patients had tumoral PD-L1 expression !5%. Patients with tumoral PD-L1 !5% had better OS vs those with lower expression, HRZ0.29 (CI 0.10-0.78), pZ0.009; 10 years OS: 84% for PD-L1 !5% vs. 46% for PD-L1 <5%. On univariate analysis, OS was associated with PD-L1 status, as well as T stage, N stage, ECOG status and gender. On multivariate analysis, PD-L1 !5% remained statistically significant for better OS, HRZ0.35 (CI 0.12-0.99), pZ0.047. 33 of 65 (51%) of tumors had high CD8 levels (3 or 4). There was no association between CD8 status and OS; further stratifying PD-L1 high patients by CD8 did not improve the prognostic impact vs PD-L1 status alone. Conclusion: This is the first study reporting significant association of PD-L1 expression with OS in patients with anal cancer treated with CRT. PD-L1 status warrants consideration in the prognostication of patients with anal cancer. Future studies are required to determine the benefit of alternative treatment strategies based on PD-L1 status.

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ImportanceMost patients presenting to US emergency departments (EDs) with acute pulmonary embolism (PE) are hospitalized, despite evidence from multiple society-based guidelines recommending consideration of outpatient treatment for those with low risk stratification scores. One barrier to outpatient treatment may be clinician concern regarding findings on PE-protocol computed tomography (CTPE), which are perceived as high risk but not incorporated into commonly used risk stratification tools.ObjectiveTo evaluate the association of concerning CTPE findings with outcomes and treatment of patients in the ED with acute, low-risk PE.Design, Setting, and ParticipantsThis cohort study used a registry of all acute PEs diagnosed in the adult ED of an academic medical center from October 10, 2016, to December 31, 2019. Acute PE cases were divided into high- and low-risk groups based on PE Severity Index (PESI) class alone or using a combination of PESI class and biomarker results. The low-risk group was further divided based on the presence of concerning CTPE findings: (1) bilateral central embolus, (2) right ventricle–to–left ventricle ratio greater than 1.0, (3) right ventricle enlargement, (4) septal abnormality, or (5) pulmonary infarction. Data analysis was conducted from June to October 2022.Main Outcomes and measuresThe primary outcome was all-cause mortality at 7 and 30 days. Secondary outcomes included hospitalization, length of stay, need for intensive care, use of echocardiography and/or bedside ultrasonography, and activation of the PE response team (PERT) .ResultsOf 817 patients (median [IQR] age, 58 [47-71] years; 417 (51.0%) female patients; 129 [15.8%] Black and 645 [78.9%] White patients) with acute PEs, 331 (40.5%) were low risk and 486 (59.5%) were high risk by PESI score. Clinical outcomes were similar for all low-risk patients, with no 30-day deaths in the low-risk group with concerning CTPE findings (0 of 151 patients) vs 4 of 180 (2.2%) in the low-risk group without concerning CTPE findings and 88 (18.1%) in the high-risk group (P &amp;lt; .001). Low-risk patients with concerning CTPE findings were less frequently discharged from the ED than those without concerning CTPE findings (3 [2.0%] vs 14 [7.8%]; P = .01) and had more frequent echocardiography (87 [57.6%] vs 49 [27.2%]; P &amp;lt; .001) and PERT activation for consideration of advanced therapies (34 [22.5%] vs 11 [6.1%]; P &amp;lt; .001).Conclusions and RelevanceIn this single-center study, CTPE findings widely believed to confer high risk were associated with increased hospitalization and resource utilization in patients with low-risk PE but not short-term adverse clinical outcomes.

radiosurgery since the installation of a 6 DOF couch (Varian Perfect Pitch TM) up until the time of analysis were captured (2015-2017). Tumors were included for analysis if they received single-fraction SRS, had no prior surgery or radiation, and had available follow-up imaging. The dose was prescribed to the edge of the GTV with no PTV margin. Local failure was defined as a 25% increase in tumor diameter on follow-up MRI or pathologic confirmation of tumor recurrence. Tumors that initially increased in diameter with resolution on subsequent imaging were considered treatment effect rather than tumor progression. Locally controlled tumors were censored at the time of last follow-up, death, or whole brain radiation for distant brain failure. Distance from the isocenter was measured to the geometric center of each target. LC was evaluated by the Kaplan-Meier (KM) method with the log-rank test utilized to compare subgroups. Multivariable analysis for predictors of LC was performed using a Cox regression analysis. Results: A total of 532 evaluable tumors were identified. The median imaging follow-up was 5 months. The median tumor diameter and volume were 0.82 cm and 0.14 cc, respectively. The median prescribed dose was 18 Gy. The median distance from isocenter was 4.86 cm (range 0.04 e 13.98 cm). The KM estimate of overall 12-month LC was 95.9%. The KM estimate of 12-month LC for tumors 1 cm, >1 to 2 cm, >2 to 4 cm, >4 to 8 cm, and >8 cm from the isocenter was 95%, 100%, 99%, 95%, and 100%, respectively (pZ0.674). Only tumor volume (HR 1.24; pZ0.002) was predictive of local failure in a multivariable analysis that also included distance from the isocenter (pZ0.382). Conclusion: Single-isocenter VMAT SRS with immediate pre-treatment CBCT and 6 DOF couch adjustments appears to offer a high rate of local tumor control regardless of distance from the isocenter. As single-isocenter SRS greatly improves treatment times, it appears to be a highly effective and efficient strategy for brain radiosurgery to intact brain metastases.