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While systemic therapy is the standard of care for extrahepatic hepatocellular carcinoma (HCC), individuals with limited intra-abdominal recurrence may benefit from local ablative radiation therapy (RT) that may complement or obviate the need for systemic therapy. This study assesses the results of ablative RT in abdominal lymph node (LN) or adrenal gland (AG) recurrences from HCC with or without systemic therapy. A retrospective chart review at a single institution from 2013 to 2024 identified patients with HCC with recurrence in an abdominal LN or AG treated with salvage ablative RT. The primary outcome is local control in the target lesion (LC; defined as no progression in target lesion after ablative RT). Secondary outcomes are progression-free survival (PFS; defined as the time from the last day of ablative RT to the LN or AG to disease progression or death) and overall survival (OS; defined as the time from the last day of ablative RT to the LN or AG to death). Fifty-five patients were included in the study, of which 41 (74.5%) had a recurrence in LN (of which 25 [61.0%] were portal LN), while 14 (25.5%) had recurrences in an AG. The median time from initial HCC diagnosis to extrahepatic recurrence was 19 months (range = 0 to 153 months). Among all patients, 39 patients (70.9%) have received immunotherapy since their disease diagnosis, of whom (53.8%) received concurrent immunotherapy with salvage RT. The median dose was 4500 in 5 fractions. LC was 98.%. The median PFS was 10.5 months. At 12 months and 18 months after the end of the salvage RT to LN or AG, 11 (20.2%) patients and 9 (16.4%) patients, respectively, remained free of any disease recurrence. The median OS was 32.4 months. Median OS for patients receiving concurrent IO was 18.8 months and RT alone was 32.4 months (p = 0.66). Median PFS for patients receiving concurrent IO was 10.5 months and RT alone was 11.3 months (p = 0.58). The median OS for patients with LN recurrence was 32.3 months, while AG was 35.2 months. Salvage ablative RT, with or without immunotherapy, can produce meaningful PFS and OS benefits in well-selected patients with abdominal limited recurrence of HCC in LN or AG. RT alone might be sufficient in some patients without starting systemic therapy. Prospective data are needed to verify these results. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to assess the health status of a cohort of adults with intellectual/developmental disabilities (I/DD) residing in family homes or institutions in Taiwan and to examine whether morbidity varied with age, sex, existing diagnosis [Down syndrome (DS), seizures, cerebral palsy (CP), intellectual disability (ID) level] and residential status. Methods: Systematic randomization based on geographic areas was employed for sampling selection. Primary carers were interviewed to provide health-related information on individuals with I/DD aged 33 years or older living in institutions (n = 614) or living with their family (n = 514) in Taiwan. Results: Cardiovascular, neurological, visual and hearing impairments increased with age; while gastrointestinal, endocrine, infectious and dermatological diseases did not, after adjusting for sex, level of ID, presence of DS, seizures or CP, across settings. Institution cohorts were more likely to have infectious diseases, skin diseases, hepatitis or to be hepatitis carriers, and to have psychiatric disorders. Conclusions: Organ system morbidity increased with age and generally was influenced by the same factors as have been reported for cohorts in western countries. The results also suggest that disease/condition outcomes may vary or be influenced differentially by residential setting.

An imbalance persists between rural and nonrural areas in terms of access to specialist care, including in radiation oncology (RO). In this study, we sought to characterize recent RO graduates who accepted clinical positions in rural U.S. counties, examine county-level parameters of these rural areas, and identify factors associated with rural practice choice. Using publicly available data sources, we identified the first employment positions accepted by RO graduates between 2015 and 2022 and classified each position by its rural-urban continuum code. Descriptive statistics were used to summarize characteristics of graduates who accepted rural positions. County-level data on population characteristics were drawn from the Health Resources and Services Administration (HRSA). χ2 or Fisher's exact tests were applied for univariate analyses comparing categorical variables and t-tests were applied for continuous variables. We identified 68 RO residents who graduated from residency between 2015 and 2022 and accepted clinical positions in rural counties. The majority obtained an M.D. from a medical school in the United States (N = 63, 92.6%) and were male (N = 53, 77.9%). At least 18 (26.5%) of the examined individuals have switched jobs at least once at the time of this analysis, of whom 16 (88.9%) switched to practice in a nonrural county. Univariate analysis demonstrated that RO graduates who chose rural practice were more likely to be graduates of small-sized residency programs (0-6 residents per class; P = 0.020) as compared to graduates who chose nonrural practice. Rural counties where recent RO graduates accepted positions (N = 62) had a higher median income (P<.0001), percentage of the population that was non-Hispanic White (P<.0001), and population density (P<.0001), and more primary care physicians per 10,000 individuals (P<0.001), as compared to all other U.S. rural counties (N = 1934). Additionally, these 62 rural counties were more populous (P<0.001) and had a lower percentage of the population in poverty (P = 0.002) and younger than 65 years of age without health insurance (P<0.0001). In this study, we found that RO residents who choose rural practice were more likely to be graduates of small-sized residency programs. Additionally, we found that the rural counties where recent RO graduates accepted clinical positions appear to represent a distinct subset of rural counties that is associated with higher income, larger population size, and lower poverty levels. These findings suggest that improving access to radiation therapy may prove more challenging than simply addressing urban-rural disparities. Further efforts to improve the retention of new graduates in rural practice and to examine the fundamental tension between maintaining a stable rural RO workforce while at the same time considering the employment preferences of graduating RO residents are necessary. [ABSTRACT FROM AUTHOR]

Radiation oncology (RO) fellowships are offered to residency graduates interested in gaining additional training. In this study, we sought to better understand the outcomes of individuals who pursue such fellowships after graduating from US RO residency programs. We generated a database of individuals who completed an ACGME-accredited RO residency training program in the US between 2015 and 2022. We then identified those individuals who subsequently pursued a RO fellowship. Multiple publicly available sources were utilized to build this database, such as hospital/institutional websites, residency/fellow training program websites, LinkedIn, and Doximity. We used descriptive statistics and the Chi-Square Goodness of Fit test to analyze our data. We identified 78 individuals who graduated from US RO residency programs and went on to pursue fellowship, 52 (66.7%) of whom were men and 26 (33.3%) of whom were women (p>0.05). 20 (25.6%) individuals graduated from large-sized residency programs (≥4 graduates per year), 43 (55.1%) from medium-sized programs (1.5-4 graduates per year), and 15 (19.2%) from small-sized programs (≤1.5 graduates per year) (p>0.05). 52 (66.7%) individuals completed residency between 2015 and 2018, and 26 (33.3%) between 2019 and 2022. 5 (6.4%) individuals who completed fellowship are not practicing radiation oncologists. The most common fellowships were in research (N = 28), protons (N = 22), and brachytherapy (N = 14). Interestingly, the employment websites of a substantial proportion of fellows did not list the focus of their fellowships as an area of expertise (Table 1). The vast majority of fellows who graduated from US residency programs pursued fellowships in research, protons, and brachytherapy. Our data raises questions about the long-term utilization of skills acquired in fellowship. Table 1. * Column percentage is reported. † 1 completed a pediatric proton therapy and neuro-oncology fellowship ‡ 2 completed immunotherapy-related fellowships, 1 gynecology fellowship, 1 epidemiology fellowship, 1 health policy, and 1 genomics fellowship § Row percentage is reported unless otherwise noted. ¶ 6 participants are still fellows, so the percentage is calculated with a denominator of 16. # Individuals who have their own labs, are in a lab, or have investigated clinical trials are included. [ABSTRACT FROM AUTHOR]