Outcomes of Total Knee Arthroplasty Revisions in Obese and Morbidly Obese Patient Populations.

BACKGROUND: The obese population is at higher risk for complications following primary total knee arthroplasty (TKA), but little data is available regarding revision outcomes. This study aimed to investigate the role of body mass index (BMI) in the cause for revision TKA and whether BMI classification is predictive of outcomes. METHODS: A multi-institutional database was generated, including revision TKAs from 2012 to 2019. Data collection included demographics, comorbidities, surgery types (primary revision, repeat revision), reasons for revision, lengths of hospital stay, and surgical times. Patients were compared using 3 BMI categories: nonobese (18.5 to 29.9), obese (30 to 39.9), and morbidly obese (≥40). Categorical and continuous variables were analyzed using chi-square and 1-way analysis of variance tests, respectively. Regression analyses were used to compare reasons for revision among weight classes. RESULTS: Obese and morbidly obese patients showed significant risk for repeat revision surgery in comparison to normal weight patients. Obese patients were at higher risk for primary revision due to stiffness/fibrosis and repeat revision due to malposition. In comparison to the obese population, morbidly obese patients were more likely to require primary revision for dislocation and implant loosening. CONCLUSION: Significant differences in primary and repeat revision etiologies exist among weight classes. Furthermore, obese and morbidly obese patients have a greater risk of requiring repeat revision surgery. These patients should be informed of their risk for multiple operations, and surgeons should be aware of the differences in revision etiologies when anticipating complications following primary TKA.

Epidemiology and outcomes of gastrointestinal mucosal melanomas: a national database analysis.

AIM: Gastrointestinal malignant melanoma is a rare mucosal melanoma (MM). Other MM include the respiratory and the genitourinary tract. All mucosal melanomas have a poor prognosis when compared to cutaneous melanomas. Ano-rectal melanomas are by far the most common and most studied gastrointestinal MM. Large-scale clinical data is lacking due to the rarity of the disease. We aim to analyze epidemiology and survival of the Gastrointestinal (G.I.) MM over 45 years using a national database. METHODS: The Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients with biopsy-proven G.I. Melanomas. We selected tumor site, intervention, and survival information for oncology codes as per the international classification of diseases. Survival analysis was performed using the SPSS v 27 ® IBM software. RESULTS: Of the 1105 biopsy-proven confirmed cases of primary G.I. melanoma's, 191 (17.3%) received chemotherapy (C.T.), 202 (18.3%) received radiotherapy (R.T.), 63 (5.7%) received both C.T and R.T., while 684 (61.9%) of the population received surgery alone or combined with C.T. and/or R.T. Statistically significant improvement in survival was noted in all treatment strategies that utilized surgery and also when site-specific MM cohorts underwent a surgical approach with or without C.T and/or R.T. CONCLUSION: This is the most extensive study reporting epidemiological and survival data of treatment strategy outcomes of primary G.I. mucosal melanoma elucidating best overall survival with a management strategy involving surgical intervention.

The Prevalence of Metabolic and Endocrine Disturbances on Fracture Nonunion.

OBJECTIVE: This study aims to determine the prevalence of metabolic disturbance in all fracture nonunion cases and identify the most common endocrine abnormalities seen using a simple screening algorithm. METHODS: A retrospective review study was performed evaluating patients who underwent operative intervention for nonunion from January 2010 to December 2018 at 2 level-1 trauma centers. Preoperative laboratory values were recorded for a 9-test "nonunion panel." A metabolic or endocrine abnormality, specifically an abnormality in the thyroid or parathyroid axis, was evaluated. RESULTS: 42% of patients had an undiagnosed metabolic laboratory abnormality. When multiple tests were used, the rate of metabolic dysfunction was between 60% and 75%, depending on the definition of vitamin D insufficiency vs deficiency used. CONCLUSION: Results indicate a relatively high prevalence of metabolic disturbance in patients with nonunion and suggest metabolic screening for all nonunion patients not only those without a mechanical or infectious cause. LEVEL OF EVIDENCE: IV, retrospective case series.

