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PURPOSE: Radiation oncologists utilize radiation variably for children with metastatic rhabdomyosarcoma (RMS). Data from the XXXX study was retrospectively analyzed to validate the prior observation that the use of radiation is associated with improved outcomes, and guide future recommendations on radiation use in this patient group. METHODS AND MATERIALS: The radiation delivered to 216 patients aged 0-21 years with metastatic RMS was retrospectively reviewed and classified as radical (all sites of disease irradiated within the protocol parameters), partial (some sites irradiated within the protocol parameters) and none (no radiation or delivered outside the protocol parameters). Landmark analysis excluded those with an event prior to day 221. Overall survival (OS) and progression free survival (PFS) were modelled using the Kaplan-Meier method to investigate the impact of radiation. The joint effect of treatment and known prognostic factors was examined using the Cox regression model. RESULTS: Overall 56 patients received radical, 104 partial and 56 no radiation per protocol. Due to non-randomised data, the groups were heterogeneous, particularly fewer sites of metatatic disease and less with bone metatases in those receiving radical radiation. 3-year PFS was 62.0% (95%CI 47.9-73.4) v 39.5% (29.8-49.1) v 30.1% (18.7-42.3)(p=0.002) for radical v partial v no radiotherapy respectively; 3-year OS was 70.1 % (55.8-80.6) v 53.1% (42.6-62.5) v 52.3% (38.3-64.5)(p=0.019) respectively. Multivariable analysis confirmed incremental improvement in OS with additional radiation with hazard ratio (HR) 1 v 1.8 v 2.4 (p=0.022) for radical v partial v no per protocol radiation. CONCLUSIONS: Radiation to all sites of disease seems to improve outcomes for children with metastatic RMS and should be considered when feasible. If not feasible, radiation is still recommended to the primary site and involved regional lymphadenopathy. Randomized clinical trials are required to confirm these findings, given the heterogeneity between the groups and potential confounding factors in this analysis.

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BACKGROUND: The role of vitamin D in increased mortality with SARS-COV-2 virus, namely, COVID-19, remains uncertain. We analysed all the patients who were treated as COVID-19-positive with or without a positive swab and were tested for vitamin D levels. METHODS: This was a retrospective, study involving 1226 patients swabbed for SARS-CoV-2 between the 10 February 2020 and 1 May 2020 at two hospitals of East Sussex Healthcare NHS Trust. Patients who were swab-positive for COVID-19 or treated as COVID-19-positive on clinical grounds even though swab results were negative were included in this study. We analysed the association of vitamin D levels and mortality, assessing linear and non-linear associations. RESULTS: A total of 1226 patients had SARS-CoV-2 RNA swabs in this period with age range from 1 year to 101 years. A cohort of 433 of these patients had swabs and recent vitamin D levels anytime in the previous 3 months. Mortality rates were not found to be associated with vitamin D levels (OR=1.04, 95% CI 0.96 to 1.12). CONCLUSION: Our findings suggest similar mortality risk from COVID-19 irrespective of the levels of vitamin D. Larger prospective studies will be needed to confirm these findings.

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Aim Our study aimed to find a correlation between low absolute lymphocyte count and COVID-19-related mortality. Methods This study followed a retrospective observational cohort design to analyze the data of patients who presented with symptoms and signs of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at the Conquest Hospital and Eastbourne District General Hospital in East Sussex, United Kingdom, between February 10, 2020 and May 1, 2020, retrospectively. Survival and mortality for the first 30 days and comorbidities were analyzed for all patients who were tested for COVID-19 irrespective of swab results and had blood lymphocyte levels taken at the time of their visit to the ED and their data were analyzed for statistical significance. Results A total of 1226 patients had SARS-CoV-2 RNA identification swabs taken between February 10, 2020 and May 1, 2020. A cohort of 742 patients of these patients tested for COVID-19 also had blood lymphocyte levels measured. Overall, the lymphocyte count did not differ significantly between patients suspected to have COVID-19 infection with either positive or negative COVID-19 swab results. The lymphocyte count, however, was significantly lower in those who died from COVID-19 (p < 0.001) but when comorbidities were analyzed, we found an association between an increased number of comorbidities and a significantly decreased lymphocyte count. Conclusion Once adjusted for comorbidities, the lymphocyte count had no association with COVID-19 infection and mortality.