Does the non-native Harlequin ladybird disrupt the feeding behaviour of the native two-spot ladybird?

Since its arrival in 2004, the non-native Harlequin ladybird Harmonia axyridis (Coleoptera: Coccinellidae) has rapidly spread throughout Britain, and it is now the most common coccinellid in England. There have since been concerns about the detrimental effects it may have on native coccinellids because there is a strong correlation between the arrival of H. axyridis and the decline in native species, including the two-spot ladybird, Adalia bipunctata. However, there have been few studies of the behavioural interactions between these two species, which occupy a high-niche overlap. This study investigated if the presence of H. axyridis impacts the feeding behaviour of A. bipunctata through direct competition for aphid prey. Foraging and interactive behaviour of A. bipunctata and H. axyridis were investigated within microcosms. Adalia bipuncata exhibited a similar consumption rate and time in the presence of H. axridis, yet H. axyridis consumed 3.5 times more prey items and were seven times faster compared to A. bipuncata. Observations showed that H. axyridis does not directly disrupt the feeding behaviour of A. bipunctata, but rather indirectly excludes the native species through being a superior competitor for prey items. Results indicate that the decline in native coccinellid species may be a consequence of H. axyridis competitive advantage, but that the concept of coexistence should not be dismissed.

Field specific monitoring of cereal yellow dwarf virus aphid vectors and factors influencing their immigration within fields

BACKGROUND

Neonicotinoid insecticide seed treatments were withdrawn from use on cereal crops in the European Union (EU) in 2018 exposing the crops to yellow dwarf viruses transmitted by cereal aphids. To reduce prophylactic pyrethroid sprays there is a need for easier, field-specific monitoring techniques given that pest incidence is spatially and temporally highly sporadic. A field-specific monitoring method based on the use of yellow sticky traps mounted horizontally just above the crop was developed and evaluated to determine: (i) predictive capabilities of the sticky trap system, (ii) practicalities of use by farmers and agronomists, and (iii) whether landscape composition, boundary type and type of tillage affect immigration of aphid vectors.

RESULTS

Yellow sticky traps effectively sampled winged cereal aphids and identified spatial differences in immigration patterns within- and between fields. Farmers and agronomist's aphid identification skills need improving, although they could detect aphid trends with minimal training. At least three times more cereal aphids were captured in crop headlands, especially next to taller field boundaries indicating that wind currents determined aphid immigration patterns within fields. Considerable between field aphid immigration was detected (24% of fields had no aphid immigration) even on the same farm. Levels of immigrating grain aphids were positively related to the proportion of grassland in the landscape. Tillage type had no impact on levels of immigrating aphids.

CONCLUSION

Field-based monitoring and different management of headland areas could be used to reduce insecticide usage when controlling of cereal/barley yellow dwarf virus.

Smoking history and cessation discussions in cancer patients receiving definitive radiotherapy: Do we treat all patients equally?

INTRODUCTION

Tobacco is recognized as a causative agent for head and neck (H&N) and lung cancers, but not for cancers of the prostate or breast. Still, tobacco use during radiotherapy has been associated with poorer outcomes for all four of these commonly treated malignancies. We sought to evaluate if our providers record smoking history and discuss cessation as frequently for prostate and breast cancers as for H&N and lung cancers.

METHODS

Initial consultation notes of 592 non-metastatic patients seen from January 2014 through June 2017 were reviewed using the electronic medical record. Descriptive statistics were used to evaluate smoking history and cessation discussions. The chi-squared test was used to compare frequencies. We chose two cancer sites commonly associated with tobacco use and causation (H&N and lung) and two sites not commonly associated (prostate and breast).

RESULTS

Prostate cancer patients were less likely to have smoking history recorded (65%) than breast (91%), H&N (96%) or lung (97%) patients (p<0.0001). Breast and prostate cancer patients were less likely to be current smokers (10%) than H&N and lung cancer patients (29%) (p<0.0001). Smoking cessation discussions were less frequently documented in breast and prostate cancer patients (14%) than in H&N and lung cancer patients (55%) (p=0.0005).

CONCLUSIONS

We document smoking history less frequently for prostate cancer patients than H&N, lung or breast cancer patients. Breast and prostate cancer patients have lower rates of current smoking than H&N and lung cancer patients. We document smoking cessation discussions less frequently in current smoking breast and prostate cancer patients than current smoking H&N and lung cancer patients. As all of these patients have been shown to experience poorer outcomes when smoking during radiotherapy, all should be asked about their smoking history.

Targeting MerTK Enhances Adaptive Immune Responses After Radiation Therapy

PURPOSE

The role of MerTK, a member of the Tyro3-Axl-MerTK family of receptor tyrosine kinase, in the immune response to radiation therapy (RT) is unclear. We investigated immune-mediated tumor control after RT in murine models of colorectal and pancreatic adenocarcinoma using MerTK wild-type and knock-out hosts and whether inhibition of MerTK signaling with warfarin could replicate MerTK knock-out phenotypes.

METHODS AND MATERIALS

Wild-type and MerTK^-/- BALB/c mice were grafted in the flanks with CT26 tumors and treated with computed tomography guided RT. The role of macrophages and CD8 T cells in the response to radiation were demonstrated with cell depletion studies. The role of MerTK in priming immune responses after RT alone and with agonist antibodies to the T cell costimulatory molecule OX40 was evaluated in a Panc02-SIY model antigen system. The effect of warfarin therapy on the in-field and abscopal response to RT was demonstrated in murine models of colorectal adenocarcinoma. The association between warfarin and progression-free survival for patients treated with SABR for early-stage non-small cell lung cancer was evaluated in a multi-institutional retrospective study.

RESULTS

MerTK^-/- hosts had better tumor control after RT compared with wild-type mice in a macrophage and CD8 T cell-dependent manner. MerTK^-/- mice showed increased counts of tumor antigen-specific CD8 T cells in the peripheral blood after tumor-directed RT alone and in combination with agonist anti-OX40. Warfarin therapy phenocopied MerTK^-/- for single-flank tumors treated with RT and improved abscopal responses for RT combined with anti-CTLA4. Patients on warfarin therapy when treated with SABR for non-small cell lung cancer had higher progression-free survival rates compared with non-warfarin users.

CONCLUSIONS

MerTK inhibits adaptive immune responses after SABR. Because warfarin inhibits MerTK signaling and phenocopies genetic deletion of MerTK in mice, warfarin therapy may have beneficial effects in combination with SABR and immune therapy in patients with cancer.

Elective Nodal Irradiation for Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Practice Patterns

BACKGROUND

Traditionally, elective nodal irradiation (ENI) has been used in clinical trials that have established thoracic radiotherapy as instrumental in improving survival for patients with limited-stage small-cell lung cancer (LS-SCLC). However, several reports have suggested that the omission of ENI might be appropriate. Current US practice patterns are unknown regarding ENI for patients with LS-SCLC.

MATERIALS AND METHODS

We surveyed US radiation oncologists via an institutional review board-approved questionnaire. The questions covered demographics, treatment recommendations, and self-assessed knowledge of key clinical trials. χ² and Cochran-Armitage tests were used to evaluate for statistically significant correlations between responses.

