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Background: Transoral surgical resectability (TOS) is a prognostic factor for patients with HPV+ T1‐2 oropharyngeal squamous cell carcinoma (OPSCC) disease undergoing radiotherapy (RT), but it is unclear whether this holds for HPV‐negative (HPV‐) patients. We aimed to compare outcomes of potential TOS‐candidates vs. non‐TOS candidates, among patients who underwent RT/CRT for early T‐stage HPV‐ OPSCC. Methods: For patients treated with RT/CRT for early T‐stage HPV‐negative OPSCC between 2014 and 2021, pretreatment imaging was reviewed by four head‐and‐neck surgeons, masked to clinical outcomes, to assess primary‐site suitability for TOS. Extracapsular extension (ECE) was assessed by a head‐and‐neck neuroradiologist. We compared outcomes based on surgical resectability relating to: (1) the primary site tumor alone, and (2) the primary site plus the absence/presence of ECE (overall assessment). Kaplan–Meier curves for overall survival (OS), disease‐specific survival (DSS), and progression‐free survival (PFS) were compared using the log‐rank test. Results: Seventy patients were included in the analysis. The primary site was TOS‐favorable in 46/70 (66%). Based on the overall assessment, 41/70 (58.6%) were TOS‐favorable. The 3‐year OS, DSS and PFS for primary site TOS‐favorable versus unfavorable were OS: 76.9% versus 37.4%; DSS: 78.1% versus 46.2%, PFS: 69.9% versus 41.3%, (log‐rank test = 0.01, 0.03, 0.04; respectively). Additionally, patients with an overall assessment of TOS favorability demonstrated better survival outcomes compared with TOS‐unfavorable patients (OS: 77.3% vs. 46.2%; DSS: 78.2% vs. 56.5%, PFS: 72.3% vs. 42.1%, log‐rank test = 0.01, 0.04, 0.01; respectively). Conclusion: Patients with TOS‐favorable HPV‐negative early T‐stage OPSCC have superior survival outcomes than TOS‐unfavorable patients. [ABSTRACT FROM AUTHOR]

Background: We aimed to analyze and compare the timing and patterns of treatment failure, and survival after progression between HPV‐positive (HPV+) and HPV‐negative (HPV−) patients undergoing chemoradiation for oropharyngeal squamous cell carcinomas (OPSCC). Methods: A retrospective review was performed of all patients undergoing primary chemoradiation for OPSCC between 2008 and 2021. Demographic and clinical data were collected. Kaplan–Meier estimates for overall survival (OS), and time to recurrence/metastases (TTR) were compared using the log‐rank test, with Cox regression used for multivariable modeling comparing HPV+ and HPV− patients. Results: HPV− patients developed recurrence or metastases at earlier time points than HPV+ patients (8.8 vs. 15.2 months, p < 0.05), due to earlier local/locoregional recurrence and distant metastases, but not isolated regional recurrences. HPV− distant metastases exclusively occurred in a single organ, most commonly the lungs or bone, while HPV+ metastases frequently had multi‐organ involvement in a wide variety of locations (p < 0.05). Once progression (recurrence/metastases) was diagnosed, HPV+ patients experienced superior survival to HPV− patients on univariate and multivariate analysis, largely due to improved outcomes after treatment of local/locoregional recurrences (p < 0.05). There were no differences in survival after isolated regional recurrences or distant metastases. Conclusion: HPV+ OPSCC patients relapse later compared to HPV− patients in local/locoregional and distant sites. HPV+ patients with local/locoregional recurrence experience superior survival after recurrence, which does not hold true for isolated regional recurrences or distant metastases. These data can be useful to inform prognosis and guide treatment decisions in patients with recurrent OPSCC. [ABSTRACT FROM AUTHOR]

