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Matthew E. Nielsen, Bruce J. Trock, and Patrick C. Walsh

Table 1 Biochemical Recurrence-Free Survival Rates in Adjuvant Radiotherapy Trials Subgroups based on standard prognostic factors, including PSADT, Gleason score, surgical margin status, and pathologic stage, were evaluated for interactions

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Corbin D. Jacobs, Daniel J. Rocke, Russel R. Kahmke, Hannah Williamson, Gita Suneja, and Yvonne M. Mowery

papillomavirus. The objective of this analysis is to determine the association between adjuvant radiotherapy (RT) and overall survival (OS) for resected ARSCC based on adverse pathologic features. Methods: Adult subjects in the National Cancer Database

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Vishruth K. Reddy, Varsha Jain, Sriram Venigalla, William P. Levin, Robert J. Wilson II, Kristy L. Weber, Anusha Kalbasi, Ronnie A. Sebro, and Jacob E. Shabason

centers, larger tumor size (>5 cm), and tumors arising in the extremities ( Table 2 ). Figure 2. Trends in receipt of neoadjuvant or adjuvant RT. Abbreviation: RT, radiation therapy. Table 2. Factors Associated With Receipt of Neoadjuvant Versus Adjuvant

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David Scott Miller, Gini Fleming, and Marcus E. Randall

. Gynecol Oncol 1990 ; 36 : 166 – 171 . 10 Kuoppala T Maenpaa J Tomas E . Surgically staged high-risk endometrial cancer: randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy . Gynecol Oncol 2008 ; 110 : 190

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Anusha Ponduri, David Z. Liao, Nicolas F. Schlecht, Gregory Rosenblatt, Michael B. Prystowsky, Rafi Kabarriti, Madhur Garg, Thomas J. Ow, Bradley A. Schiff, Richard V. Smith, and Vikas Mehta

Background: Nonadherence to NCCN Guidelines during time from surgery to postoperative radiotherapy (S-PORT) can alter survival outcomes in head and neck squamous cell carcinomna (HNSCC). There is a need to validate this impact in an underserved urban population and to understand risk factors and reasons for delay. We sought to investigate the impact of delayed PORT with outcomes of overall survival (OS) in HNSCC, to analyze predictive factors of delayed PORT, and to identify reasons for delay. Methods: We conducted a retrospective cohort study in an urban, community-based academic center. A total of 184 patients with primary HNSCC were identified through the Montefiore Medical Center cancer registry who had been treated between March 1, 2005, and March 8, 2017, and met the inclusion and exclusion criteria. The primary exposure was S-PORT. OS, recurrence, and risk factors and reasons for treatment delay were the main outcomes and measures. Results: Among 184 patients with HNSCC treated with PORT, the median S-PORT was 48.5 days (interquartile range, 41–67 days). The S-PORT threshold that optimally differentiated worse OS outcomes was >50 days (46.7% of our cohort; n=86). Independent of other relevant factors, patients with HNSCC and S-PORT >50 days had worse OS (hazard ratio, 2.30; 95% CI, 1.34–3.95) and greater recurrence (odds ratio, 3.51; 95% CI, 1.31–9.39). Predictors of delayed S-PORT included being underweight or obese, prolonged postoperative length of stay, and age >70 years. The most frequent reasons for PORT delay were complications related to surgery (22.09%), unrelated medical comorbidities (18.60%), and nonadherence/missed appointments (6.98%). Conclusions: Delayed PORT beyond 50 days after surgery was associated with decreased OS and greater recurrence. Identification of predictive factors and reasons for treatment delay helps to target at-risk patients and facilitates interventions in underserved populations.

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Paul F. Engstrom, Juan Pablo Arnoletti, Al B. Benson III, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Anne Covey, Raza A. Dilawari, Dayna S. Early, Peter C. Enzinger, Marwan G. Fakih, James Fleshman Jr., Charles Fuchs, Jean L. Grem, Krystyna Kiel, James A. Knol, Lucille A. Leong, Edward Lin, Mary F. Mulcahy, Sujata Rao, David P. Ryan, Leonard Saltz, David Shibata, John M. Skibber, Constantinos Sofocleous, James Thomas, Alan P. Venook, and Christopher Willett

Group . Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials . Lancet 2001 ; 358 : 1291 – 1304 . 83 Peeters KCMJ Marijnen CAM Nagtegaal ID . The TME trial after a median follow-up of 6

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Michelle T. Ashworth and Adil Daud

chest, abdomen, and pelvis identified no other lesions, and results of a complete right inguinal lymph node dissection were negative. The patient was treated with adjuvant radiotherapy (XRT), complicated by a nonhealing ulcer for 1 year and persistent

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Frank Qian Zhan, Vathani Sharon Packianathan, and Nathalie Charlotte Zeitouni

1999 ; 85 : 2589 – 2595 . 14 Veness MJ Perera L McCourt J . Merkel cell carcinoma: improved outcome with adjuvant radiotherapy . ANZ J Surg 2005 ; 75 : 275 – 281 . 15 Richetta AG Mancini M Torroni A . Total spontaneous

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Kilian E. Salerno

In the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer, among adjuvant radiotherapy options for whole-breast irradiation after breast-conserving surgery, hypofractionation is preferred. For the use of accelerated partial-breast irradiation, the NCCN Guidelines have adopted the updated definition of “suitability” used by the American Society for Radiation Oncology. Regional nodal irradiation is indicated—either in the setting of breast-conserving surgery or after mastectomy—for women with ≥4 positive nodes and should be strongly considered for 1 to 3 positive lymph nodes and select patients with node-negative disease deemed at high risk for recurrence.

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Samuel W. Beenken and Marshall M. Urist

Merkel cell carcinoma (MCC) or neuroendocrine carcinoma of the skin is uncommon, often aggressive, and has a poor prognosis. Complete surgical excision with histologic documentation of clear resection margins is recommended for the primary cancer. Retrospective analysis of clinical data strongly suggests that adjuvant radiotherapy improves local control of MCC, but no evidence has been published that it prolongs survival. Sentinel lymph node biopsy is a useful method of determining the need for regional lymph node dissection in stage I patients. Chemotherapy regimens similar to those employed for small cell carcinoma of the lung have been recommended for advanced MCC. Patients often show an initial response to therapy, but it is usually short-lived. The three-year overall survival for patients with MCC is 31%. Before an improvement in long-term survival can be realized, early detection, appropriate use of surgery and radiation therapy, and the development of effective systemic chemotherapy are required.