RESULTS

We received 309 responses. Of the respondents, 21% recommended ENI for N0 LS-SCLC, 29% for N1, and 30% for N2; 64% did not recommend ENI for any of these clinical scenarios. The respondents who recommended ENI were more likely to have been practicing for > 10 years (P < .001), more likely to be in private practice (P = .04), and less likely to be familiar with the ongoing Cancer and Leukemia Group B 30610 trial (P = .04). Almost all respondents (93%) prescribed the same radiation dose to the primary disease and involved lymph nodes. When delivering ENI, 36% prescribed the same dose to the involved and elective nodes, and 64% prescribed a lower dose to the elective nodes.

CONCLUSION

Nearly two thirds of respondents did not recommend ENI, which represents a shift in practice. A recent large clinical trial that omitted ENI reported greater overall survival than previously reported and lower-than-expected radiation toxicities, lending further evidence that omitting ENI should be considered a standard treatment strategy.

A critical analysis of the potential for EU Common Agricultural Policy measures to support wild pollinators on farmland

Agricultural intensification and associated loss of high-quality habitats are key drivers of insect pollinator declines. With the aim of decreasing the environmental impact of agriculture, the 2014 EU Common Agricultural Policy (CAP) defined a set of habitat and landscape features (Ecological Focus Areas: EFAs) farmers could select from as a requirement to receive basic farm payments. To inform the post-2020 CAP, we performed a European-scale evaluation to determine how different EFA options vary in their potential to support insect pollinators under standard and pollinator-friendly management, as well as the extent of farmer uptake.A structured Delphi elicitation process engaged 22 experts from 18 European countries to evaluate EFAs options. By considering life cycle requirements of key pollinating taxa (i.e. bumble bees, solitary bees and hoverflies), each option was evaluated for its potential to provide forage, bee nesting sites and hoverfly larval resources.EFA options varied substantially in the resources they were perceived to provide and their effectiveness varied geographically and temporally. For example, field margins provide relatively good forage throughout the season in Southern and Eastern Europe but lacked early-season forage in Northern and Western Europe. Under standard management, no single EFA option achieved high scores across resource categories and a scarcity of late season forage was perceived.Experts identified substantial opportunities to improve habitat quality by adopting pollinator-friendly management. Improving management alone was, however, unlikely to ensure that all pollinator resource requirements were met. Our analyses suggest that a combination of poor management, differences in the inherent pollinator habitat quality and uptake bias towards catch crops and nitrogen-fixing crops severely limit the potential of EFAs to support pollinators in European agricultural landscapes. Policy Implications. To conserve pollinators and help protect pollination services, our expert elicitation highlights the need to create a variety of interconnected, well-managed habitats that complement each other in the resources they offer. To achieve this the Common Agricultural Policy post-2020 should take a holistic view to implementation that integrates the different delivery vehicles aimed at protecting biodiversity (e.g. enhanced conditionality, eco-schemes and agri-environment and climate measures). To improve habitat quality we recommend an effective monitoring framework with target-orientated indicators and to facilitate the spatial targeting of options collaboration between land managers should be incentivised.

Approaches to Identify the Value of Seminatural Habitats for Conservation Biological Control

Invertebrates perform many vital functions in agricultural production, but many taxa are in decline, including pest natural enemies. Action is needed to increase their abundance if more sustainable agricultural systems are to be achieved. Conservation biological control (CBC) is a key component of integrated pest management yet has failed to be widely adopted in mainstream agriculture. Approaches to improving conservation biological control have been largely ad hoc. Two approaches are described to improve this process, one based upon pest natural enemy ecology and resource provision while the other focusses on the ecosystem service delivery using the QuESSA (Quantification of Ecological Services for Sustainable Agriculture) project as an example. In this project, a predictive scoring system was developed to show the potential of five seminatural habitat categories to provide biological control, from which predictive maps were generated for Europe. Actual biological control was measured in a series of case studies using sentinel systems (insect or seed prey), trade-offs between ecosystem services were explored, and heatmaps of biological control were generated. The overall conclusion from the QuESSA project was that results were context specific, indicating that more targeted approaches to CBC are needed. This may include designing new habitats or modifying existing habitats to support the types of natural enemies required for specific crops or pests.

Stop hedging your bets: reasons for non-adherence to a tri-modality regimen in the treatment of esophageal cancer in a multidisciplinary setting

Background

In locally-advanced esophageal cancer (LAEC), providers' concerns regarding eventual surgical candidacy can persuade physicians to defer to definitive doses of 50 Gy or higher preoperatively. We report the successful completion rate of tri-modality therapy (TMT) (documented at the outset) and reasons for TMT non-adherence at a large multi-disciplinary esophageal program.

Methods

LAEC patients diagnosed 2007-2016 from a prospective institutional database were subdivided into CRT/S+ [completed chemoradiation (CRT) and surgery] and CRT/S- (CRT and no subsequent surgery) groups. Chart review provided surgery non-adherence reasons.

Results

A total of 283 patients met planned TMT criteria: 164 (58.0%) patients received 50 or 50.4 Gy CRT, 27 patients (9.5%) received greater than 50.4 Gy, and 92 patients received less than 50 Gy (32.5%, only 8 patients received CRT to 41.4 Gy); 221 (78.1%) completed surgery (CRT/S+), while 62 (21.9%) failed to advance to surgery (CRT/S-): 25 of 62 CRT/S- patients (40.3%) evidenced metastatic progression before surgery, 4 (6.5%) were deemed unresectable intraoperatively, 4 (6.5%) expired prior to planned surgery (3 from unknown causes, 1 suicide), 8 (12.9%) experienced significant CRT-related medical decompensation and were withdrawn from surgical consideration, 16 (25.8%) voluntarily declined surgery post-CRT (largely due to long-term quality of life concerns), and 5 (8.1%) failed to advance for unknown reasons. Four of the 16 patients who voluntarily declined surgery after CRT received less than 50 Gy. The 22.2% of CRT/S+ patients achieved pathologic complete response (21.6% for adenocarcinoma and 29.0% for squamous cell carcinoma).

Conclusions

Our institution's 78% surgery completion rate among TMT-indicated patients highlights the benefits of upfront multidisciplinary care. Metastatic disease development most commonly truncated TMT with a low rate failing due to medical decompensation. Given the number of patients who voluntarily declined surgery following CRT, TMT counseling and involvement of a patient advocate are paramount prior to treatment planning.

Effects of land use on infestation and parasitism rates of cabbage seed weevil in oilseed rape

BACKGROUND

This study investigated how infestation rates of an important oilseed rape pest, the cabbage seed weevil (Ceutorhynchus obstrictus) and rates of parasitization by its parasitoids are affected by land use, up to 1000 m from 18 focal fields.

