Doug Brunk

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Black children who receive kidney transplants appear more likely to lose their transplants sooner, compared with whites, results from a large analysis showed.

In addition, black pediatric patients living in high poverty neighborhoods face a more than twofold risk of transplant failure, compared with white patients.

"It has been reported that kidney transplants in blacks do not last as long as in whites, but we don’t really understand why this happens," Dr. Sandra Amaral said during a press briefing at the annual meeting of the American Society of Nephrology. "We think part of it is biologic; there are genetic differences between races, differences in diseases, and differences in our immune systems. But we also think that there may be socioeconomic differences. Based on our clinical practice, what we see is that if you’re poor it’s harder to get to your [medical] appointments. It may be harder to pay for your medicines. You may live in a household with a single care provider who’s really struggling to just feed you, much less make sure that your medicines are given on time every single day."

Dr. Amaral of the department of pediatrics at Emory University, Atlanta, and her associates studied 5,024 patients from the United States Renal Data System (USRDS) under age 21 years who received a kidney transplant between 2000 and 2006. The researchers followed the patients for transplant outcomes through September 2008 and linked their residential zip codes with poverty data from the 2000 United States Census.

Dr. Amaral reported that 18.3% of the patients experienced organ rejection during a mean follow-up of 3.6 years. Black patients were 2.3 times more likely than were white, non-Hispanic patients to experience organ rejection. In addition, Hispanic white patients were 24% less likely to experience organ rejection, compared with non-Hispanic white patients (hazard ratio = 0.76).

After the researchers adjusted for demographic, clinical, and socioeconomic factors, the researchers found that blacks were more likely to experience organ rejection, compared with non-Hispanic whites, and the degree of disparity varied by patient’s residential neighborhood.

Poverty also played a role in adverse outcomes in all patients. However, black patients fared worse. For example, black patients from neighborhoods in which more than 25% of residents lived below the federal poverty line were 2.46 times more likely to experience organ rejection, compared with their white counterparts. This relationship was also apparent in the wealthiest neighborhoods (those in which fewer than 5% lived below the federal poverty line), where black patients were 40% more likely to experience organ rejection at any given time during the follow-up, compared with non-Hispanic whites.

"It looks like poverty does make a difference," Dr. Amaral said. "It makes it harder for you to have a successful transplant."

She acknowledged certain limitations of the study, including the fact that the USRDS is unable to capture the specific barriers that get in the way of better transplant survival. "Is it because patients can’t pay for their medications, or is it because they can’t get to their appointments?" she asked. "Are there other things that get in the way of them being successful? This is an area for further study."

Dr. Amaral said that she had no relevant financial disclosures.

DENVER – Black children who receive kidney transplants appear more likely to lose their transplants sooner, compared with whites, results from a large analysis showed.

In addition, black pediatric patients living in high poverty neighborhoods face a more than twofold risk of transplant failure, compared with white patients.

"It has been reported that kidney transplants in blacks do not last as long as in whites, but we don’t really understand why this happens," Dr. Sandra Amaral said during a press briefing at the annual meeting of the American Society of Nephrology. "We think part of it is biologic; there are genetic differences between races, differences in diseases, and differences in our immune systems. But we also think that there may be socioeconomic differences. Based on our clinical practice, what we see is that if you’re poor it’s harder to get to your [medical] appointments. It may be harder to pay for your medicines. You may live in a household with a single care provider who’s really struggling to just feed you, much less make sure that your medicines are given on time every single day."

Dr. Amaral of the department of pediatrics at Emory University, Atlanta, and her associates studied 5,024 patients from the United States Renal Data System (USRDS) under age 21 years who received a kidney transplant between 2000 and 2006. The researchers followed the patients for transplant outcomes through September 2008 and linked their residential zip codes with poverty data from the 2000 United States Census.

Dr. Amaral reported that 18.3% of the patients experienced organ rejection during a mean follow-up of 3.6 years. Black patients were 2.3 times more likely than were white, non-Hispanic patients to experience organ rejection. In addition, Hispanic white patients were 24% less likely to experience organ rejection, compared with non-Hispanic white patients (hazard ratio = 0.76).

After the researchers adjusted for demographic, clinical, and socioeconomic factors, the researchers found that blacks were more likely to experience organ rejection, compared with non-Hispanic whites, and the degree of disparity varied by patient’s residential neighborhood.

Poverty also played a role in adverse outcomes in all patients. However, black patients fared worse. For example, black patients from neighborhoods in which more than 25% of residents lived below the federal poverty line were 2.46 times more likely to experience organ rejection, compared with their white counterparts. This relationship was also apparent in the wealthiest neighborhoods (those in which fewer than 5% lived below the federal poverty line), where black patients were 40% more likely to experience organ rejection at any given time during the follow-up, compared with non-Hispanic whites.

"It looks like poverty does make a difference," Dr. Amaral said. "It makes it harder for you to have a successful transplant."

She acknowledged certain limitations of the study, including the fact that the USRDS is unable to capture the specific barriers that get in the way of better transplant survival. "Is it because patients can’t pay for their medications, or is it because they can’t get to their appointments?" she asked. "Are there other things that get in the way of them being successful? This is an area for further study."

Dr. Amaral said that she had no relevant financial disclosures.

DENVER – Black children who receive kidney transplants appear more likely to lose their transplants sooner, compared with whites, results from a large analysis showed.

In addition, black pediatric patients living in high poverty neighborhoods face a more than twofold risk of transplant failure, compared with white patients.

"It has been reported that kidney transplants in blacks do not last as long as in whites, but we don’t really understand why this happens," Dr. Sandra Amaral said during a press briefing at the annual meeting of the American Society of Nephrology. "We think part of it is biologic; there are genetic differences between races, differences in diseases, and differences in our immune systems. But we also think that there may be socioeconomic differences. Based on our clinical practice, what we see is that if you’re poor it’s harder to get to your [medical] appointments. It may be harder to pay for your medicines. You may live in a household with a single care provider who’s really struggling to just feed you, much less make sure that your medicines are given on time every single day."

