Adjuvant chemoradiation (CRT), with high-dose cisplatin remains standard treatment for oral cavity squamous cell carcinoma (OCSCC) with high-risk pathologic features. We evaluated outcomes associated with different cisplatin dosing and schedules, concurrent with radiation (RT), and the effect of cumulative dosing of cisplatin. An IRB-approved collaborative database of patients (pts) with primary OCSCC (Stage I–IVB AJCC 7th edition) treated with primary surgical resection between January 2005 and January 2015, with or without adjuvant therapy, was established from six academic institutions. Patients were categorized by cisplatin dose and schedule, and resultant groups compared for demographic data, pathologic features, and outcomes by statistical analysis to determine disease free survival (DFS) and freedom from metastatic disease (DM). From a total sample size of 1282 pts, 196 pts were identified with high-risk features who were treated with adjuvant CRT. Administration schedule of cisplatin was not significantly associated with DFS. On multivariate (MVA), DFS was significantly better in patients without perineural invasion (PNI) and in those receiving ≥200 mg/m2 cisplatin dose (p < 0.001 and 0.007). Median DFS, by cisplatin dose, was 10.5 (<200 mg/m2) vs. 20.8 months (≥200 mg/m2). Our analysis demonstrated cumulative cisplatin dose ≥200 mg/m2 was associated with improved DFS in high-risk resected OCSCC pts.

Objectives: Evaluate outcomes of patients with recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy (IO). Methods: Among patients with R/M HNSCC treated with IO in this retrospective single-institution cohort, Cox regression was used to compare overall survival (OS) for those with platinum-refractory disease and those treated in the first-line setting with OS from KEYNOTE-040/048, respectively. Multivariable Cox regression was used to identify predictors of OS.Results: There was no significant OS difference for those treated in the platinum-refractory setting when compared to patients on KEYNOTE-040 (HR = 1.22, p = 0.27), nor for the first-line setting compared to KEYNOTE-048 (HR = 1.23, p = 0.19). ECOG-PS 1 (HR = 2.00, p = 0.02) and ECOG-PS 2 (HR = 3.13, p < 0.01) were associated with worse OS. Higher absolute lymphocyte count (ALC) was associated with improved OS (HR = 0.93 per 100 cells/μL, p = 0.03). Conclusions: Real-world outcomes of IO in R/M HNSCC are similar to outcomes in randomized control trials, with performance status and ALC correlating with OS.

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A 37-year-old woman with a history of migraines and gastritis presented to the emergency department with 1 day of right adnexal pain. A computed tomography (CT) scan of the pelvis performed to evaluate the pelvic pain showed a fluid-filled structure in the right adnexa, indicating a possible tubo-ovarian abscess. The patient was subsequently admitted to the hospital for treatment with antibiotics. Incidentally found on CT imaging were diffuse sclerotic foci (Fig 1) throughout the visualized spine and pelvis, suggesting asymptomatic metastatic disease. Physical examination was only significant for right lower quadrant tenderness, corresponding to the CT findings. There was no lymphadenopathy, mass, or obvious tenderness of her spine and pelvis. Initial laboratory results showedanormalcompletebloodcountandserumchemistries,including calcium of 9.8 mg/dL, and alkaline phosphatase of 63 U/L, and normal CA125 level. CT imaging of the chest showed diffuse blastic-appearing lesions throughout the skeleton without notable lymphadenopathy or mass. A nuclear bone scan was found to be normal, without evidence of any blastic metastatic lesions (Fig 2). The patient was ultimately given the diagnosis of osteopoikilosis, a rare benign condition of the bone. DiscussionOsteopoikilosis is an autosomal dominant heritable condition resulting in innumerable sclerotic foci throughout the entire skeleton. These

Immune thrombocytopenic purpura (ITP) is an acquired disease characterized by thrombocytopenia secondary to autoantibodies against platelet antigens. Secondary ITP is common after viral infections 1. We here report a case of ITP in a patient with COVID-19 pneumonia. An 89-year-old man with congestive heart failure, essential hypertension, type 2 diabetes, chronic kidney disease, and atrial fibrillation on anticoagulation (AC) presented to the emergency department in March 2020 with a 3-day history of shortness of breath, dry cough, and diarrhea. On admission, he was stable and required 2 L oxygen to keep his oxygen saturation 90%. Physical examination was remarkable for bibasilar crackles.