Development and dissemination of structured hashtags for radiation oncology: Two-Year trends.

Purpose: For radiation oncology, social media is a favored communication platform, but it uses non-structured hashtags, which limits communication. In this work, we created a set of structured hashtags with key opinion leaders in radiation oncology, and we report on their use after two years post-deployment. Materials/Methods: Hashtags were created, voted on, and refined by crowdsourcing 38 international experts, including physicians, physicists, patients, and organizations from North America, Europe, and Australia. The finalized hashtag set was shared with the radiation oncology community in September 2019. The number of tweets for each hashtag was quantified via Symplur through December 2021. For the top five tweeted hashtags, we captured the number of yearly tweets in the pre-deployment and post-deployment periods from 09/01/2019 to 08/31/2021. Results: The initial 2019 list contained 39 hashtags organized into nine categories. The top five hashtags by total number of tweets were: #Radonc, #PallOnc, #MedPhys, #SurvOnc, and #SuppOnc. Six hashtags had less than 10 total tweets and were eliminated. Post-deployment, there was an increase in the yearly tweets, with the following number of tweets by the second year post-deployment: #RadOnc (98,189 tweets), #MedPhys (15,858 tweets), and #SurvOnc (6,361 tweets). Two popular radiation oncology-related hashtags were added because of increased use: #DEIinRO (1,603 tweets by year 2) and #WomenWhoCurie (7,212 tweets by year 2). Over the two years, hashtags were used mostly by physicians (131,625 tweets, 34.8%). Conclusion: We created and tracked structured social media hashtags in radiation oncology. These hashtags disseminate information among a diverse oncologic community. To maintain relevance, regular updates are needed.

Educating the Colleagues: Radiation Basics for Obstetrics and Gynecology Residents.

Exposure to radiation oncology (RO) is limited among medical students, excluding those who wish to pursue a radiation oncology career. Consequently, RO knowledge in gynecological malignancies may differ among obstetricians and gynecologists (OB&G), depending on their experience and training level. Establishing a program to educate OB&G residents about basic radiation oncology principles may improve patients' coordination and treatment with gynecological malignancies. At our institution, radiation oncology residents conducted a 2-part training session for OB&G colleagues, which included a lecture and hands-on training. Educational sessions targeting OB&G residents are needed to enhance knowledge about radiation treatments and improve patient care.

Patterns of Care and Outcomes of Low-Lying Adenocarcinoma and Squamous Cell Carcinoma of the Rectum.

PURPOSE: Squamous cell carcinoma (SCC) of the rectum is a unique entity that lacks definitive guidelines regarding prognosis and treatment. This study aimed to analyze patterns of care and survival for SCC and adenocarcinoma (AC) of the rectum. METHODS: This was a retrospective analysis of patients with stage I-III SCC or AC of the rectum treated from 2004 to 2016 from the National Cancer Database. The treatment groups analyzed were surgery alone (S), chemoradiation followed by surgery (CRT + S), surgery followed by chemoradiation (S + CRT), and definitive chemoradiation (CRT). Patient- and clinical-related factors were compared. Overall survival was assessed with the Kaplan-Meier method and Cox proportional regression models. RESULTS: Of the patients studied, 21,587 (97.1%) were AC and 640 (2.9%) were SCC. Among patients with AC, most (n = 8549, 59.4%) received chemoradiation followed by surgery; those with SCC (n = 305, 66.4%) received definitive chemoradiation. Among patients who received surgery, the majority (69.2%) with AC histology had a low anterior resection while the majority (52.1%) of SCC had an abdominoperineal resection. Five-year overall survival of AC versus SCC in the entire cohort was 61.6% versus 56.1%, respectively (p < 0.001). On multivariable analysis for AC, CRT + S (HR 0.61, p < 0.001), or S + CRT (HR 0.67, p < 0.001) had improved survival compared to S alone while those who had definitive CRT (HR 1.55, p < 0.001) had worse survival. CONCLUSIONS: SCC of the rectum tends to be treated like anal cancers with definitive chemoradiation, with similar survival to historical reports of anal cancer. AC of the rectum is most commonly treated under the rectal cancer paradigm.

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.

Current Social Media Use Among Radiation Oncology Trainees.

