Breast conservation therapy (BCT) (usually a lumpectomy plus radiotherapy (RT)) has become a standard alternative to radical mastectomy in early-stage breast cancers with equal, if not higher, survival rates. The established standard of the RT component of the BCT had been about six weeks of Monday through Friday external beam RT to the whole breast (WBRT). Recent clinical trials have shown that partial breast radiation therapy (PBRT) to the region surrounding the lumpectomy cavity with shorter courses can result in equal local control, survival, and slightly improved cosmetic outcomes. Intraoperative RT (IORT) wherein RT is administered at the time of operation for BCT to the lumpectomy cavity as a single-fraction RT is also considered PBRT. The advantage of IORT is that weeks of RT are avoided. However, the role of IORT as part of BCT has been controversial. The extreme views go from "I will not recommend to anyone" to "I can recommend to all early-stage favorable patients." These divergent views are due to difficulty in interpreting the clinical trial results. There are two modalities of delivering IORT, namely, the use of low-energy 50 kV beams or electron beams. There are several retrospective, prospective, and two randomized clinical trials comparing IORT versus WBRT. Yet, the opinions are divided. In this paper, we try to bring clarity and consensus from a highly broad-based multidisciplinary team approach. The multidisciplinary team included breast surgeons, radiation oncologists, medical physicists, biostatisticians, public health experts, nurse practitioners, and medical oncologists. We show that there is a need to more carefully interpret and differentiate the data based on electron versus low-dose X-ray modalities; the randomized study results have to be extremely carefully dissected from biostatistical points of view; the importance of the involvement of patients and families in the decision making in a very transparent and informed manner needs to be emphasized; and the compromise some women may be willing to accept between 2-4% potential increase in local recurrence (as interpreted by some of the investigators in IORT randomized studies) versus mastectomy. We conclude that, ultimately, the choice should be that of women with detailed facts of the pros and cons of all options being presented to them from the angle of patient/family-focused care. Although the guidelines of various professional societies can be helpful, they are only guidelines. The participation of women in IORT clinical trials is still needed, and as genome-based and omics-based fine-tuning of prognostic fingerprints evolve, the current guidelines need to be revisited. Finally, the use of IORT can help rural, socioeconomically, and infrastructure-deprived populations and geographic regions as the convenience of single-fraction RT and the possibility of breast preservation are likely to encourage more women to choose BCT than mastectomy. This option can also likely lead to more women choosing to get screened for breast cancer, thus enabling the diagnosis of breast cancer at an earlier stage and improving the survival outcomes.

Objective To decrease radiotherapy treatment time (RTT), measured from the day of initiation of radiotherapy to the day of its completion, specific strategies were initiated in early 2020 in the only academic safety-net medical center in a rural, resource-lean state. The factors that can succeed and those that need further improvements were analyzed in this initial assessment phase of our efforts to shorten the RTT. Methods This is an analysis of 28 cervix cancer patients treated with magnetic resonance imaging (MRI)-guided brachytherapy (February 2020-November 2021). The relationship between independent and dependent variable were analyzed by simple linear regression, and p-values ≤ 0.05 were considered statistically significant. SPSS software version 28.0 (IBM, Armonk, NY, USA) was used for statistical analysis. Results Two RTT groups (≤ 60 (32.1%) vs. > 60 days {67.9%}) with median RTT of 68 days (range, 51 to 106 days) were analyzed. Caucasians represented 66.7% of the RTT ≤ 60 days group. Four 'issues' were identified that increased the RTT: non-compliance, learning curve (early days of implementation of MRI-guided brachytherapy in the department), stage IV comorbidities, and with more than one issue mentioned; 77.8% with no issues had ≤ 60 days RTT vs. 26.3% for the > 60 days group. The breakdown of the no-issues factor by calendar year showed the RTT of ≤ 60 days was achieved higher in 2021 (85.7% vs. 20.0%; p=0.023) compared to 2020. For this entire cohort, the RTT of ≤ 60 days was achieved higher in 2021 (50.0% vs. 8.3%; p=0.019) compared to 2020. Data also showed improvement in RTT of ≤ 60 days for every sequential six months. 'Non-compliance' and 'learning curve' were the most important factors among patients having the longest RTTs. Conclusion The RTT can be further decreased. As a result of this preliminary analysis of the our strategic planning approach of 'circular' "See it," "Own it," "Solve it," and "Do it" and go back to the first step again, we plan to implement the following strategies in the immediate future to shorten the RTTs further and, in turn, improve our overall outcomes (local/regional control, disease-free survival, and overall survival): (a) Interdigitate MRI-guided brachytherapy during external beam radiotherapy (EBRT); patients who can not get the interdigitated brachytherapy procedures performed during the course of EBRT for any reason will receive two brachytherapy procedures per week; (c) attempt to add a cervix cancer care navigator to our staff to help patients having social issues, thus leading to compliance problems; (d) finally, in a year or two after these new strategic implementations, the RTT data will be reanalyzed.