RESULTS

The mean proportion of C. obstrictus-infested pods per plant was 8% (2-19.5%). Infestation rates were higher if the adjacent habitat was a herbaceous semi-natural habitat than if it was either another crop or a woody habitat. Infestation rates were positively related to the area of herbaceous semi-natural vegetation, permanent grassland and wheat (which followed oilseed rape in the crop rotation) at a spatial scale of at least 1 km. The mean parasitism rate of C. obstrictus larvae was 55% (8.3-87%), sufficient to provide efficient biocontrol. Parasitism rates were unrelated to adjacent habitats, however, they were positively related to the presence of herbaceous linear elements in the landscape and negatively related to permanent grasslands at a spatial scale of 200 m.

CONCLUSION

Proximity of herbaceous elements increased both infestation rates and parasitism, while infestation was also related to landscape factors at larger distances. The findings provide an empirical basis for designing landscapes that suppress C. obstrictus, at both field and landscape scales. © 2018 Society of Chemical Industry.

Underutilization of the CROSS Regimen Among US Radiation Oncologists: A National Survey of Practice Patterns

AIM

To examine patterns of clinical practice in locally advanced esophageal cancer among US radiation oncologists after publication of the CROSS trial.

MATERIALS AND METHODS

US radiation oncologists were surveyed on 13 questions pertaining to the management of esophageal cancer. Respondents' demographics and their clinical rationale were analyzed for statistical association with their treatment recommendations.

RESULTS

Few respondents (15%) offered the CROSS regimen to patients considered suitable surgical candidates, while a near-equivalent number (16%) prescribed between 41.4 and 50.4 Gy contingent upon radiation planning parameters. Among respondents who prescribed 50.4 Gy, 50% and 17% reported concurrent administration of carboplatin/paclitaxel and cisplatin/5-FU, respectively. Higher radiation doses, over 50.4 Gy, were utilized by 15% and 38% of respondents for borderline surgical candidates and candidates unfit for surgery, respectively. The majority of respondents believed that higher complete pathological response and R0 resection would be achieved, as well as higher toxicity conferred using 50.4 Gy instead of 41.4 Gy. A clinical trial comparing 41.4 Gy to 50.4 Gy with concurrent carboplatin/paclitaxel was supported by 76% of respondents.

CONCLUSION

Despite results from the CROSS trial, the majority of responding US radiation oncologists do not offer 41.4 Gy with concurrent chemotherapy for surgically-fit patients with locally advanced esophageal cancer, believing that a higher dose will translate to improved response.

Radiation Dose and Fractionation for Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Practice Patterns

BACKGROUND

Thoracic radiotherapy (TRT) with concurrent chemotherapy is standard for limited-stage small-cell lung cancer (LS-SCLC). However, the optimal dosing and fractionation remain unclear. The National Comprehensive Cancer Network guidelines have recommended either 45 Gy delivered twice daily (BID) or 60 to 70 Gy delivered once daily (QD). However, the current practice patterns among US radiation oncologists are unknown.

MATERIALS AND METHODS

We surveyed US radiation oncologists using an institutional review board-approved questionnaire. The questions covered demographic data, self-rated knowledge of key trials, and treatment recommendations.

RESULTS

We received 309 responses from radiation oncologists. Of the 309 radiation oncologists, 60% preferred TRT QD and 76% acknowledged QD to be more common in their practice. The respondents in academic settings were more likely to endorse BID treatment by both preference (P = .001) and actual practice (P = .009). The concordance between preferring QD and administering QD in practice was 100%. In contrast, 40% of respondents who preferred BID actually administered QD more often. Also, 15% of physicians would be unwilling to switch from QD to BID and 3% would be unwilling to switch from BID to QD, even on patient request. Most respondents (88%) recommended a dose of 45 Gy for BID treatment. For QD treatment, the division was greater, with 54% recommending 60 Gy, 30% recommending 63 to 66 Gy, and 10% recommending 70 Gy.

CONCLUSION

Substantial variation exists in how US radiation oncologists approach TRT dosing and fractionation for LS-SCLC. Three quarters of our respondents reported administering TRT QD most often. The most common doses were 60 Gy QD and 45 Gy BID. The results of the present survey have provided the most up-to-date information on US practice patterns for LS-SCLC.

Timing of Thoracic Radiation Therapy With Chemotherapy in Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Current Practice Patterns

INTRODUCTION

For limited-stage small-cell lung cancer (LS-SCLC), National Comprehensive Cancer Network guidelines recommend that thoracic radiotherapy (TRT) be delivered concurrently with chemotherapy and early in the regimen, with cycle 1 or 2. Evidence is conflicting regarding the benefit of early timing of TRT. A Korean randomized trial did not see a survival difference between early (cycle 1) and late (cycle 3) TRT. Current United States (US) practice patterns are unknown.

MATERIALS AND METHODS

We surveyed US radiation oncologists using an institutional review board-approved online questionnaire. Questions covered treatment recommendations, self-rated knowledge of trials, and demographics.

RESULTS

We received 309 responses from radiation oncologists. Ninety-eight percent recommend concurrent chemoradiotherapy over sequential. Seventy-one percent recommend starting TRT in cycle 1 of chemotherapy, and 25% recommend starting in cycle 2. In actual practice, TRT is started most commonly in cycle 2 (48%) and cycle 1 (44%). One-half of respondents (54%) believe starting in cycle 1 improves survival compared with starting in cycle 3. Knowledge of the Korean trial was associated with flexibility in delaying TRT to cycle 2 or 3 (P = .02). Over one-third (38%) treat based on pre-chemotherapy volume.

CONCLUSION

US radiation oncologists strongly align with National Comprehensive Cancer Network guidelines, which recommend early concurrent chemoradiotherapy. Nearly three-quarters of respondents prefer starting TRT with cycle 1 of chemotherapy. However, knowledge of a trial supporting a later start was associated with flexibility in delaying TRT. Treating based on pre-chemotherapy volume-endorsed by over one-third of respondents-may add unnecessary toxicity. This survey can inform development of future trials.

Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer: Survey of US Radiation Oncologists on Current Practice Patterns

PURPOSE

Prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (LS-SCLC) is considered the standard of care. Meta-analysis of 7 clinical trials indicates a survival benefit to PCI, but all of these trials were conducted in the pre-magnetic resonance imaging (MRI) era. Therefore, routine brain imaging with MRI before PCI-as recommended by National Comprehensive Cancer Network guidelines-is not directly supported by the evidence. Current US practice patterns for patients with LS-SCLC are unknown.

MATERIALS AND METHODS

We surveyed practicing US radiation oncologists via an institutional review board-approved online questionnaire. Questions covered demographic information and treatment recommendations for LS-SCLC.

RESULTS

We received 309 responses from US radiation oncologists. Ninety-eight percent recommended PCI for patients with LS-SCLC, 96% obtained brain MRI before PCI, 33% obtained serial brain imaging with MRI after PCI to detect new metastases, and 35% recommended memantine for patients undergoing PCI. Recommending memantine was associated with fewer years of practice (P < .001), fewer lung cancer patients treated per year (P = .045), and fewer LS-SCLC patients treated per year (P = .024).