Dr. Amaral of the department of pediatrics at Emory University, Atlanta, and her associates studied 5,024 patients from the United States Renal Data System (USRDS) under age 21 years who received a kidney transplant between 2000 and 2006. The researchers followed the patients for transplant outcomes through September 2008 and linked their residential zip codes with poverty data from the 2000 United States Census.

Dr. Amaral reported that 18.3% of the patients experienced organ rejection during a mean follow-up of 3.6 years. Black patients were 2.3 times more likely than were white, non-Hispanic patients to experience organ rejection. In addition, Hispanic white patients were 24% less likely to experience organ rejection, compared with non-Hispanic white patients (hazard ratio = 0.76).

After the researchers adjusted for demographic, clinical, and socioeconomic factors, the researchers found that blacks were more likely to experience organ rejection, compared with non-Hispanic whites, and the degree of disparity varied by patient’s residential neighborhood.

Poverty also played a role in adverse outcomes in all patients. However, black patients fared worse. For example, black patients from neighborhoods in which more than 25% of residents lived below the federal poverty line were 2.46 times more likely to experience organ rejection, compared with their white counterparts. This relationship was also apparent in the wealthiest neighborhoods (those in which fewer than 5% lived below the federal poverty line), where black patients were 40% more likely to experience organ rejection at any given time during the follow-up, compared with non-Hispanic whites.

"It looks like poverty does make a difference," Dr. Amaral said. "It makes it harder for you to have a successful transplant."

She acknowledged certain limitations of the study, including the fact that the USRDS is unable to capture the specific barriers that get in the way of better transplant survival. "Is it because patients can’t pay for their medications, or is it because they can’t get to their appointments?" she asked. "Are there other things that get in the way of them being successful? This is an area for further study."

Dr. Amaral said that she had no relevant financial disclosures.

DENVER – Black children who receive kidney transplants appear more likely to lose their transplants sooner, compared with whites, results from a large analysis showed.

In addition, black pediatric patients living in high poverty neighborhoods face a more than twofold risk of transplant failure, compared with white patients.

"It has been reported that kidney transplants in blacks do not last as long as in whites, but we don’t really understand why this happens," Dr. Sandra Amaral said during a press briefing at the annual meeting of the American Society of Nephrology. "We think part of it is biologic; there are genetic differences between races, differences in diseases, and differences in our immune systems. But we also think that there may be socioeconomic differences. Based on our clinical practice, what we see is that if you’re poor it’s harder to get to your [medical] appointments. It may be harder to pay for your medicines. You may live in a household with a single care provider who’s really struggling to just feed you, much less make sure that your medicines are given on time every single day."

Dr. Amaral of the department of pediatrics at Emory University, Atlanta, and her associates studied 5,024 patients from the United States Renal Data System (USRDS) under age 21 years who received a kidney transplant between 2000 and 2006. The researchers followed the patients for transplant outcomes through September 2008 and linked their residential zip codes with poverty data from the 2000 United States Census.

Dr. Amaral reported that 18.3% of the patients experienced organ rejection during a mean follow-up of 3.6 years. Black patients were 2.3 times more likely than were white, non-Hispanic patients to experience organ rejection. In addition, Hispanic white patients were 24% less likely to experience organ rejection, compared with non-Hispanic white patients (hazard ratio = 0.76).

After the researchers adjusted for demographic, clinical, and socioeconomic factors, the researchers found that blacks were more likely to experience organ rejection, compared with non-Hispanic whites, and the degree of disparity varied by patient’s residential neighborhood.

Poverty also played a role in adverse outcomes in all patients. However, black patients fared worse. For example, black patients from neighborhoods in which more than 25% of residents lived below the federal poverty line were 2.46 times more likely to experience organ rejection, compared with their white counterparts. This relationship was also apparent in the wealthiest neighborhoods (those in which fewer than 5% lived below the federal poverty line), where black patients were 40% more likely to experience organ rejection at any given time during the follow-up, compared with non-Hispanic whites.

"It looks like poverty does make a difference," Dr. Amaral said. "It makes it harder for you to have a successful transplant."

She acknowledged certain limitations of the study, including the fact that the USRDS is unable to capture the specific barriers that get in the way of better transplant survival. "Is it because patients can’t pay for their medications, or is it because they can’t get to their appointments?" she asked. "Are there other things that get in the way of them being successful? This is an area for further study."

Dr. Amaral said that she had no relevant financial disclosures.

DENVER – Black children who receive kidney transplants appear more likely to lose their transplants sooner, compared with whites, results from a large analysis showed.

In addition, black pediatric patients living in high poverty neighborhoods face a more than twofold risk of transplant failure, compared with white patients.

"It has been reported that kidney transplants in blacks do not last as long as in whites, but we don’t really understand why this happens," Dr. Sandra Amaral said during a press briefing at the annual meeting of the American Society of Nephrology. "We think part of it is biologic; there are genetic differences between races, differences in diseases, and differences in our immune systems. But we also think that there may be socioeconomic differences. Based on our clinical practice, what we see is that if you’re poor it’s harder to get to your [medical] appointments. It may be harder to pay for your medicines. You may live in a household with a single care provider who’s really struggling to just feed you, much less make sure that your medicines are given on time every single day."

Dr. Amaral of the department of pediatrics at Emory University, Atlanta, and her associates studied 5,024 patients from the United States Renal Data System (USRDS) under age 21 years who received a kidney transplant between 2000 and 2006. The researchers followed the patients for transplant outcomes through September 2008 and linked their residential zip codes with poverty data from the 2000 United States Census.

Dr. Amaral reported that 18.3% of the patients experienced organ rejection during a mean follow-up of 3.6 years. Black patients were 2.3 times more likely than were white, non-Hispanic patients to experience organ rejection. In addition, Hispanic white patients were 24% less likely to experience organ rejection, compared with non-Hispanic white patients (hazard ratio = 0.76).

After the researchers adjusted for demographic, clinical, and socioeconomic factors, the researchers found that blacks were more likely to experience organ rejection, compared with non-Hispanic whites, and the degree of disparity varied by patient’s residential neighborhood.

