Introduction: Intermountain Healthcare is a twenty-three hospital care delivery system located in the State of Utah. The system represents large referral hospitals and smaller community facilities. Approximately sixty percent of patients who reside in the State of Utah receive their care at an Intermountain facility. Intermountain Healthcare has a long history of quality improvement. In order to facilitate quality improvement Intermountain has developed clinical programs for a variety of disciplines. Oncology represents a focused area of interest. These clinical programs have dedicated infrastructure and leadership in place to evaluate care and initiate improvement in a variety of disease sites. Methods: Colorectal cancers represents one of the more common malignancies in the system. System initiatives to eliminate variations in care delivery for colorectal cancer have been continuous for 15 years. Most recently we analyzed care for primary rectal cancer. The analysis substantiated variation in care delivery and variation from standard of care across the system. From 2012 to 2015 224 cases of rectal cancer had primary surgery in the system. Forty patients received care which would be outside the standard of care either by omission of preoperative staging or treatment. Eight of the forty were deemed to be emergent by the provider and received emergent surgical resection. Analysis of outcomes revealed improved local control in those patients deemed appropriate. Results: Analysis of baseline data suggested variation in care delivery. The goal of our quality improvement initiative is to change behavior and improve care. In order to address these treatment inadequacies we initiated a statewide improvement process. This included a continual timely monitoring process. Individual provider score cards comparing their results to their peers. Infrastructure improvement relating to tumor conference presentation and timely pathology review. The resulting behavioral change and outcomes will be presented. Conclusion: Same as above.

Objectives: Lynch Syndrome (LS) is a familial cancer syndrome characterized by mutations in mismatch repair genes. LS carriers are at risk for endometrial, colorectal, ovarian and other cancers. This investigation describes the prevalence of LS and the costs associated with the Implementation of routine screening for LS in women with endometrial cancer (EC).

Purpose: Radiation Therapy Oncology Group 0417 was a phase II study that explored the safety and efficacy of the addition of bevacizumab to chemoradiation therapy. The safety results have been previously reported. Herein we report the secondary efficacy endpoints of overall survival (OS), locoregional failure (LRF), para-aortic nodal failure (PAF), distant failure (DF), and disease-free survival (DFS).Methods and Materials: Eligible patients with bulky Stage IB-IIIB disease were treated with once-weekly cisplatin (40 mg/m(2)) chemotherapy and standard pelvic radiation therapy and brachytherapy. Bevacizumab was administered at 10 mg/kg intravenously every 2 weeks for 3 cycles during chemoradiation. For OS, failure was defined as death of any cause and was measured from study entry to date of death. LRF was defined as any failure in the pelvis. PAF was defined as any para-aortic nodal failure. DF was analyzed both including and excluding PAF. DFS was measured from study entry to date of first LRF. DF was measured with or without PAF or death. OS and DFS were estimated by the Kaplan-Meier method, and LRF and DF rates were estimated by the cumulative incidence method.Results: 49 eligible patients from 28 institutions were enrolled between 2006 and 2009. The median follow-up time was 3.8 years (range, 0.8-6.0 years). The surviving patients had a median follow-up time of 3.9 years (range, 2.1-6.0 years). Most patients had tumors of International Federation of Gynecology and Obstetrics Stage IIB (63%), and 80% were squamous. The 3-year OS, DFS, and LRF were 81.3% (95% confidence interval [CI], 67.2%-89.8%), 68.7% (95% CI, 53.5%-79.8%), and 23.2% (95% CI, 11%-35.4%), respectively. The PAF, DF without PAF, and DF with PAF at 3 years were 8.4% (95% CI, 0.4%-16.3%), 14.7% (95% CI, 4.5%-24.9%), and 23.1% (95% CI 11.0%-35.2%), respectively.Conclusion: In this study, bevacizumab in combination with standard pelvic chemoradiation therapy for locally advanced cervical cancer showed efficacy results that are promising and may warrant further investigation. (C) 2014 Elsevier Inc.

Phase II Study of Accelerated High-Dose Radiotherapy With Concurrent Chemotherapy for Patients With Limited Small-Cell Lung Cancer: Radiation Therapy Oncology Group Protocol 0239 Ritsuko Komaki, MD,* Rebecca Paulus, BS,z David S. Ettinger, MD,x Gregory M.M. Videtic, MD,k Jeffrey D. Bradley, MD,{ Bonnie S. Glisson, MD,y Corey J. Langer, MD,** William T. Sause, MD,yy Walter J. Curran, Jr., MD,zz and Hak Choy, MDxx Departments of *Radiation Oncology and yThoracic/Head and Neck Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; zRadiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania; xDepartment of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; kDepartment of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio; {Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri; **Thoracic Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; yyRadiation Center, LDS Hospital, Salt Lake City, Utah; zzDepartment of Radiation Oncology, Jefferson Medical College, Philadelphia, Pennsylvania; and xxDepartment of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

BACKGROUND. The MDM2 oncoprotein promotes p53 degradation via ubiquitin, establishing negative feedback control of p53 and consequently affecting cell cycle arrest and apoptosis. The authors evaluated the association between MDM2 expression and local failure, distant metastasis (DM), cause-specific mortality, and overall mortality in men treated in Radiation Therapy Oncology Group 8610 with radiotherapy, with or without androgen deprivation.METHODS. Of the 456 eligible and analyzable patients (parent cohort), adequate archival diagnostic tissue specimens from 108 patients were available for MDM2 analysis (MDM2 cohort). Cox proportional hazards multivariate analysis (MVA) was used to determine the relation of MDM2 to the endpoints. MDM2 overexpression was manually classified as > 5% nuclear staining. An image analysis system was also used to quantify the proportion of tumor nuclei with MDM2 staining (ACIS index) and staining intensity.RESULTS. Overexpression of MDM2 by manual counts was seen in 44% (n = 47) of the patients. In the manual count analysis, there was no significant relation between MDM2 overexpression and outcome. The ACIS index, using a cutoff point defined by the median value, <= 3% versus > 3%, was related to 5-year DM rates in univariate analyses (32.6% vs. 45.8%; P = 0.057) and MVA (P = 0.06). The intensity of MDM2 staining was not significant.CONCLUSIONS. MDM2 expression quantified by image analysis was weakly associated with DM. The cohort examined was relatively small and with larger patient numbers, MDM2 overexpression may emerge as a more significant covariate.