Background: Adverse pathological features following surgery in head and neck squamous cell carcinoma (HNSCC) are strongly associated with survival and guide adjuvant therapy. We investigated molecular changes associated with these features. Methods: We downloaded data from the Cancer Genome Atlas and Cancer Proteome Atlas HNSCC cohorts. We compared tumors positive versus negative for perineural invasion (PNI), lymphovascular invasion (LVI), extracapsular spread (ECS), and positive margins (PSM), with multivariable analysis. Results: All pathological features were associated with poor survival, as were the following molecular changes: low cyclin E1 (HR = 1.7) and high PKC‐alpha (HR = 1.8) in tumors with PNI; six of 13 protein abundance changes with LVI; greater tumor hypoxia and high Raptor (HR = 2.0) and Rictor (HR = 1.6) with ECS; and low p38 (HR = 2.3), high fibronectin (HR = 1.6), low annexin A1 (HR = 3.1), and high caspase‐9 (HR = 1.6) abundances with PSM. Conclusions: Pathological features in HNSCC carry specific molecular changes that may explain their poor prognostic associations. [ABSTRACT FROM AUTHOR]

Objective: We aimed to analyze risk factors associated with poor survival outcomes for metastatic cutaneous head‐and‐neck SCC to the parotid. Methods: All patients undergoing surgery for metastatic cutaneous SCC to the parotid with curative intent between 2011 and 2018, were reviewed. Demographic and clinical characteristics were evaluated. Histopathological data including tumor size and histology, tumor grade, TNM stage, resection margins, lymphovascular invasion, and perineural invasion, were analyzed. Overall survival (OS), disease‐specific survival (DSS), and freedom from locoregional recurrence (LRR) were assessed. Results: Ninety patients were included (mean age, 77 years; 75 men [83.3%]). A total parotidectomy was performed in 48 patients (53.3%), and 42 (46.7%) underwent a superficial parotidectomy. Seventy patients (77.8%) underwent adjuvant RT. The median follow‐up was 31 months (20–39 months). Tumor volume ≥ 50 cm3 and a shorter RT duration (<20 days) were associated with reduced OS (p = 0.002 and p = 0.01, p = 0.02 and p = 0.009, respectively), and DSS (p = 0.004 and p = 0.02, p = 0.04 and p = 0.02, respectively) on univariable and multivariable analysis, respectively. Only a shorter RT duration was associated with worse freedom from LRR on univariable and multivariable analysis, (p = 0.04 and p < 0.001, respectively). However, with death as a competing risk, a shorter duration of RT was not significantly associated with freedom from LRR. Conclusion: A shorter duration of adjuvant RT, and excised tumor volume ≥50 cm3 were predictive factors of reduced OS and DSS, and a shorter duration of RT was also associated with reduced freedom from LRR in patients with metastatic SCC to the parotid gland. Level of Evidence: 4 Laryngoscope, 133:1163–1168, 2023 [ABSTRACT FROM AUTHOR]

Background: We compared the health‐related quality of life (HRQOL) in patients undergoing trimodality therapy for resectable stage I‐III esophageal cancer. Methods: A total of 96 patients were randomized to standard neoadjuvant cisplatin and 5‐fluorouracil chemotherapy plus radiotherapy (neoadjuvant) followed by surgical resection or adjuvant cisplatin, 5‐fluorouracil, and epirubicin chemotherapy with concurrent extended volume radiotherapy (adjuvant) following surgical resection. Results: There was no significant difference in the functional assessment of cancer therapy‐esophageal (FACT‐E) total scores between arms at 1 year (p = 0.759) with 36% versus 41% (neoadjuvant vs. adjuvant), respectively, showing an increase of ≥15 points compared to pre‐treatment (p = 0.638). The HRQOL was significantly inferior at 2 months in the neoadjuvant arm for FACT‐E, European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ‐OG25), and EuroQol 5‐D‐3 L in the dysphagia, reflux, pain, taste, and coughing domains (p < 0.05). Half of patients were able to complete the prescribed neoadjuvant arm chemotherapy without modification compared to only 14% in the adjuvant arm (p < 0.001). Chemotherapy related adverse events of grade ≥2 occurred significantly more frequently in the neoadjuvant arm (100% vs. 69%, p < 0.001). Surgery related adverse events of grade ≥2 were similar in both arms (72% vs. 86%, p = 0.107). There were no 30‐day mortalities and 2% vs. 10% 90‐day mortalities (p = 0.204). There were no significant differences in either overall survival (OS) (5‐year: 35% vs. 32%, p = 0.409) or disease‐free survival (DFS) (5‐year: 31% vs. 30%, p = 0.710). Conclusion: Trimodality therapy is challenging for patients with resectable esophageal cancer regardless of whether it is given before or after surgery. Newer and less toxic protocols are needed. [ABSTRACT FROM AUTHOR]

