Rapid Colorimetric and Fluorometric Discrimination of Maleic Acid vs. Fumaric Acid and Detection of Maleic Acid in Food Additives

An anthracene thiazole based Schiff base L was synthesized and employed for fluorescence switch-on detection of maleic acid in aqueous DMSO. The non-fluorescent L (10-5 M) showed an instantaneous and selective fluorescence enhancement at 506 nm upon interaction with maleic acid (10-5 M). Other potential carboxylic acids (10-5 M), such as malic acid, citric acid, acetic acid, cinnamic acid, tartaric acid, succinic acid, fumaric acid, oxalic acid and malonic acid failed to alter the chromo-fluorogenic properties of L. Probe L can be employed to detect maleic acid down to 2.74 × 10-6 M. The probe L showed good linearity from 2.97 to 6.87 µM. Analytical utility of L was examined by detecting maleic acid in various food additives and drosophila larvae.

Protein interactions, molecular docking, antimicrobial and antifungal studies of terpyridine ligands

Resistance to antibiotics/antibacterials/antifungals in pathogenic microbes has been developing over the past few decades and has recently become a commonplace public-health peril. Thus, alternative nontoxic potent antibiotic agents are covertly needed to control antibiotic-resistant outbreaks. In an effort to combat the challenges posed by the co-occurrence of multidrug resistance, two terpyridine ligands 4'-(4-N,N'-dimethylaminophenyl)-2,2':6',2″-terpyridine (L1) and 4'-(4-tolyl)-2,2':6',2″-terpyridine (L2) have been designed, prepared and confirmed their structure by spectral studies. Thereafter, antimicrobial assay was performed against gram positive and negative bacterial strains along with fungal strains. Both compounds L1 and L2 exhibited remarkable inhibitory activities against bacteria, Escherichia coli and Staphylococcus aureus at MIC values 6.25 and 3.125 µg/ml, respectively. In addition, in silico molecular docking studies were ascertained with bacterial DNA gyrase and fungal demethylase. Furthermore, both L1 and L2 could bind Bovine Serum Albumin (BSA) protein and binding interaction has been studied with the help of UV-Visible and fluorescence spectroscopy. While fluorescence of BSA unperturbed in the presence of L2, an addition of L1 to the solution of BSA resulted significant quenching. The binding constant calculations at different temperature confirmed that the fluorescence quenching between BSA and L1 is predominantly static in nature. The toxicity of L1 and L2 was checked using Drosophila melanogaster. The toxicity analysis suggest both the dyes are non-cytotoxic in nature.Communicated by Ramaswamy H. Sarma.

Histology Specific Molecular Biomarkers: Ushering in a New Era of Precision Radiation Oncology

Histopathology and clinical staging have historically formed the backbone for allocation of treatment decisions in oncology. Although this has provided an extremely practical and fruitful approach for decades, it has long been evident that these data alone do not adequately capture the heterogeneity and breadth of disease trajectories experienced by patients. As efficient and affordable DNA and RNA sequencing have become available, the ability to provide precision therapy has become within grasp. This has been realized with systemic oncologic therapy, as targeted therapies have demonstrated immense promise for subsets of patients with oncogene-driver mutations. Further, several studies have evaluated predictive biomarkers for response to systemic therapy within a variety of malignancies. Within radiation oncology, the use of genomics/transcriptomics to guide the use, dose, and fractionation of radiation therapy is rapidly evolving but still in its infancy. The genomic adjusted radiation dose/radiation sensitivity index is one such early and exciting effort to provide genomically guided radiation dosing with a pan-cancer approach. In addition to this broad method, a histology specific approach to precision radiation therapy is also underway. Herein we review select literature surrounding the use of histology specific, molecular biomarkers to allow for precision radiotherapy with the greatest emphasis on commercially available and prospectively validated biomarkers.

WNT Pathway Mutations in Metachronous Oligometastatic Castration-Sensitive Prostate Cancer

PURPOSE

WNT signaling is a cellular pathway that has been implicated in the development and progression of prostate cancer. Oligometastatic castration-sensitive prostate cancer (omCSPC) represents a unique state of disease in which metastasis-directed therapy (MDT) has demonstrated improvement in progression-free survival. Herein, we investigate the clinical implications of genomic alterations in the WNT signaling cascade in men with omCSPC.

METHODS AND MATERIALS

We performed an international multi-institutional retrospective study of 277 men with metachronous omCSPC who underwent targeted DNA sequencing of their primary/metastatic tumor. Patients were classified by presence or absence of pathogenic WNT pathway mutations (in the genes APC, RNF43, and CTNNB1). Pearson χ2 and Mann-Whitney U tests were used to determine differences in clinical factors between genomic strata. Kaplan-Meier survival curves were generated for radiographic progression-free survival and overall survival, stratified according to WNT pathway mutation status.

RESULTS

A pathogenic WNT pathway mutation was detected in 11.2% of patients. Patients with WNT pathway mutations were more likely to have visceral metastases (22.6% vs 2.8%; P < .01) and less likely to have regional lymph node metastases (29.0% vs 50.4%; P = .02). At time of oligometastasis, these patients were treated with MDT alone (33.9%), MDT + limited course of systemic therapy (20.6%), systemic therapy alone (22.4%), or observation (defined as no treatment for ≥6 months after metastatic diagnosis). Multivariable cox regression demonstrated WNT pathway mutations associated with significantly worse overall survival (hazard ratio, 3.87; 95% confidence interval, 1.25-12.00).

