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Background Stereotactic radiosurgery (SRS) is a current therapeutic option for treatment of arteriovenous malformations (AVMs) located in deep or eloquent brain regions. Obliteration usually occurs in a delayed fashion, with an expected latency of 3–5 years. Here, we assess how AVM flow correlates with volume before and after SRS treatment.Methods Patients with supratentorial AVM treated with SRS at our institution between 2012–2022 were retrospectively reviewed. Patients were included if Quantitative Magnetic Resonance Angiography (QMRA) study was performed at baseline and at least at the first follow-up. Correlation between AVM flow and volume before and after treatment was evaluated. AVM flow and volume were additionally assessed for obliteration using the non-parametric receiver operating characteristic (ROC) curve.Results Twelve patients with radiologic follow-up imaging were included. Eight patients presented AVM rupture, one of which occurred after radiosurgical treatment. Three patients underwent embolization prior SRS. Mean AVM initial volume was 3.8 cc (0.1–12.4 cc), mean initial flow 174 ml/min (11–604 ml/min), both variables showed progressive reduction at follow-up (range 3–57 months); and flow decreased with volume reduction (p< 0.001). Area under the ROC was 0.914 for both AVM flow and volume with obliteration (p= 0.019).Conclusions AVM flow significantly decreased after SRS treatment, reflecting volume reduction. Baseline AVM flow and volume both predicted obliteration. QMRA provides additional non-invasive information to monitor patients after radiosurgical treatment.

In allogeneic hematopoietic stem cell transplantation (HSCT) for high-risk myeloid disorders, the intensity of the conditioning regimen correlates with the risk of relapse, but its benefit may be offset by its risk of toxicity.

Disparities exist in lung cancer outcomes between African American and white people. The current United States Preventive Services Task Force (USPSTF) lung cancer screening eligibility criteria, which is based solely on age and smoking history, may exacerbate racial disparities. We evaluated whether the PLCOm2012 risk prediction model more effectively selects African American ever-smokers for screening.

In allogeneic hematopoietic stem cell transplantation (HSCT) for high-risk myeloid disorders, the intensity of the conditioning regimen correlates with the risk of relapse, but its benefit may be offset by its risk of toxicity. The addition of increasing doses of TMI to myeloablative conditioning was previously shown to have acceptable toxicity in a phase I trial by our group (PMID 25234438), but the efficacy of this strategy remains uncertain.

IMPORTANCE: Because locally advanced oral cavity squamous cell carcinoma (OCSCC) is often treated with surgery followed by postoperative radiotherapy (S+PORT), the effectiveness of organ preservation with concurrent chemoradiotherapy (CRT) remains unclear. OBJECTIVE: To compare the differences in survival between patients with locally advanced OCSCC treated with S+PORT or CRT. DESIGN, SETTING, AND PARTICIPANTS: Using the National Cancer Database, this study compared 6900 patients with stage III to IVA OCSCC treated with S+PORT and CRT from 2004 through 2012 at academic and community-based cancer clinics. Comparisons were made using Kaplan-Meier methods and Cox proportional hazards regression models using the entire cohort and a propensity score–matched cohort of 2286 patients. MAIN OUTCOMES AND MEASURES: Overall survival (OS). RESULTS: Of the 6900 study patients, 4809 received S+PORT (3080 male [64.0%] and 1792 [36.0%] female) and 2091 received CRT (1453 male [69.5%] and 638 [30.5%] female). Median follow-up for the entire group was 23.0 months overall but was shorter for patients receiving CRT (17.3-month) vs S+PORT (25.6 months). Patients receiving CRT were more likely to be older than 60 years, treated before 2007, live within 10 miles of the treating facility, treated at nonacademic centers, have more comorbidities, have T3 to T4a tumors, and have N2a to N2c nodal disease. Propensity score matching identified cohorts of patients with similar clinical variables. S+PORT was associated with improved survival among all patients (3-year OS: 53.9% for S+PORT vs 37.8% for CRT; difference = 16.1%; 95% CI, 13.6%-18.6%) and in the propensity score–matched cohort (3-year OS: 51.8% for S+PORT vs 39.3% for CRT; difference = 11.9%; 95% CI, 7.8%-16.0%). S+PORT was associated with improved survival among patients with T3 to T4a tumors (3-year OS: 49.7% for S+PORT vs 36.0% for CRT; difference = 16.1%; 95% CI, 13.6%-18.6%) but was not associated with improved survival among patients with T1 to T2 tumors (3-year OS: 59.1% for S+PORT vs 53.5% for CRT; difference = 5.6%; 95% CI, −3.1% to 14.3%). CONCLUSIONS AND RELEVANCE: Compared with CRT, S+PORT was associated with improved survival for locally advanced OCSCCs, especially in T3 to T4a disease. These data support the use of surgery as the initial treatment modality for operable OCSCCs.