Purpose:Total package time, or the time from diagnosis to completion of definitive treatment, has been associated with outcomes for a variety of tumor sites, but especially to head and neck (HN) cancer. Patients with HN cancer often undergo a complex diagnosis and treatment process involving multiple disciplines both within and outside of oncology. This complexity can lead to longer package times, and each involved discipline has the responsibility to maintain an efficient and effective process. Strategic intervention to improve package time must involve not only new technology or tools, but also "soft" components such as accountability, motivation, and leadership. This combination is necessary to truly optimize radiation therapy for HN cancer, leading to shorter total package times for these patients.Methods and Materials:Two interventions were strategically executed to improve radiation therapy workflow: upgrade of the treatment planning system and implementation of an automated patient management and accountability system. The radiation therapy-related timelines of 112 patients with HN cancer treated over 2 years were reviewed, and the average time differences were compared between the patient populations before and after the strategic interventions.Results:Purely upgrading the treatment planning system did not show significant improvements, but when combined with the patient management system, significant improvement in radiation-related package time can be noted for every time point. The overall reduction of radiation-related package time was statistically significant at 22.85 days (P = .002).Conclusions:On face value, the patient management system could be credited as responsible for the improvement, but on qualitative analysis, it is noted that the new system is only a tool that can be ignored or underused. Owing to the addition of important "soft" components such as accountability, motivation, and leadership, the patient management system was optimized and implemented in such a manner as to have the desired effect.

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.

Introduction Stereotactic body radiation therapy (SBRT) is an effective treatment for early-stage non-small cell lung cancer (NSCLC) patients who are either medically inoperable or who decline surgery. SBRT improves tumor control and overall survival (OS) in medically inoperable, early-stage, NSCLC patients. In this study, we investigated the effectiveness of two different SBRT doses commonly used and present our institutional experience. Purpose To determine the clinical outcomes between two treatment regiments (50 Gray [Gy] vs. 55 Gy in five fractions) among Stage I NSCLC patients treated with SBRT at a state academic medical center. Methods We performed a retrospective analysis of 114 patients with Stage I (T1-2 N0 M0) NSCLC treated at a state academic medical center between October 2009 and April 2019. Survival analyses with treatment regimens of 50 Gy and 55 Gy in five fractions were conducted to detect any improvement in outcomes associated with the higher dose. The primary endpoints of this study included OS, local control (LC), and disease-free survival (DFS). Log-rank test and the Kaplan-Meier method were used to analyze the survival curves of the two treatment doses. The SPSS v.24.0 (IBM Corp., Armonk, NY, USA) was used for statistical analyses. Results The 114 early-stage NSCLC patients (median age, 68 years; range 12 to 87 years) had a median follow-up of 25 months (range two to 86 months). The number of males (n = 72; 63.2 %) exceeded the number of females (n = 42; 36.8 %). The majority of patients in this study were Caucasians (n = 68; 59.6 %) and 46 patients were African Americans (40.4 %). Two-thirds of the patients (n = 76; 66.7 %) were treated with 50 Gy in five fractions, and 38 patients (33.3 %) with 55 Gy in five fractions. The one-, two-, and three-year OS and DFS rates were improved in the patients treated with 55 Gy [OS, 81.7 % vs. 72.8 %; 81.7 % vs. 58.9 %; 81.7 % vs. 46.7 % (p = 0.049)], [DFS, 69.7 % vs. 69.7 %; 61.9 % vs. 55.7 %; 61.9 % vs. 52.0 % (p = 0.842)], compared to those treated with 50 Gy. Adenocarcinoma was the most common histology in both groups (51.3 % and 68.4 %). Failure rates were elevated for the 50 Gy regimen [39 (34.2 %) vs. 12 (8.5 %)]. Three year control rates were (66.3 % vs. 96.6 %; p = 0.002) local control; (63.3 % vs. 94.4 %; p = 0.000) regional control; and (65.7 % vs. 97.1 %; p = 0.000) distant control, compared to those treated with 55 Gy. Conclusion Early-stage NSCLC patients treated with SBRT 55 Gy in five fractions did better in terms of local control, overall survival, and disease-free survival rates compared to the 50 Gy in five fractions group.