Poverty also played a role in adverse outcomes in all patients. However, black patients fared worse. For example, black patients from neighborhoods in which more than 25% of residents lived below the federal poverty line were 2.46 times more likely to experience organ rejection, compared with their white counterparts. This relationship was also apparent in the wealthiest neighborhoods (those in which fewer than 5% lived below the federal poverty line), where black patients were 40% more likely to experience organ rejection at any given time during the follow-up, compared with non-Hispanic whites.

"It looks like poverty does make a difference," Dr. Amaral said. "It makes it harder for you to have a successful transplant."

She acknowledged certain limitations of the study, including the fact that the USRDS is unable to capture the specific barriers that get in the way of better transplant survival. "Is it because patients can’t pay for their medications, or is it because they can’t get to their appointments?" she asked. "Are there other things that get in the way of them being successful? This is an area for further study."

Dr. Amaral said that she had no relevant financial disclosures.

DENVER – Black children who receive kidney transplants appear more likely to lose their transplants sooner, compared with whites, results from a large analysis showed.

In addition, black pediatric patients living in high poverty neighborhoods face a more than twofold risk of transplant failure, compared with white patients.

"It has been reported that kidney transplants in blacks do not last as long as in whites, but we don’t really understand why this happens," Dr. Sandra Amaral said during a press briefing at the annual meeting of the American Society of Nephrology. "We think part of it is biologic; there are genetic differences between races, differences in diseases, and differences in our immune systems. But we also think that there may be socioeconomic differences. Based on our clinical practice, what we see is that if you’re poor it’s harder to get to your [medical] appointments. It may be harder to pay for your medicines. You may live in a household with a single care provider who’s really struggling to just feed you, much less make sure that your medicines are given on time every single day."

Dr. Amaral of the department of pediatrics at Emory University, Atlanta, and her associates studied 5,024 patients from the United States Renal Data System (USRDS) under age 21 years who received a kidney transplant between 2000 and 2006. The researchers followed the patients for transplant outcomes through September 2008 and linked their residential zip codes with poverty data from the 2000 United States Census.

Dr. Amaral reported that 18.3% of the patients experienced organ rejection during a mean follow-up of 3.6 years. Black patients were 2.3 times more likely than were white, non-Hispanic patients to experience organ rejection. In addition, Hispanic white patients were 24% less likely to experience organ rejection, compared with non-Hispanic white patients (hazard ratio = 0.76).

After the researchers adjusted for demographic, clinical, and socioeconomic factors, the researchers found that blacks were more likely to experience organ rejection, compared with non-Hispanic whites, and the degree of disparity varied by patient’s residential neighborhood.

Poverty also played a role in adverse outcomes in all patients. However, black patients fared worse. For example, black patients from neighborhoods in which more than 25% of residents lived below the federal poverty line were 2.46 times more likely to experience organ rejection, compared with their white counterparts. This relationship was also apparent in the wealthiest neighborhoods (those in which fewer than 5% lived below the federal poverty line), where black patients were 40% more likely to experience organ rejection at any given time during the follow-up, compared with non-Hispanic whites.

"It looks like poverty does make a difference," Dr. Amaral said. "It makes it harder for you to have a successful transplant."

She acknowledged certain limitations of the study, including the fact that the USRDS is unable to capture the specific barriers that get in the way of better transplant survival. "Is it because patients can’t pay for their medications, or is it because they can’t get to their appointments?" she asked. "Are there other things that get in the way of them being successful? This is an area for further study."

Dr. Amaral said that she had no relevant financial disclosures.

DENVER– Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, "there is very little literature available about what happens to cancer patients admitted to the hospital," lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients."

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, reported Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas M.D. Anderson Cancer Center, Houston. The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate logistic regression, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate regression analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

"It is possible that what we are seeing is an association between severity of cancer and level of kidney injury," said Dr. Salahudeen, who emphasized the preliminary nature of the study. "This is a complex group of patients, and the study underscores the importance of being aggressive with treatment of acute kidney injury as early as possible. The question is, if we were to screen these people as they come into the hospital, can we identify those who are at risk? That’s where acute kidney injury biomarkers are going to come in useful."

Dr. Salahudeen said that he had no relevant financial conflicts to disclose.

DENVER– Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, "there is very little literature available about what happens to cancer patients admitted to the hospital," lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients."

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, reported Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas M.D. Anderson Cancer Center, Houston. The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate logistic regression, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate regression analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

"It is possible that what we are seeing is an association between severity of cancer and level of kidney injury," said Dr. Salahudeen, who emphasized the preliminary nature of the study. "This is a complex group of patients, and the study underscores the importance of being aggressive with treatment of acute kidney injury as early as possible. The question is, if we were to screen these people as they come into the hospital, can we identify those who are at risk? That’s where acute kidney injury biomarkers are going to come in useful."

Dr. Salahudeen said that he had no relevant financial conflicts to disclose.

DENVER– Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, "there is very little literature available about what happens to cancer patients admitted to the hospital," lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients."

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, reported Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas M.D. Anderson Cancer Center, Houston. The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate logistic regression, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate regression analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

"It is possible that what we are seeing is an association between severity of cancer and level of kidney injury," said Dr. Salahudeen, who emphasized the preliminary nature of the study. "This is a complex group of patients, and the study underscores the importance of being aggressive with treatment of acute kidney injury as early as possible. The question is, if we were to screen these people as they come into the hospital, can we identify those who are at risk? That’s where acute kidney injury biomarkers are going to come in useful."

Dr. Salahudeen said that he had no relevant financial conflicts to disclose.

DENVER– Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, "there is very little literature available about what happens to cancer patients admitted to the hospital," lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients."

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, reported Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas M.D. Anderson Cancer Center, Houston. The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate logistic regression, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate regression analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

"It is possible that what we are seeing is an association between severity of cancer and level of kidney injury," said Dr. Salahudeen, who emphasized the preliminary nature of the study. "This is a complex group of patients, and the study underscores the importance of being aggressive with treatment of acute kidney injury as early as possible. The question is, if we were to screen these people as they come into the hospital, can we identify those who are at risk? That’s where acute kidney injury biomarkers are going to come in useful."

Dr. Salahudeen said that he had no relevant financial conflicts to disclose.

DENVER– Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, "there is very little literature available about what happens to cancer patients admitted to the hospital," lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients."

