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Elderly men comprise a large percentage of men diagnosed with prostate cancer (PrCa). Although localized PrCa is often indolent, older men tend to be diagnosed with higher-stage disease and are more likely to die from PrCa than younger men. Multiple factors other than age play an important role in determining who will benefit from active treatment, such as comorbid conditions, life expectancy, and tumor characteristics. Careful consideration of such factors can help prevent the overtreatment of elderly men with low-risk disease and undertreatment of elderly men with high-risk disease. Management decisions should be individualized by weighing the benefits of treatment against potential risks and side effects pertinent to the elderly population, whether evaluating for surgery, radiation, or androgen deprivation. [Copyright &y& Elsevier]

To report outcomes of a 3-fraction HDR brachytherapy boost for the treatment of locally advanced cervical cancer (LACC) at a large safety net hospital. A retrospective review of 93 patients with FIGO 2018 Stage IA2 to IVB cervical cancer treated with HDR brachytherapy boost in 3 fractions between 2017 and 2022 was conducted. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) was estimated using Kaplan-Meier estimators. Hazard ratios of covariates for local failure (LF) were determined using univariate Cox proportional hazard models. Median follow-up time was 31 months. Mean cumulative EQD2 of HR-CTV D90 was 85.3 Gy (95% CI 84.2, 86.4). Mean cumulative EQD2 of the D2cc for bladder, rectum, sigmoid, and small bowel was 74.7 Gy (95% CI 72.4, 77.0), 58.2 Gy (95% CI 56.7, 59.6), 60.9 Gy (95% CI 59.4, 62.3), and 58.9 Gy (95% CI 56.7, 61.1) respectively. Two-year LC, PFS, and OS were 80.9% (95% CI 73.1%, 89.5%), 63.2% (95% CI 54.0%, 74.1%), and 85.2% (95% CI 78.1%, 93.0%) respectively. The hazard ratio for LF for incomplete concurrent chemotherapy regimen was 3.07 (95% CI 1.17, 8.09; p = 0.02). Three percent of patients experienced late grade 3+ toxicities after radiation therapy. Three-fraction HDR brachytherapy boost was generally well-tolerated by patients and may be a viable alternative in the treatment of LACC. [ABSTRACT FROM AUTHOR]

NRG/Radiation Therapy Oncology Group 0848 is a 2-step randomized trial to evaluate the benefit of the addition of concurrent fluoropyrimidine and radiation therapy (RT) after adjuvant chemotherapy (second step) for patients with resected pancreatic head adenocarcinoma. Real-time quality assurance (QA) was performed on each patient who underwent RT. This analysis aims to evaluate adherence to protocol-specified contouring and treatment planning and to report the types and frequencies of deviations requiring revisions. In addition to a web-based contouring atlas, the protocol outlined step-by-step instructions for generating the clinical treatment volume through the creation of specific regions of interest. The planning target volume was a uniform 0.5 cm clinical treatment volume expansion. One of 2 radiation oncology study chairs independently reviewed each plan. Plans with unacceptable deviations were returned for revision and resubmitted until approved. Treatment started after final approval of the RT plan. From 2014 to 2018, 354 patients were enrolled in the second randomization. Of these, 160 patients received RT and were included in the QA analysis. Resubmissions were more common for patients planned with 3-dimensional conformal RT (43%) than with intensity modulated RT (31%). In total, at least 1 resubmission of the treatment plan was required for 33% of patients. Among patients requiring resubmission, most only needed 1 resubmission (87%). The most common reasons for resubmission were unacceptable deviations with respect to the preoperative gross target volume (60.7%) and the pancreaticojejunostomy (47.5%). One-third of patients required resubmission to meet protocol compliance criteria, demonstrating the continued need for expending resources on real-time, pretreatment QA in trials evaluating the use of RT, particularly for pancreas cancer. Rigorous QA is critically important for clinical trials involving RT to ensure that the true effect of RT is assessed. Moreover, RT QA serves as an educational process through providing feedback from specialists to practicing radiation oncologists on best practices. [ABSTRACT FROM AUTHOR]