CONCLUSIONS

Somatic WNT pathway alterations are present in approximately 11% of patients with omCSPC and are associated with an increased likelihood of visceral metastases. Although these patients have a worse natural history, they may benefit from MDT.

CTNI-10. RANDOMIZED PIVOTAL STUDY OF BLOOD-BRAIN BARRIER (BBB) DISRUPTION USING EXABLATE MODEL 4000 WITH STANDARD OF CARE (SOC) THERAPY IN NON-SMALL CELL LUNG CANCER (NSCLC) BRAIN METASTASES: LIMITLESS TRIAL

BACKGROUND

NSCLC is the most common cause of brain metastases. The Exablate focused ultrasound with circulating microbubble resonators uses the concept of real-time imaging to treat small target spots focusing energy through the skull in noninvasive manner, thereby disrupting the BBB. There is preclinical evidence of synergy of FUS-mediated BBB with immunotherapy beyond improved drug delivery due to BBB disruption (BBBD).

METHODS

LIMITLESS is a prospective, multi-center, randomized, two-arm, controlled, pivotal clinical trial to evaluate the safety and efficacy of additional targeted BBB disruption using Exablate Model 4000 for the treatment of NSCLC brain metastases in subjects who are undergoing planned pembrolizumab monotherapy compared to Pembrolizumab alone in 2:1 randomization. The inclusion criteria include age ≥ 18 years, KPS ≥ 70, NSCLC (EGFR and ALK negative) with up to 3 brain metastases, one of which meets the RANO-BM criteria for measurable Disease (1 cm x 1 cm) with normal organ function. The primary endpoint is to test superiority of Exablate BBBD targeted to their brain metastases over the standard of care without Exablate BBBD as determined by Objective Response Rate (ORR) based on RANO- BM by 6 months. The secondary endpoints include best objective response rate and time to response for brain metastases by treatment arm. Other end points include progression-free survival (PFS), overall survival (OS), Intracranial and extracranial PFS, quality of life assessments. The Bayesian design statistical analysis will assume superior ORR of 60% in Exablate group compared to 30% in SOC group for a total sample size of 96 subjects (64 subjects in Exablate and 32 in SOC) for 80% power using a two-sided Pearson's Chi-Square test with alpha = 0.05. For the upper-bound estimate ORR of 45% in Exablate group and 30% in SOC group will need 369 subjects (246 subjects in Exablate and 123 in SOC).

CTNI-46. PIVOTAL STUDY TO EVALUATE SAFETY AND EFFICACY OF EXABLATE MODEL 4000 USING MICROBUBBLE RESONATORS TO TEMPORARILY MEDIATE BLOOD-BRAIN BARRIER DISRUPTION FOR LIQUID BIOPSY IN GLIOBLASTOMA (LIBERATE)

BACKGROUND

Glioblastoma (GBM) has dismal outcome of 14-16 months. One of the challenges of drug development in GBM is lack of requisite circulating-free (cfDNA) in blood samples to develop biomarker driven targeted therapy trials. The Exablate focused ultrasound with circulating microbubble resonators uses the concept of real-time imaging to treat small target spots focusing energy in a non-invasive manner, thereby disrupting the Blood-Brain Barrier (BBBD) with potential to increase cfDNA in blood.

METHODS

LIBERATE is a prospective, multi-center, self-controlled pivotal ongoing clinical trial in subjects with suspected GBM evaluating the safety and effectiveness of Exablate Model 4000 to disrupt BBB to achieve a greater proportion of cfDNA in samples taken post-BBB disruption as compared to the sample taken before BBBD. Fifty eligible subjects with suspected GBM who are scheduled to undergo brain tumor resection or biopsy at 10 centers in the U.S. will participate in this study. The primary endpoint is defined for each subject as ratio between his/her cfDNA amount found in the blood sample 1-hour post-BBBD procedure compared to the cfDNA amount found in the blood sample collected pre-BBBD procedure. This study proposes to demonstrate that on average there is at least 2-fold increase in cfDNA (measured by central laboratory) at 1 hour post BBBD. Confirmatory secondary analysis will evaluate correlation between patterns obtained in panel of biomarkers evaluated in the resected tumor tissue and/or biopsy sample and blood sample collected 1-hour post-BBBD. Exploratory endpoints will include: (1) sensitivity of detection of known somatic mutations in the circulating blood samples (circulating tumor DNA) before and after BBBD, (2) time of greatest yield of cfDNA in the samples collected post BBBD blood samples (at 30 min, 1-hour, 2-hour and 3-hour) to determine time of greatest yield, (3) correlation of biomarkers between the imaging and the post-BBBD biomarker samples. (NCT05383872)

Long-Term Outcomes and Genetic Predictors of Response to Metastasis-Directed Therapy Versus Observation in Oligometastatic Prostate Cancer: Analysis of STOMP and ORIOLE Trials

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The initial STOMP and ORIOLE trial reports suggested that metastasis-directed therapy (MDT) in oligometastatic castration-sensitive prostate cancer (omCSPC) was associated with improved treatment outcomes. Here, we present long-term outcomes of MDT in omCSPC by pooling STOMP and ORIOLE and assess the ability of a high-risk mutational signature to risk stratify outcomes after MDT. The primary end point was progression-free survival (PFS) calculated using the Kaplan-Meier method. High-risk mutations were defined as pathogenic somatic mutations within ATM, BRCA1/2, Rb1, or TP53. The median follow-up for the whole group was 52.5 months. Median PFS was prolonged with MDT compared with observation (pooled hazard ratio [HR], 0.44; 95% CI, 0.29 to 0.66; P value < .001), with the largest benefit of MDT in patients with a high-risk mutation (HR high-risk, 0.05; HR no high-risk, 0.42; P value for interaction: .12). Within the MDT cohort, the PFS was 13.4 months in those without a high-risk mutation, compared with 7.5 months in those with a high-risk mutation (HR, 0.53; 95% CI, 0.25 to 1.11; P = .09). Long-term outcomes from the only two randomized trials in omCSPC suggest a sustained clinical benefit to MDT over observation. A high-risk mutational signature may help risk stratify treatment outcomes after MDT.