CONCLUSION

Almost all responding radiation oncologists recommended PCI and pre-PCI brain MRI for LS-SCLC patients with disease responsive to initial therapy. Only a third of respondents followed these patients with serial brain MRI. Approximately one third provided memantine therapy to try to limit neurocognitive effects of PCI. Further research is warranted to determine the best treatment for patients with LS-SCLC. This survey can inform the development of future trials that depend on participation from radiation oncologists.

The fine line between regional and metastatic pelvic lymph nodes in rectal cancer: Patterns of care among U.S. radiation oncologists

758

Background: Management of rectal cancer with involved lateral pelvic lymph nodes (LPLNs) at the time of diagnosis – the stage we refer institutionally to as Stage 3.5 – is controversial. Asian investigators consider internal, external and common iliac lymph nodes (LNs) as regional disease and treat these patients (pts) with curative intent, which often includes LPLN dissection. Conversely, AJCC 7thedition classifies internal iliac LNs as regional, whereas both external and common iliac LNs as metastatic. NCCN guidelines recommend definitive trimodality therapy for Stage III rectal cancer, and palliative chemotherapy for Stage IV disease. Radiation oncologists (ROs) in the U.S. irradiate iliac LNs in the setting of other pelvic malignancies, but it is unknown how they approach newly diagnosed rectal cancer pts with LPLN involvement. Methods: We conducted an anonymous IRB-approved online survey of practicing U.S. ROs, probing their approach to management of rectal cancer pts with clinically involved LPLNs. Results: We received 220 responses. Among the responders, 85 are academically affiliated and the majority self-declared a specialization in treating GI malignancies, with 98 seeing more than 10 rectal cancer pts annually. Among respondents, 10.5% and 34.2% recommend biopsy of clinically involved internal and common iliac LNs, respectively. The vast majority of responders – 98.6% and 94.5% – treat involved internal and common iliac LNs with curative intent, respectively. Respondents recommend treatment intensification to involved internal iliac LNs by dissection of the nodal basin (88.2%) and radiation therapy (RT) boost (59.1%), and treatment intensification to involved common iliac LNs by LN dissection (76.4%) and RT boost (63.6%). Conclusions: Our analysis reveals that the vast majority of surveyed U.S. ROs approach pts with involved LPLNs, both regional (internal iliac) and metastatic (i.e. common iliac) with curative intent. They recommend treatment intensification with surgical resection and/or RT boost to involved nodes. Prospective clinical trials need to determine the appropriate management of pts with Stage 3.5 rectal cancer.

Utilization of imaging modalities in the staging of newly diagnosed rectal cancer: A survey of U.S. radiation oncologists

564

Background: Accurate staging is crucial for management of patients (pts) with newly diagnosed rectal cancer. Endorectal ultrasound (EUS) has been a commonly used imaging modality for almost two decades, with magnetic resonance imaging (MRI) now preferred by national guidelines. Routine positron emission tomography (PET) is not recommended for initial staging. The current utilization of imaging modalities by radiation oncologists (ROs) in staging newly diagnosed rectal cancer pts in the United States is unknown. Methods: We conducted an anonymous IRB-approved online survey of practicing U.S. ROs. Respondent characteristics were tested for association with self-assessed utilization of imaging modalities using Chi-squared test. Staging 75% of more rectal cancer pts with a given modality was defined as high utilization. Results: We received 220 responses from practicing U.S. ROs. Among the responders, 85 are academically affiliated and the majority specialize in treating GI malignancies, with 98 seeing more than 10 rectal cancer pts annually. Most respondents utilize all three imaging modalities for rectal cancer staging - EUS, MRI and PET/CT. Fifty two percent and 38% of respondents are high utilizers of EUS and MRI, respectively. Nearly half (47%) of respondents are high PET utilizers. High utilization of PET was associated with practice in a private setting (p < 0.05) and being within 10 years from residency training completion (p < 0.05). Conclusions: Our analysis reveals a wide discordance between national guidelines and the practice patterns among U.S. ROs, with underutilization of MRI and overutilization of PET/CT. Substantial cost savings could be realized by following national guidelines recommendations to omit the routine use of PET/CT in the initial evaluation of pts with rectal cancer.

Massive hemorrhage following definitive esophageal chemoradiation: teaching case of a fatal aortoesophageal fistula and lessons learned

Esophageal self‐expandable metal stents and radiotherapy are valuable in combination for palliation and definitive treatment of esophageal cancer. However, risk of aortoesophageal fistula is significant in patients with evidence of malignant aortic invasion. Use of thoracic endovascular repair may represent an approach to early intervention in high‐risk patients.

Association of Intervals Between Neoadjuvant Chemoradiation and Surgical Resection With Pathologic Complete Response and Survival in Patients With Esophageal Cancer

Importance

Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) may be a clinical prognostic marker of superior outcomes. In patients with esophageal cancer, pCR is associated with increased survival. While mechanisms for increasing the likelihood of pCR remain unknown, in other solid tumors, higher rates of pCR have been associated with longer time intervals between CRT completion and surgical procedures.

Objective

To determine the association between time intervals from the completion of CRT to surgical procedure with rates of pCR in patients with esophageal cancer.

Design, Setting, and Participants

A prospectively maintained multidisciplinary foregut database was reviewed for consecutively enrolled patients with esophageal cancer from January 2000 to July 2015 presenting for surgical evaluation at a single National Cancer Institute-designated cancer center within a quaternary academic medical center.

Interventions

Included patients successfully completed neoadjuvant CRT followed by esophagectomy.

Main Outcomes and Measures

Rate of pCR by logistic regression based on a categorized time interval (ie, 0 to 42, 43 to 56, 57 to 70, 71 to 84, 85 to 98, and 99 or more days) from the completion of CRT to surgical resection, adjusted for clinical stage, demographic information, and CRT regimen.

Results

Of the 234 patients who met inclusion criteria, 191 (81.6%) were male, and the median (range) age was 64 (58-70) years; 206 (88.0%) were diagnosed as having adenocarcinoma, and 65 (27.9%) had a pCR. Patients in the 85 to 98-day group had significantly increased odds of a pCR compared with other groups (odds ratio, 5.46; 95% CI, 1.16-25.68; P = .03). No significant differences in survival were seen between time groups overall or among patients with residual tumor.

Conclusions and Relevance

This study suggests that a time interval of 85 to 98 days between CRT completion and surgical resection is associated with significantly increased odds of a pCR in patients with esophageal cancer. No adverse association with survival was detected as a result of delaying resection, even in patients with residual tumor.

Structure, function and management of semi-natural habitats for conservation biological control: a review of European studies

Different semi-natural habitats occur on farmland, and it is the vegetation's traits and structure that subsequently determine their ability to support natural enemies and their associated contribution to conservation biocontrol. New habitats can be created and existing ones improved with agri-environment scheme funding in all EU member states. Understanding the contribution of each habitat type can aid the development of conservation control strategies. Here we review the extent to which the predominant habitat types in Europe support natural enemies, whether this results in enhanced natural enemy densities in the adjacent crop and whether this leads to reduced pest densities. Considerable variation exists in the available information for the different habitat types and trophic levels. Natural enemies within each habitat were the most studied, with less information on whether they were enhanced in adjacent fields, while their impact on pests was rarely investigated. Most information was available for woody and herbaceous linear habitats, yet not for woodland which can be the most common semi-natural habitat in many regions. While the management and design of habitats offer potential to stimulate conservation biocontrol, we also identified knowledge gaps. A better understanding of the relationship between resource availability and arthropod communities across habitat types, the spatiotemporal distribution of resources in the landscape and interactions with other factors that play a role in pest regulation could contribute to an informed management of semi-natural habitats for biocontrol. © 2016 Society of Chemical Industry.

