craggs, C., Luhn, P., Pollom, E. ELSEVIER. 2020: S320–S321

  View details for DOI 10.1016/j.annonc.2020.08.317

  View details for Web of Science ID 000573469100195

• Continuing Medical Student Education During the Coronavirus Disease 2019 (COVID-19) Pandemic: Development of a Virtual Radiation Oncology Clerkship. Advances in radiation oncology Pollom, E. L., Sandhu, N., Frank, J., Miller, J. A., Obeid, J., Kastelowitz, N., Panjwani, N., Soltys, S. G., Bagshaw, H. P., Donaldson, S. S., Horst, K., Beadle, B. M., Chang, D. T., Gibbs, I. 2020; 5 (4): 732–36

  Abstract

  Purpose: Our institution cancelled all in-person clerkships owing to the coronavirus disease 2019 pandemic. In response, we designed a virtual radiation oncology medical student clerkship.Methods and Materials: We convened an advisory panel to design a virtual clerkship curriculum. We implemented clerkship activities using a cloud-based learning management system, video web conferencing systems, and a telemedicine portal. Students completed assessments pre- and postclerkship to provide data to improve future versions of the clerkship.Results: The virtual clerkship spans 2 weeks and is graded pass or fail. Students attend interactive didactic sessions during the first week and participate in virtual clinic and give talks to the department during the second week. Didactic sessions include lectures, case-based discussions, treatment planning seminars, and material adapted from the Radiation Oncology Education Collaborative Study Group curriculum. Students also attend virtual departmental quality assurance rounds, cancer center seminars, and multidisciplinary tumor boards. The enrollment cap was met during the first virtual clerkship period (April 27 through May 8, 2020), with a total of 12 students enrolling.Conclusions: Our virtual clerkship can increase student exposure and engagement in radiation oncology. Data on clerkship outcomes are forthcoming.

  View details for DOI 10.1016/j.adro.2020.05.006

  View details for PubMedID 32775783

• Treating Oligometastatic Disease With SABR: More Than Just a Numbers Game? International journal of radiation oncology, biology, physics Chang, D. T., Pollom, E. L., Keane, F. K., Wo, J. Y. 2020; 107 (2): 257–60

  View details for DOI 10.1016/j.ijrobp.2020.02.018

  View details for PubMedID 32386736

• Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer Xiang, M., Chang, D. T., Pollom, E. L. 2020

  Abstract

  BACKGROUND: The comparative risks of a second cancer diagnosis are uncertain after primary cancer treatment with 3-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), or proton beam radiotherapy (PBRT).METHODS: Pediatric and adult patients with a first cancer diagnosis between 2004 and 2015 who received 3DCRT, IMRT, or PBRT were identified in the National Cancer Database from 9 tumor types: head and neck, gastrointestinal, gynecologic, lymphoma, lung, prostate, breast, bone/soft tissue, and brain/central nervous system. The diagnosis of second cancer was modeled using multivariable logistic regression adjusting for age, follow-up duration, radiotherapy (RT) dose, chemotherapy, sociodemographic variables, and other factors. Propensity score matching also was used to balance baseline characteristics.RESULTS: In total, 450,373 patients were identified (33.5% received 3DCRT, 65.2% received IMRT, and 1.3% received PBRT) with median follow-up of 5.1years after RT completion and a cumulative follow-up period of 2.54million person-years. Overall, the incidence of second cancer diagnosis was 1.55 per 100 patient-years. In a comparison between IMRT versus 3DCRT, there was no overall difference in the risk of second cancer (adjusted odds ratio [OR], 1.00; 95% CI, 0.97-1.02; P=.75). By comparison, PBRT had an overall lower risk of second cancer versus IMRT (adjusted OR, 0.31; 95% CI, 0.26-0.36; P<.0001). Results within each tumor type generally were consistent in the pooled analyses and also were maintained in propensity score-matched analyses.CONCLUSIONS: The risk of a second cancer diagnosis was similar after IMRT versus 3DCRT, whereas PBRT was associated with a lower risk of second cancer risk. Future work is warranted to determine the cost-effectiveness of PBRT and to identify the population best suited for this treatment.

  View details for DOI 10.1002/cncr.32938

  View details for PubMedID 32426866

• Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurgical review Fatima, N., Pollom, E., Soltys, S., Chang, S. D., Meola, A. 2020

  Abstract

  Head and neck paragangliomas (HNPs) are rare, usually benign hyper vascularized neuroendocrine tumors that traditionally have been treated by surgery, with or without endovascular embolization, or, more recently stereotactic radiosurgery (SRS). The aim of our study is to determine the clinical and radiographic effectiveness of SRS for treatment of HNPs. A systematic search of electronic databases was performed, and 37 articles reporting 11,174 patients (1144 tumors) with glomus jugulare (GJT: 993, 86.9%), glomus tympanicum (GTT: 94, 8.2%), carotid body tumors (CBTs: 28, 2.4%), and glomus vagale (GVT: 16, 1.4%) treated with SRS definitively or adjuvantly were included. The local control (LC) was estimated from the pooled analysis of the series, and its association with SRS technique as well as demographic and clinical factors was analyzed. The median age was 56years (44-69years). With a median clinical and radiological follow-up of 44months (9-161months), LC was 94.2%. Majority of the patients (61.0%) underwent Gamma Knife Radiosurgery (GKS), but there was no statistically significant difference in LC depending upon the SRS technique (p=0.9). Spearmen's correlation showed that LC was strongly and negatively correlated with multiple parameters, which included female gender (r=-0.4, p=0.001), right-sided tumor (r=-0.3, p=0.03), primary SRS (r=-0.5, p≤0.001), and initial clinical presentation of hearing loss (r=-0.4, p=0.001). To achieve a LC ≥90%, a median marginal dose (Gy) of 15 (range, 12-30Gy) was required. The results corroborate that SRS in HNPs is associated with good clinical and radiological outcome.

  View details for DOI 10.1007/s10143-020-01292-5

  View details for PubMedID 32318920

• Signet ring cell carcinoma of the Ampulla of Vater: outcomes of patients in the United States. HPB : the official journal of the International Hepato Pancreato Biliary Association Kinslow, C. J., May, M. S., Kozak, M., Pollom, E. L., Chang, D. T. 2020

  Abstract

  BACKGROUND: Signet ring cell carcinoma (SRCC) of the ampulla of Vater is poorly understood, with approximately 22 reported cases. Our study sought to create a comprehensive review of cases in the United States.METHODS: We used the Surveillance, Epidemiology, and End Results Program to collect all cases of ampullary adenocarcinoma diagnosed between 2010 and 2015.RESULTS: The age-adjusted incidence rate of SRCC of the ampulla of Vater was 1.2 cases per 10,000,000 persons per year, with 50% more cases in males than females. We identified 3448 cases of adenocarcinoma of the ampulla of Vater, 81 of which were SRCC (2.3%). SRCC tended to present a later stage than other ampullary cancers, with median survival times of 17 vs. 25 months, (p=0.07). Survival was significantly worse for SRCC when accounting for other clinical features (HR 1.46, p=0.01). Factors portending worse prognosis in SRCC of the ampulla of Vater were advanced age, late stage and lack of surgical intervention.CONCLUSION: Our study represents the largest study of SRCC of the ampulla of Vater to date. SRCC has a poorer prognosis compared with other ampullary cancers. Optimal treatment regimen is the most important future area of study.

  View details for DOI 10.1016/j.hpb.2020.03.024

  View details for PubMedID 32317226

• Survival Benefit of Postoperative Radiotherapy in Pathological N1 Oral Cavity Squamous Cell Carcinoma Xiang, M., Holsinger, F. C., Gensheimer, M. F., Divi, V., Pollom, E., Colevas, A. D., Le, Q. T., Beadle, B. M. ELSEVIER SCIENCE INC. 2020: 1125

  View details for Web of Science ID 000580656800057

• Clinical impact of the VOLO optimizer on treatment plan quality and clinical treatment efficiency for CyberKnife. Journal of applied clinical medical physics Schuler, E., Lo, A., Chuang, C. F., Soltys, S. G., Pollom, E. L., Wang, L. 2020

  Abstract

  With the recent CyberKnife treatment planning system (TPS) upgrade from Precision 1.0 to Precision 2.0, the new VOLO optimizer was released for plan optimization. The VOLO optimizer sought to overcome some of the limitations seen with the Sequential optimizer from previous TPS versions. The purpose of this study was to investigate the clinical impact of the VOLO optimizer on treatment plan quality and clinical treatment efficiency as compared to the Sequential optimizer. Treatment plan quality was evaluated in four categories of patients: Brain Simple (BS), Brain Complex (BC), Spine Complex (SC), and Prostate (PC). A total of 60 treatment plans were compared using both the Sequential and VOLO optimizers with Iris and MLC collimation with the same clinical constraints. Metrics evaluated included estimated treatment time, monitor units (MUs) delivered, conformity index (CI), and gradient index (GI). Furthermore, the clinical impact of the VOLO optimizer was evaluated through statistical analysis of the patient population treated during the 4months before (n=297) and 4months after (n=285) VOLO introduction. Significant MU and time reductions were observed for all four categories planned. MU reduction ranged from -14% (BS Iris) to -52% (BC MLC), and time reduction ranged from -11% (BS Iris) to -22% (BC MLC). The statistical analysis of patient population before and after VOLO introduction for patients using 6D Skull tracking with fixed cone, 6D Skull tracking with Iris, and Xsight Spine tracking with Iris were -4.6%, -22.2%, and -17.8% for treatment time reduction, -1.1%, -22.0%, and -28.4% for beam reduction and -3.2%, -21.8%, and -28.1% for MU reduction, respectively. The VOLO optimizer maintains or improves the plan quality while decreases the plan complexity and improves treatment efficiency. We anticipate an increase in patient throughput with the introduction of the VOLO optimizer.

  View details for DOI 10.1002/acm2.12851

  View details for PubMedID 32212374

• The Utility of Stereotactic Body Radiotherapy for Palliation of Metastatic Pancreatic Adenocarcinoma. Practical radiation oncology Koong, A. J., Toesca, D. A., Baclay, J. R., Pollom, E. L., von Eyben, R., Koong, A. C., Chang, D. T. 2020

  Abstract

  PURPOSE: To report the outcome of stereotactic ablative radiotherapy (SABR) to the primary tumor for patients with metastatic pancreatic cancer.MATERIALS AND METHODS: We examined the records of patients with metastatic pancreatic cancer treated with SABR to the primary tumor between 2002 and 2018. Toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Pain intensity pre- and post-SABR was scored according to the Stanford Pain Scale as reported by the patient. Time-to-events were calculated from the date of end of SABR delivery.RESULTS: In total, 27 patients were identified that met the inclusion criteria. Seventeen (63%) patients received single fraction SABR with a median dose of 25 Gy (range: 12.5-25), while 10 (37%) patients were treated in 5 fractions with a median dose of 33 Gy (range: 25-40). Prior to the start of SABR, 17 (63%) patients reported having abdominal pain, with a median intensity of 5 in the 0 to 10 pain scale (range: 1-9), 11 (41%) of them necessitating continuous opioid use. The median follow-up was of 6 months (range: 0-18). Median overall survival was of 7 months (95% CI, 3-10), with a cumulative incidence of local failures at 1 year of 25% (95% CI, 10-44). After SABR, there was a significant reduction in the mean intensity of pain (P = 0.01), and a 46% relative reduction in continuous opioid use. Only two patients (7%) presented a grade 3 toxicity that could be attributed to treatment.CONCLUSION: In this small series, SABR demonstrated to be a safe and effective option for the local palliation of metastatic pancreatic cancer, with measurable improvements in abdominal pain and opioid necessity.

  View details for DOI 10.1016/j.prro.2020.02.010

  View details for PubMedID 32119922

• Neoadjuvant treatment strategies for resectable pancreas cancer: A propensity-matched analysis of the National Cancer Database. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Xiang, M., Heestand, G. M., Chang, D. T., Pollom, E. L. 2020

  Abstract

  BACKGROUND AND PURPOSE: The optimal neoadjuvant approach in patients with resectable pancreas cancer is unclear. We investigated outcomes after preoperative chemotherapy alone, chemotherapy with conventionally-fractionated radiation (CFRT), or chemotherapy with stereotactic body radiotherapy (SBRT).MATERIALS AND METHODS: The NCDB was queried for patients with resectable pancreatic adenocarcinoma (pretreatment stage T1-3, N0-1, M0) who received preoperative, multiagent chemotherapy and definitive surgery from 2010 to 2015. CFRT was 40-60Gy in 20-35 fractions. SBRT was 20-25Gy in 1 fraction or 30-50Gy using at least 5Gy per fraction. Multivariable regression and propensity score matching were used to adjust for potential confounders, including age, comorbidity score, and pretreatment extent of disease. The primary outcome was overall survival measured from surgery.RESULTS: In total, 1355 patients received preoperative chemotherapy alone, 552 patients received preoperative chemotherapy with CFRT, and 175 patients received preoperative chemotherapy with SBRT. Receipt of SBRT was associated with significantly improved overall survival compared to chemotherapy alone (median 30 vs 21months, p=0.02; adjusted hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.47-0.90, p=0.01). Similarly, SBRT was associated with significantly improved overall survival compared to CFRT (median 29 vs 16months, p=0.002; adjusted HR 0.53, 95% CI 0.37-0.76, p=0.001). Additionally, SBRT was associated with significantly increased rates of pathological complete response and margin-negative resection. Rates of postoperative readmissions and mortality were comparable.CONCLUSIONS: Neoadjuvant chemotherapy with SBRT is associated with favorable survival and pathological outcomes, warranting consideration for prospective validation.

  View details for DOI 10.1016/j.radonc.2020.01.007

  View details for PubMedID 32044168

• Clinical outcomes of hepatocellular carcinoma patients with Child-Pugh class B treated with stereotactic body radiation therapy Baclay, J., Toesca, D., von Eyben, R., Minneci, M., Pollom, E. L., Chang, D. AMER SOC CLINICAL ONCOLOGY. 2020

  View details for Web of Science ID 000530922700539

• Emergency department use at the end of life in elderly patients with gastrointestinal malignancies and mental health comorbidities Kashyap, M., Harris, J., Chang, D., Pollom, E. L. AMER SOC CLINICAL ONCOLOGY. 2020

  View details for Web of Science ID 000530922700781

• A Phase I/II Trial of 5-Fraction Stereotactic Radiosurgery with 5-mm Margins with Concurrent Temozolomide in Newly Diagnosed Glioblastoma: Primary Outcomes. Neuro-oncology Azoulay, M. n., Chang, S. D., Gibbs, I. C., Hancock, S. L., Pollom, E. L., Harsh, G. R., Adler, J. R., Harrahar, C. n., Li, G. n., Hayden Gephart, M. n., Nagpal, S. n., Thomas, R. P., Recht, L. D., Jacobs, L. R., Modlin, L. A., Wynne, J. n., Seiger, K. n., Fujimoto, D. n., Usoz, M. n., von Eyben, R. n., Choi, C. Y., Soltys, S. G. 2020

  Abstract

  We sought to determine the maximum tolerated dose (MTD) of 5-fraction stereotactic radiosurgery (SRS) with 5-mm margins delivered with concurrent temozolomide in newly diagnosed glioblastoma.We enrolled adult patients with newly diagnosed glioblastoma to 5 days of SRS in a 3+3 design on 4 escalating dose levels: 25, 30, 35, and 40 Gy. Dose limiting toxicity (DLT) was defined as CTCAE Grade 3-5 acute or late CNS toxicity, including adverse radiation effect (ARE), the imaging correlate of radiation necrosis.From 2010 to 2015, 30 patients were enrolled. The median age was 66 years (range 51-86 years). The median target volume was 60 cm3 (range 14.7-137.3 cm3). DLT occurred in 2 patients: one for post-treatment cerebral edema and progressive disease at 3 weeks (Grade 4, Dose 40 Gy); another patient died 1.5 weeks following SRS from post-operative complications (Grade 5, Dose 40 Gy). Late grade 1-2 ARE occurred in 8 patients at a median of 7.6 months (range 3.2-12.6 months). No grade 3-5 ARE occurred. With a median follow-up of 13.8 months (range 1.7-64.4 months), the median survival times were: PFS 8.2 months (95%CI 4.6-10.5), OS 14.8 months (95%CI 10.9-19.9), MGMT hypermethylated 19.9 months (95%CI 10.5-33.5) vs. 11.3 months (95%CI 8.9-17.6) for no/unknown hypermethylation (p=0.03), and 27.2 months (95%CI 11.2-48.3) if late ARE occurred vs. 11.7 months (95%CI 8.9-17.6) for no ARE (p=0.08).The per-protocol MTD of 5-fraction SRS with 5-mm margins with concurrent temozolomide was 40 Gy in 5 fractions. ARE was limited to grade 1-2 and did not statistically impact survival.

  View details for DOI 10.1093/neuonc/noaa019

  View details for PubMedID 32002547

• Intensified Systemic Therapy and Stereotactic Ablative Radiotherapy Dose for Patients with Unresectable Pancreatic Adenocarcinoma. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Toesca, D. A., Ahmed, F. n., Kashyap, M. n., Richelcyn M Baclay, J. n., von Eyben, R. n., Pollom, E. L., Koong, A. C., Chang, D. T. 2020

  Abstract

  We aimed to report the long-term impact of modern chemotherapy and SABR dose regimens on oncologic outcomes of unresectable pancreatic adenocarcinoma (PA).We reviewed the treatment characteristics and outcomes of all patients who received multi-fraction SABR for unresectable PA between February 2007 and August 2018 at our institution. Time-to-events were calculated from date of diagnosis treating death as a competing risk.A total of 149 patients were identified. Median follow-up was 15 months (range: 5-47). Median SABR dose was 33 Gy (range: 20-45) delivered in 5 fractions in 143 patients, and 3 or 6 fractions in 6 patients. 107 patients (72%) received gemcitabine-based chemotherapy while 31 (21%) received modified FOLFIRINOX (mFFX). Median OS was 16 months (95% CI, 14-17), with a 1-year cumulative incidence of LF of 14%. The combination of SABR doses ≥40 Gy and mFFX (n = 21) showed a superior PFS and OS to the use of GEM-based chemotherapy with <40 Gy SABR doses (median PFS: 14 vs. 10 months, HR: 0.46, 95% CI: 0.29-0.71, P = 0.003; median OS: 24 vs. 14 months, HR: 0.36, 95% CI: 0.22-0.59, P = 0.002), with 1-year PFS and OS of 67% and 90% compared to 35% and 59% for those who received GEM-based chemotherapy with <40 Gy SABR doses, respectively.The use of mFFX and a SABR dose ≥40 Gy in 5 fractions may be superior compared to regimens that utilize gemcitabine-based chemotherapy or SABR doses <40 Gy.

  View details for DOI 10.1016/j.radonc.2020.07.053

  View details for PubMedID 32763253

• Stereotactic Radiosurgery for Resected Brain Metastases - Does the Surgical Corridor Need to be Targeted? Practical radiation oncology Shi, S. n., Sandhu, N. n., Jin, M. n., Wang, E. n., Liu, E. n., Jaoude, J. A., Schofield, K. n., Zhang, C. n., Gibbs, I. C., Hancock, S. L., Chang, S. D., Li, G. n., Gephart, M. H., Pollom, E. L., Soltys, S. G. 2020

  Abstract

  Although consensus guidelines for post-resection stereotactic radiosurgery (SRS) for brain metastases recommend the surgical corridor leading to the resection cavity be included in the SRS plan, no study has reported patterns of tumor recurrence based on inclusion or exclusion of the corridor as a target. We reviewed tumor control and toxicity outcomes of post-resection SRS for deep brain metastases based on whether or not the surgical corridor was targeted.We retrospectively reviewed patients who had resected brain metastases treated with SRS between 2007 and 2018 and included only 'deep' tumors (defined as located ≥1.0 cm from the pial surface prior to resection).In 66 deep brain metastases in 64 patients, the surgical corridor was targeted in 43 (65%). There were no statistical differences in the cumulative incidences of progression at 12-months for targeting vs. not targeting the corridor, respectively, for: overall local failure 2% (95% Confidence Interval [CI],0-11%) vs. 9% (95% CI,1-25%; p=0.25), corridor failure 0% (95% CI,0-0%) vs. 9% (95% CI,1-25%; p=0.06), cavity failure 2% (95% CI,0-11%) vs. 0% (95% CI,0-0%; p=0.91), adverse radiation effect 5% (95% CI,1-15%) vs. 13% (95% CI,3-30%; p=0.22). Leptomeningeal disease (7% (95% CI,2-18%) vs. 26% (95% CI,10-45%; p=0.03)) was higher in those without the corridor targeted.Omitting the surgical corridor in post-operative SRS for resected brain metastases was not associated with statistically significant differences in corridor or cavity recurrence or adverse radiation effect. As seen in recent prospective trials of post-resection SRS, the dominant pattern of progression is within the resection cavity; omission of the corridor would yield a smaller SRS volume that could allow for dose escalation to potentially improve local cavity control.

  View details for DOI 10.1016/j.prro.2020.04.009

  View details for PubMedID 32428766

• Patterns of Care and Age-Specific Impact of Extent of Resection and Adjuvant Radiotherapy in Pediatric Pineoblastoma. Neurosurgery Jin, M. C., Prolo, L. M., Wu, A. n., Azad, T. D., Shi, S. n., Rodrigues, A. J., Soltys, S. G., Pollom, E. L., Li, G. n., Hiniker, S. M., Grant, G. A. 2020

  Abstract

  Pediatric pineoblastomas are highly aggressive tumors that portend poor outcomes despite multimodal management. Controversy remains regarding optimal disease management.To evaluate patterns of care and optimal clinical management of pediatric pineoblastoma.A total of 211 pediatric (age 0-17 yr) histologically confirmed pineoblastoma patients diagnosed between 2004 and 2015 were queried from the National Cancer Database. Wilcoxon rank-sum statistics and chi-squared analyses were used to compare continuous and categorical variables, respectively. Univariable and multivariable Cox regressions were used to evaluate prognostic impact of covariates. Propensity-score matching was used to balance baseline characteristics.Older patients (age ≥ 4 yr) experienced improved overall survival compared to younger patients (age < 4 yr) (hazard ratio [HR] = 0.41; 95% CI 0.25-0.66). Older patients (adjusted odds ratio [aOR] = 5.21; 95% CI 2.61-10.78) and those residing in high-income regions (aOR = 3.16; 95% CI 1.21-8.61) received radiotherapy more frequently. Radiotherapy was independently associated with improved survival in older (adjusted HR [aHR] = 0.31; 95% CI 0.12-0.87) but not younger (aHR = 0.64; 95% CI 0.20-1.90) patients. The benefits of radiotherapy were more pronounced in patients receiving surgery than in those not receiving surgery (aHR [surgical patients] = 0.23; 95% CI 0.08-0.65; aHR [nonsurgical patients] = 0.46; 95% CI 0.22-0.97). Older patients experienced improved outcomes associated with aggressive resection (P = .041); extent of resection was not associated with survival in younger patients (P = .880).Aggressive tumor resection was associated with improved survival only in older pediatric patients. Radiotherapy was more effective in patients receiving surgery. Age-stratified approaches might allow for improved disease management of pediatric pineoblastoma.

  View details for DOI 10.1093/neuros/nyaa023

  View details for PubMedID 32110805

• Increasing Medical Student Engagement through Virtual Rotations in Radiation Oncology. Advances in radiation oncology Kahn, J. M., Fields, E. C., Pollom, E. n., Wairiri, L. n., Vapiwala, N. n., Nabavizadeh, N. n., Thomas, C. R., Jimenez, R. B., Chandra, R. A. 2020

  View details for DOI 10.1016/j.adro.2020.07.015

  View details for PubMedID 32904388

  View details for PubMedCentralID PMC7456273

• Virtual Radiation Oncology Clerkship During the COVID-19 Pandemic and Beyond. International journal of radiation oncology, biology, physics Sandhu, N., Frank, J., von Eyben, R., Miller, J., Obeid, J., Kastelowitz, N., Panjwani, N., Soltys, S., Bagshaw, H. P., Donaldson, S. S., Horst, K., Beadle, B. M., Chang, D. T., Gibbs, I. C., Pollom, E. 2020; 108 (2): 444–51

  Abstract

  PURPOSE: We evaluated the impact of a virtual radiation oncology clerkship.METHODS AND MATERIALS: We developed a 2-week virtual radiation oncology clerkship that launched on April 27, 2020. Clerkship components included a virtual clinic with radiation oncology faculty and residents, didactic lectures, student talks, and supplemental sessions such as tumor boards and chart rounds. Medical students completed pre- and post-clerkship self-assessments. Faculty and resident participants also completed surveys on their experience with virtual lectures and clinics. Pre- and post-clerkship results were compared using a 2-sided paired t test. An analysis of variance model was used to analyze the clerkship components.RESULTS: Twenty-six medical students, including 4 visiting students, enrolled over 2 clerkship periods (4 weeks). All students completed the pre- and post-clerkship self-assessments and agreed that the clerkship improved their understanding of radiation oncology. Compared with 3 (11.5%) students who agreed that they understood the daily responsibilities of a radiation oncologist before the clerkship, 22 (84.6%) students agreed and 3 (11.5%) strongly agreed that they understood the daily responsibilities of a radiation oncologist after the clerkship (P < .0001). Although 15 students (57.7%) reported an increased interest in radiation oncology because of the clerkship, the mean level of interest in radiation oncology as a career remained the same, with pre- and post-clerkship scores of 3.0 (±0.9) and 3.0 (±1.1) on a 5-point scale, respectively (P = .7). Students found virtual clinic and didactic lectures to be the most valuable components of the clerkship. Most respondents agreed (30.8%) or strongly agreed (65.4%) to recommend the clerkship to their classmates.CONCLUSIONS: Our virtual clerkship was effective in increasing medical student interest in and knowledge about radiation oncology. These data will help optimize a new paradigm of virtual radiation oncology education for medical students during COVID-19 and beyond.