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, reported Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas M.D. Anderson Cancer Center, Houston. The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate logistic regression, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate regression analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

"It is possible that what we are seeing is an association between severity of cancer and level of kidney injury," said Dr. Salahudeen, who emphasized the preliminary nature of the study. "This is a complex group of patients, and the study underscores the importance of being aggressive with treatment of acute kidney injury as early as possible. The question is, if we were to screen these people as they come into the hospital, can we identify those who are at risk? That’s where acute kidney injury biomarkers are going to come in useful."

Dr. Salahudeen said that he had no relevant financial conflicts to disclose.

DENVER– Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, "there is very little literature available about what happens to cancer patients admitted to the hospital," lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients."

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, reported Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas M.D. Anderson Cancer Center, Houston. The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate logistic regression, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate regression analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

"It is possible that what we are seeing is an association between severity of cancer and level of kidney injury," said Dr. Salahudeen, who emphasized the preliminary nature of the study. "This is a complex group of patients, and the study underscores the importance of being aggressive with treatment of acute kidney injury as early as possible. The question is, if we were to screen these people as they come into the hospital, can we identify those who are at risk? That’s where acute kidney injury biomarkers are going to come in useful."

Dr. Salahudeen said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil induction regimens are equally effective, and can be combined with radiation and transurethral resection in a bladder-sparing protocol, preliminary results from an ongoing, randomized, phase II trial show.

Both regimens produce significant acute toxicity, yet more than 90% of patients completed induction and more than 80% completed consolidation without deviation, Dr. Anthony L. Zietman reported at the annual meeting of the American Society for Radiation Oncology.

After a median of 3 years, 73% of patients in the paclitaxel/cisplatin arm and 69% in the 5-FU/cisplatin arm were alive with intact bladders. The difference was not statistically significant.

"Adjuvant therapy remains a challenge after both regimens, with low rates of completion," said Dr. Zietman, professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School, Boston. "This is a problem because many of these patients have occult micrometastatic disease, so we do want nontoxic adjuvant therapy."

In the RTOG (Radiation Therapy Oncology Group) 0233 study funded by the National Cancer Institute, Dr. Zietman and his associates at 33 institutions enrolled 97 patients with muscle-invading bladder cancer.

All patients underwent a transurethral resection and then were randomized into two chemotherapy arms: paclitaxel (50 mg/m2 weekly) plus cisplatin (15 mg/m2 on 3 days per week), or 5-FU (400 mg/m2 on 3 days per week on alternate weeks) plus the same cisplatin schedule. Patients in both arms also received radiotherapy twice daily to a total of 64.3 Gy, followed by adjuvant cisplatin/gemcitabine/paclitaxel chemotherapy.

Four patients were not eligible to complete the trial, leaving 46 in the paclitaxel/cisplatin arm and 47 in the 5-FU/cisplatin arm. Median follow-up was 3 years. The median age of patients was 66 years, 84% were men, and 95% had T2 disease.

Statistically similar proportions of patients in both arms had grade 2 or 3 toxicity during chemoradiation (70% in the paclitaxel/cisplatin arm and 62% in the 5-FU/cisplatin arm). The proportion with late toxicity reaching grade 3 or higher was also similar between the two groups (6% and 4%, respectively). The only case of grade 4 toxicity occurred in the paclitaxel/cisplatin arm.

"The big problem with the trial is with the adjuvant chemotherapy," Dr. Zietman said, noting that 86% of patients in the paclitaxel/cisplatin arm and 76% in the 5-FU/cisplatin arm had grade 3 or 4 toxicity during the later adjuvant treatment.

Dr. Zietman, the immediate past president of ASTRO, reported that 98% of patients in the paclitaxel/cisplatin arm completed induction; while 4 had grade 4 toxicity during induction, 11 had grade 4 toxicity during adjuvant therapy. Similarly, 96% of patients in the 5-FU/cisplatin arm completed induction; only 1 had grade 4 toxicity during induction, but 15 had grade 4 toxicity during adjuvant therapy.

The adjuvant cisplatin/gemcitabine/paclitaxel regimen "is standard chemotherapy given to [patients] after a cystectomy, but it really was a struggle to get them through it," he said. "It didn’t matter which chemotherapy regimen had been used up front. The outback chemotherapy was difficult. It was toxic."

After induction therapy, 87% of patients in the paclitaxel/cisplatin arm and 79% in the 5-FU/cisplatin arm were downstaged to T0, Ta, and Tcis bladder cancer; the difference was not statistically significant. Complete response was also statistically similar between the two arms (72% and 62%, respectively).

To date, Dr. Zietman concluded, "both regimens produce similarly high rates of tumor response and bladder preservation. I think it leaves you with a choice. Either regimen can be used."

Dr. Zietman said that he had no financial conflicts to disclose.

SAN DIEGO – Cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil induction regimens are equally effective, and can be combined with radiation and transurethral resection in a bladder-sparing protocol, preliminary results from an ongoing, randomized, phase II trial show.

Both regimens produce significant acute toxicity, yet more than 90% of patients completed induction and more than 80% completed consolidation without deviation, Dr. Anthony L. Zietman reported at the annual meeting of the American Society for Radiation Oncology.

After a median of 3 years, 73% of patients in the paclitaxel/cisplatin arm and 69% in the 5-FU/cisplatin arm were alive with intact bladders. The difference was not statistically significant.

"Adjuvant therapy remains a challenge after both regimens, with low rates of completion," said Dr. Zietman, professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School, Boston. "This is a problem because many of these patients have occult micrometastatic disease, so we do want nontoxic adjuvant therapy."

In the RTOG (Radiation Therapy Oncology Group) 0233 study funded by the National Cancer Institute, Dr. Zietman and his associates at 33 institutions enrolled 97 patients with muscle-invading bladder cancer.

All patients underwent a transurethral resection and then were randomized into two chemotherapy arms: paclitaxel (50 mg/m2 weekly) plus cisplatin (15 mg/m2 on 3 days per week), or 5-FU (400 mg/m2 on 3 days per week on alternate weeks) plus the same cisplatin schedule. Patients in both arms also received radiotherapy twice daily to a total of 64.3 Gy, followed by adjuvant cisplatin/gemcitabine/paclitaxel chemotherapy.

