8587 Background: A symptom cluster is 2 or more co-occurring symptoms. Patients with brain tumors experience disease and treatment-related symptoms that impact their health-related quality of life (QOL). Identifying symptom clusters will facilitate treatment and improve QOL outcomes. Methods: 66 patients were enrolled in a phase III, placebo-controlled, double-blind, prospective randomized clinical trial assessing the effect of prophylactic d-methylphenidate (d-MPH) on QOL in newly diagnosed brain tumor patients receiving brain radiation therapy (RT). Inclusion criteria were: age ≥ 13 years, primary or metastatic brain tumor, partial or whole brain RT with a total dose of ≥ 2,500 cGy in ≥ 10 fractions, KPS ≥ 70, and life expectancy ≥ 3 months. Patients received d-MPH 5–15 mg BID (or placebo) starting week 1 of RT and continuing for 8 weeks post-RT. QOL data were collected at baseline, the end of RT, and 4, 8, and 12 weeks following RT using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and the Center for Epidemiologic Studies Depression Scale (CES-D). Symptom data were analyzed using exploratory factor analysis, multi-dimensional scaling (MDS), and cluster analysis. Results: The study failed to show a treatment effect for d-MPH (Butler J et al, Int J Radiat Oncol Biol Physics 63 [Supp1]:80, 2005).Thus, both d-MPH and placebo patients were analyzed together. 58 and 48 patients were analyzed at baseline and the end of RT, respectively. Two symptom clusters were identified using exploratory factor analysis and supported by MDS and cluster analysis: an expressive language cluster including difficulty reading, writing, and finding the right words, and a mood cluster including feeling sad, anxious, and having depressed mood. Conclusions: Two symptom clusters were identified in patients undergoing brain RT: an expressive language cluster and a mood cluster. This suggests that interventions that target both cognitive function and mood should be utilized. Further research on symptom clusters in cancer patients is needed. This study was supported by NCI grant 1 U10 CA81851. No significant financial relationships to disclose.

Background Many elderly cancer patients experience increased cancer-related morbidity and mortality compared to younger patients. In soft tissue sarcoma, adjuvant radiotherapy is an integral part of definitive therapy for limb preservation. We hypothesized that age-related disparities exist in the use of radiation. Methods We used SEER data to conduct a retrospective cohort study among patients 25 years or older diagnosed from 1998 to 2004 with non-metastatic, biopsy-proven, high-grade soft tissue sarcoma in the extremities undergoing a limb-sparing procedure. Patients were stratified according to age (<50, 50-70, and >70). Logistic regression was used to determine the association between age and radiotherapy use, adjusting for histology, location, size, surgery, gender, race, and marital status. A Cox proportional hazards model was used to compare disease-specific and all-cause mortality. Results Among 1,354 eligible patients; 37.1% were older than age 70, 44.3% female, and 84.4% Caucasian. While almost three-quarters (73.8%) of the cohort received radiotherapy, receipt decreased from 78.2% in patients younger than age 50 to 69.6% in patients older than age 70 (test of trend p=0.006). After adjusting for demographic and tumor factors, older patients remained less likely to receive radiotherapy (odds ratio=0.66, 95% confidence interval (CI)=0.47-0.92) and more likely to experience disease-specific death (hazard ratio=2.4, CI=1.4-4.1) as compared to the youngest group. Conclusion Older adults appear less likely to receive definitive therapy for soft tissue sarcoma of the extremities. In the absence of clinical trials and treatment guidelines tailored to this population, under-treatment may disadvantage the elderly with increased cancer-related morbidity and mortality.

This one-time greenhouse study examined the phenology, morphology, frost hardiness and response to moisture stress of three Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) stocktypes from the same seed lot. The types were mini-plug TM transplants (MPT), 1 + 1 bareroot transplants (1 + 1), and 2 + 0 barefoot seedlings (2 + 0). In late summer and fall before lifting, 2 + 0 seedlings set bud before 1 + 1 seedlings, 1 + 1 seedlings before MPT seedlings, The 2 + 0 seedlings appeared slowest to acquire frost hardiness in fall and seemed to deharden most rapidly in spring. Although the 2 + 0 seedlings were taller than the MPT stocktype, MPT and 2 + 0 seedlings were relatively similar in other morphological respects, but 1 + 1 seedlings were much larger. All stocktypes were potted on January 20, 1989, placed in a greenhouse, and subjected to 39%, 18%, 16%, or 6% soil water content (% dry weight) until the end of the experiment in midJuly 1990. The largest decrease in pre-dawn xylem water potential occurred with 16% and 6% soil water content; pre-dawn xylem water potential averaged over the three stocktypes generally declined 219% from low to high soil moisture stress. The 1 + 1 seedlings used more water than the other two stocktypes, and at maximum soil moisture stress, plant moisture stress increased in the order: MPT < 2 + (I < 1 + 1. During the 6-month greenhouse experiment, the larger 1 + 1 stocktype showed the most absolute growth, but the smaller stocktypes grew more on a relative scale. Growth of the stocktypes appeared to be related to differences in morphology and water-use patterns as the seedlings competed for available water within each pot. The results show that MPT seedlings, a new stocktype, performed as well as the more traditionally used 2 + 0 and 1 3-1 seedlings and that stocktype selection is important in reforestation efforts.Application.Seedlings of three different stocktypes (mini-plug ~ ~ transplants, 2 + 1) bareroot, and 1 3-1 transplants) responded differently to various levels of soil moisture content. Results indicate that mini-plug TM seedlings, a new stocktype, may be an excellent alternative to more traditionally used 2 + 0 and 1 + 1 stocktypes.

Objective This study aims to report the long-term outcomes of a novel treatment approach utilizing induction low-dose fractionated radiation therapy (LDFRT) and chemotherapy for locally advanced squamous cell carcinoma of head and neck (SCCHN). Methods We prospectively enrolled 40 patients with locally advanced SCCHN (77 % stage IV) on a phase II clinical trial and treated with induction paclitaxel (225 mg/m2), carboplatin (AUC 6), and LDFRT (80 cGy BID on days 1 and 2) every 21 days for two cycles. Results Forty patients enrolled; 39 were evaluable. The acute toxicity and response data have been previously reported; overall response rate (RR) was 82 %. After induction, definitive therapy was concurrent chemoradiation (CRT) in 51 %, XRT alone in 39 %, surgery in 5 %, and surgery and XRT in 5 %. The long-term outcomes are now reported with a median follow-up of 83 months. Locoregional control (LRC) is 80 % and distant control (DC) is 77 %. Five-year overall survival (OS), disease-specific survival, and progression-free survival (PFS) are 62 %, 66 %, and 58 %, respectively. Conclusion Induction chemotherapy with LDFRT has a high initial RR, comparable toxicity to two-drug induction regimens, but adds a third novel and effective agent, LDFRT. Five-year follow-up shows favorable outcomes compared to historical controls and excellent compliance with definitive therapy. This novel treatment approach is now planned for phase 3 trial evaluation.