An Antidote to Decreasing Interest in Radiation Oncology: Earlier Engagement.

PURPOSE: In recent years, there has been a national decline in applicants to radiation oncology (RO) residencies, partly due to limited exposure to RO during medical school. Student Interest Groups (SIGs) give students early exposure to a variety of specialties. This study investigates the efficacy of a RO-SIG to increase knowledge and interest in the field. METHODOLOGY: First and second-year medical students attending an RO-SIG event or shadowing experience completed surveys both prior and following participation. Students ranked their interest in oncology, in RO, and their perceived accessibility of mentors in oncology. Questions were rated on a Likert scale from 0 to 5 (5 highest, 0 lowest). The survey included one short response question about the understanding of the role of the RO, which was evaluated qualitatively. RESULTS: 44 students (42 M1s, 2 M2s) completed the pre-survey and 18 (41%, 17 M1s, 1 M2) completed the post-survey. Of the 18 matched responses, interest in oncology increased from 3.67 pre-SIG to 3.89 (p = 0.19) and in RO specifically from 3.17 to 3.89 (p < 0.01). The mean perceived accessibility of faculty mentors in oncology increased from 3.18 to 3.72 (p < 0.01). After interacting with the RO-SIG, the short response answers were more detailed in the understanding of the role of RO. CONCLUSIONS: RO-SIGs can increase interest in RO through early exposure to the field. In a time where RO has seen a decline in student interest, RO-SIGs are an option to increase engagement, develop interest, and form relationships with mentors in pre-clinical years.

Enfortumab vedotin-induced cutaneous eruption: Ring mitotic figures as a distinctive histopathologic feature.

Enfortumab vedotin (EV), a nectin-4-binding agent that affects microtubules, has become standard therapy for advanced urothelial carcinoma. The agent, now given in combination with pembrolizumab, frequently induces cutaneous reactions. Here, we report a severe EV-induced cutaneous eruption. A 58-year-old woman with metastatic urothelial carcinoma developed a rash after receiving simultaneous first doses of EV and pembrolizumab. The eruption began on the flank and spread to involve her trunk and extremities with prominent involvement of folds, including the axillae and medial thighs. Skin biopsy revealed extensive vacuolar alteration of the basal epidermis and numerous epidermal keratinocytic mitotic figures, often suprabasilar, including ring and "starburst" forms. The findings supported a diagnosis of EV-induced eruption. With EV cessation and systemic corticosteroids, the rash resolved over a few weeks. Pembrolizumab was restarted as monotherapy, and the patient's cancer showed a significant radiographic treatment response at 3 months. An emerging literature of small series and case reports, largely from oncologic literature, presents the histopathology of EV-induced cutaneous eruption as a vacuolar interface dermatitis with the inconsistently reported feature of arrested mitotic figures. This case study demonstrates distinctive clinical and histopathologic features of EV-induced eruption, which may inform dermatologic and oncologic management.

To whom and by whom: Discussions of sexual health, fertility, and premature menopause with women with locally advanced cervical cancer.

PURPOSE: To investigate whether gynecologic and radiation oncologists document discussions of chemoradiation treatment's gonadotoxicity for patients with cervical cancer and what patient and physician factors make discussions more likely. METHODS AND MATERIALS: Women with LACC treated with definitive CRT between 2009 and 2022 were included. Visit notes with gynecologic and radiation oncologists were reviewed for sexual health discussions. Fertility and premature menopause discussions were only evaluated among premenopausal patients. Variables of interest including demographics and staging were collected. Univariate and multivariate analyses were conducted using Rv4.2.1. RESULTS: A total of 93 women were included (22-91 years old). Most were Stage IIB (32%) or IIIB (34%). Sexual health discussions occurred among 74.2% of patients and did not have a significant relationship with any patient factors. Fertility discussions occurred with 17.5% of the 57 premenopausal patients and were more likely among younger patients (≤31.9, p < 0.001) with fewer children (≤1, p < 0.001). Premature menopause discussions occurred among 73.7% of premenopausal patients and were more likely among younger patients (≤39.0, p = 0.015). CONCLUSIONS: It is promising to see that oncologists are discussing sexual health and premature menopause with most patients. The limited fertility discussions suggest that oncologists are less likely to discuss fertility as women approach the age of menopause or already have children. Involvement of reproductive endocrinologists and psychologists may provide patients with a more comprehensive understanding of long-term quality of life.