Background: There are very few studies demonstrating Will Roger's phenomenon [WRP] in breast cancer [BC] especially among African Americans [AA]. We hypothesize that WRP’s existence in BC, including among AA’s. In this retrospective patient cohort with a sizeable AA population, the presence of WRP is investigated.Methods: This is a retrospective analysis of 300 BC women (2007- 2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS], estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses, used to identify racial factors associated with outcomes.Findings: Our patient cohort included 30.3%Caucasians [C] and 69.7%AA. Stages I, II, III, and IV were 46.2%, 26.3%, 23.1%, and 4.4% of C; 28.7%, 43.1%, 24.4%, and 3.8% of AA respectively, in anatomic staging (p=0.043). In prognostic staging, 52.8%, 18.7%, 23%, and 5.5% were C while 35%, 17.2%, 43.5%, and 4.3% were AA, respectively (p=0.011).A total of C (45.05% vs. 47.85%) AA, upstaged. C (16.49% vs. 14.35%) AA, down-staged. Remaining, 38.46% and 37.79% patients had their stages unchanged.With a median follow-up of 54 months, the AA patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p=0.000). Among the C, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p=0.000). The 8th showed complex results (p=0.176) compared to DFS estimated using the 7th’s (p=0.004).Interpretation: The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BCS (both C and AA patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.Funding: This research did not receive specific grant from any funding agencies.Declaration of Interests: There is no conflict of interest present for authors relative to this casereport.Ethics Approval Statement: Institutional review board approval (IRB #2018-0218) obtained and a browser-based database tool, research electronic data capture (RedCap) was used to gather and store the patient's information in password-protected computers. The written consent was waived due to the retrospective nature of the study and patient identifiers were removed before extracting the data.

Abstract Background Triple negative breast cancer (TNBC) (estrogen receptor (ER) – negative, progesterone receptor (PR) - negative, and human epidermal growth factor receptor 2 (HER2) -negative) is an aggressive subtype of breast cancer that is more common in younger women, carries a poorer prognosis and has a greater metastatic potential than receptor positive subtypes. Radiation therapy’s ability to improve outcomes, especially the overall survival is controversial, more so among African American patients. The objective of this study is to evaluate local control and survival rates of TNBC patients treated with radiotherapy (RT) in our institution with a sizeable cohort of African American women. Methods This is a retrospective analysis of 67 TNBCs (2007–2017) at an academic state institution who underwent a lumpectomy and /or mastectomy (surgery) followed by adjuvant irradiation to a median total dose of 50 Gy (range 40.5–50.40 Gy). Chemotherapy was administered in a neoadjuvant (32) or adjuvant setting (35). For all 67 TNBCs, local control (LC), overall survival (OS), and disease-free survival (DFS) were estimated using the Kaplan-Meier method. The significance of survival variables was analyzed using the Cox univariate and multivariate proportional hazards model. A p-value of less than 0.05 was considered statistically significant. The SPSS 24.0 software was used for data analysis. Results The baseline characteristics of all 67 TNBCs were measured with median follow up of 58 months (range 10–142 months). Patients were stratified into two groups (neoadjuvant chemotherapy-RT (32) vs. adjuvant chemotherapy-RT (35)). The five-year rates for LC, DFS and OS were 14.8 % vs. 47.9 % (p = 0.002), 24.2% vs. 53.1 % (p = 0.015), and 65.1% vs. 92.2% (0.002) respectively. On Cox multivariate analysis, patients who received adjuvant chemotherapy were associated with statistically improved significant LC (p = 0.002) and OS (p = 0.002). The variables included were: BMI (p = 0.050), distance travelled (p = 0.027), 8th AJCC TNM staging (p = 0.018) and tumor grade (p = 0.022). Conclusion In this hypothesis-generating report, among TNBC patients undergoing RT, adjuvant chemotherapy appears to be better than neoadjuvant chemotherapy in determining the clinical outcomes.

Introduction As traditional measures such as overall survival (OS) or disease-free survival (DFS) alone do not give a holistic view of the outcomes of a treatment paradigm, we determine to add the evidence of quality-adjusted life year (QALY) and disability-adjusted life year (DALY) to the outcomes of the nasopharyngeal carcinoma patients (NCP) treated with definitive chemoradiation therapy (chemoRT) with or without induction chemotherapy (induction chemo). Methods This is a retrospective analysis of 85 NCPs treated at an academic state institution. The OS estimated by the Kaplan-Meier method and the multivariate Cox regression model determined the co-variables associated with the OS. The relationship between QALYs gained and DALYs saved were calculated from age of the disease onset, duration of the disease, quality of life (QoL) and disability weights. Results Of the 85 eligible NCPs of this cohort, the disease frequency distribution per the World Health Organization (WHO) classification was 41.2% for Type-I, 42.4% for Type-II, and 16.5% for Type-I II. The median follow-up (24 months). The five-year OS of patients treated with concurrent chemoRT vs. induction chemo followed by concurrent chemoRT was 54.7 vs. 14.8% for WHO Type I, 60.1 vs. 58.3% for WHO Type II, and 83.3 vs. 50.0% for WHO Type III (p=0.029). The average DALYs saved with concurrent chemoRT were 12.2 years vs. 5 years for induction chemo followed by concurrent chemoRT. The average QALYs gained with concurrent chemoRT were 6.9 years vs. 3.1 years for induction chemo followed by concurrent chemoRT. Conclusion Patients treated with concurrent chemoRT had an increased QoL when compared to induction chemo followed by concurrent chemoRT. The average DALYs saved were higher in the patients treated with concurrent chemoRT than treated with induction chemo followed by concurrent chemoRT.

