Daugherty, Larry C.

Objective To update a previously proposed prognostic scoring system that predicts risk of biochemical recurrence ( BCR ) after salvage radiation therapy ( SRT ) for recurrent prostate cancer when using additional patients and a PSA value of 0.2 ng/ mL and rising as the definition of BCR . Patients and Methods We included 577 patients who received SRT for a rising PSA after radical prostatectomy in this retrospective cohort study. Clinical, pathological, and SRT characteristics were evaluated for association with BCR using relative risks ( RR s) from multivariable Cox regression models. Results With a median follow‐up of 5.5 years after SRT , 354 patients (61%) experienced BCR . At 5 years after SRT , 40% of patients were free of BCR . Independent associations with BCR were identified for the PSA level before SRT ( RR [doubling]: 1.25, P < 0.001), pathological tumour stage ( RR [T3a vs T2] 1.21, P = 0.19; RR [T3b/T4 vs T2] 2.09, P < 0.001; overall P < 0.001), Gleason score ( RR [7 vs <7] 1.63, P < 0.001; RR [8–10 vs <7] 2.28, P < 0.001; overall P < 0.001), and surgical margin status ( RR [positive vs negative] 0.71, P = 0.003). We combined these four variables to create a prognostic scoring system that predicted BCR risk with a c ‐index of 0.66. Scores ranged from 0 to 7, and 5‐year freedom from BCR for different levels of the score was as follows: Score = 0–1: 66%, Score = 2: 46%, Score = 3: 28%, Score = 4: 19%, and Score = 5–7: 15%. Conclusion We developed a scoring system that provides an estimation of the risk of BCR after SRT . These findings will be useful for patients and physicians in decision making for radiation therapy in the salvage setting.

Rosai-Dorfman disease (RDD) is a rare, benign histiocyte disorder originally described by Rosai and Dorfman in 1969 as sinus histiocytosis with massive lymphadenopathy. It most typically presents as massive, painless cervical lymphadenopathy, and it is most often found in adolescents and young adults. Extranodal involvement is a common feature of RDD and may occur in more than 40% of patients. Less commonly, the disease can be seen in the bone. There are scattered case reports discussing the use of radiotherapy in the treatment of RDD. Here, we present a case of extranodal RDD of the femur in a 49-year-old African American female. The patient underwent three surgical procedures prior to undergoing radiotherapy. Pathology was consistent with extranodal RDD. The cells stained positive for CD68 and S-100. Pathognomonic features such as emperipolesis and replacement of the bone marrow by diffuse infiltrating of histiocytes and intervening bands of plasma cells proliferation were noted. Prior to radiotherapy, the patient required a walker to assist with ambulation and was utilizing a wheelchair while in the clinic. The decision was made to proceed with 30 Gy of external beam radiotherapy in 15 fractions. After five fractions, the patient's pain resolved entirely. She no longer required pain medication and was ambulating without assistance. She experienced no adverse events from the radiation. Extranodal RDD is a rare disorder, and evidence for treatment is derived from scattered case reports. Previous reports have indicated a dose response to radiotherapy in the 20-30 Gy range for RDD; however, our patient developed complete resolution of her symptoms after 10 Gy. While the optimal dose regimen has not yet been established, symptomatic patients appear to benefit from external beam radiotherapy for extranodal RDD.

BackgroundWe sought to examine adherence to National Comprehensive Cancer Network guidelines for use of radiation therapy (RT) in patients with soft tissue sarcoma (STS) in the United States.MethodsThe surveillance, epidemiology, and end results cancer registry was queried to identify patients undergoing surgery for truncal and extremity STS from 2004 to 2009.ResultsOf 5,075 patients, 50% received RT. Although routine RT is not recommended for Stage I patients, 25% still underwent RT. Even though routine RT is recommended for Stage II and III tumors, only 60% underwent RT. On multivariate analysis predictors of RT included age <50 years (OR 1.57, 95% CI 1.28–1.91), malignant fibrous histiocytoma histology (OR 1.47, 95% CI 1.3–1.92), T2 classification (OR 1.88, 95% CI 1.60–2.20), and G3 (OR 6.27, 95% CI 5.10–7.72). Patients with Stage III STS who received RT showed improved disease specific survival at 5 years compared to those who did not, 68% versus 46%, P <0.001.ConclusionsUnderuse of RT is seen for a significant proportion of patients undergoing treatment for STS in the United States. More effort needs to be directed towards compliance with appropriate treatment recommendations, perhaps by regionalizing sarcoma care or remote multidisciplinary tumor boards. J. Surg. Oncol 2014; 109:633–638. © 2014 Wiley Periodicals, Inc.

Background. Previous reports have shown a positive association between serum calcium level and prostate cancer mortality. However, there is no data regarding whether higher serum calcium levels are associated with increased risk of biochemical recurrence (BCR) following salvage radiation therapy (SRT) for prostate cancer. Herein, we evaluate the association between pretreatment serum calcium levels and BCR in a cohort of men who underwent SRT. Methods. We evaluated 165 patients who underwent SRT at our institution. Median dose was 65.0 Gy (range: 54.0–72.4 Gy). We considered serum calcium as both a continuous variable and a 3-level categorical variable (low [≤9.0 mg/dL], moderate [>9.0 mg/dL and ≤9.35 mg/dL], and high [>9.35 mg/dL]) based on sample tertiles. Results. We observed no evidence of a linear association between serum calcium and BCR (relative risk (RR): 0.96, P=0.76). Compared to men with low calcium, there was no significantly increased risk of BCR for men with moderate (RR: 0.94, P=0.79) or high (RR: 1.08, P=0.76) serum calcium levels. Adjustment for clinical, pathological, and SRT characteristics in multivariable analyses did not alter these findings. Conclusion. Our results provide evidence that pretreatment serum calcium is unlikely to be a useful tool in predicting BCR risk following SRT.