Does Obesity Affect Preoperative Shoulder Balance in Adolescent Idiopathic Scoliosis?

BACKGROUND: Obese patients with adolescent idiopathic scoliosis (AIS) have been shown to present with larger curve magnitudes preoperatively. However, the effect of obesity on shoulder balance in AIS remains unknown. The purpose of our study was to determine if overweight and obese patients with AIS have worse radiographic shoulder balance on initial presentation when compared with normal weight patients. METHODS: AIS patients <18 years old, with Lenke 1 or 2 curves, who underwent a posterior spinal fusion between March 2013 and December 2018 were retrospectively evaluated. BMI-for-age percentiles as defined by the Center for Disease Control and Prevention were used: obese (≥95th percentile), overweight (85th to <95th percentile), and normal weight (5th to <85th percentile). Shoulder height was measured via the radiographic shoulder height (RSH) method, with an RSH ≤ 1 cm considered balanced. The primary outcome was preoperative shoulder balance. Secondary outcomes included postoperative shoulder balance, major curve correction, and UIV selection. RESULTS: One hundred eighty-four patients (116 [63%] normal weight and 68 [37%] overweight/obese) were included. The mean age at surgery was 13.1 ± 2 years, and mean follow-up was 17.4 ± 13 months. Preoperative shoulder imbalance was significantly greater in the overweight/obese group compared to the normal weight group (1.9 ± 1 cm vs. 1.5 ± 1 cm, p = 0.04). The odds ratio of presenting with unbalanced shoulders was 2.0 (95% CI: 1.02-3.83, p = 0.04) for the overweight/obese group. No significant differences were found for postoperative shoulder balance, UIV selection, or major curve correction. CONCLUSIONS: Overweight and obese patients with AIS are twice as likely to present with unbalanced shoulders preoperatively; however, this difference is not clinically relevant with a mean difference of 0.4 cm between cohorts. Finally, the preoperative BMI percentile did not show a significant effect on the chosen UIV or curve magnitude correction. LEVEL OF EVIDENCE: Level III: this is a retrospective case-control study.

Surgical Outcomes of Obese Patients With Adolescent Idiopathic Scoliosis From Endemic Areas of Obesity in the United States.

BACKGROUND: Obesity rates continue to rise among children and adolescents across the globe. A multicenter research consortium composed of institutions in the Southern US, located in states endemic for childhood obesity, was formed to evaluate the effect of obesity on pediatric musculoskeletal disorders. This study evaluates the effect of body mass index (BMI) percentile and socioeconomic status (SES) on surgical site infections (SSIs) and perioperative complications in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF). METHODS: Eleven centers in the Southern US retrospectively reviewed postoperative AIS patients after PSF between 2011 and 2017. Each center contributed data to a centralized database from patients in the following BMI-for-age groups: normal weight (NW, 5th to <85th percentile), overweight (OW, 85th to <95th percentile), and obese (OB, ≥95th percentile). The primary outcome variable was the occurrence of an SSI. SES was measured by the Area Deprivation Index (ADI), with higher scores indicating a lower SES. RESULTS: Seven hundred fifty-one patients were included in this study (256 NW, 235 OW, and 260 OB). OB and OW patients presented with significantly higher ADIs indicating a lower SES (P<0.001). In addition, SSI rates were significantly different between BMI groups (0.8% NW, 4.3% OW, and 5.4% OB, P=0.012). Further analysis showed that superficial and not deep SSIs were significantly different between BMI groups. These differences in SSI rates persisted even while controlling for ADI. Wound dehiscence and readmission rates were significantly different between groups (P=0.004 and 0.03, respectively), with OB patients demonstrating the highest rates. EBL and cell saver return were significantly higher in overweight patients (P=0.007 and 0.002, respectively). CONCLUSION: OB and OW AIS patients have significantly greater superficial SSI rates than NW patients, even after controlling for SES. LEVEL OF EVIDENCE: Level III.

Somatostatin receptor expression in non-classical locations - clinical relevance?

