Rapid in-field failures following adjuvant radiation for buccal squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: Squamous cell carcinoma originating in the buccal mucosa and retromolar trigone (RMT) have historically poor outcomes. Difficulties in discriminating tumor origin often result in these subsites being combined in surgical and pathological reports. We aimed to determine if making this anatomical distinction has implications for treatment design and clinical outcomes. STUDY DESIGN: Retrospective case series. METHODS: We identified 27 tumors from either the buccal mucosa patients or RMT patients who underwent surgery followed by radiation. For patients who developed a local failure, we fused the pretreatment imaging, simulation computed tomography, and follow-up imaging to determine the location of failures relative to the radiation field. We calculated the 2-year locoregional control and 2-year disease-free survival. RESULTS: The median time from surgery to radiation was 50 days (range, 32-133 days). The 2-year locoregional control for buccal mucosa versus RMT, respectively, were 35.9% versus 68.4% (P = .252). The 2-year disease-free survival rates were 32.7% versus 68.4%, respectively (P = .196). The median times to failure were 12.00 months (range, 4.9-115.0 months) versus 18.5 months (range, 4.5-61.0 months), respectively. All buccal mucosa failures occurred within the high-dose planning target volume, with a median dose of 60 Gy within the failure region. Following locoregional failure, 10 of the 12 patients have died, with a median time from local failure to death of 3.6 months (range, 1-17.6 months). CONCLUSIONS: Squamous cell carcinomas of the buccal mucosa appear to have a poor prognosis characterized by rapid in-field failure. Therefore, differentiating tumor origin may be important for prognostication and treatment. LEVEL OF EVIDENCE: 3 Laryngoscope, 130:413-417, 2020.

Stereotactic body radiation therapy for centrally located hepatocellular carcinoma: outcomes and toxicities.

PURPOSE: To examine safety and efficacy of stereotactic body radiation therapy (SBRT) for centrally located hepatocellular carcinoma (CL-HCC). METHODS: Fifty-three patients with CL-HCC were treated with SBRT from 2011 to 2017 in our institution. CL-HCC was defined as a tumor sited in segments 4, 5, or 8 adjacent to the hepatic hilum, or < 1.5 cm from main portal branches. Primary endpoints were treatment response, local control (LC), and hepatobiliary toxicity (HBT). RESULTS: Thirty-three (62.3%) patients had Child-Turcotte-Pugh score A, 20 (37.77%)-score B. Albumin-bilirubin grade 1 constituted 6 (11.3%) cases, grade 2-32 (60.4%), grade 3-15 (28.3%). Median tumor diameter was 34 mm. Median BED10 was 72 Gy. Complete/partial response was observed in 40 (75.5%) lesions, stable disease-in 9 (17.0%). At a median follow-up of 12.2 months, there were 6 (11.3%) local failures. The actuarial 2-year LC rate was 87.9%. 2-year LC was better with higher BED10 (> 70 vs ≤ 70 Gy) 96.9 vs 72.5%, p = 0.01. The 2-year rates for disease-specific and overall survival were 53.2 and 39.1%, respectively. The incidence of any Grade ≥ 3 AE was 9 (17.0%). There were no grade 5 AEs. There was a trend toward an increased risk of grade ≥ 3 AE with mean liver dose > 10 Gy (p = 0.07). CONCLUSIONS: In the present cohort, SBRT to the CL-HCC produced excellent treatment response with acceptable HBT and LC. Select HCC patients who are not candidates for surgery or other locoregional therapies can be considered for SBRT to the central liver.

Stereotactic body radiation therapy for stage I non-small cell lung cancer: a small academic hospital experience.

PURPOSE/OBJECTIVE(S): Stereotactic body radiation therapy (SBRT) has been shown to have increased local control and overall survival relative to conventional external beam radiation therapy in patients with medically inoperable stage I non-small cell lung cancer (NSCLC). Excellent rates of local control have been demonstrated both in clinical trials and in single-center studies at large academic institutions. However, there is limited data on the experiences of small academic hospitals with SBRT for stage I NSCLC. The purpose of this study is to report the local control and overall survival rates in patients treated with SBRT for stage I NSCLC at Winthrop-University Hospital (WUH), a small academic hospital. MATERIALS/METHODS: This is a retrospective review of 78 stage I central and peripheral NSCLC tumors treated between December 2006 and July 2012 with SBRT at WUH. Treatment was given utilizing fiducials and a respiratory tracking system. If the fiducials were not trackable, a spine tracking system was used for tumor localization. CT-based planning was performed using the ray trace algorithm. Treatment was delivered over consecutive days to a median dose of 4800 cGy delivered in four fractions. The Kaplan-Meier method was used to calculate local control and overall survival. RESULTS: The median age was 78.5 years. Fifty-four percent of the patient population was female. Sixty seven percent of the tumors were stage IA, and 33% of the tumors were stage IB. Fifty-three percent of the tumors were adenocarcinomas and 29% were squamous cell carcinomas, with the remainder being of unknown histology or NSCLC, not otherwise specified The 2-year local control rate was 87%, and the 2-year overall survival was 68%. CONCLUSION: Our findings support that local control and overall survival at a small academic hospital are comparable to that of larger academic institutions' published experiences with SBRT for stage I NSCLC.