Total body irradiation (TBI) is commonly used for myeloablative conditioning prior to allogeneic hematopoietic stem cell transplantation (HSCT) in high-risk, relapsed, or refractory hematologic malignancies. Pulmonary toxicity (PT)—including pneumonia, diffuse alveolar hemorrhage, and interstitial pneumonitis—is a serious complication after HSCT. Idiopathic pneumonia syndrome (IPS), defined as widespread alveolar injury without cardiogenic or infectious causes, represents a non-infectious form of PT. This study characterizes PT and IPS and explores associated factors following TBI-based HSCT in adults. We conducted a retrospective review of a prospectively collected database of adult patients treated with TBI-based HSCT from 2015 to 2022. Clinical records and chest imaging were reviewed to identify PT and IPS. IPS occurred in 20 patients (18%) of the cohort, with 8 patients (7%) within 100 days and 13 patients (13%) after 100 days. One patient experienced both early- and late-onset IPS and was counted once in the cumulative analysis. Early pulmonary infection was associated with reduced overall survival in both univariable (p = 0.002) and multivariable 100-day landmark analyses (p = 0.047). Acute graft-versus-host disease (GVHD) was independently associated with improved survival (p = 0.017), whereas chronic GVHD was not statistically significant in the landmark analyses. PT and IPS incidences were consistent with previously published adult TBI cohorts. While no significant clinical or radiation-related predictors of IPS were identified, pulmonary infection emerged as a predictor of inferior overall survival.

OBJECTIVES:Anaplastic thyroid carcinoma (ATC) is a rare and aggressive malignancy. The purpose of this study was to update the outcomes of ATC in a large provincial database in a modern cohort. METHODS:All patients diagnosed with ATC in British Columbia between 2000 and 2022 were included in this retrospective analysis. Charts were reviewed for demographic, staging, treatment, and outcomes data. Statistical analysis was performed using the Kaplan-Meier method for overall survival. The Fine and Gray method was used to determine factors associated with progression. RESULTS:A total of 127 patients were included, with a median age of 73 years. At diagnosis, 22% had stage IVA, 42% stage IVB, and 36% stage IVC disease. Surgery was performed in 43% of patients, and 66% received radiotherapy. Molecular testing was conducted in 13%, with 5 patients testing positive for BRAF mutations. Chemotherapy was used in 15 patients, either concurrently with radiotherapy or palliatively. Median OS was 5.7 months (stage IVA), 4.3 months (IVB), and 2.5 months (IVC). Improved OS was associated with better ECOG performance status, surgery, radiotherapy, and higher radiation doses (P<0.05). Improved progression-free survival was linked to better ECOG status, absence of metastases, and higher radiation dose (P<0.05). Only 3% of patients survived longer than 3 years. CONCLUSIONS:In this large population-based cohort, ATC remains associated with poor survival, with outcomes strongly influenced by stage and performance status at diagnosis. Surgery and radiotherapy, particularly higher radiation doses, were associated with improved survival outcomes in selected patients.

PURPOSE:Nasopharyngeal carcinoma (NPC) is a rare cancer, especially in nonendemic regions such as North America, occurring in a bimodal age distribution with the first peak in adolescents and young adults (AYA). Limited data exist on treatment outcomes in this group. The purpose of our study is to evaluate treatment outcomes of NPC in the AYA population in British Columbia, Canada, and evaluate late effects. METHODS:We conducted a retrospective cohort study of AYA patients (ages of 15-39 years at diagnosis) diagnosed with NPC and treated between 2000 and 2015. Demographics, treatment outcomes, and late toxicities were collected. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier and Cox regression. Locoregional recurrence and distant metastatic recurrence were evaluated using the competing risk method. Late effects were described qualitatively and quantitatively. RESULTS:The cohort included 97 patients: 93 received curative intent treatment, 3 received palliative treatment, and 1 was excluded from survival analysis. Five-year OS rates were 81% (Stage I/II), 80% (Stage III), and 68% (Stage IV), with corresponding DFS rates of 78%, 77%, and 66%. The addition of neoadjuvant and/or adjuvant chemotherapy to radiotherapy was associated with improved survival. Advanced-stage disease had a higher incidence of locoregional relapse. Common late toxicities included xerostomia, hearing loss, epistaxis, and hypothyroidism. CONCLUSION:Although survival rates in our cohort were comparable to existing literature, the rate of late toxicities was high. These findings support the need for AYA-tailored treatment strategies and survivorship care to minimize long-term complications and optimize quality of life.

