bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of human papillomavirus in vulva cancer tissue.
Authors: Antonets Anna v , Nerodo Galina , Dvadnenko Konstantin v , Zykova Tatyana A , Ohremenko Natalya V , Nerodo Ekaterina Alekseevna
Published: March 2020

e16514

Background: Human Papillomavirus (HPV) status of the patients with vulva cancer was investigated retrospectively. Methods: We detected HPV of high cancerogenic risk (16, 18, 31, 33, 35, 45, 51, 52, 58, 59 types) in archival paraffin-embedded vulva cancer tissue of 58 patients aged from 26 to 82 years with I-IV grades. The extraction of DNA was performed with classical phenol-chloroform laboratory technic for further real-time PCR analysis (with HPV screening and HPV genotype kits of Amplisens). Results: HPV DNA was found out in 12 patients (20.6%). Among these patients 8 from 10 women (80%) belong to the group of reproductive age (26-50 years) whilst 4 from 48 (8.33%) were seniors. HPV of 16 type presented in 50%, HPV of 16 and 18 types – in 50% of all HPV positive patients of reproductive age. Among elderly patients 50 % had HPV of 16 type, 50 % - 16 and 31 types. Conclusions: Our investigations confirm the existence of two pathogenic variants of vulva cancer. For young age group there are up to 80% of HPV positive patients. The second elderly group (50-82 years) is not related with infection, there are only 8% of HPV positive patients.
Preliminary clinical outcomes and dosimetry study on adaptive IMRT integrated HDR brachytherapy in local advanced uterine cervical cancer.
Authors: Lang Jinyi , Wang Weidong , Li Zhiru , Yin Gang , Wang Pei , Fu Binyu
Published: March 2020

e16520

Background: To analyze the dosimetry features of adaptive IMRT integrated 3D-HDR brachytherapy in local advanced cervical carcinoma and report its preliminary clinical results. Methods: From 2009.06 to 2012.06, patients with cervical carcinoma (IIb-IIIb by FIGO staging) in Sichuan Cancer Hospital were treated with IMRT firstly in a 45Gy/25f/5w fraction modal, replanning at 30Gy adapting to the volume alterations of cervical lesions. Subsequently, adaptive IMRT integrated 3D-HDR brachytherapy was applied to boost the dosage of residual cervical lesions, MRI/CT scanning and replanning for each fraction, 6 (8Gy/f×4) 6f. Concurrent chemotherapy with DDP 40 mg/m2, was used weekly in the full course. The DVH data were collected for dosimetry analysis. The acute and late side effects, early responses and long term efficacy were evaluated for these group of patients. Results: Seventy-nine patients with local advanced cervical cancer were recruited in this study with a median age of 50yr (29-70yr) and median follow-up of 25mons (6-34mons). Dosimetry analysis demonstrated that IMRT-HDR not only yielded substantially improved high-risk CTV coverage (average V95 = 96.2%), but also kept the doses to the bladder (D1cc 69 (76Gy) and rectum(D1cc 63 (70Gy) reasonably low. Out of this group of patients, 87.8% reached complete response (CR) and 12.2% partial response (PR). Two-year follow-up showed that local control rate (LC), distant-metastasis free survival rate (DMFS), overall survival rate (OS) was 93.2%, 86.4% and 87.5%,respectively. Blood toxicity was the main early side effect with a 37.5% grade III-IV (RTOG), mild toxicities occurred in bladder (grade I/II 24.2%) and rectum (grade I/II 26.6%). Late side effects were found in 3 patients (2 radiocystitis, 1 intestinal obstruction). Conclusions: IMRT integrated adaptive 3D-HDR brachytherapy is a feasible way to boost the dosage of cervical lesions,preliminary clinical evaluation showed a better outcome and tolerable side effects.
The role of gamma-glutamyltransferase in malignant transformation and prognosis of ovarian cancer.
Authors: Schwameis Richard , Hofstetter Gerda , Aust Stefanie , Polterauer Stephan , Concin Nicole , Zeillinger Robert , Speiser Paul , Marth Christian , Zeimet Alain G , Reinthaller Alexander , Grimm Christoph
Published: March 2020

