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Objective: To evaluate patterns of patient management in an academic Radiation Oncology department between 3/17/20 and 5/8/20 during the COVID-19 pandemic. Background: As a response to the worldwide COVID-19 pandemic, our Radiation Oncology department instituted a number of measures to limit spread of the disease to our patients and staff. This included prospectively evaluating all new referrals for radiation treatment and determining an appropriate course of action, which if appropriate included delaying the start of radiation, hypofractionation, or using other modalities of treatment prior to start of radiation. Methods: We analyzed data for 82 patients between 3/17/20-5/8/20 to evaluate patterns of management. The chi-squared test was used to evaluate the descriptive characteristics of the study population, with P values ≤ 0.05 considered statistically significant. One sample t-test was used to compare the statistical mean difference between sample variables. Data were analyzed using SPSS 24.0 software (IBM, Armonk, NY, USA). Results: The data set comprised 38% Caucasians and 59% African Americans. An age breakdown revealed 12.3% below age 30, 42% between ages 30-60, and 45.7% over age of 60. When the data were analyzed by gender, we noted a significant difference by site of treatment (p=0.005) and whether immediate treatment was required or not (p=0.029). This likely reflects gender-driven differences in cancer site with patients diagnosed with prostate cancer getting LHRH agonist therapy prior to start of radiation. Hypofractionated radiation schedules were used in 2 patients with cord compression early during the study period compared to 3 patients who received standard fractionation later, and one person elected to go straight to hospice care (p=0.002). Of patients for heterotopic ossification prophylaxis, 3/14 declined radiation and one was over the weight limit of the radiation table (p=0.000). 41% of patients were inpatients. No patients developed COVID-19 during our study period. Conclusion: A prospective evaluation of new patient referrals may have helped mitigate the spread of COVID-19 at our Radiation Oncology facility. This is one of several prospective measures that our department took to protect patients and staff. Citation Format: Sanjay Joseph, Mary Nittala, Paul Roberts, Maurice King, Hiba Ahmed, Ashley Albert, Toms Thomas, Robert Allbright, Satyaseelan Packianathan, Eswarkumar Mundra, Srinivasan Vijayakumar. Prospective planning of radiation treatment at new patient conference during the COVID-19 Pandemic: The University of Mississippi Medical Center experience [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-034.

Introduction: The purpose of this study is to evaluate the incidence, management, and prognosis of hypopharyngeal carcinoma in a tertiary care institution over the past 25 years. Methods: We retrospectively analyzed patients from 1995 to 2019 from the head and neck cancer data base of our institution. The data regarding the demographics, stage, treatment, and follow-up were collected. Outcomes including median survival and overall survival were evaluated using the Kaplan Meier method. All analyses were performed using SPSS version 24. Results: We identified 144 hypopharyngeal carcinoma patients, and the incidence was almost 4% of all head and neck cancers. All patients had squamous cell carcinoma. Sixty-one percent of patients were African Americans and 36% were Caucasians. Ninety percent of the patients were males, and 10% were females. Pyriform sinus was the subsite most commonly affected (67%), followed by posterior pharyngeal wall (10%) and postcricoid area (5%). Ninety-six percent of patients presented with advanced-stage disease (stages III and IV), with only 4% of patients presenting with early-stage disease (Stages I and II). Fifty-one percent of patients underwent definitive chemoradiotherapy with or without induction chemotherapy and 23% of patients underwent surgical management, followed by adjuvant radiation or chemoradiation, depending on risk factors. Ten percent of patients received only palliative chemotherapy and 15% did not receive any treatments. Induction chemotherapy was used in 31% of patients prior to initiation of definitive chemoradiation treatment. The median overall survival of early-stage patients and of advanced-stage patients was 56 months and 15 months, respectively. The median survival of the patients with advanced-stage patients who received definitive treatment was 26 months. The patients who underwent definitive operative management followed by adjuvant treatments had an improved median survival as compared to those undergoing definitive chemoradiation treatment (38 months vs. 16 months, p=0.05). Similarly, the overall survival at 3 years (30% vs. 54%, p=0.05) and 5 years (13% vs. 34%, p=0.05) was also better for surgery patients. The patients who received induction chemotherapy had clinically worse median survival as compared to those who did not, but this was not statistically significant (14 months vs. 21 months, p=0.2). Conclusions: Our results agree with the published literature regarding the low incidence of hypopharyngeal cancer, presentation in advanced stages, and poor long-term outcomes. Selection of patients for laryngeal preservation should be done very carefully. Our results suggest that trimodality treatment may be more efficacious than definitive chemoradiotherapy for locally advanced disease. Future studies are warranted to evaluate if neoadjuvant chemoradiotherapy followed by surgery might be able to improve the current poor outcomes for advanced hypopharyngeal cancer patients who are not eligible for laryngeal preservation. Citation Format: Toms Vengaloor Thomas, Mary R. Nittala, Divyang Mehta, Madhava Rao Kanakamedala, Anu Abraham, Lacey Weatherall, Eldrin Bhanat, Ashley A. Albert, Srinivasan Vijayakumar. Hypopharyngeal carcinoma management: 25-year experience from a tertiary care medical center in United States [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B20.