For Patients with T4 laryngeal cancer, surgery is usually followed by adjuvant radiotherapy (RT) to improve local or regional control and distant metastasis rates. We decided to test the hypothesis that adjuvant RT improves the disease free survival (DFS), overall survival (OS), and local or regional control more in patients with shorter intervals between surgery and RT compared to that of patients treated with longer intervals. To assess whether the time interval between surgery followed by adjuvant RT determines the clinical outcomes in T4 laryngeal cancer patients (T4LCPs). This is a retrospective analysis of 112 T4LCPs who underwent laryngectomy (surgery) followed by adjuvant RT with different time intervals (4 to 10 weeks) at an academic state institution. Correlation of survival with several treatment duration interval parameters were evaluated. The OS and DFS were estimated by using Kaplan–Meier method. The significance of survival variables were analyzed using the Cox univariate and multivariate proportional hazards model. A p value of less than 0.05 was considered statistically significant. The SPSS 24.0 software was used for data analysis. The baseline characteristics of all 112 T4LCPs were measured with median follow up of 31 months. Our results indicated a higher survival rates in T4LCPs who were treated by RT shortly after surgery compared with T4LCPs treated by RT with prolonged duration (p=0.013) and negatively correlated with the time interval indicating that the early start of RT after surgery increased the survival outcomes. There was a trend for improved loco regional control (p=0.038) and fewer distant metastasis (p= 0.038) in T4LCPs treated within short duration compared with long intervals indicating a statistically significant DFS (p=0.030). Age is the only factor that affected the clinical outcome in the multivariate Cox regression analysis (p=0.015) with a statistically significant OS (p=0.041). The NCCN guidelines recommend laryngectomy with or without RT as the primary treatment modality for all advanced laryngeal cancers. Our report indicates that OS and DFS among patients undergoing surgery followed by adjuvant RT with a shorter intervals between surgery and RT to be superior to that of the patients treated with longer intervals.

Abstract Purpose: The objective of this study is to evaluate local control and survival rates of node negative triple negative breast cancer patients (TNBCs) treated with radiotherapy (RT) in our institution. Methods: This is a retrospective analysis of 67 TNBCs (2007 - 2017) at an academic state institution who underwent lumpectomy and /or mastectomy (surgery) followed by adjuvant irradiation to median total dose of 50 Gy (range 40.5-50.40 Gy). Chemotherapy was administered in a neoadjuvant (31) or adjuvant setting (36). For all 67 TNBCs, local control (LC), overall survival (OS) and disease free survival (DFS) were estimated using the Kaplan-Meier method. The significance of survival variables were analyzed using the Cox univariate and multivariate proportional hazards model. A p-value of less than 0.05 was considered statistically significant. The SPSS 24.0 software was used for data analysis. Results: The baseline characteristics of all 67 TNBCs were measured with median follow up of 58 months (range 10-142 months). Patients were stratified into two groups (neoadjuvant chemotherapy-RT (31) vs. adjuvant chemotherapy-RT (36)). The median rates for LC, DFS and OS were 27 % vs. 68 % (p= 0.001), 27.2% vs. 63.2 % (p= 0.034), and 63.4% vs. 92.5% (0.001) respectively. On Cox multivariate analysis, patients who received adjuvant chemotherapy were associated with statistically improved significant LC (p= 0.002) and OS (p=0.005). The variables included were: ethnicity (p=0.251), age (p=0.984), BMI (p=0.032), lump boost (p=0.300), TNM (p=0.162) and tumor grade (p=0.336). Conclusion: Among TNBC patients undergoing RT, adjuvant chemotherapy appears to be better than neoadjuvant chemotherapy in determining the clinical outcomes. Citation Format: Mary R. Nittala, Eswar K. Mundra, Satya Packianathan, Divyang Mehta, Maria L. Smith, William C. Woods, Shawn McKinney, Barbara S. Craft, Srinivasan Vijayakumar. Triple negative breast cancer patients treated with radiation therapy: Improvement in survival and local control with adjuvant chemotherapy compared to neoadjuvant chemotherapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6177.