Artists on Social Media: an Analysis of Personal Branding Strategies employed by Indian Independent Artists on Social Media Platforms

The main objective of this paper is to understand the different tactics and platforms used by independent artists successfully to promote themselves as a brand and garner attention to their music, building a fan base. The platforms include social media and other platforms and also understand the most favorable platform for promoting oneself as an artist. This paper also deals with the different strategies they use to promote themselves. The first part of the paper includes the evolution of the music industry, the rise of streaming services, and independent artists. The revenue models of famous streaming platforms and how much they earn through streaming. The second part deals with the definition of personal branding, the different subsections involved in branding, and the strategies in general used by independent music artists on different social media platforms. Organizations’ expenditure on online promotional activities is constantly and dynamically increasing in tandem with the increasing level of digital media consumption. Simultaneously, with increasing expenditures on digital promotion, it is clear that the effectiveness of activities carried out in the electronic space in its current form is decreasing. As a result, when promoting products and services has never been more difficult in the new market situation, organizations have begun to seek alternative methods of influencing consumers.

AB1416 WHAT IS THE FULL ECONOMIC COST OF DELAYED DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS IN THE UK?

Background

Axial Spondyloarthritis (AS) is an umbrella term for both inflammatory conditions known as Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis. AS generally develops in younger people. Symptoms typically start in the late teenage years to early twenties (with the average age of onset being 24). Hence this condition has a life-long impact, which could increase if left untreated. Average delay to diagnosis is over eight years after the appearance of symptoms. There are currently 220,000 people in the UK living with this painful and progressive form of inflammatory arthritis. While people wait for a diagnosis, many withdraw from socialising and find it harder to establish careers, form relationships, and start families. In addition to healthcare costs, that include multiple visits to GPs, prescription of unnecessary medication and extensive use of over the counter painkillers, there are intangible costs that have large impacts on patients and society. For example, quality of life for the patient, their earning and saving for retirement capacity, social care costs.

Objectives

To determine the full economic cost, including medical productively loss and other out of pocket related costs of delayed diagnosis for AS in the UK.

Methods

We are building an economic Markov model to determine a total cost per patient per year of delay. The model will project disease progression forward in time-steps with feedback loops to allow movement in states back and forth. Transition states within each time-step will be constructed according to the various stage of the disease and they will be used primarily to demonstrate an assessment of the costs in the time taken to a confirmed diagnosis. The model will capture symptoms and impacts of AS leading up to that diagnosis and before initiation of treatment. Assuming the one-year maximum ‘gold standard’ time to diagnosis that NASS would like to see to, the sum of costs prior to this in each consecutive cycle will be estimated.

The inputs will consist of the average delay to diagnosis per gender and age group, the health resources utilisation, the cost of managing the symptoms, cost related to productivity losses and any other parameters and costs reflecting real resources required to diagnose, confirm, treat, cope with, manage and accommodate AS symptoms. Data include anonymised diagnosed patient data with the pathways they followed pre-diagnosis shared under strict confidentiality data sharing agreement from the secondary health units participating in the project. Cost data gathered from national sources and research into AS, NHS unit costs reports, productivity related reports and interviews with people with AS and clinicians providing valuable insight into the condition. The model will be validated by experts in the field and sufferers of AS to ensure accurate representation of actual events.

Results

The results will be provided at the conference and this is work in progress. A preliminary analysis of anonymised data of the pathway of 513 people towards an AS diagnosis show that the delay on female patients is slightly longer (mean of 9.85 years) compared to male patients (mean of 9.39 years). In both genders the delay is higher if the patient present symptom after the age of 31 years increasing the mean of previous age groups by 5 to 9 yrs.

Table 1.FemaleMaleAge GroupObs.Mean95% CIObs.Mean95% CI0-1511-21.000.00, 13.7116-30493.592.69, 4.49144.004.013.45, 4.5731-455011.729.64, 13.80161.009.618.58, 10.6546-602418.1713.05, 23.2860.0015.9013.30, 18.5061+317.330.00, 52.5819.0028.5821.14, 36.02

Conclusion

The results will help the National Axial Spondyloarthritis Society (NASS) to build an economic case for earlier diagnosis. The interactive model will support decision making in the future by allowing assumptions to be changed e.g., changing prices over time; varying wage rates depending on staff and skill mix; and the anticipated scale of savings in actual practice.

References

[1]Standfield et al. (2014). Markov Modelling and DES in health care: a comparison. Journal of technology Assessment in Health C 30 (2) 166-172

Acknowledgements

With thanks to the National Axial Spondyloarthritis Society for commissioning this research and special thanks to Dale Webb and Jill Hamilton for their valuable support to contact clinician and sufferers of AS and for accessing necessary data. Importantly, thank you to the clinicians and sufferers of AS for their contribution to the research.

