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Radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) is the gold standard for management of muscle-invasive bladder cancer (MIBC). Patients without residual tumor at the time of extirpative surgery (ypT0) have excellent prognosis. Distant metastases in this population are rare. We present a unique case of a patient with ypT0N0 urothelial carcinoma (UC) with rapid development of metastasis to the brain.

Purpose : This study attempted to assess the toxicity and possible preliminary benefits from teh administration of low-dose external beam irradiation for age-related macular degeneration (ARMD). The premise of the treatment is that radiation induces regression and/or promotes inactivation of the subretinal neovasculature which would result in reabsorption of fluid and blood. This would reduce the risk for further leakage or bleedings, as well as subretinal fibrosis. Consequently, the beneficial effect could be translated into stabilization of visual acuity and prevention of progression of the wet ARMD with the possibility for slight improvement. Methods and Materials : Allegheny University Department of Radiation Oncology treated 41 patients prospectively from January through October 1995 with low-dose irradiation for wet-type macular degeneration. A total of 39 patients were treated with a total dose of 14.4 Gy in eight fractions of 1.8 Gy/fraction over 10–13 elapsed days. The first two patients were treated with a total dose of 10 Gy in fivefractions of 2 Gy. Patients were evaluated at 2–3 weeks and 2–3 months. Some of the patients (6.7%) had laser treatment in the study eye: 21.9% (9) once, 5% (2) twice, 9.7% (4) thrice or more. Subjective visual acuity and toxicity data were collected on all patients. Results : At 2–3 weeks after treatment 29 patients (70%) retained their visual acuity without change, 10 (24.5%) stated they had improved vision, adn 2 (4.8%) stated their vision continued to decrease. At 2–3 months after treatment, 27 patients (65.8%) had no change in their vision, 11 (27%) had an improvement in their vision, and 3 (7.2%) had a decrease in visual acuity. Six patients of 41 in the treated group had acute transient side effects. Conclusion : Our observation in this group of 41 patients support the conclusion that many patients will have improved or stable vision after treatment with low-dose irradiation for age-related wet-type macular degeneration.

Twenty-five patients with primary presentation of malignant astrocytoma, astrocytoma with anaplastic foci, and glioblastoma multiforme were treated with surgical resection and definitive radiation therapy followed by intravenous or infra-arterial administration of Iodine-125 labeled monoclonal antibody-425, which binds specifically to human epidermal growth factor receptor. The patients presented with primary untreated disease, positive contrast enhanced computed tomography scans of the brain, and compatible clinical symptoms. In this Phase II clinical trial, the patients had surgical debulking or biopsy followed by definitively administered external beam radiation therapy and one or multiple doses (35 to 90 mCi per infusion) of radiolabeled antibody. The total cumulative doses ranged from 40 to 224 mCi. The administrations of the radiolabeled antibody were performed in most cases 4–6 weeks following completion of the primary surgery and radiation therapy. Ten patients had astrocytoma with anaplastic foci and 15 had glioblastoma multiforme. No significant life-threatening toxicities were observed during this trial. At 1 year 60% of the patients with astrocytoma with anaplastic foci or glioblastoma multiforme are alive. The median survival for both groups was 15.6 months.

Purpose/Objective(s): Radiation therapy (RT) for prevention of heterotopic ossification (HO) around the joints has been used for decades. While there is ample evidence to support its use at the hip, data on non-hip joints such as the elbow are scant, with recent studies raising concern over toxicities. We conducted an IRB-approved single-institution retrospective review of our experience delivering radiation to the elbow to evaluate outcomes and complications related to RT. Materials/Methods: From 2003 to 2012, 31 patients received perioperative RT for HO prophylaxis at the elbow. Patients with postoperative films (n Z 20) were included in our study. Data on patient characteristics, treatment details, and clinical status at each encounter were reviewed. Radiological studies were reviewed using 5 classification schemes. Patients were contacted for interview on current status using the Mayo Elbow Performance Score (MEPS). Results: Median patient age was 42.5 years, median body mass index (BMI) was 29, and 85% were male. Mean follow-up was 9.2 months. All patients received a single fraction of 600-700 cGy, preoperatively within 24 hours (n Z 8), postoperatively within 24 hours (n Z 11), or postoperatively in 3 days (n Z 1). Five patients underwent primary prophylaxis while 15 patients received RT for secondary prophylaxis. Two patients developed new HO and 1 patient had progression of disease at the time of follow-up, but all 3 reported a fair MEPS and denied severe functional limitations. Three patients required surgical re-excision of HO. Conclusions: NSAID treatment, whether newly prescribed or prior use, variations in field size, differences in technique, whether open-field AP/PA or 3D conformal with multi-leaf collimation, did not appear to make a difference in risk of recurrence, mal-union, non-union, or functional outcome. Furthermore, all of the subjects available for phone interview, including those with evidence of severe HO, reported fair or better functionality. Timing of RT seems optimal within 24 hours preoperatively or postoperatively. Patients with high-risk indications should undergo primary prophylaxis against HO. Author Disclosure: S.K. Yoo: None. C. Miyamoto: None.