Author: Caleb Dulaney

This meta-analysis of >5000 patients with >32,000 brain mets found that the rate of hippocampal 4.4%, and the rate of perihippocampal mets was 9.2%. Among patients treated with hippocampal avoidance, the failure rate was 4.5%. | Wiegreffe, Radiother Oncol 2024

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Immunotherapy has had disappointing outcomes in head and neck cancer. In this prospective phase 2 trial, 51 patients with recurrent or second primary HNSCC received nivolumab concurrent with reirradiation. The prescription dose was 60-66 Gy in 30-33 fractions, and nivo was given concurrently and up to 52 weeks total after radiation. The rate of PFS at 1 year was 61.7%, which exceeded their historical control of 43.8%. Grade 3+ toxicity was relatively low at 12%. | Saba, JAMA Oncol 2024

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Top Line: Can SBRT be used to treat mediastinal nodes?The Study: As much as we fret over using SBRT for ultracentral lung tumors overlapping with mediastinal structures, you would think SBRT for mediastinal nodes would be out of the question. This single-arm phase 2 trial from Italy evaluated the safety of using SBRT to treat oligometastatic mediastinal nodes. It included 32 patients with 41 mediastinal lymph nodes metastases. Eligible patients could have up to 3 mediastinal nodal oligomets and any primary histology, but most (40%) had NSCLC followed by breast (16%). The most common involved nodal stations were the hilum…

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Here is a fascinating review of HPV-driven cancers from oropharynx to nether regions and in between with a particular focus on how modern prevention strategies may eradicate (dare we say…cure…) this disease altogether. | Malagón, Nat Rev Clin Oncol 2024

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A qualitative study delved into the complicated nature of establishing oncologic care for head and neck cancer. A few common, if unsurprising, themes emerged. First, a stopgap is getting in to see a primary care physician or dentist in a timely manner once symptoms emerge. Even then, there needs to be a clear sense of urgency communicated to specialized physicians receiving the referrals. From there, the triage pathway is fragmented, meaning several steps must happen, some sequentially and some in parallel, which can be very confusing to patients and their support system. Finally, ease of communication with the healthcare team…

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Top Line: Does moderately hypofractionated prostate radiation hold up against standard fractionation after >10 years?The Study: RTOG 0415 helped establish moderate hypofractionation using 70 Gy in 28 fractions as a widely used regimen for prostate cancer. Here we have long-term results from 0415. As a reminder, over 1000 patients with low risk prostate cancer were randomized to receive 70 Gy in 28 fractions or 73.8 Gy in 41 fractions. The dose constraints in the hypofrac arm were somewhat loose, and most of us now use much more strict constraints. At the 12 year mark, disease free survival was deemed non-inferior…

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Take a listen to the latest ACRO podcast where Radiation Oncology Education Collaborative Study Group leadership discuss rad onc CME past, present and future with Dr. Paul Wallner at the close of his 15-year tenure as associate executive director of the ABR. | ACRO 2024

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There are many ways to potentially de-escalate definitive treatment of oropharyngeal SCC across surgery, drugs and radiation. When it comes to radiation, either dose or volumes can be reduced. This topic discussion brought to you by the Mayo Clinic of Florida delves into whether we should de-escalate elective coverage of retropharyngeal (RP) nodes for tonsil primaries. In short, no. Comprehensive literature reviews suggest approximately 15% of palatine tonsil primaries have metastatic disease present in ipsilateral lateral RP nodes. In fact, the only time this group would omit covering ipsilateral RP nodes appears to be for the earliest of tonsil primaries…

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Top Line: Does comprehensive bridging radiation improve outcomes for patients receiving CART for relapsed/refractory B-cell lymphoma?The Study: Failure at pre-existing sites is a common pattern of progression following CART for B-cell lymphoma. For patients with a limited extent of disease, could bridging radiation to all sites increase the chances of success after CART? This retrospective study compared control and survival outcomes for 100 patients treated with CART who had <5 sites of disease. A third (34%) received bridging RT with a median EQD2 of 26.5 Gy. The rate of sustained complete response was significantly higher in patients who received bridging…

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An unplanned secondary analysis of a large prospective observational study of women receiving treatment for obesity in Sweden indicates women undergoing bariatric surgery had a significantly lower risk of later breast cancer, particularly among women with hyperinsulinemia who had less than half the risk of subsequent breast cancer after bariatric surgery. | Kristensson, JAMA Surg 2024

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