The results of our mentorship program highlight the continued interest and need for formal radiation oncology mentorship programs. The major strength of the program has been the high rates of interaction which is based on mutual respect, shared values and personal connection. Areas of future focus includes recruiting more new practitioners and private practice radiation oncologists to help enrich and diversify the mentorship program.

Brain metastasis velocity (BMV) is a metric that predicts overall survival (OS) in patients with new brain metastases (BrM) after initial radiosurgery (SRS). While BMV has been applied to patients with breast cancer BrM, it has not yet been evaluated within receptor subtypes. The purpose of this study was to evaluate if BMV was predictive of OS within subtypes of breast cancer and to assess if the BMV differed between the receptor subtypes. We retrospectively reviewed patients with breast cancer BrM treated at two institutions. All patients were treated with SRS and followed serially with MRI approximately every 2-3 months. Patients were divided into three distinct groups: estrogen/progesterone positive, human epidermal growth factor 2 negative (ER/PR (+)/HER2(-), HER2 enriched (HER2+), and triple negative (TN). BMV was calculated as the number of new BrM that developed over time (years) after initial SRS at first relapse. BMV was recorded as a continuous variable (BrM/year) for patients and also categorized within three previously identified risk groups: low (0-4 BrM/year), intermediate (4-13 BrM/year), and high (>13 BrM/year). Patients who did not develop a subsequent BrM or developed leptomeningeal disease as the first site of distant failure were not included in the BMV calculation. Time-to-event outcomes were estimated with the Kaplan-Meier method and OS was calculated from time of BrM diagnosis to death. Cox proportional hazards methods were used to estimate the hazard ratio (HR) of BMV as a continuous variable and BMV risk groups on OS. From 2000-2018, 226 patients were reviewed. The median age at diagnosis of BrM was 53.5 (43-61) and median number of initial BrM was 1 [1-3]. The median OS for the entire cohort was 14.3 months (95% confidence interval [95% CI] 10.9-17) with a median follow up of 12.6 months (95% CI 10-15.6) with reverse Kaplan-Meier method. BMV was calculated for the 100 patients who developed new BrM after initial SRS. Overall, BMV was associated with an increased hazard for mortality (HR 1.03 (95% CI 1.02-1.04). Within all subtypes, BMV was associated with an increased HR for mortality (Table). BMV did not vary significantly between subtypes (p = 0.97). Patients with a high risk BMV had significantly worse OS in all subtypes with an OS <12 months (Table). BMV does not vary significantly between subtypes of breast cancer BrM, however it is associated with an inferior OS across all subtypes. In particular, the high risk BMV subgroup accurately identifies a population that carries a poor prognosis across all subtypes.Abstract 3658; TableSubtypeMedian BMVBMV HRMedian OS within BMV Risk GroupLowIntermediateHighER/PR (+) HER2 (-) N = 385.13 (2.0-8.3)1.07 (1.03-1.11)28 (18-NR)21 (17-31)5.1* (2.8-NR)HER2 (+) N = 433.2 (1.4-20)1.03 (1.01-1.04)42 (31-59)26* (22-NR)11* (8.7-NR)TN N = 192.8 (1.7-6.5)1.02 (1.00-1.05)20 (14.3-NR)30 (6.2-NR)7.8* (5.3-NR)*Indicates statistically significant difference with reference to low risk BMV group within subtype. Open table in a new tab