  View details for DOI 10.1016/j.ijrobp.2020.06.050

  View details for PubMedID 32890529

• Intracranial Tumor Control Following Immune-Related Adverse Events and Discontinuation of Immunotherapy for Melanoma. World neurosurgery Zhang, M. n., Rodrigues, A. J., Bhambhvani, H. P., Fatemi, P. n., Pollom, E. L., Gibbs, I. C., Thomas, R. P., Soltys, S. G., Hancock, S. L., Chang, S. D., Reddy, S. A., Gephart, M. H., Li, G. n. 2020

  Abstract

  Immunotherapy for melanoma patients with brain metastasis has significantly improved outcomes; however, they have also been characterized by potentially dangerous immune-related adverse events (IRAEs). Several reports suggest these reactions can precede improved treatment responses. We sought to identify if such association exists for intracranial disease control.We conducted a retrospective chart review of melanoma patients who underwent immunotherapy treatment following diagnosis of brain metastasis. The study cohort was then stratified into two groups based on their history of developing an IRAE that prompted discontinuation of that regimen. The primary outcome variable included intracranial progression-free survival (PFS). Kaplan-Meier and Cox proportional hazard analysis were used to evaluate survival and predictors of outcomes.Fifty-two patients met inclusion criteria, seventeen of whom experienced severe IRAEs that led to discontinuation of immunotherapy. Median intracranial PFS was 19.9 vs 10.5 months (p = 0.053) in patients who did and did not experience severe IRAEs prompting discontinuation, respectively. No additional outcome benefits were identified for systemic PFS or overall survival, mean (33.1 months and 27.6 months, respectively). Multivariable analysis identified BRAF mutation status as a negative prognosticator of brain progression (p = 0.013, HR = 3.90). Initial treatment with BRAF inhibitor was also a negative predictor of all-cause mortality (p = 0.015, HR = 10.73) CONCLUSION: Immune related adverse events may signify an underlying immunogenic response that has intracranial disease control benefits. Despite their associated side effects, immunotherapies continue to demonstrate promising outcomes as a first-line agent for melanoma with brain metastasis.

  View details for DOI 10.1016/j.wneu.2020.08.124

  View details for PubMedID 32853767

• Local control and toxicity outcomes of stereotactic radiosurgery for spinal metastases of gastrointestinal origin. Journal of neurosurgery. Spine Sandhu, N. n., Benson, K. R., Kumar, K. A., Eyben, R. V., Chang, D. T., Gibbs, I. C., Hancock, S. L., Meola, A. n., Chang, S. D., Li, G. n., Hayden-Gephart, M. n., Soltys, S. G., Pollom, E. L. 2020: 1–8

  Abstract

  Colorectal cancer (CRC) and other gastrointestinal (GI) cancers are believed to have greater radioresistance than other histologies. The authors report local control and toxicity outcomes of stereotactic radiosurgery (SRS) to spinal metastases from GI primary cancers.A retrospective single-center review was conducted of patients with spinal metastases from GI primary cancers treated with SRS from 2004 to 2017. Patient demographics and lesion characteristics were summarized using medians, interquartile ranges (IQRs), and proportions. Local failure (LF) was estimated using the cumulative incidence function adjusted for the competing risk of death and compared using Gray's test for equality. Multivariable analyses were conducted using Cox proportional hazard models, adjusting for death as a competing risk, on a per-lesion basis. Patients were stratified in the Cox model to account for repeated measures for clustered outcomes. Median survival was calculated using the Kaplan-Meier method.A total of 74 patients with 114 spine lesions were included in our analysis. The median age of the cohort was 62 years (IQR 53-70 years). Histologies included CRC (46%), hepatocellular carcinoma (19%), neuroendocrine carcinoma (13%), pancreatic carcinoma (12%), and other (10%). The 1- and 2-year cumulative incidence rates of LF were 24% (95% confidence interval [CI] 16%-33%) and 32% (95% CI 23%-42%), respectively. Univariable analysis revealed that older age (p = 0.015), right-sided primary CRCs (p = 0.038), and single fraction equivalent dose (SFED; α/β = 10) < 20 Gy (p = 0.004) were associated with higher rates of LF. The 1-year cumulative incidence rates of LF for SFED < 20 Gy10 versus SFED ≥ 20 Gy10 were 35% and 7%, respectively. After controlling for gross tumor volume and prior radiation therapy to the lesion, SFED < 20 Gy10 remained independently associated with worse LF (hazard ratio 2.92, 95% CI 1.24-6.89, p = 0.014). Toxicities were minimal, with pain flare observed in 6 patients (8%) and 15 vertebral compression fractures (13%).Spinal metastases from GI primary cancers have high rates of LF with SRS at a lower dose. This study found that SRS dose is a significant predictor of failure and that prescribed SFED ≥ 20 Gy10 (biological equivalent dose ≥ 60 Gy10) is associated with superior local control.

  View details for DOI 10.3171/2020.1.SPINE191260

  View details for PubMedID 32114530

• Prolongation of definitive head and neck cancer radiotherapy: Survival impact and predisposing factors. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Xiang, M. n., Gensheimer, M. F., Pollom, E. L., Holsinger, F. C., Colevas, A. D., Le, Q. T., Beadle, B. M. 2020

  Abstract

  To quantify the survival impact of prolongation of definitive radiotherapy (RT) for head and neck cancer in a national, modern cohort, and to identify predictive factors for prolongation.The National Cancer Database was queried for adults with non-metastatic cancer of the nasopharynx, oropharynx, larynx, or hypopharynx diagnosed 2004-2015, treated with definitive RT to 66-70 Gy in 30-35 fractions at 2-2.2 Gy per fraction. Multivariable Cox regression and propensity score matching were used to model the survival impact of RT prolongation, adjusting for potential confounders such as age and comorbidity. Predictors of RT prolongation were identified using multivariable multinomial logistic regression.In total, 36,367 patients were identified. As a continuous variable, RT prolongation increased the relative hazard of death by 2% per day (P < .0001). In the matched cohorts, patients with short (4-8 days) or long prolongation (> 8 days) had lower absolute 4-year overall survival by 4% and 12% respectively (P < .0001), while prolongation of 1-3 days was not significantly adverse. Major predictors of increased risk of prolongation were administration of systemic therapy, baseline comorbidity, lack of private insurance, and tumor/nodal stage. Conversely, higher facility volume was significantly protective, with a 55% lower risk of long prolongation within the topmost quartile (> 11.5 patients/year).RT prolongation, especially > 8 days, is significantly deleterious. Systemic therapy and facility volume were major predictors. Early identification of patients at increased risk of treatment interruptions may facilitate implementation of preventive measures.

  View details for DOI 10.1016/j.radonc.2020.12.025

  View details for PubMedID 33383061

• Stereotactic Body Radiation Therapy for Cholangiocarcinoma: Optimizing Locoregional Control With Elective Nodal Irradiation. Advances in radiation oncology Kozak, M. M., Toesca, D. A., von Eyben, R., Pollom, E. L., Chang, D. T. 2020; 5 (1): 77–84

  Abstract

  Purpose: To review our institutional experience of treating cholangiocarcinoma using stereotactic body radiation therapy (SBRT).Methods and Materials: A total of 40 patients with intrahepatic (n=25) or perihilar (n=15) cholangiocarcinoma treated with SBRT were retrospectively reviewed. SBRT was delivered in 1 to 5 fractions with median dose of 40Gy. Competing risk analysis was used to estimate cumulative incidence of local in-field, local out-of-field, regional, and distant failure. Kaplan-Meier and log-rank tests were used to calculate overall survival (OS). Toxicity was scored using Common Terminology Criteria for Adverse Events, version 4.0.Results: The median follow-up time was 18months. The 1-year incidence of local in-field, local out-of-field, regional, and distant failure was 8%, 23%, 13%, and 22%, respectively. Median OS was 23months and 1- and 2-year OS rates were 69% and 39%, respectively. Patients with perihilar tumors had a 1-year incidence of regional failure of 24% and worse OS (P=.013). Patients with regional failure were more likely to develop distant metastases, 32% versus 19% at 1year (P=.11). Acute grade 3+hepatobiliary toxicity developed in 15 patients (36%).Conclusions: In this series of cholangiocarcinoma patients treated with definitive SBRT, patterns of failure reveal that regional failures are not insignificant, particularly for perihilar tumors. Elective nodal irradiation of regional lymphatics should be considered when using SBRT. A prospective study of elective nodal irradiation in patients with perihilar tumors would further clarify whether this approach improves outcomes without increasing hepatobiliary toxicity.

  View details for DOI 10.1016/j.adro.2019.08.003

  View details for PubMedID 32051893

• Impact of Proton Radiotherapy on Treatment Timing in Pediatric and Adult Patients with Central Nervous System Tumors Neuro-Oncology Practice Jin, M. C., Shi, S., Wu, A., Sandhu, N., Xiang, M., Soltys, S. G., Hiniker, S., Li, G., Pollom, E. L. 2020

  View details for DOI 10.1093/nop/npaa034

• Automated model versus treating physician for predicting survival time of patients with metastatic cancer. Journal of the American Medical Informatics Association : JAMIA Gensheimer, M. F., Aggarwal, S. n., Benson, K. R., Carter, J. N., Henry, A. S., Wood, D. J., Soltys, S. G., Hancock, S. n., Pollom, E. n., Shah, N. H., Chang, D. T. 2020

  Abstract

  Being able to predict a patient's life expectancy can help doctors and patients prioritize treatments and supportive care. For predicting life expectancy, physicians have been shown to outperform traditional models that use only a few predictor variables. It is possible that a machine learning model that uses many predictor variables and diverse data sources from the electronic medical record can improve on physicians' performance. For patients with metastatic cancer, we compared accuracy of life expectancy predictions by the treating physician, a machine learning model, and a traditional model.A machine learning model was trained using 14 600 metastatic cancer patients' data to predict each patient's distribution of survival time. Data sources included note text, laboratory values, and vital signs. From 2015-2016, 899 patients receiving radiotherapy for metastatic cancer were enrolled in a study in which their radiation oncologist estimated life expectancy. Survival predictions were also made by the machine learning model and a traditional model using only performance status. Performance was assessed with area under the curve for 1-year survival and calibration plots.The radiotherapy study included 1190 treatment courses in 899 patients. A total of 879 treatment courses in 685 patients were included in this analysis. Median overall survival was 11.7 months. Physicians, machine learning model, and traditional model had area under the curve for 1-year survival of 0.72 (95% CI 0.63-0.81), 0.77 (0.73-0.81), and 0.68 (0.65-0.71), respectively.The machine learning model's predictions were more accurate than those of the treating physician or a traditional model.

  View details for DOI 10.1093/jamia/ocaa290

  View details for PubMedID 33313792

• Outcomes and Tolerability of Definitive and Preoperative Chemoradiation in Elderly Patients With Esophageal Cancer: A Retrospective Institutional Review. Advances in radiation oncology Rahimy, E. n., Koong, A. n., Toesca, D. n., White, M. N., Panjwani, N. n., Fisher, G. n., Chang, D. n., Pollom, E. n. 2020; 5 (6): 1188–96

  Abstract

  Our purpose was to report outcomes of elderly patients who underwent definitive treatment involving radiation therapy for esophageal cancer at our institution.We performed a retrospective review of patients aged ≥75 years with esophageal cancer treated with definitive radiation therapy (≥45 Gy) at our institution from 1997 to 2019. Acute and late Radiation Therapy Oncology Group grade 3+ toxicities were recorded. Survival was estimated using the Kaplan-Meier method.Of the 89 patients included, median age was 80 and 78% were male. Median adjusted Charlson Comorbidity Index and Karnofsky Performance Status were 5 (3-12) and 80 (50-100), respectively. The majority of cancers were adenocarcinoma (58%), distal (67%), and stage III (62%). Fifty-eight percent underwent definitive chemoradiotherapy, and one-third underwent preoperative intent chemoradiotherapy. Median prescribed dose was 50 Gy (45-66 Gy), and intensity modulated radiation therapy was used in 76%. Eighty-five percent completed the radiation therapy course. Among these, 20% had radiation therapy breaks. For those receiving concurrent chemotherapy, 37% had a dose reduction and 39.5% had a break/cycle reduction. Acute grade 3+ toxicity was 22%, with 2% grade 5 toxicity. Twenty-one of the 29 patients (72%) treated with preoperative intent underwent surgery. There were no deaths 90 days postoperatively. For patients who underwent surgery, 1- and 2-year overall survival were 95% and 84%. For those who did not undergo surgery, 1- and 2-year overall survival were 70% and 52%.There is a role for aggressive radiation therapy in well-selected elderly patients with esophageal cancer. However, optimization of supportive care, chemotherapy regimens, radiation therapy dose/fractionation, and surgical indications are needed to reduce toxicity.

  View details for DOI 10.1016/j.adro.2020.05.001

  View details for PubMedID 33305080

  View details for PubMedCentralID PMC7718494

• Stereotactic Radiosurgery After Resection of Brain Metastases: Changing Patterns of Care in the United States. World neurosurgery Chin, A. L., Li, G. n., Gephart, M. H., Sandhu, N. n., Nagpal, S. n., Soltys, S. G., Pollom, E. L. 2020

  Abstract

  Management of symptomatic brain metastases often includes surgical resection with postoperative radiotherapy. Postoperative whole brain radiotherapy (WBRT) improves intracranial control but detrimentally impacts quality of life and neurocognition. We sought to characterize the use in the United States of postoperative stereotactic radiosurgery (SRS), an evolving standard-of-care associated with reduced cognitive effects.With the MarketScan Commercial Claims and Encounters Database from 2007 to 2015, we identified patients aged 18-65 years treated with resection of a brain metastasis followed by SRS or WBRT within 60 days of surgery. Logistic regression estimated associations between co-variables (treatment year, age, sex, geographic region, place of service, insurance type, disease histology, comorbidity score, and median area household income and educational attainment) and SRS receipt.Of 4,007 patients included, 1,506 (37.6%) received SRS and 2,501 (62.4%) received WBRT. Postoperative SRS increased from 16.5% (2007-2008) to 56.8% (2014-2015). Patients residing in areas with a median household income or an educational attainment below 50th percentile were significantly less likely to receive SRS after controlling for treatment year and other demographic characteristics (p<0.01). Factors associated with higher odds of receiving SRS included younger age, female sex, melanoma histology, Western region location, hospital-based facility, and high-deductible health plan enrollment (p<0.05 for each).Postoperative SRS for brain metastases has increased from 2007 to 2015, with the majority of patients now receiving SRS over WBRT. Patients in areas of lower socioeconomic class were less likely to receive SRS, warranting further investigation of barriers to SRS adoption.

  View details for DOI 10.1016/j.wneu.2020.09.085

  View details for PubMedID 32971279

• Treatment patterns and outcomes for cerebellar glioblastoma in the concomitant chemoradiation era: A National Cancer database study. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Zhang, M. n., Li, R. n., Pollom, E. L., Amini, A. n., Dandapani, S. n., Li, G. n. 2020; 82 (Pt A): 122–27

  Abstract

  Cerebellar glioblastoma (GB) is much rarer than its supratentorial counterpart, and potentially of different molecular origin. Prior database studies are of limited size and reported on patients who preceded the validation of temozolomide. Thus, we provide an updated population-based analysis of the treatment trends and outcomes since the standardization of GB adjuvant chemoradiation. Patients diagnosed with primary cerebellar and supratentorial GB were identified from the National Cancer Database spanning 2005-2015. Patients were characterized by demographics, extent of resection, and adjuvant chemotherapy or radiation status. Cohorts were primarily and secondarily assessed for overall survival by tumor site and treatment history, respectively. A total of 655 patients with cerebellar GB were identified (0.6%). Cerebellar GB patients, compared to supratentorial GB were more likely to undergo a biopsy or subtotal resection (13.4% vs 9.3% and 16.0% vs 13.4%, p-value < 0.001), and less likely to pursue adjuvant therapy (48.4% vs 52.7%, p-value < 0.001). Overall median survivals were 9.3 and 9.4 months, respectively. On multivariable analysis, gross total resection, radiation, and chemotherapy were found to be predictors of improved overall survival (HR 0.77, p = 0.038; HR 0.67, p < 0.001; and HR = 0.77, p = 0.030, respectively). While many management principles are currently shared between cerebellar and supratentorial GB, aggressive regimens appear less frequently prescribed. Survival continues to match supratentorial outcomes and may benefit from future, systemic guidance by distinguishing molecular features.

  View details for DOI 10.1016/j.jocn.2020.10.049

  View details for PubMedID 33317719

• Cost-Effectiveness and Quality-Adjusted Survival of Watch-and-Wait after Complete Response to Chemoradiotherapy for Rectal Cancer. Journal of the National Cancer Institute Miller, J. A., Wang, H. n., Chang, D. T., Pollom, E. L. 2020

  Abstract

  Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) is the standard treatment for locally-advanced rectal cancer. There is interest in de-escalating local therapy after a clinical complete response (cCR) to CRT. We hypothesized that a watch-and-wait (WW) strategy offers comparable cancer-specific survival (CSS), superior quality-adjusted survival, and reduced cost compared to upfront TME.We developed a decision-analytic model to compare WW, low anterior resection (LAR), and abdominoperineal resection (APR) for patients achieving a cCR to CRT. Rates of local regrowth, pelvic recurrence, and distant metastasis were derived from series comparing WW to TME after pathologic complete response. Lifetime incremental costs and quality-adjusted life-years (QALYs) were calculated between strategies, and sensitivity analyses were performed to study model uncertainty.The base case 5-year CSS was 93.5% (95% confidence interval [CI] 91.5 to 94.9%) on a WW program, compared to 95.9% (95% CI 93.6 to 97.4%) after upfront TME. WW was dominant relative to LAR, with cost savings of $28,500 (95% CI $22,200 to $39,000) and incremental QALY of 0.527 (95% CI 0.138 to 1.125). WW was also dominant relative to APR, with cost savings of $32,100 (95% CI $21,800 to $49,200) and incremental QALY of 0.601 (95% CI 0.213 to 1.208). WW remained dominant in sensitivity analysis unless the rate of surgical salvage fell to 73.0%.Using current multi-institutional recurrence estimates, we observed comparable CSS, superior quality-adjusted survival, and decreased costs with WW compared to upfront TME. Upfront TME was preferred when surgical salvage rates were low.

  View details for DOI 10.1093/jnci/djaa003

  View details for PubMedID 31930400

• Evaluating Surgical Resection Extent and Adjuvant Therapy in the Management of Gliosarcoma. Frontiers in oncology Jin, M. C., Liu, E. K., Shi, S. n., Gibbs, I. C., Thomas, R. n., Recht, L. n., Soltys, S. G., Pollom, E. L., Chang, S. D., Hayden Gephart, M. n., Nagpal, S. n., Li, G. n. 2020; 10: 337

  Abstract

  Introduction: Gliosarcomas are clinically aggressive tumors, histologically distinct from glioblastoma. Data regarding the impact of extent of resection and post-operative adjuvant therapy on gliosarcoma outcomes are limited. Methods: Patients with histologically confirmed gliosarcoma diagnosed between 1999 and 2019 were identified. Clinical, molecular, and radiographic data were assembled based on historical records. Comparisons of categorical variables used Pearson's Chi-square and Fisher's exact test while continuous values were compared using the Wilcoxon signed-rank test. Survival comparisons were assessed using Kaplan-Meier statistics and Cox regressions. Results: Seventy-one gliosarcoma patients were identified. Secondary gliosarcoma was not associated with worse survival when compared to recurrent primary gliosarcoma (median survival 9.8 [3.8 to 21.0] months vs. 7.6 [1.0 to 35.7], p = 0.7493). On multivariable analysis, receipt of temozolomide (HR = 0.02, 95% CI 0.001-0.21) and achievement of gross total resection (GTR; HR = 0.13, 95% CI 0.02-0.77) were independently prognostic for improved progression-free survival (PFS) while only receipt of temozolomide was independently associated with extended overall survival (OS) (HR = 0.03, 95% CI 0.001-0.89). In patients receiving surgical resection followed by radiotherapy and concomitant temozolomide, achievement of GTR was significantly associated with improved PFS (median 32.97 [7.1-79.6] months vs. 5.45 [1.8-26.3], p = 0.0092) and OS (median 56.73 months [7.8-104.5] vs. 14.83 [3.8 to 29.1], p = 0.0252). Conclusion: Multimodal therapy is associated with improved survival in gliosarcoma. Even in patients receiving aggressive post-operative multimodal management, total surgical removal of macroscopic disease remains important for optimal outcomes.

  View details for DOI 10.3389/fonc.2020.00337

  View details for PubMedID 32219069

  View details for PubMedCentralID PMC7078164

• Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma. The Laryngoscope Jin, M. C., Harris, J. P., Sabolch, A. N., Gensheimer, M., Le, Q., Beadle, B. M., Pollom, E. L. 2019

  Abstract

  OBJECTIVE: For patients with head and neck squamous cell carcinoma (HNSCC), delays in the initiation of radiotherapy (RT) have been closely associated with worse outcomes. We sought to investigate whether RT modality (proton vs. photon) is associated with differences in the time to initiation of RT.METHODS: The National Cancer Database was queried for patients diagnosed with nonmetastatic HNSCC between 2004 and 2015 who received either proton or photon RT as part of their initial treatment. Wilcoxon rank-sum and chi-square tests were used to compare continuous and categorical variables, respectively. Multivariable logistic regression was used to determine the association between use of proton RT and delayed RT initiation.RESULTS: A total of 175,088 patients with HNSCC receiving either photon or proton RT were identified. Patients receiving proton RT were more likely to be white, reside in higher income areas, and have private insurance. Proton RT was associated with delayed RT initiation compared to photon RT (median 59days vs. 45, P <0.001). Receipt of proton therapy was independently associated with RT initiation beyond 6weeks after diagnosis (adjusted OR [aOR, definitive RT] = 1.69; 95% confidence interval [CI] 1.26-2.30) or surgery (aOR [adjuvant RT] = 4.08; 95% CI 2.64-6.62). In the context of adjuvant proton RT, increases in treatment delay were associated with worse overall survival (weeks, adjusted hazard ratio =1.099, 95% CI 1.011-1.194).CONCLUSION: Use of proton therapy is associated with delayed RT in both the definitive and adjuvant settings for patients with HNSCC and could be associated with poorer outcomes.LEVEL OF EVIDENCE: 2b Laryngoscope, 122:0000-0000, 2019 Laryngoscope, 2019.

  View details for DOI 10.1002/lary.28458

  View details for PubMedID 31837165

• Use of Preoperative Radiation Therapy in Early-stage and Locally Advanced Breast Cancer CUREUS Koenig, J. L., Kozak, M. M., Sabolch, A., Horst, K., Tsai, J., Wapnir, I. L., Pollom, E. 2019; 11 (9)

  View details for DOI 10.7759/cureus.5748

  View details for Web of Science ID 000487712800013

• Use of Preoperative Radiation Therapy in Early-stage and Locally Advanced Breast Cancer. Cureus Koenig, J. L., Kozak, M. M., Sabolch, A., Horst, K., Tsai, J., Wapnir, I. L., Pollom, E. 2019; 11 (9): e5748

  Abstract

  Purpose There is growing interest in delivering radiation preoperatively (preopRT) rather than postoperatively (postopRT) for breast cancer. Using the National Cancer Database, we evaluated the use and outcomes of preopRT in breast cancer. Methods We identified adult females diagnosed with non-metastatic breast cancer treated with definitive surgery and radiation between 2004 and 2014. Logistic regression models evaluated factors associated with use of preopRT in early-stage (clinical T1-3/N0-1) and locally advanced (clinical T4/N2-3) disease. Rates of breast-conserving surgery, breast reconstruction, positive surgical margins, and 30-day surgical readmissions were compared between patients receiving preopRT and postopRT. Results Of 373,595 patients who met our inclusion criteria, 1,245 (0.3%) patients received preopRT. Patients receiving preopRT were more likely to be of lower socioeconomic status and have tumors with higher T stage. Younger age and N1 (vs N0) disease predicted for use of preopRT in early-stage disease, while older age and N0 disease predicted for use of preopRT in the locally advanced setting. PreopRT patients were less likely to undergo breast-conserving surgery and more likely to have positive surgical margins. Rates of unplanned readmissions within 30 days of surgery were similar among patients treated with preopRT and postopRT. Conclusions PreopRT is a new treatment strategy for patients with breast cancer with different clinical and sociodemographic drivers of its use in the early-stage and locally advanced settings. We await the results of clinical trials studying the efficacy of this approach.