The optimal role for postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. We used the National Cancer Data Base to investigate the impact of PORT on overall survival (OS).

Purpose/Objectives: Patients receiving stereotactic body radiotherapy for stage I non-small cell lung cancer are typically staged clinically with positron emission tomography–computed tomography. Currently, limited data exist for the detection of occult hilar/peribronchial (N1) disease. We hypothesize that positron emission tomography–computed tomography underestimates spread of cancer to N1 lymph nodes and that future stereotactic body radiotherapy patients may benefit from increased pathologic evaluation of N1 nodal stations in addition to N2 nodes.Materials/Methods: A retrospective study was performed of all patients with clinical stage I (T1-2aN0) non-small cell lung cancer (American Joint Committee on Cancer, 7th edition) by positron emission tomography–computed tomography at our institution from 2003 to 2011, with subsequent surgical resection and lymph node staging. Findings on positron emission tomography–computed tomography were compared to pathologic nodal involvement to determine the negative predictive value of positron emission tomography–computed tomography for the detection of N1 nodal disease. An analysis was conducted to identify predictors of occult spread.Results: A total of 105 patients with clinical stage I non-small cell lung cancer were included in this study, of which 8 (7.6%) patients were found to have occult N1 metastasis on pathologic review yielding a negative predictive value for N1 disease of 92.4%. No patients had occult mediastinal nodes. The negative predictive value for positron emission tomography–computed tomography in patients with clinical stage T1 versus T2 tumors was 72 (96%) of 75 versus 25 (83%) of 30, respectively (P= .03), and for peripheral versus central tumor location was 77 (98%) of 78 versus 20 (74%) of 27, respectively (P= .0001). The negative predictive values for peripheral T1 and T2 tumors were 98% and 100%, respectively; while for central T1 and T2 tumors, the rates were 85% and 64%, respectively. Occult lymph node involvement was not associated with primary tumor maximum standard uptake value, histology, grade, or interval between positron emission tomography–computed tomography and surgery.Conclusion: Our results support pathologic assessment of N1 lymph nodes in patients with stage Inon-small cell lung cancer considered for stereotactic body radiotherapy, with the greatest benefit in patients with central and T2 tumors. Diagnostic evaluation with endoscopic bronchial ultrasound should be considered in the evaluation of stereotactic body radiotherapy candidates.