Racial differences in clinical outcomes among laryngeal cancer patients have been reported and Black American patients appear to have worse survival compared to White Americans. However, there are not many studies looking at the potential racial differences in outcomes in T1 Glottic cancers. One of the hypotheses underlying racial differences in clinical outcomes is lack of adequate access to healthcare for the Blacks. Thus, the Blacks may present with more advanced stages at the time of diagnosis, thus leading to poorer outcomes. We hypothesized that since T1 glottic cancer is one of the earliest stages, with the least tumor burden, outcomes should be similar between the two races. At our institution, a safety-net academic medical center, there are no differences in the treatment being given Blacks or Whites, stage-for-stage. To our surprise, we found poorer clinical outcomes for the blacks. What we report here is a hypothesis generating analysis. To evaluate the impact of race (Black vs. White) on the outcome of T1 glottic squamous cell carcinoma (SCCa) in patients treated with radiation therapy (RT) alone. Between 2002 and 2018, twenty-five (37.3%) Black patients and forty-two (62.7%) White patients with T1 glottic SCCa underwent RT in our academic state institution. Chi- square test, Kaplan- Meier method, and Cox regression models were used to assess for racial influence; p-values less than 0.05 were considered statistically significant. The SPSS 24.0 software was used for data analyses. The baseline characteristics of all 67 T1 glottic SCCa patients documented. The median follow-up duration was 51 months (range, 0-266 months). Black patients (n=14; 20.9%) and White patients (n=28; 41.8%) were treated with a conventional schedule (CONV) 2 Gy/ day; total dose 66 Gy/ 7 weeks. Eleven Black patients (16.4%) and White patients (n=14; 20.9%) were treated in a hypo-fractionated (HYPO) schedule 2.25 Gy/ day; total dose 63 Gy/5 weeks. The 5-year overall survival (OS) for Blacks vs. Whites treated with CONV was 51.6 vs. 66.0% (p= 0.001). For those treated with HYPO, the OS was 85.7 vs. 99.6% (p= 0.001). The 5- year local relapse free survival (LRPS) for Blacks vs. Whites treated with CONV was 34.1 vs. 40.9% (p= 0.163) and for those treated with HYPO was 42.6 vs. 72.7% (p= 0.163), showing no statistical significance between the two groups. In the univariate Cox regression analysis, the covariates of ethnicity, RT type, voice-hoarseness, gender, and type of insurance were statistically significant with p-value less than 0.05. However, in the multivariate Cox regression analysis only, the co-variates of ethnicity-Black (HR, 4.39; 95% CI, 1.46-13.17; p=0.008), RT type-CONV (HR, 20.82; 95% CI, 3.63-119.32; p=0.001), voice-hoarseness (HR, 3.80; 95% CI, 1.26-11.41; p=0.017), and gender-male (HR, 7.08; 95% CI, 1.46-34.22; p=0.015) were statistically significant. Race appears to be an independent prognostic factor for OS in T1 glottic cancers. Although local control rates were poorer for Blacks, it didn’t reach statistical significance.