Preoperative carboplatin and paclitaxel-based chemoradiotherapy for esophageal carcinoma: results of a modified CROSS regimen utilizing radiation doses greater than 41.4 Gy

Trimodality therapy for resectable esophageal and gastroesophageal junction cancers utilizing preoperative radiotherapy with concurrent carboplatin and paclitaxel-based chemotherapy is being increasingly utilized secondary to the results of the phase III CROSS trial. However, there is a paucity of reports of this regimen as a component of chemoradiotherapy in North America. We aim to report on our clinical experience using a modified CROSS regimen with higher radiotherapy doses. Patients with advanced (cT2-cT4 or node positive) esophageal or gastroesophageal junction carcinoma who received preoperative carboplatin/paclitaxel-based chemoradiotherapy with radiation doses of greater than 41.4 Gray (Gy) followed by esophagectomy were identified from an institutional database. Patient, imaging, treatment, and tumor response characteristics were analyzed. Twenty-four patients were analyzed. All but one tumor had adenocarcinoma histology. The median radiation dose was 50.4 Gy. Pathologic complete response was achieved in 29% of patients, with all receiving 50.4 Gy. Three early postoperative deaths were seen, due in part to acute respiratory distress syndrome and all three patients received 50-50.4 Gy. With a median follow-up of 9.4 months (23 days-2 years), median survival was 24 months. Trimodality therapy utilizing concurrent carboplatin/paclitaxel with North American radiotherapy doses appeared to have similar pathologic complete response rates compared with the CROSS trial, but may be associated with higher toxicity. Although the sample size is small and further follow-up is necessary, radiation doses greater than 41.4 Gy may not be warranted secondary to a potentially increased risk of severe radiation-induced acute lung injury.

Image Guided Radiation Therapy (IGRT) Practice Patterns and IGRT's Impact on Workflow and Treatment Planning: Results From a National Survey of American Society for Radiation Oncology Members

PURPOSE

To survey image guided radiation therapy (IGRT) practice patterns, as well as IGRT's impact on clinical workflow and planning treatment volumes (PTVs).

METHODS AND MATERIALS

A sample of 5979 treatment site-specific surveys was e-mailed to the membership of the American Society for Radiation Oncology (ASTRO), with questions pertaining to IGRT modality/frequency, PTV expansions, method of image verification, and perceived utility/value of IGRT. On-line image verification was defined as images obtained and reviewed by the physician before treatment. Off-line image verification was defined as images obtained before treatment and then reviewed by the physician before the next treatment.

RESULTS

Of 601 evaluable responses, 95% reported IGRT capabilities other than portal imaging. The majority (92%) used volumetric imaging (cone-beam CT [CBCT] or megavoltage CT), with volumetric imaging being the most commonly used modality for all sites except breast. The majority of respondents obtained daily CBCTs for head and neck intensity modulated radiation therapy (IMRT), lung 3-dimensional conformal radiation therapy or IMRT, anus or pelvis IMRT, prostate IMRT, and prostatic fossa IMRT. For all sites, on-line image verification was most frequently performed during the first few fractions only. No association was seen between IGRT frequency or CBCT utilization and clinical treatment volume to PTV expansions. Of the 208 academic radiation oncologists who reported working with residents, only 41% reported trainee involvement in IGRT verification processes.

CONCLUSION

Consensus guidelines, further evidence-based approaches for PTV margin selection, and greater resident involvement are needed for standardized use of IGRT practices.

Significant understaging is seen in clinically staged T2N0 esophageal cancer patients undergoing esophagectomy

This study aimed to determine the impact of preoperative staging on the treatment of clinical T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy. We reviewed a retrospective cohort of 27 patients treated at a single institution between 1999 and 2011. Clinical staging was performed with computed tomography, positron emission tomography, and endoscopic ultrasound. Patients were separated into two groups: neoadjuvant therapy followed by surgery (NEOSURG) and surgery alone (SURG). There were 11 patients (41%) in the NEOSURG group and 16 patients (59%) in the SURG group. In the NEOSURG group, three of 11 patients (27%) had a pathological complete response and eight (73%) were partial or nonresponders after neoadjuvant therapy. In the SURG group, nine of 16 patients (56%) were understaged, 6 (38%) were overstaged, and 1 (6%) was correctly staged. In the entire cohort, despite being clinically node negative, 14 of 27 patients (52%) had node-positive disease (5/11 [45%] in the NEOSURG group, and 9/16 [56%] in the SURG group). Overall survival rate was not statistically significant between the two groups (P = 0.96). Many cT2N0 patients are clinically understaged and show no preoperative evidence of node-positive disease. Consequently, neoadjuvant therapy may have a beneficial role in treatment.

Cereal aphid colony turnover and persistence in winter wheat

An understanding of spatial and temporal processes in agricultural ecosystems provides a basis for rational decision-making with regards to the management and husbandry of crops, supporting the implementation of integrated farming strategies. In this study we investigated the spatial and temporal distribution of aphid pests (Sitobion avenae and Metopolophium dirhodum) within winter wheat fields. Using an intensive sampling programme we investigated distributions at both the small (single shoot) and large (field) scales. Within two fields, a grid with 82 locations was established (area 120 m by 168 m). At each location, 25 shoots were individually marked and aphid counts by observation conducted on 21 and 22 occasions as the crop matured, resulting in 43,050 and 45,100 counts being conducted in the two fields respectively. We quantified field scale spatial distributions, demonstrating that spatial pattern generally emerged, with temporal stability being both species- and field- dependent. We then measured turnover of colonies at the small (individual shoot) and large (field) scales by comparing consecutive pairs of sampling occasions. Four turnover categories were defined: Empty (no aphids recorded on either occasion); Colonised (aphids recorded on the second occasion but not the first); Extinction (aphids recorded on the first occasion but not the second); Stable (aphids recorded on both occasions). At the field scale, population stability soon established, but, at the small scale there was a consistently high proportion of unoccupied shoots with considerable colonisation and extinction and low stability. The redistribution of aphids within the crop at the local scale is a vulnerability which could be used to disrupt population development – by mediating exposure to ground-active natural enemies and by incurring a metabolic cost caused by the physiological demands to re-establish on a nearby host plant.

An oral cavity carcinoma nomogram to predict benefit of adjuvant radiotherapy

IMPORTANCE

After surgical resection for oral cavity squamous cell carcinoma, adjuvant radiotherapy may be recommended for patients at higher risk for locoregional recurrence, but it can be difficult to predict whether a particular patient will benefit.

