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Summary Background/Aims Methods Results Conclusions Patients with hepatocellular cancer (HCC) are vulnerable to psychological distress given a new cancer diagnosis superimposed on pre‐existing chronic liver disease. We aimed to characterise the psychiatric burden in HCC, risk factors for incident diagnosis and treatment patterns over time.Using IQVIA PharMetrics® Plus for Academics—a nationally representative claims database of the commercially insured US population—we identified psychiatric diagnoses and treatment among patients with newly diagnosed HCC. Multivariable logistic regression modelling identified factors associated with psychiatric diagnosis and treatment.Of 11,609 patients with HCC, 2166 (18.6%) had a psychiatric diagnosis after cancer diagnosis with depression (58.3%) and anxiety (53.0%) being most common. Women (aOR 1.33, 95% CI [1.19–1.49]), pre‐existing psychiatric diagnoses (aOR 9.12 [8.08–10.3]) and HCC treatment type (transplant: aOR 2.15 [1.66–2.77]; locoregional therapies: aOR 1.74 [1.52–1.99]; hospice: aOR 2.43 [1.79–3.29]) were significantly associated with psychiatric diagnosis. Female sex, ascites, higher comorbidity and treatment type were associated with incident psychiatric diagnosis. Pharmacotherapy was used in 1392 (64.3%) patients with a psychiatric diagnosis, with antidepressants (46.2%) and anxiolytics (32.8%) being most common. Psychiatric diagnoses increased from 14.8% in 2006–2009 to 21.1% in 2018–2021 (p < 0.001). In almost 20% of patients with pre‐existing psychiatric conditions, therapy was discontinued after HCC diagnosis.Nearly 2 of 10 patients with HCC were diagnosed with a psychiatric condition after cancer diagnosis with unique sociodemographic and clinical risk factors identified. This highlights a risk for increased psychological burden in need of early evaluation and treatment among patients with newly diagnosed HCC. [ABSTRACT FROM AUTHOR]

Purpose: To compare brachytherapy to external beam radiation therapy (EBRT) with respect to overall survival (OS) and disease-specific survival (DSS) among NSCLC patients undergoing limited surgical resection. Methods: All cases of T1-4 N0 M0 NSCLC undergoing limited resection and either brachytherapy or EBRT diagnosed between 2004 and 2014 were extracted from the Surveillance, Epidemiology, and End Results database. Chi-square test and Fisher's exact analysis were used to analyze categorical variables while Student's t-test was used to analyze continuous variables. Univariate analysis to assess for differences in survival with respect to covariates was performed with the log-rank test. Multivariable analysis was performed with Cox proportional hazards regression models among the entire cohort and after sub-stratification by T stage. Results: Among 543 patients, 471 underwent EBRT and 72 underwent brachytherapy. Brachytherapy demonstrated improved OS and DSS on univariate analysis as compared to EBRT (p < 0.05). Cox regression also demonstrated improved OS and DSS with brachytherapy (HR 0.604; 95% CI [0.380; 0.961] and HR 0.524; 95% CI [0.303; 0.908], respectively). Sub-cohort analysis demonstrated significant improvement in survival only among patients with T1 disease with similar survival between brachytherapy and EBRT among higher stage disease. Conclusions: Patients undergoing brachytherapy for T1-T4, N0, M0 NSCLC demonstrated at least similar survival as compared to those undergoing EBRT among patients undergoing limited resection. Improved survival was demonstrated among patients with T1 disease. [ABSTRACT FROM AUTHOR]