Disclosure of Interests

None declared

NCOG-12. COGNITIVE FUNCTION (CF) & QUALITY OF LIFE (QOL) IN PATIENTS TREATED WITH PROCARBAZINE, CCNU, & VINCRISTINE (PCV) + RADIOTHERAPY (RT) VS. RT FOR ANAPLASTIC OLIGODENDROGLIOMA (AO) ON NRG RTOG TRIAL 9402

BACKGROUND

PCV+RT substantially prolongs survival in AO patients, but long-term CF and QOL implications are unclear. We compared CF and QOL by treatment arm in RTOG 9402 participants and evaluated the impact that baseline characteristics had on CF, QOL, and survival.

METHODS

CF and QOL were evaluated using the Mini Mental State Exam (MMSE) and Brain-Quality of Life (B-QOL) scale at baseline and annually. Scores were analyzed between treatment arms at each time point for patients with ≥ 10 years of follow-up data. Shared parameter models evaluated MMSE and B-QOL scores and survival for all patients.

RESULTS

42/148 (28.4%) participants in PCV+RT and 20/143 (14%) in RT alone arms survived ≥ 10 years. 35/42 and 39/42 (PCV+RT) and 18/20 and 17/20 (RT) participants completed baseline B-QOL and MMSE assessments, respectively. B-QOL scores did not differ between treatment groups at any time-point. Among 16 patients (10 PCV+RT, 6 RT) who completed year 10 MMSE evaluations, mean MMSE score at 10 years was higher in the RT arm (29.83 [95% CI 22.1, 30.0] vs. 26.50 [95% CI 29.4, 30.0], P= 0.04). Change in MMSE and B-QOL scores from baseline did not differ significantly between treatment groups at any time. In shared parameter models including all patients with baseline assessments, MMSE and B-QOL scores decreased over time (MMSE P= 0.0189, B-QOL P= 0.0005), but this did not differ by treatment group (MMSE P= 0.5727, B-QOL P= 0.3592). Younger age and higher KPS predicted better scores (MMSE P &lt; 0.0001, P = 0.0002; B-QOL P = 0.0043, P = 0.0007). PCV+RT predicted better survival in both models.

CONCLUSIONS

PCV+RT improves survival in AO. Shared parameter models show decrease in MMSE and B-QOL over time. However, relative to RT alone, the addition of PCV did not impact change in CF and QOL over time.

Dosimetry and Acute Toxicity Profile of Patients With Esophageal Cancer Treated With Proton Beam Radiation Therapy: Outcomes From the Proton Collaborative Group REG001-09 Trial

PURPOSE

Concurrent chemoradiation plays an integral role in the treatment of esophageal cancer. Proton beam radiation therapy has the potential to spare adjacent critical organs, improving toxicity profiles and potentially improving clinical outcomes.

METHODS AND MATERIALS

We evaluated the REG001-09 registry for patients undergoing proton radiation therapy for esophageal cancer. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled.

RESULTS

We identified 155 patients treated at 10 institutions between 2010 and 2019. One hundred twenty (77%) had adenocarcinoma and 34 (22%) had squamous cell carcinoma. One hundred thirty-seven (88%) received concurrent chemotherapy. The median delivered dose was 50.51 Gy-equivalent (GyE; range, 41.4-70.1). Grade ≥3 toxicities occurred in 22 (14%) of patients and were most commonly dysphagia (6%), esophagitis (4%), anorexia (4%), and nausea (2%). There were no episodes of grade ≥4 lymphopenia and no grade 5 toxicities. The average mean heart, lung, and liver doses and average maximum spinal cord dose were 10.0 GyE, 4.8 GyE, 3.8 GyE, and 34.2 GyE, respectively. For gastroesophageal junction tumors, 8% of patients developed acute grade ≥3 toxicity and the mean heart, liver, right kidney, and left kidney doses were 10.5 GyE, 3.9 GyE, 0.4 GyE, and 4.9 GyE, respectively. Gastroesophageal junction location was protective against development of grade ≥3 toxicity on univariate (P = .0009) and multivariate (P = .004) analysis.

CONCLUSIONS

Proton beam radiation therapy affords excellent dosimetric parameters and low toxicity in patients with esophageal cancer treated with curative intent. Prospective trials are underway investigating the comparative benefit of proton-based therapy.

68Ga-DOTATATE PET-CT as a tool for radiation planning and evaluating treatment responses in the clinical management of meningiomas

Background and purpose

Meningiomas express the somatostatin receptor (SSTR), which normal bone and brain lack. PET imaging with SSTR ligands such as ⁶⁸ Ga-DOTATATE have been recently shown to aid in the imaging and identification of menginiomas. We hypothesize that ⁶⁸ Ga-DOTATATE PET/CT in conjunction with MRI aids in radiation (RT) target volume delineation and evaluating treatment response.

Materials and methods

Nineteen patients with meningiomas underwent ⁶⁸ Ga-DOTATATE PET/CT and MRI for RT planning and/or post-treatment follow-up. Meningiomas were grade I (n = 9) or not biopsied (n = 8) and frequently involved base of skull (n = 10). Ten (53%) patients received post-operative RT and 9 (47%) received fractaionted RT. In the subgroup that underwent both pre- and post-RT ⁶⁸ Ga-DOTATATE PET as well as MRI (n = 10), ROVER (ABX GmbH, Radeberg, Germany) adaptive thresholding software was utilized to measure total lesion activity (mean and max) before and after treatment. Tumor volume based on MRI was calculated before and after treatment. Total lesion activity and tumor volume changes were compared using Wilcoxon signed rank test.

