Faculty Bibliography

Purpose: Obesity is an established risk factor for many types of cancer. While obesity has been linked to worse long-term outcomes among patients with breast and colorectal cancer, the relationship of body mass index (BMI) and adrenocortical carcinoma (ACC) remains ill-defined. Since ACC can express adipokine and estrogen receptors, the impact of BMI on outcomes in this patient population is important. We sought to define the association of BMI on ACC clinical and biologic factors, as well as long-term survival. Methods: Data was obtained on 187 patients who underwent surgery for ACC at 13 institutions for whom BMI data were available. Patients were stratified according to the WHO classification of BMI: BMI<25, 25-29.9, 30-34.9, 35-39.9 and >=40. Demographics, tumor biology, management strategies and clinical outcomes were assessed relative to BMI category. Categorical data were analyzed by Fisher's exact test, while continuous variables were analyzed by ANOVA model; disease-free and overall survival were analyzed by Kaplan-Meier survival curves. Results: Mean BMI was 29.5, with a range of 19 to 69. Patient age was comparable among all BMI groups (p=0.9917). Patient sex (p=0.0079) and race (p=0.0373) varied by BMI category. Mean tumor size was 12.1 cm and mean tumor weight was 875 grams, which was similar in all BMI groups. AJCC stage (Stage I: n=12; Stage II: n=62; Stage III: n=47; and Stage IV: n=48) and ENSAT stage (Stage I: n=12; Stage II: n=62; Stage III: n=72; and Stage IV: n=23) did not vary by BMI. BMI tended to be associated with mean mitotic rate (BMI<25: 12.4; 25-29.9: 14.2; 30-34.9: 21.0; 35-39.9: 33.8 and >=40: 8.7; p=0.0773) and percent lymphatic invasion (BMI<25: 37%; 25-29.9: 68%; 30-34.9: 60%; 35-39.9: 67% and>=40: 44%; p=0.0818). In addition, R0 resection rate differed by BMI group (BMI<25: 68%; 25-29.9: 76%; 30-34.9: 50%; 35-39.9: 27% and >=40: 71%; p=0.0029). BMI was not associated with disease-free interval or overall survival. Conclusion: Increased BMI was associated with ACC tumor characteristics but did not affect disease-free or overall survival in our cohort. Further studies are needed to evaluate whether the endocrine effect of lipocytes influences ACC pathology

Background: Incidence and prevalence of idiopathic pulmonary fibrosis (IPF) from electronic databases without case confirmation may be inaccurate. Objectives: Assess the positive predictive value (PPV) of claims-based algorithms to identify IPF and estimate its incidence and prevalence in the US. Methods: We developed two algorithms to identify IPF cases 50 years of age or older in the HealthCore Integrated Research DatabaseSM from 2006 to 2012. One algorithm was developed to be sensitive and the other specific. Medical records were reviewed to determine the PPV of each algorithm and measure the corrected incidence and period prevalence of IPF as identified by the sensitive algorithm. Results: We identified 4,598 patients using the sensitive algorithm and 2,052 (44.6%) patients using the specific algorithm. After medical record review, the PPV of the sensitive and specific algorithms were 40.0% (95% CI 26.4-54.8) and 56.1% (95% CI 43.3-68.3). PPV was higher in patients over the age of 65 years. The incidence and prevalence of IPF identified by the sensitive algorithm and confirmed by chart review were 12.7 per 100,000 person-years and 50.1 per 100,000 persons respectively. Incidence and prevalence of IPF Conclusions: The low PPV of the sensitive algorithm confirmed that non-validated case-finding approaches overestimate the incidence and prevalence of IPF. A revised specific algorithm with improved PPV is needed. (Table Presented)