Despite advancements in diagnostic imaging, patients are often found to have discordant clinical and pathologic stages at the time of surgery for invasive breast cancer (IBC). Limited data exist describing rates of surgical upstaging in patients undergoing breast conservation therapy, defined as higher tumor (T) stage or nodal (N) stage found at time of surgery compared to clinical staging. The purpose of this study is to describe rates and predictors of surgical upstaging at initial resection of invasive breast cancers in the National Cancer Database (NCDB). From 2004-2013 patients with non-metastatic IBC who underwent breast conservation surgery (BCS) were identified from the NCDB. Patients' demographic, clinical, and treatment characteristics were collected and compared. Tumor (T) upstaging was defined by higher pathologic compared to preoperative stage. Nodal (N) upstaging was defined by clinically negative nodal (N) stage, but pathologically positive N stage. Bivariate unadjusted chi-square tests and adjusted logistic regression models were used to identify the predictors of pathologic upstaging at the time of initial resection. A total of 707,798 patients were identified with non-metastatic invasive breast tumors who underwent BCS. Node upstaging data was available for 426,411 and tumor upstaging data for 490,142 patients. Pathologic T- and N-upstaging occurred in 5.8% and 13.1% of patients, respectively. On multivariable analysis, factors contributing to T-upstaging included: lobular or mixed histology, and higher grade (Table 1). Comparing tumor grade, T-stage upgrading occurred in 3.6%, 6.1%, and 7.6% and N- upstaging occurred in 9.4%, 14.4%, and 15.6% in grades 1, 2, and 3, respectively (p<.001, p<.001). On multivariable analysis, increasing grade remained significant to predict for N- upstaging (grade 3 vs 1, OR 2.06 (95% CI: 1.85-2.29). Estrogen (ER) and progesterone (PR) positive status was also significant for nodal, but not tumor, upstaging on multivariable analysis (ER pos, OR 1.14 (95% CI: 1.03-1.26); PR pos OR, 1.27 (95% CI: 1.17-1.38)). Using a modern American cohort, this NCDB analysis demonstrates patients with non-metastatic, IBC have a 5.8% risk of T-stage and 13% risk of N-stage surgical upstaging at time of initial resection. Lobular histology and higher grade tumor confer a higher risk of tumor upstaging, with grade 3 tumor doubling risk of T and N upstaging compared to grade 1. Receptor status has significant impact on nodal, but not tumor, upstaging. Patients should have appropriate pre-operative counseling regarding risk of tumor and nodal upstaging, particularly for higher grade IBC.Abstract 2091; Table 1Multivariate analysis of factors predicting for tumor upstagingFactorOdds RatioConfidence Interval (95%)Ductal histology1.0(reference)Lobular histology2.14(1.86-2.46)Mixed histology1.51(1.27-1.79)Grade 11.0(reference)Grade 21.74(1.51-2.00)Grade 32.31(1.99-2.67) Open table in a new tab

The adrenal gland is a common site of metastatic disease given its rich vascular supply, most notably with non-small cell lung cancer (NSCLC) histology. Progression-free and overall survival improvements with treatment of oligometastatic sites of disease have piqued interest in aggressive local therapies for these "intermediate" disease states. Stereotactic Body Radiation Therapy (SBRT) deposits tumoricidal radiation doses within the target volume, with minimal exposure to nearby organs at risk. Therefore, SBRT is dosimetrically an ideal radiation modality to provide local control (LC) for metastases in periadrenal and adrenal sites. However, limited data exist supporting fractionated SBRT for metastases in these locations. This study investigates LC rates with fractionated SBRT targeting periadrenal and adrenal metastases. From 2010-2018, 33 patients with periadrenal or adrenal metastases and limited oligometastatic (<5 sites) disease were consecutively treated with SBRT at a single institution. 3 patients were excluded for limited imaging or follow up data after treatment. Patients' demographic, clinical, and treatment data were abstracted from their charts. Local and distant failures on imaging studies were recorded to evaluate disease control. Toxicity was scored using CTCAE v 4.0. Overall survival (OS), progression free survival (PFS), and local failure free survival (LFFS) were estimated by Kaplan-Meier methods. Impact of clinical and treatment variables were calculated using Kaplan-Meier statistics and compared with log rank tests. Thirty patients (8 female, 22 male) with various primary histologies (12 hepatocellular carcinoma; 4 NSCLC; 3 melanoma; 9 other) received fractionated SBRT for definitive treatment of their metastases. Prescription doses were 30-54 Gy in 3-5 fractions, with mean and median BED10 of 75.8Gy and 60 Gy, respectively (range 48-151.2 Gy). Treatment related toxicities were minimal, with grade 1 or 2 nausea in 12 patients, no grade 3 GI toxicity, and no renal toxicity. Local control (LC) was achieved at the treated site in 25 patients (83.3%), with a median LFFS not reached (mean of 41 months). Median PFS was 12.3 months and median OS was 19.7 months. Histology and maximum tumor size did not significantly impact oncologic outcomes. Treatment with immunotherapy showed a non-significant trend towards improving OS (p=0.138), with no impact on LC or PFS. BED10 above 80 Gy showed a non-significant trend towards improved LC (p=0.177), without improvement in OS or PFS. Fractionated SBRT provides excellent tumor control with minimal toxicity in peri-adrenal and adrenal gland metastases. Dose schedules with BED10 above 80 Gy should be considered for definitive therapy to provide optimal local control. With modern systemic treatments improving survival outcomes in patients with oligometastatic disease, this treatment approach warrants further investigation in appropriately selected patients.

