Author: Caleb Dulaney

This exposé delves into what it frames as a major failure of the US to protect its military from its biggest threat while deployed during the “war on terror,” exposure to carcinogens, as veterans are reportedly 100 times more likely to receive a cancer diagnosis than to die in action. | Venutolo-Mantovani, The New Republic 2023

One of the major criticisms of the recently published trials of postoperative radiation (PORT) for lung cancer such as LungART is the vast majority of enrollees received 3D-conformal treatment. Maybe the excess cardiopulmonary toxicity wouldn’t have happened with more modern techniques such as intensity modulated radiation (IMRT)? Here is a pooled analysis of outcomes across 377 patients receiving PORT at 27 rad onc clinics in Michigan where two-thirds of patients had IMRT. It turns out, heart and lung dosimetry did not significantly differ by technique. Nor did it notably differ from that reported in LungART: the average mean heart dose…

Top Line: Are outcomes from breast conservation therapy for multifocal breast cancer the same as those with unifocal breast cancer? The Story: ACOSOG Z11102 was a single arm, phase 2 trial that described the outcomes of breast conservation therapy for patients with multifocal breast cancer. 204 patients with 2 (97%) or 3 foci of disease amenable to breast conservation and cN0-1 disease had lumpectomies followed by whole breast radiation and a boost. They had to have at least 2cm of normal tissue between foci and could have disease in no more than two quadrants. Standard fractionation was used (45-50 Gy)…

Yesterday the FDA approved Narcan nasal spray for over-the-counter use, a first for overdose reversal agents, with some cities even planning to install Narcan vending machines, though concerns remain over potential price-gouging when a single naloxone producer has approval. | FDA 2023

This retrospective study analyzed data from over 600 patients and over 1400 spine segments treated with SBRT. Of these, 24 (4%) patients and 31 lesions (2.1%) received treatment to the posterior elements only with no coverage of the vertebral body. The cumulative rate of local failure was 9.7% at 12 months and 30.8% at 24 months. Paraspinal disease is a known risk factor for local recurrence, and indeed 73% of recurrences had paraspinal disease. Just over half of recurrences were completely within the original target while 45.5% were in adjacent but untreated sectors. Four of 5 failures adjacent to the…

Top Line: Stereotactic body radiation (SBRT) is now a mainstay treatment for prostate cancer, but considerable debate remains surrounding the optimal dose and interfraction time interval to maximize the therapeutic window.The Story: Here we have 5-years results of a prospective phase 2 trial that randomized 165 evaluable men across nine European centers to prostate SBRT delivered every other day (EOD) versus weekly. Why weekly? The thought was interval normal tissue repair would decrease toxicity while tumor reoxygenation could even improve efficacy. Approximately two-thirds (64%) had intermediate risk disease followed by low (22%) and high (15%) risk. The target was the…

It should mean one less barrier to organ transplantation, with this practical UK series of 887 organ transplants from 282 donors with histories of primary brain tumors (many high-grade) resulting in zero related transmitted malignancies and post-transplant survival equal to that of matched controls. | Greenhall, JAMA Surg 2023

Two trials presented at the Society of Gynecologic Oncology have shown significant improvement in progression free survival for patients with advanced endometrial cancer and mismatch repair deficient disease. In the first trial, 816 patients with measurable stage III or IVA disease, stage IVB diseaes, or recurrent disease received first-line carboplatin and paclitaxel with or without pembrolizumab. Among those who had dMMR, the addition of pembro nearly double the rate of PFS at 12 months from 38% to 74% and prolonged median PFS from 8.7 to 13.1 months. In the second trial, 494 patients with advanced stage III, stage IV, or…

An Indian-made “preservative-free” product of one of the most seemingly benign over-the-counters out there, artificial tears, has been found to widely carry a terrifyingly drug-resistant strain of Pseudomonas aeruginosa that has led to US cases of vision loss, enucleation and even death. | Olson, NPR 2023

The prospective HOME trial randomized nearly 20K women ages 30-64 in the Kaiser Permanente Washington System to standard cervical cancer screening reminders +/- mailed HPV self-sampling kits to demonstrate a significant uptick in the number of women compliant with screening guidelines. But was it worth the cost of mailing out thousands of kits? This cost effectiveness analysis of the HOME trial reports a cost of $86-146 to achieve one additional screening, with higher costs to gain additional young women and lower for older women. Whether or not this is a good value all depends on willingness to pay. | Meenan,…