Four patients were not eligible to complete the trial, leaving 46 in the paclitaxel/cisplatin arm and 47 in the 5-FU/cisplatin arm. Median follow-up was 3 years. The median age of patients was 66 years, 84% were men, and 95% had T2 disease.

Statistically similar proportions of patients in both arms had grade 2 or 3 toxicity during chemoradiation (70% in the paclitaxel/cisplatin arm and 62% in the 5-FU/cisplatin arm). The proportion with late toxicity reaching grade 3 or higher was also similar between the two groups (6% and 4%, respectively). The only case of grade 4 toxicity occurred in the paclitaxel/cisplatin arm.

"The big problem with the trial is with the adjuvant chemotherapy," Dr. Zietman said, noting that 86% of patients in the paclitaxel/cisplatin arm and 76% in the 5-FU/cisplatin arm had grade 3 or 4 toxicity during the later adjuvant treatment.

Dr. Zietman, the immediate past president of ASTRO, reported that 98% of patients in the paclitaxel/cisplatin arm completed induction; while 4 had grade 4 toxicity during induction, 11 had grade 4 toxicity during adjuvant therapy. Similarly, 96% of patients in the 5-FU/cisplatin arm completed induction; only 1 had grade 4 toxicity during induction, but 15 had grade 4 toxicity during adjuvant therapy.

The adjuvant cisplatin/gemcitabine/paclitaxel regimen "is standard chemotherapy given to [patients] after a cystectomy, but it really was a struggle to get them through it," he said. "It didn’t matter which chemotherapy regimen had been used up front. The outback chemotherapy was difficult. It was toxic."

After induction therapy, 87% of patients in the paclitaxel/cisplatin arm and 79% in the 5-FU/cisplatin arm were downstaged to T0, Ta, and Tcis bladder cancer; the difference was not statistically significant. Complete response was also statistically similar between the two arms (72% and 62%, respectively).

To date, Dr. Zietman concluded, "both regimens produce similarly high rates of tumor response and bladder preservation. I think it leaves you with a choice. Either regimen can be used."

Dr. Zietman said that he had no financial conflicts to disclose.

SAN DIEGO – Cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil induction regimens are equally effective, and can be combined with radiation and transurethral resection in a bladder-sparing protocol, preliminary results from an ongoing, randomized, phase II trial show.

Both regimens produce significant acute toxicity, yet more than 90% of patients completed induction and more than 80% completed consolidation without deviation, Dr. Anthony L. Zietman reported at the annual meeting of the American Society for Radiation Oncology.

After a median of 3 years, 73% of patients in the paclitaxel/cisplatin arm and 69% in the 5-FU/cisplatin arm were alive with intact bladders. The difference was not statistically significant.

"Adjuvant therapy remains a challenge after both regimens, with low rates of completion," said Dr. Zietman, professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School, Boston. "This is a problem because many of these patients have occult micrometastatic disease, so we do want nontoxic adjuvant therapy."

In the RTOG (Radiation Therapy Oncology Group) 0233 study funded by the National Cancer Institute, Dr. Zietman and his associates at 33 institutions enrolled 97 patients with muscle-invading bladder cancer.

All patients underwent a transurethral resection and then were randomized into two chemotherapy arms: paclitaxel (50 mg/m2 weekly) plus cisplatin (15 mg/m2 on 3 days per week), or 5-FU (400 mg/m2 on 3 days per week on alternate weeks) plus the same cisplatin schedule. Patients in both arms also received radiotherapy twice daily to a total of 64.3 Gy, followed by adjuvant cisplatin/gemcitabine/paclitaxel chemotherapy.

Four patients were not eligible to complete the trial, leaving 46 in the paclitaxel/cisplatin arm and 47 in the 5-FU/cisplatin arm. Median follow-up was 3 years. The median age of patients was 66 years, 84% were men, and 95% had T2 disease.

Statistically similar proportions of patients in both arms had grade 2 or 3 toxicity during chemoradiation (70% in the paclitaxel/cisplatin arm and 62% in the 5-FU/cisplatin arm). The proportion with late toxicity reaching grade 3 or higher was also similar between the two groups (6% and 4%, respectively). The only case of grade 4 toxicity occurred in the paclitaxel/cisplatin arm.

"The big problem with the trial is with the adjuvant chemotherapy," Dr. Zietman said, noting that 86% of patients in the paclitaxel/cisplatin arm and 76% in the 5-FU/cisplatin arm had grade 3 or 4 toxicity during the later adjuvant treatment.

Dr. Zietman, the immediate past president of ASTRO, reported that 98% of patients in the paclitaxel/cisplatin arm completed induction; while 4 had grade 4 toxicity during induction, 11 had grade 4 toxicity during adjuvant therapy. Similarly, 96% of patients in the 5-FU/cisplatin arm completed induction; only 1 had grade 4 toxicity during induction, but 15 had grade 4 toxicity during adjuvant therapy.

The adjuvant cisplatin/gemcitabine/paclitaxel regimen "is standard chemotherapy given to [patients] after a cystectomy, but it really was a struggle to get them through it," he said. "It didn’t matter which chemotherapy regimen had been used up front. The outback chemotherapy was difficult. It was toxic."

After induction therapy, 87% of patients in the paclitaxel/cisplatin arm and 79% in the 5-FU/cisplatin arm were downstaged to T0, Ta, and Tcis bladder cancer; the difference was not statistically significant. Complete response was also statistically similar between the two arms (72% and 62%, respectively).

To date, Dr. Zietman concluded, "both regimens produce similarly high rates of tumor response and bladder preservation. I think it leaves you with a choice. Either regimen can be used."

Dr. Zietman said that he had no financial conflicts to disclose.

SAN DIEGO – Cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil induction regimens are equally effective, and can be combined with radiation and transurethral resection in a bladder-sparing protocol, preliminary results from an ongoing, randomized, phase II trial show.

Both regimens produce significant acute toxicity, yet more than 90% of patients completed induction and more than 80% completed consolidation without deviation, Dr. Anthony L. Zietman reported at the annual meeting of the American Society for Radiation Oncology.