Background: Neck carcinoma of unknown primary (CUP) is a frequent scenario. Transoral robotic mucosectomies (TORM) of pharynx have increased rate of primary identification, but come with cost of treatment delay. Methods: We reviewed patients who underwent CUP protocol from 2014 to 2020. Patients with cervical nodes carcinoma and failure to localize a primary source were classified as CUP. We determined primary identification rate and postoperative complications. Results: We included 65 patients underwent TORM. Surgical approach consisted of lingual and/or palatine tonsillectomies. The primary detection rate was 49.2%. Average weight reduction was 2.5 ± 4.3 kg. The average number of days from consultation to definitive treatment was 52.2 ± 18.3. Conclusion: A systematic approach to patients with CUP showed a promising primary identification rate compared to panendoscopy alone. TORM carries a small risk of complications. The benefits of primary identification must be weighed with the morbidity and delay to definitive treatment. [ABSTRACT FROM AUTHOR]

Background: Numerous studies of head and neck squamous cell carcinoma (HNSCC) have demonstrated disparate outcomes by race and ethnicity. Beyond known associations with socioeconomic variables, whether these are also associated with differences in tumor molecular composition has thus far been poorly explored. Methods: We downloaded clinical and multiplatform molecular data from The Cancer Genome Atlas and other published studies. These were compared between non‐Hispanic Black (n = 43) and White (n = 354) patients with non‐HPV‐related tumors, using multivariable models. Publicly available validation cohorts were used. Results: Black patients had poorer progression‐free survival than White patients. Tumors of Black patients had greater copy number aberrations, and increased SFRP1 methylation and miRNA‐mediated PRG4 silencing associated with poor survival. PI3K/AkT/mTOR pathway proteins were differentially expressed. Conclusions: There are molecular differences between tumors of Black and White patients that may partially account for differences in survival. These may inform targeted treatment decisions to achieve equitable outcomes. [ABSTRACT FROM AUTHOR]

We resort to X‐ray constrained wavefunctions in order to separately analyze crystal field and correlation effects in ammonia. With this aim in mind, we compare the electron density and the amount of electron localization in different molecular regions derived from three different calculations: the isolated molecule, the solid‐state and the X‐ray constrained wavefunctions. While the crystal field effects lead to a contraction (localization) of electron pairs, the introduction of correlation as a correction from the experimental density leads to a compensating effect that diffuses back again the electron pairs. We have also compared the effect on the most widely used methods in solid state, HF and DFT, showing that (as in molecules) correlation has well differenciated effects, with DFT overdelocalizing. It is now well known that approximate functionals have errors in the density reconstruction and in the energy estimation. Resorting to experimental densities thus allows expanding the separation of the errors in the functional and the density in solid state, where correlated wavefunctions are not easily available. [ABSTRACT FROM AUTHOR]

Introduction: Stereotactic ablative radiotherapy (SABR) is a guideline-recommended treatment for inoperable stage I non-small cell lung cancer (NSCLC), but imaging assessment of response after SABR is difficult. The goal of this study was to evaluate imaging-based biomarkers of tumour response using dynamic 18 F-FDG-PET and CT perfusion (CTP).Methods: Thirty-one patients with early-stage NSCLC participated in this prospective correlative study. Each underwent dynamic 18 F-FDG-PET/CTP studies on a PET/CT scanner pre- and 8 weeks post-SABR. The dynamic 18 F-FDG-PET measured the tumour SUVmax , SUVmean and the following parameters: K1 , k2 , k3 , k4 and Ki , all using the Johnson-Wilson-Lee kinetic model. CTP quantitatively mapped BF, BV, MTT and PS in tumours and measured largest tumour diameter. Since free-breathing was allowed during CTP scanning, non-rigid image registration of CT images was applied to minimize misregistration before generating the CTP functional maps. Differences between pre- and post-SABR imaging-based parameters were compared.Results: Tumour size changed only slightly after SABR (median 26 mm pre-SABR vs. 23 mm post-SABR; P = 0.01). However, dynamic 18 F-FDG-PET and CTP study showed substantial and significant changes in SUVmax , SUVmean , k3 , k4 and Ki . Significant decreases were evident in SUVmax (median 6.1 vs. 2.6; P < 0.001), SUVmean (median 2.5 vs. 1.5; P < 0.001), k3 (relative decrease of 52%; P = 0.002), Ki (relative decrease of 27%; P = 0.03), whereas there was an increase in k4 (+367%; P < 0.001).Conclusions: Hybrid 18 F-FDG-PET/CTP allowed the response of NSCLC to SABR to be assessed regarding metabolic and functional parameters. Future studies are needed, with correlation with long-term outcomes, to evaluate these findings as potential imaging biomarkers of response. [ABSTRACT FROM AUTHOR]