Results

⁶⁸ Ga-DOTATATE PET/CT identified intraosseous (n = 4, 22%), falcine (n = 5, 26%) and satellite lesions (n = 3, 19%) and clarified the diagnosis of meningioma, resulting in a change in management in three patients. Mean total lesion activity decreased 14.7% (median), from pre to post-RT ⁶⁸ Ga-DOTATATE PET [range 97–8.5% (25–75%),S = − 26.5, p = 0.0039]. Max total lesion activity decreased 36% (median) over the same period [range 105–15% (25–75%), S = − 26.5 p = 0.0039]. In contrast, meningioma volumes based on MRI measurements did not significantly change per RECIST criteria and Wilcoxon signed rank test (S = − 3, p = 0.7422).

Conclusion

⁶⁸ Ga-DOTATATE PET/CT helped confirm suspected diagnoses and delineate target volumes particularly when lesions involved osseous structures and the falx. Mean and max total tumor ⁶⁸ Ga-DOTATATE activity on PET/CT decreased at three months following RT despite stable tumor volumes on MRI. Future studies are warranted to (1) assess the sensitivity and specificity of ⁶⁸ Ga-DOTATATE PET/CT, (2) evaluate the impact of ⁶⁸ Ga-DOTATATE PET/CT-based planning on treatment outcomes, and (3) assess the prognostic significance of these post-treatment imaging changes.

Abstract PS15-12: Initial outcomes of adjuvant proton pencil beam scanning radiation for patients with breast cancer requiring comprehensive nodal irradiation within a single institution

Background:Following lumpectomy or mastectomy, locally advanced breast cancer (LABC)requires adjuvant radiation (RT) to the chest wall (CW) and comprehensiveregional nodal basins (CNI). Proton therapy (PBT) has demonstrated dosimetricadvantages in heart, lung, and esophageal exposures compared to photon RT, butlittle is published regarding oncologic outcomes of PBT for LABC. Methods:Consecutive patients treated from 2016-2019 wereretrospectively reviewed. Men and women over the age of 18 requiring adjuvantRT with CNI were included; all patients had at least 6 months of follow up fromRT completion. Initial treatment volumes, excluding boosts to scars or grossdisease, (CTV_init) included CW-CNI per the RADCOMP atlas. CTV_init coveragewas prescribed as 95% CTV_init at 100% Rx dose. All patients were treated with proton pencil-beam scanning RT (PBS-PBT),typically with a two-field anterior SFO technique. Patient, tumor, and dosimetric characteristics wereanalyzed. Tumoral control and survival rates were estimated by the Kaplan Meiermethod. Toxicities were recorded prospectively by treating physicians andreviewed retrospectively. Local recurrence was defined as in-breast, or skin/chestwall; regional recurrence was defined as a nodal failure. Results:One hundred patients were included with a median follow upof 15.4 months (6-42). Ninety-eight percent were female, and 61% were white.Median age was 52 years, and 94% of patients had an ECOG PS ≤1.AJCC 8th edition anatomic staging was predominantly stage II (49%)or III (48%).Sixty-five percent of patients were treated for left-sideddisease; 7% of patient received bilateral RT; 87% received cytotoxicchemotherapy (63% neoadjuvant, 37% adjuvant). Twenty six patients receivedconcurrent systemic therapy with trastuzumab (H)/pertuzumab (P)(38% ),capecitabine (29%), H-emtansine (21%), or H (12%). The median initial RT dosewas 50.4 (45-50.4) while median total RT dose was 50.4Gy (45-70.2). Forty-twopercent of patient underwent an RT boost to nodal areas and/or the scar. Allpatients were treated in 1.8 or 2.0Gy fractions. Eighty-seven percent oflesions were invasive ductal carcinomas; 52% were ER+/Her2-, 17% weretriple-negative (TNBC), and 31% were Her2+.Nine (9%) of patients experienced a ≥G3 acute toxicity, all in theform of radiation dermatitis. There was one acute G4 incidence of skinnecrosis. There were no ≥G3 late toxicities or documented major cardiac events atthe time of last follow up. Median doses to critical organs at risk (OARs) were asfollows: mean heart 0.9Gy (&lt;0.1 - 3.9), V25 heart 0.9% (0 - 6.6) ipsilaterallung V20 15% (4.6 - 29.2) ipsilateral lung V5 41.1% (17.5 - 62.2), volume ofthe esophagus receiving 70% Rx dose 0.1cc (0 - 5.3). For bilateral plans, themedian total lung V20 was 15.6% (6.6 - 23.5) and V5 was 41.5% (18.5 - 45.0). Overall, there were 3 local, 3 regional, and 8 distantfailures. All local failures were TNBC; regional and distant failures wereequally distributed between histologies. All distant failures occurred in patientswith at least AJCC 8th Edition anatomic stage IIIA. Actuarial ratesof 2-year local, regional, locoregional, and distant failures were 4% (±3),2% (±2),6% (±3%),and 11% (±4).Two-year actuarial survival was 94% (±3).Conclusions:We present a large series of patients with high-risk or LABCtreated with adjuvant PBS-PBT and CNI. Our series includes significant percentagesof TNBC, non-white patients, and patients requiring dose-escalated RT boosts overalldemonstrating promising initial oncologic outcomes and very favorable acutetoxicity and dosimetric profiles. Continued follow up is warranted to confirmlong-term oncologic outcomes.

Citation Format: Cristina DeCesaris, Ariel Pollock, Emily Kowalski, Kayla Paulosky, Sung Choi, Mark Mishra, Elizabeth Nichols. Initial outcomes of adjuvant proton pencil beam scanning radiation for patients with breast cancer requiring comprehensive nodal irradiation within a single institution [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS15-12.