Introduction: The purpose of this study is to determine the likelihood of racial disparities between African American and Caucasian patients treated with hypopharyngeal carcinoma at a tertiary care institution over the last 25 years. Methods: HIPPA-compliant, IRB-approved retrospective analysis of patients with squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018 was performed. The data regarding the demographics, stage, treatment and follow up were collected. Outcomes including median survival and overall survival were evaluated using the Kaplan Meier method. All analyses were performed using SPSS version 24. Results: We evaluated 144 hypopharyngeal carcinoma patients who were treated during the time period. Our patient cohort consisted of 61.8% African Americans and 35.4% Caucasians (P= 0.538). Overall, 96% of patients presented with advanced stage disease (stages III & IV), and only 4% of patients presented with early stage disease (Stages I & II). There was no significant difference between African American and Caucasians who presented with advanced disease (96.6 % vs 94.1%). Among our patient cohort, 15.3% of patients didn’t receive any treatments, 51.4%, 22.9% and 10.4% of patients underwent definitive chemoradiotherapy, definitive surgery, and palliative chemotherapy respectively. There were no significant differences in each treatment group between the two races. The median follow up of the entire cohort was 13 months. There was no significant difference in the median survival of African American and Caucasian patients (16 months vs 15 months, p=0.917). In addition, there was no significant difference in the overall survival between African American and Caucasian patients at 3 years (27.2% vs 36.3%, p=0.917) or at 5 years (20.4% vs 16.7 %, p= 0.917). Conclusions: Retrospective review of the patients with hypopharyngeal cancer treated at our institution over the last 25 years did not reveal a significant racial disparity in regards to stage at presentation or prognosis. This study demonstrates that if patients have equal access to the care, they are likely to have similar prognosis despite racial differences. Further studies are warranted to validate this hypothesis. At the meantime, efforts should be focused on improving the access to medical care for the underserved population. Citation Format: Toms Vengaloor Thomas, Mary R Nittala, Teessa Perekattu Kuruvilla, Anu Abraham, Eldrin Bhanat, Satyaseelan Packianathan, Madhava Kanakamedala, Srinivasan Vijayakumar. Is there a racial disparity in the prognosis of hypopharyngeal carcinoma? 25-year experience from a tertiary care medical center in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D127.

Introduction: The purpose of this study was to evaluate the racial disparities among patients with carcinoma of cervix treated at a tertiary care institution. Methods: An IRB-approved and HIPPA-compliant retrospective analysis of patients with carcinoma of cervix was performed. All patients were treated in the department of Radiation Oncology at our institution between 2010 and 2018. Data regarding demographics, stage, treatment administered, and follow up were collected. Patient outcomes including median survival and overall survival were evaluated using the Kaplan Meier method. All analyses were performed using SPSS v. 24. Results: One hundred sixty-five patients with carcinoma of the cervix were treated between January 2010 and December 2018. We had significantly higher proportion of African American (AA) as compared to Caucasian Americans (CA) patients (59.4 % vs 36.4 %; p=0.03). There was a significant difference in stage at the time of presentation between African Americans and Caucasian Americans in that a higher number of CA patients presented with locally advanced disease, (FIGO Stages IB2 to IVA) as compared to AA (86.7 vs 78.6 %; p=0.000). Unfortunately, a higher number of African Americans presented with metastatic disease at diagnosis 13.3 % vs 8.3 % (p=0.000), as compared to Caucasian Americans. In regard to treatment, 157 (95.2 %) underwent definitive chemoradiotherapy while 3 (1.8 %) had definitive surgery, followed by adjuvant radiation or chemoradiation depending on the risk factors. The treatment details of 5 patients were not available. The median follow up and the median survival of the entire cohort was 16 months and 79 months, respectively. In our cohort, there was no significant difference in overall survival between AA and CA patients at 3 years (80 % vs 68 %; p=0.883) or at 5 years (77 % vs 68 %; p=0.883). As expected, patients with locally advanced disease showed a significantly improved median survival of 79 months as compared to 11 months for those with metastatic disease at their presentation (p=0.000). Conclusions: Retrospective review of the patients with carcinoma of the cervix treated at our institution over the last 8 years revealed a significant racial disparity in that more AA women presented with metastatic disease. However, our analysis did not identify any racial disparity in the prognosis of the whole cohort. Citation Format: Toms Vengaloor Thomas, Eldrin Bhanat, Shivanthidevi Gandhi, Teessa Perekattu Kuruvilla, Anu Abraham, Mildred Ridgway, Satyaseelan Packianathan, Srinivasan Vijayakumar. Racial disparities among patients with carcinoma of the cervix [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D126.

To identify differences in 3-year overall survival (OS) and disease-free survival (DFS) based on race in patients with tonsillar squamous cell carcinoma.We retrospectively analyzed 80 patients with squamous cell carcinoma of the tonsil treated between 2006 and 2015. Overall survival and DFS curves comparing white and black patients were generated using the Kaplan-Meier method. Cox regression was used to determine covariables associated with OS and DFS.Forty-one percent of the patients in this cohort were black and 59% were white. Three-year OS for black patients was 45.5% versus 88.1% for white patients (P = 0.003). Three-year DFS for black patients was 41.1% versus 66.6% in white patients (P = 0.001). Black race (hazard ratio [HR] 4.81, 95% confidence interval [CI] 1.48-15.6, P = 0.009) and lack of insurance (HR 9.50, 95% CI 2.92-13.0, P 0.009) were independently associated with worse OS on multivariable analysis. Black patients were more likely to have high-risk tumor features. Black patients with stage IV disease (American Joint Committee on Cancer, 7th edition) had decreased OS as compared to white patients, 41.4% versus 82.1% (P = 0.005). There was a trend toward worse OS in human papillomavirus (HPV)-negative black patients compared to HPV-negative white patients. Uninsured black patient experienced worse OS than white patients without insurance, 22.2% versus 68.1%, respectively (P 0.001).Significant racial disparities were found in presentation, tumor, and nodal characteristics, as well as in outcomes in this group of patients with tonsillar cancer. The difference in HPV-associated tonsillar cancer is likely the primary cause of these disparities, but other factors may also contribute to inferior outcomes in black patients.3 Laryngoscope, 129:643-654, 2019.