Previous studies suggest the rate of margin positive resection with breast conservation therapy is approximately 20%. The risk of positive margin at time of resection is often a source of fear for patients, driving many to elect to undergo mastectomy. At initial consultation, patients should have appropriate counseling regarding risks of positive margin resection, to aide in treatment decision making. This study describes rates and predictors of positive margin at initial resection of invasive breast cancers in the National Cancer Database (NCDB). From (2004-2013) patients with non-metastatic invasive breast cancers who underwent breast conservation surgery were identified from the NCDB. Patients' demographic, clinical, and facility of treatment characteristics were collected and compared. Per NCDB criteria, margin negative is defined as no gross or microscopic disease (i.e. no tumor on ink). Bivariate tests and multivariate logistic regression was conducted to identify independent predictors of patients with initial positive margin at the time of resection. A total of 707,798 patients were identified with non-metastatic invasive breast tumors who underwent breast conservation surgery. Rate of margin positive resection across the entire cohort was 5.02%. Over time, the rate of positive margin decreased significantly from 6.54% in 2004 to 3.91% in 2013 (p<.001). Pure lobular histology predicted for the highest rate of positive margin compared with IDC (8.63 vs 4.55%; p<.001). In adjusted analysis, histology and HER2 status were significantly associated with margin-positive resection with breast conservation while grade, estrogen and progesterone status were not (Table 1). Compared with historic data, this study demonstrates only 5% risk of positive margin at initial resection using a large, modern national database. However, patients with invasive lobular histology have a nearly two-fold risk of margin positive resection with breast conservation therapy compared to invasive ductal cancers. HER2 status impacts margin results, while grade, estrogen, and progesterone status did not significantly predict for initial positive margin. These results are important data points to help appropriately counsel patients regarding the risk of positive margins, and possible need for re-excision in patients desiring breast conservation therapy.Abstract 2078; Table 1FactorOdds RatioConfidence Interval (95%)Ductal histology1.0(reference)Lobular histology1.94(1.63-2.31)Mixed histology1.64(1.34-2.01)Grade 11.0(reference)Grade 21.12(0.96-1.32)Grade 31.16(0.98-1.38)Estrogen receptor positive1.07(0.93-1.24)Progesterone receptor negative0.93(0.83-1.06)HER 2 Receptor positive1.12(1.01-1.24) Open table in a new tab

In 2007, a randomized clinical study demonstrated improved PFS and OS for patients with extensive stage small cell lung cancer (ES-SCLC) who receive prophylactic cranial irradiation (PCI). Since that time, national guidelines have recommended PCI as standard treatment for ES-SCLC patients without brain metastasis. However, more recent studies incorporating MRI brain for staging showed contradictory results, where PCI resulted in no improvement in progression free survival (PFS) or overall survival (OS). The purpose of this study is to describe survival outcomes after PCI using the National Cancer Database (NCDB), and factors influencing patient treatment with this modality. From 2010-2014, a total of 32315 ES-SCLC patients without brain metastasis at diagnosis who received systemic treatment were identified from the NCDB. Patients’ demographic, clinical, and survival data were collected and compared. A multivariate logistic regression was conducted to identify the predictors of patients receiving PCI, which was defined as radiotherapy directed to the whole brain ≤180 days from diagnosis. Patients who develop brain metastases after initial diagnosis and subsequently receive brain directed radiotherapy are not included in this NCDB analysis. To compare OS between PCI vs no PCI, a propensity score matching was performed. The survival outcomes of case and controls were estimated by the Kaplan-Meier methods. Among the 32315 patients without brain metastasis at diagnosis with ES-SCLC, 3572 (11.1%) received PCI within 180 days of diagnosis. Rates of PCI were relatively stable from 2010-2014. Variables influencing patients’ likelihood of treatment included increasing age (OR 0.99, p=0.01), facility type (academic vs. community cancer program: OR 1.37, p<0.0001), and insurance status (private vs Medicaid insurance: OR 1.23, p=0.02). Of those receiving PCI, 65.3% of patients received 25-30 Gy brain-directed radiation treatment, and 77.7% were treated at comprehensive or academic cancer centers. Median survival was not significantly different between the groups receiving brain-directed therapy compared to those without radiation therapy (9.7 vs. 8.7 months, p=0.45). Using a modern American cohort, our NCDB analysis demonstrates no improvement in overall survival with utilization of PCI for ES-SCLC, which supports a recently published large randomized trial. In addition, this study demonstrates a significantly higher rate of PCI utilization in younger and privately insured patients that are treated at comprehensive cancer and academic centers, with approximately 11% of ES-SCLC patients receiving PCI. In the era of widespread availability of brain MRI for staging of SCLC, this analysis supports consideration of omission of PCI in patients with ES-SCLC.