  View details for DOI 10.7759/cureus.5748

  View details for PubMedID 31723509

  View details for PubMedCentralID PMC6825433

• Outcomes of Oligometastatic Colorectal Cancer treated with Stereotactic Ablative Radiotherapy Benson, K., Sandhu, N., Zhang, C., Ko, R. B., Toesca, D. S., Von Eyben, R., Diehn, M., Bush, K., Maxim, P. G., Gensheimer, M. F., Soltys, S. G., Loo, B. W., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2019: E161–E162

  View details for DOI 10.1016/j.ijrobp.2019.06.2134

  View details for Web of Science ID 000485671500365

• Treating Elderly Glioblastoma Patients > 65 Years with TTFields - a Cost-Effectiveness Perspective Guzauskas, G. F., Pollom, E., Leonard, F., Stieber, V. W. ELSEVIER SCIENCE INC. 2019: E439–E440

  View details for DOI 10.1016/j.ijrobp.2019.06.1470

  View details for Web of Science ID 000485671501289

• Patterns and Disparities of Ablative Radiation Therapy Use in Patients with Metastatic Cancer: a Study of the National Cancer Database Koenig, J. L., Shi, W., Hannum, M., Yang, T. J., Gillespie, E. F., Zhang, Z., Pollom, E., Tsai, C. J. ELSEVIER SCIENCE INC. 2019: E567

  View details for DOI 10.1016/j.ijrobp.2019.06.1227

  View details for Web of Science ID 000485671501593

• Habitat Evolution Imaging Biomarkers to Assess Early Response and Predict Treatment Outcomes in Oropharyngeal Cancer Wu, J., Gensheimer, M., Liang, R., Zhang, C., Pollom, E., Beadle, B. M., Le, Q. T., Li, R. ELSEVIER SCIENCE INC. 2019: S32

  View details for DOI 10.1016/j.ijrobp.2019.06.444

  View details for Web of Science ID 000485671502476

• Improved Survival with Modified Folfirinox and Higher Doses of Stereotactic Body Radiation Therapy for Treatment of Locally Advanced Pancreatic Adenocarcinoma Ahmed, F., Toesca, D. S., Von Eyben, R., Kashyap, M., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2019: E232–E233

  View details for DOI 10.1016/j.ijrobp.2019.06.2001

  View details for Web of Science ID 000485671500531

• Defining the Optimal Neoadjuvant Treatment Strategy in Patients with Resectable Pancreas Cancer Xiang, M., Chang, D. T., Heestand, M., Pollom, E. ELSEVIER SCIENCE INC. 2019: E249

  View details for DOI 10.1016/j.ijrobp.2019.06.1939

  View details for Web of Science ID 000485671500568

• Stereotactic Body Radiotherapy for Cholangiocarcinoma: Optimizing Locoregional Control with Elective Nodal Irradiation Kozak, M., Toesca, D. S., Von Eyben, R., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2019: E223–E224

  View details for DOI 10.1016/j.ijrobp.2019.06.1979

  View details for Web of Science ID 000485671500509

• Outcomes of Chemoradiation and Trimodality Therapy Among Elderly Patients with Locally Advanced Esophageal Cancer Panjwani, N., Chin, A. L., Xiang, M., Rahimy, E., Chang, D. T., Pollom, E. ELSEVIER SCIENCE INC. 2019: E193–E194

  View details for DOI 10.1016/j.ijrobp.2019.06.2111

  View details for Web of Science ID 000485671500441

• Clinical and Economic Impact of Mental Health Illnesses Surrounding a Gastrointestinal Malignancy Among Elderly Patients Harris, J. P., Panjwani, N., Chang, D. T., Pollom, E. ELSEVIER SCIENCE INC. 2019: E595–E596

  View details for DOI 10.1016/j.ijrobp.2019.06.1198

  View details for Web of Science ID 000485671501662

• Tolerability and Toxicity of Definitive and Preoperative Chemoradiation in Octogenarian Patients with Esophageal Cancer Rahimy, E., Koong, A., Toesca, D. S., Panjwani, N., Fisher, G. A., Chang, D. T., Pollom, E. ELSEVIER SCIENCE INC. 2019: E196

  View details for DOI 10.1016/j.ijrobp.2019.06.2016

  View details for Web of Science ID 000485671500446

• Analysis of the EF-14 Phase 3 Trial Reveals That Tumor-Treating Fields Alter Progression Patterns in Glioblastoma Jeyapalan, S., Toms, S. A., Hottinger, A., Kleinberg, L. R., Pollom, E., Soltys, S. G., Glas, M. ELSEVIER SCIENCE INC. 2019: E100–E101

  View details for DOI 10.1016/j.ijrobp.2019.06.2292

  View details for Web of Science ID 000485671500227

• Impact of Lymphopenia on Survival Following Stereotactic Radiosurgery and Immune-Checkpoint Inhibitors Among Patients with Brain Metastases Benitez, C. M., Koenig, J. L., Sborov, K., Gibbs, I. C., Gensheimer, M. F., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2019: S144

  View details for DOI 10.1016/j.ijrobp.2019.06.142

  View details for Web of Science ID 000485671502710

• Financial Toxicity in Metastatic Cancer Patients Receiving Stereotactic Radiosurgery Koenig, J. L., Sborov, K., Sandhu, N., Sabolch, A., Usoz, M., Hiniker, S. M., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2019: E596–E597

  View details for DOI 10.1016/j.ijrobp.2019.06.1200

  View details for Web of Science ID 000485671501664

• Stereotactic Radiosurgery for Spine Metastases of Gastrointestinal Origin Sandhu, N., Benson, K., Kumar, K. A., Von Eyben, R., Chang, D. T., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2019: E125–E126

  View details for DOI 10.1016/j.ijrobp.2019.06.2248

  View details for Web of Science ID 000485671500283

• Cost Effectiveness of Watch-and-Wait or Total Mesorectal Excision after Complete Clinical Response to Chemoradiotherapy for Rectal Cancer Miller, J. A., Wang, H., Chang, D. T., Pollom, E. ELSEVIER SCIENCE INC. 2019: E171

  View details for DOI 10.1016/j.ijrobp.2019.06.2155

  View details for Web of Science ID 000485671500386

• Vertebral Compression Fracture Rates after Stereotactic Radiosurgery for Spinal Metastases Usoz, M., Dhillon, J., Kumar, K. A., Von Eyben, R., White, E. C., Ho, C. K., Azoulay, M., Fujimoto, D. K., Gibbs, I. C., Chang, S. D., Hancock, S. L., Pollom, E., Soltys, S. G. ELSEVIER SCIENCE INC. 2019: E126–E127

  View details for DOI 10.1016/j.ijrobp.2019.06.2250

  View details for Web of Science ID 000485671500285

• Factors Associated with Treatment Failure and Radiation Necrosis Following Cavity Radiosurgery for Resected Brain Metastases Wang, E. H., Shi, S., Sandhu, N., Liu, E., Jin, M., Schofield, K., Zhang, C., Jaoude, J., Gibbs, I. C., Hancock, S. L., Chang, S. D., Li, G., Hayden, M., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2019: E92

  View details for DOI 10.1016/j.ijrobp.2019.06.2271

  View details for Web of Science ID 000485671500206

• Stereotactic Radiosurgery for Small Cell Lung Cancer Brain Metastases Bagshaw, H. P., Taggarsi, R. S., Moding, E. J., Fawaz, Z. S., Von Eyben, R., Pollom, E., Chang, S. D., Gibbs, I. C., Hancock, S. L., Soltys, S. G. ELSEVIER SCIENCE INC. 2019: E70–E71

  View details for DOI 10.1016/j.ijrobp.2019.06.2323

  View details for Web of Science ID 000485671500158

• Stereotactic Radiosurgery for Resected Brain Metastases: Single-Institutional Experience of over 500 Cavities Shi, S., Sandhu, N., Wang, E. H., Liu, E., Jaoude, J., Jin, M., Schofield, K., Zhang, C., Gibbs, I. C., Hancock, S. L., Chang, S. D., Li, G., Hayden, M., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2019: E90

  View details for DOI 10.1016/j.ijrobp.2019.06.2266

  View details for Web of Science ID 000485671500201

• Tumor Subregion Evolution-based Imaging Features to Assess Early Response and Predict Prognosis in Oropharyngeal Cancer. Journal of nuclear medicine : official publication, Society of Nuclear Medicine Wu, J., Gensheimer, M., Zhang, N., Guo, M., Liang, R., Zhang, C., Fischbein, N., Pollom, E., Beadle, B., Le, Q., Li, R. 2019

  Abstract

  Background: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been rapidly increasing. Disease stage and smoking history are often used in current clinical trials to select patients for de-intensification therapy, but these features lack sufficient accuracy for predicting disease relapse. Purpose: To develop an imaging signature to assess early response and predict outcomes of OPSCC. Methods: We retrospectively analyzed 162 OPSCC patients treated with concurrent chemoradiotherapy, equally divided into separate training and validation cohorts with similar clinical characteristics. A robust consensus clustering approach was used to spatially partition the primary tumor and involved lymph nodes into subregions (i.e., habitats) based on fluorine 18 (18F) fluorodeoxyglucose (FDG) PET and contrast CT imaging. We proposed quantitative image features to characterize the temporal volumetric change of the habitats and peritumor/nodal tissue between baseline and mid-treatment. The reproducibility of these features was evaluated. We developed an imaging signature to predict progression-free survival (PFS) by fitting an L1-regularized Cox regression model. Results: We identified three phenotypically distinct intratumoral habitats, which were (1) metabolically active and heterogeneous, (2) enhancing and heterogeneous, and (3) metabolically inactive and homogeneous. The final Cox model consisted of four habitat evolution-based features. In both cohorts, this imaging signature significantly outperformed traditional imaging metrics including mid-treatment metabolic tumor volume for predicting PFS, with C-index: 0.72 vs 0.67 (training) and 0.66 vs 0.56 (validation). The imaging signature stratified patients into high-risk vs low-risk groups with 2-year PFS rates: 59.1% vs 89.4% (HR=4.4, 95% CI: 1.4-13.4, training), and 61.4% vs 87.8% (HR=4.6, 95% CI: 1.7-12.1, validation). It remained an independent predictor of PFS in multivariable analysis adjusting for stage, human papillomavirus status, and smoking history. Conclusion: The proposed imaging signature allows more accurate prediction of disease progression and, if prospectively validated, may refine OPSCC patient selection for risk-adaptive therapy.

  View details for DOI 10.2967/jnumed.119.230037

  View details for PubMedID 31420498

• Successful Use of Frameless Stereotactic Radiosurgery for Treatment of Recurrent Brain Metastases in an 18 Month Old Child. The International journal of neuroscience Rahimy, E., Chuang, C., Spunt, S. L., Mahaney, K., Donaldson, S. S., Gibbs, I. C., Soltys, S. G., Pollom, E., Hiniker, S. M. 2019: 1–6

  Abstract

  There are very few reported cases of stereotactic radiosurgery delivered in children under 3 years of age. We report an 18 month old boy with metastatic recurrence of undifferentiated round cell sarcoma to the brain which was treated with chemotherapy, resection, and robotic frameless stereotactic radiosurgery (SRS). Frameless SRS was delivered without technical difficulties, acute adverse events, or clinical sequelae 1.5 months post-radiation. Longer term follow-up will be needed to evaluate local tumor control and effects on neurocognitive development, endocrine function, and growth. This report adds to the literature of the few reported cases of successfully attempted SRS in very young children.

  View details for DOI 10.1080/00207454.2019.1655015

  View details for PubMedID 31401906

• Prognostic Factors and Treatment Patterns in the Management of Giant Cell Glioblastoma WORLD NEUROSURGERY Jin, M. C., Wu, A., Xiang, M., Azad, T. D., Soltys, S. G., Li, G., Pollom, E. L. 2019; 128: E217–E224

  View details for DOI 10.1016/j.wneu.2019.04.103

  View details for Web of Science ID 000475895100024

• TTFIELDS DOSE DISTRIBUTION AND TUMOR GROWTH PATTERNS CONFIRM CLINICAL ACTIVITY OF TTFIELDS: MRI ANALYSIS OF THE RANDOMIZED PHASE 3 EF-14 TRIAL Kebir, S., Ballo, M. T., Jeyapalan, S., Toms, S. A., Hottinger, A., Pollom, E., Glas, M. OXFORD UNIV PRESS INC. 2019: 82–83

  View details for DOI 10.1093/neuonc/noz126.301

  View details for Web of Science ID 000493085900303

• Integrating Tumor and Nodal Imaging Characteristics at Baseline and Mid-Treatment Computed Tomography Scans to Predict Distant Metastasis in Oropharyngeal Cancer Treated With Concurrent Chemoradiotherapy INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Wu, J., Gensheimer, M. F., Zhang, N., Han, F., Liang, R., Qian, Y., Zhang, C., Fischbein, N., Pollom, E. L., Beadle, B., Quynh-Thu Le, Li, R. 2019; 104 (4): 942–52

  View details for DOI 10.1016/j.ijrobp.2019.03.036

  View details for Web of Science ID 000471624800037

• Tumor Treating Fields alters progression patterns in glioblastoma: An imaging analysis of the EF-14 Phase III trial Jeyapalan, S., Toms, S. A., Hottinger, A., Kleinberg, L., Pollom, E., Soltys, S. G., Glas, M. AMER ASSOC CANCER RESEARCH. 2019

  View details for DOI 10.1158/1538-7445.AM2019-CT205

  View details for Web of Science ID 000488129900182

• Cost-effectiveness of Screening for Nasopharyngeal Carcinoma among Asian American Men in the United States OTOLARYNGOLOGY-HEAD AND NECK SURGERY Harris, J. P., Saraswathula, A., Kaplun, B., Qian, Y., Chan, K., Chan, A. C., Quynh-Thu Le, Owens, D. K., Goldhaber-Fiebert, J. D., Pollom, E. 2019; 161 (1): 82–90

  View details for DOI 10.1177/0194599819832593

  View details for Web of Science ID 000473507100011

• Treating elderly glioblastoma patients > 65 years with TTFields - a cost-effectiveness perspective Guzauskas, G. F., Pollom, E. L., Stieber, V. W. AMER ASSOC CANCER RESEARCH. 2019

  View details for DOI 10.1158/1538-7445.AM2019-LB-162

  View details for Web of Science ID 000488129900353

• Stereotactic radiosurgery in large intracranial meningiomas: a systematic review. World neurosurgery Fatima, N., Meola, A., Pollom, E., Chaudhary, N., Soltys, S., Chang, S. 2019

  Abstract

  Gross total resection (GTR) of large intracranial meningiomas (LIMs) can be challenging and cause significant morbidity and mortality. The aim of this systematic review is to determine the clinical effectiveness and safety of Stereotactic Radiosurgery (SRS) either as primary or adjuvant therapy for LIMs, with tumor ≥2.5 cm in maximum dimension (tumor volume ≥8.1 cm3). A total of 452 tumors in 496 patients [350 females (69.3%) and 146 males (30.6%)] with median age 60 years (48 to 65 years) were included. The median tumor volume at the time of diagnosis was 16.7 cm3 (10 to 53.3cm3). The tumors were typically located in the skull-base (77.2%), while only 14.6% were in the supratentorial space. The median follow-up after SRS was 54 months (18-90 months). 87.8% of patients were treated with single session gamma knife radiosurgery (SS GKS), while the remaining 12.1% patients received non-single session (non-SS) GKS. Of 452 LIMs assessed for clinical response, 45.1% showed improvement, and 15.7% deteriorated after SRS. Radiographic tumor control at last follow-up (2-7.5 years) ranged from 84% to 100%. Overall, radiation-induced toxicity occurred in 23% of patients; with the most common adverse effect being cranial nerve neuropathy (5.5%) and peritumoral edema (PTE) (5.3%). Sub-group analysis revealed that there is 2-fold higher likelihood of improvement in clinical symptoms in patients with non-SS GKS than SS GKS [OR: 2.47; 95% (1.38-4.44); p=0.002].SRS is safe and effective in the treatment of LIMs as primary or adjuvant treatment. Further prospective studies are required to validate our results.

  View details for DOI 10.1016/j.wneu.2019.06.064

  View details for PubMedID 31226450

• Automated Survival Prediction in Metastatic Cancer Patients Using High-Dimensional Electronic Medical Record Data JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE Gensheimer, M. F., Henry, A., Wood, D. J., Hastie, T. J., Aggarwal, S., Dudley, S. A., Pradhan, P., Banerjee, I., Cho, E., Ramchandran, K., Pollom, E., Koong, A. C., Rubin, D. L., Chang, D. T. 2019; 111 (6): 568–74

  View details for DOI 10.1093/jnci/djy178

  View details for Web of Science ID 000474267400007

• Adverse Radiation Effect and Disease Control in Patients Undergoing Stereotactic Radiosurgery and Immune Checkpoint Inhibitor Therapy for Brain Metastases WORLD NEUROSURGERY Koenig, J. L., Shi, S., Sborov, K., Gensheimer, M. F., Le, G., Nagpal, S., Chang, S. D., Gibbs, I. C., Soltys, S. G., Pollom, E. L. 2019; 126: E1399–E1411

  View details for DOI 10.1016/j.wneu.2019.03.110

  View details for Web of Science ID 000469222400177

• Stereotactic radiosurgery for resected brain metastases: Does the surgical corridor need to be treated? Shi, S., Jaoude, J., Sandhu, N., Wang, E., Schofield, K., Jin, M. C., Zhang, C., Liu, E., Pollom, E. L., Soltys, S. G. AMER SOC CLINICAL ONCOLOGY. 2019

  View details for DOI 10.1200/JCO.2019.37.15_suppl.2068

  View details for Web of Science ID 000487345804449

• Risk of subsequent cancer diagnosis in patients treated with 3D conformal, intensity modulated, or proton beam radiation therapy. Xiang, M. H., Chang, D., Pollom, E. L. AMER SOC CLINICAL ONCOLOGY. 2019

  View details for DOI 10.1200/JCO.2019.37.15_suppl.1503

  View details for Web of Science ID 000487345804299

• Analysis of the EF-14 phase Ill trial reveals that tumor treating fields alter progression patterns in glioblastoma. Jeyapalan, S. A., Toms, S. A., Hottinger, A., Kleinberg, L., Pollom, E., Soltys, S. G., Glas, M. AMER SOC CLINICAL ONCOLOGY. 2019

  View details for DOI 10.1200/JCO.2019.37.15_suppl.2055

  View details for Web of Science ID 000487345804437

• Tumor treating fields and maintenance temozolomide for newly-diagnosed glioblastoma: a cost-effectiveness study JOURNAL OF MEDICAL ECONOMICS Guzauskas, G. F., Pollom, E. L., Stieber, V. W., Wang, B. M., Garrison, L. P. 2019

  View details for DOI 10.1080/13696998.2019.1614933

  View details for Web of Science ID 000469585600001

• Predicting Pancreatic Cancer Resectability and Outcomes Based on an Objective Quantitative Scoring System Toesca, D. S., Jeffrey, R., von Eyben, R., Pollom, E. L., Poullos, P. D., Poultsides, G. A., Fisher, G. A., Visser, B. C., Koong, A. C., Chang, D. T. LIPPINCOTT WILLIAMS & WILKINS. 2019: 622–28

  View details for DOI 10.1097/MPA.0000000000001314

  View details for Web of Science ID 000480685300015

• Prognostic Factors and Treatment Patterns in the Management of Giant Cell Glioblastoma. World neurosurgery Jin, M. C., Wu, A., Xiang, M., Azad, T. D., Soltys, S. G., Li, G., Pollom, E. L. 2019

  Abstract

  BACKGROUND: There is a lack of literature guiding treatment of giant cell glioblastoma (gcGBM), a rare subtype of glioblastoma (GBM). We used a national hospital-based registry to explore treatment patterns and outcomes associated with gcGBM.METHODS: Adult patients (age 18+) diagnosed with gcGBM or GBM between 2004-2014 were identified from the National Cancer Database (NCDB). Chi-squared analysis and Wilcoxon rank sum testing were used to compare characteristics between the gcGBM and GBM cohorts. Kaplan-Meier statistics, univariable and multivariable Cox regression, and propensity score matching were used to evaluate association between patient, tumor and treatment factors and survival outcomes. Correlation analysis was used to evaluate historical trends in the treatment of gcGBM. Landmark analysis allowed for accounting of immortal time.RESULTS: In total, 683 patients with gcGBM were identified. Patients with gcGBM had improved survival compared to patients with GBM (15.5 months from landmark vs 11.7, p < 0.001). Increased age (p < 0.001) was associated with worse survival while being of female sex (p = 0.023) and having a median income of higher than $63,000 (p = 0.004) predisposed patients to improved outcomes. Patients receiving trimodal therapy (biopsy and/or surgery, radiotherapy, and chemotherapy) experienced better outcomes compared to those receiving either biopsy and/or surgery only or biopsy and/or surgery and radiotherapy without systemic therapy (median survival 17.55 months vs 6.68 months; p < 0.001).CONCLUSION: gcGBM has favorable prognosis compared with GBM and should be aggressively managed with trimodal therapy. Prospective studies on gcGBM are warranted to better characterize gcGBM treatment outcomes.

  View details for PubMedID 31009783

• The Burden of Mental Health Disorders Among Elderly Patients with Gastrointestinal Malignancies Harris, J., Xiang, M., Chang, D., Pollom, E. ELSEVIER SCIENCE INC. 2019: E30–E31

  View details for DOI 10.1016/S0360-3016(19)30470-5

  View details for Web of Science ID 000463350600070

• Integrating tumor and nodal imaging characteristics at baseline and mid-treatment CT scans to predict distant metastasis in oropharyngeal cancer treated with concurrent chemoradiotherapy. International journal of radiation oncology, biology, physics Wu, J., Gensheimer, M. F., Zhang, N., Han, F., Liang, R., Qian, Y., Zhang, C., Fischbein, N., Pollom, E. L., Beadle, B., Le, Q., Li, R. 2019

  Abstract

  PURPOSE: Prognostic biomarkers of disease relapse are needed for risk-adaptive therapy of oropharyngeal cancer (OPC). This work aims to identify an imaging signature to predict distant metastasis in OPC.MATERIALS/METHODS: This single-institution retrospective study included 140 patients treated with definitive concurrent chemoradiotherapy, for whom both pre and mid-treatment contrast-enhanced CT scans were available. Patients were divided into separate training and testing cohorts. Forty-five quantitative image features were extracted to characterize tumor and involved lymph nodes at both time points. By incorporating both imaging and clinicopathological features, a random survival forest (RSF) model was built to predict distant metastasis-free survival (DMFS). The model was optimized via repeated cross-validation in the training cohort, and then independently validated in the testing cohort.RESULTS: The most important features for predicting DMFS were the maximum distance among nodes, maximum distance between tumor and nodes at mid-treatment, and pre-treatment tumor sphericity. In the testing cohort, the RSF model achieved good discriminability for DMFS (C-index=0.73, P=0.008), and further divided patients into two risk groups with different 2-year DMFS rates: 96.7% vs. 67.6%. Similar trends were observed for patients with p16+ tumors and smoking ≤10 pack-years. The RSF model based on pre-treatment CT features alone achieved lower performance (C-index=0.68, P=0.03).CONCLUSION: Integrating tumor and nodal imaging characteristics at baseline and mid-treatment CT allows prediction of distant metastasis in OPC. The proposed imaging signature requires prospective validation, and if successful, may help identify high-risk HPV-positive patients who should not be considered for de-intensification therapy.

  View details for PubMedID 30940529

• Adjuvant treatment and survival in older women with triple negative breast cancer: A Surveillance, Epidemiology, and End Results analysis. The breast journal Kozak, M. M., Xiang, M., Pollom, E. L., Horst, K. C. 2019

  Abstract

  Patients with triple negative breast cancer were identified using the Surveillance, Epidemiology, and End Results database. Competing risks analysis was used to assess the cumulative incidence of breast cancer-specific mortality (BCSM). Multivariable Fine-Gray regression was used to identify predictors of BCSM. Women age 70+ (n=4221) were less likely to receive chemotherapy and radiation treatment (P<0.0001) and had higher BCSM compared to younger women (P<0.0001). There were no differences in BCSM in patients who received adjuvant treatment (P=0.10). Stage II patients derived the greatest relative and absolute benefit from adjuvant treatment. Age was not a significant predictor of BCSM.

  View details for DOI 10.1111/tbj.13251

  View details for PubMedID 30925635

• Adverse Radiation Effect and Disease Control in Patients Undergoing Stereotactic Radiosurgery and Immune Checkpoint Inhibitor Therapy for Brain Metastases. World neurosurgery Koenig, J. L., Shi, S., Sborov, K., Gensheimer, M. F., Li, G., Nagpal, S., Chang, S. D., Gibbs, I. C., Soltys, S. G., Pollom, E. L. 2019

  Abstract

  BACKGROUND: Immune checkpoint inhibitors (ICIs) and stereotactic radiosurgery (SRS) are increasingly used together to manage brain metastases (BMs). We assessed adverse radiation effect, disease control, and overall survival in patients with BMs who received SRS with anti-CTLA-4 and/or anti-PD-1/PD-L1 therapies.METHODS: We retrospectively reviewed the records of patients with intact or resected BMs treated with SRS and ICIs within 5 months of SRS between 2010 and 2018. Patients were defined as receiving 'concurrent' SRS and ICI if a dose of ICI was given within 4 weeks of SRS. Local failure (LF), distant intracranial failure (DIF), extracranial failure (EF), and adverse radiation effect (ARE) were assessed using cumulative incidence rates and competing risk regressions with death as a competing risk. Overall survival was assessed using the Kaplan-Meier method and Cox proportional hazards models.RESULTS: A total of 97 patients with 580 BMs were included in our analysis. Competing risk analyses demonstrated that concurrent SRS-ICI therapy is associated with higher rates of ARE (6.4% vs 2.0% at 1 year; multivariable HR 4.47; 95% CI, 1.57-12.73; p=0.005), lower rates of EF (69.7% vs 80.8% at 1 year; multivariable HR 0.60; 95% CI, 0.42-0.87; p=0.007), and better overall survival (48.6% vs 25.4% at 1 year; multivariable HR 0.57; 95% CI, 0.33-0.99; p=0.044) as compared to non-concurrent therapy. SRS-ICI timing was not associated with LF or DIF.CONCLUSIONS: Concurrent SRS-ICI therapy has a tolerable adverse event profile and may improve extracranial disease control and overall survival, supporting concurrent use in the management of BMs.

  View details for PubMedID 30902777

• Cost-effectiveness of Screening for Nasopharyngeal Carcinoma among Asian American Men in the United States. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Harris, J. P., Saraswathula, A., Kaplun, B., Qian, Y., Chan, K. C., Chan, A. T., Le, Q., Owens, D. K., Goldhaber-Fiebert, J. D., Pollom, E. 2019: 194599819832593

  Abstract

  OBJECTIVE: Most patients with nasopharyngeal carcinoma (NPC) in the United States are diagnosed with stage III-IV disease. Screening for NPC in endemic areas results in earlier detection and improved outcomes. We examined the cost-effectiveness of screening for NPC with plasma Epstein-Barr virus DNA among Asian American men in the United States.STUDY DESIGN: We used a Markov cohort model to estimate discounted life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios for screening as compared with usual care without screening.SETTING: The base case analysis considered onetime screening for 50-year-old Asian American men.SUBJECTS AND METHODS: Confirmatory testing was magnetic resonance imaging and nasopharyngoscopy. Cancer-specific outcomes, health utility values, and costs were determined from cancer registries and the published literature.RESULTS: For Asian American men, usual care without screening resulted in the detection of NPC at stages I, II, III-IVB, and IVC among 6%, 29%, 54%, and 11% of those with cancer, respectively, whereas screening resulted in earlier detection with a stage distribution of 43%, 24%, 32%, and 1%. This corresponded to an additional 0.00055 QALYs gained at a cost of $63 per person: an incremental cost of $113,341 per QALY gained. In probabilistic sensitivity analysis, screening Asian American men was cost-effective at $100,000 per QALY gained in 35% of samples.CONCLUSION: Although screening for NPC with plasma Epstein-Barr virus DNA for 50-year-old Asian American men may result in earlier detection, in this study it was unlikely to be cost-effective. Screening may be reasonable for certain subpopulations at higher risk for NPC, but clinical studies are necessary before implementation.