AIM: To evaluate the locoregional control and treatment toxicity of patients with pleomorphic adenoma after resection with close or positive margins followed by postoperative radiation therapy (PORT). PATIENTS AND METHODS: Between 2002 and 2011, twenty-one patients underwent PORT at the Mount Sinai Beth Israel Medical Center for pleomorphic adenoma of the parotid with close or positive margins. Four out of the 21 patients (19%) had recurrent lesions. The median dose was 57.6 Gy (range 55.8-69.96) delivered at 1.8-2.12 Gy/fraction. Treatment and follow-up data were retrospectively analyzed for locoregional control as well as acute- and late-treatment toxicities. Actuarial survival analysis was also performed. RESULTS: Twelve women and 9 men with a median age of 46 (26-65) at PORT were included in this study. Eighty-one percent of the cohort had positive resection margins while 19% had close margins. At a median follow-up of 92 months, 19/21 patients (90%) had locoregional control. Two patients who failed had primary lesions which recurred locally, and initially had positive margins. The two recurrences occurred at 8 months and 12 months. Acute Radiation Therapy Oncology Group (RTOG) grade 1 and 2 toxicities were experienced by 11 (52%) and 4 (19%) patients, respectively, while 2 (10%) experienced late RTOG grade 1 toxicities. No patients experienced any grade 2-4 late toxicities. Actuarial survival was 100%. CONCLUSION: PORT for patients with pleomorphic adenoma of the parotid gland after resection with close or positive margins results in excellent locoregional control and low treatment-related morbidity.

Concomitant chemoradiotherapy provides organ preservation for those patients with head and neck cancer. We report the results of a prospective study that examined functional outcomes and quality of life (QOL) after chemoradiotherapy over the first 6 months post-treatment (tx). Twenty-nine patients with head and neck cancer were treated with chemoradiotherapy. All were seen baseline and 3 and 6 months post-tx. Assessments included the performance status scale (PSS), Karnofsky performance status scale, tongue strength, jaw opening, and saliva weight. QOL was patient-rated using the eating assessment tool (EAT-10), MD Anderson dysphagia inventory, speech handicap index (SHI), and the EORTC H&N35 scale. Repeated-measures ANOVAs were used, with significance at p < 0.05. PSS scores were significantly different across time points. Tongue strength, jaw range of motion (ROM), and saliva weight were significantly lower at 3 and 6 months than at baseline. QOL was significantly worse after tx, although it improved by 6 months as rated with the EAT-10 and the SHI scores were significantly worse at 3 and 6 months. EORTC domains of swallowing, senses, speech, dry mouth, and sticky saliva were significantly worse at 3 and 6 months. Concomitant chemoradiotherapy for treatment of head and neck tumors can result in impaired performance outcomes and QOL over the first 6 months post-tx. However, performance status, tongue strength, jaw ROM, and eating QOL were only mildly impaired by 6 months post-tx. Saliva production and speech QOL remained significantly impaired at 6 months post-treatment. Current studies are examining outcomes at 12 and 24 months post-treatment to better predict outcomes over time in this population.

PURPOSE: To retrospectively review our single institution experience of patients with tonsillar squamous cell carcinoma. MATERIAL AND METHODS: Between 1999 and 2005, a total of 79 patients were identified. Stage distribution was as follows: stages I-II, III, IVA, and IVB were in 6, 14, 43, and 16 patients, respectively. Sixty-three patients (80%) were male. Median age was 55.5 years. Treatment generally consisted of external beam radiation therapy (RT) (median dose, 70 Gy), concomitant chemotherapy (CCRT) (cisplatin 100 mg/m on days 1, 22, and 43), and neck dissection (ND), and was administered as follows: stages I/II, 6 patients received RT alone; stages III/IVA, 20, 5, and 32 patients received RT alone, CCRT, and CCRT followed by ND, respectively; stage IVB, 9 and 7 patients received CCRT and CCRT plus ND, respectively. RESULTS: After a median follow-up of 56 months (range, 12 to 122 mo), the 5-year local control (LC), regional control (RC), distant control (DC), and overall survival (OS) by stage were as follows: stage I-II 100%, 100%, 100%, 100%; stage III-IVA 98%, 96%, 95%, and 88%; stage IVB 100%, 100%, 69%, and 66%, respectively. Among stage IVB patients, DC was significantly lower (P=0.01) and a trend toward lower OS was noted (P=0.08). Long-term percutaneous endoscopic gastrostomy dependence was noted in 3% of them who had received CCRT. The effect of both chemotherapy and ND on treatment outcomes was analyzed; in stage III/IVA patients treated with or without chemotherapy, LC was 97% and 100% (P=0.43); RC was 92% and 100%(P=0.27); and DC was 91% and 94% (P=0.92), respectively. In stage III/IVA, patients treated with CCRT with or without ND, RC was 100% and 88%, respectively (P=0.087). CONCLUSIONS: Primary radiotherapy with or without CCRT followed by ND provides excellent tumor control with acceptable toxicity in treating squamous cell carcinoma of the tonsil.