e13596 Background: Belong.life, a global oncology social network for patients and caregivers, recently launched “Dave” the first conversational AI oncology mentor and companion. “Dave’s” objectives are to provide uninterrupted support, clarify relevant clinical issues and guide patients and caregivers with relevant and empathetic information and education in all aspects of cancer, from diagnosis to treatment protocols and side effects management. “Dave” underwent training on Belong’s unique and large datasets of patients to physicians, and patients to patients’ interactions, as well as incorporating high quality information from the latest international cancer guidelines, providing it with a robust up-to-date supportive data and a wide understanding of the patients’ cancer journey. Methods: “Dave’s” responses to inquiries from Belong members were subjected to a validation survey conducted by eight oncologists, each specializing in various solid and haematological cancers and affiliated with several medical institutions. From the social network datasets, 471 questions from patients and caregivers were randomly selected and categorized into groups, including Breast, Gastrointestinal and Pancreatic, Genito-urinary, Bone, Haematological cancers, and Radiation therapy. The oncologists assessed the AI mentor's replies for their relevance and helpfulness, aligning them with evidence-based medicine, current recommendations, and guidelines. Results: Results were categorized into positive or negative assessments. Impressively, 432 out of 471 “Dave’s” responses (91.8%) received positive validation for providing suitable and relevant recommendations. Conversely, 39/471 responses (8.2%) received a negative validation, of which only 5/471 (1%) were graded as not at all helpful or relevant. Minor variations were observed within diagnostic groups, with positive validation rates as follows: Genito-urinary 100%, Breast 98.4%, Musculoskeletal 97%, Radiation therapy 88%, Gastrointestinal and Pancreatic 86%, and Haematological cancers 84%. Conclusions: The documented results on 471 patients’ posts are very promising, indicating that “Dave” provides valuable and reliable recommendations, achieving a positive validation rate of nearly 92%, with only 1% graded as not at all helpful or relevant. The findings also offer insights into the AI mentor's performance across distinct medical domains. This validation study provides a solid foundation and adds confirmation that the addition of an AI oncology mentor and companion, like “Dave”, improves patients’ knowledge and coping mechanisms and provides helpful and relevant guidance during their cancer journey, while supporting physicians in the daily management of their cancer patients.
Stereotactic body radiotherapy and stereotactic radiosurgery are advanced radiotherapy techniques used to treat a variety of malignancies with high precision. However, there is significant variability in dose prescription and delivery, which may impact treatment consistency and efficacy. This work presents an analysis of retrospective dosimetric data collected from 300 stereotactic body radiotherapy/stereotactic radiosurgery (SBRT/SRS) clinical treatment plans. The study evaluated the dosimetric variability across different disease sites, including lung, brain, prostate, pelvis, liver, and bone, as well as among individual treatment planning strategies. Parameters analyzed included D0.1cc, D50, D95, D99, homogeneity index, and conformity index. The results showed that, despite variations in tumor types and planning approaches, a standardized protocol at our institution helped minimize dosimetric variability. These data may facilitate interinstitutional comparisons and help to enrich the SBRT/SRS data pool for treatment standardization.
To determine the impact of using fiducial match for daily image-guidance on pelvic lymph node (PLN) coverage for prostate cancer patients receiving stereotactic body radiation therapy (SBRT).Thirty patients underwent SBRT treatment to the prostate and PLN from 2014 to 2016. Each patient received either 800cGy × 5 or 500cGy × 5 to the prostate and 500cGy × 5 to the PLN. A 5 mm clinical target volume (CTV)-to-planning target volume (PTV) margin around the PLN was used for planning. Two registrations with planning computed tomography (PCT) for each of the daily cone beam CTs (CBCTs) were performed: a rigid registration to fiducials and to the bony anatomy. The average translational difference between fiducial and bony match as well as percentage of fractions with differences > 5mm were calculated. Changes in bladder and rectal volume as well as center-of-mass (COM) position from simulation parameters, and their correlation with translational difference were also evaluated. The dosimetric impact of the translational differences was calculated by shifting the plan isocenter.The average translational difference between fiducial and bony match was 0.06 ± 0.82, 2.1 ± 4.1, -2.8 ± 4.3, and 5.5 ± 4.2 mm for lateral, vertical, longitudinal, and vector directions. The average change in bladder and rectal volume from simulation was -67.2 ± 163.04 cc (-12 ± 52%) and -1.6 ± 18.75 (-2 ± 30%) cc. The average change in COM of bladder from the simulation position was 0.34 ± 2.49, 4.4 ± 8.1, and -3.9 ± 7.5 mm along the LR, AP, and SI directions. The corresponding COM change for the rectum was 0.17 ± 1.9, 1.34 ± 3.5, and -0.6 ± 5.2 mm.The 5 mm margin covered ~75% of fractions receiving PLN irradiation with SBRT, daily CBCT and fiducial-guided setup. The dosimetric impact on PLN coverage was significant in 19% of fractions or 25% of patients. A larger translational shift was due to variation in rectal volume and changes in COM position of the bladder and rectum. A consistent bladder positioning and/or rectum filling compared with presimulation volume were essential for adequate coverage of PLN in a hypofractionated treatment regime.
