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Background Here, we investigated radiological responses following chemotherapy alone as compared to both radiation/chemotherapy (chemoRT) in patients with thymic epithelial tumors (TETs) who did not receive upfront surgery. Methods TETs treated at a tertiary academic cancer center between January 2007 and July 2018 were identified. Patients received chemotherapy or chemoRT as initial therapy and pre‐ and post‐treatment scans were available. Student's t‐test, Wilcoxon rank‐sum tests, and Cox proportional hazards method were used to compare clinical details and survival between groups. The primary outcome was change in tumor size, which was compared between groups using linear mixed‐effects regression models, adjusting for baseline tumor size, age, and histology. Results A total of 24 of 114 patients with TETs identified met the inclusion criteria. The majority of patients had 67% thymoma (67%, n = 16) and AJCC8 III–IVA disease (58%, n = 14). Median age was 58.5 years (range: 33–76), median initial tumor volume was 187.1 cc (range: 28.7–653.6) and diameter was 8.5 cm (range: 4.5–14.3). Half of the patients received upfront chemotherapy (n = 12: 83% cisplatin/adriamycin/cyclophosphamide) or chemoRT (n = 12: 58% carboplatin/paclitaxel; median RT dose: 63 Gy [range: 60–70 Gy]). At a median imaging follow‐up of 15 months (range: 0–86): ChemoRT was associated with increased average radiological response compared to chemotherapy alone (volume: −47.0 cc more, P, ChemoRT was associated with a greater radiologic response than chemotherapy alone in patients with upfront unresectable TET

Background: We seek to investigate whether carboplatin-based induction chemotherapy before modern day concurrent chemoradiotherapy (CCRT) improves survival in patients with bulky, locally advanced nonsmall cell lung cancer (NSCLC). Materials and Methods: This analysis included 105 patients with Stage II and III NSCLC treated with definitive CCRT from 2003 to 2013. All patients underwent definitive treatment with weekly platinum-based doublet chemotherapy delivered concurrently with 60–66 Gy of thoracic radiotherapy. Thirty patients who received induction chemotherapy before CCRT had T4 disease, N3 disease, or gross tumor volume (GTV) of >150 cm 3. These patients were compared to those with unresectable disease who received CCRT alone without induction chemotherapy. Statistical analysis included univariate and multivariate methods. Results: Mean follow-up time was 15.6 months. Patients treated with carboplatin based induction chemotherapy demonstrated prolonged overall survival (28.2 vs. 14.2 months, P = 0.04), progression free survival (12.6 vs. 9.0 months, P = 0.02), and distant metastasis free survival (15.8 vs. 10.1months, P = 0.05) compared to those who received CCRT alone without induction chemotherapy. Univariate analysis revealed older age, larger GTV, and squamous pathology as negative prognostic factors. When controlling for these factors, Cox regression analysis indicated a trend toward significantly improved overall survival in the induction cohort (P = 0.10). Conclusion: In patients with large tumors or bulky nodal NSCLC, carboplatin-based induction chemotherapy may be an important addition to definitive CCRT in the modern era. Our findings strongly support further investigation induction chemotherapy in this population.

There is a paucity of data regarding factors affecting enrollment onto radiation oncology clinical trials. The purpose of this study was to determine patients and tumor characteristics that influenced enrollment of breast cancer patients onto hypofractionated breast radiotherapy trials (HBRTs) at a single institution. In this retrospective cohort study, patients enrolled on HBRTs at the Rutgers Cancer Institute of New Jersey (n = 132) were compared with a cohort of breast cancer patients eligible for, but not enrolled onto HBRTs treated during the same time period (n = 132). Charts were retrospectively reviewed to determine patients' demographics, clinico-pathologic factors, and treatment characteristics. Statistical analysis was performed to analyze variables affecting enrollment onto HBRTs between the two groups. Over a 42-month time period, 132 patients treated on HBRTs received 2,475-4,995 cGy over 3 to 15 fractions. When compared with patients treated off trial, there was no statistically significant effect of age, family history, lymph node positivity, tumor grade, estrogen or Her-2 receptor status, use of chemotherapy or hormones, use of brachytherapy, or the site of initial consultation on HBRT enrollment. Non-White women were less likely to enroll in HBRT's when compared with White women (25.7% versus 40.1%, p = 0.0129), though this was found to be a nonsignificant trend when taking stage into consideration on multivariate analysis (OR for lower T-stage: 0.281, p = 0.003, OR 1.839 for white race, p = 0.076). Consistent with previous studies, non-White women were less likely to enroll in HBRTs than White women. However, disease stage accounted for these racial disparities. Further studies must be performed to determine if race is an independent factor determining radiation oncology clinical trial enrollment.

The purpose of this study was to determine if seroma cavity visualization could be further improved with placement of gold fiducial markers in each anatomic wall of the seroma cavity compared with placement of surgical titanium clips at the surgeon's discretion.We identified patients with breast cancer who received breast-conservation surgery. Patients were grouped into 3 categories: patients without clips, patients with titanium clips placed at the discretion of the treating surgeon, and patients with gold fiducial markers directly sutured to each wall of the seroma cavity. Cavity visualization was determined using the cavity visualization score criteria.A total of 262 patients met the criteria for the study; 119 patients did not have surgical clips placed during breast-conservation surgery, 109 patients received surgical titanium clip placement at the surgeon's discretion, and 34 patients received directed placement of gold fiducial markers in each anatomic wall of the seroma cavity. There was improvement in the visualization of the seroma cavity in patients who received directed gold fiducial marker placement in each wall of the seroma cavity compared with titanium clip placement at the surgeon's discretion (P.05). An association was not identified between the quantity of titanium clips used, the amount of seroma walls with titanium clips present, or the time interval between surgery and radiation therapy planning with cavity visualization when surgical titanium clips were placed at the surgeon's discretion.The placement of a gold fiducial marker in each of the seroma cavity walls improved visualization of the seroma cavity compared with the placement of titanium clips at the surgeon's discretion. This technique may be utilized in order to assist in planning a seroma boost following whole breast irradiation or in accelerated partial breast irradiation.