Objective To increase the diagnostic sensitivity of standard MAG3 diuretic renal scans for ureteropelvic junction obstruction (UPJO) by exploring the utility of an alternative measurement P 40, the percentage of maximal tracer counts present at 40 minutes. Materials and Methods Patients with strong clinical and anatomic evidence for UPJO may have a normal T 1/2 , making definitive diagnosis difficult. We reviewed the charts of 142 consecutive patients who underwent successful laparoscopic or robotic-assisted laparoscopic pyeloplasty for UPJO between 2005 and 2015. Both pre- and postoperative renal scan images were available for 37 symptomatic patients with primary unilateral UPJO and 2 kidneys. We defined P 40 as the percentage of maximal tracer counts present at 40 minutes. We identified the upper limit of normal (97.5th percentile, +2SD) for P 40 using the preoperative renal scans from the unaffected kidney. We compared the sensitivity of P 40 to T 1/2 to identify symptomatic UPJO. Results In our cohort, 51% of symptomatic patients (n = 19) had a normal T 1/2 (median 8.9 minutes; interquartile range: 7.5 minutes) and 49% (n = 18) had an abnormal T 1/2 (median: 40 minutes; interquartile range: 0 minute). None of the patients had an abnormal P 40 on their unaffected kidney. All patients with an abnormal T 1/2 also had an abnormal P 40 . P 40 increased the sensitivity of the renal scan from 49% (n = 18 of 37) to 73% (n = 27 of 37) when compared to T 1/2 . The majority of patients (95%) demonstrated an improvement in P40 after pyeloplasty. Conclusion P 40 markedly increases the sensitivity of a renal scan for diagnosing symptomatic UPJO and may be another valuable marker in addition to T 1/2 to document functional improvement in drainage after pyeloplasty. [ABSTRACT FROM AUTHOR]

Comprehensive understanding of oncologic treatment is essential for shared decision-making. However, comprehension of information in radiation oncology consults is poorly understood, particularly among Spanish-speaking patients at safetynet hospitals. The purpose of this pilot study was to examine post-consultation radiation oncology knowledge and health literacy among breast cancer patients from culturally diverse backgrounds. After consultation for curative post-operative breast radiotherapy (cT1-4N1-3M0), the Radiation Oncology Knowledge Assessment Survey (ROKAS) was administered to Spanish- and English-speaking patients ≥ 18 years old, from January 2021 to January 2022 at a safety-net hospital. Radiation knowledge was assessed using the ROKAS which included eight radiation-specific multiple-choice questions and two separate questions regarding short- and long-term side effects. Additional independent variables included validated questionnaires related to health literacy, health numeracy, acculturation, primary language, and sociodemographic factors. Bivariate Pearson correlations and T-test analyses were conducted to examine the relationship between the independent variables and post-consultation radiation knowledge. Fifty ROKAS were obtained from 25 English- and 25 Spanish-speaking breast cancer patients (median age 57 [IQR 49.75-62.25]). When compared to Englishspeaking patients, Spanish-speaking patients had lower health literacy, health numeracy, and acculturation. There was no difference in the multiple-choice ROKAS score between English- and Spanish-speakers, or correlation with the other independent factors. Higher health numeracy correlated with a higher accuracy for identifying short-term side effects. Lower accuracy of identifying long-term side effects was seen in patients with lower education levels, health literacy, health numeracy, and acculturation, with the most missed long-term side effects being arm swelling, skin toxicity, and heart toxicity. Patients with low health literacy, health numeracy, acculturation, and education levels as well as Spanish-speaking patients were associated with poor understanding of radiotherapy long-term side effects. Determining barriers to radiation knowledge is crucial to improve shared decision-making between patients and providers in a culturally diverse population. [ABSTRACT FROM AUTHOR]

Locally advanced cervical cancer is routinely treated with concurrent cisplatin and pelvic external beam radiation therapy (EBRT) followed by high-dose-rate (HDR) brachytherapy. There is significant variation regarding the doses per fraction in HDR brachytherapy for cervical cancer, with 5-fraction (fx) regimens most commonly used in the US. Here, we report on the dosimetric outcomes for a 3 fraction HDR brachytherapy boost in addition to summative statistics for early and late toxicities. A retrospective review of 94 patients with FIGO 2018 Stage IA2-IVB cervical cancer treated with 3 fx HDR brachytherapy boost from May 2017 to April 2022 was conducted. Dose metrics including cumulative EQD2 D90 as well as cumulative EQD2 D2cc of organs at risk (bladder, rectum, sigmoid colon and small bowel) were extracted from radiation treatment plans. Descriptive statistics were used to summarize patient demographics and rates of early (< 6 months) and late toxicities (> 6 months). Median follow-up time was 29.5 months. For EBRT, patients were treated with either 45 Gy in 25 fractions (n = 90), 50 Gy in 25 fractions (n = 2), or 50.4 Gy in 28 fractions (n = 2). For HDR brachytherapy, patients received 8 Gy in 3 fractions (n = 88) or 6.5 Gy in 3 fractions (n = 6) when adjuvant hysterectomy was planned. 91.5% (n = 86) of patients received concurrent cisplatin or carboplatin chemotherapy. Median overall treatment time was 51 days (range: 39 - 146). The median age of patients was 48 years (range: 16 - 78). Squamous cell carcinoma was the most common histology (74.5%), followed by adenocarcinoma (16.0%). The 2018 FIGO stage distribution was: I (14.9%); II (31.9%); III (48.9%); IV (4.3%). The mean HR CTV volume was 31.39 cc (95% CI 28.31, 34.48). The mean cumulative EQD2 of HR CTV D90 was 85.26 Gy (95% CI 84.18, 86.34). The mean cumulative EQD2 D2cc of bladder, rectum, sigmoid, and small bowel for all patients was 74.59Gy (95% CI 72.32, 76.86), 58.06Gy (95% CI 56.64, 59.49), 61.00Gy (95% CI 59.56, 62.45), and 58.87Gy (95% CI 56.68, 61.07), respectively. Acute grade 2, and 3+ toxicity rates were 4.3%, and 1.1% respectively. Late grade 2, and 3+ toxicity rates were 18.6%, and 1.0% respectively, with vaginal dryness being the most common grade 2+ toxicity. Pelvic chemoradiation followed by 3 fx HDR brachytherapy boost is a less resource-intensive and more convenient fractionation regimen for patients. Low rates of acute and late grade 3+ toxicity was observed with this regimen. Long-term follow up is needed to further assess oncologic outcomes. [ABSTRACT FROM AUTHOR]