Purpose: Patients with lower mediastinal lymphoma (LML) benefit dosimetrically from proton therapy (PT) compared with intensity modulated radiation therapy (IMRT). The added dosimetric benefit of deep-inspiration breath-hold (DIBH) is unknown; therefore, we evaluated IMRT versus PT and free-breathing (FB) versus DIBH among patients with LML. Methods and Materials: Twenty-one patients with LML underwent 4-dimensional computed tomography and 3 sequential DIBH scans at simulation. Involved-site radiation therapy target volumes and organ-at-risk contours were developed for both DIBH and FB scans. FB-IMRT, DIBH-IMRT, FB-PT, and DIBH-PT plans were generated for each patient for comparison. Results: The median difference in lung volume between the DIBH and FB scans was 1275 mL; the average difference in clinical target volume was 5.7 mL. DIBH-IMRT produced a lower mean lung dose (10.8 vs 11.9 Gy; P < .001) than FB-IMRT, with no difference in mean heart dose (MHD; 16.1 vs 15.0 Gy; P = .992). Both PT plans produced a significantly lower mean dose to the lung, heart, left ventricle, esophagus, and nontarget body than DIBH-IMRT. DIBH-PT reduced the median MHD by 4.2 Gy (P < .0001); left ventricle dose by 5.1 Gy (P < .0001); and lung V5 by 26% (P < .0001) versus DIBH-IMRT. The 2 PT plans were comparable, with DIBH-PT reducing mean lung dose (7.0 vs 7.7 Gy; P = .063) and with no difference in MHD (10.3 vs 9.5 Gy; P = .992). Conclusions: Among patients with LML, DIBH (IMRT or PT) improved lung dosimetry over FB but had little influence on MHD. PT (DIBH and FB) significantly reduced lung, heart, esophagus, and nontarget body dose compared with DIBH IMRT, potentially reducing the risk of late complications. (C) 2019 The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.

The polarizations of the Υ(1S), Υ(2S), and Υ(3S) mesons are measured in proton-proton collisions at √s=7 TeV, using a data sample of Υ(nS)→μ+μ− decays collected by the CMS experiment, corresponding to an integrated luminosity of 4.9 fb−1. The dimuon decay angular distributions are analyzed in three different polarization frames. The polarization parameters λϑ, λφ, and λϑφ, as well as the frame-invariant quantity ˜λ, are presented as a function of the Υ(nS) transverse momentum between 10 and 50 GeV, in the rapidity ranges |y|<0.6 and 0.6<|y|<1.2. No evidence of large transverse or longitudinal polarizations is seen in the explored kinematic region.Received 13 September 2012DOI:https://doi.org/10.1103/PhysRevLett.110.081802This article is available under the terms of the Creative Commons Attribution 3.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.© 2013 CERN, for the CMS Collaboration

Rapidity distributions are presented for events containing either a $Z$ boson or a photon with a single jet in proton-proton collisions produced at the CERN LHC. The data, collected with the CMS detector at $\sqrt{s}=7\text{ }\text{ }\mathrm{TeV}$, correspond to an integrated luminosity of $5.0\text{ }\text{ }{\mathrm{fb}}^{\ensuremath{-}1}$. The individual rapidity distributions of the boson and the jet are consistent within 5% with expectations from perturbative QCD. However, QCD predictions for the sum and the difference in rapidities of the two final-state objects show discrepancies with CMS data. In particular, next-to-leading-order QCD calculations, and two common Monte Carlo event generators using different methods to match matrix-element partons with parton showers, appear inconsistent with the data as well as with each other.

Citation Chatrchyan, S., V. Khachatryan, A. M. Sirunyan, A. Tumasyan, W. Adam, T. Bergauer, M. Dragicevic, et al. “Measurement of neutral strange particle production in the underlying event in proton-proton collisions at s = 7TeV .” Physical Review D 88, no. 5 (September 2013). © 2013 CERN, for the CMS Collaboration As Published http://dx.doi.org/10.1103/PhysRevD.88.052001 Publisher American Physical Society

A search for supersymmetry or other new physics resulting in similar final states is presented using a data sample of 4.73 fb−1 of pp collisions collected at \( \sqrt{s}=7 \) TeV with the CMS detector at the LHC. Fully hadronic final states are selected based on the variable M T2, an extension of the transverse mass in events with two invisible particles. Two complementary studies are performed. The first targets the region of parameter space with medium to high squark and gluino masses, in which the signal can be separated from the standard model backgrounds by a tight requirement on M T2. The second is optimized to be sensitive to events with a light gluino and heavy squarks. In this case, the M T2 requirement is relaxed, but a higher jet multiplicity and at least one b-tagged jet are required. No significant excess of events over the standard model expectations is observed. Exclusion limits are derived for the parameter space of the constrained minimal supersymmetric extension of the standard model, as well as on a variety of simplified model spectra.