Radiation-induced CRS patients exhibited greater squamous metaplasia and subepithelial edema when compared with a cohort of patients with CRSsNP, and decreased eosinophilia and basement membrane thickening compared with a cohort of CRSwNP patients. CRSr cases demonstrated no difference in eosinophilia or neutrophilia compared with CRSsNP, and decreased eosinophilia compared with CRSwNP, lending further credence to the unique nature of radiation in the development of CRS in this patient group. These findings may have major implications with regard to extent of surgical intervention and medical management.

No abstract

Purpose/Objective(s): Standard of care for inoperable N+ M0 non-small cell lung cancer (NSCLC) is concurrent platinum-based chemoradiation (CRT) and thoracic radiation to 60 Gy in daily fractions. However, many patients with a poor performance status or social limitations may receive radiation monotherapy (RT). The primary aim of this study was to compare characteristics and survival of patients who received standard CRT vs RT alone. Materials/Methods: The national cancer database (NCDB) captures >70% of incident cancer diagnoses in the United States. We selected patients diagnosed with clinical or pathological stage Tany N+ M0 during 2004-2013 who did not undergo definitive surgery. Definitive RT was defined as 58-80 Gy in 30-45 fractions or 45-60 Gy in 15 fractions, starting within 90 days of diagnosis. Definitive CRT was defined as RT with systemic chemotherapy administered within 180 days of diagnosis, without distinction between concurrent and sequential administration. Patient demographic, diagnosis, and treatment information and overall survival (OS) were compared with descriptive statistics, multivariable logistic regression, and single and multivariable survival analyses. Results: After applying selection criteria, 89,195 patients had clinical or pathological stage Tany N+ M0, and of these 3,073 (3.4%) received RT, 24,412 (27%) received CRT, 49,394 (55%) received chemo, and 12,316 (14%) did not receive any treatment. Eleven percent of patients (3,073 out of 27,485) receiving RT did not receive chemo. We used 1:1 propensity score matching to compare RT and CRT groups, focusing on 2,883 patients in each group. RT patients had older age (median 75 vs 70, range 38-90 in both). Baseline and cancer characteristics were comparable except race (RT 85% vs CRT 82% white, pZ0.04), and insurance (RT 70% vs CT 67% Medicare, pZ0.02). In multivariable analysis the groups were comparable except for borderline significance of Medicaid insurance (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.0-1.7) and Charlson-Deyo comorbidity score of 1 (OR 1.1, 95% CI 1.0-1.3) favoring CRT. Kaplan-Meier survival analysis found improved OS associated with CRT (5-year 15%, median 17 months) vs RT (5-year 8%, median 12 months) (p<0.0001), with a hazard ratio (HR) of 0.7 (95%CI 0.7-0.7). Improved survival was also associated with female gender, younger age, insurance other than Medicare/unknown/ none, fewer comorbidities, treatment at an academic/research facility, and earlier stage at diagnosis. Conclusion: Of patients referred for definitive chemoradiation, 11% received RT alone. Definitive CRT was associated with higher OS when compared to RT alone but selection bias may have contributed since patients who received RT alone had more comorbidities and were older than patients who received definitive CRT. Novel approaches are needed to improve the outcomes in patients who are not candidate for systemic chemotherapy with concurrent thoracic RT, such as combination of RT with targeted and immunotherapy agents.

Background: MicroRNA is a kind of single-stranded non-coding RNA whose length is about 22 nucleotides and its abnormal expression is related to disease closely. This study is aiming to explore the relative expression of miR-34b-3p and miR-302a-5p in the plasma of non-small cell lung cancer (NSCLC) patients and its clinical value. Method: The levels of miR-34b-3p and miR-302a-5p in plasma were detected by real-time polymerase chain reaction (RTPCR) in 86 patients with NSCLC, 64 patients with pulmonary tuberculosis (PTB) and 39 healthy subjects. Analyze their value in diagnosing NSCLC by contrasting and combining carcino-embryonic antigen (CEA), neuron-specific enolase (NSE), and cytokeratin 19 fragments 21-1 (CYFRA21-1) Results: The levels of plasma miR-34b-3p and miR-302a-5p in NSCLC group were significantly higher than those in the PTB group and the healthy group (P<0.05). In patients with NSCLC, the levels of plasma miR-34b-3p was correlated with the diameter of tumor (P<0.01). When using one plasma marker to diagnose NSCLC, miR-302a-5p had the highest sensitivity (82.6%) and CEA had the highest specificity (81.6%). While combined two plasma markers, miR-34b-3p+miR-302a-5p had the highest sensitivity (80.2%) and miR-34b-3p+CEA had the highest specificity (81.4%). As detected multiple markers, miR-302a-5p+ NSE+ CYFRA21-1 had the highest sensitivity (81.4%) and miR-34b-3p+CEA+ NSE had the highest specificity (90.3%). The combination of miR-34b-3p, miR-302a-5p and CEA obtained the highest area under the curve (AUC), which was 0.832. Logistic regression model indicated that miR-34b-3p was independent risk factor for NSCLC compared to control groups. Conclusion: The miR-34b-3p and miR-302a-5p in plasma could be hopefully used as biological markers for the diagnosis of NSCLC.

No abstract