In-111 pentetreotide (Octreoscan) is a radiolabeled somatostatin analog with high binding affinity to somatostatin receptors (SSTR) used in somatostatin receptor scintigraphy (SRS). Pentetreotide labelled with In-111 is widely used due to its high affinity to SSTR 2 and 5. SSTR are expressed on neuroendocrine cells as well as several non-neural and non-endocrine cells with varying levels of density. We retrospectively reviewed articles and publications related to octreoscan accumulation in sites that classically do not have high concentrations of SSTR as well as in organs and tissues from diseases which are not usually diagnosed by octreoscan. The significance of a positive uptake as assessed by octreoscan in non-somatostatin receptor related diseases is not fully understood yet. Localization of octreotide in non-oncological disease states such as inflammation is due to presence of SSTR in activated immunological cells, over-expression by activated cells in the respective tissue and SSTR expression by blood vessels. In granulomatous diseases, over-expression of SSTR2 preferential binding sites were detected in epitheloid and giant cells. The purpose of the current study is to identify octreoscan localization in non-somatostatin receptor related disease sites to better understand the mechanism of this nonspecific accumulation which may help expand the clinical utilization of functional imaging utilizing somatostatin receptor scintigraphy in diagnosis and perhaps therapy.

The Influence of Training Pathway, Institution Type, Gender, and a Global Pandemic on Post Graduation Career Plans in Plastic Surgery.

Background: Anecdotal statements are often made about what percentage of residents go into fellowship versus private practice versus academia after graduation. However, few objective studies have been completed on this topic. This project is designed to shed light on the career choices of plastic surgery residents immediately after graduation from 2018 to 2022. A secondary objective was to determine whether the COVID-19 pandemic had any measurable impact on postgraduation plans. Methods: After obtaining institutional review board approval, publicly available data were obtained from institution websites or via program queries. Comparison between pre-COVID-19 and post-COVID-19 (2018-2019 versus 2020-2022), integrated versus independent, and private versus public cohorts were analyzed using Fisher exact test. A two-sided P value less than 0.01 was considered statistically significant. Results: Data were collected for 690 graduates across 64 plastic surgery training programs. Responses were obtained from 60 of 88 (68%) integrated and 30 of 47 (64%) independent programs. Most graduates pursued fellowship training (61%), followed by private practice (28%), academic practice (5%), or military post (1%). Independent residents were more likely to pursue private practice (40% versus 26%, P = 0.001), whereas integrated residents were more likely to pursue fellowship (49% versus 70%, P < 0.0001). Public institution graduates were more likely to go into private practice (37% versus 23%, P = 0.0002), whereas private institution residents were more likely to pursue fellowship (55% versus 72%, P < 0.0001). Public institutions were more likely to graduate women (45% versus 35%, P = 0.009). The COVID-19 pandemic (P = 0.31) had no impact on postgraduation plans. Conclusions: This study demonstrates that training pathway and institution type have a significant impact on postgraduation plans, whereas a global pandemic does not. This information can be used by educators, residents, and medical students as they plan for the future.

Bicondylar tibial plateau fracture dislocations with an intact anterolateral cortical rim: A surgical technique.

A displaced medial tibial plateau fracture with central and lateral impaction, but an intact anterolateral cortical rim, is an uncommon variant of bicondylar tibial plateau fracture that presents a number of challenges. Without a lateral metaphyseal fracture line to work through, it is challenging to address central and lateral impaction. Previously published techniques for addressing this fracture pattern describe an intra-articular osteotomy of the lateral plateau to aid visualization and reduction, or use a posterolateral approach to the proximal tibia with or without an osteotomy of the proximal fibula. This study presents a technique which utilizes standard dual incision approaches and does not involve an intra-articular osteotomy of the lateral tibial plateau or a posterolateral approach. A case series was conducted evaluating radiographic and functional outcomes of 8 patients.

Hemoglobin A1c as a Predictor of Surgical Site Infection in Patients With Orthopaedic Trauma.

