American Society for Radiation Oncology, Sept. 15-18

The 61st Annual Meeting of the American Society for Radiation Oncology

The annual meeting of the American Society for Radiation Oncology was held from Sept. 15 to 18 in Chicago and attracted approximately 11,000 participants from around the world, including physicians, oncology nurses, radiation therapists, biologists, physicists, and other cancer researchers. The conference featured educational courses focusing on radiation, surgical, and medical oncology.

In a phase II study, Allison M. Campbell, M.D., Ph.D., of the Yale Cancer Center in New Haven, Connecticut, and colleagues found that among a percentage of patients with metastatic non-small cell lung cancer who failed to respond to immunotherapy alone, adding stereotactic body radiotherapy (SBRT) to immunotherapy (pembrolizumab) improved progression-free survival.

"Ten percent of patients who had already progressed on immunotherapy had a partial response to radiation that lasted for longer than one year. Tumors that weren't targeted with radiation shrank, and this was associated with more CD8 effector memory T cells in the peripheral blood," Campbell said. "It's too early to make definitive statements about the benefit of adding SBRT for patients who have progressed on immunotherapy, but the approach is already being used in the clinic. When patients progress on immunotherapy (off trial), growing tumors are associated with pain, and radiation is a natural choice for palliation at those sites. It's becoming more common to treat those sites with SBRT, especially in patients who don't have a lot of metastatic sites (patients with oligometastatic disease)."

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In another study, Clifford Robinson, M.D., of the Washington University School of Medicine in St. Louis, and colleagues found that a single dose of radiation therapy was able to reduce ventricular tachycardia (VT) for patients with VT refractory to medication and catheter ablation, allowing for reduced medication and improved quality of life.

"For up to 78 percent of patients alive at two years, the effect was durable. Late complications were few, but did occur, including pericardial effusion and a gastropericardial fistula; thus, further long-term follow-up is warranted," Robinson said. "For patients with refractory VT, few options exist. A completely noninvasive approach using noninvasive imaging and radiation therapy may provide new hope for these patients."

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Daniel Spratt, M.D., of the University of Michigan Rogel Cancer Center in Ann Arbor, and colleagues found that men with recurring prostate cancer and prostate-specific antigen (PSA) values less than 0.6 ng/mL who underwent early salvage radiotherapy (SRT) showed no improvement in metastasis or survival from the addition of long-term hormone therapy. Furthermore, the investigators found that high-dose bicalutamide resulted in a twofold increased risk in other-cause mortality and threefold to 4.5-fold higher odds of having a severe cardiac event.

"Men receiving early SRT should not routinely be given hormone therapy. However, men receiving SRT at higher PSAs, termed late SRT, should be receiving hormone therapy as there is a survival benefit," Spratt said. "National guidelines should change to reflect these new data. For men receiving early SRT, especially at PSAs of approximately 0.2, there is no evidence that hormone therapy helps their outcome and has well-documented harms."

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Amar Srivastava, M.D., M.P.H., of the Washington University School of Medicine in St. Louis, and colleagues found that women living in states with health clinic closures underwent relatively less screening for cervical cancer, were diagnosed with less early-stage and more late-stage and metastatic disease, and appeared to have a significantly increased risk for death.

"A trend that has been observed over the past several years is the closure of women's health clinics. These closures were in part due to funding, restructuring, and the passage of new laws throughout the states. Between 2010 and 2013 itself, nearly 100 of these clinics closed. With knowledge of the care these clinics provide for women, especially marginalized groups, we undertook this study with the goal of evaluating the association between clinic closures on screening for cervical cancer, stage at diagnosis, and mortality associated with this disease," Srivastava explained. "Previously, surveys had been completed by national groups looking at the number of clinics providing women's health services, including comprehensive reproductive and family planning services. Using these data, we divided states into two separate groups: those with a decrease in the number of clinics per capita and those with no decrease; we then compared these two groups."

The investigators used two different databases to examine outcomes related to cervical cancer. The first database was the Behavioral Risk Factors Surveillance Study (BRFSS), a national telephone survey collecting data from residents from all 50 states regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. The investigators used the BRFSS to obtain data related to screening behaviors and compared the two groups using a differences-in-differences analysis.

"We saw that between 2010 and 2013, cancer screening with a pap smear declined more so in states with a decrease in the number of women's health clinics compared to states with no decrease," Srivastava said. "When we looked at subgroups, we saw that this disparity was more pronounced in Hispanic women, young women ages 21 to 34 years old, unmarried women, and uninsured patients."

The second database the investigators used was the Surveillance, Epidemiology, and End Results (SEER) database. SEER collects data on cancer-related outcomes for about 30 percent of the U.S. population living in different states.

"We did a similar analysis [to BRFSS], and we ultimately saw that there was a notable decrease in early-stage diagnoses among women ages 18 to 34 in states with a decrease in clinics. Now that may sound like a good outcome, but we saw a similar trend towards increases in late-stage diagnoses among all patients with cervical cancer," Srivastava said. "Additionally, SEER also has data on mortality, and we observed an increase in mortality in states with a decrease in clinics compared to states with no decrease in clinics over this same time period."

Overall, the key takeaway from this study is that the closure of women's health clinics is associated with adverse outcomes related to cervical cancer.

"This is a retrospective study, as opposed to a prospective clinical trial, so we can't report causality. Meaning, I can't say that the closure of these clinics caused these adverse outcomes as there could have been a good number of other factors that contributed to these outcomes," Srivastava said. "With our statistical approach, we tried to control for a lot of these factors, including age, ethnicity, socioeconomic factors, etc., but it's impossible to control for all of these factors. Still, the data are concerning enough, especially with the changes in screening and survival, that it should really give us pause."

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ASTRO: NSAIDs May Offer Benefit to Head & Neck Cancer Patients

MONDAY, Sept. 23, 2019 (HealthDay News) -- Nonsteroidal anti-inflammatory drugs are correlated with better overall survival in patients with head and neck squamous cell carcinoma, and there is a nonsignificant benefit for aspirin use in non-small cell lung cancer, according to two studies presented at the annual meeting of the American Society for Radiation Oncology, held from Sept. 15 to 19 in Chicago.

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Physician’s Briefing Staff

Physician’s Briefing Staff

Published on September 26, 2019

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