PURPOSE: Resident physicians use social media (SM) for many reasons. We sought to characterize current SM use by radiation oncology (RO) trainees for education and professional development. METHODS AND MATERIALS: An anonymous 40-question survey was sent by e-mail to RO residents in the 2018 to 2019 academic year. SM platform use, time spent on SM, professional use, and opinions regarding SM use were assessed. Descriptive statistics and a univariate logistic regression analysis were performed to identify factors associated with perceptions of SM and spending >25% of SM time for academic or professional purposes. RESULTS: Of the 615 residents surveyed, 149 responded (24% response rate). Facebook (73%), theMednet (62%), Instagram (59%), Twitter (57%), and Doximity (50%) were the top SM platforms used. Most respondents (53%) reported <25% of overall SM time on professional/academic purposes, and 21% reported using SM >60 minutes per day over the past week. Residents with an RO mentor on SM (n = 35; 24%; odds ratio [OR]: 2.79; 95% confidence interval [CI], 1.29-6.08; P = .010), those participating in RO discussions on SM (n = 71; 48%; OR: 2.85; 95% CI, 1.42-5.72; P = .003), and those interacting with professional societies (n = 69; 46%; OR: 7.11; 95% CI, 3.32-15.24; P < .001) were more likely to spend >25% of their SM time on professional/academic purposes. The vast majority of respondents agreed that SM exposed them to novel educational content (82%) and was helpful for career development (65%). In addition, 69% agreed that SM can improve clinical skills and knowledge. A substantial minority agreed that SM distracts them from studying (38%) or they felt pressure to have a SM presence (29%). CONCLUSIONS: Most RO residents reported that SM provides novel educational content and can help with career development. Potential disadvantages of SM for trainees may include distraction and pressure to maintain a SM presence. SM use by RO trainees merits further research to optimize its potential for education and professional development.

No Longer a Match: Trends in Radiation Oncology National Resident Matching Program (NRMP) Data from 2010-2020 and Comparison Across Specialties.

PURPOSE: To report trends in the number and types of applicants and matched trainees to radiation oncology in comparison to other specialties participating in the National Resident Matching Program (NRMP) between 2010 and 2020. METHODS AND MATERIALS: Data from the NRMP and Electronic Residency Application System (ERAS) were obtained for 18 medical specialties between 2010 and 2020. We assessed the numbers and types of applicants and matched trainees relative to available positions in the NRMP and Supplemental Offer and Acceptance Program (SOAP). RESULTS: In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from a median of 187 between 2010 to 2019 (interquartile range [IQR], 170-192; P < .001). Across all 18 specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010 to 2019, in both the number of ERAS applicants from the United States and Canada (-31%) and the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 81% (n = 154) filled in the NRMP prior to the SOAP, of which 65% (n = 122) were "matched" by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, representing a significant decrease from a median of 92% between 2010 to 2019 (IQR, 88%-94%; P = .002). The percentages of radiation oncology programs and positions unfilled in the NRMP prior to the SOAP were significantly increased in 2020 compared with 2010 to 2019 (programs: 29% vs 8% [IQR, 5%-8%; P < .001]; positions: 19% vs 4% [IQR, 2%-4%; P <.001]). Despite >99% (n = 127 of 128) of US MD or DO senior applicants preferring radiation oncology successfully matching to a radiation oncology position in the 2020 NRMP, 16 of 35 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top user of the SOAP across all specialties participating in the 2020 NRMP, filling 15% of total positions versus a median of 0.9% (IQR, 0.3%-2.3%; P <.001). CONCLUSIONS: The supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole.

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 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.

Radiation Oncology Initial Certification Qualification Examinations: The Resident Experience in 2019.