IMPORTANCE: There is a growing debate on the relative benefits of adjuvant chemoradiotherapy (CRT) and boost doses of postoperative radiotherapy (B-PORT) in oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery, especially for patients with human papillomavirus (HPV)-driven disease. OBJECTIVE: To characterize the recent patterns of care in and overall survival (OS) outcomes following the use of adjuvant CRT and B-PORT after primary surgery for OPSCC. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients in the National Cancer Database with stage III to IVA-B OPSCC treated with surgery and adjuvant radiotherapy between 2010 and 2012 at Commission on Cancer–accredited facilities. The data analysis was performed between June 15, 2015, and May 4, 2016. MAIN OUTCOMES AND MEASURES: The primary outcomes were prevalence of CRT and B-PORT, and OS. The primary predictors were HPV positivity and high-risk pathologic features (HRPFs) (extracapsular extension and positive surgical margins). RESULTS: Of the 1409 patients (1153 [82%] male; median age, 57 [interquartile range {IQR}, 51-63] years), 873 (62%) and 789 (56%) patients received CRT and B-PORT, respectively; most patients (n = 583 [79%]) with HRPFs received CRT, and many patients (n = 227 [40%]) without HRPFs received CRT. Multivariable predictors of CRT included adverse pathologic features (extracapsular extension [OR, 6.99; 95% CI, 5.22-9.35], positive surgical margins [OR, 2.07; 95% CI, 1.50-2.87], ≥6 involved nodes [OR, 2.34; 95% CI, 1.39-3.92], or low-neck disease [OR, 1.52; 95% CI, 1.01-2.28]), and treatment at a nonacademic institution (OR, 1.59 [95% CI, 1.21-2.10] for comprehensive community cancer center vs academic program). Patients with HPV-positive disease (OR, 0.47; 95% CI, 0.33-0.68) were less likely to receive CRT; this decrease was limited to absent HRPF treated at academic institutions (n = 173, 44 [25%] received CRT). With a median follow-up of surviving patients of 27 (IQR, 21-33) months, the 2-year OS probability was 92% (95% CI, 90%-94%). Multivariable analysis including age, sex, pathologic T stage, 6 or more positive nodes, and educational status confirmed the prognostic impact of HPV positivity (hazard ratio [HR], 0.41; 95% CI, 0.21-0.80) and HRPFs (positive surgical margins [HR, 2.15; 95% CI, 1.27-3.66] and ≥6 involved nodes [HR, 2.11; 95% CI, 1.13-3.93]), but neither CRT (HR, 1.27; 95% CI, 0.70-2.30) nor B-PORT (HR, 1.04; 95% CI, 0.63-1.73) was associated with improved OS. CONCLUSIONS AND RELEVANCE: Postoperative CRT and B-PORT following resection of OPSCC were dependent on factors beyond HRPFs, including HPV status and treatment at an academic institution. No benefit was seen with intensified adjuvant therapy, supporting enrollment of the HPV-positive population into deintensification trials.

IMPORTANCE: The optimal management for elderly patients with glioblastoma (GBM) is controversial. Following maximal safe resection or biopsy, accepted treatment paradigms for elderly patients with GBM include combined-modality therapy (CMT) with both radiotherapy (RT) and chemotherapy (CT), RT alone, and CT alone. OBJECTIVE: To evaluate the overall survival (OS) outcomes associated with RT, CT, and CMT for elderly patients with GBM in the modern temozolomide era. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study of a prospectively maintained, multi-institutional national cancer registry, the National Cancer Database was queried for elderly patients (≥65 years) with newly diagnosed GBM from January 1, 2005, through December 31, 2011, with complete data sets for RT, CT, tumor resection, Charlson-Deyo comorbidity scores, age, sex, and year of diagnosis. Data analysis was performed from October 2015 through December 2015. INTERVENTIONS: Combined-modality therapy, RT, CT. MAIN OUTCOMES AND MEASURES: Survival by treatment cohort was estimated using the Kaplan-Meier method and analyzed using the log rank test, univariate and multivariate Cox models, and propensity score–matched analyses. RESULTS: A total of 16 717 patients (median [range] age, 73 [65-≥90 y]; 8870 [53%] male) were identified. The median OS by treatment was 9.0 (95% CI, 8.8-9.3) months with CMT (8435 patients), 4.7 (95% CI, 4.5-5.0) months with RT alone (1693 patients), 4.3 (95% CI, 4.0-4.7) months with CT alone (1018 patients), and 2.8 (95% CI, 2.8-2.9) months with no therapy (5571 patients) (P &lt; .001). On multivariate analysis, CMT was superior to both CT alone (hazard ratio, 1.50 [95% CI, 1.40-1.60]; P &lt; .001) and RT alone (hazard ratio, 1.47 [95% CI, 1.39-1.55]; P &lt; .001), whereas no differences were observed between CT alone vs RT alone (P = .60). Propensity score–matched analyses redemonstrated improved OS with CMT over CT alone (P = .002) and RT alone (P &lt; .001); no differences were observed between CT alone vs RT alone (P = .44). On subgroup analyses, a consistent OS advantage was observed with CMT over both CT alone and RT alone across each age stratification (65-69, 70-74, 75-79, and ≥80 years) and among patients treated with or without tumor resection (all P &lt; .001). CONCLUSIONS AND RELEVANCE: In this analysis of multimodality therapy for elderly patients with GBM, OS was superior with CMT compared with CT alone and RT alone. Survival was similar between CT alone and RT alone, and both CT alone and RT alone were superior to no therapy. This analysis supports the use of CMT for suitable elderly candidates.