OBJECTIVE

To construct a model to predict which patients with oral cavity squamous cell carcinoma would benefit from adjuvant radiotherapy.

DESIGN AND SETTING

We constructed several types of survival models using a set of 979 patients with oral cavity squamous cell carcinoma. Covariates were age, sex, tobacco use, stage, grade, margins, and subsite. The best performing model was externally validated on a set of 431 patients.

PARTICIPANTS

The model was based on a set of 979 patients with oral cavity squamous cell carcinoma, including 563 from Memorial Sloan Kettering Cancer Center, New York, New York, and 416 from the Hospital AC Camargo, São Paulo, Brazil. The validation set consisted of 431 patients from Princess Margaret Hospital, Toronto, Ontario, Canada.

MAIN OUTCOME AND MEASURE

The primary outcome measure of interest was locoregional recurrence-free survival.

RESULTS

The lognormal model showed the best performance per the Akaike information criterion. An online nomogram was built from this model that estimates locoregional failure-free survival with and without postoperative radiotherapy.

CONCLUSIONS AND RELEVANCE

A web-based nomogram can be used as a decision aid for adjuvant treatment decisions for patients with oral cavity squamous cell carcinoma.

Is neoadjuvant therapy beneficial in clinically staged T2N0 esophageal cancer?

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Background: The optimal treatment strategy for clinical stage T2N0 (cT2N0) esophageal cancer is poorly defined. The specific aims of this analysis were to determine the impact of neoadjuvant therapy (NAT) in cT2N0 esophageal cancer patients on overall survival, nodal metastasis, staging, and pathological complete responders (pCR) NAT. Methods: We reviewed a retrospective cohort of 27 patients with cT2N0 esophageal cancer at Oregon Health & Science University, an NCI-Designated Cancer Center from 1999 to 2011. All patients were staged pre-operatively using Endoscopic Ultrasound (EUS), CT +/- FDG-PET. Patients were identified into two cohorts: NAT followed by surgery and surgery alone. We compared overall survival between the cohorts using Kaplan-Meier analysis. Results: Eleven patients (41%) received NAT followed by surgery and sixteen patients (59%) underwent surgery alone. Minimal invasive esophagectomy and decreased length of stay (p < 0.05) were associated with the presence of neoadjuvant therapy. The difference in overall survival rate was not statistically significant between NAT and surgery alone groups (p = 0.96). Three of 11 patients (27%) had a pCR and 8 (73%) were partial or non responders after NAT. In the surgery only group, nine of 16 patients (56%) were understaged, 6 (38%) were overstaged and 1 (6%) was correctly staged. Despite being clinically node negative, 14/27 (52%) had node positive disease in both groups with 5/11 (45%) in NAT group and 9/16 (56%) in surgery group. Conclusions: The benefit of NAT in cT2N0 esophageal cancer patients remains unclear. However, our finding of significant clinical understaging and frequent positive nodes in clinically node negative patients suggests a clinical benefit to NAT for some cT2N0 patients before surgery. These observations support design of a prospective clinical trial to define the role of NAT in patients with cT2N0 esophageal cancer.

Overall survival (OS) and risk of distant failure among malignant salivary gland tumors (MSGTs) in a large single-institution registry cohort

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Background: MSGTs are rare, biologically diverse cancers. Registry data and large series suggest 5-year OS exceeding 50%, superior to historical data and attributed to postoperative radiation (pXRT). Hypothesizing OS has remained poor despite modern therapy, we reviewed our cancer registry (OHSUCR), which began collecting data on MSGTs in 1995. Methods: We interrogated the OHSUCR for pts with MSGTs (WHO classification) and obtained data on age, sex, race, AJCC stage, histology, primary site, surgery, pXRT. OS was estimated using the Kaplan Meier (KM) method. The log rank test was used to compare OS among pts treated with and without pXRT, and those diagnosed between 1995-2000, 2001-2005, and 2005-present. Results: 110 pts with MSGTs were entered into the OHSUCR from 5/1996 to 5/2011. The median age was 60 (range 10-90), 65 (59%) were male, and 106 (96%) were white. The primary site was: 101 (92%) parotid, 3 (3%) unspecified major salivary gland, 4 (3%) submandibular gland, and 2 (2%) minor salivary gland. MSGT histologies were: 41 (37%) mucoepidermoid carcinoma, 24 (22%) adenoid cystic carcinoma, 21 (19%) adenocarcinoma, 12 (11%) acinar cell carcinoma, 5 (4%) carcinoma ex pleomorphic adenoma, 3 (3%) epithelial-myoepithelial carcinoma, 1 (1%) undifferentiated carcinoma, 1 (1%) small cell carcinoma, 1(1%) salivary duct carcinoma, 1 (1%) carcinosarcoma. AJCC Stage was: I in 29, (26%) II in 20 (18%), III in 16 (15%), IV in 45 (41%). 102 (96%) underwent surgical resection, 73 (66%) pXRT. 89 (81%) pts were rendered disease free, although 23 (21%) eventually recurred, 20 in distant sites. At the time of analysis 57 (52%) pts were alive and disease free. With a median follow up of 30 months (range 1 to 165), the 5 year KM OS for the entire cohort is 46%. Median survival was not influenced by pXRT (p=0.93) or period of diagnosis (1995-2000, 2001-2005, or 2005-present; p=0.83). Conclusions: In this large single institution series, pts with MSGT remain at high risk for mortality despite routine administration of pXRT. Distant metastasis is the most common pattern of failure indicating a clear unmet need for improved systemic therapy for MSGTs.

Contralateral parotid volume as an objective marker for adaptive radiotherapy in head and neck cancer

5596^

Background: Deformable image registration simplifies the process of adaptive radiotherapy and allows for sophisticated dosimetric analyses of anatomic changes. Lacking is an objective measurement that could reliably predict for undesirable dosimetric changes during a course of radiotherapy. We analyzed daily changes in contralateral parotid volume and correlated these changes to mean dose delivered to the parotid gland over a course of radiotherapy in four patients. Methods: Daily cone-beam CT (CBCT) scans of four patients were imported into the MIM Maestro software. The simulation CT scan was registered to 35 daily CBCT’s per patient using a sequence of rigid and deformable registrations. Parotid contours were resampled and a deformed reconstruction of the planning CT was exported to the Eclipse treatment planning software. The CT reconstructions were extended superiorly and inferiorly and the original fluence map was re-computed on the reconstructions with the isocenter at daily treatment position. Mean dose percent change and mean volume percent change were calculated for all CBCT’s and averaged across all patients. Average mean dose percent change was plotted against average mean volume change and evaluated with simple regression analysis. Results: A mean of 31 CBCT’s per patient were evaluated. Contralateral parotid volume percent changes for all patients were -31%, -40%, -40%, and -22% with a mean percent change of -33%. Mean dose percent changes were 25%, 35%, 19%, and 25% with a mean percent change of 26% and a mean absolute dose increase to the parotids of 6.8 Gy. Simple regression analysis identified a coefficient of determination (R2) of 0.23 where the independent variable is volume percent change and the dependent variable is mean dose percent change. Conclusions: Daily or weekly volume assessment of critical volumes is feasible utilizing deformable image registration and CBCT. Our data suggests there may be a correlation between parotid volume changes and increases in mean parotid dose though no causality is inferred. This relationship could be useful as a simple objective volumetric threshold measurement to prompt adaptive re-planning and warrants further investigation.