Summary Throughout development, cell fate decisions are converted into epigenetic information that determines cellular identity. Covalent histone modifications are heritable epigenetic marks and are hypothesized to play a central role in this process. In this report, we assess the concordance of histone H3 lysine 4 dimethylation (H3K4me2) and trimethylation (H3K4me3) on a genome-wide scale in erythroid development by analyzing pluripotent, multipotent, and unipotent cell types. Although H3K4me2 and H3K4me3 are concordant at most genes, multipotential hematopoietic cells have a subset of genes that are differentially methylated (H3K4me2+/me3−). These genes are transcriptionally silent, highly enriched in lineage-specific hematopoietic genes, and uniquely susceptible to differentiation-induced H3K4 demethylation. Self-renewing embryonic stem cells, which restrict H3K4 methylation to genes that contain CpG islands (CGIs), lack H3K4me2+/me3− genes. These data reveal distinct epigenetic regulation of CGI and non-CGI genes during development and indicate an interactive relationship between DNA sequence and differential H3K4 methylation in lineage-specific differentiation.

As the use of hypofractionated breast radiation therapy (RT) increases, so will the need for long-term data on post-RT mammographic changes. The purpose of the present study was to longitudinally compare the incidence of common mammographic sequelae seen after breast conserving surgery and RT in patients treated with accelerated partial breast irradiation (APBI), hypofractionated whole breast irradiation (HWBI), and conventionally fractionated whole breast irradiation (WBI).Patients treated with either APBI or HWBI after breast conserving therapy and with ≥3 mammograms of the treated breast were identified. They were matched 1:1 by age ±5 years to patients treated with WBI. The mammograms were evaluated for common post-RT breast findings by a mammographer who was unaware of the treatment. The outcomes were analyzed using a cumulative logistic regression model; P.05 indicated statistically significance.Of 89 patients treated with RT from 2006 to 2011, 29 had received APBI, 30 had received HWBI, and 30 had received WBI. Their median age was 60 years (range 33-83). A total of 605 mammograms were evaluated, with a median follow-up of 48 months. The treatment technique did not affect the severity of architectural distortion when the groups were evaluated longitudinally. The likelihood of finding skin thickening decreased with increasing follow-up duration (odds ratio 0.6; P.001) adjusted for fractionation schemes. No differences were seen with respect to changes in skin thickening, fluid collections, or calcifications among the treatment groups, after adjustment for the follow-up time. The clinical characteristics, including age, race, T stage, and chemotherapy use, were not linked to the likelihood of finding several mammographic phenomena over time.Although specific post-treatment imaging findings evolved over time, RT fractionation did not alter the relative incidence or severity of architectural distortion, skin thickening, fluid collections, or calcifications. These findings will be useful to both radiologists and radiation oncologists when counseling patients regarding follow-up studies after RT.

This study describes our institution's experience using whole brain radiation therapy (WBRT) to treat patients with acute myelogenous leukemia (AML) presenting with hyperleukocytosis. After approval by the institutional review board, we identified patients with AML and hyperleukocytosis using hospital records. The primary endpoints in the study included alleviation of neurological symptoms (or prevention if prophylactic RT was used), overall survival, development of intracranial hemorrhage (ICH) and ≥ grade 3 toxicities using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). Eighteen patients received WBRT for the treatment of AML hyperleukocytosis. Thirteen patients received treatment in order to control neurological symptoms. Clinical assessment showed that 12 of 13 patients (92%) achieved resolution of neurological symptoms either concurrent with RT or immediately after RT. The mean overall survival for all of the patients who received WBRT was 14.2 months (95% confidence interval, 5.4-23.0). No patient who received RT experienced ≥ grade 3 toxicity. Two (6%) patients developed ICH following therapy. Our institution's experience demonstrates that WBRT may be utilized as part of multimodality therapy in order to alleviate or prevent neurological symptoms in patients with AML presenting with leukostasis.

Purpose. The purpose of this study was to evaluate acute locoregional toxicity in patients with breast cancer receiving concurrent metformin plus radiation therapy.Methods and Materials. Diabetic breast cancer patients receiving concurrent metformin and radiation therapy were matched with nondiabetic patients and diabetic patients using an alternative diabetes medication. Primary endpoints included the presence of a treatment break and development of dry or moist desquamation.Results. There was a statistically significant increase in treatment breaks for diabetic patients receiving concurrent metformin when compared to the nondiabetic patients (Pvalue = 0.02) and a trend toward significance when compared to diabetic patients receiving an alternate diabetes medication (Pvalue = 0.08). Multiple logistic regression analysis demonstrated concurrent metformin use as being associated with a trend toward the predictive value of determining the incidence of developing desquamation in diabetic patients receiving radiation therapy compared to diabetic patients receiving an alternate diabetes medication (Pvalue = 0.06).Conclusions. Diabetic patients treated with concurrent metformin and radiation therapy developed increased acute locoregional toxicity in comparison with diabetic patients receiving an alternate diabetes medication and nondiabetic patients. Further clinical investigation should be conducted to determine the therapeutic ratio of metformin in combination with radiation therapy.