Patient and Treatment Factors Associated With Improved Local Control and Survival in Oligometastatic Bone Disease: Results From a Large Single-Institution Experience Using Stereotactic Body Radiation Therapy.

PURPOSE: Limited data exist to guide optimal patient selection and treatment of bone metastases with curative intent despite the increasing application of stereotactic body radiation therapy (SBRT) for oligometastatic (OM) disease control and reirradiation (Re-RT). METHODS AND MATERIALS: Clinical characteristics for 434 patients consecutively treated with bone SBRT at a single institution from March 2011 to June 2020 were analyzed by OM, spine, and nonspine bone using Cox regression to determine association with local control (LC), progression-free survival (PFS), and overall survival (OS), and the Kaplan-Meier method to estimate PFS and OS. RESULTS: Most patients had prostate (39%) or breast/lung (21%) cancer and 1 to 3 lesions (96%), with 651 lesions (spine 63%) treated for Re-RT (12%) or OMD (88%), including synchronous (10%), metachronous (28%), repeat (27%), or induced (23%) states as defined by The European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer criteria. Biologically effective dose (BED10) ≥50 (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96; P < .03) predicted improved LC among OM lesions and planning target volume (PTV) ≥150 cc (hazard ratio, 1.94; 95% confidence interval, 1.02-3.70; P < .04) predicted worse LC for nonspine bone. Prostate histology, performance status (PS) 0 to 1, and metastasis-free interval ≥2 year predicted improved PFS and OS (P < .05). Metachronous, synchronous, or repeat OM had higher PFS and OS (P ≤ .001) than induced OM. With median follow-up 25.7 months, 1- and 2-year PFS was 63% and 47% for OM and 36% and 25% for Re-RT; 1- and 2-year OS was 87% and 73% for OM and 58% and 43% for Re-RT. Acute toxicities included grade 1 to 2 pain flare (9%) and fatigue (14%). Late toxicities included fracture (1%) for OM and myelopathy (2.5%) or nerve pain (1.2%) for Re-RT. CONCLUSIONS: BED10 ≥50 for OM and PTV <150 cc for nonspine bone lesions was associated with improved LC. Prostate histology, PS 0 to 1, metastasis-free interval ≥2 years, and metachronous, synchronous, or repeat presentations per The European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer criteria predicted improved PFS and OS among OM patients treated with bone SBRT.

Use of real-world evidence for oncology clinical decision making in emerging economies.

Real-world evidence (RWE) can provide insights into patient profiles, disease detection, treatment choice, dosing strategies, treatment sequencing, adverse event management and financial toxicity associated with oncology treatment. However, the full potential of RWE is untapped in emerging economies due to structural and behavioral factors. Structural barriers include lack of regulatory engagement, real-world data availability, quality and integrity. Behavioral barriers include entrenched healthcare professional behaviors that impede rapid RWE understanding and adoption. These barriers can be addressed with close collaboration of healthcare stakeholders; of whom, regulators need to be at the forefront given their ability to facilitate use of RWE in healthcare policy and legislation.

Lay abstract Traditionally, randomized clinical trials have been used to provide insights on new medical therapies and continue to remain the gold standard for approval. The-increasing availability of patient level data in the real-world, it is now possible to generate evidence regarding the usage and potential benefits or risks of a medical therapy derived from analysis of real-world data. This evidence is collectively referred to real-world evidence (RWE). randomized clinical trials and RWE are complementary and the area of Oncology especially benefits from RWE to guide clinical decision making across the patient journey. Key benefits include cancer screening and diagnosis, optimal treatment choices (including personalized medicine) and disease management such as dosing and treatment of side effects. In recent times, RWE generation in oncology has been prolific in the USA and western Europe. With expansive biopharmaceutical investments into infrastructure harnessing patient-level data and greater local regulatory guidance, oncology patients in emerging economies may now also have the opportunity to benefit from clinical decision making informed by RWE.

Adolescent Victims of Commercial Sexual Exploitation versus Sexually Abused Adolescents.

We have discovered in our clinical review that sexually abused girls have significantly better therapeutic outcomes than girls who have been victims of sex trafficking. Thus, we compared the mental health records of 25 adolescent female victims of commercial sexual exploitation with a group of 25 girls with a history of sexual abuse matched for age. Exclusion criteria included IQ <70, organicity, and psychosis. Victims of sexual exploitation were more likely to be in foster care; to have arrests, suspensions from school, and a history of running away; to abuse drugs; to be more impaired in social and school activities; to be withdrawn and depressed; to manifest social and thought problems and aggressive and rule-breaking behaviors; and to have a diagnosis of mood or conduct disorder or both. The results of this study suggest that the psychopathology of girl victims of sexual exploitation is markedly different from that of sexually abused girls.

The effect of exercise training on disease progression, fitness, quality of life, and mental health in people living with HIV on antiretroviral therapy: a systematic review.

BACKGROUND: Exercise has been associated with improvements in adverse physiological and psychological effects of long-term antiretroviral therapy (ART) in people living with HIV (PLWH). AIM: To summarizes the findings on the effects of aerobic or resistance training alone or combined aerobic and resistance exercise training (CARET) on disease progression, fitness, physical functioning, mental health, and quality of life (QOL) in PLWH receiving ART. A systematic search of articles was performed in several databases, and 20 articles that met inclusion criteria were summarized. RELEVANCE FOR PATIENTS: Aerobic exercise was associated with improvements in aerobic capacity, QOL, and depressive symptoms, while resistance training improved strength. CARET was related to improved aerobic fitness, strength, physical functioning, QOL, and self-efficacy. At least one of the exercise interventions resulted in improvements in CD4+ cell count and HIV RNA viral load. Moreover, another study showed that HIV-specific biomarkers remained unchanged in the exercise intervention group, while they significantly worsened in the non-exercise group. In general, in spite of their well-known benefits, exercise programs have not been extensively utilized or widely recognized as viable therapeutic treatment options for this patient population. Knowing the possible health benefits of increasing physical activity level is important to better recommend exercise programs. However, the prescription must be done carefully and on an individual basis. Additional studies investigating the efficiency and effectiveness of different exercise training regimens for PLWH are needed.