Author: QuadShot News
Top Line: The indications for whole brain radiation (WBRT) are becoming ever narrower as alternative techniques such as radiosurgery and hippocampus-sparing IMRT prove to result in comparable disease control with fewer neurocognitive sequelae. The Story: But what is it exactly about standard WBRT that causes such negative effects in the minds of patients, particularly the elderly? This fascinating imaging study retrospectively looked for clues across the standard pre- and post-treatment brain MRIs performed on 72 patients receiving WBRT over the last decade at Northwestern. It used a recently-developed AI platform designed to accurately predict a patient’s age by analyzing brain…
This SEER-Medicare analysis of over 31K women receiving breast cancer surgery at age 65 or older demonstrates 1 in 5 experience an increase in frailty per a validated claims-based frailty index, which was even more likely with increasing age and for those receiving a mastectomy. | Minami, JAMA Surg 2023
This authentic and humorous reflection of a rad onc resident’s journey of learning to deliver bad news concludes “human connection was more meaningful than eloquence, substance more important than style,” an important reminder that just being yourself often comes across more authentic than any phrases or acronyms you can memorize. | Farrell, JAMA 2023 tags:
How do PARP inhibitors compare to docetaxel in the second line for mCRPC? In TRITON3, men with mCRPC progressing after treatment with ADT and a 2nd generation androgen receptor pathway inhibitor (ARPI) were screened for BRCA1, BRCA2, or ATM mutation. Of 4855 screened patients, 405 were randomized to treatment with either the PARP inhibitor rucaparib or physician’s choice of docetaxel or a different ARPI. Just over half of patients (~55%) received docetaxel. Most patients (75%) had BRCA mutations. The primary endpoint of median duration of radiographic progression free survival was significantly longer with rucaparib than physician’s choice (10.2 v 6.4…
Top Line: Does cervical tumor HPV-clearance correlate to treatment response to definitive chemoradiation? The Study: It seems to work for HPV+ oropharyngeal cancer, after all. This prospective study collected cervical tumor swabs analyzed for HPV at baseline and at the end of external beam radiation for 79 women. Why tumor swabs versus the arguably easier obtained circulate tumor DNA? “Given the practicality of serial tumor swabs in cervical cancer, tumor samples are a more sensitive and specific medium for serial virome analysis.” Overall, HPV-viral loads decreased at the end of treatment with the exception of low-risk subtypes (n=13). Patients with…
Top Line: Who is ready to rehash the benefits of radiation following breast-conservation for low risk breast cancer? The Study: PRIME II was a randomized phase 3 trial in which 1326 women 65 and older with low risk breast cancer were randomized to radiation or no radiation after breast conservation surgery. Low risk criteria included hormone receptor positive, node negative, ≤3 cm tumor, and negative margins. Grade 3 histology or LVI (but not both) were allowed, but this was a small minority (<5%) of cases. Everyone received the obligatory 5 years +of adjuvant endocrine therapy. In the radiation arm, everyone…
In spite of the clear local control superiority of radiation even in low risk patients and even in the setting of endocrine therapy, the narrative surrounding PRIME II has pivoted to focus on the lack of survival benefit with radiation. Comparing survival was not the purpose of PRIME II. In fact, an EBCTCG meta-analysis from over a decade ago estimated a 1% or less absolute reduction in breast cancer mortality at 15 years in patients with low risk disease. Furthermore, PRIME II and similar trials were based on the assumptions that 1) 6 weeks of 90’s era radiation therapy was…
Another RELATIVITY trial demonstrates the promise of adding the LAG-3 inhibitor relatlimab to nivolumab for metastatic melanoma, not only upfront, but also after failing prior PD-L1 inhibition. Citation(s) Asierto, J Clin Oncol 2023
This phase 2 trial found that the addition of venlafaxine to prophylactic gabapentin did not reduce pain from mucositis during head and neck RT. Citation(s) Ma, Int J Radiat Oncol Biol Phys 2023
One of the most common patterns of failure after lung SBRT is distant metastasis. In this study, a multi-institutional database of 1280 lung SBRT patients was used to develop a model that predicted the risk of DM after treatment. The overall rate of DM was approximately 13.4% with a median time to DM of 19.5 months. Factors included in the model were tumor size, SUVmax, age, ECOG PS, history of prior lung cancer, and tumor histology. The model identified a subgroup of patients at highest risk of DM when all of the following were present: age <77, ECOG <2, tumor…