INTRODUCTION: Previous research involving diabetes mellitus (DM), glycemic control, and complications in orthopaedic patients has primarily focused on elective procedures. The purpose of this study was to evaluate hemoglobin A1c (A1c) as a predictor of postoperative surgical site infection (SSI) in patients with orthopaedic trauma. METHODS: Patients aged 18 years or older treated surgically for an acute fracture by a fellowship-trained orthopaedic trauma surgeon at a single academic tertiary referral center with a laboratory value for A1c available within 3 months of their surgery were identified retrospectively. Postoperative SSI was defined according to 'Fracture related infection: A consensus on definition from an international expert group,' by Metsemakers et al. RESULTS: A total of 925 patients met criteria for analysis. A receiver operating characteristic curve was calculated using A1c as a predictor for signs suggestive and confirmatory of SSI and demonstrated an area under the curve of 0.535 and 0.539, respectively. No significant difference was found in the rate of signs suggestive or confirmatory of SSI in patients with normal A1c levels (<6.5) compared with patients with A1c levels consistent with a diagnosis of DM (>6.5), P-value = 0.199 and P-value = 0.297, respectively. No significant difference was found in the rate of signs suggestive or confirmatory of SSI in patients with completely uncontrolled DM (A1c > 10) compared with patients with A1c levels <10, P-value 0.528 and P-value = 0.552, respectively. CONCLUSION: Existing literature has demonstrated an association with postoperative infection in orthopaedic patients who have elevated A1c values. In this cohort of patients with orthopaedic trauma, hemoglobin A1c was not a valuable tool to predict postoperative SSI. Given these findings, routine A1c monitoring is not a reliable predictor of SSI criteria in patients with orthopaedic trauma based on the current consensus definition of SSI in fracture surgery.

Blood Pressure, Hypertension, and Antihypertensive Medication Use and Risk of Total and Fatal Prostate Cancer in Black and White Men in the Atherosclerosis Risk in Communities (ARIC) Study.

Black men are disproportionately burdened by hypertension and prostate cancer (PCa), and some cohorts suggest hypertension is associated with increased PCa risk. We investigated the association of hypertension and antihypertensive use with total (N = 889; 290 Black, 599 White) and fatal (N = 127; 42 Black, 85 White) PCa risk in 6658 (1578 Black, 5080 White) men in the Atherosclerosis Risk in Communities study. In adjusted Cox models, time-updated untreated stage 1 hypertension (systolic/diastolic blood pressure 130-139/80-89 mmHg) was associated with a higher risk of fatal PCa compared to untreated normal blood pressure (hazard ratio (HR) = 1.95; 95% confidence interval (CI) = 1.03-3.70). Compared to untreated normal/elevated blood pressure (combined given few events in those with untreated normal blood pressure), the association was significant in Black (HR = 3.35; 95% CI = 1.27-8.83), but not White (HR = 1.21; 95% CI = 0.58-2.55) men. Ever antihypertensive use was associated with a lower risk of fatal PCa compared to never use (HR = 0.52; 95% CI = 0.31-0.87), including short-term (< 10 years) and long-term (310 years) use (p-trend = 0.02) with similar inverse associations in Black and White men. Hypertension and antihypertensive use were not significantly associated with total PCa. The positive association of untreated stage 1 hypertension and fatal PCa warrants additional confirmation, especially in Black men, and characterization of the underlying mechanism.

Effect of pelvic fixation on ambulation in children with neuromuscular scoliosis.

BACKGROUND: The effect of posterior spinal fusion (PSF) incorporating the pelvis on an ambulatory patient's ability to mobilize after the fusion is not well understood. AIM: To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis (NMS) patients influences postoperative ambulatory ability. METHODS: A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1, 2012 and February 29, 2019. A total of 118 patients were eligible, including 11 ambulatory patients. The primary outcome was the maintenance of ambulatory status postoperatively. Secondary outcomes included postoperative curve magnitude, pelvic obliquity, and complications, comprising infections, instrumentation failure, and any unplanned returns to the operative room. RESULTS: The ambulatory function was maintained in all 11 ambulatory NMS patients. One patient had an improvement in functional status with equipment-free ambulation postoperatively. An average postoperative follow-up was 19 mo. The overall complication rate was 19.4% (n = 23) with no significant differences between the groups in infection (P = 0.365), hardware failure (P = 0.505), and reoperation rate (P = 1.0). Ambulatory status did not affect complication rate (P = 0.967). CONCLUSION: Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.