Retrospective analysis of neoadjuvant chemoradiotherapy for esophageal cancer: The Knight Cancer Institute experience

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Background: Neoadjuvant chemoradiotherapy (NAT) followed by esophagectomy has been established as standard of care for early stage (II – III), resectable esophageal cancer (EC). Patients (pts) treated with NAT are more likely to be downstaged and have a complete (R0) resection. Additionally, pts with aggressive disease are more likely to progress during NAT and, consequently, avoid unnecessary surgery. The aim of the current report was to analyze the outcomes of trimodality therapy at the Knight Cancer Institute.

Methods: A retrospective study of 124 pts who underwent NAT followed by esophagectomy for EC from 1999-2010 at our institution was performed. All pts were initially staged by imaging (EUS, CT and/or PET imaging) prior to commencing treatment. After esophagectomy, pathological staging was compared to initial staging to determine the effect of NAT.

Results: There were 25 women and 99 men. Initial staging is shown in the table below. Patients received cisplatin, oxaliplatin or carboplatin with 5-FU plus concurrent radiotherapy (RT). RT total dose of 45 Gy to the tumor and regional nodes was given in 1.8 Gy daily fractions, followed by a boost to the tumor for final dose 50.4-54 Gy. 27 (21.8%) of the pts had a pathologic complete response. Additionally, 54 (43.6%) pts were downstaged by chemoradiation. Of the pts that had complete remission or were downstaged, pre-treatment clinical stage was Stage II (22 pts), Stage III (55 pts), and Stage IVa (4 pts).

Conclusions: NAT was effective in complete remission or downstaging of two-thirds (81) pts, including 4 pts that were initially unresectable (Stage IVa) and successfully underwent subsequent esophagectomy. As has been shown previously, NAT is effective for downstaging prior to esophagectomy making it more likely that pts will undergo R0 resection. This study also demonstrated that some pts with clinically unresectable tumors could undergo successful esophagectomy after NAT.

[Table: see text]

Individualized estimation of conditional survival for patients with head and neck cancer

Survival for cancer patients is usually only reported as survival from time of diagnosis. For patients who survive 1 or more years after diagnosis, however, survival probability changes over time and is more accurately depicted by conditional survival. The specific aim of this project was to build a survival regression model and Web-based tool to make individualized estimates of conditional survival for patients with head and neck cancer based on tumor and patient characteristics. Using data from the Surveillance, Epidemiology, and End Results (SEER) database, a prediction modeling tool was built that can estimate prognosis for patients with head and neck cancer who have already survived a period of time after diagnosis. Having more accurate prognostic information may empower both patients and clinicians to make more appropriate decisions regarding follow-up, surveillance testing, and future treatment.

Angiosarcoma developing after curative induction chemotherapy and radiotherapy for locally advanced squamous cell carcinoma of the larynx

BACKGROUND

Angiosarcoma arising after radiation is described in breast cancer but occurs elsewhere. Here, we present an angiosarcoma of the neck occurring after curative chemoradiation.

METHODS

This is a case of angiosarcoma developing 5 years after curative therapy for T3N0 squamous cell carcinoma of the supraglottic larynx. Therapy consisted of 3 cycles of induction cisplatin/5-fluorouracil chemotherapy followed by radiotherapy. The patient did well until developing a rapidly progressive lesion of the left neck. Examination showed a 7-cm mass and biopsy revealed angiosarcoma. CT scans assessed the local extent of the tumor and ruled out metastatic disease prior to initiating therapy.

RESULTS

Therapy consisted of 4 cycles of paclitaxel chemotherapy. At completion, examination revealed mild induration of the neck with near-complete resolution of the mass. Imaging confirmed this excellent response.

CONCLUSION

This rare therapy-related second malignancy developed after curative larynx-preserving treatment. Paclitaxel was an effective therapy in this setting.

Open-label, long-term safety study of cevimeline in the treatment of postirradiation xerostomia

PURPOSE

To assess the safety of long-term cevimeline treatment of radiation-induced xerostomia in patients with head-and-neck cancer; and to assess the efficacy of cevimeline in these patients.

METHODS AND MATERIALS

A total of 255 adults with head-and-neck cancer who had received more than 40 Gy of radiation 4 months or more before entry and had clinically significant salivary gland dysfunction received cevimeline hydrochloride 45 mg t.i.d. orally for 52 weeks. Adverse events (AEs), their severity, and their relationship to the study medication were assessed by each investigator. The efficacy assessment was based on subjects' global evaluation of oral dryness on a scale of 0 (none) to 3 (severe).

RESULTS

Overall, 175 subjects (68.6%) experienced expected treatment-related AEs, most mild to moderate. The most frequent was increased sweating (47.5%), followed by dyspepsia (9.4%), nausea (8.2%), and diarrhea (6.3%). Fifteen subjects (5.9%) experienced Grade 3 treatment-related AEs, of which the most frequent was increased sweating. Eighteen subjects (7.1%) reported at least one serious AE, and 45 subjects (17.6%) discontinued study medication because of an AE. The global efficacy evaluation at the last study visit showed that cevimeline improved dry mouth in most subjects (59.2%). Significant improvement was seen at each study visit in the mean change from baseline of the numeric global evaluation score (p < 0.0001).

CONCLUSIONS

Cevimeline 45 mg t.i.d. was generally well tolerated over a period of 52 weeks in subjects with xerostomia secondary to radiotherapy for cancer in the head-and-neck region.

Spatio-temporal distribution and emergence of beetles in arable fields in relation to soil moisture

Predatory beetles contribute to the control of crop pests and are an important food resource for farmland birds. Many of these beetle species overwinter as larvae within agricultural soils, however, their spatio-temporal emergence patterns are poorly understood, even though such knowledge can assist with their management for biocontrol. Soil moisture is considered to be a key factor influencing oviposition site selection and larval survival. The time, density and spatial pattern of Carabidae and Staphylidae emergence was therefore measured across two fields and compared to soil moisture levels in the previous winter and adult distribution in the previous July. The mean density of Carabidae and Staphylidae that emerged between April and harvest within each field was 157 and 86 m-2, indicating that soils are an important over-wintering habitat for beneficial invertebrates and should be managed sympathetically if numbers are to be increased. Of the species that were sufficiently numerous to allow their spatial pattern to be analysed, all showed a heterogeneous emergence pattern, although patches with high emergence were stable over the sampling period. The distribution of eight species was influenced by soil moisture levels in the previous winter and eight species, although not the same, were spatially associated with the distribution of adults in the previous summer suggesting that the females selected oviposition areas with the appropriate soil wetness.

Radiation therapy for gastrointestinal cancer

This article has reviewed the current role of radiation in the treatment of gastrointestinal malignancies and discussed the data supporting its use. Radiation treatment in this setting continues to evolve with the increasing implementation of more conformal delivery techniques. Further scientific investigation is needed to establish the optimal role of radiation and to better define its integration with novel systemic and biologic modalities.

