Background Aspiration pneumonia represents an under-reported complication of chemoradiotherapy in head-and-neck cancer. This study evaluated the incidence, risk factors, and mortality of aspiration pneumonia in a large cohort of head-and-neck cancer patients treated with concurrent chemoradiotherapy. Methods Patients with head-and-neck cancer diagnosed between 2000 and 2009 were identified from the SEER-Medicare database. Aspiration pneumonia was identified from Medicare billing claims. The cumulative incidence, risk factors, and survival after aspiration pneumonia were estimated and compared to a non-cancer population. Results Of 3,513 head-and-neck cancer patients, 801 patients developed aspiration pneumonia at a median time of 5 months after initiating treatment. The 1- and 5-year cumulative incidence of aspiration pneumonia was 15.8% and 23.8% for head-and-neck cancer patients and 3.6% and 8.7% for non-cancer controls, respectively. Among cancer patients multivariate analysis identified independent risk factors (p<0.05) for aspiration pneumonia including hypopharyngeal and nasopharyngeal tumors, male gender, older age, increased comorbidity, no surgery prior to radiation, and care received at a teaching hospital. Among cancer patients who experienced aspiration pneumonia, 674 (84%) were hospitalized of which 301 (45%) were admitted to an intensive care unit. Thirty-day mortality after hospitalization for aspiration pneumonia was 32.5%. Aspiration pneumonia was associated with a 42% increased risk of death (HR=1.42, p<0.001) after controlling for confounders. Conclusions This study found that nearly one-quarter of elderly patients will develop aspiration pneumonia within 5 years of chemoradiotherapy for head-and-neck cancer. A better understanding of mitigating factors will help identify patients at risk for this potentially lethal complication.

Purpose: Preclinical models have shown that the effectiveness of GL-ONC1, a modified oncolytic vaccinia virus, is enhanced by radiation and chemotherapy. The purpose of this study was to determine the safety of GL-ONC1 when delivered intravenously with chemoradiotherapy to patients with primary, nonmetastatic head and neck cancer.Experimental Design: Patients with locoregionally advanced unresected, nonmetastatic carcinoma of the head/neck, excluding stage III-IVA p16-positive oropharyngeal cancers, were treated with escalating doses and cycles of intravenous GL-ONC1, along with radiotherapy and chemotherapy. The primary aims were to define the MTD and dose-limiting toxicities, and to recommend a dose for phase II trials.Results: Between May 2012 and December 2014, 19 patients were enrolled. The most frequent adverse reactions included grade 1-2 rigors, fever, fatigue, and rash. Grade 3 adverse reactions included hypotension, mucositis, nausea, and vomiting. In 2 patients, the rash was confirmed as viral in origin by fluorescence imaging and viral plaque assay. In 4 patients, viral presence in tumor was confirmed on midtreatment biopsy by quantitative PCR. In 1 patient, live virus was confirmed in a tongue tumor 7 days after receiving the first dose of virus. The MTD was not reached. With median follow-up of 30 months, 1-year (2-year) progression-free survival and overall survival were 74.4% (64.1%) and 84.6% (69.2%), respectively.Conclusions: Delivery of GL-ONC1 is safe and feasible in patients with locoregionally advanced head/neck cancer undergoing standard chemoradiotherapy. A phase II study is warranted to further investigate this novel treatment strategy.

This article reports a patient with a rare metastatic, chemotherapy‐refractory neuroendocrine carcinoma who was treated with stereotactic body radiation therapy (SBRT) combined with anti‐programmed cell death protein 1 antibody. The novel treatment modality of SBRT combined with a checkpoint inhibitor is discussed, as well as the implications of molecular profiling and tumor mutational burden as potential predictors of response.

The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood-brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years. The controversy involves whether patients with a limited number of brain metastases should undergo whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) delivered only to the radiographically visible tumours. Survival is comparable for patients treated with either modality. Instead, the controversy involves the neurocognitive function (NCF) of radiating cerebrum that appeared radiographically normal relative to effects of the growth from micro-metastatic foci. A fundamental question in this debate involves quantifying the effect of WBRT in patients with cerebral metastasis. To disentangle the effects of WBRT on neurocognition from the effects inherent to the underlying disease, we analysed the results from randomised controlled studies of prophylactic cranial irradiation in oncology patients as well as studies where patients with limited cerebral metastasis were randomised to SRS versus SRS+WBRT. In aggregate, these results suggest deleterious effects of WBRT in select neurocognitive domains. However, there are insufficient data to resolve the controversy of upfront WBRT versus SRS in the management of patients with limited cerebral metastases.

Purpose Anatomic distortion is present in all MRI data due to non-linearity of gradient fields and measures up to several millimeters. We evaluate the potential for uncorrected MRI to lead to geometric miss of the target volume in stereotactic radiosurgery (SRS). Methods and Materials Twenty-eight SRS cases were studied retrospectively. MRIs were corrected for gradient non-linearity distortion in three dimensions, and gross tumor volumes (GTVs) were contoured. The manufacturer-specified distortion field was then re-applied to GTV masks to allow measurement of GTV displacement in uncorrected images. The uncorrected GTV was used for SRS planning, and the dose received by the true (corrected) GTV was measured. Results Median displacement of the GTV due to gradient distortion was 1.2 mm (interquartile range 0.1 mm – 2.3 mm), with a minimum of 0 mm and a maximum of 3.9 mm. Eight of the twenty-eight cases met a priori criteria for “geometric miss.” Conclusions While MRI distortion is often subtle on visual inspection, there is a significant clinical impact of this distortion on SRS planning. Distortion-corrected MRI should uniformly be used for intracranial radiosurgery planning because uncorrected MRI can lead to potential geometric miss.