e16524

Background: Gamma-glutamyltransferase (GGT) – a membrane bound enzyme crucially involved in the cell’s detoxification pathway and apoptotic balance – is involved in tumor development, progression and chemotherapy resistance. Elevated GGT serum levels are associated with increased cancer risk in women and worse prognosis in gynecologic cancers. The present study investigated the prognostic role of GGT in ovarian cancer patients. Methods: In this multi-center study, pre-therapeutic GGT levels were ascertained in 634 consecutive patients with epithelial ovarian cancer (EOC, n = 567) and borderline tumor of the ovary (BTO, n = 67). GGT serum levels were associated with clinico-pathological parameters and uni- and multivariate survival analyses were performed.Immunohistochemistry of GGT was performed in ovarian cancer tissue and correlated with GGT serum levels. Results: Pre-therapeutic GGT serum levels were higher in patients with EOC (28.56 [38.24] U/L) than in patients with BTO (20.01 [12.78] U/L, p = 0.01). High GGT serum levels were associated with advanced FIGO stage (p<0.001) and with worse overall survival in univariate (p < 0.001) and multivariable analysis (p=0.02, HR 1.2 [1.1-1.5]). We further investigated the association between systemic GGT serum levels and local GGT expression in EOC tumor tissue and observed an association between these two parameters (p = 0.03). Conclusions: High pre-therapeutic GGT serum levels are associated with advanced tumor stage and serve as an independent prognostic marker for worse overall survival in patients with EOC. GGT expression in ovarian cancer tissue is reflected in GGT serum levels.
Recurrence rates in patients with uterine papillary serous cancer with and without breast cancer.
Authors: Stine Jessica E. , Pierce Stuart , Gehrig Paola A. , Nakayama John , Havrilesky Laura Jean , Secord Angeles Alvarez , Chiu Wing K. , Moore Dominic T. , Kim Kenneth H.
Published: March 2020

e16529

Background: Women with uterine papillary serous carcinoma (UPSC) are at increased risk for breast cancer and the converse is true. A genetic association between breast cancer and UPSC was recently described and counseling women faced with more than one cancer diagnosis can be difficult. Our objective was to evaluate recurrence rates of women with UPSC to those with UPSC and a personal history of breast cancer (UPSCBR). Methods: Data was collected for UPSCBR patients at two academic institutions between 7/1990 and 7/2012. Patient demographics, pathology, disease stage, and treatments were recorded. A UPSC literature review was performed focusing on recurrences per number of at-risk patients by stage. We used the fixed effect Mantel-Haenszel method to estimate the common pooled effect (recurrence rate) for the UPSC studies and compared these to UPSCBR patients. Results: Forty-three UPSCBR patients were identified. Median age at diagnosis was 72 (49-93). Twenty-six patients were Caucasian, 14 African-American and 3 other. Twenty-four (56%) had early stage at diagnosis (IA-IC) and 19 (44%) had late stage (III-IV). All but one underwent surgical staging/debulking; 36 (90%) were optimally debulked. Twelve (50%) early stage and 17 (89.5%) late stage patients underwent adjuvant therapy with radiation and/or chemotherapy. Nine studies were identified with available recurrence data for early stage UPSC; 8 for late stage. The recurrence rate for stage IA UPSCBR patients was 2/11 (18%) [95% CI: 2 to 52%] compared to 11% [95% CI: 9.8 to 13%] in the UPSC literature. In IB/IC UPSCBR patients we had 3/13 (23%) [95% CI: 5 to 54%] recur versus 21% [95% CI: 19 to 23%]. In later stages III/IV, 7/19 (37%) [95% CI:16 to 62%] UPSCBR patients had recurrences compared to 58% [95% CI: 56 to 60%] of UPSC patients. Conclusions: There is an association between breast cancer and UPSC with regard to incidence. We failed to find evidence of an appreciable difference in recurrence rates between our UPSCBR patients and UPSC patient groups from other reported studies. While diagnosis with two primary malignancies can be challenging for patients, this does not appear to impact their risk of recurrence.
Outcomes of patients with endometrial cancer and aggressive histology.
Authors: Rahatli Samed , Kucukoztas Nadire , Dizdar Omer , Dursun Polat , Yalcin Selim , Haberal Nihan , Ozen Ozlem , Tarhan Cagla , Altundag Ozden , Yildiz Ferah , Ayhan Ali
Published: March 2020