Introduction In select tumor sites, symptom palliation and local control can be improved through delivering higher biological equivalent doses (BED) of radiotherapy. However, not all patients are suitable candidates for stereotactic body radiation therapy (SBRT). The 30 Grays in five fractions (30/5) regimen is a conformal, hypofractionated regimen that offers a higher BED compared to conventional palliative radiotherapy. It adheres to the same organ-at-risk constraints as five-fraction SBRT. The planning and set-up processes are optimized to expedite treatment delivery compared to SBRT. This study aims to assess the oncologic and safety profiles of the 30/5 regimen. Methods Clinical data of patients who received the 30/5 regimen between October 2020 and August 2022 at our institution, the BC Cancer Vancouver Centre, were retrospectively reviewed. Local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), time to change in systemic therapy (CIS), and overall survival (OS) were calculated using the Kaplan-Meier method. Survival distributions between groups were compared using the log-rank test. Univariable and multivariable analyses were performed using Cox regression analysis to identify factors associated with the oncologic outcomes. Results Over 22 months, 77 patients received 92 courses of the 30/5 regimen. The median age was 68 years. The median tumor size treated was 11.4 cm3. The most common treatment locations were lung (34%), lymph nodes (21%), non-spine bone (18%), and spine (15%). At a median follow-up of 13.5 months, 29 deaths were observed. The 12-month LC was 66.1% (95% CI: 55.7-76.5%), and the 12-month DMFS, PFS, CIS, and OS were 35.9% (95% CI: 24.5-47.3%), 33.2% (95% CI: 22.0-44.4%), 59.2% (95% CI: 46.8-71.5%), and 72.5% (95% CI: 62.1-82.9%), respectively. The univariable analysis showed that radiosensitive and smaller tumors had better LC outcomes (p=0.005 and <0.001, respectively). These associations remained significant upon multivariable analysis too (p=0.035 and 0.026, respectively). No grade three or higher toxicity was reported. Conclusion The 30/5 regimen demonstrates good local control and favorable safety profile, particularly for small and radiosensitive tumors. Our findings suggest that 30/5 may be a viable alternative palliative regimen for patients who require high-dose radiotherapy, but are not suitable candidates for SBRT or prolonged interruptions in systemic therapy. In resource-limited settings, its hypofractionated approach may help conserve healthcare resources. Future studies are warranted to prospectively evaluate the impact of dosimetric distribution on oncologic outcomes.

Background: This study evaluates population-based outcomes of patients with squamous cell carcinoma (SCC) of the nasal cavity treated in British Columbia. Methods: A retrospective review of nasal cavity SCC treated from 1984 to 2014 was performed (n = 159). Locoregional recurrence (LRR) and overall survival (OS) were evaluated. Results: The 3-year OS was 74.2% for radiation alone, 75.8% for surgery alone, and 78.4% for surgery and radiation (P = 0.16). The 3-year LRR was 28.4% for radiation alone, 28.2% for surgery alone, and 22.6% for surgery and radiation (P = 0.21). On multivariable analysis, surgery and postoperative radiation relative to surgery alone was associated with a lower risk of LRR (hazard ratio: 0.36, P = 0.03). Poor Eastern Cooperative Oncology Group status, node-positive, orbital invasion, smoking, and advanced age were associated with worse OS (all P <0.05). Conclusion: In this population-based analysis, multimodality treatment with surgery and adjuvant radiation were associated with improved locoregional control for SCC of the nasal cavity.

