Increasing Diversity of Patients in Radiation Oncology Clinical Trials.

Radiation oncology clinical trials lack full representation of the ethnic and racial diversity present in the general United States and in the cancer patient population. There are low rates of both recruitment and enrollment of individuals from underrepresented ethnic and racial backgrounds, especially Black and Hispanic patients, people with disabilities, and patients from underrepresented sexual and gender groups. Even if approached for enrollment, barriers such as mistrust in medical research stemming from historical abuse and contemporary biased systems, low socioeconomic status, and lack of awareness prohibit historically marginalized populations from participating in clinical trials. In this review, we reflect on these specific barriers and detail approaches to increase diversity of the patient population in radiation oncology clinical trials to better reflect the communities we serve. We hope that implementation of these approaches will increase the diversity of clinical trials patient populations in not only radiation oncology but also other medical specialties.

Neutrophil-Lymphocyte, Platelet-Neutrophil, and Platelet-Lymphocyte Ratios as Indicators of Sickle Cell Anaemia Severity.

Background: Sickle cell anaemia (SCA) imposes a substantial healthcare burden, affecting millions of people worldwide. Understanding the determinants influencing SCA severity is crucial for enhanced disease management and optimized patient outcomes. This study aimed to investigate the relationship between Neutrophil-Lymphocyte Ratio (NLR), Platelet-Neutrophil Ratio (PNR), Platelet-Lymphocyte Ratio (PLR), and SCA severity. Methods: A cohort of 45 children diagnosed with SCA and undergoing treatment at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, was included in this study. Demographic and clinical data, along with laboratory measurements of the aforementioned ratios, were collected. The severity of SCA was assessed using numerical scoring. Results: The analysis revealed that PNR and PLR emerged as significant predictors of SCA severity, irrespective of the level of adiposity. In contrast, NLR demonstrated no predictive value in relation to SCA severity. Conclusion: The findings challenge the conventional notion that neutrophils alone play a central role in the pathogenesis of sickle cell crises. These results contribute to a deeper understanding of the disease and provide insights into possible alternative mechanisms underlying SCA severity. Further research is warranted to explore the intricate interplay between platelets, neutrophils, lymphocytes, and other biological factors within the context of SCA. Ultimately, this knowledge may pave the way for targeted interventions and improved management strategies for individuals living with SCA.

Treating COVID-19 Positive Cancer Patients With Radiation Therapy: A Case Report From Epicenter of the Pandemic.

The coronavirus disease 2019 (SARS-Cov-2 or COVID-19) pandemic has resulted in unprecedented clinical challenges across the globe. Outcomes of patients with this infection are likely dependent on underlying comorbidities that predict worse outcome in older patients. However, it is unknown whether COVID-19 infected cancer patients receiving radiation therapy (RT) have any different outcome than non-infected patients. We present the first series from our center of COVID-19 infected patients who received RT for malignancy, their outcome, and toxicities.

High-dose-rate (HDR) brachytherapy for the treatment of benign obstructive endobronchial granulation tissue.

BACKGROUND: Severe airway obstruction can occur in the setting of benign granulation tissue forming at bronchial anastomotic sites after lung transplantation in up to 20% of patients. Many of these benign lesions respond to stent placement, laser ablation, or balloon bronchoplasty. However, in certain cases, proliferation of granulation tissue may persist despite all therapeutic attempts. This study describes a series of refractory patients treated with high-dose-rate (HDR) brachytherapy for benign proliferation of granulation tissue, causing airway compromise. METHODS AND MATERIALS: Between April 2002 and June 2005, 5 patients with significant airway compromise from recurrent granulation tissue were treated with HDR brachytherapy. All patients had previously failed to maintain a patent airway despite multiple bronchoscopic interventions. Treatment was delivered using an HDR brachytherapy afterloader with (192)Ir. Dose prescription was to a depth of 1 cm. All patients were treated weekly, with total doses ranging from 10 Gy to 21 Gy in two to three fractions. RESULTS: The median follow-up was 12 months. All patients experienced a reduction in therapeutic bronchoscopic procedures after HDR brachytherapy compared with the pretreatment period. With the exception of possible radiation-induced bronchitis in 1 patient, there were no other treatment related complications. At the time of this report, 2 patients have died and the other 3 are alive with marked symptomatic improvement and reduced bronchoscopic procedures. CONCLUSION: High-dose-rate brachytherapy is an effective treatment for benign proliferation of granulation tissue causing airway obstruction. The early response to therapy is encouraging and further follow-up is necessary to determine long-term durability and late effects.