Author: Caleb Dulaney

Nearly ⅔ of cancer patients review their radiology and pathology results a median 6.4 hours after they hit the EHR, and a whopping 75% are viewed by patients before the clinician. | Bhalla, JAMA Oncol 2023

Data is mixed on whether reducing dose to bone marrow reduces hematologic toxicity. In this study of 132 patients who received thoracic radiation for NSCLC, dosimetry for the thoracic vertebral bodies was analyzed to determine if there was an association with hematologic toxicity. Overall, 19.7% experienced grade 3+ hematologic toxicity. Mean dose to the vertebral bodies and V5-V20 were associated with heme toxicity. Exceeding the following thresholds was associated with double the risk of grade 3+ heme toxicity: Dmean >30.2Gy, V5 >69.1%, V10 >64.6%, and V20 >53.5%. | Ma, Int J Radiat Oncol Biol Phys 2023

Top Line: Did you know breast cancer cells can sometimes be found in the axillary tissue completely separate from axillary nodes and extracapsular extension (ECE)?The Study: Here is a novel investigation asking what is the significance, if any, of this finding. Looking back at 2162 pathology specimens from node-positive breast cancer, it turns out involvement of axillary soft tissue was a harbinger of both axillary recurrence and distant mets. At 10 years, the rate of distant mets was 42% with both involvement of axillary soft tissue and ECE, 23% for either involvement of axillary soft tissue or ECE, and 13%…

While logically it should give you pause, a particularly large prostate ≥100 cc does not appear to confer any increased risk of high-grade toxicity following definitive ultra-hypofractionated prostate radiation in a retrospective analysis of 71 such cases. | Hurwitz, Pract Radiat Oncol 2023

look back at 123 men receiving definitive ultra-hypofractionated radiation 36.25 Gy / 5 with or without androgen deprivation therapy (ADT) for predominantly intermediate risk prostate cancer found three pre-treatment multiparametric prostate MRI parameters to be highly predictive of post-treatment PSA nadir and time to PSA nadir: PI-RADS score, prostate lesion size, and number of prostate lesions. This adds to prior data suggesting prostate lesion size—something we could visualize only recently—may one day impact decisions on aggressiveness of treatment such as when to incorporate a targeted dose-escalated boost. | Rayn, Adv Radiat Oncol 2023

Top Line: Is nivolumab an effective treatment for high risk oral cavity leukoplakia?The Study: Proliferative verrucous leukoplakia (PVL) is a type of oral leukoplakia that has a high rate of malignant transformation. Preclinical studies have shown a robust immune infiltrate associated with PVL. In this nonrandomized trial, 33 patients with PVL were treated with nivolumab. They had to have high risk disease consisting of at least one of the following: multifocal disease with a contiguous area >3cm, a single lesion >4cm, involvement of 4 oral cavity quadrants, leukoplakia with moderate dysplasia, or unresectable erythroleukoplakia. A quarter of patients (24%) had…

A Canadian registry study of 400 patients with head and neck Merkel cell carcinoma (MCC) demonstrated longer survival times across the board when radiation was added to surgery, again suggesting MCC of the head and neck uniquely benefit from the addition of radiation. | Knudsen, JAMA Netw Open2023

It sure seems like radiation gets a bad rap in the mainstream media these days, but perhaps that’s because these articles leave such a strong impression? An analysis of 342 articles about radiotherapy printed in the New York Times since its inception indicates coverage has, in fact, become more negative over time, with a significant turning point in 2009-2010 when negative coverage began to outweigh positive. ​​”The media coverage has shifted its focus away from describing scientific breakthroughs and the implementation of new techniques and toward treatment errors, toxicity, and ineffectiveness.” | Wawrzuta, Radiother Oncol 2023

Top Line: Chemoradiation and maintenance durvalumab remains the standard treatment for unresectable, stage III NSCLC, but multiple trials are exploring radioimmunotherapy without chemotherapy. The Study: In this small, single-arm trial, 25 patients with unresectable stage II-III NSCLC and a PD-L1 tumor proportion score (TPS) ≥50% (median 75%) were treated with a chemo-free regimen of pembrolizumab and risk-adapted, hypofractionated radiation. They received 3 cycles of induction pembro followed by a restaging PET. About half (48%) had a radiographic response. Hypermetabolic tumor and involved nodes were then treated with either 55 Gy (metabolic volume >20cc, 48%) or 48 Gy (metabolic volume <20cc,…

DNA mutational profiling of over 500 colorectal cancers identified mutations associated with prognosis and response as well as important differences in the frequency of certain mutations between Black and White patients. | Innocenti, J Clin Oncol 2023