OBJECTIVE To examine the effect of adjuvant radiation therapy (RT) on survival of high-grade and/or locally advanced malignant major salivary gland tumors (MMSGT). PATIENTS The study population comprised 2170 patients with high-grade (poorly differentiated or undifferentiated) and/or locally advanced MMSGT (T3/4 or N+). MAIN OUTCOME MEASURES The Surveillance, Epidemiology, and End Results registry was used to obtained data for all patients 20 years or older who underwent surgery for high-grade and/or locally advanced nonmetastatic MMSGT between 1988 and 2005. Univariate and multivariable regression analyses were performed to identify factors associated with improved survival. RESULTS Seventy-two percent of patients received adjuvant RT, while 28% underwent surgery alone. Patients receiving adjuvant RT were younger and had higher T and N categories and grade. Multivariable analysis revealed significantly improved survival with adjuvant RT (HR for mortality, 0.76; 95% CI, 0.65-0.89; P &lt; .001). Other factors associated with improved survival included younger age at diagnosis, less than radical surgery, certain histologic subtypes, lower grade, and lower T and N categories. Subset analyses found significantly improved survival with adjuvant RT among patients with both high-grade and locally advanced disease (P &lt; .001), involvement of the parotid gland (P = .002), or squamous cell carcinoma (P = .004), with a survival benefit seen among patients with adenocarcinoma that did not reach significance (P = .06). CONCLUSIONS Adjuvant RT is associated with improved survival for high-grade and/or locally advanced MMSGT based on analysis of this large, population-based database. Further prospective studies are warranted to examine the role of RT in the management of this disease.

Eligibility criteria for lung cancer screening based solely on age and smoking history are less sensitive than validated risk prediction models. The U.S. Preventive Services Task Force (USPSTF) has proposed new guidelines to improve the sensitivity for selecting high-risk individuals and to decrease race disparity. In this retrospective study, termed the Chicago Race Eligibility for Screening Cohort, we compare the sensitivity of the proposed USPSTF2020 criteria versus the PLCOm2012 risk prediction model for selecting a racially diverse lung cancer population with a smoking history for lung cancer screening.

Lung cancer is the leading cause of cancer death in women in the United States. Prospective randomized lung screening trials suggest a greater lung cancer mortality benefit from screening women compared to men.

The widespread application of allogeneic hematopoietic stem cell transplantation (HSCT) to cure patients with clinically aggressive sickle cell disease (SCD) has been limited by a lack of HLA-matched sibling donors. HSCT from a haploidentical donor represents a feasible option to increase transplant availability to a majority of the patients. However, current published studies using haploidentical donors in adults with SCD have resulted in long-term event-free survival rates of only 50-57%.

No relevant conflicts of interest to declare.

High dose melphalan at 200mg/m2(Mel200) followed by autologous stem cell transplant (ASCT) prolongs the survival of patients with multiple myeloma (MM) although it does not prevent relapse. Enhancing the anti-myeloma effect of pre-transplant conditioning without increasing toxicity is an important goal. To this purpose, intensity modulated radiation therapy (IMRT) can be used to deliver radiation to the marrow (total marrow irradiation, TMI) while sparing other organs. Here we tested the safety of combining linear accelerator based TMI to Mel200 in a phase 1, 3+3 trial.

No relevant conflicts of interest to declare.

Allogeneic hematopoietic stem cell transplantation (HSCT) can cure SCD but chemotherapy-based conditioning regimens are associated with substantial morbidity and mortality, particularly in adult patients. A chemotherapy-free, non-myeloablative HSCT with alemtuzumab 1mg/kg divided over 5 days followed by total body irradiation (TBI) 300cGy was recently developed at the National Institute of Health and obtained stable mixed chimerism and clinical cure in 90% of SCD patients receiving an HLA and ABO-matched, related HSCT. The same study was replicated in high risk SCD adult patients at the University of Illinois at Chicago.

Total body irradiation has been decreasingly utilized in hematopoietic stem cell transplant due to extra-hematologic toxicity. However, patients with a high risk of relapse may benefit from a combination of chemotherapy and radiation. Intensity modulated total marrow irradiation (IM-TMI) represents an innovative technique to irradiate the bone marrow with limited radiation to surrounding tissues and was tested here in combination with fully myeloablative chemotherapy. We designed a phase I trial with escalating doses of IM-TMI to standard myeloablative fludarabine/ IV targeted busulfan conditioning.

No relevant conflicts of interest to declare.