A Multi-Center Comparison of Orthopaedic Attending and Resident Learning Styles.

OBJECTIVE: Effective education of orthopedic residents requires an understanding of how they process information. To date however no literature has described resident learning styles based on the updated Kolb Learning Style Inventory (KLSI) v4.0. The purpose of this study is to identify common learning styles amongst orthopedic residents and attendings and evaluate the effect that race, gender, and resident/attending status have on learning styles. DESIGN: The KLSI v4.0 and a demographic survey were distributed to 103 orthopedic attendings and residents at two academic centers during the 2019 to 2020 academic year. Frequencies and descriptive statistics were reported. Learning styles based on gender, race, attending versus resident status, and institution were evaluated. A p-value < 0.05 was considered significant. SETTING: This is a multi-center study performed at two academic, university based orthopedic surgery departments. PARTICIPANTS: Orthopaedic surgery residents and attending surgeons. RESULTS: At both institutions, the combined response rate for the KLSI v4.0 was 66% and 68% for the demographic surgery. The three most common learning styles recorded were: Deciding (26.5%), Acting (17.6%), and Thinking (17.6%). Learning styles were compared by gender, race, attending and/or resident status, and institution with no statistically significant difference found between any of the comparisons (p > 0.05). CONCLUSION: The majority of orthopedic surgeons have Deciding, Acting, or Thinking learning styles, which are categorized by motivation to achieve goals, disciplined and logical reasoning, and the use of theories and models to solve problems. However, not all residents and attendings utilize these common learning styles. A mismatch in learning styles between residents and attendings could result in poor educational experiences. Understanding the learning styles of orthopedic surgeons has implications for improving evaluation interpretation, mentorship pairing, quality of life, and resident remediation.

Demographic profile, management, and survival of primary Gastrointestinal Kaposi Sarcoma: A USA Nationwide SEER-based study.

Kaposi Sarcoma (KS) is a Human Herpes Virus-8 (HHV-8) associated angio-proliferative disorder commonly seen in patients with HIV. It most commonly involves the skin as classic purple lesions but occasionally involves the gastrointestinal (GI) tract. To date, published data is scarce on primary GI KS. Using a national database, this study analyzes the incidence, demographics, and survival of primary GI KS. We conducted a retrospective analysis (1975-2019) on biopsy-proven primary GI KS cases from 17 registries from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 685 patients with GI KS were identified. Female gender, Non-Hispanic Asian or Pacific Islander (NHAPI), married marital status, and large bowel site-specific primary KS to have better overall survival. Luminal gastrointestinal KS was more frequent (84.96%) than solid organ involvement (3.07% of all cases). This study is the most extensive population-based study about the epidemiological and survival data of patients with primary GI KS, revealing GI KS to be a young male disease with best outcomes in the large bowel and anal canal KS while inferior outcomes in extraintestinal GI KS.

A track record of diversity: Medical schools ranked by successful black applicants to orthopaedic residencies.

BACKGROUND: Orthopaedic surgery is the least diverse surgical subspecialty in medicine. However, to date, there is no literature that shows which medical schools have successfully contributed to improving orthopaedic surgeon diversity. OBJECTIVE: The purpose of this study is to identify the top U.S. medical schools that have successfully matched black applicants into orthopaedic surgery residencies and juxtapose this ranking to the current top medical schools as ranked by the U.S. News and World Report (USNWR). METHODS: The J. Robert Gladden Orthopaedic Society (JRGOS) database was queried for all orthopaedic surgeons, fellows, and residents who identified as black or multi-racial with black being one of the included races, yielding 938 physicians, of which 672 met our inclusion criteria. From this list, a ranking of the top 20 medical schools was generated. RESULTS: The top five medical schools ranked in the JRGOS database are Howard University College of Medicine (HUCOM), Meharry Medical College, Harvard Medical School (HMS), the University of Pennsylvania, and Morehouse School of Medicine (MSM). In addition, 10 (50%) of the medical schools ranked in the top 20 by the JRGOS database were also ranked by the USNWR. When ranking medical schools for black female applicants, HUCOM, MSM, HMS are the top three programs. Lastly, a ranking by region identified that the northeast contained the highest number of ranked medical schools. CONCLUSION: There are both historically black and non-historically black medical schools which have a proven track record of producing a significant number of future black orthopaedic surgery residents.