A retrospective analysis of the Surveillance, Epidemiology, and End Results database was performed to evaluate the effect of radiotherapy (RT) on overall survival and disease-specific survival. Patients undergoing RT had improved overall survival and disease-specific survival on multivariate Cox regression and after propensity score matching as compared with patients who did not receive RT. Introduction: The aim of this study was to perform a Surveillance, Epidemiology, and End Results (SEER) analysis on the effect of radiotherapy (RT) on survival among patients with prostate ductal adenocarcinoma (DA), a rare variant of prostate cancer. Patients and Methods: Cases of T1 to 4 N0 M0 prostate DA diagnosed between 2004 and 2013 were extracted from SEER. The association between categorical variables and radiation therapy was assessed for statistical significance using the x² test or Fisher exact test. Difference in continuous variables across the RT groups was assessed for statistical significance using the 2-sample t test or non-parametric test. The distribution of overall survival (OS) and disease-specific survival (DSS) between the RT groups was assessed using the Kaplan-Meier method and the log rank test and after propensity matching. The association between hazards of death (HR) and covariates was examined using Cox proportional hazards model. A 2-sided P-value of .05 was used to determine statistical significance. Results: A total of 205 patients met inclusion criteria. On univariate analysis, RT was associated with significant improvement in OS and DSS. On multivariate Cox regression, RT significantly decreased risk of death for both OS and DSS (HR, 0.516; 95% confidence interval [CI], 0.273-0.978 and HR, 0.232; 95% CI, 0.082-0.658, respectively). After propensity score matching, RT demonstrated a persistent improvement in both OS and DSS. Conclusions: RT decreased risk of death for both OS and DSS in patients with node-negative, nonmetastatic prostate DA on multivariable analysis. RT was also associated with improved OS and DSS after propensity matching. [ABSTRACT FROM AUTHOR]

Poly(ADP-ribose) polymerase (PARP) inhibitors represent one of the successful novel approaches to targeted cancer treatment. Indeed, the US Food and Drug Administration (FDA) has recently approved PARP inhibitors for the treatment of breast and ovarian cancers. Despite the proven efficacy of these agents, certain challenges remain with their use. Among the most important are primary and secondary resistance. Here, we review the mechanism of action of PARP inhibitors and their ability to exploit certain inherent deficiencies among malignant cells to improve cell killing, with a focus on deficiencies in homologous recombination among cells with BRCA1 and BRCA2 mutations. Moreover, we discuss the different mechanisms of resistance including development of secondary resistance and strategies to overcome them. Finally, we discuss the limitations of novel therapeutic interventions and possible future studies to exploit biochemical pathways in order to improve therapeutic efficacy of PARP inhibitors. [ABSTRACT FROM AUTHOR]

Abstract: Biomechanical model assumptions affect the interpretation of the role of the muscle or joint moments to the segmental power estimated by induced acceleration analysis (IAA). We evaluated the effect of modeling the pelvis and trunk segments as two separate segments (8 SM) versus as a single segment (7 SM) on the segmental power, support of the body, knee and hip extension acceleration produced by the joint moments during the stance phase of normal walking. Significant differences were observed in the contribution of the stance hip abductor and extensor moments to support, ipsilateral knee and hip acceleration, and ipsilateral thigh and upper body power. The primary finding was that the role of the stance hip moment in generating ipsilateral thigh and upper body power differed based on degrees of freedom in the model. Secondarily, the magnitude of contributions also differed. For example, the hip abductor and extensor moments showed greater contribution to support, hip and knee acceleration in the 8 SM. IAA and segment power analysis are sensitive to the degrees of freedom between the pelvis and trunk. There is currently no gold standard by which to evaluate the accuracy of IAA predictions. However, modeling the pelvis and trunk as separate segments is closer to the anatomical architecture of the body. An 8 SM appears to be more appropriate for estimating the role of joint moments, particularly to motion of more proximal segments during normal walking. [Copyright &y& Elsevier]