There are only sporadic reports on the clinical behavior and appropriate treatment of anaplastic seminoma. This retrospective study summarizes our experience with the anaplastic variant of classical (typical) seminoma.Between 1986 and 2006, seven anaplastic seminoma patients were staged and treated at the Northern Israel Oncology Center. Staging procedures included meticulous physical and neurological examinations, complete blood count, full biochemistry profile, specific tumor markers, testicular ultrasound, and other radiological measures. All patients underwent inguinal orchiectomy and were staged properly. Six patients had stage I disease, and one patient had stage IIA disease. Patients were irradiated with doses ranging from 2,500 to 3,000 cGy, and the stage IIA patient received an additional 1,000 cGy boost to radiographically involved lymph nodes.After a mean follow-up of 11 years, six patients are alive with no evidence of disease. One patient died due to an unknown, non-oncological, cause, unrelated to his previous testicular tumor, while in complete remission.Despite the low patient numbers and the retrospective nature of our study, it can be concluded that radiotherapy treatment for early-stage anaplastic seminoma patients might achieve the same excellent survival as for classical seminoma. However, the general consensus achieved through large-scale studies suggests that active surveillance should be offered to all stage I seminoma patients, regardless of the pathologic variant.
Myoepithelial tumor is a rare form of cancer, mainly arising from the salivary glands and extremities. Due to its rarity, no formal treatment guidelines exist. Here we report a case of a male patient diagnosed with metastatic myoepithelial tumor which was successfully treated with an androgen-receptor (AR) antagonist (bicalutamide), based on the results of molecular testing. Six years after the initiation of bicalutamide, patient was diagnosed with metastatic prostate cancer. To our knowledge, this is the first case described in literature that demonstrate the effectiveness of anti-androgens in treating myoepithelial tumor. Vigilance should be maintained when screening these patients for prostate cancer as their 'true' prostate specific antigen levels might be masked by the ongoing endocrine therapy.
Our objective was to report our experience and to evaluate the feasibility and toxicity of focal salvage stereotactic body radiation therapy (SBRT) in patients with post-radiation local recurrence of prostate cancer.We retrospectively reviewed medical records of patients treated with Cyberknife ® between October 2014 and April 2017 at our institution for a focal reirradiation delivered to the prostate/prostatic bed for local recurrence after radical or adjuvant radiotherapy. All patients underwent prostate biopsies at recurrence at the time of fiducial markers placement, had choline PET/CT and pelvic MRI. The treatment consisted in 36 Gy in six fractions delivered every other day. Post reirradiation toxicities were assessed according to the CTCAE v4 (Common Terminology Criteria for Adverse Events).42 patients were treated with followed with a median follow-up of 21 months (range 3 - 31). 34 patients had biopsy proven recurrence. The initial treatment was radical prostatectomy and radiation therapy for 9 patients and radiation therapy alone for 33 patients. 23 patients from the group of prostate reirradiation had placement of rectal spacers. No Grade 4 or 5 toxicity were observed. 27 acute urinary events were recorded: 18 patients experienced Grade 1, 9 patients experienced Grade 2 toxicity and 1 patient experienced Grade 3 urinary toxicity, namely cystitis and/or dysuria. No Grade 2 or more digestive toxicity was observed. Rectal doses were significantly lower with rectal spacers.Salvage focal Cyberknife ® seems feasible and show promising results.SBRT for local prostate cancer recurrence after initial radiotherapy is well tolerated with short follow-up.
Head and neck malignancies have the propensity to invade nerves. Perineural tumor invasion is common, with some series reporting rates of 30 to 100%. Squamous cell carcinoma and adenoid cystic carcinoma are the most commonly involved tumors. The most commonly involved nerves are the trigeminal (cranial nerve [CN] V) and facial (CN VII) and their branches. Neural spread away from a tumor is encountered less often and usually causes specific symptoms such as pain, muscle weakness, and atrophy, depending on the involved nerves. While clinical symptoms and physical examination may suggest the presence of neural invasion, specific imaging modalities such as fat-suppressed T1-weighted magnetic resonance images, should be utilized to identify perineural tumor spread in its early phases. Perineural tumor spread should be considered and addressed in the treatment planning of patients with head and neck or skull base cancers as it can influence the extent of surgery, and the dosage and fields of radiation therapy. In the current review, we discuss the clinical course of perineural tumor spread and its therapeutic implications.