An Analysis of the Residents' Research, Education, and Wellness Resources in Radiation Oncology Residency Programs in the United States.

The purpose of this research was to evaluate the variations in research, education, and wellness resources for residents among radiation oncology (RO) residency programs across the United States. A list of accredited programs for the academic year 2018 to 2019 was collected using the Accreditation Council for Graduate Medical Education website. Individual residency program websites were used as the primary source of the data, and the Fellowship Residency Electronic Interactive Data Access System website complemented any missing data. We collected data on dedicated research time, resident rotations, wellness resources, and salary information. Excel 2013 was used for analysis. Information from the 94 Accreditation Council for Graduate Medical Education accredited RO residency programs during the academic year 2018 to 2019 was collected. Seventy-five (80%) programs reported the duration of dedicated research time on their websites. At least 6 months are allowed in 48 (51%) programs, and 27 (29%) programs report that dedicated research time is negotiable. Outstandingly, 20 (21%) programs allow 1 year of dedicated research time, and the median dedicated research time is 9 months. From our study, only 13 (14%) residency programs allow residents to rotate in other departments of the same institution. Fifty-nine (63%) programs allow away rotations at other institutions (external electives). An international rotation is permitted only in 19 (20%) programs. Wellness resoursces specifically fatigue managment, resident retreat and resident mentoring programs were available in 53%, 26% and 42% of programs, respectively. The salary information is obtainable for 63 institutions, and the yearly compensation ranges between $51,000 and $78,000. Moonlighting is allowed only in 28 (30%) programs. Our study found that major variations exist among RO residency programs in the United States regarding research, education, and wellness resources for residents.

Predictors of Extracapsular Extension in Patients With Squamous Cell Carcinoma of the Head and Neck and Outcome Analysis.

Introduction Extracapsular extension (ECE) in the lymph nodes for patients with head and neck cancer has been found to be a poor prognostic factor in multiple studies. The purpose of the study is to evaluate the predictive factors for ECE on computer tomography (CT) imaging for patients undergoing surgery and to analyze outcomes. Methods We conducted an Institutional Review Board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective review of 82 patients with biopsy-proven squamous cell carcinomas of the head and neck who underwent definitive surgery without neoadjuvant chemotherapy or radiation therapy. CT scans were evaluated for the level of involvement, size, and presence or absence of central necrosis. Extracapsular extension in lymph nodes on the postoperative pathology was correlated with the central necrosis in the lymph nodes appreciated on the CT neck with contrast. Survival estimates were evaluated using the Kaplan-Meier test. Results ECE on postoperative pathology was seen in 74.07% of patients who had evidence of central necrosis in lymph nodes on preoperative CT neck compared to 46.43% without CT necrosis (p=0.013). The incidence of ECE is higher in poorly differentiated tumors and also nodal stages >N2c at presentation. Patents with ECE had inferior disease-free and overall survival (OS). Conclusions Our results reveal that patients with necrosis on CT and with moderately to poorly differentiated tumors have a high incidence of extracapsular extension. There was no difference in local control (LC) between the groups of patients, but the OS was inferior in patients with ECE. Predicting extracapsular extension upfront helps to formulate the appropriate treatment. We propose to study additional chemotherapy to improve outcomes in patients with positive extracapsular extension.

Factors Affecting Outcomes in Patients With Stage III & IV Squamous Cell Carcinoma of Oropharynx: The Importance of p16 Status, BMI, and Race.