To characterize inventions and assess trends in brachytherapy innovation based on brachytherapy-related patents awarded across the past 2 decades and provide insights that will help inform future research and entrepreneurship in the field. The United States Patent and Trademark Office database was searched for patents awarded between 1999 and 2018 with a classification code corresponding to the broadest brachytherapy search category. Patent characteristics were stratified and compared by geographic location, affiliation, and theme of invention. There were 202 brachytherapy-related patents awarded from 2009 to 2018, which indicates a 56% increase in patent productivity and brachytherapy innovation compared with the previous decade from 1999 to 2008. Patents had an industry affiliation in 83% of cases from 1999 to 2008 and in 76% of cases from 2009 to 2018. Meanwhile, academic participation in brachytherapy patent innovation rose from 4% to 11% in that time. The focus and theme of inventions evolved across time, with radiation sources being the most common theme from 1999 to 2008 and falling to third place in 2009–2018. Conversely, development of brachytherapy-related patents involving exogenous agents such as drug-conjugates, radiosensitizers, and adjuncts to treatment increased substantially in the subsequent decade. While no collaboration was observed between academia and industry between 1999 and 2008, notable partnerships emerged in the subsequent decade which amounted to almost 5% of all patents awarded between 2009 and 2018. There has been an increase in overall brachytherapy patent production over time, and this has been accompanied by a greater variety of distinct patent themes. Collaboration between industry and academia is rare. Knowledge of brachytherapy patents may inform future research innovation in this field. [ABSTRACT FROM AUTHOR]

Accurate target delineation/contouring is essential for radiation treatment planning and the clinical efficacy of radiation therapy. Clinical trial data has demonstrated the importance of quality contouring and treatment planning for optimal survival outcomes. As a result, improving the quality of target delineation is an important goal in the education of radiation oncology residents. However, there is limited quantitative data on the quality of residents' contours. Therefore, it would be beneficial to track performance and improvement in resident target delineation during residency. The purpose of this study was to determine if it was feasible to track the concordance of radiation oncology residents' contours with faculty physicians' contours. Residents were asked to contour target volumes (GTV, CTV, ITV, PTV, etc.) based on patient history, physical exam, clinical stage and fused diagnostic imaging and were allowed to use any available outside resources, including textbooks, review articles, consensus guidelines, and online atlases. Resident contours were saved as separate structures. Finalized, faculty physician-approved contours were also saved. Saved contour structures and data from October 2019 through June 2020 were reviewed for feasibility. In total, 209 structures had both resident and faculty versions saved within Eclipse and were available for analysis. The Boolean Operations Tool in Eclipse (Varian Medical Systems, Palo Alto, CA, USA) was used to create an intersection volume of the resident/faculty contours. Separately, the Boolean Operations Tool was used to create a union volume of the resident/faculty contours. Based on these two volumes, the Jaccard Concordance Index (JCI) was calculated by dividing the intersection volume (in cubic centimeters [cc]) by the union volume (cc). The JCI could be successfully calculated for 203 (97.1%) of the 209 structures. For 6 structures (2.9%), both the intersection and union volumes could not be calculated because the volumes were too small for Eclipse to determine. All 6 of these structures were small brain metastases. Tracking and comparing the concordance of resident contours and faculty physician contours is feasible using available tools in Eclipse. Additional data collection and assessment is necessary before this technique can be more widely utilized. [ABSTRACT FROM AUTHOR]

• Many head/neck squamous cell cancer patients develop recurrence or second primary. • Re-irradiation is a curative treatment option for these patients. • However, it is associated with significant risk of toxicity. • Pulsed Reduced Dose Rate radiation may reduce re-irradiation toxicity. Pulsed reduced dose rate (PRDR) radiation (RT) is a re-irradiation (Re-RT) technique that potentially overcomes dose/volume constraints in the setting of previous RT. There is minimal data for its use for recurrent or secondary primary head and neck squamous cell carcinoma (HNSCC). In this study, we report preliminary data from our institution of a consecutive cohort of HNSCC patients who received PRDR Re-RT. Nine patients received PRDR Re-RT from August 2020 to January 2023 and had analyzable data. Intensity modulated RT was used for treatment delivery and a wait time between 20 cGy arc/helical deliveries was used to achieve the effective low dose rate. Data collected included patient demographic information, prior interventions, diagnosis, radiation therapy dose and fractionation, progression free survival, overall survival, and toxicity rates. The median time to PRDR-RT from completion of initial RT was 13 months (range, 6–50 months). All but one patient underwent salvage surgery prior to PRDR-RT. The median follow-up after Re-RT was 7 months. The median OS from PRDR-RT was 7 months (range, 1–32 months). Median PFS was 7 months (range, 1–32 months). One patient (11.1 %) had acute grade 3 toxicity, and two patients (22.2 %) had late grade 3 toxicities. There were no grade 4+ toxicities. PRDR Re-RT is a feasible treatment strategy for patients with recurrent or second primary HNSCC. Initial findings from this retrospective review suggest reasonable survival outcomes and potentially improved toxicity; prospective data is needed to establish the safety and efficacy of this technique. [ABSTRACT FROM AUTHOR]

