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Background: Standard treatment for locally advanced anal squamous cell carcinoma (SCC) consists of concurrent chemoradiation. We evaluated whether racial differences exist in the receipt of standard treatment and its association with survival. Methods: From the National Cancer Database, we identified patients diagnosed with anal SCC (Stages 2–3) between 2004 and 2015. Using logistic regression, we evaluated racial differences in the probability of receiving standard chemoradiation. We used Cox proportional hazards models to evaluate associations between race, receipt of standard therapy and survival. Results: Our analysis included 19,835 patients. Patients receiving standard chemoradiation had better survival than patients receiving nonstandard therapy (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.61–0.68; p < 0.001). Compared to White patients, Black patients were less likely to receive standard therapy (odds ratio [OR] 0.85; 95% CI 0.76–0.96; p < 0.008). We observed no statistical difference in mortality between Black and White patients overall (HR 1.05, 95% CI 0.97–1.15; p = 0.24). However, for the subgroup of patients receiving nonstandard therapy, Black patients had an increased mortality risk compared to White patients (HR 1.17, CI 1.01–1.35; p = 0.034). We observed no survival differences in the subgroup of patients receiving standard treatment (HR 1.00, CI 0.90–1.11, p = 0.99). Conclusion: Standard treatment in anal SCC is associated with better survival, but Black patients are less likely to receive standard treatment than White patients. Although Black patients had higher mortality than White patients in the subgroup of patients receiving nonstandard therapy, this difference was ameliorated in the subset receiving standard therapy. [ABSTRACT FROM AUTHOR]

Abstract: Stereotactic Radiosurgery (SRS) is considered standard of care for patients with 1–3 brain metastases (BM). Recent observational studies have shown equivalent OS in patients with 5+ BM compared to those with 2–4, suggesting SRS alone may be appropriate in these patients. We aim to review outcomes of patients treated with SRS with 2–4 versus 5+ BM. This analysis included consecutive patients from 1994 to 2015 treated with SRS. Of 1017 patients, we excluded patients with a single BM and patients without adequate survival data, resulting in 391 patients. All risk factors were entered into univariate analysis using Cox proportional hazards model, and significant factors were entered into multivariate analysis (MVA). We additionally analyzed outcomes after excluding patients with prior surgery or whole‐brain radiotherapy (WBRT). Median follow‐up was 7.1 months. Median KPS was 90, mean age was 59, and most common histologies were melanoma and lung. Median tumor volume was 3.41 cc. Patients with 2–4 BM had a median OS of 8.1 months compared to 6.2 months for those with 5+ BM (P = 0.0136). On MVA, tumor volume, KPS, and histology remained significant for OS, whereas lesion number did not. Similar results were found when excluding patients with prior surgery or WBRT. Rather than lesion number, the strongest prognostic factors for patients undergoing SRS were tumor volume >10 cc, KPS, and histology. BM number may therefore not be the most important criterion for candidacy for SRS. Patients with 5 or more BM should be considered for SRS. [ABSTRACT FROM AUTHOR]

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]

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]