Objective To identify racial disparities in survival outcomes among Stage III & IV patients with squamous cell carcinomas (SCCa) of the oropharynx treated with definitive radiation therapy (RT), with concurrent chemotherapy. Method This is a retrospective analysis of patients with stage III & IV SCCa of oropharynx treated with definitive RT at the State Academic Medical Center. All patients were treated to 70 Gy utilizing intensity-modulated radiation treatment (IMRT), and received concurrent chemotherapy with weekly cisplatin or cetuximab. Chi-square test was used to test the goodness of fit, overall survival (OS), and locoregional control (LRC) comparing races were generated by using Log-rank test & Kaplan-Meier method. The covariables associated with the OS and LRC were determined by the Cox regression model. A p-value of less than 0.05 was considered statistically significant. The SPSS 24.0 software (IBM Corp., Armonk, NY) was used. Results In the total 73 eligible patients, 54.8% were black, and 45.2% white patients. Stage distribution (per American Joint Committee on Cancer-AJCC 8th Ed) between black patients vs. white patients, Stage III (45.5% vs. 54.5%) and for Stage IV (56.5% vs. 43.5%); p=0.499. Median follow-up for the entire group was 41 months (range: 4-144 months). In the univariate analysis, variables p16 status, body mass index (BMI), alcohol history and tumor subsite were found to be significant. In the multivariate analysis, only BMI has shown to be significant. Three-year LRC for black patients was 37.8% vs.66.8% in white patients (p=0.354) and three-year OS for black patients was 51.8% vs. 80.9% for white patients (p=0.063), respectively. Five-year OS for p16 positive patients was 69.7% vs. 43% for p16 negative patients (p=0.034). Five-year OS for Stage IV black patients was 34% vs. 69.5% for Stage IV white patients (p=0.014). Conclusion Among all the co-variables examined, only BMI has shown affecting the OS outcomes; gender and BMI shown to be affecting the LRC. Racial factor appears to be significant in Stage IV patients.

Variations in Resources Among Radiation Oncology Residency Programs in the United States.

The purpose of this research was to assess the existing variations in the residency training resources among radiation oncology (RO) residency programs in the United States. We queried each residency program website and Fellowship Residency Electronic Interactive Data Access System website (www.freida.ama-assn.org) to obtain information on faculty and available treatment modalities. The data were continuously updated, most recently as of April 30, 2019. A total of 94 RO residency programs were identified during the academic year 2018-2019, and data were collected. The median number of attending physicians was 13 (range, 4 -71). The median number of physicists and biologists were 9 and 3, respectively. The conventional techniques, including 3 dimensional conformal radation therapy, intensity modulated radiation therapy, electron therapy, and stereotactic body radiation therap/stereotactic radiosurgery, were available in all residency programs. In terms of specialized external beam radiation therapy machines, gamma knife, CyberKnife, and magnetic resonance imaging (MRI) linear accelerator were available in 49 (52%), 21(22%), and 7 (8%) programs, respectively. Only 19 programs (20%) had in-house proton therapy availability; however, 37 programs (39%) offered proton therapy training via resident rotation at an affiliated institution. Prostate, gynecologic, and breast brachytherapy were available in 81 (86%), 82 (87%), and 58 (62%) programs, respectively. Eighty-one (86%) programs reported to have high dose rate, and only 20 (21%) programs had low dose rate brachytherapy. Our study found that marked variations exist among RO residency programs in the United States during academic year 2018-2019 and will serve as a baseline for future intervention.

An Analysis of the Racial Disparities Among Cervical Cancer Patients Treated at an Academic Medical Center in the Southeastern United States.

