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B Introduction: b In patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) treated with CD19-directed chimeric antigen receptor T-cell therapy (CAR-T), the large majority (~70%) ultimately fail. PHASE I TRIAL OF "RE-PRIMING" RADIATION THERAPY FOR RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA PATIENTS IN INCOMPLETE RESPONSE AFTER CAR-T THERAPY B Conclusion: b Early hypofractionated salvage focal "definitive" dose RT to sites of incomplete response on day 30 post-CAR-T for R/R/ DLBCL patients was safe without any dose de-escalation required. [Extracted from the article]

COMBINED MODALITY ULTRA-LOW-DOSE ADAPTIVE RADIOTHERAPY AND RITUXIMAB AS TREATMENT STRATEGY FOR INDOLENT NON-HODGKIN LYMPHOMAS: THE UT SOUTHWESTERN EXPERIENCE B Methods: b We conducted an IRB approved retrospective review of patients with iNHL who were treated with both ULDRT and rituximab (4 weekly doses of 375 mg/m SP 2 sp ) as frontline therapy, either concurrently, or within a short interval (median 13 days), at our institution from 2017-2023. B Introduction: b For indolent non-Hodgkin lymphomas (iNHL), ultra-low-dose radiation therapy (ULDRT) with 4 Gy (2 Gy × 2 or "boom-boom") has demonstrated durable local control (70%), though distal relapses may occur. [Extracted from the article]

Carotid artery stenosis (CAS) is a known potential late effect of neck radiation. There are varying estimates of its incidence and mixed consensus on whether screening for this late effect standard practice should be. As treatment techniques have evolved and the presence of HPV has increased, the impact on the future trajectory of this problem is unclear. A sample of head and neck cancer (HNC) patients treated from 1997 through 2022 who underwent carotid ultrasound (US) at any time after receiving radiation therapy to the neck were identified from an IRB-approved, single institution database. Patient treatment characteristics including radiation laterality, co-morbidities at consult, and smoking history were coded in addition to carotid US dates and results. CAS was defined as >40% stenosis of either side of the vessel, which prompted a vascular surgery consult. A total of 308 patients were included in this study with an average follow up of 70 months (range: 3.3-255.9 months). All included patients received bilateral neck radiation and had no evidence of disease at their last follow up. Most patients received definitive, concurrent chemoradiation (96.4%), were male (85.1%) and had a primary oropharyngeal tumor (64%). The most common co-morbidity at time of consult was hypertension (HTN, 45.8%). Median time to CAS was 10.7 years. The five- and ten-year rates of CAS were 15.4% and 39.6%, respectively. On Cox regression univariate analysis age at consult (HR=1.054, 95% CI= 0.649-1.941, p<0.001), having known HTN (HR=2.551, 95% CI=1.610-4.032, p<0.0001), hyperlipidemia (HR=1.658, 95% CI= 1.066-2.584, p=0.0248), diabetes (HR=2.398, 95% CI=1.397-4.115, p=0.0015), or cardiac disease (HR=2.283, 95% CI=1.333-3.922, p=0.0026) at time of consult, and being an ever smoker (HR=2.336, 95% CI=1.403-3.891, p=0.0011) were statistically predictive of CAS. On multivariate analysis, patients who were older (HR=1.037, 95% CI=1.008-1.068, p=0.0122), were an ever smoker (HR=2.375, 95% CI=1.425-3.968, p=0.0009), and having known hypertension (HR=2.037, 95% CI=1.235-3.356, 0.0053) at consult were at highest risk for CAS. CAS was frequently detected five and ten years after head and neck radiation. Carotid artery US screening should be strongly considered in these patients, especially older patients with a history of smoking and/or HTN. Future prospective studies are warranted to verify this finding. [ABSTRACT FROM AUTHOR]

