An analysis of trends in prostate cancer treatment from a CMS database.

e19288 Background: The Centers for Medicare and Medicaid services (CMS) has announced a new payment model for radiotherapy services, a Radiation Oncology Alternative Payment Model (ROAPM), for 17 malignancies. The data used to calculate the base payments were released with the program announcement. The purpose of this study was to analyze trends in treatment as well as payments for each treatment modality in an attempt to provide a baseline for future comparison once the ROAPM has been completed. Methods: The database, CY2015-2017, contains payment, site of service, anatomic site and limited patient data for 517,988 patients, 91,551 having a diagnosis of prostate cancer. Only CPT codes for radiotherapy were included in the calculation of payment and only codes registered 90 days after a treatment planning charge were included. Stata 15m College Station, Texas, was used to perform all statistical analysis. Chi squared test was used to determine associations between variables. The Kruskal-Wallis H test was used to determine the relationship of total payment to clinical variables. Results: Treatment included IMRT (66,663 patients[pts], conventional therapy[ceb] (8,942 pts), brachy therapy (7,156 pts), stereotactic radiotherapy (srs) (5,120 pts) and proton beam therapy [pbt] (3,661). A slight majority of patients, 51%, were treated in the outpatient setting. Patients treated in a freestanding center were significantly more likely to have more than 41 fractions (54%) as compared to patients treated in an outpatient setting (32%), P < 0.001. Patients receiving pbt were significantly younger when compared to patients receiving other therapies, p < 0.001. Pbt was significantly costlier, mean $45,606.85 when compared to IMRT, $26,33.14, ceb, $10,242.27, srs, $16,514.98, or brachytherapy, $15,615.44, p < 0.001. In addition, patients treated at an outpatient center with IMRT experienced higher cost compared to patients treated at a freestanding setting, $25,448.48 vs $22,934.69 p = 0.001. Conclusions: These data gives baseline treatment practice information prior to the implementation of a ROAPM. These data, however, are limited and do not give any indication as to the outcome, both disease specific metrics, and quality of life metrics. Post ROAPM analysis will be needed to determine the effect of a new payment paradigm on treatment practices of this malignancy.

Application of the transfer learning to the medical images texture classification task

This study is conducted to determine effectiveness and perspectives of application of the transfer learning approach to the medical images classification task. There are a lot of medical studies that involve image acquisition, such as XRay radiography, ultrasonic scanning, computer tomography (CT), magnetic resonance imaging (MRI) etc. Besides those medical procedures there are different operations that use medical images processing including but not limited to digital radiograph reconstruction (DRR), radiotherapy planning, brachy therapy planning. All those tasks could be effectively performed with help of software capable to perform segmentation, classification and object recognition. Those capabilities are naturally depend on neural classifiers. Presented work investigates different approaches to solving image classification task with neural networks, specifically, using pre-processing for feature extraction and end-to-end application of convolutional neural networks (CNN). Due to requirement of significantly big datasets and large computing power CNNs sometimes may appear difficult to train, so our results pay attention to application of transfer learning technique that can potentially relax requirements to classifier training. The conclusions of this study state that transfer learning can be effectively used for classification tasks, especially texture classification.

Choroidal Melanoma: Our Experience

Background: Choroidal melanomas are diagnosed in approximately 6 out of one million Americans per year, and although their incidence is low, they are the most common primary intraocular tumor in adults. Methods: Choroidal melanoma is rare tumors and till date no such reports with sclera involvement has been reported from Nepal. It is a prospective case series. The aim of this study is for awareness of the severity of the Choroidal melanoma and it’s management. Besides, it is also to study the demography, presentation, histopathological variations and management of cases of choroidal melanoma. All the consecutive cases of Choroidal melanoma presenting between Jan 2017 to May 2018 and those who were within the inclusion criteria were included in this study. Results: There were eight patients, five male and three female, within age range of 18-73, median age was 47. All patients presented with decreased vision ranging from 6/24 to PL of less then three months to 2 years duration. Fund us showed choroidal mass associated with Vitreous hemorrhage (VH), and retinal detachment (RD). Two patients were managed with enucleation with External beam radiotherapy (EBRT). Four underwent only enucleation. One patient with lesion size less then 10mm under went plaque brachy therapy. One patient underwent initially Plaque brachy therapy but later had to undergo Enucleation. Histopathological examination (HPE) of enucleated patient revealed epitheloid cell melanoma grade three in four and Spindle cell melanoma in three patients. Each one patient of epitheloid cell melanoma and spindle cell melanomahad scleral involvement. Indication for radiotherapy was scleral involvement. Conclusion: With 8 cases of Choroidal melanoma in a single year in a single hospitalgives us a clue that there may be much more undiagnosed cases of Choroidal melanomain Nepal that should be taken seriously. Going for annual eye examination with routine dilated fund us exams can help in prevention and early diagnosis of this life and sight threatening condition and to reduce the mortality rate.

Drug Delivery System of a Radio-Protective Inclusion Complex

The novel radio-protective drug 9-phenyl symm octahydro selenoxanthene is insoluble in water. The complexation with hydroxypropyl beta-cyclodextrin increases the water solubility improving the bioavailability. The stoichiometry of the supramolecular host-guest complex was studied by displacement experiments using fluorescence spectroscopy. With respect to the application in the radiologic brachy therapy the inclusion complex was encapsulated by spray drying with both, poly D,L-lactic-co-glycolic acid and gelatin. The in-vitro irradiation tests of the final ointment formulation show the inhibition of neoplasm development, and an efficient protection effect against radiation.