  View details for PubMedID 30832545

• Downstaging and survival after neoadjuvant approaches to gastroesophageal junction adenocarcinoma. Xiang, M. H., Chang, D., Heestand, G. M., Pollom, E. L. AMER SOC CLINICAL ONCOLOGY. 2019

  View details for DOI 10.1200/JCO.2019.37.4_suppl.92

  View details for Web of Science ID 000489107600139

• The impact of state parity laws on copayments for and adherence to oral endocrine therapy for breast cancer CANCER Chin, A. L., Bentley, J. P., Pollom, E. L. 2019; 125 (3): 374–81

  View details for DOI 10.1002/cncr.31910

  View details for Web of Science ID 000456686000010

• False News of a Cannabis Cancer Cure. Cureus Shi, S., Brant, A. R., Sabolch, A., Pollom, E. 2019; 11 (1): e3918

  Abstract

  Background There is increasing concern among healthcare communities about the misinformation online about using cannabis to cure cancer. We have characterized this online interest in using cannabis as a cancer treatment and the propagation of this information on social media. Materials & methods We compared search activity over time for cannabis and cancer versus standard cancer therapies using Google Trends' relative search volume (RSV) tool and determined the impact of cannabis legalization. We classified news on social media about cannabis use in cancer as false, accurate, or irrelevant. We evaluated the cannabis-related social media activities of cancer organizations. Results The online search volume for cannabis and cancer increased at 10 times the rate of standard therapies (RSV 0.10/month versus 0.01/month, p<0.001), more so in states where medical or recreational cannabis is legal. The use of cannabis as a cancer cure represented the largest category (23.5%) of social media content on alternative cancer treatments. The top false news story claiming cannabis as a cancer cure generated 4.26 million engagements on social media, while the top accurate news story debunking this false news generated 0.036 million engagements. Cancer organizations infrequently addressed cannabis (average 0.7 Tweets; 0.4 Facebook posts), with low influence compared to false news (average 5.6 versus 527 Twitter retweets; 98 versus 452,050 Facebook engagements, p<0.001). Conclusions These findings reveal a growing interest in cannabis use as a cancer cure, and a crucial opportunity for physicians and medical organizations to communicate accurate information about the role of cannabis in cancer to patients, caregivers, and the general public.

  View details for DOI 10.7759/cureus.3918

  View details for PubMedID 30931189

  View details for PubMedCentralID PMC6426557

• False News of a Cannabis Cancer Cure CUREUS Shi, S., Brant, A. R., Sabolch, A., Pollom, E. 2019; 11 (1)

  View details for DOI 10.7759/cureus.3918

  View details for Web of Science ID 000461367200006

• Impact of Accuracy of Survival Predictions on Quality of End-of-Life Care Among Patients With Metastatic Cancer Who Receive Radiation Therapy. Journal of oncology practice Sborov, K., Giaretta, S., Koong, A., Aggarwal, S., Aslakson, R., Gensheimer, M. F., Chang, D. T., Pollom, E. L. 2019: JOP1800516

  Abstract

  PURPOSE:: For patients treated with palliative radiation, we examined the association between life expectancy predictions by radiation oncologists and aggressive end-of-life care.MATERIALS AND METHODS:: We included decedents from a study that assessed the ability of oncologists to predict survival of patients with metastatic cancer who received radiation. We identified patients who died within 12 months of study enrollment to assess accuracy of predictions. Aggressive end-of-life care was defined by the National Quality Forum, ASCO Quality Oncology Practice Initiative metrics, and advanced radiation modalities in the last month of life. Survival predictions were categorized as follows: correct (< 12 months), 12 to 18 months, 18 to 24 months, and more than 24 months. We assessed association between prediction and aggressive end-of-life care using a generalized estimation equation.RESULTS:: Of 489 decedents, we identified 467 encounters with survival estimates. Overall, 156 decedents (32%) met at least one metric of aggressive end-of-life care. Factors associated with aggressive end-of-life care included younger age, female sex, primary cancer diagnosis, no brain metastases, and private insurance. In each encounter when an oncologist predicted survival, 363 predictions (78%) were correct (< 12 months), 54 (11%) incorrectly predicted 12 to 18 months, 27 (6%) predicted 18 to 24 months, and 23 (5%) predicted more than 24 months. Compared with patients who had encounters that had correct survival predictions, patients predicted to live more than 24 months were more likely to meet at least one metric of aggressive end-of-life care (odds ratio, 2.55; 95% CI, 1.09 to 5.99; P = .03).CONCLUSION:: Inaccurate survival predictions by oncologists are associated with more aggressive end-of-life care for patients with advanced cancer.

  View details for DOI 10.1200/JOP.18.00516

  View details for PubMedID 30620629

• Nodular Leptomeningeal Disease - A Distinct Pattern of Recurrence After Post-Resection Stereotactic Radiosurgery for Brain Metastases: A Multi-Institutional Study of Inter-Observer Reliability. International journal of radiation oncology, biology, physics Turner, B. E., Prabhu, R. S., Burri, S. H., Brown, P. D., Pollom, E. L., Milano, M. T., Weiss, S. E., Iv, M. n., Fischbein, N. n., Soliman, H. n., Lo, S. S., Chao, S. T., Cox, B. W., Murphy, J. D., Li, G. n., Gephart, M. H., Nagpal, S. n., Atalar, B. n., Azoulay, M. n., Thomas, R. n., Tillman, G. n., Durkee, B. Y., Shah, J. L., Soltys, S. G. 2019

  Abstract

  For brain metastases, surgical resection with postoperative stereotactic radiosurgery (SRS) is an emerging standard of care. Postoperative cavity SRS is associated with a specific, under-recognized pattern of intracranial recurrence, herein termed nodular leptomeningeal disease (nLMD), which is distinct from classical leptomeningeal disease (cLMD). We hypothesized that there is poor consensus regarding the definition of LMD, and that a formal, self-guided training module will improve inter-rater reliability (IRR) and validity in diagnosing LMD.Twenty-two physicians at 16 institutions, including 15 physicians with central nervous system (CNS) expertise, completed a two-phase survey that included MRI imaging and treatment information for 30 patients. In the "pre-training" phase, physicians labeled cases using 3 patterns of recurrence commonly reported in prospective studies: local recurrence (LR), distant parenchymal recurrence (DR), and LMD. After a self-directed training module, participating physicians completed the "post-training" phase and relabeled the 30 cases using the 4 following labels: LR, DR, cLMD, nLMD.Inter-rater reliability (IRR) increased 34% after training (Fleiss' Kappa K=0.41 to K=0.55, p<0.001). IRR increased most among non-CNS specialists (+58%, p<0.001). Prior to training, IRR was lowest for LMD (K=0.33). After training, IRR increased across all recurrence subgroups and increased most for LMD (+67%). After training, ≥27% of cases initially labeled LR or DR were later recognized as nLMD.This study highlights the large degree of inconsistency among clinicians in recognizing nLMD. Our findings demonstrate that a brief self-guided training module distinguishing nLMD can significantly improve IRR across all patterns of recurrence, and particularly in nLMD. To optimize outcomes reporting, prospective trials in brain metastases should incorporate central imaging review and investigator training.

  View details for DOI 10.1016/j.ijrobp.2019.10.002

  View details for PubMedID 31605786

• Survival after neoadjuvant approaches to gastroesophageal junction cancer. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Xiang, M. n., Chang, D. T., Heestand, G. M., Pollom, E. L. 2019

  Abstract

  Gastroesophageal junction (GEJ) cancers can be treated with equipoise using neoadjuvant chemoradiation (NACRT) or chemotherapy alone (NAC), but the comparative outcomes are unclear. Patients with non-metastatic T2-4 or N1-3 GEJ adenocarcinoma who underwent definitive surgery and NAC or NACRT were selected from the National Cancer Database. The primary outcome was overall survival (OS). Multivariable regression and propensity score analysis were used to adjust for age, comorbidity, and other characteristics.We identified 2435 patients treated with NACRT and 648 patients treated with NAC. OS was not significantly different between NACRT and NAC (51% versus 54% at 3 years, respectively, P = 0.11). Extent of pathological downstaging (complete, partial/mixed, none) after NACRT or NAC was highly prognostic of survival. Patients with no response did equally poorly after either preoperative regimen, and NAC was significantly less likely than NACRT to produce any response (adjusted odds ratio 0.62, P < 0.0001). Rate of adjuvant chemotherapy usage was significantly lower after NACRT than after NAC (12% versus 34%, P < 0.0001). In patients with residual tumor and nodal disease, adjuvant chemotherapy was associated with higher OS after NACRT (adjusted hazard ratio 0.81, P = 0.05), but not after NAC. These results were further validated by propensity score analysis.NACRT had similar survival to NAC despite superior pathological downstaging. Adjuvant chemotherapy is relatively underused after NACRT and warrants further study as a risk-adapted means to improve survival, especially in patients with larger burden of residual disease.

  View details for DOI 10.1007/s10120-019-00980-6

  View details for PubMedID 31230228

• Tumor treating fields and maintenance temozolomide for newly diagnosed glioblastoma: a cost-effectiveness study. Journal of medical economics Guzauskas, G. F., Pollom, E. L., Stieber, V. W., Wang, B. C., Garrison, L. n. 2019: 1

  Abstract

  The EF-14 trial demonstrated that adding tumor treating fields (TTFields) to maintenance temozolomide (TMZ) significantly extends progression-free survival (PFS) and overall survival (OS) for newly diagnosed glioblastoma (GBM) patients. We assessed the cost-effectiveness of TTFields and TMZ for newly diagnosed GBM from the U.S. healthcare system perspective.Outcomes for newly diagnosed GBM patients were estimated over a lifetime horizon using an area under the curve model with three states: stable disease, progressive disease, or death. The survival model integrated the 5-year EF-14 trial results with long-term GBM epidemiology data and U.S. background mortality rates. Adverse event rates were derived from the EF-14 trial data. Utility values to determine quality-adjusted life-years, adverse event costs and supportive care costs were obtained from published literature. We applied a 3% discount rate to future costs and outcomes. One-way and probabilistic sensitivity analyses were performed to assess result uncertainty due to parameter variability.Treatment with TTFields and TMZ was estimated to result in a mean increase in survival of 1.25 life years (95% credible range [CR]: 0.89 to 1.67) and 0.96 quality-adjusted life years (QALYs) (95% CR: 0.67 to 1.30) compared to treatment with TMZ alone. The incremental total cost was $188,637 (95% CR: $145,324 to $225,330). The incremental cost-effectiveness ratio (ICER) was $150,452 per life year gained and $197,336 per QALY gained. The model was most sensitive to changes in the cost of TTFields treatment.Adding TTFields to maintenance TMZ resulted in a substantial increase in the estimated mean lifetime survival and quality-adjusted survival for newly diagnosed GBM patients. Treatment with TTFields can be considered cost-effective within the reported range of willingness-to-pay thresholds in the United States.

  View details for PubMedID 31050315

• Microsatellite Instability and Adjuvant Chemotherapy in Stage II Colon Cancer. American journal of clinical oncology Koenig, J. L., Toesca, D. A., Harris, J. P., Tsai, C. J., Haraldsdottir, S. n., Lin, A. Y., Pollom, E. L., Chang, D. T. 2019

  Abstract

  Randomized control trials and population-based studies do not demonstrate a definitive benefit for adjuvant chemotherapy (ACT) in stage II colon cancer (CC). Tumor sidedness and microsatellite instability (MSI) status may predict response to ACT, but previous studies have limited microsatellite data. We assessed the efficacy of ACT and possible interaction with MSI status and tumor sidedness in patients with resected stage II CC diagnosed between 2010 and 2013 using the National Cancer Database.Overall survival was evaluated with the Kaplan-Meier method and multivariate and propensity score matched Cox proportional hazards models. The interaction between receipt of ACT, MSI status, and tumor sidedness was evaluated. The efficacy of ACT was assessed in patient subgroups by MSI status and tumor sidedness.Among 6964 stage II CC patients with known MSI status, 1497 (21.5%) received ACT, 843 had MSI tumors, and 6121 had microsatellite stable (MSS) tumors. In multivariate and propensity score matched analyses, ACT was associated with improved survival after adjusting for factors including high-risk features, MSI status, and tumor sidedness (multivariate hazard ratio, 0.52; P<0.001). There was no interaction between receipt of ACT and MSI status (P=0.25). Patients with MSS tumors benefitted from ACT (multivariate hazard ratio, 0.47; P<0.001), even without other high-risk features. Patients with MSI tumors did not (P=0.671). ACT was associated with improved survival regardless of tumor sidedness.MSS alone may warrant ACT in stage II CC while patients with MSI tumors may not derive significant benefit from ACT.

  View details for DOI 10.1097/COC.0000000000000554

  View details for PubMedID 31166206

• Physiological motion of the optic chiasm and its impact on stereotactic radiosurgery dose BRITISH JOURNAL OF RADIOLOGY Xiang, M., Chan, C., Wang, L., Jani, K., Holdsworth, S. J., Iv, M., Pollom, E. L., Soltys, S. G. 2019; 92 (1099)

  View details for DOI 10.1259/bjr.20190170

  View details for Web of Science ID 000472476700013

• Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. Neurosurgical focus Fatima, N. n., Meola, A. n., Pollom, E. L., Soltys, S. G., Chang, S. D. 2019; 46 (6): E2

  Abstract

  OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27-0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61-1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26-0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21-3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06-4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67-12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4-10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.

  View details for DOI 10.3171/2019.3.FOCUS1970

  View details for PubMedID 31153149

• Stereotactic radiosurgery for resected brain metastases: single-institutional experience of over 500 cavities. International journal of radiation oncology, biology, physics Shi, S. n., Sandhu, N. n., Jin, M. C., Wang, E. n., Jaoude, J. A., Schofield, K. n., Zhang, C. n., Liu, E. n., Gibbs, I. C., Hancock, S. L., Chang, S. D., Li, G. n., Hayden-Gephart, M. n., Adler, J. R., Soltys, S. G., Pollom, E. L. 2019

  Abstract

  Post-operative stereotactic radiosurgery (SRS) has less detrimental impact on cognition and quality of life compared to whole brain radiotherapy (WBRT) and is increasingly used for resected brain metastases (BMs). Post-operative SRS techniques are not standardized, and there is a concern for a different pattern of failure following post-operative SRS compared to WBRT. We aim to study the efficacy, toxicity, and failure pattern of post-operative SRS.We retrospectively reviewed outcomes of patients with resected BMs treated with post-operative SRS between 2007 and 2018. Overall survival (OS) and cumulative incidences of local failure (LF), overall distant intracranial failure [distant parenchymal failure (DPF), nodular leptomeningeal disease (nLMD), classical leptomeningeal disease (cLMD)], and adverse radiation effect (ARE) were reported. Neurological death was determined for patients with leptomeningeal disease (LMD).A total of 442 patients with 501 resected BMs were treated over 475 total SRS courses. Median clinical follow-up and OS after SRS were 10.1 months [interquartile range (IQR) 3.6-20.7 months] and 13.9 months [95% confidence interval (CI) 11.8-15.2 months], respectively. At 12 months, event rates were 7% (95% CI 5%-10%) for LF, 9% (95% CI 7%-12%) for ARE, 44% (95% CI 40%-49%) for overall distant intracranial failure, 37% (95% CI 33%-42%) for DPF and 13% (95% CI 10%-17%) for LMD. The overall incidence of LMD was 15.8% (53% cLMD, 46% nLMD). cLMD was associated with shorter survival than nLMD (2.0 versus 11.2 months, p<0.01) and a higher proportion of neurological death (67% versus 41%, p=0.02). A total of 15% of patients ultimately received WBRT.We report the largest clinical experience of post-operative SRS for resected BMs, showing excellent local control and low toxicity. Intracranial failure was predominantly distant, with a rising incidence of LMD.

  View details for DOI 10.1016/j.ijrobp.2019.11.022

  View details for PubMedID 31785338

• Physiological motion of the optic chiasm and its impact on stereotactic radiosurgery dose. The British journal of radiology Xiang, M. n., Chan, C. n., Wang, L. n., Jani, K. n., Holdsworth, S. J., Iv, M. n., Pollom, E. n., Soltys, S. n. 2019: 20190170

  Abstract

  Avoidance of radiation-induced optic neuropathy (RION) from stereotactic radiosurgery (SRS) requires precise anatomical localization; however, no prior studies have characterized the physiologic motion of the optic chiasm. We measured the extent of chiasm motion and its impact on SRS dose.In this cross-sectional study, serial magnetic resonance imaging was performed in multiple planes in 11 human subjects without optic pathway abnormalities to determine chiasm motion across time. Subsequently, the measured displacement was applied to the hypothetical chiasm dose received in 11 patients treated with SRS to a perichiasmatic lesion.On sagittal images, the average anteroposterior chiasm displacement was 0.51 mm (95 % confidence interval [CI] 0.27 - 0.75 mm), and the average superior-inferior displacement was 0.48 mm (95% CI 0.22 - 0.74 mm). On coronal images, the average superior-inferior displacement was 0.42 mm (95% CI 0.13 - 0.71 mm), and the average lateral displacement was 0.75 mm (95% CI 0.42 - 1.08 mm). In 11 patients who underwent SRS to a perichiasmatic lesion, the average displacements increased the maximum chiasm dose (Dmax) by a mean of 14 % (range 6 - 23 %; p < 0.001).Average motion of the optic chiasm was approximately 0.50 - 0.75 mm, which increased chiasm Dmax by a mean of 14 %. In the occasional patient with higher-than-average chiasm motion in a region of steep dose gradient, the increase in chiasm Dmax and risk of RION could be even larger. Similarly, previously reported chiasm dose constraints may underestimate the true dose received during radiosurgery.To limit the risk of RION, clinicians may consider adding a 0.50 - 0.75 mm expansion to the chiasm avoidance structure.

  View details for PubMedID 31067077

• Stereotactic Radiosurgery for Large Benign Intracranial Tumors. World neurosurgery Fatima, N. n., Meola, A. n., Pollom, E. n., Chang, S. D., Soltys, S. n. 2019

  Abstract

  Historically, it is stated that large intracranial tumors, herein defined as a maximum dimension of > 3cm or tumor volume >14.2 cm3, are not candidates for Stereotactic Radiosurgery (SRS). We report outcomes of patients with large benign intracranial tumors treated with SRS.With IRB approval, we retrospectively identified 74 patients with large benign intracranial tumors (59 meningiomas, 9 vestibular schwannomas, and 6 glomus jugulare tumors) treated with robotic SRS (2007-2018). Patients received definitive SRS in 47.3% of the cases, adjuvant to surgical resection in 44.6%, and salvage following past radiation treatment in 8.1%. A median tumor volume of 16.0 cm3 (10.1-65.5 cm3) received a median dose of 24.0 Gy (14.0-30.0 Gy) in a median of 3 fractions (1-5), for a median single fraction equivalent dose (SFED) (with alpha/beta of 3) of 14.8 Gy (11.3-18.0 Gy). The Kaplan-Meier estimate of tumor local control (LC) was calculated from date of SRS.With a median clinical follow-up of 32.8 months (0.6-125.9 months) and median radiological follow-up of 28.5 months (0.6-121.4 months), LC was 96.5% (95%CI:92.4-100%) at 3-years and 91.7% (95%CI:87.6-95.7%) at 5-years. Adverse radiation effect (ARE) was seen in 10 patients (13.5%) at a median of 13.5 months (7.8-34.5 months). ARE occurred in 9% of those with prior treatment compared to 5% radiation-naïve (p=0.23). With 236.4 person-years of follow-up, no secondary malignancies were seen.Despite the historical adage, we find that SRS provides high rates of LC for these large tumors, with rates of ARE similar to historical reports of SRS for smaller benign tumors.

  View details for DOI 10.1016/j.wneu.2019.10.005

  View details for PubMedID 31605862

• Stereotactic Radiosurgery for Pediatric and Adult Intracranial and Spinal Ependymomas. Stereotactic and functional neurosurgery Shi, S. n., Jin, M. C., Koenig, J. n., Gibbs, I. C., Soltys, S. G., Chang, S. D., Li, G. n., Hayden Gephart, M. n., Hiniker, S. M., Pollom, E. L. 2019: 1–6

  Abstract

  We report efficacy and toxicity outcomes with stereotactic radiosurgery (SRS) for intracranial and spinal ependymoma.We analyzed adult and pediatric patients with newly diagnosed or recurrent intracranial or spinal ependymoma lesions treated with SRS at our institution. Following SRS, local failure (LF) was defined as failure within or adjacent to the SRS target volume, while distant failure (DF) was defined as failure outside of the SRS target volume. Time to LF and DF was analyzed using competing risk analysis with death as a competing risk.Overall survival (OS) was calculated from the date of first SRS to the date of death or censored at the date of last follow-up using the Kaplan-Meier method.Twenty-one patients underwent SRS to 40 intracranial (n = 30) or spinal (n = 10) ependymoma lesions between 2007 and 2018, most commonly with 18 or 20 Gy in 1 fraction. Median follow-up for all patients after first SRS treatment was 54 months (range 2-157). The 1-year, 2-year, and 5-year rates of survival among patients with initial intracranial ependymoma were 86, 74, and 52%, respectively. The 2-year cumulative incidences of LF and DF after SRS among intracranial ependymoma patients were 25% (95% CI 11-43) and 42% (95% CI 22-60), respectively. No spinal ependymoma patient experienced LF, DF, or death within 2 years of SRS. Three patients had adverse radiation effects.SRS is a viable treatment option for intracranial and spinal ependymoma with excellent local control and acceptable toxicity.

  View details for DOI 10.1159/000502653

  View details for PubMedID 31590165

• The impact of state parity laws on copayments for and adherence to oral endocrine therapy for breast cancer. Cancer Chin, A. L., Bentley, J. P., Pollom, E. L. 2018

  Abstract

  BACKGROUND: Adherence to endocrine therapy for breast cancer is often inadequate, in part because of out-of-pocket costs for medication. Numerous states have enacted parity laws to limit patient cost-sharing for oral anticancer drugs. The objective of this study was to estimate the impact of these laws on patient copayments for and adherence to oral endocrine therapy for breast cancer.METHODS: Administrative health insurance claims data from 2007 to 2014 derived from a US health care database were used to identify female patients aged 18 to 64 years with invasive cancer or ductal carcinoma in situ of the breast who initiated endocrine therapy and were enrolled in fully insured health plans in states that either enacted parity legislation between 2008 and 2013 or had not yet enacted such legislation by 2015. Differences-in-differences analysis was used to compare copayments for and adherence to endocrine therapy during the 1-year period before and after each year of legislation enactment.RESULTS: In total, 6900 individuals who received 7778 unique drug therapy courses were identified. Parity legislation was associated with significant decreases in the 25th percentile of copayments for anastrozole of $4.39 (95% confidence interval [CI], -$4.52 to -$4.26; P < .001) and for exemestane of $3.08 (95% CI, -$4.80 to -$1.35; P < .001). The median copayment for exemestane decreased by $10.25 (95% CI, -$12.61 to -$7.89; P < .001). A higher median monthly copayment was significantly associated with a greater risk of medication nonadherence (adjusted risk ratio, 1.006 per dollar increase; P < .001).CONCLUSIONS: Parity laws had a modest effect on lowering the cost of anastrozole and exemestane, but more focused efforts to limit out-of-pocket costs for endocrine therapy may have a greater impact on medication adherence.

