Ledderhose disease, kind of like Dupuytren’s but of the plantar foot, can similarly improve with relatively low dose electron therapy of 15 Gy in 5 fractions over two courses 10 weeks apart (30 Gy total over 12 weeks) as demonstrated by the first prospective randomized trial in this space reporting a significant improvement in pain relief and walking speed 12 months out from radiation. Find the article here (https://www.thegreenjournal.com/article/S0167-8140%2823%2900256-6/fulltext).
The ever popular 5-α-reductase inhibitors that minimize symptoms of BPH while both reducing overall prostate cancer incidence and obscuring early diagnosis have a new indication to tout: reducing the risk of bladder cancer progression. In a huge Korean cohort study of over 22K men with bladder cancer, the 5300 men with pre-existing 5-α-reductase inhibitor prescriptions for at least one year had lower risk of subsequent radical cystectomy (HR 0.74) and mortality (HR 0.83) when compared to propensity-matched counterparts. The thought is these agents impede well-established androgen-mediated bladder carcinogenesis.
In this small trial, the combination of radiation and atezolizumab alone resulted in a favorable pCR rate of 84.4% for patients with MIBC who were not cystectomy candidates. Find the article here (https://www.redjournal.org/article/S0360-3016(23)00461-3/fulltext).
A national survey of primary care physicians demonstrates, after performance status, a patient’s risk of developing cancer in their remaining lifetime is the most important deciding factor on whether or not to continue said cancer screening, highlighting the importance of tools to help make this information readily available. (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804869).
This look back at outcomes for 211 patients receiving chemoradiation for unresectable pancreatic cancer makes the interesting observation that the presence of a biliary stent was strongly associated with developing a GI bleed after treatment, which was the most common late toxicity observed. The underlying pathophysiology of this link remains unclear, though the authors propose that chronic stent irritation may predispose to radiation-accelerated GI ulceration. Another more techy explanation is that high-Z stents may be unknowingly enhancing radiation dose to adjacent tissue. A final take away from the study is that IMRT resulted in notably less nausea than 3D-conformal treatment. (https://www.advancesradonc.org/article/S2452-1094(23)00095-7/fulltext).
This case report details an occurrence of life-threatening tumor lysis syndrome occurring after a single fraction of palliative quad shot radiation for diffuse large B cell lymphoma in a 26 year old female, serving as a reminder to monitor biomarkers such as phosphorus and uric acid daily during treatment for patients at high risk. Find the article here (https://www.advancesradonc.org/article/S2452-1094(23)00094-5/fulltext).
This cross-sectional study asked a hard-hitting question: how often do oncology trialists commit the methodological sin of changing their primary endpoints after a study is already underway? Since such an occurrence is often brushed under the rug, they actually reviewed all protocol documents available from inception as well as analyzed tracked changes on ClincalTrials.gov. It turns out, a whopping one in five (n=145 of 755) published trials did change in primary endpoint from initial to final reporting. What’s more, less than a third (n=43) of these mentioned the change in the final manuscript. As suspected, trials with detected changes in primary endpoint had increased odds (OR 1.86) of achieving said primary endpoint. (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805005).
It’s been a few years since the notorious publishing behemoth Elsevier has made scandalous headlines so a recent en masse resignation of prestigious editorial board members in protest of its truly outrageous business model is here to remind you of the racket of academic publishing. (https://www.theguardian.com/science/2023/may/07/too-greedy-mass-walkout-at-global-science-journal-over-unethical-fees).
When delivering a dose-escalated simultaneous integrated boost to MRI-defined gross disease with prostate SBRT in the style of hypo-FLAME, twice weekly fractionation was associated with a higher rate of acute grade 2 toxicity than once per week fractionation. Find the article here (https://www.redjournal.org/article/S0360-3016(23)00301-2/fulltext).
If you ever make the analogy to a sunburn when explaining to women the symptoms of acute dermatitis they may experience with breast irradiation, those with darkly pigmented skin may assume they’re in the clear. This look back at 325 women receiving breast radiation assessed the impact of pigmented skin (Fitzpatrick IV+) on toxicity. While Black women were less likely to experience physician-reported grade 2-3 acute dermatitis and less likely to use topical steroids, pigmented skin was significantly associated with higher odds of developing grade 2-3 late hyperpigmentation. (https://www.redjournal.org/article/S0360-3016(23)00365-6/fulltext).
This study found that the combination of VEGFi and lung SABR increases the risk of grade 3+ pulmonary hemorrhage. The absolute risk is relatively low with peripheral lesions, but significant caution should be exercised with central and ultracentral tumors where the risk could exceed 20%. (https://www.jto.org/article/S1556-0864(23)00494-X/fulltext).
This multi-institutional study provides the best evidence to date showing similar oncological outcomes between radical cystectomy and trimodality therapy for select patients with muscle-invasive bladder cancer. These results support that trimodality therapy, in the setting of multidisciplinary shared decision making, should be offered to all suitable candidates with muscle-invasive bladder cancer and not only to patients with significant comorbidities for whom surgery is not an option. (https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00170-5/fulltext).
Here is an economic analysis using Medicare database to describe trends in radiation oncology reimbursement at free standing clinics over the past decade. Specifically it looked at reimbursements for 16 common head and neck, breast, prostate, lung, and palliative radiation courses. To no surprise, from 2010 to 2020 the inflation-adjusted average reimbursement notably decreased for all 16 analyzed courses. The most jaw-dropping was IMRT courses that saw a 38-39% decrease in reimbursement over this decade alone. (https://www.practicalradonc.org/article/S1879-8500(23)00120-0/fulltext).
The Society for Women in Radiation Oncology (SWRO) has published an official statement imploring all medical and physics residency programs to explicitly offer the allowed 12 weeks of family leave to all birthing and non-birthing new parents in training without extending overall training time. Ideally, this would be paid without the use of vacation or sick days and coupled with well-publicized lactation policies and subsidized child care options. Find the article here (https://www.redjournal.org/article/S0360-3016(22)03675-6/fulltext).
In this interesting double-blind randomized trial, patients seen at an outpatient oncology palliative care clinic preferred question prompt sheets to general information sheets, which makes sense as it prompts engagement and individualized patient-led discussions.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804389
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