After a median of 3 years, 73% of patients in the paclitaxel/cisplatin arm and 69% in the 5-FU/cisplatin arm were alive with intact bladders. The difference was not statistically significant.

"Adjuvant therapy remains a challenge after both regimens, with low rates of completion," said Dr. Zietman, professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School, Boston. "This is a problem because many of these patients have occult micrometastatic disease, so we do want nontoxic adjuvant therapy."

In the RTOG (Radiation Therapy Oncology Group) 0233 study funded by the National Cancer Institute, Dr. Zietman and his associates at 33 institutions enrolled 97 patients with muscle-invading bladder cancer.

All patients underwent a transurethral resection and then were randomized into two chemotherapy arms: paclitaxel (50 mg/m2 weekly) plus cisplatin (15 mg/m2 on 3 days per week), or 5-FU (400 mg/m2 on 3 days per week on alternate weeks) plus the same cisplatin schedule. Patients in both arms also received radiotherapy twice daily to a total of 64.3 Gy, followed by adjuvant cisplatin/gemcitabine/paclitaxel chemotherapy.

Four patients were not eligible to complete the trial, leaving 46 in the paclitaxel/cisplatin arm and 47 in the 5-FU/cisplatin arm. Median follow-up was 3 years. The median age of patients was 66 years, 84% were men, and 95% had T2 disease.

Statistically similar proportions of patients in both arms had grade 2 or 3 toxicity during chemoradiation (70% in the paclitaxel/cisplatin arm and 62% in the 5-FU/cisplatin arm). The proportion with late toxicity reaching grade 3 or higher was also similar between the two groups (6% and 4%, respectively). The only case of grade 4 toxicity occurred in the paclitaxel/cisplatin arm.

"The big problem with the trial is with the adjuvant chemotherapy," Dr. Zietman said, noting that 86% of patients in the paclitaxel/cisplatin arm and 76% in the 5-FU/cisplatin arm had grade 3 or 4 toxicity during the later adjuvant treatment.

Dr. Zietman, the immediate past president of ASTRO, reported that 98% of patients in the paclitaxel/cisplatin arm completed induction; while 4 had grade 4 toxicity during induction, 11 had grade 4 toxicity during adjuvant therapy. Similarly, 96% of patients in the 5-FU/cisplatin arm completed induction; only 1 had grade 4 toxicity during induction, but 15 had grade 4 toxicity during adjuvant therapy.

The adjuvant cisplatin/gemcitabine/paclitaxel regimen "is standard chemotherapy given to [patients] after a cystectomy, but it really was a struggle to get them through it," he said. "It didn’t matter which chemotherapy regimen had been used up front. The outback chemotherapy was difficult. It was toxic."

After induction therapy, 87% of patients in the paclitaxel/cisplatin arm and 79% in the 5-FU/cisplatin arm were downstaged to T0, Ta, and Tcis bladder cancer; the difference was not statistically significant. Complete response was also statistically similar between the two arms (72% and 62%, respectively).

To date, Dr. Zietman concluded, "both regimens produce similarly high rates of tumor response and bladder preservation. I think it leaves you with a choice. Either regimen can be used."

Dr. Zietman said that he had no financial conflicts to disclose.

SAN DIEGO – Cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil induction regimens are equally effective, and can be combined with radiation and transurethral resection in a bladder-sparing protocol, preliminary results from an ongoing, randomized, phase II trial show.

Both regimens produce significant acute toxicity, yet more than 90% of patients completed induction and more than 80% completed consolidation without deviation, Dr. Anthony L. Zietman reported at the annual meeting of the American Society for Radiation Oncology.

After a median of 3 years, 73% of patients in the paclitaxel/cisplatin arm and 69% in the 5-FU/cisplatin arm were alive with intact bladders. The difference was not statistically significant.

"Adjuvant therapy remains a challenge after both regimens, with low rates of completion," said Dr. Zietman, professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School, Boston. "This is a problem because many of these patients have occult micrometastatic disease, so we do want nontoxic adjuvant therapy."

In the RTOG (Radiation Therapy Oncology Group) 0233 study funded by the National Cancer Institute, Dr. Zietman and his associates at 33 institutions enrolled 97 patients with muscle-invading bladder cancer.

All patients underwent a transurethral resection and then were randomized into two chemotherapy arms: paclitaxel (50 mg/m2 weekly) plus cisplatin (15 mg/m2 on 3 days per week), or 5-FU (400 mg/m2 on 3 days per week on alternate weeks) plus the same cisplatin schedule. Patients in both arms also received radiotherapy twice daily to a total of 64.3 Gy, followed by adjuvant cisplatin/gemcitabine/paclitaxel chemotherapy.

Four patients were not eligible to complete the trial, leaving 46 in the paclitaxel/cisplatin arm and 47 in the 5-FU/cisplatin arm. Median follow-up was 3 years. The median age of patients was 66 years, 84% were men, and 95% had T2 disease.

Statistically similar proportions of patients in both arms had grade 2 or 3 toxicity during chemoradiation (70% in the paclitaxel/cisplatin arm and 62% in the 5-FU/cisplatin arm). The proportion with late toxicity reaching grade 3 or higher was also similar between the two groups (6% and 4%, respectively). The only case of grade 4 toxicity occurred in the paclitaxel/cisplatin arm.

"The big problem with the trial is with the adjuvant chemotherapy," Dr. Zietman said, noting that 86% of patients in the paclitaxel/cisplatin arm and 76% in the 5-FU/cisplatin arm had grade 3 or 4 toxicity during the later adjuvant treatment.

Dr. Zietman, the immediate past president of ASTRO, reported that 98% of patients in the paclitaxel/cisplatin arm completed induction; while 4 had grade 4 toxicity during induction, 11 had grade 4 toxicity during adjuvant therapy. Similarly, 96% of patients in the 5-FU/cisplatin arm completed induction; only 1 had grade 4 toxicity during induction, but 15 had grade 4 toxicity during adjuvant therapy.

The adjuvant cisplatin/gemcitabine/paclitaxel regimen "is standard chemotherapy given to [patients] after a cystectomy, but it really was a struggle to get them through it," he said. "It didn’t matter which chemotherapy regimen had been used up front. The outback chemotherapy was difficult. It was toxic."