  View details for PubMedID 30566762

• Rising rates of bilateral mastectomy with reconstruction following neoadjuvant chemotherapy INTERNATIONAL JOURNAL OF CANCER Pollom, E. L., Qian, Y., Chin, A. L., Dirbas, F. M., Asch, S. M., Kurian, A. W., Horst, K. C., Tsai, C. 2018; 143 (12): 3262–72

  View details for DOI 10.1002/ijc.31747

  View details for Web of Science ID 000451115900020

• Advance Care Planning Needs in Patients With Glioblastoma Undergoing Radiotherapy JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Pollom, E. L., Sborov, K. D., Soltys, S. G., Asch, S. M., Sudore, R. L., Aslakson, R. A. 2018; 56 (6): E6–E8

  View details for DOI 10.1016/j.jpainsymman.2018.08.021

  View details for Web of Science ID 000451633700003

• F-18-EF5 PET-based Imageable Hypoxia Predicts Local Recurrence in Tumors Treated With Highly Conformal Radiation Therapy INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Qian, Y., Von Eyben, R., Liu, Y., Chin, F. T., Miao, Z., Apte, S., Carter, J. N., Binkley, M. S., Pollom, E. L., Harris, J. P., Prionas, N. D., Kissel, M., Simmons, A., Diehn, M., Shultz, D. B., Brown, J., Maxim, P. G., Koong, A. C., Graves, E. E., Loo Jr, B. W. 2018; 102 (4): 1183–92

  View details for DOI 10.1016/j.ijrobp.2018.03.045

  View details for Web of Science ID 000447789700063

• F-18-EF5 PET-based Imageable Hypoxia Predicts Local Recurrence in Tumors Treated with Highly Conformal Radiation Therapy Qian, Y., Von Eyben, R., Liu, Y., Chin, F., Miao, Z., Apte, S., Carter, J. N., Binkley, M. S., Pollom, E., Harris, J. P., Prionas, N. D., Kissel, M., Simmons, A., Diehn, M., Shultz, D. B., Brown, M., Maxim, P. G., Koong, A. C., Graves, E. E., Loo, B. W. ELSEVIER SCIENCE INC. 2018: S114–S115

  View details for DOI 10.1016/j.ijrobp.2018.06.287

  View details for Web of Science ID 000447811602483

• Quality of End of Life Care among Metastatic Cancer Patients Receiving Radiation Therapy Sborov, K., Giaretta, S., Koong, A., Aggarwal, S., Von Eyben, R., Chang, D. T., Gensheimer, M. F., Pollom, E. ELSEVIER SCIENCE INC. 2018: E423

  View details for DOI 10.1016/j.ijrobp.2018.07.1235

  View details for Web of Science ID 000447811601257

• Association Between Accuracy of Survival Predictions and Quality of End of Life Care Among Metastatic Cancer Patients Receiving Radiation Therapy Sborov, K., Giaretta, S., Koong, A., Aggarwal, S., Von Eyben, R., Chang, D. T., Gensheimer, M. F., Pollom, E. ELSEVIER SCIENCE INC. 2018: S168

  View details for DOI 10.1016/j.ijrobp.2018.07.031

  View details for Web of Science ID 000447811602596

• Cost-Effectiveness of Screening for Nasopharyngeal Carcinoma with Plasma Epstein-Barr Virus DNA Harris, J. P., Saraswathula, A., Kaplun, B. D., Qian, Y., Chan, K. A., Chan, A. C., Le, Q. T., Owens, D., Goldhaber-Fiebert, J. D., Pollom, E. ELSEVIER SCIENCE INC. 2018: E401

  View details for DOI 10.1016/j.ijrobp.2018.07.1184

  View details for Web of Science ID 000447811601207

• Sarcopenia in Overweight or Obese Patient is an Adverse Prognostic Factor in Pancreatic Cancer Nwachukwu, C. R., Wu, Y., Toesca, D. S., Von Eyben, R., Pollom, E., Chang, D. T. ELSEVIER SCIENCE INC. 2018: E76

  View details for DOI 10.1016/j.ijrobp.2018.07.425

  View details for Web of Science ID 000447811600176

• COST EFFECTIVENESS OF TREATING GLIOBLASTOMA PATIENTS AGE 65 YEARS OR OLDER WITH TUMOR TREATING FIELDS PLUS TEMOZOLOMIDE VERSUS TEMOZOLOMIDE ALONE Guzauskas, G., Wang, B. M., Pollom, E., Stieber, V. W., Garrison, L. OXFORD UNIV PRESS INC. 2018: 116–17

  View details for Web of Science ID 000460646300488

• THE COST EFFECTIVENESS OF TUMOR TREATING FIELDS TREATMENT FOR PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA BASED ON THE EF-14 TRIAL Guzauskas, G., Wang, B. M., Pollom, E., Stieber, V. W., Garrison, L. OXFORD UNIV PRESS INC. 2018: 116

  View details for Web of Science ID 000460646300486

• Nodular Leptomeningeal Disease - A Distinct Pattern of Recurrence after Post-Resection Stereotactic Radiosurgery for Brain Metastases: A Multi-Institutional Study of Inter-Observer Reliability Turner, B. E., Prabhu, R. S., Burri, S. H., Brown, P. D., Pollom, E., Milano, M. T., Weiss, S. E., Iv, M., Fischbein, N., Soliman, H., Lo, S. S., Soltys, S. G. ELSEVIER SCIENCE INC. 2018: E363–E364

  View details for DOI 10.1016/j.ijrobp.2018.07.1091

  View details for Web of Science ID 000447811601118

• Adverse Radiation Effect and Disease Control in Patients Undergoing Concurrent Stereotactic Radiosurgery and Immunotherapy for Brain Metastases Koenig, J. L., Sborov, K., Sandhu, N., Gensheimer, M. F., Soltys, S. G., Pollom, E. ELSEVIER SCIENCE INC. 2018: E275–E276

  View details for DOI 10.1016/j.ijrobp.2018.07.888

  View details for Web of Science ID 000447811600633

• Use of Preoperative Radiation Therapy in Early and Advanced Stage Breast Cancer Koenig, J. L., Kozak, M., Sabolch, A., Wapnir, I. L., Horst, K. C., Tsai, C. J., Pollom, E. ELSEVIER SCIENCE INC. 2018: E589

  View details for DOI 10.1016/j.ijrobp.2018.07.1621

  View details for Web of Science ID 000447811601635

• Estimated Increase in Mean Lifetime Survival for Glioblastoma Patients Age 65 Years and Older Treated with Tumor Treating Fields and Temozolomide Compared to Patients Treated with Temozolomide Alone Guzauskas, G. F., Pollom, E., Wang, B. M. ELSEVIER SCIENCE INC. 2018: E244–E245

  View details for DOI 10.1016/j.ijrobp.2018.07.815

  View details for Web of Science ID 000447811600561

• Early Metabolic Response at Mid-Radiation Therapy FDG-PET Imaging Predicts Patterns of Treatment Failure in Locally Advanced Oropharyngeal Cancer Liang, R., Zhang, N., Wu, J., Sandhu, N., Pollom, E., Le, Q. T., Hara, W., Li, R. ELSEVIER SCIENCE INC. 2018: E298–E299

  View details for DOI 10.1016/j.ijrobp.2018.07.942

  View details for Web of Science ID 000447811600686

• Automated Survival Prediction in Metastatic Cancer Patients Using High-Dimensional Electronic Medical Record Data. Journal of the National Cancer Institute Gensheimer, M. F., Henry, A. S., Wood, D. J., Hastie, T. J., Aggarwal, S., Dudley, S. A., Pradhan, P., Banerjee, I., Cho, E., Ramchandran, K., Pollom, E., Koong, A. C., Rubin, D. L., Chang, D. T. 2018

  Abstract

  Background: Oncologists use patients' life expectancy to guide decisions and may benefit from a tool that accurately predicts prognosis. Existing prognostic models generally use only a few predictor variables. We used an electronic medical record dataset to train a prognostic model for patients with metastatic cancer.Methods: The model was trained and tested using 12588 patients treated for metastatic cancer in the Stanford Health Care system from 2008 to 2017. Data sources included provider note text, labs, vital signs, procedures, medication orders, and diagnosis codes. Patients were divided randomly into a training set used to fit the model coefficients and a test set used to evaluate model performance (80%/20% split). A regularized Cox model with 4126 predictor variables was used. A landmarking approach was used due to the multiple observations per patient, with t0 set to the time of metastatic cancer diagnosis. Performance was also evaluated using 399 palliative radiation courses in test set patients.Results: The C-index for overall survival was 0.786 in the test set (averaged across landmark times). For palliative radiation courses, the C-index was 0.745 (95% confidence interval [CI] = 0.715 to 0.775) compared with 0.635 (95% CI = 0.601 to 0.669) for a published model using performance status, primary tumor site, and treated site (two-sided P<.001). Our model's predictions were well-calibrated.Conclusions: The model showed high predictive performance, which will need to be validated using external data. Because it is fully automated, the model can be used to examine providers' practice patterns and could be deployed in a decision support tool to help improve quality of care.

  View details for PubMedID 30346554

• Invasive nodal evaluation prior to stereotactic ablative radiation for non-small cell lung cancer LUNG CANCER Harris, J. P., Nwachukwu, C., Qian, Y., Pollom, E., Loo, B. W., Das, M., Diehn, M. 2018; 124: 76–85

  View details for DOI 10.1016/j.lungcan.2018.07.033

  View details for Web of Science ID 000448100600012

• Automated survival prediction in metastatic cancer patients using high-dimensional electronic medical record data. Annals of oncology : official journal of the European Society for Medical Oncology Gensheimer, M. F., Henry, A. S., Wood, D. J., Hastie, T. J., Aggarwal, S., Dudley, S., Pradhan, P., Banerjee, I., Cho, E., Ramchandran, K., Pollom, E., Koong, A., Rubin, D., Chang, D. T. 2018; 29 Suppl 8: viii548

  View details for DOI 10.1093/annonc/mdy295.001

  View details for PubMedID 32137428

• Automated survival prediction in metastatic cancer patients using high-dimensional electronic medical record data Gensheimer, M. F., Henry, A. S., Wood, D. J., Hastie, T. J., Aggarwal, S., Dudley, S., Pradhan, P., Banerjee, I., Cho, E., Ramchandran, K., Pollom, E., Koong, A., Rubin, D., Chang, D. T. OXFORD UNIV PRESS. 2018: 548

  View details for Web of Science ID 000459277303282

• Patterns of Distant Failure by Intrinsic Breast Cancer Subtype in Premenopausal Women Treated With Neoadjuvant Chemotherapy CLINICAL BREAST CANCER Kozak, M. M., Jacobson, C. E., von Eyben, R., Walck, E., Pollom, E. L., Telli, M., Horst, K. C. 2018; 18 (5): E1077–E1085

  View details for DOI 10.1016/j.clbc.2018.04.020

  View details for Web of Science ID 000445702400046

• Invasive nodal evaluation prior to stereotactic ablative radiation for non-small cell lung cancer. Lung cancer (Amsterdam, Netherlands) Harris, J. P., Nwachukwu, C., Qian, Y., Pollom, E., Loo, B. W., Das, M., Diehn, M. 2018; 124: 76–85

  Abstract

  INTRODUCTION: Invasive nodal evaluation (INE) is used to improve staging for early stage non-small cell lung cancer (NSCLC), including when stereotactic ablative radiation (SABR) is used. Consensus guidelines from the NCCN recommend performing INE for patients with T2N0 tumors and considering INE for those with T1N0 tumors. We reasoned that if INE results in significant stage migration in the form of substantially fewer patients with occult nodal involvement, then patients treated with SABR who do not undergo INE should have worse overall survival (OS).METHODS: Patients diagnosed 2004-2014 with stage T1-2N0M0 NSCLC and treated with SABR were identified from the National Cancer Database. Factors associated with INE were determined using mixed effects logistic regression. We tested for an association between INE and OS for patients diagnosed 2004-2013 using mixed effects proportional hazards regression methods.RESULTS: 24,603 SABR patients were identified. 6% of the 19,322 patients with T1 tumors and 9% of the 5281 patients with T2 tumors had INE. Median OS was 2.8 years for the no-INE group and 2.7 years for the INE group (log-rank P=0.69). No significant association was observed between the use of INE and OS in the univariate analysis (HR 1.02, 95% CI 0.94-1.11) or the multivariate analysis (HR 0.94, 95% CI 0.86-1.02). These findings were confirmed using propensity score matched and instrumental variable analysis. On subgroup analysis, INE was associated with a non-significant trend for improved OS in patients with T2 tumors (HR 0.87, 95% CI 0.76-1.00) but not T1 tumors (HR 0.98, 95% CI 0.88-1.09).CONCLUSIONS: Despite current NCCN recommendations, the rate of INE was low for patients with stage T1 or T2 tumors. While omitting INE represents a compromise in the completeness of nodal evaluation, we found that it was not associated with a detriment in overall survival.

  View details for PubMedID 30268484

• Integrating Radiosensitivity and Immune Gene Signatures for Predicting Benefit of Radiotherapy in Breast Cancer CLINICAL CANCER RESEARCH Cui, Y., Li, B., Pollom, E. L., Horst, K. C., Li, R. 2018; 24 (19): 4754–62

  View details for DOI 10.1158/1078-0432.CCR-18-0825

  View details for Web of Science ID 000446207700015

• Advance care planning needs in patients with glioblastoma undergoing radiotherapy. Journal of pain and symptom management Pollom, E., Sborov, K., Soltys, S. G., Asch, S. M., Sudore, R., Aslakson, R. A. 2018

  View details for PubMedID 30201484

• COST EFFECTIVENESS OF TREATING GLIOBLASTOMA PATIENTS AGE 65 YEARS OR OLDER WITH TUMOR TREATING FIELDS PLUS TEMOZOLOMIDE VERSUS TEMOZOLOMIDE ALONE Guzauskas, G. F., Wang, B. M., Pollom, E. L., Stieber, V. W., Kinzel, A., Proescholdt, C., Garrison, L. OXFORD UNIV PRESS INC. 2018: 254

  View details for Web of Science ID 000460645600146

• Survival impact of postoperative radiotherapy timing in pediatric and adolescent medulloblastoma NEURO-ONCOLOGY Chin, A. L., Moding, E. J., Donaldson, S. S., Gibbs, I. C., Soltys, S. G., Hiniker, S. M., Pollom, E. L. 2018; 20 (8): 1133–41

  View details for DOI 10.1093/neuonc/noy001

  View details for Web of Science ID 000438338000014

• Hippocampus-Sparing Radiation and Chemotherapy INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Pollom, E., Soltys, S. G. 2018; 101 (3): 519–20

  View details for PubMedID 29893271

• Tumor treating fields treatment for patients with newly diagnosed glioblastoma: A cost-effectiveness analysis Guzauskas, G. F., Pollom, E. L., Stieber, V. W., Wang, B. C., Garrison, L. AMER ASSOC CANCER RESEARCH. 2018

  View details for DOI 10.1158/1538-7445.AM2018-LB-257

  View details for Web of Science ID 000468818900403

• Outcomes Following Neoadjuvant Chemotherapy for Breast Cancer in Women Aged 40 Years and Younger: Impact of Pathologic Nodal Response. Journal of the National Comprehensive Cancer Network : JNCCN Kozak, M. M., Jacobson, C. E., von Eyben, R., Pollom, E. L., Telli, M., Horst, K. C. 2018; 16 (7): 845–50

  Abstract

  Purpose: We sought to evaluate whether pathologic nodal response was predictive of outcomes in women aged ≤40 years with breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: A total of 220 patients treated with NAC between 1991 and 2015 were retrospectively reviewed. Pathologic complete response (pCR) was defined as no evidence of residual invasive tumor in the breast and lymph nodes (LNs) (ypT0/Tis ypN0); partial response if there was no tumor in the LNs but residual tumor in the breast (ypT+ ypN0) or residual tumor in the LNs (ypT0/Tis ypN+); and limited response if there was residual tumor in both the breast and the LNs (ypT+ ypN+). Kaplan-Meier and Cox proportional hazards analyses were performed to identify factors predictive for overall survival (OS). Results: A total of 155 patients were included. Following NAC, 39 patients (25.2%) achieved pCR, 57 (36.8%) achieved a partial response (either ypT+ ypN0 or ypT0/Tis ypN+), and 59 (38.1%) had a limited response. A total of 22 patients (14.2%) experienced local failure, 20 (12.9%) experienced regional failure, and 59 (38.1%) experienced distant failure. Median OS for patients who achieved pCR was not reached, and was significantly worse for patients who had residual disease in the breast and/or LNs (P<.001). No difference in OS was seen among patients who had residual disease in the breast alone versus those who remained LN-positive (97 vs 83 months, respectively; P=.25). Subset analysis did not reveal differences in OS based on year of treatment or cN1 disease at the time of initial diagnosis. Conclusions: Women aged ≤40 years who achieved pCR had excellent outcomes; however, those who achieved a pathologic response in the LNs but had residual disease in the breast continued to have outcomes similar to those who remained LN-positive.

  View details for DOI 10.6004/jnccn.2018.7022

  View details for PubMedID 30006427

• Comparing Modalities Using the National Cancer Database: Concerns With Rajyaguru et al. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Pollom, E. L., Feng, M., Chang, D. T. 2018: JCO2018780403

  View details for DOI 10.1200/JCO.2018.78.0403

  View details for PubMedID 29945518

• Integrating Radiosensitivity and Immune Gene Signatures for Predicting Benefit of Radiotherapy in Breast Cancer. Clinical cancer research : an official journal of the American Association for Cancer Research Cui, Y., Li, B., Pollom, E. L., Horst, K., Li, R. 2018

  Abstract

  PURPOSE: Breast cancer is a heterogeneous disease and not all patients respond equally to adjuvant radiotherapy. Predictive biomarkers are needed to select patients who will benefit from the treatment and spare others the toxicity and burden of radiation.EXPERIMENTAL DESIGN: We first trained and tested an intrinsic radiosensitivity gene signature to predict local recurrence after radiotherapy in three cohorts of 948 patients. Next, we developed an antigen processing and presentation-based immune signature by maximizing the treatment interaction effect in 129 patients. To test their predictive value, we matched patients treated with or without radiotherapy in an independent validation cohort for clinicopathologic factors including age, ER status, HER2 status, stage, hormone-therapy, chemotherapy, and surgery. Disease specific survival (DSS) was the primary endpoint.RESULTS: Our validation cohort consisted of 1,439 patients. After matching and stratification by the radiosensitivity signature, patients who received radiotherapy had better DSS than patients who did not in the radiation-sensitive group (hazard ratio [HR]=0.68, P=0.059, n=322), while a reverse trend was observed in the radiation-resistant group (HR=1.53, P=0.059, n=202). Similarly, patients treated with radiotherapy had significantly better DSS in the immuneeffective group (HR=0.46, P=0.0076, n=180), with no difference in DSS in the immunedefective group (HR=1.27, P=0.16, n=348). Both signatures were predictive of radiotherapy benefit (Pinteraction=0.007 and 0.005). Integration of radiosensitivity and immune signatures further stratified patients into three groups with differential outcomes for those treated with or without radiotherapy (Pinteraction=0.003).CONCLUSIONS: The proposed signatures have the potential to select patients who are most likely to benefit from radiotherapy.

  View details for PubMedID 29921729

• 18F-EF5 Pet-Based Imageable Hypoxia Predicts for Local Control in Tumors Treated With Conformal Radiotherapy Qian, Y., Liu, Y., Von Eyben, R., Carter, J. N., Pollom, E. L., Harris, J. P., Prionas, N. D., Binkley, M. S., Simmons, A., Diehn, M., Chin, F. T., Shultz, D. B., Brown, J., Maxim, P. G., Koong, A. C., Graves, E. E., Loo, B. W. ELSEVIER SCIENCE INC. 2018: E17–E18

  View details for Web of Science ID 000432447200042

• Cost Effectiveness of Radiation and Chemotherapy for High-Risk Low Grade Glioma Qian, Y., Maruyama, S., Kim, H., Pollom, E. L., Kumar, K. A., Harris, J. P., Chin, A. L., Pitt, A., Bendavid, E., Owens, D. K., Durkee, B. Y., Soltys, S. G. ELSEVIER SCIENCE INC. 2018: E26

  View details for Web of Science ID 000432447200062

• National trends in mastectomy for operable breast cancers treated with neoadjuvant chemotherapy Pollom, E., Qian, Y., Dirbas, F., Horst, K., Tsai, C. AMER ASSOC CANCER RESEARCH. 2018

  View details for Web of Science ID 000425489402128

• Microsatellite instability and adjuvant chemotherapy in stage II colon cancer. Koenig, J. L., Lin, A. Y., Pollom, E. L., Chang, D. AMER SOC CLINICAL ONCOLOGY. 2018

  View details for DOI 10.1200/JCO.2018.36.4_suppl.767

  View details for Web of Science ID 000436174100741

• Survival Impact of Postoperative Radiotherapy Timing in Pediatric and Adolescent Medulloblastoma. Neuro-oncology Chin, A. L., Moding, E. J., Donaldson, S. S., Gibbs, I. C., Soltys, S. G., Hiniker, S. M., Pollom, E. L. 2018

  Abstract

  Radiation therapy (RT) remains a critical component of multimodality treatment for medulloblastoma. Traditionally, clinicians strive to start RT within 4-5 weeks of surgery, but the optimal timing after surgery remains unclear.Using the National Cancer Database, we identified pediatric and adolescent patients with medulloblastoma treated with curative-intent surgery, RT, and chemotherapy. Factors associated with early or delayed RT were identified using Pearson chi-squared tests. Overall survival (OS) differences based on RT timing were compared using the Kaplan-Meier estimator with log-rank tests. Patient, tumor, and treatment characteristics associated with OS were analyzed with univariate and multivariate Cox proportional hazard models.Among the 1338 patients analyzed, early RT (defined as initiation ≤3 weeks after surgery) was associated with younger age, M1-3 disease, and subtotal resection. Patients who initiated RT early had decreased five-year OS compared with patients who initiated RT 3.1-4, 4.1-5, or >5 weeks after surgery (72.5%, 80.5%, 79.4%, and 77.8%, respectively; p=0.019), but there was no significant difference in OS among the latter three groups (p=0.788). On multivariate analysis, early RT versus the 3.1-4-week interval was significantly associated with poorer OS (adjusted HR 1.72; 95% CI 1.19-2.48; p=0.004), while time to RT of >5 weeks but within 90 days of surgery did not adversely impact OS (p=0.563).In this large national database analysis, delaying RT within 90 days of surgery was not associated with inferior outcomes. Although clinical judgment remains paramount, postoperative RT timing should allow for healing and the development of an optimal treatment plan.

  View details for PubMedID 29309676

• Rising rates of bilateral mastectomy with reconstruction following neoadjuvant chemotherapy. International journal of cancer Pollom, E. L., Qian, Y. n., Chin, A. L., Dirbas, F. M., Asch, S. M., Kurian, A. W., Horst, K. C., Tsai, C. J. 2018

  Abstract

  Neoadjuvant chemotherapy is used to allow more limited breast surgery without compromising local control. We sought to evaluate nationwide surgical trends in patients with operable breast cancer treated with neoadjuvant chemotherapy and factors associated with surgical type. We used the National Cancer Database to identify 235,339 women with unilateral T1-3N0-3M0 breast cancer diagnosed between 2010 and 2014, and treated with surgery and chemotherapy. Of these, 59,568 patients (25.3%) were treated with neoadjuvant chemotherapy. Rates of pathologic complete response to neoadjuvant chemotherapy increased from 33.3% at the start of the study period in 2010 to 46.3% at the end of the period in 2014 (p=0.02). Rates of breast-conserving surgery changed little, from 37.0% to 40.8% (p=0.22). While rates of unilateral mastectomy decreased from 43.3% to 34.7% (p=0.02) and rates of bilateral mastectomy without immediate reconstruction remained similar (11.7% to 11.5%, p=0.82), rates of bilateral mastectomy with immediate reconstruction rose from 8.0% to 13.1% (p=0.02). Patients who were younger, with private/managed care insurance, and diagnosed in more recent years were more likely to achieve pathologic complete response; however, these same characteristics were associated with receipt of bilateral mastectomy (versus breast-conserving surgery). Additionally, non-Hispanic white race and higher area education attainment were both associated with bilateral mastectomy. These findings did not differ by age or molecular subtype. Further study of non-clinical factors that influence selection of more extensive surgery despite excellent response to neoadjuvant chemotherapy is warranted. This article is protected by copyright. All rights reserved.

  View details for PubMedID 29992582

• Patterns of Distant Failure by Intrinsic Breast Cancer Subtype in Premenopausal Women Treated With Neoadjuvant Chemotherapy. Clinical breast cancer Kozak, M. M., Jacobson, C. E., von Eyben, R. n., Walck, E. n., Pollom, E. L., Telli, M. n., Horst, K. C. 2018

  Abstract

  To identify patterns of distant failure (DF) in premenopausal women receiving neoadjuvant chemotherapy (NAC) for breast cancer.Premenopausal patients treated with NAC between 2005 and 2015 at a single institution were retrospectively reviewed. Timing and location of local, regional, and distant metastases were described. Predictors for DF and overall survival (OS) were analyzed.Of 225 patients, there were 24 (10.7%) local, 30 (13.3%) regional, and 63 (28.0%) distant recurrences. Cumulative incidence of DF was higher in patients younger than age 40 (P = .01), in those with residual tumor size > 2 cm (P < .0001), in those with positive lymph nodes after NAC (P = .0003), and in those without pathologic complete response (P < .0001). Cumulative incidence of brain metastases was most common in patients with human epidermal growth factor receptor 2 (HER2)-positive disease (P = .05). Time from development of metastatic disease to death varied by breast cancer subtype (P = .019), as did 5-year OS (P = .024). Women with HER2-positive and triple-negative disease had the highest incidence of brain metastases and the shortest time from development of metastases to death. On multivariable analysis, luminal B subtype (P = .025), pathologic complete response (P = .0014), young age (P = .0008), lack of hormone therapy (P < .0001), lymphovascular space involvement (P < .0001), and pathologic size of the primary tumor (P < .0001) were all significant predictors for DF.Patterns of DF after NAC in premenopausal women vary by breast cancer subtype, with DF more common than locoregional failure. Young age remains an independent poor prognostic factor, and OS differs by breast cancer subtype.

  View details for PubMedID 29843987

• Impact of Insurance Coverage on Outcomes in Primary Breast Sarcoma. Sarcoma Koenig, J. L., Tsai, C. J., Sborov, K. n., Horst, K. C., Pollom, E. L. 2018; 2018: 4626174

  Abstract

  Private insurance is associated with better outcomes in multiple common cancers. We hypothesized that insurance status would significantly impact outcomes in primary breast sarcoma (PBS) due to the additional challenges of diagnosing and coordinating specialized care for a rare cancer. Using the National Cancer Database, we identified adult females diagnosed with PBS between 2004 and 2013. The influence of insurance status on overall survival (OS) was evaluated using the Kaplan-Meier estimator with log-rank tests and Cox proportional hazard models. Among a cohort of 607 patients, 67 (11.0%) had Medicaid, 217 (35.7%) had Medicare, and 323 (53.2%) had private insurance. Compared to privately insured patients, Medicaid patients were more likely to present with larger tumors and have their first surgical procedure further after diagnosis. Treatment was similar between patients with comparable disease stage. In multivariate analysis, Medicaid (hazard ratio (HR), 2.47; 95% confidence interval (CI), 1.62-3.77; p < 0.001) and Medicare (HR, 1.68; 95% CI, 1.10-2.57; p=0.017) were independently associated with worse OS. Medicaid insurance coverage negatively impacted survival compared to private insurance more in breast sarcoma than in breast carcinoma (interaction p < 0.001). In conclusion, patients with Medicaid insurance present with later stage disease and have worse overall survival than privately insured patients with PBS. Worse outcomes for Medicaid patients are exacerbated in this rare cancer.