High-dose-rate (HDR) brachytherapy is a validated method for treating locally advanced cervical cancer. While the most common brachytherapy fractionation scheme for cervical cancer used in the United States is 4-5 fractions, shorter fractionation schemes using a higher dose-per-fraction have been reported in the literature and are more frequently used in other countries. Given limited resources at high-volume centers, shorter fractionation schemes with higher dose-per-fraction can reduce a potential barrier to healthcare by decreasing the number of required treatment sessions. We aim to review and report the clinical outcomes of our single institution experience at a large safety net hospital using a 3-fraction HDR brachytherapy boost for locally advanced cervical cancer. From May 2017 to February 2022, 90 patients with FIGO 2018 stage IA2 to IVB cervical cancer were treated with external beam radiation therapy (EBRT), either whole pelvis (n=71) or extended-field whole pelvis (n=19), followed by HDR brachytherapy in 3 fractions (Table 1). For EBRT, patients were treated with either 45 Gy in 25 fractions (n=86), 50 Gy in 25 fractions (n=2), or 50.4 Gy in 28 fractions (n=2). For HDR brachytherapy, patients received 8 Gy in 3 fractions (n=84) or 6.5 Gy in 3 fractions (n=6) when adjuvant hysterectomy was planned. 82 (91.1%) patients received concurrent weekly chemotherapy, with 69 (84.1%) receiving 5 or more cycles and 13 (15.9%) receiving 4 or fewer cycles. 2-year overall survival, 2-year progression-free survival, and 2-year local control rate were estimated using Kaplan-Meier estimators. Hazard ratios of covariables for local recurrence were determined using univariable Cox proportional hazard models. The mean HR-CTV volume was 30.98 cm3 (95% CI 27.84, 34.12). The average EQD2 of cumulative HR-CTV D90 was 85.20 Gy (95% CI 84.07, 86.32). The mean cumulative EQD2 D2cc for bladder and rectum was 74.88 Gy (95% CI 72.54, 77.23) and 58.29 Gy (95% CI 56.83, 59.76) respectively. The estimated 2-year overall survival, 2-year progression-free survival, and 2-year local control rate were 89.1% (95% CI 82.5%, 96.1%), 63.9% (95% CI 54.5%, 75.0%), and 80.3% (95% CI 72.2%, 89.2%) respectively. The hazard ratio for local recurrence for incomplete concurrent chemotherapy regimen and HR-CTV volume was 3.537 (95% CI 1.181, 10.593) and 1.029 (95% CI 1.002, 1.056) respectively. Radiation therapy was generally well tolerated, with only 1.5% of patients experiencing late grade 3+ toxicities after radiation therapy. We present our findings from our single institution retrospective review of 3-fraction HDR brachytherapy boost following EBRT with concurrent chemotherapy. Further research and longer follow-up are warranted to fully assess the efficacy and extent of toxicity relative to conventional fractionation schemes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the predictive value of the RENAL Nephrometry Score (RNS) on operative outcomes during both laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN). Methods: We reviewed 67 consecutive patients with suspicious renal lesions and available radiographic data who underwent LPN or RPN by a single surgeon. Data included operative type, body mass index (BMI), gender, age, and side of tumor. RNSs were recorded using either magnetic resonance imaging or computed tomography scans. Warm ischemia time (WIT), estimated blood loss (EBL), and collecting system entry (CSE) were the endpoints for the analyses. Results: Total RNS entered as a continuous or dichotomous variable (<7 or ≥7), R-score, and N-score were independent predictors of WIT on multivariable analyses (P <.001, P = .001, P = .026, and P <.01, respectively). The total RNS and N-score were predictive of CSE in univariate analysis (P <.001). Neither total RNS nor its individual components were predictive of EBL. Conclusion: Total RNS, as well as the N- and R-scores, can help predict both longer WIT and CSE during LPN and RPN. The RNS and its individual components may be useful in the preoperative planning and counseling of patients undergoing LPN or RPN. [Copyright &y& Elsevier]