Copper(I) complexes (CICs) are of great interest due to their applications as redox mediators and molecular switches. CICs present drastic geometrical change in their excited states, which interferes with their luminescence properties. The photophysical process has been extensively studied by several time‐resolved methods to gain an understanding of the dynamics and mechanism of the torsion, which has been explained in terms of a Jahn–Teller effect. Here, we propose an alternative explanation for the photoinduced structural change of CICs, based on electron density redistribution. After photoexcitation of a CIC (S0→S1), a metal‐to‐ligand charge transfer stabilizes the ligand and destabilizes the metal. A subsequent electron transfer, through an intersystem crossing process, followed by an internal conversion (S1→T2→T1), intensifies the energetic differences between the metal and ligand within the complex. The energy profile of each state is the result of the balance between metal and ligand energy changes. The loss of electrons originates an increase in the attractive potential energy within the copper basin, which is not compensated by the associated reduction of the repulsive atomic potential. To counterbalance the atomic destabilization, the valence shell of the copper center is polarized (defined by ∇2ρ(r) and ∇2Vne(r)) during the deactivation path. This polarization increases the magnitude of the intra‐atomic nuclear–electron interactions within the copper atom and provokes the flattening of the structure to obtain the geometry with the maximum interaction between the charge depletions of the metal and the charge concentrations of the ligand. That's exciting! We propose an alternative explanation for the photoinduced structural change of a copper(I) complex during the deactivation process following photoexcitation, where the metal valence shell polarizes to increase intra‐metal nuclear‐electron interactions, which provokes the flattening of the structure to obtain the maximum interaction between the charge depletions of the metal with the charge concentrations of the ligand. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Common endpoints in reporting the outcomes for early glottic cancer do not highlight the importance of organ preservation. We evaluated the treatment outcomes among patients with T1aN0 laryngeal cancer with laryngectomy-free disease-specific survival (LFS-DSS), which is defined as time to total laryngectomy or time to death from cancer cause, against all other endpoints.Study Design: Outcome research on an institutional database.Methods: A retrospective review covered all consecutive patients from 2003 to 2013. Patients with T1a laryngeal squamous cell carcinoma (SCC) were offered the options of either radiation treatment (RT) or transoral laser microsurgery (TLM). Tumor control, survival outcomes, standard definition laryngectomy-free survival (LFS), and LFS-DSS were calculated.Results: There were 105 patients, of whom 53 were treated with TLM and 52 were treated with RT. There were 11 recurrences within the TLM group, of which four were successfully salvaged with repeated TLM and two were salvaged with RT. Among the four recurrences within the RT group, all four patients had salvage total laryngectomies. The 5-year overall survival for patients treated with TLM versus RT was 86% versus 85% (P = .887), disease-free survival was 69% versus 78% (P = .151), LFS was 65% versus 77% (P = .198), LFS-DSS was 100% versus 88% (P = .030), and ultimate locoregional control was 100% in both groups.Conclusions: Patients with T1aN0 glottic SCC treated with RT or TLM have similar survival outcomes. Patients with T1a tumor treated with TLM have better organ preservation compared to RT, when measured with LFS-DSS.Level Of Evidence: 4. Laryngoscope, 127:1322-1327, 2017. [ABSTRACT FROM AUTHOR]