  View details for PubMedID 29736143

  View details for PubMedCentralID PMC5875066

• Gross total resection and adjuvant radiotherapy most significant predictors of improved survival in patients with atypical meningioma. Cancer Rydzewski, N. R., Lesniak, M. S., Chandler, J. P., Kalapurakal, J. A., Pollom, E. n., Tate, M. C., Bloch, O. n., Kruser, T. n., Dalal, P. n., Sachdev, S. n. 2018; 124 (4): 734–42

  Abstract

  Atypical and malignant meningiomas are far less common than benign meningiomas. As aggressive lesions, they are prone to local recurrence and may lead to decreased survival. Although malignant meningiomas typically are treated with maximal surgical resection and adjuvant radiotherapy (RT), to the authors' knowledge the optimal treatment for atypical lesions remains to be defined. There are limited prospective data in this setting.The National Cancer Data Base was queried to investigate cases of histologically confirmed meningiomas diagnosed from 2004 to 2014. This included 7811 patients with atypical meningiomas (World Health Organization grade 2) and 1936 patients with malignant meningiomas (World Health Organization grade 3); during the same period, a total of 60,345 patients were diagnosed with benign meningiomas (World Health Organization grade 1). Data collected included patient and tumor characteristics, extent of surgical resection, and use of RT. Survival analysis was performed using Kaplan-Meier estimates with the log-rank test of significance and Cox univariate and multivariate regression. Logistic regression was used to determine factors associated with use of RT.The 5-year overall survival rate was 85.5% in patients with benign meningiomas, 75.9% in patients with atypical meningiomas, and 55.4% in patients with malignant meningiomas (P<.0001). In patients with atypical meningiomas, gross (macroscopic) total resection (GTR) and adjuvant RT were found to be associated with significantly improved survival, independently and especially in unison (GTR plus RT: hazard ratio, 0.47; P = .002). On multivariate analysis, the combination of GTR plus RT was found to be the most important factor for improved survival. However, GTR was associated with significantly lower rates of RT use.GTR and adjuvant RT appear to be highly associated with improved survival, independent of other factors, in patients with atypical meningiomas. Cancer 2018;124:734-42. © 2017 American Cancer Society.

  View details for PubMedID 29131312

• Newly diagnosed glioblastoma: adverse socioeconomic factors correlate with delay in radiotherapy initiation and worse overall survival. Journal of radiation research Pollom, E. L., Fujimoto, D. K., Han, S. S., Harris, J. P., Tharin, S. A., Soltys, S. G. 2018

  Abstract

  The optimal time for starting radiation in patients with glioblastoma (GBM) is controversial. We aimed to evaluate postoperative radiotherapy treatment patterns and the impact of timing of radiotherapy on survival outcomes in patients with GBM using a large, national hospital-based registry in the era of Stupp chemoradiation. We performed a retrospective cohort study using the National Cancer Data Base and identified adults with GBM diagnosed between 2010 and 2013 and treated with chemoradiation. We classified time from surgery/biopsy to radiation start into the following categories: <15 days, 15-21 days, 22-28 days, 29-35 days, 36-42 days and >42 days. We assessed the relation between time to radiation start and survival using Cox proportional hazards modeling adjusting for clinically relevant variables that were selected a priori. We used multivariate logistic modeling to determine factors independently associated with receipt of delayed radiation treatment. A total of 12 738 patients met our inclusion criteria after our cohort selection process. The majority of patients underwent either gross total (n = 5270, 41%) or subtotal (n = 4700, 37%) resection, while 2768 patients (22%) underwent biopsy only. Median time from definitive surgery or biopsy to initiation of radiation was 29 days (interquartile range 24-36 days). For patients who had biopsy or subtotal resection, earlier initiation of radiation did not appear to be associated with improved survival. However, among patients who underwent gross total resection, there appeared to be improved survival with early initiation of radiation. Patients who initiated radiation within 15-21 days of gross total resection had improved survival (hazard ratio 0.82, 95% confidence interval 0.69-0.98, P = 0.03) compared with patients who had delayed (>42 days after surgery) radiation. There was also a trend (P = 0.07 to 0.12) for improved survival for patients who initiated radiation within 22-35 days of gross total resection compared with patients who had delayed radiation. Patients who were black, had Medicaid or other government insurance or were not insured, and who lived in metropolitan areas or further away from the treating facility had higher odds of receiving radiation >35 days after gross total resection. Patients who lived in higher income areas had higher odds of receiving radiation within 35 days of a gross total resection. In a large cohort of patients with GBM treated with chemoradiation, our data suggest a survival benefit in initiating radiotherapy within 35 days after gross total resection. Further research is warranted to understand barriers to timely access to optimal therapy.

  View details for PubMedID 29432548

• Newly Diagnosed Glioblastoma: Delay in Radiation Therapy Initiation Associated With Adverse Socioeconomic Factors and Worse Survival Pollom, E., Fujimoto, D. K., Harris, J. P., Chin, A. L., Qian, Y., Tharin, S., Soltys, S. G. ELSEVIER SCIENCE INC. 2017: E100

  View details for DOI 10.1016/j.ijrobp.2017.06.830

  View details for Web of Science ID 000411559100235

• Extent of lymphovascular space invasion may predict lymph node metastasis in uterine serous carcinoma GYNECOLOGIC ONCOLOGY Qian, Y., Pollom, E. L., Nwachukwu, C., Seiger, K., von Eyben, R., Folkins, A. K., Kidd, E. A. 2017; 147 (1): 24–29

  Abstract

  Emerging evidence suggests that extent of lymphovascular space invasion (LVSI) predicts for risk of lymph node metastasis in endometrioid uterine cancers. However, this correlation remains unknown in the setting of uterine serous carcinoma (USC). We sought to examine the association between extent of LVSI and other histopathologic characteristics with risk of nodal metastasis for women with USC.Pathological data from all cases of uterine serous carcinoma between July 1998 to July 2015 at our institution were reviewed. Descriptive, univariate, and multivariate logistic regression analysis of selected pathologic features were performed.88 patients with USC underwent total abdominal or laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and selective lymphadenectomy. Surgical staging revealed the following FIGO stage distributions: I (41%), II (8%), III (32%), IV (19%). LVSI was present in 44 (50%) patients. 36 patients (41%) had LN metastases with median number of total nodes removed of 17 (range, 1-49). On univariate analysis, depth of myometrial invasion, LVSI, tumor size, and cervical stromal involvement were significantly associated with nodal involvement. In a multivariate model, LVSI (OR 6.25, 95% CI 2.2-18.0, p<0.01) and cervical stromal involvement (OR 3.33, 95% CI 1.10-10.0, p=0.03) were the only factors that remained significant. Among patients with LVSI-positive disease, extensive LVSI was associated with increased risk of nodal involvement compared to focal LVSI (90% vs 29%, p=0.04).Presence and extent of LVSI, and cervical stromal invasion are important predictors for lymph node metastasis in uterine serous carcinoma.

  View details for PubMedID 28709703

  View details for PubMedCentralID PMC5605436

• Impact of IMRT on Health Care Costs Among Elderly Patients with Anal Squamous Cell Carcinoma Chin, A. L., Pollom, E., Koong, A. C., Chang, D. T. ELSEVIER SCIENCE INC. 2017: S38

  View details for DOI 10.1016/j.ijrobp.2017.06.101

  View details for Web of Science ID 000411559106166

• Cost-Effectiveness of Radiation and Chemotherapy for High-Risk Low Grade Glioma Qian, Y., Maruyama, S., Kim, H., Pollom, E., Kumar, K. A., Harris, J. P., Chin, A. L., Pitt, A., Bendavid, E., Owens, D., Durkee, B. Y., Soltys, S. G. ELSEVIER SCIENCE INC. 2017: S37

  View details for DOI 10.1016/j.ijrobp.2017.06.098

  View details for Web of Science ID 000411559106163

• Normal Tissue Constraints for Abdominal and Thoracic Stereotactic Body Radiotherapy. Seminars in radiation oncology Pollom, E. L., Chin, A. L., Diehn, M., Loo, B. W., Chang, D. T. 2017; 27 (3): 197-208

  Abstract

  Although stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy has become an established standard of care for the treatment of a variety of malignancies, our understanding of normal tissue dose tolerance with extreme hypofractionation remains immature. Since Timmerman initially proposed normal tissue dose constraints for SBRT in the 2008 issue of Seminars of Radiation Oncology, experience with SBRT has grown, and more long-term clinical outcome data have been reported. This article reviews the modern toxicity literature and provides updated clinically practical and useful recommendations of SBRT dose constraints for extracranial sites. We focus on the major organs of the thoracic and upper abdomen, specifically the liver and the lung.

  View details for DOI 10.1016/j.semradonc.2017.02.001

  View details for PubMedID 28577827

• Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in the Elderly Chin, A. L., Pollom, E. L., Lee, N. Y., Tsai, C. ELSEVIER SCIENCE INC. 2017: E32

  View details for DOI 10.1016/j.ijrobp.2017.02.160

  View details for Web of Science ID 000403079100103

• Phase 1/2 Trial of 5-Fraction Stereotactic Radiosurgery With 5-mm Margins With Concurrent and Adjuvant Temozolomide in Newly Diagnosed Supratentorial Glioblastoma: Health-Related Quality of Life Results. International journal of radiation oncology, biology, physics Pollom, E. L., Fujimoto, D., Wynne, J., Seiger, K., Modlin, L. A., Jacobs, L. R., Azoulay, M., von Eyben, R., Tupper, L., Gibbs, I. C., Hancock, S. L., Li, G., Chang, S. D., Adler, J. R., Harsh, G. R., Harraher, C., Nagpal, S., Thomas, R. P., Recht, L. D., Choi, C. Y., Soltys, S. G. 2017; 98 (1): 123-130

  Abstract

  We report a longitudinal assessment of health-related quality of life (HRQOL) in patients with glioblastoma (GBM) treated on a prospective dose escalation trial of 5-fraction stereotactic radiosurgery (25-40 Gy in 5 fractions) with concurrent and adjuvant temozolomide.HRQOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire core-30 (QLQ-C30) general, the EORTC quality of life questionnaire-brain cancer specific module (QLQ-BN20), and the M.D. Anderson Symptom Inventory-Brain Tumor (MDASI-BT). Questionnaires were completed at baseline and at every follow-up visit after completion of radiosurgery. Changes from baseline for 9 predefined HRQOL measures (global quality of life, physical functioning, social functioning, emotional functioning, motor dysfunction, communication deficit, fatigue, insomnia, and future uncertainty) were calculated at every time point.With a median follow-up time of 10.4 months (range, 0.4-52 months), 139 total HRQOL questionnaires were completed by the 30 patients on trial. Compliance with HRQOL assessment was 76% at 12 months. Communication deficit significantly worsened over time, with a decline of 1.7 points per month (P=.008). No significant changes over time were detected in the other 8 scales of our primary analysis, including global quality of life. Although 8 patients (27%) experienced adverse radiation effects (ARE) on this dose escalation trial, it was not associated with a statistically significant decline in any of the primary HRQOL scales. Disease progression was associated with communication deficit, with patients experiencing an average worsening of 13.9 points per month after progression compared with 0.7 points per month before progression (P=.01).On this 5-fraction dose escalation protocol for newly diagnosed GBM, overall HRQOL remained stable and appears similar to historical controls of 30 fractions of radiation therapy. Tumor recurrence was associated with worsening communication deficit, and ARE did not correlate with a decline in HRQOL.

  View details for DOI 10.1016/j.ijrobp.2017.01.242

  View details for PubMedID 28586949

• Assessing local progression after stereotactic body radiation therapy for unresectable pancreatic adenocarcinoma: CT versus PET. Practical radiation oncology Toesca, D. A., Pollom, E. L., Poullos, P. D., Flynt, L., Cui, Y., Quon, A., von Eyben, R., Koong, A. C., Chang, D. T. 2017; 7 (2): 120-125

  Abstract

  Evaluation of local tumor progression (LP) has typically been defined by contrast-enhanced computed tomography (CT) imaging after stereotactic body radiation therapy (SBRT) for locally advanced pancreatic cancer (PDAC). The purpose of this study is to determine the benefit of adding 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging to CT for LP assessment of PDAC after SBRT.We retrospectively reviewed pretreatment, follow-up images, and outcomes of all patients treated with definitive SBRT for unresectable PDAC between December 2002 and December 2015 at our institution. For each patient, we independently analyzed LP both by CT and by FDG-PET criteria, using the Response Evaluation Criteria In Solid Tumors version 1.1 and the FDG-PET Response Evaluation Criteria In Solid Tumors version 1.0, respectively.Among 206 patients treated with definitive SBRT for unresectable PDAC, we identified 30 with LP on follow-up. Four did not undergo follow-up FDG-PET. Median time to LP after SBRT was 7.5 months (range, 2-25 months). Of the 26 patients with LP who had follow-up FDG-PET, 21 were diagnosed by FDG-PET (80.7%), 14 by CT (53.8%), and 9 by both FDG-PET and CT (34.6%). Use of CT alone revealed only 53.8% of cases of LP detected when FDG-PET and CT were combined. The cumulative incidence of LP, based on competing risk of death, at 1 and 2 years after SBRT was 9.6% and 16.7% by CT and 11% and 29.1% by FDG-PET, respectively.FDG-PET increases the chance of detecting LP of unresectable PDAC after SBRT and can have an important impact on reported outcomes. We recommend obtaining FDG-PET to assess treatment response when evaluating efficacy of SBRT and taking its use into account when comparing clinical data.

  View details for DOI 10.1016/j.prro.2016.09.002

  View details for PubMedID 28274396

• Sinoatrial node dysfunction after stereotactic ablative radiation therapy in the chest Qian, Y., Dudley, S., Kumar, K., Chaudhuri, A., Chin, A., Harris, J., Prionas, N., Nwachukwu, C., Bagshaw, H., Pollom, E. L., Ben Durkee, Shultz, D., Gensheimer, M. F., Diehn, M., Loo, B. W. AMER SOC CLINICAL ONCOLOGY. 2017

  View details for Web of Science ID 000443300500123

• Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients. International journal of radiation oncology, biology, physics Pollom, E. L., Chin, A. L., Lee, N. Y., Tsai, C. J. 2017

  Abstract

  To characterize the patterns of care and potential barriers to access to care for elderly patients with oral cavity cancer in the adjuvant setting.We performed a retrospective cohort study using the National Cancer Data Base and identified patients with resected oral cavity squamous cell carcinoma diagnosed between 2004 and 2012, who survived for ≥3 months after surgery. We used logistic regression models to assess the association between age (<70, 70-79, and ≥80 years) and the receipt of adjuvant therapy within 3 months of surgery. We additionally assessed the association between patient and tumor characteristics and the receipt of adjuvant therapy among those aged ≥70 years.A total of 25,829 patients were included in the study. Compared with those aged <70 years, older patients were more likely to have no neck dissection or have fewer lymph nodes dissected and were less likely to receive adjuvant therapy than younger patients. Among our cohort, 11,361 patients (44%) had pathologic T3-T4 disease or N2-N3 disease, and 4185 patients (16%) had extracapsular nodal extension or positive surgical margins. In multivariate analyses controlling for comorbidity and demographic characteristics, older age was independently associated with lower odds of receiving adjuvant radiation therapy in the subgroup with T3 or T4 disease or N2 or N3 disease and adjuvant chemoradiation therapy in the positive extracapsular nodal extension or positive surgical margin subgroup. Among elderly patients, both greater patient distance from reporting facility and older age were associated with lower odds of receiving both adjuvant radiation therapy (odds ratio 0.66; 95% confidence interval, 0.55-0.81) and chemoradiation therapy (odds ratio 0.56; 95% confidence interval, 0.40-0.79).In a national hospital-based cohort of patients with oral cavity cancer, elderly patients were less likely to receive adjuvant radiation or chemoradiation therapy. Greater patient distance from reporting facility, in addition to older age, was associated with lower odds of receiving both adjuvant radiation therapy and adjuvant chemoradiation therapy.

  View details for DOI 10.1016/j.ijrobp.2017.01.224

  View details for PubMedID 28366574

• The Impact of Intensity Modulated Radiation Therapy on Hospitalization Outcomes in the SEER-Medicare Population With Anal Squamous Cell Carcinoma. International journal of radiation oncology, biology, physics Pollom, E. L., Wang, G., Harris, J. P., Koong, A. C., Bendavid, E., Bhattacharya, J., Chang, D. T. 2017

  Abstract

  We examined the impact of intensity modulated radiation therapy (IMRT) on hospitalization rates in the Surveillance, Epidemiology, and End Results (SEER)-Medicare population with anal squamous cell carcinoma (SCC).We performed a retrospective cohort study using the SEER-Medicare database. We identified patients with nonmetastatic anal SCC diagnosed between 2001 and 2011 and treated with chemoradiation therapy. We assessed the relation between IMRT and first hospitalization by use of a multivariate competing-risk model, as well as instrumental variable analysis, using provider IMRT affinity as our instrument.Of the 1165 patients included in our study, 458 (39%) received IMRT. IMRT use increased over time and was associated more with regional and provider characteristics than with patient characteristics. The 3- and 6-month cumulative incidences of first hospitalization were 41.9% (95% confidence interval [CI], 37.3%-46.4%) and 47.6% (95% CI, 43.0%-52.2%), respectively, for the IMRT cohort and 46.7% (95% CI, 43.0%-50.4%) and 52.1% (95% CI, 48.4%-55.7%), respectively, for the non-IMRT cohort. IMRT was associated with a decreased hazard of first hospitalization compared with 3-dimensional radiation techniques (hazard ratio, 0.70; 95% CI, 0.58-0.84; P=.0002). Instrumental variable analysis suggested an even greater reduction in hospitalizations with IMRT after controlling for unmeasured confounders. There was a trend toward improved overall survival with IMRT, with an adjusted hazard ratio of 0.77 (95% CI, 0.59-1.00; P=.05).The use of IMRT is associated with reduced hospitalizations in elderly patients with anal SCC. Further work is warranted to understand the long-term health and cost impact of IMRT, particularly for patient subgroups most at risk of toxicity and hospitalization.

  View details for DOI 10.1016/j.ijrobp.2017.01.006

  View details for PubMedID 28258896

• Cost-effectiveness of Stereotactic Body Radiation Therapy versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Markov Modeling Study. Radiology Pollom, E. L., Lee, K., Durkee, B. Y., Grade, M., Mokhtari, D. A., Wahl, D. R., Feng, M., Kothary, N., Koong, A. C., Owens, D. K., Goldhaber-Fiebert, J., Chang, D. T. 2017: 161509-?

  Abstract

  Purpose To assess the cost-effectiveness of stereotactic body radiation therapy (SBRT) versus radiofrequency ablation (RFA) for patients with inoperable localized hepatocellular carcinoma (HCC) who are eligible for both SBRT and RFA. Materials and Methods A decision-analytic Markov model was developed for patients with inoperable, localized HCC who were eligible for both RFA and SBRT to evaluate the cost-effectiveness of the following treatment strategies: (a) SBRT as initial treatment followed by SBRT for local progression (SBRT-SBRT), (b) RFA followed by RFA for local progression (RFA-RFA), (c) SBRT followed by RFA for local progression (SBRT-RFA), and (d) RFA followed by SBRT for local progression (RFA-SBRT). Probabilities of disease progression, treatment characteristics, and mortality were derived from published studies. Outcomes included health benefits expressed as discounted quality-adjusted life years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analysis was performed to assess the robustness of the findings. Results In the base case, SBRT-SBRT yielded the most QALYs (1.565) and cost $197 557. RFA-SBRT yielded 1.558 QALYs and cost $193 288. SBRT-SBRT was not cost-effective, at $558 679 per QALY gained relative to RFA-SBRT. RFA-SBRT was the preferred strategy, because RFA-RFA and SBRT-RFA were less effective and more costly. In all evaluated scenarios, SBRT was preferred as salvage therapy for local progression after RFA. Probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100 000 per QALY gained, RFA-SBRT was preferred in 65.8% of simulations. Conclusion SBRT for initial treatment of localized, inoperable HCC is not cost-effective. However, SBRT is the preferred salvage therapy for local progression after RFA. (©) RSNA, 2017 Online supplemental material is available for this article.

  View details for DOI 10.1148/radiol.2016161509

  View details for PubMedID 28045603

• Sinoatrial node toxicity after stereotactic ablative radiation therapy to lung tumors. Practical radiation oncology Qian, Y. n., Zhu, H. n., Pollom, E. L., Durkee, B. Y., Chaudhuri, A. A., Gensheimer, M. F., Diehn, M. n., Shultz, D. B., Loo, B. W. 2017

  Abstract

  Stereotactic ablative radiation therapy (SABR) is an established treatment for selected lung tumors. Sinoatrial node (SAN) toxicity after thoracic SABR has not been reported in the literature. We sought to understand the risk of SAN toxicity owing to incidental dose to the SAN from SABR.We conducted a retrospective review of patients with early-stage lung cancer or limited pulmonary metastases who underwent thoracic SABR to a right-sided central lung tumor (within 2 cm of the mainstem bronchus or other mediastinal structures) between January 2008 and December 2014, analyzed a subset whose treatment imparted dose to the SAN exceeding 10% of the prescription dose, and examined patient and treatment dosimetric characteristics. Mean follow-up interval was 28 months. Time to toxicity was defined from start of SABR.Of 47 patients with central tumors in the right lung treated with SABR reviewed, 13 met our study criteria. A contouring atlas of regional cardiac anatomy was created. One patient treated with SABR for non-small cell lung cancer at the right hilum developed symptomatic sick sinus syndrome, requiring pacemaker placement 6 months after treatment. Her acute presentation and short interval between SABR and onset of symptoms suggest that SAN toxicity was likely due to radiation-induced injury. Both her age and mean dose to her SAN were the third highest in our cohort. She remained free from cancer progression at 24 months' follow-up. Twelve additional patients who received significant dose to the SAN from SABR did not develop toxicity.While uncommon, SAN toxicity from SABR to right-sided central thoracic tumors should be recognized and followed in future studies.

  View details for PubMedID 28669706

• Reirradiation with stereotactic body radiation therapy after prior conventional fractionation radiation for locally recurrent pancreatic adenocarcinoma ADVANCES IN RADIATION ONCOLOGY Koong, A. J., Toesca, D. S., von Eyben, R., Pollom, E. L., Chang, D. T. 2017; 2 (1): 27-36

  View details for DOI 10.1016/j.adro.2017.01.003

  View details for Web of Science ID 000680672300005

• New Hypofractionation Radiation Strategies for Glioblastoma. Current oncology reports Azoulay, M. n., Shah, J. n., Pollom, E. n., Soltys, S. G. 2017; 19 (9): 58

  Abstract

  Glioblastoma (GBM) is the most common and lethal primary brain tumor in adults, with a median survival of less than 2 years despite the standard of care treatment of 6 weeks of chemoradiotherapy. We review the data investigating hypofractionated radiotherapy (HFRT) in the treatment of newly diagnosed GBM.Investigators have explored alternative radiotherapy strategies that shorten treatment duration with the goal of similar or improved survival while minimizing toxicity. HFRT over 1-3 weeks is already a standard of care for patients with advanced age or poor performance status. For young patients with good performance status, HFRT holds the promise of radiobiologically escalating the dose and potentially improving local control while maintaining quality of life. Through the use of shorter radiotherapy fractionation regimens coupled with novel systemic agents, improved outcomes for patients with GBM may be achieved.

  View details for PubMedID 28735440

• Cost-Effectiveness of Radiation and Chemotherapy for High-Risk Low-Grade Glioma. Neuro-oncology Qian, Y. n., Maruyama, S. n., Kim, H. n., Pollom, E. L., Kumar, K. A., Chin, A. L., Harris, J. P., Chang, D. T., Pitt, A. n., Bendavid, E. n., Owens, D. K., Durkee, B. Y., Soltys, S. G. 2017

  Abstract

  The addition of PCV (procarbazine, lomustine, vincristine) chemotherapy to radiotherapy (RT) for patients with high-risk (≥ 40 years old or sub-totally resected) low-grade glioma (LGG) results in an absolute median survival benefit of over 5 years. We evaluated the cost-effectiveness of this treatment strategy.A decision tree with an integrated three-state Markov model was created to follow patients with high risk LGG after surgery treated with RT vs. RT+PCV. Patients existed in one of 3 health states: stable, progressive, and dead. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using time-dependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Analysis was conducted from the healthcare perspective. Deterministic and probabilistic sensitivity analysis explored uncertainty in model parameters.Modeled outcomes demonstrated agreement with clinical data in expected benefit of addition of PCV to RT. The addition of PCV to RT yielded an incremental benefit of 4.77 quality-adjusted life-years (QALYs) (9.94 for RT+PCV vs. 5.17 for RT alone) at an incremental cost of $48,635 ($188,234 for RT+PCV vs. $139,598 for RT alone), resulting in an incremental cost-effectiveness ratio of $10,186 per QALY gained. Probabilistic sensitivity analysis demonstrates that within modeled distributions of parameters, RT+PCV has 99.96% probability of being cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY.The addition of PCV to RT is a cost-effective treatment strategy for patients with high-risk LGG.

