Faculty Bibliography

OBJECTIVE:Acinic cell carcinoma (AciCC) is a rare, usually low-grade salivary malignancy. Evidence on rates of lymph node metastases (LNMs) is limited in pediatric patients and varies significantly (4%-45%) in adults. We set out to determine and compare rates of LNMs in pediatric and adult AciCC and to analyze their impact on survival, using the National Cancer Database. STUDY DESIGN/METHODS:Historical cohort study. SETTING/METHODS:National Cancer Database. METHODS:All AciCCs of the major salivary glands with complete clinical and pathologic nodal staging were selected between 2010 and 2016. Patient demographics, tumor characteristics, treatment, and survival were analyzed. Univariable and multivariable regression were performed to determine factors associated with LNMs and survival. RESULTS:< .001) were associated with LNM in adult patients. CONCLUSION/CONCLUSIONS:LNMs in AciCC of the major salivary glands are rare in children and adults. However, high-grade and T3-T4 tumors are associated with an increased risk of LNM. LNM is associated with worse survival.

OBJECTIVE:Sinonasal cancer often presents as locoregionally advanced disease. National guidelines recommend management of stage T4b tumors with systemic therapy and radiotherapy, but recent studies suggest that including surgical resection in the multimodal treatment of these tumors may improve local control and survival. We queried the National Cancer Database to examine patterns of care and outcomes in T4b sinonasal squamous cell carcinoma (SCC). STUDY DESIGN/METHODS:Prospectively gathered data. SETTING/METHODS:National Cancer Database. METHODS:Patients with T4b N0-3 M0 sinonasal squamous cell carcinoma diagnosed in 2004 to 2016 were stratified between those who received chemoradiotherapy and those who underwent surgical resection with neoadjuvant or adjuvant treatment. The overall survival of each cohort was assessed via Kaplan-Meier analysis and Cox proportional hazard models, with repeat analysis after reweighting of data via inverse probability of treatment weighting. RESULTS:= .004]). CONCLUSION/CONCLUSIONS:Surgical treatment with neoadjuvant or adjuvant treatment for stage T4b sinonasal SCC was associated with promising survival outcomes, suggesting a role for incorporating surgery in treatment of select T4b SCC, particularly when removal of all macroscopic disease is feasible.

PURPOSE/OBJECTIVE(S): Lacrimal gland cancer is a rare tumor with little data regarding outcomes and optimal management. We performed a large database analysis using the National Cancer Database (NC

PURPOSE/OBJECTIVE(S): Remote training programs have been shown as a cost-effective way to bridge education and training gaps for radiation oncology providers in low- and middle-income countries (LMICs) and could be used to improve contouring skill. Given the expansion of 3D and intensity-modulated radiotherapy and high interest in contouring training in the Philippines, we seek to measure and report the efficacy of a pilot head and neck contouring curriculum. MATERIALS/METHODS: A 13-week, 13-session remote training program on head and neck contouring and plan evaluation was provided at no cost to 8 participating radiation oncology residency programs in the Philippines. The program consisted of weekly 1-hour live video conferencing sessions with interactive didactics and case-based learning through a cloud-based contouring platform. Resident participants were assigned a pre-curriculum and a post-curriculum stage T3N2M0 oropharynx cancer case with 27 OARs. The cases were respectively rated as 2.67/5 and 3.83/5 in difficulty by 6 U.S. educator head and neck radiation oncologists involved in the curriculum. Participants self-rated their confidence in their performance according to a 1-5 Likert scale at the time of each submission regarding three categories: organs at risk (OARs), nodal contouring, and primary target contouring. A team of 4 educators later independently graded contours, according to a 1-5 grading rubric for the same three categories. Cases received 1-2 grades total, which were averaged for analysis. Contour submission was required for a certificate of participation, however no incentives for higher scores were provided.
RESULT(S): 41 residents in the Philippines (10 R1, 12 R2, 11 R3, and 9 R4) participated in the curriculum. Average participation per session was 26 (range 12-39, SD=7.2). 26 (63.4%) participants completed pre-contours for evaluation and 17 (41.5%) post-contours for evaluation. Of these, 14 participants were eligible for paired pre- vs. post-curriculum analysis. Paired pre- and post-curriculum confidence scores (out of 5) were 3.0 and 3.77 for OARs (P=0.003), 3.08 and 3.54 for nodal stations (P=0.056), and 2.85 and 3.31 for primary target contouring (P=0.027), respectively. Overall confidence in contouring the assigned case rose from 2.85 to 3.54 (P < 0.001). Paired pre- and post-curriculum educator grades were 2.96 and 3.38 for OARs (P=0.135), 2.61 and 1.96 for nodal coverage (P=0.019), and 2.54 and 2.73 for primary target contours (P=0.292), respectively. Qualitative observations included greater participant uniformity of left and right parotid glands.
CONCLUSION(S): Longitudinal telehealth training integrating cloud-based tools for radiation oncology professionals is a viable and scalable method for providing head and neck contouring education in a LMIC setting. Our findings suggest that work remains to assess the concordance of confidence with performance, especially in challenging cases, and that further contouring education is needed in LMIC regions.
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PURPOSE/OBJECTIVE:To examine the role age plays in the treatment and prognosis of locally advanced head and neck cancer (LAHNC) treated definitively with radiation alone or combined modality therapy. METHODS:A retrospective analysis was performed of three NRG/RTOG trials examining either radiation alone or combined radiation and systemic therapy for LAHNC. The effect of age (≥70 yrs.) on cause-specific survival (CSS), overall survival (OS), and toxicity was evaluated. RESULTS:A total of 2688 patients were analyzed, of whom 309 patients (11.5%) were ≥ 70. For all studies combined, the hazard ratio (HR) for CSS for patients age ≥ 70 vs. those <70 was 1.33 (95%CI: 1.14-1.55, p < 0.001). For OS, the HR for patients age ≥ 70 vs. those <70 for all studies combined was 1.55 (95% CI 1.35-1.77, p < 0.001). After adjustment for all covariates, age ≥ 70 was associated with worse OS regardless of adjustment for smoking and p16 status. The survival difference was more pronounced in those receiving combined radiation and systemic therapy. Hematologic and renal toxicities were increased in combined modality trials in patients ≥70 years old. CONCLUSIONS:Patients age ≥ 70 with LAHNC were underrepresented in these clinical trials. Their CSS and OS proved inferior to patients <70 years old.