Abstract Purpose: To assess if the time interval between concurrent chemo radiotherapy [conc ChemoRT] followed by brachytherapy [B] determines the clinical outcomes in cervical cancer patients (FIGO stage IB2 – IVA) among a predominantly African- American population in a state university medical center. Methods: A retrospective analysis of 147 cervical cancer patients diagnosed with stage IB2- IVA treated with conc ChemoRT followed by B at various time intervals between 2005 and 2018 was performed. Survival analysis with several treatment [TX] duration interval parameters (pre 2010 and post 2010 to evaluate the significant organizational advancements); conc ChemoRT and B completed ≤ 60 days and > 60 days per American College of Surgeons cervical cancer surveillance measure; and TX intervals 6 to 10 weeks were evaluated. The overall survival [OS], local control [LC] and distant control [DC] were estimated by using Kaplan- Meier method. Uni, bi and multi- variable Cox hazard regression analyses were used to compare the risk of death among cervical cancer patients with different TX intervals. The SPSS v.24.0 was used for statistical analyses. Results: The 147 cervical cancer patients (median age, 55 y; range 28-83 y) had a median follow-up of 32 months (range 0 to 164 months). Our patient cohort included 34% patients treated pre 2010 and 66% post 2010; 42.2% ≤60 days and 57.8% > 60 days; 53.1% ≤ 6 to 8 weeks, 12.2% ≤ 8 to 10 weeks and 34.7% d>10 weeks. The patients diagnosed and treated post 2010 had better 5-year OS rates (65% vs. 32%) compared to pre 2010; p=0.000; patients treated ≤ 60 days had better 5-year OS rates (59.3% vs. 40.3%) to > 60 days; p=0.094; patients treated ≤ 6 to 8 weeks had better 5-year OS rates (56.1% vs. 53.1% and 34.3%) compared to ≤ 8 to 10 weeks and > 10 weeks; p=0.188 respectively. The 5-y OS rates for FIGO stages were IB2 (65.8%); IIA (62.5%); IIB (40.4%); IIIA (50%); IIIB (42.4%); and IVA (25.2%); p=0.508. There was no trend for improved LC (p=0.331; p=0.962; p=0.616) and DC (p= 0.284; p=0.596; p=0.606) observed among patients with different TX intervals. In the bi-variate analysis for TX year group, after adjusting for age, race, insurance, income level, distance travelled, tobacco exposure, alcohol history, and tumor stage, BMI-lower had twice the risk of death (hazard ratio [HR], 2.74; 95% CI, 1.34-5.59; p= 0.005). For patients treated ≤ 60 days, their insurance-private had a 63% reduction (HR, 0.37; 95% CI, 0.15-0.90; p=0.029), and for the weekly TX group by the multivariate analysis, insurance-private showed a 76% reduction in the risk of death (HR, 0.35; 95% CI, 0.14-0.87; p=0.024). Conclusion: Our analysis suggests better OS among patients diagnosed and treated post 2010; ≤ 60 days duration; and ≤ 6 to 8 weeks with a shorter interval between conc ChemoRT and B to be superior to that of the patients undergoing longer TX’s. Citation Format: Mary R. Nittala, Satyaseelan Packianathan, Eswar K. Mundra, Maurice L. King, Shivanthidevi Gandhi, Robert M. Albright, Maria L. Smith, William C. Woods, Toms V. Thomas, Mildred Ridgway, Srinivasan Vijayakumar. Improved clinical outcomes with shorter intervals between concurrent chemoradiation and brachytherapy in FIGO IB2-IVA cervical cancer patients among a predominantly African-American population [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-230.

Abstract Purpose: To assess the prognostic significance of tumor HPV/p16 status among oropharyngeal squamous-cell carcinoma (SCC) patients. Methods: A retrospective analysis of 80 patients diagnosed with oropharyngeal SCC between 2008 and 2018 at an academic medical center with known HPV/p16 status was performed. Pearson’s Chi-squared test was used to compare the proportional differences between the known tumor HPV status among positive and negative p16 staining groups. Kaplan- Meier analysis was used to estimate overall survival [OS] and local control [LC] between the HPV groups stratified by risk and compared using the log-rank test. Uni and multi-variable Cox hazard regression analyses were used to compare the risk of death among patients with HPV- positive and HPV- negative cancer. The SPSS v.24.0 was used for all statistical analyses. Results: Our patient cohort included 37.5% HPV- positive and 62.5% HPV-negative (median age, 61 y; range 45-86 y) patients. Patient groups were classified on the basis of risk factors: HPV/p16 status, pack-years [py] of tobacco smoking, and tumor stage into low (p16+, ≤ 10 py), intermediate (p16+, > 10 py/p16-, < 10 py), and high risk (p16-, > 10 py/ any T4), accounting for 36.7%, 36.7% and 26.7% of HPV-positive and 0%, 20% and 40% of HPV-negative patients, respectively (p=0.000). The median follow-up duration for this cohort was 34 months (range 0 to 154 months). The low risk HPV-positive group had better 5-year OS rates (87.5%, vs. 59.5% and 27.2%) compared to intermediate and high risk groups (p=0.003 by the log-rank test). After adjustment for gender, age, race, income level, distance travelled, tobacco exposure, alcohol history, tumor stage, and treatment modality, this group had a 63% reduction in the risk of death (hazard ratio, 0.37; 95% CI, 0.18-0.77; p= 0.008). Insurance and BMI was associated with a 71% reduction (hazard ratio, 0.29; 95% CI, 0.97-0.89; p=0.032), and a 49% reduction in the risk of death (hazard ratio, 0.51; 95% CI, 0.37-0.71; p=0.000), respectively. In terms of LC, the low risk HPV-positive patients had better 3-year rates 70.1%, vs. 55.7% and 39.9% compared to the intermediate and, high risk groups (p=0.379). Conclusion: Tumor HPV/p16 status may be an independent prognostic factor along with insurance status and BMI for overall survival among oropharyngeal SCC patients. Citation Format: Mary R. Nittala, Eswar K. Mundra, Ashley Albert, William C. Woods, Maria L. Smith, Robert D. Hamilton, Lana Jackson, Gina Jefferson, Satyaseelan Packianathan, Eldrin Bhanat, Varsha Manucha, Srinivasan Vijayakumar. Univariate and multivariate prognostic factors for overall survival among oropharyngeal cancer patients with known HPV/p16 status [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-232.