e16536

Background: To present patterns of practice and outcomes of patients with early stage poor histology endometrial cancer. Methods: Records of the patients with FIGO stage I-II serous papillary, clear cell, mixed or undifferentiated endometrial cancer were retrospectively evaluated. All patients were initially treated surgically by the same surgeon with comprehensive staging lymphadenectomy, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Adjuvant chemotherapy was offered to all patients and given unless the patient refused. Results: 38 patients with early stage poor histology were identified Median age was 61 and 86.8 % of the patients were post menopausal. Median BMI was 31.2 kg/m2. 28 patients (73.7%) received chemotherapy (90% with paclitaxel and carboplatin for 6 cycles). 5 patients (13.2 %) received external radiotherapy 3 patients (7.9%) received brachytherapy. Median follow up was 19 mos. Totally 3 patients (7.9%) had relapse on follow up; Among those who received adjuvant chemotherapy, only one patient had recurrence on vaginal cuff and was treated with radiotherapy and currently disease free for 4 years. Among those who did not receive adjuvant chemotherapy, 2 patients had widespread abdominal and distal recurrence and died on follow up. 2 patients died without recurrence. Conclusions: Complete surgical staging and adjuvant chemotherapy results in excellent prognosis in our patient series. [Table: see text]
Treatment failure in endometrial cancer.
Authors: Tang Yun-hsin , Chao Angel , Lai Chyong-Huey , Lin Cheng-Tao , Lin Gingin , Liu Feng-yuan
Published: March 2020

e16537

Background: To evaluate the clinical features and the outcomes of endometrial cancer with treatment failure after primary definitive surgery. Methods: A total of 89 patients who received primary definitive surgery between 2000 and 2010 with treatment failure were retrospectively reviewed. The correlation of clinicopathological features, primary treatment, failure pattern, and salvage treatment with outcomes were analyzed. Results: Twenty of the 89 patients with persistent or progressive diseases died at a median of 7.6 months (range, 1.9-14.0 months). The remaining 69 patients with initial disease controlled but subsequent relapse had a median time to recurrence of 13.9 months (range, 3.2 – 97.1). Assessable failure patterns included vaginal only in 14.5%, pelvic in 2.9%, distant in 59.4%, distant and loco-regional in 23.2%. The median survival after recurrence (SAR) was 25.5 months (range 1.5-121.7 months). The 5-year SAR rate was 52.7%. By univariate analysis, FIGO stage, grade of differentiation, histologic cell type, cervical invasion, adnexal metastasis, and status of lymph node metastasis when initial diagnosis, and bone or/and lung metastasis, radiotherapy after recurrence, and CA-125 ≥ 35 U/mL at recurrence were significant factors of 5-year survival after recurrence. By multivariate analysis, high-grade cancer (HR 3.05, 1.17-8.01; p = 0.023), bone and/or lung metastasis at recurrence (HR2.81, 1.15-6.85; p = 0.023), and CA-125 ≥ 35 U/mL (HR 2.85, 1.18-6.87; p = 0.013) were significantly poor prognostic factors for SAR. Six patients achieved long-term survival with more than one recurrence after aggressive multimodal salvage therapy along with deliberate restaging and post-therapy surveillance. Conclusions: High-grade, bone and/or lung metastasis and CA-125 ≥ 35 U/mL at recurrence were significantly poor prognostic factors for SAR. After intensive treatment, patients with recurrent endometrial cancer may have long-term survival.
Definitive image guided (IGRT) intensity-modulated arc radiotherapy (arctherapy) for locally advanced squamous cell carcinoma of the vulva.
Authors: Banner-Voigt Marie Louise Vorndran Coeln , Mathiesen Hanne From , Lassen Soeren , Mirza Mansoor Raza
Published: March 2020