Purpose: The primary objective was to compare 3’-deoxy-3’-(18F) fluorothymidine (FLT) positron emission tomography (PET)/computed tomography (CT) uptake in 3 cohorts of stereotactic body radiation therapy (SBRT) patients: (1) pre-SBRT, (2) stable post-SBRT lung fibrosis, and (3) suspicious or proven local recurrence post-SBRT. The secondary objectives were to optimize FLT-PET imaging by comparing FLT uptake in respiratory-gated (4-dimensional) versus nongated (3-dimensional) FLT-PET scans. Methods: Patients with early-stage non-small cell lung cancer planned or treated with SBRT at the institution with radiographic findings of fibrosis or recurrence were eligible for the study. All patients underwent imaging with FLT-PET/CT before SBRT in cohort 1 and at fibrosis or recurrence in cohort 2 and 3, respectively. The planned sample size was 20 patients in each cohort, with 60 patients total. FLT-PET standardized uptake value (SUV) variables including SUVmax, SUVmean, SUVpeak, SUV50, and SUV95 were compared among the 3 cohorts using the Kruskal-Wallis test. The correlation of respiratory-gated and nongated FLT-PET SUV variables was performed using the Spearman correlation coefficient. Results: Forty-one patients were recruited for the study (20 in cohort 1, 16 in cohort 2, and 5 in cohort 3) between 2015 and 2019. The majority received a diagnosis of stage I lung cancer (86%), and the most common prescription was 48 Gy in 4 fractions (59%). Respiratory-gated FLT-PET was performed in 35 patients. The FLT SUV variables were well correlated between respiratory-gated and nongated scans (r = 0.8-1.0). The SUVpeak, SUVmean, and SUVmax were significantly lower in the fibrosis cohort compared with the recurrence and pretreatment cohorts. The SUV50 and SUV95 values in the recurrence cohort were statistically similar to the pretreatment cohort. Conclusions: FLT-PET/CT may be helpful in differentiating SBRT-related fibrosis from recurrence. Nongated FLT-PET/CT with reporting of SUVmax and SUV95 values is recommended.

There are limited patient-reported outcome (PRO) data tracking changes in toxicity in patients actively undergoing radiotherapy. Between 2015–2019, acute toxicity was prospectively measured in 698 patients undergoing a 5-week course of pelvic radiotherapy for gynecologic cancers using a weekly PRO questionnaire. Our questionnaire was able detect a pattern of onset and resolution of acute gastrointestinal (GI) and genitourinary (GU) toxicity in 27 out of 32 questions. Logistic regression analysis showed that increasing GI and GU toxicity at week 2 could predict for severe toxicity at week 5. However, due to a low number of severe events, univariate results could not be productively added to a multivariate model. We observed a >70% response rate for all sections of the questionnaire, except for questions on sexual and vaginal health, which had a 13% average response rate. By demonstrating that PRO data can be used to track acute toxicity during radiotherapy, there is a need to further examine how this tool may be implemented in the clinic to provide complex, adaptive care, such as early side effect management, and modifying radiation delivery in real-time.

We assessed whether advanced RT techniques were associated with differences in patient-reported outcomes (PROs). Patients with bone metastases who completed the brief pain inventory (BPI) before and after RT were identified, and RT technique was categorized as simple (e.g., parallel opposed pair) or advanced (e.g., 3D-conformal RT (3DCRT), intensity-modulated RT (IMRT), or stereotactic ablative RT (SABR)). Pain response and patient-reported interference on quality of life secondary to pain was compared. A total of 1712 patients completed the BPI. From 2017–2021, the rate of advanced RT technique increased significantly (p < 0.001; 2.4%, 2.4%, 9.7%, 5.5%, 9.3%), with most advanced techniques consisting of IMRT, and only 7% of advanced techniques were SABR. Comparing simple vs. advanced technique, neither the complete pain response (12.3% vs. 11.4%; p = 0.99) nor the partial pain response (50.0% vs. 51.8%; p = 0.42) was significantly different. There was no significant patient-reported difference in pain interfering with general activity, mood, walking ability, normal work, relationships, sleep, or enjoyment of life. Given that there is increasing utilization of advanced RT techniques, there is further need for randomized trials to assess their benefits given the increased cost and inconvenience to patients.

Purpose This study compares patient reported outcomes and treatment related complications during radiotherapy before (August 2019 -Feb 2020) versus during (March -October 2020) the COVID-19 pandemic. Materials and Methods The MD Anderson Symptom Inventory – Head & Neck Module was used to assess curative intent H&N cancer patients’ symptoms during radiotherapy. Results There were 158 patients in the pre-pandemic cohort and 137 patients in the pandemic cohort. There was a trend towards more patients requiring an enteral feeding during the pandemic (21% vs 30%, p = 0.07). Weight loss was higher during the pandemic (mean − 5.6% vs 6.8%, p = 0.03). On multivariate analysis, treatment during the pandemic was associated with higher symptom scores for coughing/choking while eating (2.7 vs 2.1, p = 0.013). Conclusions Complication rates during H&N radiotherapy during the COVID-19 pandemic were similar at our institution relative to the pre-pandemic era although weight loss was greater and patients reported more severe choking/coughing while eating.