Swallowing Function After Chemoradiation for Advanced Stage Oropharyngeal Cancer

OBJECTIVE

Advanced-stage oropharyngeal cancer may be treated either surgically or nonsurgically. We reported previously functional outcomes after surgical resection with free-tissue transfer. In the present study, we evaluated swallowing function after combined chemoradiation for oropharyngeal cancer.

STUDY DESIGN AND SETTING

Retrospective review of 30 patients treated at a tertiary academic center for Stage III/IV oropharyngeal cancer with sequential or concurrent chemoradiation from 1994 to 2003.

RESULTS

Inclusion criteria were met by 27 of 30 (90%) patients. Most patients had base of tongue lesions (67%) and Stage IV disease (93%). Gastrostomy was carried out in 22 (82%) patients either before or during treatment. Three months after chemoradiation, 33% (9/27) were consuming all nutrition orally, 22% (6 of 27) were NPO, and 45% (12 of 27) had some oral intake but still required tube feeds. One year after treatment, 53% (10 of 19) had an exclusively oral diet whereas 47% still required tube feeds including 1 patient (5%) who was NPO. In patients without recurrence and follow-up length >1 year, 69% (9 of 13) were consuming all nutrition orally whereas 31% still required gastrostomy tube (G-tube) support. A higher rate of G-tube dependence was observed in patients treated for base of tongue lesions vs tonsil lesions (67% vs 25%, P = 0.049, chi(2) analysis).

CONCLUSIONS

At this institution, the short-term (3-4 months) rate of G-tube dependence was similar after surgical and non-surgical treatment of oropharyngeal cancer. One year after chemoradiation, 31% of patients without recurrence still required tube feeds.

SIGNIFICANCE

These results suggest that organ-preservation protocols do not reduce the prevalence of chronic dysphagia and G-tube dependence after management of oropharyngeal cancer.

EBM RATING

C-4.

The role of large-scale spatially explicit and small-scale localized processes on the population dynamics of cereal aphids

A field-scale study of the spatially explicit interaction between the carabid Poecilus cupreus Linnaeus, and two common aphid species (Sitobion avenae (Fabricius) and Metopolophium dirhodum (Walker)) in winter wheat was conducted. All three species showed considerable spatial pattern at the field scale. Activity-density of P. cupreus was an order of magnitude higher in the central part of the field compared to its periphery. Where P. cupreus activity-density was highest, S. avenae and M. dirhodum population peaks were delayed. Additionally, in the case of M. dirhodum, lower maximum counts were evident where P. cupreus activity-density was highest. An analysis of the movement of individual P. cupreus using release-recapture indicated that those beetles within the centre of the field exhibited reduced displacement, which may have caused the generation or maintenance of spatial pattern. Crop density was also measured throughout the field. Although crop density had no large-scale spatial pattern, its variability at the small-scale was consistent with an influence on aphid population dynamics. This study demonstrates empirically that both large-scale spatially explicit and small-scale localized processes influenced aphid population dynamics simultaneously.

Positron Emission Tomography Scan to Determine the Need for Neck Dissection after Chemoradiation for Head and Neck Cancer: Timing is Everything

We present a case of a negative positron emission tomography (PET) scan in a patient with pathologic viable cancer at neck dissection.

STUDY DESIGN

Case Report.

METHODS

A 69-year-old man presented with clinical stage T2N2c squamous cell cancer of the left tonsil and was treated with definitive chemoradiation. Left-sided adenopathy decreased but remained palpable after therapy.

RESULTS

PET scan performed 23 days after completion of treatment showed no suspicious uptake in the left neck. Neck dissection performed at 2 months post-therapy revealed viable tumor in left cervical nodes.

CONCLUSIONS

Persistent adenopathy after chemoradiation for head and neck cancer remains a clinical dilemma. A negative PET scan is accurate but only if the scan is performed 3 to 4 months after therapy.

Histological effects of tazarotene 0.1% cream vs. vehicle on photodamaged skin: a 6-month, multicentre, double-blind, randomized, vehicle-controlled study in patients with photodamaged facial skin

BACKGROUND

Topical tazarotene has been shown to offer efficacy in ameliorating multiple effects of photodamage.

OBJECTIVES

To evaluate the histological effects of tazarotene cream on photodamaged skin.

METHODS

In this multicentre, double-blind, randomized, vehicle-controlled study, 50 patients with photodamaged facial skin (at least mild fine wrinkling and mottled hyperpigmentation, with at least one of these being moderate) were randomized to apply tazarotene 0.1% cream or vehicle cream to their face, once daily for 24 weeks.

RESULTS

Blinded assessments showed that tazarotene was less likely than vehicle to be associated with an increase in keratinocytic and melanocytic atypia, and more likely than vehicle to be associated with a reduction in atypia. Between-group comparisons in distribution of change from baseline categories of severity were in favour of tazarotene (P = 0.055 for keratinocytic atypia, P = 0.034 for melanocytic atypia, and P < 0.001 for the number of granular cell layers). Compared with vehicle, tazarotene was associated with an increase in epidermal polarity (P = 0.008) and epidermal thickness (P = 0.012), and a tendency for stratum corneum compaction. Tazarotene was also associated with widened intercellular spaces (reported as epidermal oedema) relative to vehicle (P < 0.001).

CONCLUSIONS

Treatment of photodamaged skin with tazarotene is associated with an amelioration of keratinocytic and melanocytic atypia, an improvement in epidermal polarity, and an increase in epidermal thickness.

The spatial dynamics of crop and ground active predatory arthropods and their aphid prey in winter wheat

The distribution of aphid predators within arable fields has been previously examined using pitfall traps. With this technique predominantly larger invertebrate species are captured, especially Carabidae, but the technique provides no estimate of density unless mark-recapture is used. However, many other numerically important aphid predators occur in arable fields and relatively little is known about their distribution patterns nor whether they exhibit a density-dependent response to patches of cereal aphids. Identification of the most effective predators can allow management practices to be developed accordingly. In this study, the distribution of cereal aphids and their predators was examined by suction sampling within a field of winter wheat in Devon, UK, along with visual estimates of weed patchiness. Sampling was conducted on four occasions in 1999 across a grid of 128 sample locations. The distribution of 11 predatory taxa from the Carabidae, Staphylinidae and Linyphiidae was examined. Additionally, the total number of aphid predators and a predation index were used in these analyses. Carabid adults and larvae, along with staphylinid larvae showed the strongest aggregation into patches and the most temporal stability in their distribution. Other taxa had more ephemeral distributions as did the cereal aphids. The distribution of carabid larvae was disassociated from the distribution of cereal aphids for the first two sampling occasions indicating biocontrol was occurring. Other predatory groups showed both association and disassociation. Carabid larvae, Bathyphantes and total numbers of Linyphiidae showed a strong correlation with weed cover for two of the sample dates. Cereal aphids were disassociated from weed cover on three sampling occasions.