e16540

Background: To determine early clinical outcome of PET-CT image guided intensity modulated arc radiotherapy with concomitant weekly cisplatin as definitive treatment of locally advanced or loco-regional unresectable relapsed vulvar cancer. Methods: Primary or relapsed (after surgery) patients (pts) with locally or loco-regionally advanced vulvar cancer not amenable to surgery were treated with radiation (RT) plus weekly cisplatin. All pts were planed by PET-CT scan. The decision to irradiate vulva and/or unilateral/bilateral nodes was made independently. Vulva was irradiated if macroscopic tumor was present (64Gy) or free-margins were less than 8mm (50Gy). Radiotherapy was applied to the unilateral or bilateral nodal regions according to nodal involvement/sentinal node/central or lateral vulvar tumor statuses. Principal of one-plus nodal region was applied. Target volumes were delineated together with onc-radiologist. Arctherapy was used. Results: 24 consecutive pts (median age 68 years) were treated during 01.09.2008-30.09.2012. In the initial period IMRT was used (9 pts). Vulva was treated in 20 pts; unilateral nodal RT in 7 pts and bilateral nodal RT in 17 pts. Grade ≥2 skin toxicity was registered in 20 pts, diarrhea in 3 pts., bladder related toxicity in 4 pts. Median follow-up is 15.7 months. 18 pts had complete clinical & radiological remission. 6 pts had treatment failure (residual tumor at 3 months follow-up) and another 6 pts relapsed. Conclusions: Image guided arctherapy is well tolerated and is effective in unresectable locally advanced vulvar cancer pts. Further experience and long-term data with this technique is to be attained.
Prolonging the platinum-free interval (PFI) with trabectedin to allow retreatment with platinum-based chemotherapy in patients with platinum-refractory and -resistant recurrent ovarian cancer (PROC).
Authors: Casado Herraez Antonio , Callata Hector , Manzano Aranzazu , Coronado Pluvio , Alonso Teresa , Sanchiz Barbara , Gajate Pablo , Cabezas Santiago , Vidart Jose Antonio , Diaz Rubio Eduardo
Published: March 2020