Background: The incidence of shoulder and elbow injuries in adolescent baseball players is rapidly increasing. One leading theory about this increase is that breaking pitches (such as the curveball) place increased moments on the dominant arm and thereby increase the risk of injury. Hypothesis: There is no difference in the moments at the shoulder and elbow between fastball and curveball pitches in adolescent baseball pitchers. Study Design: Controlled laboratory study. Methods: Thirty-three adolescent baseball pitchers with a minimum of 2 years of pitching experience underwent 3-dimensional motion analysis using reflective markers aligned to bony landmarks. After a warm-up, pitchers threw either a fastball or curveball, randomly assigned, from a portable pitching mound until 3 appropriate trials were collected for each pitch technique. Kinematic and kinetic data for the upper extremities, lower extremities, thorax, and pelvis were collected and computed for both pitch types. Statistical analysis included both the paired sample t test and mixed model regression. Results: There were lower moments on the shoulder and elbow when throwing a curveball versus when throwing a fastball. As expected, speed for the 2 pitches differed: fastball, 65.8 ± 4.8 mph; and curveball, 57.7 ± 6.2 mph (P < .001). Maximal glenohumeral internal rotation moment for the fastball was significantly higher than for the curveball (59.8 ± 16.5 N·m vs 53.9 ± 15.5 N·m; P < .0001). Similarly, the maximum varus elbow moment for the fastball was significantly higher than for the curveball (59.6 ± 16.3 N·m vs 54.1 ± 16.1 N·m; P < .001). The wrist flexor moment was greater in the fastball, 8.3 ± 3.6 N·m, than in the curveball, 7.8 ± 3.6 N·m (P < .001), but the wrist ulnar moment was greater in the curveball, 4.9 ± 2.0 N·m, than in the fastball, 3.2 ± 1.5 N·m (P < .001). Relatively minor motion differences were noted at the shoulder and elbow throughout the pitching motion, while significant differences were seen in forearm and wrist motion. The forearm remained more supinated at each point in the pitching cycle for the curveball but had less overall range of motion (62° ± 20°) than with the fastball (69° ± 17°) (P < .001), and the difference in the forearm pronation and supination moment between the pitches was not significant (P = .104 for pronation and P = .447 for supination). The wrist remained in greater extension during the fastball from foot contact through ball release but did not have significantly different total sagittal range of motion (53° ± 11°) when compared with the curveball (54° ± 15°) (P = .91). Conclusion: In general, the moments on the shoulder and elbow were less when throwing a curveball than when throwing a fastball. In each comparison, the fastball demonstrated higher moments for each individual pitcher for both joints. Clinical Relevance: The findings based on the kinematic and kinetic data in this study suggest that the rising incidence of shoulder and elbow injuries in pitchers may not be caused by the curveball mechanics. Further evaluation of adolescent and adult baseball pitchers is warranted to help determine and subsequently reduce the risk of injury. [ABSTRACT FROM AUTHOR]

A three-dimensional biomechanical analysis on baseball pitching technique among adolescent is presented. The purpose of the study was to understand the etiology of injuries common to adolescent baseball pitchers. Kinetic and kinematics data for the lower and upper extremities, thorax, and pelvis of 24 adolescent pitchers were collected and analyzed using three-dimensional computerized motion analysis. Result of the measurements of motion of forearm, wrist shoulders, thorax and pelvic are analyzed. It is concluded that the measured parameters and the difference between adolescent and adult pitchers can be used to determine causes of pitching injuries.