Objective The purpose of this study was to identify racial disparities in treatment outcomes, if any, among patients with carcinoma of the cervix treated at a tertiary care institution in the state of Mississippi. Methods A retrospective review of patients with carcinoma of the cervix treated in the Department of Radiation Oncology at our institution between 2010 and 2018 was performed. Data regarding demographics, disease stage, treatments administered, and follow-up were collected. Patient outcomes, including median survival and overall survival, were analyzed using the Kaplan-Meier method. All analyses were performed using SPSS Statistics version 24 (IBM, Armonk, NY). Results Between January 2010 and December 2018, a total of 165 patients with carcinoma of the cervix were treated at our institution. We had a significantly higher proportion of African American (AA) compared to Caucasian American (CA) patients (59.4 vs. 36.4%; p=0.03). There was a significant difference in the disease stage at the time of presentation between AA and CA in that compared to AA women, a higher number of CA patients presented with locally advanced disease [Federation of Gynecology and Obstetrics (FIGO) stages IB2 to IVA] (78.6 vs. 86.7%; p<0.001). However, a higher number of AA patients presented with metastatic disease at diagnosis compared to CA women (13.3 vs. 8.3%; p<0.001). Regarding their treatment, 157 (95.2%) underwent definitive chemoradiotherapy, while three (1.8%) had definitive surgery followed by adjuvant radiation or chemoradiation, depending on the risk factors identified operatively. The treatment details of five patients were not available. The median follow-up and the median survival of the entire cohort were 16 months and 79 months, respectively. In our cohort, there was no significant difference in overall survival between AA and CA patients at either three years (80 vs. 68%; p=0.883) or five years (77 vs. 68%; p=0.883). As expected, patients with locally advanced disease showed a significantly better median survival of 79 months compared to only 11 months for those with metastatic disease at their presentation (p<0.001). Conclusions Our study revealed that more AA women presented with metastatic disease compared to CA women. However, our analysis did not identify any racial disparities in the prognosis of the entire cohort.

Management of Advanced-stage Hypopharyngeal Carcinoma: 25-Year Experience from a Tertiary Care Medical Center.

Introduction Due to conflicting data in the literature, there is a continuing debate on whether advanced hypopharyngeal carcinoma patients should be treated with definitive surgery or chemoradiotherapy. The purpose of this study is to evaluate the management and outcomes of advanced hypopharyngeal carcinoma in a tertiary care institution over the last 25 years. Methods An Institutional Review Board (IRB)-approved and HIPPA-compliant retrospective analysis was performed of patients with advanced-stage squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes including median survival and overall survival were calculated using the Kaplan Meier method. All analyses were performed using SPSS v. 24.  Results This study included a total of 103 advanced stage hypopharyngeal cancer patients. The median age for this cohort is 61 years (range: 41-88, SD 9.3). Of the total 103 eligible patients treated, 92 (89.3%) were male and 11 (10.7%) female; 61 (59.2%) were African Americans, 39 (37.9%) were Caucasians and three (2.9%) were other races. Seventeen patients (16.5%) had stage III disease, whereas 86 (83.5%) patients were diagnosed with Stage IV A or B disease. Seventy-two patients (69.9%) were treated with definitive chemoradiotherapy (ChemoRT group), and 31 patients (30.1%) underwent primary surgery with or without adjuvant treatments (Surgery group). The two treatment groups were similar in terms of age, gender, ethnicity, alcohol status, N staging, and subsites but were significantly different for smoking status (p = 0.035) and T staging (p = 0.024). The median follow-up was 17 months. The median survival of the overall cohort was 26 months, and five-year overall survival was 25.5%. The median survival was found to be significantly better for the surgery group as compared to the definitive chemoradiotherapy group (43 months vs 16 months, p = 0.049). The five-year overall survival (OS; 41.5% vs 18.5%, p = 0.049) and disease-free survival (DFS; 75.3% vs 56%; p = 0.029) were significantly better for patients in the surgery group compared to the chemoradiotherapy group. On multivariate Cox-regression analysis, lymph nodal status (HR = 1.27, CI: 1.00-1.62, p = 0.047) and chemoradiation treatment (HR = 1.82, CI: 1.00-3.29, p = 0.048) were associated with higher risk of mortality.  Conclusion In our single institutional experience of advanced hypopharyngeal carcinoma management, the five-year overall survival rate was found to be 25.5 % and was the poorest among head and neck cancers. The patients with advanced hypopharyngeal cancer treated with surgery followed by adjuvant radiation or chemoradiation have significantly improved overall survival compared to those treated with definitive chemoradiotherapy. Further research warranted for early detection and better treatment to improve the cure rate in hypopharyngeal carcinoma patients.