After induction therapy, 87% of patients in the paclitaxel/cisplatin arm and 79% in the 5-FU/cisplatin arm were downstaged to T0, Ta, and Tcis bladder cancer; the difference was not statistically significant. Complete response was also statistically similar between the two arms (72% and 62%, respectively).

To date, Dr. Zietman concluded, "both regimens produce similarly high rates of tumor response and bladder preservation. I think it leaves you with a choice. Either regimen can be used."

Dr. Zietman said that he had no financial conflicts to disclose.

SAN DIEGO – Cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil induction regimens are equally effective, and can be combined with radiation and transurethral resection in a bladder-sparing protocol, preliminary results from an ongoing, randomized, phase II trial show.

Both regimens produce significant acute toxicity, yet more than 90% of patients completed induction and more than 80% completed consolidation without deviation, Dr. Anthony L. Zietman reported at the annual meeting of the American Society for Radiation Oncology.

After a median of 3 years, 73% of patients in the paclitaxel/cisplatin arm and 69% in the 5-FU/cisplatin arm were alive with intact bladders. The difference was not statistically significant.

"Adjuvant therapy remains a challenge after both regimens, with low rates of completion," said Dr. Zietman, professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School, Boston. "This is a problem because many of these patients have occult micrometastatic disease, so we do want nontoxic adjuvant therapy."

In the RTOG (Radiation Therapy Oncology Group) 0233 study funded by the National Cancer Institute, Dr. Zietman and his associates at 33 institutions enrolled 97 patients with muscle-invading bladder cancer.

All patients underwent a transurethral resection and then were randomized into two chemotherapy arms: paclitaxel (50 mg/m2 weekly) plus cisplatin (15 mg/m2 on 3 days per week), or 5-FU (400 mg/m2 on 3 days per week on alternate weeks) plus the same cisplatin schedule. Patients in both arms also received radiotherapy twice daily to a total of 64.3 Gy, followed by adjuvant cisplatin/gemcitabine/paclitaxel chemotherapy.

Four patients were not eligible to complete the trial, leaving 46 in the paclitaxel/cisplatin arm and 47 in the 5-FU/cisplatin arm. Median follow-up was 3 years. The median age of patients was 66 years, 84% were men, and 95% had T2 disease.

Statistically similar proportions of patients in both arms had grade 2 or 3 toxicity during chemoradiation (70% in the paclitaxel/cisplatin arm and 62% in the 5-FU/cisplatin arm). The proportion with late toxicity reaching grade 3 or higher was also similar between the two groups (6% and 4%, respectively). The only case of grade 4 toxicity occurred in the paclitaxel/cisplatin arm.

"The big problem with the trial is with the adjuvant chemotherapy," Dr. Zietman said, noting that 86% of patients in the paclitaxel/cisplatin arm and 76% in the 5-FU/cisplatin arm had grade 3 or 4 toxicity during the later adjuvant treatment.

Dr. Zietman, the immediate past president of ASTRO, reported that 98% of patients in the paclitaxel/cisplatin arm completed induction; while 4 had grade 4 toxicity during induction, 11 had grade 4 toxicity during adjuvant therapy. Similarly, 96% of patients in the 5-FU/cisplatin arm completed induction; only 1 had grade 4 toxicity during induction, but 15 had grade 4 toxicity during adjuvant therapy.

The adjuvant cisplatin/gemcitabine/paclitaxel regimen "is standard chemotherapy given to [patients] after a cystectomy, but it really was a struggle to get them through it," he said. "It didn’t matter which chemotherapy regimen had been used up front. The outback chemotherapy was difficult. It was toxic."

After induction therapy, 87% of patients in the paclitaxel/cisplatin arm and 79% in the 5-FU/cisplatin arm were downstaged to T0, Ta, and Tcis bladder cancer; the difference was not statistically significant. Complete response was also statistically similar between the two arms (72% and 62%, respectively).

To date, Dr. Zietman concluded, "both regimens produce similarly high rates of tumor response and bladder preservation. I think it leaves you with a choice. Either regimen can be used."

Dr. Zietman said that he had no financial conflicts to disclose.

SAN DIEGO (EGMN) – Radiotherapy is correlated with superior disease-specific and overall survival in clinically staged, lymph node–positive prostate cancer that is not metastatic, according to a retrospective analysis of more than 1,000 patients.

The number needed to treat to prevent one prostate cancer death in 10 years is eight persons, Dr. Jonathan Tward reported at the annual meeting of the American Society for Radiation Oncology.

"Radiotherapy should be strongly considered for all men with clinically node-positive, nonmetastatic prostate cancer, and is consistent with National Comprehensive Cancer Network guidelines," said Dr. Tward, a radiation oncologist at Huntsman Cancer Hospital in Salt Lake City.

Clinically staged, lymph node–positive prostate cancer is rare, accounting for fewer than 2% of new diagnoses, he said. The Cancer Staging Manual (7th ed.) of the American Joint Committee on Cancer classifies clinically staged, lymph node–positive prostate cancer as stage IV, implying incurability.

"In spite of that dismal prognosis, retrospective data in the postoperative setting [suggest] that adding radiotherapy to androgen deprivation therapy improves overall survival in pathologically node-positive patients after prostatectomy," Dr. Tward noted. "Interestingly, NCCN guidelines offer definitive radiotherapy with androgen deprivation therapy for clinically node-positive patients as an option."

To evaluate the role of definitive radiotherapy in clinically node-positive prostate cancer, Dr. Tward and his associate, Dr. Dennis C. Shrieve, reviewed data from 1,082 patients in the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) program who were diagnosed with prostate cancer in 1988-2006. They included patients with clinically staged, node-positive disease, and excluded patients who had undergone surgery, those who had nonregional lymphadenopathy, and those with metastatic disease.

The median age of the 1,082 patients was 69 years, and the median follow-up of patients who did not die from any cause was 91 months. Of the 1,082 patients, 377 had external-beam radiotherapy, 703 had no radiation, and 20 had external-beam radiation plus brachytherapy.