  View details for PubMedID 28666368

• Impact of Intensity-Modulated Radiotherapy on Health Care Costs of Patients With Anal Squamous Cell Carcinoma. Journal of oncology practice Chin, A. L., Pollom, E. L., Qian, Y. n., Koong, A. C., Chang, D. T. 2017: JOP2017024810

  Abstract

  Drivers of variation in the cost of care after chemoradiotherapy for the management of anal squamous cell carcinoma (SCC) have not been fully elucidated. We sought to characterize the direct and indirect impact of radiotherapy modality on health care costs among patients with anal SCC.A retrospective cohort study was performed using the 2014 linkage of the SEER-Medicare database. We identified 1,025 patients with anal SCC diagnosed between 2001 and 2011 and treated with chemoradiotherapy. Propensity score matching was used to balance baseline differences between patients treated with intensity-modulated radiotherapy (IMRT) and those treated with three-dimensional conformal radiotherapy (3D-CRT). Differences in total, cancer-attributable, and procedure-specific costs between groups were measured.Radiation-related, patient out-of-pocket, and total costs in the 1-year period after radiotherapy start were all higher for the IMRT group than the 3D-CRT group (median total cost, $35,890 v $27,262, respectively; P < .001). Patients who received IMRT had lower cumulative costs associated with urgent hospitalizations and emergency department visits at both 9 months and 1 year after treatment start compared with a matched cohort of patients who received 3D-CRT (median, $711 v $4,957 at 1 year, respectively; P = .021).Although total costs of care were higher for IMRT compared with 3D-CRT, primarily as a result of higher radiotherapy-specific costs, IMRT was associated with decreased unplanned health care utilization costs starting at 9 months after treatment start. Radiotherapy-centered episodes of care may need to encompass a longer time horizon to capture the full cost savings associated with more advanced radiation modalities.

  View details for DOI 10.1200/JOP.2017.024810

  View details for PubMedID 29035618

• Does radiotherapy still have a role in unresected biliary tract cancer? Cancer medicine Pollom, E. L., Alagappan, M., Park, L. S., Whittemore, A. S., Koong, A. C., Chang, D. T. 2017; 6 (1): 129-141

  Abstract

  The benefits of radiotherapy for inoperable biliary tract cancer remain unclear due to the lack of randomized data. We evaluated the impact of radiotherapy on survival in elderly patients using the SEER-Medicare database. Patients in the SEER-Medicare database with inoperable biliary tract tumors diagnosed between 1998 and 2011 were included. We used multivariate logistic regression to evaluate factors associated with treatment selection, and multivariate Cox regression and propensity score matching to evaluate treatment selection in relation to subsequent survival. Of the 2343 patients included, 451 (19%) received radiotherapy within 4 months of diagnosis. The use of radiotherapy declined over time, and was influenced by receipt of chemotherapy and patient age, race, marital status, poverty status, and tumor stage and type. Median survival was 9.3 (95% CI 8.7-9.7) months among patients who did not receive radiation and 10.0 (95% CI 9.1-11.3) months among those who received radiation, conditional on having survived 4 months. In patients who received chemotherapy (n = 1053), receipt of radiation was associated with improved survival, with an adjusted hazard ratio of 0.82 (95% 0.70-0.97, P = 0.02). In patients who did not receive chemotherapy (n = 1290), receipt of radiation was not associated with improved survival, with an adjusted hazard ratio of 1.09 (95% 0.91-1.30, P = 0.34). Propensity-scored matched analyses showed similar results. Despite the survival benefit associated with the addition of radiotherapy to chemotherapy, the use of radiation for unresectable biliary tract cancers has declined over time.

  View details for DOI 10.1002/cam4.975

  View details for PubMedID 27891822

• Hypofractionated Intensity-Modulated Radiotherapy for Patients With Non-Small-Cell Lung Cancer. Clinical lung cancer Pollom, E. L., Qian, Y., Durkee, B. Y., von Eyben, R., Maxim, P. G., Shultz, D. B., Gensheimer, M., Diehn, M., Loo, B. W. 2016; 17 (6): 588-594

  Abstract

  Alternative treatment regimens are needed for patients with non-small cell lung cancer (NSCLC) who cannot receive definitive treatment with concurrent chemoradiotherapy, surgery, or stereotactic ablative radiotherapy (SABR).We report survival, patterns of failure and toxicity outcomes for patients with NSCLC who were not eligible for surgical resection, concurrent chemoradiotherapy, or SABR and underwent hypofractionated intensity-modulated radiotherapy (IMRT). Kaplan-Meier survival analysis was used to evaluate the progression-free and overall survival. Competing risk analysis was used to evaluate in-field, locoregional, and distant failure.A total of 42 patients treated to 52.5 to 60 Gy in 15 fractions were included. Most of the patients had metastatic or recurrent disease (64%) and a relatively large, centrally located tumor burden (74%). The median follow-up period was 13 months (interquartile range, 6-18 months). All patients received the total prescribed dose. The median survival was 15.1 months. The overall and progression-free survival rates at 1 year were 63% and 22.5%, respectively. The pattern of failure was predominantly distant, with only 2% of patients experiencing isolated in-field recurrence. The cumulative incidence of in-field failure at 6 and 12 months was 2.5% (95% confidence interval, 0.4%-15.6%) and 16.1% (95% confidence interval, 7.5%-34.7%), respectively. The risk of esophageal toxicity was associated with the esophageal mean dose, maximal point dose, and dose to the 5 cm(3) volume. The risk of pneumonitis was associated with the lung mean dose and volume receiving 18 Gy.Hypofractionated IMRT without concurrent chemotherapy provides favorable rates of local control and survival for well-selected patients with NSCLC who cannot tolerate standard definitive therapy.

  View details for DOI 10.1016/j.cllc.2016.05.024

  View details for PubMedID 27378172

• Fractionation of Palliative Radiation Therapy in Metastatic Breast Cancer-Selection and Survival Qian, Y., Aggarwal, S., Dudley, S. A., Durkee, B. Y., Kumar, K. A., Chaudhuri, A. A., Pollom, E., von Eyben, R., Chang, D. T., Horst, K. C. ELSEVIER SCIENCE INC. 2016: E513

  View details for DOI 10.1016/j.ijrobp.2016.06.1915

  View details for Web of Science ID 000387655803571

• Cost-Effectiveness of Local Therapies for Inoperable, Localized Hepatocellular Carcinoma Pollom, E., Lee, K., Durkee, B. Y., Grade, M., Mokhtari, D., Weeks, B., Feng, M., Wahl, D. R., Kothary, N., Koong, A. C., Owens, D., Goldhaber-Fiebert, J., Chang, D. T. ELSEVIER SCIENCE INC. 2016: E138

  View details for DOI 10.1016/j.ijrobp.2016.06.938

  View details for Web of Science ID 000387655802337

• The Impact of FDG Positron Emission Tomography for Assessment of Local Progression of Unresectable Pancreatic Adenocarcinoma After Stereotactic Body Radiation Therapy 58th Annual Meeting of the American-Society-for-Radiation-Oncology (ASTRO) Toesca, D. A., Pollom, E., Nwachukwu, C. R., von Eyben, R., Koong, A. C., Chang, D. T. ELSEVIER SCIENCE INC. 2016: E205–E205

  View details for Web of Science ID 000387655802500

• Stereotactic Body Radiation Therapy After Surgical Resection for Locally Recurrent Pancreatic Adenocarcinoma 58th Annual Meeting of the American-Society-for-Radiation-Oncology (ASTRO) Nwachukwu, C. R., Toesca, D. A., Pollom, E., von Eyben, R., Chang, D. T., Koong, A. C. ELSEVIER SCIENCE INC. 2016: E158–E158

  View details for Web of Science ID 000387655802386

• Reirradiation With Stereotactic Body Radiation Therapy After Prior Conventional Fractionation Radiation for Locally Recurrent Pancreatic Adenocarcinoma 58th Annual Meeting of the American-Society-for-Radiation-Oncology (ASTRO) Toesca, D. A., Pollom, E., Nwachukwu, C. R., von Eyben, R., Koong, A. C., Chang, D. T. ELSEVIER SCIENCE INC. 2016: E205–E205

  View details for Web of Science ID 000387655802501

• Prognostic value of midtreatment FDG-PET in oropharyngeal cancer. Head & neck Pollom, E. L., Song, J., Durkee, B. Y., Aggarwal, S., Bui, T., von Eyben, R., Li, R., Brizel, D. M., Loo, B. W., Le, Q., Hara, W. Y. 2016; 38 (10): 1472-1478

  Abstract

  Prognostic metabolic imaging indices are needed for risk stratification for patients with locally advanced oropharyngeal cancer.We retrospectively examined pretreatment and midtreatment fluorodeoxyglucose-positron emission tomography (FDG-PET) parameters in patients with locally advanced oropharyngeal cancer who were treated with definitive chemoradiation.A total of 74 patients were evaluated. Pretreatment metabolic tumor volume (MTV) using threshold of 50% standardized uptake value (SUV) maximum (MTV50% ) was associated with progression-free survival (PFS; p = .003; hazard ratio [HR] = 1.57 per 10 cc; 95% confidence interval [CI] = 1.17-2.11) and overall survival (OS; p = .01; HR = 1.36 per 10 cc; 95% CI = 1.07-1.74). Midtreatment MTV using a threshold of SUV 2.0 (MTV2.0 ) was associated with PFS (p < .001; HR = 1.24 per 10 cc; 95% CI = 1.10-1.39) and OS (p = .009; HR = 1.21 per 10 cc; 95% CI = 1.05-1.39). Nodal total lesion glycolysis (TLG) velocity >5% decrease/week was associated with improved PFS (p = .04; HR = 0.37; 95% CI = 0.15-0.95).Metabolic response during chemoradiation is associated with survival in locally advanced oropharyngeal cancer and may aid with risk-adapting treatment. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

  View details for DOI 10.1002/hed.24454

  View details for PubMedID 27043927

• Patterns of Failure After Hypofractionated Intensity Modulated Radiation Therapy for Patients With Non-Small Cell Lung Cancer Qian, Y., Pollom, E., Durkee, B. Y., von Eyben, R., Gensheimer, M. F., Shultz, D. B., Diehn, M., Loo, B. W. ELSEVIER SCIENCE INC. 2016: E422–E423

  View details for DOI 10.1016/j.ijrobp.2016.06.1692

  View details for Web of Science ID 000387655803354

• Quantitative Analysis of (18)F-Fluorodeoxyglucose Positron Emission Tomography Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated With Stereotactic Body Radiation Therapy. International journal of radiation oncology, biology, physics Cui, Y., Song, J., Pollom, E., Alagappan, M., Shirato, H., Chang, D. T., Koong, A. C., Li, R. 2016; 96 (1): 102-109

  Abstract

  To identify prognostic biomarkers in pancreatic cancer using high-throughput quantitative image analysis.In this institutional review board-approved study, we retrospectively analyzed images and outcomes for 139 locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy (SBRT). The overall population was split into a training cohort (n=90) and a validation cohort (n=49) according to the time of treatment. We extracted quantitative imaging characteristics from pre-SBRT (18)F-fluorodeoxyglucose positron emission tomography, including statistical, morphologic, and texture features. A Cox proportional hazard regression model was built to predict overall survival (OS) in the training cohort using 162 robust image features. To avoid over-fitting, we applied the elastic net to obtain a sparse set of image features, whose linear combination constitutes a prognostic imaging signature. Univariate and multivariate Cox regression analyses were used to evaluate the association with OS, and concordance index (CI) was used to evaluate the survival prediction accuracy.The prognostic imaging signature included 7 features characterizing different tumor phenotypes, including shape, intensity, and texture. On the validation cohort, univariate analysis showed that this prognostic signature was significantly associated with OS (P=.002, hazard ratio 2.74), which improved upon conventional imaging predictors including tumor volume, maximum standardized uptake value, and total legion glycolysis (P=.018-.028, hazard ratio 1.51-1.57). On multivariate analysis, the proposed signature was the only significant prognostic index (P=.037, hazard ratio 3.72) when adjusted for conventional imaging and clinical factors (P=.123-.870, hazard ratio 0.53-1.30). In terms of CI, the proposed signature scored 0.66 and was significantly better than competing prognostic indices (CI 0.48-0.64, Wilcoxon rank sum test P<1e-6).Quantitative analysis identified novel (18)F-fluorodeoxyglucose positron emission tomography image features that showed improved prognostic value over conventional imaging metrics. If validated in large, prospective cohorts, the new prognostic signature might be used to identify patients for individualized risk-adaptive therapy.

  View details for DOI 10.1016/j.ijrobp.2016.04.034

  View details for PubMedID 27511850

• Nomogram to Predict Risk of Lymph Node Metastases in Patients With Endometrioid Endometrial Cancer. International journal of gynecological pathology Pollom, E. L., Conklin, C. M., von Eyben, R., Folkins, A. K., Kidd, E. A. 2016; 35 (5): 395-401

  Abstract

  Pelvic lymphadenectomy in early-stage endometrial cancer is controversial, but the findings influence prognosis and treatment decisions. Noninvasive tools to identify women at high risk of lymph node metastasis can assist in determining the need for lymph node dissection and adjuvant treatment for patients who do not have a lymph node dissection performed initially. A retrospective review of surgical pathology was conducted for endometrioid endometrial adenocarcinoma at our institution. Univariate and multivariate logistic regression analysis of selected pathologic features were performed. A nomogram to predict for lymph node metastasis was constructed. From August 1996 to October 2013, 296 patients underwent total abdominal or laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and selective lymphadenectomy for endometrioid endometrial adenocarcinoma. Median age at surgery was 62.7 yr (range, 24.9-93.6 yr). Median number of lymph nodes removed was 13 (range, 1-72). Of all patients, 38 (12.8%) had lymph node metastases. On univariate analysis, tumor size ≥4 cm, grade, lymphovascular space involvement, cervical stromal involvement, adnexal or serosal or parametrial involvement, positive pelvic washings, and deep (more than one half) myometrial invasion were all significantly associated with lymph node involvement. In a multivariate model, lymphovascular space involvement, deep myometrial invasion, and cervical stromal involvement remained significant predictors of nodal involvement, whereas tumor size of ≥4 cm was borderline significant. A lymph node predictive nomogram was constructed using these factors. Our nomogram can help estimate risk of nodal disease and aid in directing the need for additional surgery or adjuvant therapy in patients without lymph node surgery. Lymphovascular space involvement is the most important predictor for lymph node metastases, regardless of grade, and should be consistently assessed.

  View details for DOI 10.1097/PGP.0000000000000246

  View details for PubMedID 26598977

• Socioeconomic resources and survival in patients with metastatic breast cancer treated with palliative radiotherapy Qian, Y., Aggarwal, S., Dudley, S., Durkee, B. Y., Kumar, K., Chaudhuri, A., Pollom, E. L., von Eyben, R., Chang, D., Horst, K. C. AMER SOC CLINICAL ONCOLOGY. 2016

  View details for DOI 10.1200/JCO.2016.34.15_suppl.e18082

  View details for Web of Science ID 000404711503222

• Cost-Effectiveness of Pertuzumab in Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer. Journal of clinical oncology Durkee, B. Y., Qian, Y., Pollom, E. L., King, M. T., Dudley, S. A., Shaffer, J. L., Chang, D. T., Gibbs, I. C., Goldhaber-Fiebert, J. D., Horst, K. C. 2016; 34 (9): 902-909

  Abstract

  The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab to docetaxel and trastuzumab (THP) as first-line treatment for patients with human epidermal growth factor receptor 2 (HER2) -overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of adding pertuzumab.We developed a decision-analytic Markov model to evaluate the cost effectiveness of docetaxel plus trastuzumab (TH) with or without pertuzumab in US patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in US dollars, and cost effectiveness expressed as an incremental cost-effectiveness ratio. One- and multiway deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions.Modeled median survival was 39.4 months for TH and 56.9 months for THP. The addition of pertuzumab resulted in an additional 1.82 life-years gained, or 0.64 QALYs, at a cost of $713,219 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost effectiveness at a willingness to pay of $100,000 per QALY gained.THP in patients with metastatic HER2-positive breast cancer is unlikely to be cost effective in the United States.

  View details for DOI 10.1200/JCO.2015.62.9105

  View details for PubMedID 26351332

• A Pilot Study of Electronic Quality of Life Assessments Using Tablet Devices During and After Treatment of Head and Neck Cancers Wang, E., Pollom, E., Bui, T., Ognibene, G., von Eyben, R., Divi, V., Sunwoo, J., Kaplan, M., Colevas, A. D., Le, Q. T., Hara, W. ELSEVIER SCIENCE INC. 2016: 969

  View details for DOI 10.1016/j.ijrobp.2015.12.343

  View details for Web of Science ID 000371581900289

• Cost-effectiveness of pertuzumab in HER2+metastatic breast cancer Qian, Y., Durkee, B. Y., Pollom, E. L., King, M., Dudley, S. A., Shaffer, J. B., Chang, D. T., Gibbs, I. C., Goldhaber-Fiebert, J. D., Horst, K. C. AMER ASSOC CANCER RESEARCH. 2016

  View details for DOI 10.1158/1538-7445.SABCS15-P6-11-01

  View details for Web of Science ID 000375622403068

• Albumin and Neutrophil-Lymphocyte Ratio (NLR) Predict Survival in Patients With Pancreatic Adenocarcinoma Treated With SBRT. American journal of clinical oncology Alagappan, M., Pollom, E. L., von Eyben, R., Kozak, M. M., Aggarwal, S., Poultsides, G. A., Koong, A. C., Chang, D. T. 2016: -?

  Abstract

  To determine if pretreatment nutritional status and inflammatory markers correlate with survival in patients with locally advanced pancreatic adenocarcinoma treated with stereotactic body radiotherapy (SBRT).We retrospectively reviewed 208 patients with newly diagnosed, locally advanced pancreatic adenocarcinoma treated with SBRT at our institution from 2002 to 2014. Laboratory values were collected before SBRT, including hemoglobin, platelets, albumin, red blood cell, white blood cell, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and tumor markers CA 19-9 and CEA. Patients were followed every 3 months with computed tomography (CT) and/or positron emission tomography-CT imaging to monitor for local recurrence and overall survival (OS).Median follow-up after SBRT was 7.5 months (interquartile range, 4.6 to 12.0 mo) for all patients. Median OS for patients with NLR>5 compared with NLR≤5 was 6.9 and 8.5 months, respectively (P=0.0057). On univariate analysis, receipt of chemotherapy (P=0.05, hazard ratio [HR]=0.69), increased albumin (P=0.002, HR=0.64), increased red blood cell (P=0.05, HR=0.75), increased lymphocyte count (P=0.002, HR=0.66), decreased CEA (P=0.01, HR=0.96), and NLR≤5 (P=0.01, HR=0.65) correlated with improved OS. On multivariate analysis, higher albumin (P=0.03, HR=0.70), receipt of chemotherapy (P=0.007, HR=0.56), and NLR≤5 (P=0.02, HR=0.66) correlated with better survival.Preradiotherapy low albumin levels and NLR>5 correlate with decreased survival in patients with locally advanced pancreatic adenocarcinoma treated with SBRT, indicating the prognostic value of systemic inflammatory markers (such as NLR) and a role of nutritional supplementation to improve outcomes in these patients. Further investigation is warranted.

  View details for PubMedID 26757436

• A prospective study of electronic quality of life assessment using tablet devices during and after treatment of head and neck cancers. Oral oncology Pollom, E. L., Wang, E., Bui, T. T., Ognibene, G., von Eyben, R., Divi, V., Sunwoo, J., Kaplan, M., Dimitri Colevas, A., Le, Q., Hara, W. Y. 2015; 51 (12): 1132-1137

  Abstract

  Electronic data collection is increasingly used for quality of life (QOL) assessments in the field of oncology. It is important to assess the feasibility of these new data capture technologies.Patients at our institution who were 18years or older with a pathological diagnosis of head and neck cancer were prospectively enrolled. Each patient completed two questionnaires [EORTC-QLQ-C30 and EORTC-QLQ-H&N35] administered on a touch-screen tablet device (iPad™) at initial consult, during treatment, at the completion of treatment and at each subsequent follow up visit for one year after treatment.A total of 50 patients were included in this study. Although all patients completed the surveys at the initial consult, 86% of initially enrolled patients completed surveys at the end of radiation treatment, and 48% of initially enrolled patients completed surveys by the fourth follow-up visit. Average time to complete the survey for all patients over all time points was 9.8min (standard deviation 6.1). Age as a continuous variable was significantly associated with time for survey completion (p<0.001), with older age associated with longer survey completion times.QOL assessment using tablet devices in head and neck cancer patients is feasible, but may be more challenging in elderly patients. Patients ⩾70years old may benefit from more assistance with electronic forms and should be allotted more time for completing tablet-based QOL surveys.

  View details for DOI 10.1016/j.oraloncology.2015.10.003

  View details for PubMedID 26475062

• Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Wahl, D. R., Stenmark, M. H., Tao, Y., Pollom, E. L., Caoili, E. M., Lawrence, T. S., Schipper, M. J., Feng, M. 2015

  Abstract

  Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC.From 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed.RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P < .001). One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors ≥ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT.Both RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC.

  View details for DOI 10.1200/JCO.2015.61.4925

  View details for PubMedID 26628466

• Neurocognitive Preservation for Whole-Brain Radiation Therapy is Cost-Effective for Well Selected Patients Durkee, B. Y., Sanford, J., Oh, A., Slate, D., Turner, B., Pollom, E., Gibbs, I. C., Gondi, V., Soltys, S. G. ELSEVIER SCIENCE INC. 2015: S91

  View details for DOI 10.1016/j.ijrobp.2015.07.219

  View details for Web of Science ID 000373215301878

• A Single-Institution Study of Pathologic Predictors of Lymph Node Metastasis in Uterine Serous Carcinoma Pollom, E., Seiger, K., von Eyben, R., Folkins, A., Kidd, E. A. ELSEVIER SCIENCE INC. 2015: E270

  View details for DOI 10.1016/j.ijrobp.2015.07.1228

  View details for Web of Science ID 000373215300670

• Radiomic Analysis of FDG-PET Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated With SBRT Cui, Y., Song, J., Pollom, E., Shirato, H., Chang, D. T., Koong, A. C., Li, R. ELSEVIER SCIENCE INC. 2015: S4–S5

  View details for DOI 10.1016/j.ijrobp.2015.07.017

  View details for Web of Science ID 000373215301679

• Fractionation of palliative radiotherapy in metastatic breast cancer: Selection and survival Qian, Y., Dudley, S., Durkee, B. Y., Kumar, K., Chaudhuri, A., Pollom, E. L., Aggarwal, S., Horst, K. C., Chang, D. AMER SOC CLINICAL ONCOLOGY. 2015

  View details for DOI 10.1200/jco.2015.33.29_suppl.201

  View details for Web of Science ID 000378107000196

• Concurrent Vismodegib and Radiotherapy for Recurrent, Advanced Basal Cell Carcinoma. JAMA dermatology Pollom, E. L., Bui, T. T., Chang, A. L., Colevas, A. D., Hara, W. Y. 2015; 151 (9): 998-1001

  Abstract

  Vismodegib is a targeted agent recently approved for treating patients who develop recurrent or locally advanced basal cell carcinoma (BCC), and will inevitably be integrated into existing therapy for advanced BCC as it becomes increasingly used. Improved understanding of how vismodegib interacts with other treatment modalities, including radiotherapy, would help optimize multidisciplinary therapy and clinical outcomes.We report 2 cases of recurrent, advanced BCC treated from April 1, 2012, through October 31, 2014, with concurrent radiotherapy and vismodegib. Concurrent treatment appeared to be well tolerated and efficacious, with both patients having no evidence of progressive disease at last follow-up.We found that the combination of vismodegib and radiotherapy is feasible for patients with recurrent or locally advanced BCC and that combined use of currently available therapies for advanced BCC warrants further prospective study.

  View details for DOI 10.1001/jamadermatol.2015.0326

  View details for PubMedID 25874733

• Treatment Approaches to Locally Advanced Pancreatic Adenocarcinoma. Hematology/oncology clinics of North America Pollom, E. L., Koong, A. C., Ko, A. H. 2015; 29 (4): 741-759

  Abstract

  This article focuses on the management of locally advanced pancreatic cancer, which should be treated as a distinct entity separate from metastatic disease and borderline resectable disease. Although the role, timing, and sequencing of radiation relative to systemic therapy in this disease are controversial, an emerging treatment paradigm involves induction chemotherapy, followed by consolidative chemoradiation in patients who do not progress. In addition, new chemotherapy regimens as well as novel radiosensitizers have shown promise and need to be tested further in the locally advanced setting. Advances in radiotherapy have enabled stereotactic body radiotherapy and should continue to be prospectively evaluated.

  View details for DOI 10.1016/j.hoc.2015.04.005

  View details for PubMedID 26226908

• Gastrointestinal Toxicities With Combined Antiangiogenic and Stereotactic Body Radiation Therapy INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Pollom, E. L., Deng, L., Pai, R. K., Brown, J. M., Giaccia, A., Loo, B. W., Shultz, D. B., Quynh Thu Le, Q. T., Koong, A. C., Chang, D. T. 2015; 92 (3): 568-576

  Abstract

  Combining the latest targeted biologic agents with the most advanced radiation technologies has been an exciting development in the treatment of cancer patients. Stereotactic body radiation therapy (SBRT) is an ablative radiation approach that has become established for the treatment of a variety of malignancies, and it has been increasingly used in combination with biologic agents, including those targeting angiogenesis-specific pathways. Multiple reports have emerged describing unanticipated toxicities arising from the combination of SBRT and angiogenesis-targeting agents, particularly of late luminal gastrointestinal toxicities. In this review, we summarize the literature describing these toxicities, explore the biological mechanism of action of toxicity with the combined use of antiangiogenic therapies, and discuss areas of future research, so that this combination of treatment modalities can continue to be used in broader clinical contexts.

  View details for DOI 10.1016/j.ijrobp.2015.02.016

  View details for Web of Science ID 000355636800018

• TU-CD-BRB-08: Radiomic Analysis of FDG-PET Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated with SBRT. Medical physics Cui, Y., Song, J., Pollom, E., Shirato, H., Chang, D., Koong, A., Li, R. 2015; 42 (6): 3604-?