QOLP-27. USE OF THE NEURO-QOL COGNITIVE FUNCTION SHORT-FORM AS A TOOL FOR ASSESSING PATIENT-PERCEIVED NEUROCOGNITION FOLLOWING RADIOTHERAPY

The Quality-of-Life in Neurological Disorders (Neuro-QOL) instruments are a practical set of validated tools utilized to measure a core set of health-related quality-of-life parameters that are relevant to patients with neurological disorders. The tools can be completed in approximately 1-minute. The primary objective of this study was to evaluate the feasibility of utilizing the eight-question Neuro-QoL Cognitive Function- Short Form (NCF-SF) tool (v2.0) to assess cognitive outcomes in patients with primary and secondary brain tumors undergoing radiotherapy. Patients completed the NCF-SF at baseline and during follow-up visits. Raw scores were converted to a standardized T-score that has been normalized to have mean score of 50 and standard deviation (SD) of 10. Descriptive statistical analyses were performed to assess the prevalence of baseline cognitive impairment (defined as &gt; 1 SD below the normative mean), and to assess longitudinal changes in Neuro-QOL scores. A minimum clinically important difference (MCID) was defined as a change from baseline of &gt;7.5, based on previously published literature. Ninety-one patients completed NCF-SF at baseline and at least one follow-up visit. The mean baseline score for the study cohort was 49.9 (SD 9.2). Nineteen percent of patients (n=17/91) had impaired function at baseline. Baseline scores did not differ based on tumor type (p=0.79): Glioma/ependymoma 49.6 (n=35); brain metastases 49.1 (n=24); Meningioma/benign 50.7 (n=32). Following radiation, 15% and 22% of patients experienced a MCID decline at 1- (n=60) and 3- months (n=65), respectively. However, 17% and 20% of patients demonstrated a MCID improvement at 1- and 3-months, respectively. In conclusion, this represents the first study to utilize the NCF-SF to measure cognitive function in patients undergoing brain radiotherapy. Use of NCG-SF was feasible, and identified patients with meaningful changes in cognitive function over time. Future clinical trials may consider use of Neuro-QOL to assess patient-perceived cognitive function.

CTNI-50. NEUROCOGNITIVE FUNCTION (NCF) OF THE PHOTON COHORT IN NRG-BN001

NRG BN001 is an ongoing randomized phase II trial of dose-intense (DI-RT) versus standard dose photon-based radiation therapy (SD-RT) with temozolomide (TMZ) for newly diagnosed glioblastoma. We report preliminary results of Group 1, DI-RT delivered with IMRT while SD-RT could be 3DCRT or IMRT. Group 2, DI-RT delivered with proton therapy, continues to accrue. From 10/2014 to 7/2018, 229 patients were eligible and randomized. Differences in overall survival following DI-RT versus SD-RT were not significant. Patients were scheduled to complete NCF testing at baseline, cycle 3 (within 7 days of cycle 4), and cycle 12 (day 22–28 of cycle 12, or 60 weeks from completion of chemoradiation). At baseline, 93–94% of eligible patients completed NCF testing. Compliance for evaluable patients at cycle 3 and cycle 12 was 66–68% and 51–54%, respectively, across the battery of NCF tests. The most common reasons for missing data were patient refusal (cycle 3: 14%, cycle 12: 22–23%) and institutional error (cycle 3: 9–10%, cycle 12: 14–15%). A prespecified secondary endpoint analysis was conducted to evaluate differences in NCF between SD-RT and DI-RT based on the Clinical Trial Battery Composite (CTB COMP), which is the mean of the standardized scores from the NCF test battery (HVLT-R, TMT, COWA). There was no statistically significant between arm difference in change from baseline on the CTB COMP at cycle 3 (DI-RT vs SD-RT mean/SD, 0.0 +/- 1.3 vs -0.3 +/- 1.5, p=0.370, Cohen’s d=0.22) or cycle 12 (DI-RT vs SD-RT mean/SD, 0.2 +/- 1.7 vs 0.2 +/- 1.1, p=0.977, Cohen’s d=0.01). A mixed effects longitudinal model of the CTB COMP yielded a non-significant time by treatment effect interaction (p=0.216). There were no significant differences in change scores between arms on any NCF test at cycles 3 or 12. NCF outcomes were similar for photon-based SD-RT and DI-RT.

Borderline serous ovarian neoplasm: case report of a diagnostic challenge in intraoperative frozen sections

Surface epithelial tumors of the ovary account for 25% of all ovarian neoplasms. When composed predominantly of fibrous stroma, with glands and cysts forming a minor component, their appearance on imaging is often complex; cystic- to solid-appearing masses often raise suspicion of a malignant tumor. An accurate frozen histopathological diagnosis of a benign cystadenofibroma of this tumor can facilitate appropriate surgical management. However, it is equally important to diagnose areas of borderline changes/malignancy arising in these tumors, particularly when large or complex surface and inner papillary areas with multilayering or stratification are seen microscopically. We present here a case of bilateral complex ovarian mass in a 68-year-old woman, which was equivocal for malignancy on radiology, per operative gross examination as well as on frozen section evaluation. It was finally diagnosed as a borderline serous tumor (BOT) in a cystadenofibroma on histopathological examination.

•

Borderline tumors among surface epithelial tumors with a prominent stromal component are uncommon.

•

Adhesions & bilaterality with a prominent stromal component result in radiological interpretation of a complex ovarian mass.

•

The Risk of Malignancy Index is usually <200 if the CA125 is low.

•

Intraoperative surgical decisions are based on frozen section examination which are challenging.

•

A benign tumor diagnosis may results in inadequate surgery, additional interventions later and possible tumor spread.