Abstract Purpose: To assess whether the Will Roger’s phenomenon [WRP] exists with the move from the AJCC 7th to AJCC 8th edition in Breast Cancer staging and if racial differences are manifested in the expression of the WRP. Methods: A retrospective analysis of 300 women diagnosed with breast cancer between 2007 and 2017 at an academic medical center was performed. Pearson’s square test was used to compare the proportional differences between the anatomic staging system represented by the 7th edition and the prognostic staging of the 8th edition among Caucasian [C] and African-American [AA] women. Kaplan- Meier analysis was used to estimate overall survival [OS] and disease-free survival [DFS] between the races and compared using the log-rank test. Bi and multi-variate Cox hazard regression analyses were used to identify any racial factors associated with outcomes. The SPSS v.24.0 was used for all statistical analyses. Results: Our patient cohort included 30.3% C and 69.7% AA (median age, 62 y; range 34- 92 y). Stages I, II, III, and IV accounted for 46.2%, 26.3%, 23.1%, and 4.4% of C and 28.7%, 43.1%, 24.4%, and 3.8% of AA respectively, in anatomic staging (p= 0.043). In prognostic staging, 52.8%, 18.7%, 23%, and 5.5% were C while 35%, 17.2%, 43.5%, and 4.3 % were AA, respectively (p=0.011). A total number of 41 C (45.05 %) were upstaged compared to 100 AA (47.85 %) patients. Fifteen C patients (16.49 %) and 30 AA patients (14.35 %) were down-staged. Of the remainder, 35 C (38.46 %) and 79 AA (37.79 %) patients had their stages unchanged (P=0.859). The median follow-up duration for this cohort was 58 months (range 4- 235 months). The AA patients showed better stage -by- stage 5- year OS rates using 8th edition compared to the 7th edition, suggesting a manifestation of the WRP. Among the C patients, those who were stage IIIA in the 7th edition but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th edition (p=0.000). For AA patients, stage IIIA, IIIB, IIIC, and IV all demonstrated better prognoses in the 8th edition when compared to the 7th edition (p=0.000). In terms of DFS, the 8th edition’s clinical staging showed complex results (p=0.176) compared to DFS estimated using the 7th’s anatomic staging system (p=0.004). For C patients, stages IA, IB, IIB, and IIIC all recorded better DFS when using the 8th edition while for AA patients, only those with stages IB and IIIC showed better DFS in the 8th edition compared to the 7th. Conclusion: Our analyses suggest that the WRP exists in the move from the AJCC 7thto the 8th edition in breast cancer staging in both C and AA patients. However, there was significant variability between the races in the extent of its manifestation. We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data. Citation Format: Mary R Nittala, Eswar K Mundra, SatyaSeelan Packianathan, Divyang Mehta, William C Woods, Shawn Mckinney, Barbara S Craft, Srinivasan Vijayakumar. The Will Rogers phenomenon in breast cancer: The AJCC 8th Ed. and the importance of caution in the interpretation of outcomes differences for overall population and race-specific cohorts [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B126.

To evaluate the impact of race (African-American [AA] vs. Caucasians [C]) on the survival and local control outcomes in cervical cancer (FIGO stage IB2-IVA) patients in a University medical center. This is a retrospective analysis of 147 cervical cancer patients diagnosed with stage IB2 to IVA who underwent concurrent chemo radiotherapy followed by brachytherapy between 2005 and 2018. Ninety-six (65.3%) AA patients and fifty-one (34.7%) C patients diagnosed with cervical cancer were treated in our academic state institution. For all the patients, local control [LC], and overall survival [OS] were estimated using Kaplan-Meier method. The racial significance of the survival variables were analyzed using the Cox regression model. A p-value of less than 0.05 was considered statistically significant. The SPSS v.24.0 was used for data analyses. The baseline characteristics of all 147 cervical cancer patients were documented; median age was 55 y (range 28-83 y) and median follow-up was 32 months (range 0 to 164 months). The C patients had 5-year OS rate of 64.2% vs. 46.6% for AA patients (p = 0.139). In the bi-variate Cox regression analysis, the covariates stratified by race, type of insurance, BMI, smoking pack years [py] were statistically significant with p-value less than 0.05. In the multivariate analysis, the covariates of insurance-private was associated with 73% reduction (hazard ratio [HR], 0.27; 95% CI, 0.11-0.66; p = 0.004), insurance-self pay with 71% reduction (HR, 0.29; 95% CI, 0.11-0.76; p = 0.012), insurance-Medicare with 43% reduction (HR, 0.56; 95% CI, 0.32-0.97; p = 0.039), BMI–normal with 76% reduction (HR, 0.24; 95%CI, 1.21-5.11; p = 0.013), py ≤ 10 years with 53% reduction (HR, 0.47; 95% CI, 0.26-0.86; p = 0.014), and ethnicity-C with 53% reduction in the risk of death (HR, 0.47; 95% CI, 0.26-0.86; p = 0.014). In terms of LC, the C patients had a 3-year rate of 50.7% vs. 42.9% for AA patients (p = 0.398). In many disease sites, AA patients have worse outcomes compared to C patients. In our cohort of patients with non-metastatic cervix cancer, we did not identify any racial differences in outcomes.