Radiation oncologists require an in-depth understanding of anatomical relationships for modern clinical practice, although most do not receive formal anatomy training during residency. To fulfill the need for instruction in relevant anatomy, a series of four multidisciplinary, interactive learning modules were developed for a cohort of radiation oncology and medical physics residents. Instructional design was based on established learning theories, with the intent of integrating knowledge of specific anatomical regions with radiology and radiation oncology practice. Each session included presentations by a radiologist and a radiation oncologist, as well as hands-on exploration of anatomical specimens with guidance from anatomists. Pre- and post-tests distributed during each session showed significant short-term knowledge retention. According to qualitative surveys and exit interviews, participants felt more comfort' with delineating structures, gross anatomy, and radiograph interpretation at the end of each session. Overall participant experience was positive, and the modules were considered effective for learning radiologic anatomy. Suggestions for future interventions include more time, increased clinical application, additional contouring practice and feedback, and improved coordination between each of the three disciplines. Results and conclusions from this study will be used to inform the design of a future multi-day national workshop for Canadian radiation oncology residents. Anat Sci Educ 8: 158-165. © 2014 American Association of Anatomists. [ABSTRACT FROM AUTHOR]

Purpose: Benign computed tomography (CT) changes due to radiation induced lung injury (RILI) are common following stereotactic ablative radiotherapy (SABR) and can be difficult to differentiate from tumor recurrence. The authors measured the ability of CT image texture analysis, compared to more traditional measures of response, to predict eventual cancer recurrence based on CT images acquired within 5 months of treatment. Methods: A total of 24 lesions from 22 patients treated with SABR were selected for this study: 13 with moderate to severe benign RILI, and 11 with recurrence. Three-dimensional (3D) consolidative and ground-glass opacity (GGO) changes were manually delineated on all follow-up CT scans. Two size measures of the consolidation regions (longest axial diameter and 3D volume) and nine appearance features of the GGO were calculated: 2 first-order features [mean density and standard deviation of density (first-order texture)], and 7 second-order texture features [energy, entropy, correlation, inverse difference moment (IDM), inertia, cluster shade, and cluster prominence]. For comparison, the corresponding response evaluation criteria in solid tumors measures were also taken for the consolidation regions. Prediction accuracy was determined using the area under the receiver operating characteristic curve (AUC) and two-fold cross validation (CV). Results: For this analysis, 46 diagnostic CT scans scheduled for approximately 3 and 6 months posttreatment were binned based on their recorded scan dates into 2-5 month and 5-8 month follow-up time ranges. At 2-5 months post-treatment, first-order texture, energy, and entropy provided AUCs of 0.79-0.81 using a linear classifier. On two-fold CV, first-order texture yielded 73% accuracy versus 76%-77% with the second-order features. The size measures of the consolidative region, longest axial diameter and 3D volume, gave two-fold CV accuracies of 60% and 57%, and AUCs of 0.72 and 0.65, respectively. Conclusions: Texture measures of the GGO appearance following SABR demonstrated the ability to predict recurrence in individual patients within 5 months of SABR treatment. Appearance changes were also shown to be more accurately predictive of recurrence, as compared to size measures within the same time period. With further validation, these results could form the substrate for a clinically useful computer-aided diagnosis tool which could provide earlier salvage of patients with recurrence. [ABSTRACT FROM AUTHOR]

Background Assessment of nodal response after radiotherapy ( RT) for head and neck squamous cell carcinoma is difficult, as both CT and positron emission tomography scanning have limited predictive value for residual disease. We sought to measure changes in nodal volume during RT to determine whether such changes are predictive of nodal disease control. Methods Patients with locally advanced head and neck squamous cell carcinoma treated with 70 Gy of radical RT (±chemotherapy or anti-epidermal growth factor receptor ( EGFR) antibodies) were eligible. Baseline pre- RT scans and cone-beam CT scans done at the outset of treatment and at weeks 3, 5 and 7 (cone-beam CTs # 1, 2, 3 and 4, respectively) were deformably coregistered, and 3 D nodal volumes were measured. Results Thirty-eight eligible patients were identified. The main primary tumour site was oropharyngeal; most patients had stage IVa disease. Twenty-seven patients received concurrent platinum-based chemotherapy, 10 received only an EGFR inhibitor with RT and one received RT alone. Twelve patients had a failure in the neck. After week 1 of treatment, a 4% mean decrease in nodal volume was observed, increasing to 40% at week 7. Platinum-based chemotherapy achieved significantly greater decreases in nodal volume than EGFR inhibitors (44 vs. 25%; P = 0.026). Advanced tumour stage predicted neck failure ( P = 0.002), but nodal volumes did not correlate with neck control. Conclusions Changes in nodal volume are minimal initially during RT but accelerate during the latter weeks of therapy. This study suggests that chemotherapy achieves a greater decrease in nodal volume than EGFR inhibitors and that nodal changes do not predict disease control in the neck. [ABSTRACT FROM AUTHOR]