Waveguide design optimization for compact silicon photonic ferroelectric phase shifters

In this paper, a new, to the best of our knowledge, design for a ferroelectric BaTiO₃ cladded silicon photonic phase shifter with very small switching length for compact photonic integrated circuits (PICs) is proposed. The proposed design is based on the choice of a waveguide core with suitably slanted sidewalls in order to favor the desired polarization of ferroelectric cladding and to make guided modes spread toward the ferroelectric cladding with the consequence of further reduction in switching length compared to the conventional (rectangular core) structure. The proposed design also gives the additional benefit of having the identical switching length for both TE and TM modes with the same configuration. These results offer a viable strategy to realize compact non-volatile phase shifters for reconfigurable and programmable PICs.

Radiation Oncology Emergencies

This article reviews the most common oncologic emergencies encountered by the radiation oncologist, including malignant spinal cord compression, intramedullary spinal cord metastasis, superior vena cava syndrome, hemoptysis, and airway compromise caused by tumor. Important trials evaluating different treatments for these emergencies are reviewed. The role of corticosteroids, surgery, chemotherapy, and radiation therapy in these patients is discussed and patient-specific treatment guidelines are suggested.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Evaluating the cost-effectiveness of hydrogel spacer in radiotherapy (RT) of prostate cancer (PC)

43

Background: A hydrogel rectal spacer (HRS) is an FDA-approved medical device used to increase the separation between the rectum and the prostate. A recent phase III trial demonstrated a small reduction in the incidence of RT toxicities associated with use of HRS. We conducted a cost-effectiveness analysis of HRS use in PC patients undergoing intensity modulated radiation therapy (IMRT). Methods: A multi-state Markov model was constructed to examine the cost-effectiveness of HRS in men with localized PC receiving IMRT in the US (arms: IMRT alone vs. IMRT + HRS). Subgroups included delivery site of IMRT (hospital vs. ambulatory) and baseline sexual function (SF) (general population vs. those with good SF). Based on previous studies, recurrence and survival were assumed equal for both arms. Data on SF, gastrointestinal and genitourinary toxicities incidence, as well as potential risks associated with HRS implantation were obtained from a recently published clinical trial. Health utilities and costs were derived from the literature and 2018 Physician Fee Schedule. Quality-adjusted life years (QALYs) and costs were modeled for a 5-year period from receipt of RT. Probabilistic sensitivity analysis (PSA) and value-based threshold analysis were conducted. Costs and utilities were discounted at 3% annually. Results: The per-person 5-year incremental cost for HRS administered in a hospital was $4,008 and the incremental effectiveness was 0.0273 QALYs. The incremental cost-effectiveness ratio (ICER) was $146,746 (95% credible interval from PSA $125,638 – $178,049) for PC patients undergoing HRS insertion in a hospital vs. $73,359 ($66,732 – $86,767) for patients undergoing HRS insertion in an ambulatory facility. For men with good SF, the ICER was $55,153 ($46,002 – $76,090) and $26,542 ($17,399 – $46,044) in hospital vs. ambulatory facility. Conclusions: This study is the first to evaluate the cost-effectiveness of HRS based on long-term toxicity data. Based on the current Medicare Physician Fee Schedule, HRS is cost-effective in men with good SF at a willingness to pay threshold of $100,000 and it is marginally cost-effective for the entire population depending on the facility where the HRS is inserted.

Impact of USPSTF recommendations on utilization of PSA screening in Medicare beneficiaries

166

Background: Previous studies assessing the impact of the United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of the 2008 recommendations nor have they investigated the impact of the 2012 recommendations in the Medicare population. The study aim was to evaluate change in utilization of PSA screening, post USPSTF recommendations of 2008 and 2012, and to assess trends and determinants of receipt of PSA screening in the Medicare population. Methods: This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey (MCBS) data and linked administrative claims from 2006-2013. Beneficiaries aged ≥65 years, with continuous enrollment in Parts A and B for each year they were surveyed were included in the study cohort. Beneficiaries with self-reported or claims-based diagnosis of prostate cancer were excluded. Beneficiaries with Medicare eligibility due to end stage renal disease or disability were also excluded. The primary outcome was receipt of PSA screening. Other measures include age groups (65-74 and ≥75), time periods (pre- and post-2008 and 2012 recommendations), and sociodemographic variables. Results: The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed only in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% percent in men aged ≥75 after the 2008 recommendations and by 29% in men aged ≥65 after the 2012 recommendations. Conclusions: The USPSTF recommendations of 2008 and 2012 against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services. Future studies should evaluate if the proposed 2017 update to these recommendations advocating shared decision-making for PSA screening in men aged 55-69 increase utilization in this age-group.

Primary epiphyseal and metaepiphyseal tubercular osteomyelitis in children A series of 8 case

Clinical series of primary epiphyseal and metaepiphyseal tubercular osteomyelitis are few. The purpose of our study was to retrospectively review the presentation, healing response and functional results of 8 such cases in children.

MATERIAL AND METHODS

The patients were evaluated for pain, deformity, range of motion, limb length discrepancy (if any) and recurrence. Serial radiographs of the region were studied to see remineralization, obliteration of radiological lesions, status of physis and remodeling of the growth plate.

RESULTS

The mean patient age was 7.1 years. Average follow up was 3.7 years. The mean duration of symptom before presentation was 2.9 months (range, 0.5-8 months). Knee region was involved in 4, distal radius in 2, shoulder and distal fibula in 1 patient each. The lesions were either localized or diffuse depending upon physeal involvement and osseous destruction. At the last follow up, the involved joints were painfree and had useful range of motion. Limb length lengthening was seen in all knee patients. The diffuse variety resulted in premature physeal closure. The residual lucencies persisted for several years without any clinical manifestations.