BACKGROUND Transformation of primary cutaneous follicle center lymphoma (PCFCL), a low-grade B-cell non-Hodgkin lymphoma (NHL), into a high-grade NHL is rare with uncertain prognosis and treatment. A case is reported of a 40-year-old man who presented with a scalp mass that was diagnosed histologically as PCFCL. Imaging of the head and neck identified diffuse large B-cell lymphoma (DLBCL) involving the parotid gland and cervical lymph nodes, which responded well to radiation therapy. CASE REPORT A 40-year-old African American man presented with a two-year history of a progressively enlarging scalp mass that measured 10.5×7.1×6.6 cm. Histology showed a low-grade lymphoma with a follicular pattern. Immunohistochemistry was positive for B-cell markers and Bcl-6, consistent with a diagnosis of PCFCL. Computed tomography (CT) identified a 4.9×3.7×3.4 cm mass in the left parotid gland with bilateral cervical lymphadenopathy that had been present for the previous two or three months. The diagnosis of DLBCL was made on histology from a needle biopsy. Treatment began with rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH) chemotherapy, followed by radiation therapy to the scalp, both sides of the neck, and left parotid gland. At four-month follow-up, combined positron emission tomography (PET) and CT showed only diffuse low-level uptake in the scalp and parotid gland. CONCLUSIONS Transformation of low-grade PCFCL to high-grade DLBCL is rare, and the approach to treatment varies. This case showed a good response to chemotherapy and radiation therapy.

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.

To prospectively assess health-related quality of life (HRQOL) and treatment-related morbidity following Cs-131 permanent prostate brachytherapy (PB) combined with external beam radiation therapy (EBRT) in the setting of intermediate- and high-risk prostate cancer. Eighteen men were enrolled in the phase 1-2 institutional study between June 2009 and October 2010. After 2 months of neoadjuvant androgen deprivation and 85-Gy Cs-131 PB, patients had a 6-week break followed by 45-Gy EBRT. The Functional Assessment of Cancer Therapy – Prostate (FACT-P), the International Prostate Symptom Score (IPSS), and the International Index of Erectile Function (IIEF-5) questionnaires were completed prior to treatment, at weekly intervals after PB and during EBRT, and at 3-month intervals for 1 year following completion of EBRT. Dosimetric data was calculated on post implant CT and included prostate volume; dose to 90% of the prostate; volume of prostate receiving 100%, 150%, and 200% of prescribed dose; volume of rectum receiving 100% of prescribed dose; and urethral maximum dose. HRQOL, urinary symptoms, and erectile function were analyzed for change over time and for correlation with dose parameters. A change of ≥10 points in the total FACT-P score or ≥3 for subscale values was clinically meaningful. The median age of study participants was 63 years (range 49-80 years) with median pretreatment prostate-specific antigen (PSA) of 11.2 ng/mL (range 5.0-339.0 ng/mL). Patients had clinical stage T1c-T3b with a Gleason score ≥8 in 12 (67%) patients. At median follow-up of 3.7 years, 1 patient had expired with no evidence of disease. The 1-yr, 2-yr, and 3-yr biochemical relapse-free survival (bRFS) was 94%, 94%, and 88%, respectively. Assessment of FACT-P results revealed both statistically significant (P<.05) and clinically meaningful decreases in HRQOL from baseline as measured by the cumulative total as well as the prostate cancer subscale and trial outcome index. HRQOL for all subscales decreased within 1 week of PB while IPSS changes were observed after 3 weeks; however, both returned to near baseline levels within 2 months. IIEF-5 scores remained persistently lower at 1 year after completion of treatment. At last follow-up, 3 (16%) patients had been treated for grade 2 urethral strictures and 2 (11%) patients were treated for grade 2 radiation proctitis. No correlation was found between dosimetric variables and HRQOL results. Dose escalation with Cs-131 PB in combination with EBRT resulted in improved bRFS compared to results previously reported with I-125 and Pd-103. The shorter half-life of Cs-131 allowed for more rapid recovery from treatment morbidity and improved HRQOL.