e16543

Background: Dose-dense therapy and administration of sequential non-platinum agents in PROC plays a role in reverting platinum-resistance and may improve the prognosis of such patients over years (Bamias A, 2013). The PFI extension is one of the current strategies to improve survival in partially platinum-sensitive (PPS) ROC, with a PFI 6-12 months (Poveda A, 2011). Trabectedin is a minor groove DNA-binder, which may play a role in reverting platinum resistance in patients with PROC and PPS ROC. Methods: Trabectedin 1.1-1.5 mg/m2as single agent was given as a 3-h infusion every 3 weeks with antiemetic and steroid premedication. Tumor response was assessed every 12 weeks. Results: Overall, 27 patients (24 with PROC and 3 with PPS ROC) treated from 2003 to 2013 in a single institution were included in the analysis. The patients had a median age of 63 years (range 45-81), most had serous-papillary (67%), clear-cell (11%), endometrioid (7%) and other (15%) histological subtypes and received a median of 5 prior chemotherapy lines (range: 1-9), 89% of whom also received other non-platinum agents. A median of 4.9 trabectedin cycles (range 1-14) was given. The overall response rate (ORR) was 15%, with a median duration of response of 16.5 weeks (range 5.86-44.43), while 41% of patients achieved stable disease (SD) lasting ≥4 months as best response. Thirteen of 27 patients were retreated with platinum-based chemotherapy after progression with trabectedin treatment. The ORR to platinum retreatment was 54% (n = 7) and SD was achieved in 8% (n = 1) of these patients, for an overall clinical benefit of 61%. Conclusions: Intercalation of a non-platinum therapy with trabectedin prior to subsequent platinum rechallenge may contribute to prolong PFI and to re-sensitize the patients with PROC and PPS ROC to further platinum-based therapies leading to a significant clinical benefit. Further prospective studies are warranted to determine the contribution of sequential treatments with trabectedin in patients with PROC and PPS ROC.
Impact of the trifunctional antibody catumaxomab followed by systemic chemotherapy (CTX) on overall survival (OS): Results of a subgroup analysis in patients (pts) with relapsed ovarian cancer (OC) and malignant ascites (MA).
Authors: Chekerov Radoslav , Wimberger Pauline , Vergote Ignace , Rosenberg Per , Schneeweiss Andreas , Scambia Giovanni , Guastalla Jean Paul , Colombo Nicoletta , Westermann A.M. , Lordick Florian , Schulze Elisabeth , Sehouli Jalid
Published: March 2020

e16547

Background: MA can compromise QoL in pts with OC. The safety and efficacy of catumaxomab in pts with MA due to EpCAM+ carcinomas where standard therapy was not available, not effective or no longer feasible was confirmed in a phase III trial comparing a 3-h intraperitoneal (i.p.) infusion with and without prednisolone premedication (Sehouli, ASCO 2012). Pts with OC who received subsequent CTX after treatment with catumaxomab (post-catumaxomab CTX) were analysed separately. Methods: OC pts in both treatment arms were pooled. The efficacy parameters time to next puncture (TTPu), puncture-free survival (PuFS) and OS were evaluated in relation to post-catumaxomab CTX. Results: 42/109 (39%) pts with MA due to OC received post-catumaxomab CTX, which included a platinum-containing regimen in 19 pts (17%). 21/109 (19%) received >1 post-catumaxomab CTX regimen. Pts with any post-catumaxomab CTX compared with those without CTX had significantly prolonged OS (median 273 vs 81 d, HR 0.24, p<0.0001) and PuFS (median 138 vs 43 d, HR 0.46, p = 0.0002). The difference in TTPu was not significant (223 vs 110 d, HR 0.68, p = 0.1788). Pts with >1 post-catumaxomab CTX compared with 1 post-catumaxomab CTX had significantly prolonged OS (480 vs 167 d, HR 0.20, p < 0.0001). The difference between the groups with 1 and >1 post-catumaxomab CTX in PuFS (153 vs 123 d, HR 0.64, p = 0.1804) and TTPu (153 vs 169 d, HR 1.52, p = 0.3600) was not significant. Pts who received platinum-containing post-catumaxomab CTX had significantly prolonged OS compared with those who received post-catumaxomab CTX without platinum (462 vs 169 d, HR 0.32, p = 0.0026). The difference between the groups with and without platinum in PuFS (153 vs 123 d, HR 0.76, p = 0.4448) and TTPu (153 vs 229 d, HR 1.68, p = 0.2373) was not significant. Conclusions: The data indicate that pts with MA due to OC who are able to receive CTX after catumaxomab treatment have significantly prolonged survival compared with pts who could not receive CTX. Further trials have been initiated to identify the best patient population to receive i.p. catumaxomab followed by subsequent CTX.
Recurrence and survival outcomes following adjuvant therapy for early-stage uterine serous carcinoma (USC).
Authors: Iglesias David A. , Holman Laura L. , Westin Shannon Neville , Fellman Bryan , Schmeler Kathleen M. , Ramirez Pedro T , Frumovitz Michael M. , Lu Karen H. , Soliman Pamela T.
Published: March 2020