PURPOSE: To characterize the resident experience preparing for the 2019 American Board of Radiology initial certification (IC) qualifying examinations in radiation oncology. METHODS AND MATERIALS: The Association of Residents in Radiation Oncology distributed a survey to 360 radiation oncology residents from the 2019 and 2020 graduating classes covering topics pertinent to preparation for the medical physics (MP), radiation and cancer biology (RCB), and clinical radiation oncology (CRO) qualifying examinations. RESULTS: The response rate was 58% (n = 210). In the 12 weeks before the MP and RCB examinations, first-time examinees studied a median of 160 hours (interquartile range, 96 to 270). Residents reported a "moderate" or "significant" negative effect on research productivity (3 [2-4]), mental health (3 [2-4]), clinical development (3 [2-4]), and family life (3 [2-4]). Half of surveyed residents (52%, n = 110) used a protected research or elective block to study while an additional 21% (n = 45) used a median of 5 (3-20) vacation days. Residents overall "agreed" (4 [2-4]) that their program's physics course was "important" for their preparation but were "neutral" (3 [2-4]) regarding the value of their program's radiobiology course. Question-based educational resources were most frequently rated as "important" study resources. Respondents "strongly" endorsed the development of a consensus radiation oncology curriculum (5 [4-5]) and "agreed" (4 [3-4]) that consolidation of the MP, RCB, and CRO qualifying examinations into a single written examination would be preferred. CONCLUSIONS: Radiation oncology residents dedicate substantial time preparing for the IC examinations at the expense of training- and health-related outcomes. Residents report a wide range in quality of internal program didactic courses in physics and radiobiology, endorse development of a consensus radiation oncology curriculum, and prefer consolidation of the three qualifying examinations into a single written IC examination. We caution the high pass rates seen on the 2019 examinations do not obviate the need for ongoing improvement in radiation oncology graduate medical education and the board certification process.

#ThisIsBrachytherapy: Increasing awareness of brachytherapy.

PURPOSE: The use of brachytherapy continues to be a vital application of radiation oncology for various cancers. Despite this, there has been a decrease in the utilization of brachytherapy in many cancers. Social media in medicine facilitates engagement and advocacy. We launched a social media campaign to bring awareness of brachytherapy throughout the world with #ThisIsBrachytherapy hashtag on July 17, 2019. METHODS AND MATERIALS: #ThisIsBrachytherapy hashtag was registered with Symplur Healthcare Hashtag Project. We collected total tweet counts, retweet counts, impression counts, geolocation, top 10 influencers, associated hashtags, associated words, and word sentiment score. RESULTS: The campaign launched on July 17, 2019, had a total of 145 tweets on that day with 213,416 impressions. Twenty-seven accounts (45%) were identified as physicians. Top countries which tweeted, among those with information available, included the United States, United Kingdom, and Australia. Since July 17, 2019, there has been an increase in tweets using #ThisIsBrachytherapy, with 1990 total tweets with 1,999,248 impressions. Fifty-four percent (1030) of the tweets contained photos and 319 contained links. This was from 462 unique users. Word sentiment was overwhelmingly positive. Associated hashtags with #ThisIsBrachytherapy included most commonly #radonc, #brachytherapy, #brachy, #prostatecancer, and #pcsm. CONCLUSIONS: The #ThisIsBrachytherapy inaugural campaign was successful and has continued to grow throughout the months after the initiation. By continuing to advocate for brachytherapy through the social media campaign #ThisIsBrachytherapy, we can empower radiation oncologists, especially trainees, and patients to address underutilization.

Cross-Sectional Gender Analysis of US Radiation Oncology Residency Programs in 2019: More Than a Pipeline Issue?

PURPOSE: The purpose of this study is to assess the current status of gender disparities in academic radiation oncology departments in the United States and the associated factors. METHODS AND MATERIALS: The data were collected from publicly available resources, including websites of individual radiation oncology programs, the Fellowship and Residency Electronic Interactive Database, the Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges. We collected data on the gender information of residents in each year (postgraduate years 2-5) and of the faculty (attendings, program director, and chair) during the academic year 2018 to 2019. Spearman's rho test, Pearson's chi-squared test, and Fisher exact tests were used for evaluating the correlation among variables using SPSS version 24. RESULTS: Women constituted 30.8% of radiation oncology residents in the United States in 2019. Eight programs (12.5%) did not have any female residents in their programs, whereas 6 programs (9%) had women constituting more than half of their resident class. The fraction of female medical students applying to radiation oncology over the last 7 years varied between 27% and 33%. Female attending physicians accounted for 30.5% of all the attending physicians in the academic programs. In the leadership positions of the department, the gender gap was wider where only 19 (20%) and 11 (12%) of programs had female program director or chair, respectively. There was a positive correlation between the number of attending physicians and the number of female residents in programs (P = .01). CONCLUSIONS: A significant gender disparity continues to exist among the residents and physicians in the academic radiation oncology departments in the US. This disparity is pronounced in the leadership positions. The results of this study could be used as a benchmark to evaluate the progress that has been made by the efforts to improve gender disparities in radiation oncology.

Lack of Racial Survival Differences in Metastatic Prostate Cancer in National Cancer Data Base (NCDB): A Different Finding Compared to Non-metastatic Disease.