CONCLUSIONS

Primary epiphyseal and metaepiphyseal tuberculosis was relatively uncommon. The clinical outcome was good following curettage and multidrug antitubercular therapy. The epiphyseal and metaphyseal lucencies persisted for several months even after successful treatment. The diffuse variety lead to premature physeal closure. Limb length lengthening was common sequelae of tuberculosis of knee region.

Sino-Nasal Status in Patients with Chronic Obstructive Pulmonary Disease

Background. Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with serious impact on quality of life (QoL). There are limited studies available supporting coexistence of sino-nasal involvement in COPD. Methods. A prospective study was conducted to evaluate sino-nasal status in patients with COPD (n=100) presenting to the Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur from July 2011 to October 2012. COPD was diagnosed based on the Global initiative on Obstructive Lung Disease (GOLD) guidelines. Sino-nasal status was assessed by detailed history, radiograph of the para-nasal sinuses (PNS), nasal endoscopy and mucociliary clearance time. Results. Sino-nasal symptoms were present in 74 patients with COPD; nasal discharge (75.7%) being the most common. Tobacco smokers with COPD had a higher occurrence of sino-nasal symptoms (76.8%). Radiograph of para-nasal sinuses showed that maxillary sinus was most commonly involved. Nasal endoscopy revealed discharge in 63.5% cases. Nasal mucociliary clearance time was delayed (>11 to >40 min) in 98% cases. Nasal mucociliary clearance time was significantly delayed (>20 min) in COPD patients who were tobacco smokers as compared to non-smokers (53.7% versus 16.7%) and also related with increasing severity of COPD. Conclusions. Our observations suggest that sino-nasal involvement and delayed mucociliary clearance are common in patients with COPD, especially in tobacco smokers. Assessment of upper airway involvement in all the patients with COPD can help better therapeutic intervention and improvement in QoL.

Nuclear carrier and RNA-binding proteins in frontotemporal lobar degeneration associated with fused in sarcoma (FUS) pathological changes

AIMS

We aimed to investigate the role of the nuclear carrier and binding proteins, transportin 1 (TRN1) and transportin 2 (TRN2), TATA-binding protein-associated factor 15 (TAF15) and Ewing's sarcoma protein (EWS) in inclusion body formation in cases of frontotemporal lobar degeneration (FTLD) associated with fused in sarcoma protein (FTLD-FUS).

METHODS

Eight cases of FTLD-FUS (five cases of atypical FTLD-U, two of neuronal intermediate filament inclusion body disease and one of basophilic inclusion body disease) were immunostained for FUS, TRN1, TRN2, TAF15 and EWS. Ten cases of FTLD associated with TDP-43 inclusions served as reference cases.

RESULTS

The inclusion bodies in FTLD-FUS contained TRN1 and TAF15 and, to a lesser extent, EWS, but not TRN2. The patterns of immunostaining for TRN1 and TAF15 were very similar to that of FUS. None of these proteins was associated with tau or TDP-43 aggregations in FTLD.

CONCLUSIONS

Data suggest that FUS, TRN1 and TAF15 may participate in a functional pathway in an interdependent way, and imply that the function of TDP-43 may not necessarily be in parallel with, or complementary to, that of FUS, despite each protein sharing many similar structural elements.

Risk Factors and Outcome of Neonates Born through Meconium Stained Amniotic Fluid in a Tertiary Hospital of Nepal

Introduction: The incidence of meconium aspiration syndrome is still high in the developing world contributing significantly to the neonatal mortality. The study was aimed to know the risk factors contributing to meconium aspiration syndrome and neonatal outcome in a tertiary government hospital of the country.Materials and Methods: It was a hospital based cross sectional study done over a period of three months. All live newborns born through meconium stained liquor were enrolled and all the details regarding mother, neonate were recorded. Odd’s ratio and bivariate analysis was done to assess the risk factors for meconium aspiration syndrome.Result: Out of all the deliveries 14.6% were meconium stained amniotic fluid and meconium aspiration syndrome developed in 6.6% of the neonates. Low Apgar score and premature rupture of membranes was significantly associated with the risk of occurrence of meconium aspiration syndrome. Neonates who developed meconium aspiration syndrome had mortality of 11.3%.Conclusion: Perinatal asphyxia and premature rupture of membranes were significantly associated with the development of meconium aspiration syndrome and neonates who developed meconium aspiration syndrome had high mortality.J Nepal Paediatr Soc 2015;35(1):44-48

Measurements of Elliptic and Triangular Flow in High-Multiplicity 3He+Au Collisions at √(s(NN))=200 GeV

We present the first measurement of elliptic (v(2)) and triangular (v(3)) flow in high-multiplicity (3)He+Au collisions at √(s(NN))=200  GeV. Two-particle correlations, where the particles have a large separation in pseudorapidity, are compared in (3)He+Au and in p+p collisions and indicate that collective effects dominate the second and third Fourier components for the correlations observed in the (3)He+Au system. The collective behavior is quantified in terms of elliptic v(2) and triangular v(3) anisotropy coefficients measured with respect to their corresponding event planes. The v(2) values are comparable to those previously measured in d+Au collisions at the same nucleon-nucleon center-of-mass energy. Comparisons with various theoretical predictions are made, including to models where the hot spots created by the impact of the three (3)He nucleons on the Au nucleus expand hydrodynamically to generate the triangular flow. The agreement of these models with data may indicate the formation of low-viscosity quark-gluon plasma even in these small collision systems.