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A recent nomogram for glioblastoma (GBM) was designed to incorporate methylguanine-DNA methyltransferase (MGMT) methylation status in trial patients receiving temozolomide. Since clinical trial patients are strictly selected, compared to the general population, we performed a multi-institutional, external, independent assessment of the nomogram. Consecutive adult patients with supratentorial GBM diagnosed between June 2007 and December 2014 who initiated TMZ-based concurrent chemoradiotherapy (CRT) and were not enrolled on RTOG 0525 or 0825 were eligible. We collected age, gender, MGMT status, performance status, resection extent, race, and tumor site and Cox regression analysis of overall survival (OS) was conducted with the 1-year nomogram-predicted survival (NPS). The predictive accuracy was quantified by the concordance index (c-index) as well as by separating patients into quintile-groups of the population distribution of NPS and comparing mean NPS and observed OS. Of 514 patients with GBM, 309 had all nomogram factors. Median OS was 18.7 months. NPS and observed OS demonstrated a c-index of 0.695. On univariate analysis, the NPS and all included factors except gender were significant. On multivariable analysis (MVA) the only significant factor for worse survival was lower NPS. When separated into quintile-groups of NPS, the observed survival was slightly better than the predicted survival for all but the worst prognostic group. Our multi-institutional cohort provides independent external validation of a novel GBM nomogram incorporating MGMT methylation status. No individual factor included in the nomogram retained significance on MVA after adjusting for NPS.

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Introduction:The BD Helping Build Healthy Communities (HBHC) program is a philanthropically funded initiative designed to provide support for comprehensive medication management (CMM) services at Federally Qualified Health Centers (FQHCs) to support care for low-income populations.Objectives: The primary outcome of interest was the change in glycosylated hemoglobin (HbA1c) between baseline and 6 months with changes in systolic (SBP) and diastolic blood pressure (DBP) between baseline and 6 months being evaluated as secondary outcomes.Methods: Awardees of the HBHC program who provided clinical pharmacist led CMM services in 2017, 2018, or 2019 to address the needs of people living with diabetes, were asked to complete a standardized monitoring template to evaluate their progress in serving patients receiving care at their clinic. The data from these reports was then analyzed using the paired t test to identify statistically significant changes in HbA1c, SBP, and DBP.Results: A total of eight FQHCs, providing care to a total of 2502 patients, received funding within the HBHC program for their CMM activities related to diabetes.Within the primary outcome analysis of the change in HbA1c at 6 months, a statistically significant reduction in average clinic HbA1c between baseline and 6 months (9.4 vs 8.2, mean difference 1.2, 95% CI [0.45-1.97, P <.01]) was observed. Similarly, a statistically significant reduction was observed between baseline and 6 months for

Patients with head and neck malignancies commonly develop metastatic disease, yet rarely do these carcinomas metastasize to the brain. Stereotactic radiosurgery (SRS) is routinely employed to treat brain metastases (BM). This study was undertaken to examine the efficacy of SRS for BM from primary head and neck carcinomas. From 2000 to 2016, a total of 19 patients with 38 lesions were retrospectively identified. All patients presented with a primary head and neck malignancy and subsequently developed metastatic disease to the brain treated with SRS at our institution. Actuarial rates for overall survival (OS), local control (LC) and distant brain metastases (DBM) were calculated using Kaplan-Meier estimates. Median follow up was 6.8 months and median survival was 15.8 months. Eleven lesions received post-operative SRS to a surgical cavity and 27 lesions received definitive SRS to a metastasis. The median dose prescribed was 18 Gy. One-year actuarial rate for LC was 77.3% (95% confidence interval [CI] 44-92%) while 1 year and 2 year rates of OS were 52.9% (CI 28-73%) and 31.7% (CI 11-55%) respectively. The median time to develop DBM was 8.4 months. Three patients (16%) underwent repeat SRS following development of new BM and three patients (16%) underwent salvage whole brain radiotherapy (WBRT). SRS may be utilized in the treatment of patients with primary head and neck malignancies metastasized to the brain with high efficacy. Patients with well-controlled systemic disease and good performance status may benefit the most from definitive SRS while avoiding WBRT.