Background: Inconsistent findings have been reported in the literature regarding racial differences in survival outcomes between African American and white patients with metastatic prostate cancer (mPCa). The current study utilized a national database to determine whether racial differences exist among the target population to address this inconsistency. Methods: This study retrospectively reviewed prostate cancer (PCa) patient data (N = 1,319,225) from the National Cancer Database (NCDB). The data were divided into three groupings based on the metastatic status: (1) no metastasis (N = 318,291), (2) bone metastasis (N = 29,639), and (3) metastases to locations other than bone, such as brain, liver, or lung (N = 952). Survival probabilities of African American and white PCa patients with bone metastasis were examined through parametric proportional hazards Weibull models and Bayesian survival analysis. These results were compared to patients with no metastasis or other types of metastases. Results: No statistically supported racial disparities were observed for African American and white men with bone metastasis (p = 0.885). Similarly, there were no racial disparities in survival for those men suffering from other metastases (liver, lung, or brain). However, racial disparities in survival were observed among the two racial groups with non-metastatic PCa (p < 0.001) or when metastasis status was not taken into account (p < 0.001). The Bayesian analysis corroborates the finding. Conclusion: This research supports our previous findings and shows that there are no racial differences in survival outcomes between African American and white patients with mPCa. In contrast, racial disparities in the survival outcome continue to exist among non-metastatic PCa patients. Further research is warranted to explain this difference.

Vulvar melanoma: an analysis of prognostic factors and treatment patterns.

OBJECTIVE: Melanoma comprises 5% to 10% of vulvar cancers and prognosis is poor. The purpose of this study was to identify prognostic factors and treatment patterns for vulvar melanoma using the National Cancer Database (NCDB). METHODS: The NCDB was queried for patients with invasive vulvar melanoma from 2004-2015. Descriptive statistics were generated to describe clinical and treatment details. Multivariable Cox regression and the Kaplan-Meier method were used to examine overall survival (OS). RESULTS: 1,917 patients with vulvar melanoma met inclusion criteria. Median follow-up time was 32 months (range, 0-151 months). Older age, larger tumor size, advanced disease stage, increased Charlson-Deyo comorbidity score, and care at a non-academic center were independent predictors for decreased OS. Surgical management of the primary site, lymph node surgery, and insurance provided a significant survival benefit. Use of immunotherapy for vulvar melanoma has increased over time. Two-year OS with immunotherapy in patients with distant metastatic disease was higher, although this did not reach statistical significance (33% vs. 12%, p=0.054). CONCLUSIONS: Vulvar melanoma has a poor prognosis for those with regional and distant metastatic disease. Extent of disease, tumor size, and patient age are important prognostic factors. Other favorable factors included insurance and surgical management. The use of immunotherapy has increased over time and may improve survival in those with distant disease. These data support further investigation into the role of immunotherapy for vulvar melanoma to optimize outcomes.

Mentorship in Radiation Oncology: Role of Gender Diversity in Abstract Presenting and Senior Author Dyads on Subsequent High-Impact Publications.

PURPOSE: To generate insights regarding the role of gender in research mentorship, we analyzed characteristics of abstracts selected for oral and poster discussion presentations at the American Society for Radiation Oncology annual meeting and subsequent high-impact publications. METHODS AND MATERIALS: Clinical radiation oncology abstracts selected for oral and poster discussion presentations at the American Society for Radiation Oncology annual meetings in 2014 and 2015 were reviewed. A multivariable logistic regression model evaluated factors associated with subsequent higher-impact publications among abstracts that led to manuscript publications. The primary independent variable was the presenting-senior (last) author gender dyad (divided into 4 groups based on gender of presenting and senior authors, respectively; eg, "MF" indicates male presenting and female senior). Dyads were classified as MF, FM, MM, or FF. RESULTS: Data were derived from 390 oral and 142 poster discussions. Presenting and senior author pairings were MM for 286 (53.8%), FF for 67 (12.6%), MF for 84 (15.8%), and FM for 94 (17.7%) abstracts. Overall, 403 abstracts led to subsequent publications, of which 52.1% (210) were in a higher-impact journal. Eventual publication in a higher-impact journal was significantly associated with senior author H-index (odds ratio [OR] 3.30 for H ≥ 41 vs < 17; group P = .007), grant support for the study (OR 2.09 for funded vs not, P = .0261), and with the presenting and senior author gender pairing (group P = .0107). Specifically, FM pairings (OR 2.48; 95% confidence interval, 1.32-4.66) and MF pairings (OR 2.38; 95% confidence interval, 1.19-4.77) had higher odds of high-impact publication than MM pairings, whereas there was no significant difference in this outcome between FF and MM pairings. CONCLUSIONS: Although unmeasured confounding remains possible, MF and FM dyads of presenting and senior authors were more likely than MM dyads to obtain journal publication in a higher-impact journal. Institutions and the profession should support the development and maintenance of respectful, collaborative cross-gender mentorship.

