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Purpose: Advancements in breast radiation therapy offer innumerable benefits to patients and the health care system. Despite promising outcomes, clinicians remain hesitant about long-term side effects and disease control with accelerated partial breast radiation therapy (APBI). Herein, we review the long-term outcomes of patients with early-stage breast cancer treated with adjuvant stereotactic partial breast irradiation (SAPBI). Methods and Materials: This retrospective study examined outcomes of patients who received diagnoses of early-stage breast cancer treated with adjuvant robotic SAPBI. All patients were eligible for standard ABPI and underwent lumpectomy, followed by fiducial placement in preparation for SAPBI. Using fiducial and respiratory tracking to maintain a precise dose distribution throughout the course of treatment, patients received 30 Gy in 5 fractions on consecutive days. Follow-up occurred at routine intervals to evaluate disease control, toxicity, and cosmesis. Toxicity and cosmesis were characterized using the Common Terminology Criteria for Adverse Events version 5.0 and Harvard Cosmesis Scale, respectively. Results: Patients (N = 50) were a median age of 68.5 years at the time of treatment. The median tumor size was 7.2 mm, 60% had an invasive cell type, and 90% were estrogen receptor positive, progesterone receptor positive, or both. Patients (n = 49) were followed for a median of 4.68 years for disease control and 1.25 years for cosmesis and toxicity. One patient experienced local recurrence, 1 patient experienced grade 3+ late toxicity, and 44 patients demonstrated excellent cosmesis. Conclusions: To our knowledge, this is the largest retrospective analysis with the longest follow-up time for disease control among patients with early breast cancer treated with robotic SAPBI. With follow-up time for cosmesis and toxicity comparable to that of previous studies, results of the present cohort advance our understanding of the excellent disease control, excellent cosmesis, and limited toxicity that can be achieved by treating select patients with early-stage breast cancer with robotic SAPBI.

Purpose: Whole gland cryoablation is a guideline-approved definitive treatment for localized prostate cancer, and is being explored for partial gland ablation. However, there is limited data regarding management of cryoablation failures. Stereotactic body radiation therapy (SBRT) is a well-established method of primary treatment for prostate cancer. Here we review salvage SBRT after cryoablation failures. Methods and Materials: A large database of patients treated with definitive SBRT was interrogated to identify those who underwent primary cryoablation. All patients were determined to have progressive disease based on a rising prostate specific antigen and/or postcryoablation biopsy. All patients were treated with SBRT over 5 treatment fractions using a robotic radiosurgical platform. Baseline cryoablation characteristics and pre- and posttreatment Expanded Prostate Cancer Index Composite questionnaires were analyzed. Acute and late toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Cancer outcomes after salvage SBRT were stratified by disease and treatment characteristics. Results: A total of 51 patients were identified who underwent cryoablation followed by salvage SBRT. The majority (47%) were found to have intermediate-risk disease at the time of SBRT salvage and most commonly were treated with 3500 cGy in 5 fractions to the prostate and seminal vesicles. Only 1 grade 3+ toxicity was identified. Patient-reported quality of life metrics after SBRT salvage followed prior patterns observed in the de novo SBRT setting. With a median follow-up of 40 months, 76% of the cohort demonstrated disease control. Median time to prostate cancer recurrence was 57.5 months, and recurrence was predominantly seen in patients with underlying high-risk disease. Conclusions: This is the largest cohort of patients treated with any radiation therapy salvage after cryoablation and the first institution to report SBRT as a modality of salvage. Salvage SBRT after cryoablation results in low rates of high-grade toxicity, acceptable changes in patient-reported quality of life, and durable rates of long-term oncologic control.

Background: In the USA, one in six Americans have had a foodborne illness, resulting in approximately US$17·6 billion (2018) of losses annually attributed to medical costs, productivity losses, and economic burden due to death. Previous research has characterised these burdens with use of various methods, including disability-adjusted life-years (DALYs), medical care costs, and revenue losses of food retailers. However, these indices assess only the socioeconomic burdens of outbreaks without providing an index to compare the health-related severity of outbreaks regarding geographical spread of transmission, outbreak duration, and the morbidity and mortality of case outcomes. Methods: In this study, we proposed a data-driven index for evaluating outbreak severity using the publicly available US Centers for Disease Control and Prevention's National Outbreak Reporting System (NORS) database from Jan 1, 2009, to Dec 31, 2019. We identified 67 metrics related to the geographical extent (eg, counties or states where individuals with a foodborne illness resided and were exposed), case severity (eg, primary cases, hospital admissions, emergency room visits, and deaths), duration (eg, days of illness and days of exposure events), and their ratios. We selected 11 metrics to create the index on the basis of completeness and distributional characteristics of these metrics. We generated index scores by normalising natural log-transformed values on a 0–1 scale and averaging all metrics per outbreak. Scores ranged from 0 (lowest severity) to 1 (highest severity). Findings: NORS reported 9407 outbreaks in our 11-year study period. We found that bacterial outbreaks associated with the genera Streptococcus, Listeria, and Salmonella had the highest median severity scores, whereas Bacillus, Staphylococcus, and Clostridium had the lowest scores. Among protozoa, Cryptosporidium and Cyclospora had the lowest median scores, whereas Giardia and Toxoplasma had the highest scores. Hepatitis had the highest median score for virus-associated outbreaks, whereas Norovirus, which had the most outbreaks reported in our study period (n=3088), had the lowest score. Interpretation: Our index illustrates the usefulness of publicly reported surveillance data in establishing a data-driven approach for monitoring the severity of foodborne outbreaks regarding their spread, duration, and morbidity and mortality. Differences in outbreak severity by pathogen inform how to best allocate resources for monitoring, tracking, and preventing foodborne disease outbreaks. Being data driven, our index emphasises the importance of improved data quality, integrity, and completeness of surveillance records. Future research should strive to validate this index by use of longitudinal cohort studies. Funding: US Department of Defense, National Institute of Food and Agriculture.

Background. The causal relationship between gout and renal transplant outcomes is difficult to assess due to multiple interacting covariates. This study sought to estimate the independent effect of new-onset gout on renal transplant outcomes using a methodology that accounted for these interactions. Methods. This study analyzed data on patients in the US Renal Data System (USRDS) who received a primary kidney transplant between 2008 and 2015. The exposure was new-onset gout, and the primary endpoint was returning to dialysis >12 months postindex date (transplant date). A marginal structural model (MSM) was fitted to determine the relative risk of new-onset gout on return to dialysis. Results. 18 525 kidney transplant recipients in the USRDS met study eligibility. One thousand three hundred ninety-nine (7.6%) patients developed new-onset gout, and 1420 (7.7%) returned to dialysis >12 months postindex. Adjusting for baseline and time-varying confounders via the MSM showed new-onset gout was associated with a 51% increased risk of return to (RR, 1.51; 95% CI, 1.03-2.20). Conclusions. This finding suggests that new onset gout after kidney transplantation could be a harbinger for poor renal outcomes, and to our knowledge is the first study of kidney transplant outcomes using a technique that accounted for the dynamic relationship between renal dysfunction and gout.