Loco-regional Failure (LRF) can be an important cause of morbidity and mortality in patients with advanced medullary thyroid cancer (MTC), especially in the era of more effective systemic therapies. We sought to identify risk factors predictive of LRF and the role of radiation therapy in modifying this outcome. Patients with MTC treated with definitive surgical resection between 2004 and 2020 were identified in an IRB approved database. Patients who did not undergo definitive surgery, with or without metastatic disease, or those treated with radiation alone were excluded. Patients who underwent postoperative radiation (PORT) to a dose of >45Gy were included. LRF was defined as any failure in the thyroid bed, neck or mediastinum. Kaplan Meier analysis was performed to calculate rates of LRF and log rank analysis was used to identify associations of specific high-risk features with LRF. High-risk pathologic factors included in this analysis were positive surgical margins, multifocal disease, angiolymphatic and/or lymphovascular space invasion (LVI), extrathyroidal extension, nodal extracapsular extension, and rising CEA or calcitonin postoperatively. Of 68 patients who were included in this study, 36 (53%) were stage I/II and 32 (47%) were stage III/IV. MTC was co-incidental with a papillary thyroid cancer in 34 patients (50%). LRF occurred in 1 (3%) stage I/II and 12 (38%) stage III/IV patients. Among stage III/IV patients with known mutational analysis, 14/25 (56%) harbored RET mutations, 11 of whom received targeted therapies. Patients with these mutations had numerically lower rates of LRF compared to non-mutated tumors (18% vs. 43%; p=0.23). Patients with positive margin, LVI, or multifocal disease trended towards an increased risk of 3-yr LRF (36.2% vs 0%; p=0.22). No other pathologic risk factors were associated with LRF. PORT was used in 14 stage III/IV patients (44%), and was associated with a lower 3-yr LRF rate (7% vs. 38%; p=0.17). This was independent of known risk factors. Patients with stage III/IV MTC treated with definitive resection with either a positive margin, LVI and/or multifocal disease have high rates of LRF and may benefit from PORT. Further studies are needed to corroborate this finding, especially in RET mutated tumors in the era of targeted therapies. [ABSTRACT FROM AUTHOR]

Adenosquamous carcinoma of the head and neck (ASC-HN) is a rare and aggressive variant of squamous cell carcinoma (SCC). Limited data suggests inferior outcomes compared to conventional SCC. We report one of the largest single institutional experiences of this disease in patients treated definitively to further elucidate oncologic outcomes. Patients with non-metastatic ASC-HN treated definitively between 2003 and 2021 were identified retrospectively from an IRB approved database with histology verified by head and neck pathologists. All tumors of the oropharynx were tested for p16 and/or HPV to document HPV associated disease. For non-oropharyngeal lesions, a designation of HPV positivity required the presence of HPV DNA/RNA per CISH. Actuarial analyses were performed for PFS and OS. 29 patients with ASC-HN (72.4% male, 93.1% Caucasian) with median age of 66 (range 34-91) and a median follow up of 33 months (range 6.6-126.7) were identified. The most common primary tumor sites were: oropharynx (27.6%), oral cavity (20.7%), nasal cavity (17.2%), and larynx (17.2%). 3 patients had primaries in the hypopharynx, nasopharynx and parotid gland respectively. 11 patients (37.9%) were HPV positive of whom 8 had oropharyngeal primaries. The majority (n=23, 79.3%) were treated with primary surgery of whom 19 (82.6%) received adjuvant radiation (RT) to a median dose of 60 Gy (range 36-70 Gy) with 7 receiving concurrent chemotherapy. 6 patients were treated with definitive RT to a median dose of 70 Gy with two receiving concurrent chemotherapy. There were 10 recurrences (34.5%) which occurred at a median of 14.3 months (range 5.4-28) after diagnosis including 8 loco-regional and 2 distant recurrences. Recurrences were documented in patients with primary salivary gland, oral cavity, laryngeal, hypo-pharyngeal, and oropharyngeal tumors. 3 of the 10 recurrences were in patients with HPV positive disease. Among the 6 patients treated with definitive radiation or chemo-radiation no failures were observed. 9 patients (31%) were deceased at the time of analysis. Overall, 3-year PFS and OS were 54.2% and 72.9%, respectively. 3-year PFS and OS were 45.6% and 69.6% for primary surgery and 83.3% and 83.3% in the definitive RT group. 3-year PFS was 50% and 75% for HPV negative and positive patients respectively. In our single institutional experience of 29 patients with adenosquamous carcinoma of the head and neck there was a 34.5% recurrence rate. Loco-regional recurrence was the primary mode of failure. [ABSTRACT FROM AUTHOR]