Oligometastatic head and neck cancer: Comprehensive review.

There are limited data available regarding the management of oligometastatic squamous cell carcinoma of the head and neck (SCCHN) patients, and no consensus guidelines are available. The objective is to review the available literature for the management of oligometastatic SCCHN. Articles were selected from English Medline literature between 1995 and 2018, searched by using the keywords: oligometastatic SCCHN/metastasectomy/stereotactic body radiation treatment (SBRT). With the available data, oligometastatic SCCHN patients appear to behave differently and tend to have a better prognosis than those with widespread metastases. Retrospective evidence suggests that the aggressive treatment of the primary disease and local treatment of the metastatic sites improves survival in oligometastatic SCCHN at diagnosis. The definitive treatment of the distant metastatic sites using metastasectomy or SBRT correlates with better survival in oligorecurrent patients. Oligometastatic SCCHN patients may have a better prognosis if treated aggressively.

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.

Primary sarcoma of the cervix: an analysis of patient and tumor characteristics, treatment patterns, and outcomes.

OBJECTIVE: Primary sarcoma of the cervix is rare and is associated with worse outcomes as compared to other histologies. The purpose of this study was to identify national treatment patterns and outcomes based on histological subtype using the National Cancer Database (NCDB). METHODS: The NCDB was queried for patients with cervical cancer from 2004-2015. Clinico-demographic treatment details were obtained and compared between patients with squamous cell carcinoma (SCC), adenocarcinoma, and sarcoma of the cervix. Multivariable Cox regression and the Kaplan-Meier method was used to examine survival. RESULTS: 107,177 patients met inclusion criteria including 81,245 (75.8%) women with SCC, 24,562 (22.9%) women with adenocarcinoma, and 1,370 (1.3%) women with sarcoma. Of the patients with cervical sarcoma, 680 (49.6%) patients had carcinosarcoma or malignant mixed Müllerian tumor, 255 (18.6%) patients had leiomyosarcoma, 197 (14.4%) patients had adenosarcoma, 28 (2.0%) patients had endometrial stromal sarcoma (ESS), 85 (6.2%) patients had rhabdomyosarcoma, and 125 (9.1%) patients had sarcoma not otherwise specified (NOS). Patients with sarcoma were older and more likely to be treated primarily with surgery. On multivariable Cox regression, sarcoma had decreased overall survival (OS) as compared to patients with SCC (hazard ratio=2.17; 95% CI=1.99-2.37; p<0.001). Among patients with sarcoma, 5-year OS was 89.2% for adenosarcoma, 66.2% for rhabdomyosarcoma, 55.6% for leiomyosarcoma, 45.8% for ESS, 31.6% for carcinosarcoma, and 29.2% for sarcoma NOS. CONCLUSIONS: Primary cervical sarcomas have inferior outcomes compared to SCC and adenocarcinoma. Sarcoma NOS and carcinosarcoma have the worst prognosis among sarcoma subtypes.

Patterns of Care and Outcomes of Adjuvant Chemoradiation for Node-Positive Pancreatic Adenocarcinoma.