Background Early detection of circulating tumor cells (CTCs) offers the possibility of improved outcome for patients with head and neck squamous cell cancer (HNSCC). Methods Patients with advanced-stage HNSCC (stage III/IV) were tested for CTCs using the CellSearch system (a registered trade name), which has been approved by the U.S. Food and Drug Administration (FDA) for monitoring CTCs in other cancers. Results CTCs were detected in 6 of 15 patients with advanced-stage HNSCC (range, 1-2 cells/7.5 mL of blood). CTCs were significantly associated with patients with lung nodules >1 cm ( p = .04). There was also a suggestion of improved survival in the CTC-negative versus the CTC-positive patients ( p = .11). Conclusions CTCs can be successfully isolated in patients with advanced-stage HNSCC using the CellSearch system. CTC detection may be important for prognosis, evaluating treatment outcome, and for determining efficacy of adjuvant treatments. © 2011 Wiley Periodicals, Inc. Head Neck, 2011 [ABSTRACT FROM AUTHOR]

The article discusses a study aimed at determining whether pretreatment prostate-specific antigen (PSA) velocity (PSAV) is associated with biochemical disease-free survival, patterns of recurrence, and survival outcomes in men treated with radiation therapy and androgen-deprivation therapy (ADT). In order to evaluate the association of PSAV with disease outcomes, Kaplan-Meier survival estimates and Cox regression analyses were used. It concludes the association of a high pretreatment PSAV with distant metastasis and prostate cancer-specific mortality.

OBJECTIVE Obesity has been demonstrated to predict biochemical progression in men undergoing radical prostatectomy for prostate adenocarcinoma, and is associated with a higher risk of biochemical and clinical relapse after radiation therapy (RT). We evaluated if obesity, determined by body mass index (BMI), is associated with adverse disease characteristics, pre-treatment serum testosterone, biochemical disease free survival (bDFS), disease-specific survival (DSS), or overall survival (OS) in patients undergoing radical external beam radiation therapy for prostate cancer. PATIENTS AND METHODS A cohort of 706 patients with localized prostate adenocarcinoma treated with RT between 1993 and 2001 were categorized as obese (BMI ≥ 30 kg/m2), overweight (BMI 25–29.9 kg/m2) or normal (BMI < 25 kg/m2). The association between BMI, disease characteristics, and progression were evaluated by Chi-square and ANOVA tests, Kaplan-Meier survival analysis, and Cox regression analysis. RESULTS 195 patients (27.6%) were normal weight, 358 (50.7%) were overweight and 153 (21.7%) were obese. Obese men had lower serum testosterone levels than overweight and normal-weight men (means 12.8, 14.1, and 15.7 nmol/L, respectively; p < 0.001). The BMI groups did not differ in Gleason score, pretreatment PSA, or stage. On multivariate analysis, BMI group was predictive of reduced bDFS (p = 0.02) and DSS (p = 0.008), with a trend toward reduced OS (p = 0.062). CONCLUSION Obesity was associated with lower serum testosterone levels but not with adverse pretreatment pathological features. Obese men have a higher risk of biochemical recurrence and prostate-cancer specific death after RT. [ABSTRACT FROM AUTHOR]

An alternative explanation for the photoinduced structural change of copper(I) complexes, based on the electron density redistribution, is described. The electronic excitation produces a metal‐to‐ligand charge transfer that destabilizes the metal center due to the decrease of the nuclear‐electron interactions. To counterbalance the copper destabilization, the metal valence shell polarizes during the deactivation path to increase the magnitude of the intra‐metal nuclear‐electron interactions, which provokes the flattening of the structure to obtain the geometry with the maximum interaction between the charge depletions of the metal with the charge concentrations of the ligand. For more information, see the Full Paper by F. Cortés‐Guzmán et al. on page 775 ff. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The impact of radiation therapy sequencing on survival and cardiopulmonary mortality in the combined modality treatment of patients with esophageal cancer" by A. P. Wojcieszynski in the February 7, 2013 issue.

A letter to the editor is presented in response to an article on the link between duration of androgen suppression after hormone therapy and risk of death from prostate cancer by A.V. D'Amico and colleagues.