Dr. Tward reported that prostate cancer–specific survival significantly favored patients who underwent radiotherapy (hazard ratio, 0.66; P = .0002). Overall survival also significantly favored patients who underwent radiotherapy (HR, 0.70; P less than .0001). This translated into a number needed to treat of seven patients in 10 years to prevent one death.

After factoring in heart disease and other competing causes of death, the researchers still found a significant survival benefit among those who received radiotherapy compared with those who did not (P less than .05).

Definitive radiotherapy with androgen deprivation therapy is the institutional standard of care at the University of Utah, Dr. Tward said.

He acknowledged certain limitations of the study, including that the data were retrospective and no information was available about the use of androgen deprivation therapy, chemotherapy, or radiation therapy parameters.

Dr. Tward said that he had no relevant financial conflicts to disclose.

SAN DIEGO (EGMN) – Radiotherapy is correlated with superior disease-specific and overall survival in clinically staged, lymph node–positive prostate cancer that is not metastatic, according to a retrospective analysis of more than 1,000 patients.

The number needed to treat to prevent one prostate cancer death in 10 years is eight persons, Dr. Jonathan Tward reported at the annual meeting of the American Society for Radiation Oncology.

"Radiotherapy should be strongly considered for all men with clinically node-positive, nonmetastatic prostate cancer, and is consistent with National Comprehensive Cancer Network guidelines," said Dr. Tward, a radiation oncologist at Huntsman Cancer Hospital in Salt Lake City.

Clinically staged, lymph node–positive prostate cancer is rare, accounting for fewer than 2% of new diagnoses, he said. The Cancer Staging Manual (7th ed.) of the American Joint Committee on Cancer classifies clinically staged, lymph node–positive prostate cancer as stage IV, implying incurability.

"In spite of that dismal prognosis, retrospective data in the postoperative setting [suggest] that adding radiotherapy to androgen deprivation therapy improves overall survival in pathologically node-positive patients after prostatectomy," Dr. Tward noted. "Interestingly, NCCN guidelines offer definitive radiotherapy with androgen deprivation therapy for clinically node-positive patients as an option."

To evaluate the role of definitive radiotherapy in clinically node-positive prostate cancer, Dr. Tward and his associate, Dr. Dennis C. Shrieve, reviewed data from 1,082 patients in the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) program who were diagnosed with prostate cancer in 1988-2006. They included patients with clinically staged, node-positive disease, and excluded patients who had undergone surgery, those who had nonregional lymphadenopathy, and those with metastatic disease.

The median age of the 1,082 patients was 69 years, and the median follow-up of patients who did not die from any cause was 91 months. Of the 1,082 patients, 377 had external-beam radiotherapy, 703 had no radiation, and 20 had external-beam radiation plus brachytherapy.

Dr. Tward reported that prostate cancer–specific survival significantly favored patients who underwent radiotherapy (hazard ratio, 0.66; P = .0002). Overall survival also significantly favored patients who underwent radiotherapy (HR, 0.70; P less than .0001). This translated into a number needed to treat of seven patients in 10 years to prevent one death.

After factoring in heart disease and other competing causes of death, the researchers still found a significant survival benefit among those who received radiotherapy compared with those who did not (P less than .05).

Definitive radiotherapy with androgen deprivation therapy is the institutional standard of care at the University of Utah, Dr. Tward said.

He acknowledged certain limitations of the study, including that the data were retrospective and no information was available about the use of androgen deprivation therapy, chemotherapy, or radiation therapy parameters.

Dr. Tward said that he had no relevant financial conflicts to disclose.

SAN DIEGO (EGMN) – Radiotherapy is correlated with superior disease-specific and overall survival in clinically staged, lymph node–positive prostate cancer that is not metastatic, according to a retrospective analysis of more than 1,000 patients.

The number needed to treat to prevent one prostate cancer death in 10 years is eight persons, Dr. Jonathan Tward reported at the annual meeting of the American Society for Radiation Oncology.

"Radiotherapy should be strongly considered for all men with clinically node-positive, nonmetastatic prostate cancer, and is consistent with National Comprehensive Cancer Network guidelines," said Dr. Tward, a radiation oncologist at Huntsman Cancer Hospital in Salt Lake City.

Clinically staged, lymph node–positive prostate cancer is rare, accounting for fewer than 2% of new diagnoses, he said. The Cancer Staging Manual (7th ed.) of the American Joint Committee on Cancer classifies clinically staged, lymph node–positive prostate cancer as stage IV, implying incurability.

"In spite of that dismal prognosis, retrospective data in the postoperative setting [suggest] that adding radiotherapy to androgen deprivation therapy improves overall survival in pathologically node-positive patients after prostatectomy," Dr. Tward noted. "Interestingly, NCCN guidelines offer definitive radiotherapy with androgen deprivation therapy for clinically node-positive patients as an option."

To evaluate the role of definitive radiotherapy in clinically node-positive prostate cancer, Dr. Tward and his associate, Dr. Dennis C. Shrieve, reviewed data from 1,082 patients in the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) program who were diagnosed with prostate cancer in 1988-2006. They included patients with clinically staged, node-positive disease, and excluded patients who had undergone surgery, those who had nonregional lymphadenopathy, and those with metastatic disease.

The median age of the 1,082 patients was 69 years, and the median follow-up of patients who did not die from any cause was 91 months. Of the 1,082 patients, 377 had external-beam radiotherapy, 703 had no radiation, and 20 had external-beam radiation plus brachytherapy.

Dr. Tward reported that prostate cancer–specific survival significantly favored patients who underwent radiotherapy (hazard ratio, 0.66; P = .0002). Overall survival also significantly favored patients who underwent radiotherapy (HR, 0.70; P less than .0001). This translated into a number needed to treat of seven patients in 10 years to prevent one death.

After factoring in heart disease and other competing causes of death, the researchers still found a significant survival benefit among those who received radiotherapy compared with those who did not (P less than .05).

Definitive radiotherapy with androgen deprivation therapy is the institutional standard of care at the University of Utah, Dr. Tward said.

He acknowledged certain limitations of the study, including that the data were retrospective and no information was available about the use of androgen deprivation therapy, chemotherapy, or radiation therapy parameters.

Dr. Tward said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.