PURPOSE: The literature has been conflicting on the superiority of adjuvant chemoradiation over chemotherapy for node-positive adenocarcinoma of the pancreas following definitive surgery. We aimed to evaluate the patterns of care and outcomes of these two treatment options using the National Cancer Database (NCDB). METHODS: Patients diagnosed with non-metastatic, node-positive adenocarcinoma of the pancreas from 2006 to 2014 who received oncologic resection with negative margins were identified in the NCDB. Patient- and clinical-related factors were compared between those who received adjuvant chemotherapy alone (aC) versus adjuvant chemoradiation (aCRT). Univariable and multivariable logistic regression was performed to assess for predictors of adjuvant chemoradiation use. The Kaplan-Meier method was used to assess overall survival (OS) and Cox regression analysis was used to assess impact of covariables on OS. RESULTS: There were 3609 patients who met the study criteria, of which 2988 (82.8%) received chemotherapy alone and 621 (17.2%) who received chemoradiation. Median follow up for living patients was 33.8 months (IQR 22-51). On multivariable logistic regression, those who received treatment in more recent years of diagnoses (OR 0.21-0.37, p < 0.001) were less likely to receive aCRT over aC. Two-year OS for those who received chemo alone was 44.9% and for chemoradiation was 42.6% (p = 0.169). This finding was sustained on multivariable survival analysis (HR 0.99, p = 0.867). CONCLUSIONS: Adjuvant chemotherapy alone for adenocarcinoma of the pancreas is the predominant treatment of choice among US hospitals. There was no overall survival benefit noted in those who were treated with adjuvant chemoradiation.

Use of Amifostine for Cytoprotection during Radiation Therapy: A Review.

BACKGROUND: Radiation therapy is a cornerstone of the therapeutic modalities used in modern oncology. However, it is sometimes limited in its ability to achieve optimal tumor control by radiation-induced normal tissue toxicity. In delivering radiation therapy, a balance must be achieved between maximizing the dose to the tumor and minimizing any injury to the normal tissues. Amifostine was the first Food and Drug Administration (FDA)-approved clinical radiation protector intended to reduce the impact of radiation on normal tissue, lessening its toxicity and potentially allowing for increased tumor dose/control. Despite being FDA-approved almost 20 years ago, Amifostine has yet to achieve widespread clinical use. SUMMARY: A thorough review of Amifostine's development, mechanism of action, and current clinical status were conducted. A brief history of Amifostine is given, from its development at Walter Reid Institute of Research to its approval for clinical use. The mechanism of action of Amifostine is explored. The results of a complete literature review of all prospective randomized trials to date involving the use of Amifostine in radiation therapy are presented. The results are arranged by treatment site and salient findings discussed. Side effects and complications to consider in using Amifostine are reviewed. Key Messages: Amifostine has been explored as a radiation protectant in most radiation treatment sites. Studies have demonstrated efficacy of Amifostine in all treatment sites reviewed, but results are heterogeneous. The heterogeneity of studies looking at Amifostine as a clinical radiation protectant has precluded a definitive answer on its efficacy. Complicating its clinical use is its toxicity and delivery requirements. Amifostine has largely fallen out of use with the advent of intensity modulated radiation therapy (IMRT). However, side effects with IMRT remain a challenge and concern. The use of Amifostine in the IMRT era has been poorly explored and is worthy of future study.

Outcomes of benign meningioma in older patients in the United States.

PURPOSE: Older patients have inferior outcomes for meningioma and experience more post-operative complications. The purpose of this study was to identify national treatment patterns and outcomes based on age for benign meningiomas using the National Cancer Database (NCDB). MATERIAL AND METHODS: The NCDB was queried for patients with biopsy-proven World Health Organization Grade (WHO) grade I meningioma diagnosed between 2004 and 2015. Patients were stratified based on age: 18-50, 51-60, 61-70, 71-80, and > 80 years of age. Clinicodemographic details were compared via the Chi Square test. Multivariable logistic regression was used to determine factors associated with receipt of treatment and post-operative complications. Multivariable Cox regression and the Kaplan-Meier method were used to examine survival. RESULTS: 56,960 patients met inclusion criteria with a median follow-up of 48 months. Ages 61-70 (OR 0.73, 95% CI 0.62-0.85, p < .001), ages 71-80 (OR 0.51, 95% CI 0.43-0.60, p < .001), and age > 80 (0.16, 95% CI 0.14-0.19, p < .001) were less likely to receive treatment. Older age groups were associated with increased risk of post-operative complications and post-operative complications predicted for decreased survival. Treatment with surgery (HR 0.57, 95% CI 0.52-0.62, p < .001) and surgery and radiation (HR 0.59, 95% CI 0.50-0.70, p < .001) provided a survival benefit. Older age was associated with a survival decrement. CONCLUSIONS: Older patients are less likely to undergo treatment for benign meningioma and are more likely to have post-operative complications. Survival decreased with increasing age. Treatment improved survival among all patients. Risk-benefit ratio of treatment should be carefully considered when treating older patients with benign meningioma.