  Abstract

  This study aims to identify novel prognostic imaging biomarkers in locally advanced pancreatic cancer (LAPC) using quantitative, high-throughput image analysis.86 patients with LAPC receiving chemotherapy followed by SBRT were retrospectively studied. All patients had a baseline FDG-PET scan prior to SBRT. For each patient, we extracted 435 PET imaging features of five types: statistical, morphological, textural, histogram, and wavelet. These features went through redundancy checks, robustness analysis, as well as a prescreening process based on their concordance indices with respect to the relevant outcomes. We then performed principle component analysis on the remaining features (number ranged from 10 to 16), and fitted a Cox proportional hazard regression model using the first 3 principle components. Kaplan-Meier analysis was used to assess the ability to distinguish high versus low-risk patients separated by median predicted survival. To avoid overfitting, all evaluations were based on leave-one-out cross validation (LOOCV), in which each holdout patient was assigned to a risk group according to the model obtained from a separate training set.For predicting overall survival (OS), the most dominant imaging features were wavelet coefficients. There was a statistically significant difference in OS between patients with predicted high and low-risk based on LOOCV (hazard ratio: 2.26, p<0.001). Similar imaging features were also strongly associated with local progression-free survival (LPFS) (hazard ratio: 1.53, p=0.026) on LOOCV. In comparison, neither SUVmax nor TLG was associated with LPFS (p=0.103, p=0.433) (Table 1). Results for progression-free survival and distant progression-free survival showed similar trends.Radiomic analysis identified novel imaging features that showed improved prognostic value over conventional methods. These features characterize the degree of intra-tumor heterogeneity reflected on FDG-PET images, and their biological underpinnings warrant further investigation. If validated in large, prospective cohorts, this method could be used to stratify patients based on individualized risk.

  View details for DOI 10.1118/1.4925593

  View details for PubMedID 26128895

• TU-AB-BRA-10: Prognostic Value of Intra-Radiation Treatment FDG-PET and CT Imaging Features in Locally Advanced Head and Neck Cancer. Medical physics Song, J., Cui, Y., Pollom, E., Durkee, B., Aggarwal, S., Bui, T., Le, Q., Loo, B., Hara, W., Li, R. 2015; 42 (6): 3588-?

  Abstract

  To predict response to radiation treatment using computational FDG-PET and CT images in locally advanced head and neck cancer (HNC).68 patients with State III-IVB HNC treated with chemoradiation were included in this retrospective study. For each patient, we analyzed primary tumor and lymph nodes on PET and CT scans acquired both prior to and during radiation treatment, which led to 8 combinations of image datasets. From each image set, we extracted high-throughput, radiomic features of the following types: statistical, morphological, textural, histogram, and wavelet, resulting in a total of 437 features. We then performed unsupervised redundancy removal and stability test on these features. To avoid over-fitting, we trained a logistic regression model with simultaneous feature selection based on least absolute shrinkage and selection operator (LASSO). To objectively evaluate the prediction ability, we performed 5-fold cross validation (CV) with 50 random repeats of stratified bootstrapping. Feature selection and model training was solely conducted on the training set and independently validated on the holdout test set. Receiver operating characteristic (ROC) curve of the pooled Result and the area under the ROC curve (AUC) was calculated as figure of merit.For predicting local-regional recurrence, our model built on pre-treatment PET of lymph nodes achieved the best performance (AUC=0.762) on 5-fold CV, which compared favorably with node volume and SUVmax (AUC=0.704 and 0.449, p<0.001). Wavelet coefficients turned out to be the most predictive features. Prediction of distant recurrence showed a similar trend, in which pre-treatment PET features of lymph nodes had the highest AUC of 0.705.The radiomics approach identified novel imaging features that are predictive to radiation treatment response. If prospectively validated in larger cohorts, they could aid in risk-adaptive treatment of HNC.

  View details for DOI 10.1118/1.4925515

  View details for PubMedID 26128812

• Prognostic value of mid-treatment total lesion glycolysis in p16+oropharyngeal cancer Pollom, E. L., Song, J., Durkee, B. Y., Aggarwal, S., Bui, T., Li, R., Quynh-Thu Le, Loo, B. W., Hara, W. AMER SOC CLINICAL ONCOLOGY. 2015

  View details for Web of Science ID 000358036901362

• Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era. International journal of radiation oncology, biology, physics Hiniker, S. M., Pollom, E. L., Khodadoust, M. S., Kozak, M. M., Xu, G., Quon, A., Advani, R. H., Hoppe, R. T. 2015; 92 (1): 99-106

  Abstract

  The role of surveillance studies in limited-stage diffuse large B-cell lymphoma (DLBCL) in the rituximab era has not been well defined. We sought to evaluate the use of imaging (computed tomography [CT] and positron emission tomography [PET]-CT) scans and lactate dehydrogenase (LDH) in surveillance of patients with stage I to II DLBCL.A retrospective analysis was performed of patients who received definitive treatment between 2000 and 2013.One hundred sixty-two consecutive patients with stage I to II DLBCL were treated with chemotherapy +/- rituximab, radiation, or combined modality therapy. The 5-year rates of overall survival (OS) and freedom from progression (FFP) were 81.2% and 80.8%, respectively. Of the 162 patients, 124 (77%) were followed up with at least 1 surveillance PET scan beyond end-of-treatment scans; of those, 94 of 124 (76%) achieved a complete metabolic response on PET scan after completion of chemotherapy, and this was associated with superior FFP (P=.01, HR=0.3) and OS (P=.01, HR 0.3). Eighteen patients experienced relapse after initial response to therapy. Nine relapses were initially suspected by surveillance imaging studies (8 PET, 1 CT), and 9 were suspected clinically (5 by patient-reported symptoms and 4 by symptoms and physical examination). No relapses were detected by surveillance LDH. The median duration from initiation of treatment to relapse was 14.3 months among patients with relapses suspected by imaging, and 59.8 months among patients with relapses suspected clinically (P=.077). There was no significant difference in OS from date of first therapy or OS after relapse between patients whose relapse was suspected by imaging versus clinically. Thirteen of 18 patients underwent successful salvage therapy after relapse.A complete response on PET scan immediately after initial chemotherapy is associated with superior FFP and OS in stage I to II DLBCL. The use of PET scans as posttreatment surveillance is not associated with a survival advantage. LDH is not a sensitive marker for relapse. Our results argue for limiting the use of posttreatment surveillance in patients with limited-stage DLBCL.

  View details for DOI 10.1016/j.ijrobp.2015.01.039

  View details for PubMedID 25863757

• Pretreatment lab values to predict overall survival in patients with primary unresectable pancreatic adenocarcinoma treated with SBRT Alagappan, M., Pollom, E. L., von Eyben, R., Kunz, P. L., Fisher, G. A., Ford, J. M., Poultsides, G. A., Visser, B. C., Norton, J. A., Kamaya, A., Columbo, L., Koong, A., Chang, D. AMER SOC CLINICAL ONCOLOGY. 2015

  View details for DOI 10.1200/jco.2015.33.3_suppl.433

  View details for Web of Science ID 000356883800431

• Single-versus Multifraction Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma: Outcomes and Toxicity INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Pollom, E. L., Alagappan, M., von Eyben, R., Kunz, P. L., Fisher, G. A., Ford, J. A., Poultsides, G. A., Visser, B. C., Norton, J. A., Kamaya, A., Cox, V. L., Columbo, L. A., Koong, A. C., Chang, D. T. 2014; 90 (4): 918-925

  Abstract

  We report updated outcomes of single- versus multifraction stereotactic body radiation therapy (SBRT) for unresectable pancreatic adenocarcinoma.We included 167 patients with unresectable pancreatic adenocarcinoma treated at our institution from 2002 to 2013, with 1-fraction (45.5% of patient) or 5-fraction (54.5% of patients) SBRT. The majority of patients (87.5%) received chemotherapy.Median follow-up was 7.9 months (range: 0.1-63.6). The 6- and 12-month cumulative incidence rates (CIR) of local recurrence for patients treated with single-fraction SBRT were 5.3% (95% confidence interval [CI], 0.2%-10.4%) and 9.5% (95% CI, 2.7%-16.2%), respectively. The 6- and 12-month CIR with multifraction SBRT were 3.4% (95% CI, 0.0-7.2%) and 11.7% (95% CI, 4.8%-18.6%), respectively. Median survival from diagnosis for all patients was 13.6 months (95% CI, 12.2-15.0 months). The 6- and 12- month survival rates from SBRT for the single-fraction group were 67.0% (95% CI, 57.2%-78.5%) and 30.8% (95% CI, 21.9%-43.6%), respectively. The 6- and 12- month survival rates for the multifraction group were 75.7% (95% CI, 67.2%-85.3%) and 34.9% (95% CI, 26.1%-46.8%), respectively. There were no differences in CIR or survival rates between the single- and multifraction groups. The 6- and 12-month cumulative incidence rates of gastrointestinal toxicity grade ≥3 were 8.1% (95% CI, 1.8%-14.4%) and 12.3% (95% CI, 4.7%-20.0%), respectively, in the single-fraction group, and both were 5.6% (95% CI, 0.8%-10.5%) in the multifraction group. There were significantly fewer instances of toxicity grade ≥2 with multifraction SBRT (P=.005). Local recurrence and toxicity grade ≥2 were independent predictors of worse survival.Multifraction SBRT for pancreatic cancer significantly reduces gastrointestinal toxicity without compromising local control.

  View details for DOI 10.1016/j.ijrobp.2014.06.066

  View details for Web of Science ID 000344734300029

• Single- versus multifraction stereotactic body radiation therapy for pancreatic adenocarcinoma: outcomes and toxicity. International journal of radiation oncology, biology, physics Pollom, E. L., Alagappan, M., von Eyben, R., Kunz, P. L., Fisher, G. A., Ford, J. A., Poultsides, G. A., Visser, B. C., Norton, J. A., Kamaya, A., Cox, V. L., Columbo, L. A., Koong, A. C., Chang, D. T. 2014; 90 (4): 918-925

  Abstract

  We report updated outcomes of single- versus multifraction stereotactic body radiation therapy (SBRT) for unresectable pancreatic adenocarcinoma.We included 167 patients with unresectable pancreatic adenocarcinoma treated at our institution from 2002 to 2013, with 1-fraction (45.5% of patient) or 5-fraction (54.5% of patients) SBRT. The majority of patients (87.5%) received chemotherapy.Median follow-up was 7.9 months (range: 0.1-63.6). The 6- and 12-month cumulative incidence rates (CIR) of local recurrence for patients treated with single-fraction SBRT were 5.3% (95% confidence interval [CI], 0.2%-10.4%) and 9.5% (95% CI, 2.7%-16.2%), respectively. The 6- and 12-month CIR with multifraction SBRT were 3.4% (95% CI, 0.0-7.2%) and 11.7% (95% CI, 4.8%-18.6%), respectively. Median survival from diagnosis for all patients was 13.6 months (95% CI, 12.2-15.0 months). The 6- and 12- month survival rates from SBRT for the single-fraction group were 67.0% (95% CI, 57.2%-78.5%) and 30.8% (95% CI, 21.9%-43.6%), respectively. The 6- and 12- month survival rates for the multifraction group were 75.7% (95% CI, 67.2%-85.3%) and 34.9% (95% CI, 26.1%-46.8%), respectively. There were no differences in CIR or survival rates between the single- and multifraction groups. The 6- and 12-month cumulative incidence rates of gastrointestinal toxicity grade ≥3 were 8.1% (95% CI, 1.8%-14.4%) and 12.3% (95% CI, 4.7%-20.0%), respectively, in the single-fraction group, and both were 5.6% (95% CI, 0.8%-10.5%) in the multifraction group. There were significantly fewer instances of toxicity grade ≥2 with multifraction SBRT (P=.005). Local recurrence and toxicity grade ≥2 were independent predictors of worse survival.Multifraction SBRT for pancreatic cancer significantly reduces gastrointestinal toxicity without compromising local control.

  View details for DOI 10.1016/j.ijrobp.2014.06.066

  View details for PubMedID 25585785

• Pooled Analysis of Liver Stereotactic Body Radiation Therapy for Colorectal Metastases: Results From 5 Institutions Shaffer, J., Feng, M. U., Pollom, E., Stenmark, M. H., Tang, M., Monroe, A. T., Lee, P., Merrell, K. W., Olivier, K. R., Koong, A. C., Chang, D. T. ELSEVIER SCIENCE INC. 2014: S376

  View details for DOI 10.1016/j.ijrobp.2014.05.1210

  View details for Web of Science ID 000342331401308

• Pooled Analysis of Stereotactic Body Radiation Therapy for Liver Tumors: Results From 5 Institutions Shaffer, J., Feng, M. U., Pollom, E., Stenmark, M. H., Tang, M., Monroe, A. T., Merrell, K. W., Lee, P., Olivier, K. R., Koong, A. C., Chang, D. T. ELSEVIER SCIENCE INC. 2014: S380–S381

  View details for DOI 10.1016/j.ijrobp.2014.05.1223

  View details for Web of Science ID 000342331401321

• Surgical Outcomes Following Chemotherapy and Stereotactic Body Radiation Therapy in Patients With Borderline and Unresectable Pancreatic Cancer Moningi, S., Dholakia, A. S., Raman, S., Hacker-Prietz, A., Pawlik, T., Zheng, L., Pollom, E., Weiss, M., Laheru, D., Wolfgang, C., Chang, D. T., Koong, A. C., Herman, J. M. ELSEVIER SCIENCE INC. 2014: S366–S367

  View details for DOI 10.1016/j.ijrobp.2014.05.1186

  View details for Web of Science ID 000342331401284

• Pooled Analysis of Liver Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Results From a Multi-institution Study Chang, D. T., Shaffer, J., Pollom, E., Stenmark, M. H., Tang, M., Merrell, K. W., Lee, P., Olivier, K. R., Koong, A. C., Feng, M. U. ELSEVIER SCIENCE INC. 2014: S376

  View details for DOI 10.1016/j.ijrobp.2014.05.1211

  View details for Web of Science ID 000342331401309

• Stereotactic Body Radiotherapy for Pancreatic Adenocarcinoma: Single versus Multi-Fraction Pollom, E., Alagappan, M., Cox, V., Kamaya, A., Kunz, P., Poultsides, G., Visser, B., Koong, A., Chang, D. ELSEVIER SCIENCE INC. 2014: S50

  View details for DOI 10.1016/j.ijrobp.2014.05.184

  View details for Web of Science ID 000342331400113

• Prognostic Factors, Treatment, and Outcomes of Limited-Stage Diffuse Large B-Cell Lymphoma (DLBCL) in the Rituximab (R) Era Hiniker, S. M., Pollom, E. L., Khodadoust, M. S., Kozak, M. M., Advani, R. H., Hoppe, R. T. ELSEVIER SCIENCE INC. 2014: S677–S678

  View details for DOI 10.1016/j.ijrobp.2014.05.1993

  View details for Web of Science ID 000342331402400

• Lymphovascular Space Invasion Is an Important Prognostic Factor for Lymph Node Metastases in Endometrioid Endometrial Cancer Pollom, E., Conklin, C., Von Eyben, R., Folkins, A., Kidd, E. ELSEVIER SCIENCE INC. 2014: S186–S187

  View details for DOI 10.1016/j.ijrobp.2014.05.715

  View details for Web of Science ID 000342331400430

• SBRT Provides Equivalent Local Control Compared to RFA for the Treatment of Hepatocellular Carcinoma With Minimal Toxicity Wahl, D. R., Stenmark, M. H., Pollom, E., Tao, Y., Lee, O. E., Schipper, M. J., Caoili, E. M., Ben-Josef, E., Lawrence, T. S., Feng, M. ELSEVIER SCIENCE INC. 2014: S378–S379

  View details for DOI 10.1016/j.ijrobp.2014.05.1218

  View details for Web of Science ID 000342331401316

• Value of surveillance studies for patients (pts) with stage I-II diffuse large B-cell lymphoma (DLBCL) in the rituximab (R) era. Hiniker, S. M., Pollom, E. L., Khodadoust, M. S., Kozak, M. M., Advani, R. H., Hoppe, R. T. AMER SOC CLINICAL ONCOLOGY. 2014

  View details for Web of Science ID 000358613204223

• Outcomes and toxicity of SBRT for patients with unresectable pancreatic adenocarcinoma Pollom, E. L., Alagappan, M., Chan, C., Shultz, D., Kunz, P. L., Koong, A., Chang, D. AMER SOC CLINICAL ONCOLOGY. 2014

  View details for DOI 10.1200/jco.2014.32.3_suppl.317

  View details for Web of Science ID 000333682100318

• Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors TRANSLATIONAL ONCOLOGY Liu, E., Stenmark, M. H., Schipper, M. J., Balter, J. M., Kessler, M. L., Caoili, E. M., Lee, O. E., Ben-Josef, E., Lawrence, T. S., Feng, M. 2013; 6 (4): 442-446

  Abstract

  The full potential of stereotactic body radiation therapy (SBRT), in the treatment of unresectable intrahepatic malignancies, has yet to be realized as our experience is still limited. Thus, we evaluated SBRT outcomes for primary and metastatic liver tumors, with the goal of identifying factors that may aid in optimization of therapy.From 2005 to 2010, 62 patients with 106 primary and metastatic liver tumors were treated with SBRT to a median biologic effective dose (BED) of 100 Gy (42.6-180). The majority of patients received either three (47%) or five fractions (48%). Median gross tumor volume (GTV) was 8.8 cm(3) (0.2-222.4).With a median follow-up of 18 months (0.46-46.8), freedom from local progression (FFLP) was observed in 97 of 106 treated tumors, with 1- and 2-year FFLP rates of 93% and 82%. Median overall survival (OS) for all patients was 25.2 months, with 1- and 2-year OS of 81% and 52%. Neither BED nor GTV significantly predicted for FFLP. Local failure was associated with a higher risk of death [hazard ratio (HR) = 5.1, P = .0007]. One Child-Pugh Class B patient developed radiation-induced liver disease. There were no other significant toxicities.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.

  View details for DOI 10.1593/tlo.12448

  View details for Web of Science ID 000328361500007

  View details for PubMedID 23908687

• Selective radiosensitization of p53 mutant pancreatic cancer cells by combined inhibition of Chk1 and PARP1 CELL CYCLE Vance, S. M., Liu, E., Zhao, L., Parsels, J. D., Parsels, L. A., Brown, J. L., Maybaum, J., Lawrence, T. S., Morgan, M. A. 2011; 10 (24): 4321-4329

  Abstract

  We have recently shown that inhibition of HRR (homologous recombination repair) by Chk1 (checkpoint kinase 1) inhibition radiosensitizes pancreatic cancer cells and others have demonstrated that Chk1 inhibition selectively sensitizes p53 mutant tumor cells. Furthermore, PARP1 [poly (ADP-ribose) polymerase-1] inhibitors dramatically radiosensitize cells with DNA double strand break repair defects. Thus, we hypothesized that inhibition of HRR (mediated by Chk1 via AZD7762) and PARP1 [via olaparib (AZD2281)] would selectively sensitize p53 mutant pancreatic cancer cells to radiation. We also used 2 isogenic p53 cell models to assess the role of p53 status in cancer cells and intestinal epithelial cells to assess overall cancer specificity. DNA damage response and repair were assessed by flow cytometry, γH2AX, and an HRR reporter assay. We found that the combination of AZD7762 and olaparib produced significant radiosensitization in p53 mutant pancreatic cancer cells and in all of the isogenic cancer cell lines. The magnitude of radiosensitization by AZD7762 and olaparib was greater in p53 mutant cells compared with p53 wild type cells. Importantly, normal intestinal epithelial cells were not radiosensitized. The combination of AZD7762 and olaparib caused G 2 checkpoint abrogation, inhibition of HRR, and persistent DNA damage responses. These findings demonstrate that the combination of Chk1 and PARP1 inhibition selectively radiosensitizes p53 mutant pancreatic cancer cells. Furthermore, these studies suggest that inhibition of HRR by Chk1 inhibitors may be a useful strategy for selectively inducing a BRCA1/2 'deficient-like' phenotype in p53 mutant tumor cells, while sparing normal tissue.

  View details for DOI 10.4161/cc.10.24.18661

  View details for Web of Science ID 000298407200033

  View details for PubMedID 22134241

• Resident Workload, Pager Communications, and Quality of Care 5th Annual Academic Surgical Congress Patel, S. P., Lee, J. S., Ranney, D. N., Al-Holou, S. N., Frost, C. M., Harris, M. E., Lewin, S. A., Liu, E., Madenci, A., Majkrzak, A. A., Nelson, J., Peterson, S. F., Serecky, K. A., Wilkinson, D. A., Wojcik, B. M., Englesbe, M. J., Lynch, R. J. SPRINGER. 2010: 2524–29

  Abstract

  With the recent regulations limiting resident work hours, it has become more important to understand how residents spend their time. The volume and content of the pages they receive provide a valuable source of information that give insight into their workload and help identify inefficiencies in hospital communication. We hypothesized that above a certain workload threshold, paging data would suggest breakdowns in communication and implications for quality of care. All pages sent to six general surgery interns at the University of Michigan over the course of one academic year (7/1/2008-6/30/2009) were retrospectively categorized by sender type, message type, message modifier, and message quality. Census, discharge, and admission information for each intern service were also collected, and intern duties were further analyzed with respect to schedule. "On-call" days were defined as days on which the intern bore responsibility for care of all admitted floor patients. The interns received a total of 9,843 pages during the study period. During on-call shifts, each intern was paged an average of 57 ± 3 times, and those on non-call shifts received an average of 12 ± 3 pages. Floor/intensive care unit (ICU) nurses represented 32% of the page volume received by interns. Interestingly, as patient volume increased, there was a decrease in the number of pages received per patient. By contrast, at higher patient volumes, there was a trend toward an increasing percentage of urgent pages per patient. At high intern workloads, our data suggest no major communication breakdowns but reveal the potential for inferior quality of care.

  View details for DOI 10.1007/s00268-010-0740-9

  View details for Web of Science ID 000282506500004

  View details for PubMedID 20703470

• Connectivity Need Not Come at the Expense of Professionalism ACADEMIC MEDICINE Parikh, S. M., Liu, E., White, C. B. 2010; 85 (6): 930-930

  View details for DOI 10.1097/ACM.0b013e3181dbe54b

  View details for Web of Science ID 000279377300004

  View details for PubMedID 20505384

• Reirradiation with stereotactic body radiation therapy after prior conventional fractionation radiation for locally recurrent pancreatic adenocarcinoma. Advances in radiation oncology Koong, A. J., Toesca, D. A., von Eyben, R. n., Pollom, E. L., Chang, D. T. ; 2 (1): 27–36

  Abstract

  Locally recurrent pancreatic cancer after prior radiotherapy is a therapeutic challenge with limited treatment options. This study examines the safety and efficacy of stereotactic body radiation therapy (SBRT) for locally recurrent pancreatic adenocarcinoma after prior conventional fractionation radiotherapy (CRT).Outcomes from all patients treated with SBRT for locally recurrent pancreatic adenocarcinoma after prior CRT at our institution were reviewed. A total of 23 patients were identified. Prior CRT median dose was 50.4 Gy (range, 30-60 Gy). Twelve patients (52%) had previously undergone surgery and received CRT as neo- or adjuvant treatment. Nine patients (39.1%) were reirradiated with SBRT with a dose of 25 Gy in a single fraction, and 14 patients (60.8%) received a 5-fraction SBRT schedule with a median dose of 25 Gy (range, 20-33 Gy) in 5 fractions (1-5 fractions).Median follow-up time was 28 months (range, 9-77 months). The median planning target volume was 46 cm(3) (range, 14-89 cm(3)). Median overall survival from diagnosis and from reirradiation were 27.5 months (range, 10-77 months) and 8.5 months (range, 1 month to not reached) respectively. The cumulative incidence of local failures at the last follow-up was 19%. For the 4 patients who presented with local failure, one was treated with a single fraction of 25 Gy, and the other 3 were treated with 25 Gy in 5 fractions. Three patients presented regional failure, with a cumulative incidence of 14%, all with concurrent distant progression. The cumulative incidence of distant progression was 64% at last follow-up. After reirradiation, 6 patients (26.1%) developed a grade 2 or 3 gastrointestinal toxicity, 4 of them occurring among patients treated with a single-fraction SBRT regimen.Our report shows that SBRT for reirradiation of locally recurrent pancreas adenocarcinoma is a feasible option with good local control and acceptable toxicity rates, especially with a multifraction schedule.

  View details for PubMedID 28740913

• The Impact of Chemotherapy Regimen and Radiation Dose of Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Adenocarcinoma 59th Annual Meeting of the American-Society-for-Radiation-Oncology (ASTRO) Toesca, D. A., Pollom, E. L., von Eyben, R., Koong, A. C., Chang, D. T. 2017: E193

  View details for DOI 10.1016/j.ijrobp.2017.06.1063

• Predicting Pancreatic Cancer Resectability and Outcomes Based on an Objective Quantitative Scoring System. Pancreas Toesca, D. A., Jeffrey, R. B., von Eyben, R. n., Pollom, E. L., Poullos, P. D., Poultsides, G. A., Fisher, G. A., Visser, B. C., Koong, A. C., Chang, D. T. ; 48 (5): 622–28

  Abstract

  To quantitatively assess the probability of tumor resection based on measurements of tumor contact with the major peripancreatic vessels.This is a retrospective cohort study of pancreatic cancer patients treated between January 2001 and December 2015 in a single academic comprehensive cancer center. Radiographic measurements of the circumferential degree and length of solid tumor contact with major peripancreatic vessels were obtained from diagnostic pancreatic protocol computed tomography images and tested for correlation with tumor resection and margin status.Of 294 patients analyzed, 113 (38%) were resected, with 71 (63%) with negative margins. Based on the individual measurements of vascular involvement, a resectability scoring system (RSS) was created. The RSS correlated strongly with resection (P < 0.0001) and R0 resection (P < 0.0001) probabilities. Moreover, the RSS correlated with overall survival (P < 0.0001) and metastasis-free survival (P < 0.0001), being able to substratify resectable (P = 0.022) and unresectable patients (P = 0.014) into subgroups with different prognosis based on RSS scores.Based on a comprehensive and systematic quantitative approach, we developed a scoring system that demonstrated excellent accuracy to predict tumor resection, surgical margin status, and prognosis.

  View details for PubMedID 31091207