e16556

Background: The choice of adjuvant therapy for early-stage USC remains controversial. The objective of this study was to estimate the recurrence rates of patients with surgically resected early-stage USC stratified by observation alone or adjuvant therapy. Methods: A retrospective review of women with surgically-staged stage IA-II USC followed at M.D. Anderson Cancer Center between January 2000 and December 2011. Descriptive statistics were used to summarize the demographic and clinical characteristics of patients. We estimated the cumulative incidence of disease recurrence, overall survival (OS), and recurrence-free survival (RFS) as a function of adjuvant therapy received. Adjuvant therapy groups listed in the Table. Results: 80 patients included in study. 58 patients had stage IA, 14 had stage IB, and 8 had stage II disease. Mean age was 66.4 years. Median follow-up for all patients was 4.83 years (range: 0.02 – 18.16). Cumulative incidence of recurrence for the whole group was 0.18 (95% CI: 0.10 – 0.28) which was reached at 3.96 years and remained at this rate until rising to 0.23 (95% CI: 0.12 – 0.36) at 11.12 years. Adjuvant treatment was not significantly associated with decreased risk of recurrence (Table). RFS at 5 years for the whole population was 0.71 (95% CI: 0.59 – 0.80) and OS at 5 years was 0.76 (95% CI: 0.63 – 0.85). Adjuvant treatment was not significantly associated with RFS or OS. In a subset of stage IA patients, 4 of 27 patients in the observation or cuff alone group recurred compared with 1 of 16 patients in the chemotherapy +/- cuff group (HR 0.48, CI: 0.05 – 4.27, p=0.511). Conclusions: In this study, there were no observed differences between observation and adjuvant treatment modalities in recurrence rates or survival outcomes for patients with early-stage USC. The addition of adjuvant chemotherapy may reduce risk for recurrence in stage IA patients, but further study is needed. [Table: see text]
Designing a survivorship program for head and neck cancer patients.
Authors: Ringash Jolie , McQuestion Maurene
Published: March 2020

e17007

Background: Our institution receives approximately 700 new patients with head and neck cancer (HNC) annually. A need was identified to develop, provide and evaluate services for the unique needs of HNC patients and their families. Methods: A dual leadership model was established, involving two HNC specialists: an advanced practice nurse and a radiation oncologist. After a literature search and environmental survey, we contacted identified H&N survivorship programs. Internal participants were identified from the HNC clinical team and existing institutional survivorship program. We established interdisciplinary Steering (focused on development and oversight of clinical & education programs) and Research (tasked with assessing needs and outcomes) committees. We sought consensus on program principles, scope, a definition of survivorship, and a theoretical model of the HNC journey. A half-day retreat including community partners and patient/family representatives was held to set 5-year priorities. Results: Little published literature on survivorship initiatives specific to HNC exists. Three HNC survivorship clinical or research programs were identified; the largest (established in 2009) was visited, while telephone contact was made with investigators at the others. Principles guiding program development included interdisciplinary collaboration, grass-roots expertise, and a holistic scope. We defined survivors as all HNC patients and their families, from diagnosis through death. Program scope includes physical, emotional, social, financial, functional and psychosocial needs. A theoretical map of the cancer journey and evolving challenges was developed. The retreat included 50 participants, representing 20 different roles. We identified these top priorities: 1) Establish a post-treatment team; 2) Make survivorship a (mandatory) standard of care; 3) Optimize patient navigation; 4) Match services to specific patient groups (eg. men); 5) Expand access to allied health services; and 6) Develop a clinical care pathway. Conclusions: Survivorship is a complex and evolving area of research and care delivery. A team-based, comprehensive approach has been developed to address the needs of the highly specialized HNC population.
Comparing the outcome of nasopharyngeal carcinoma in paediatrics and adolescents treated with neoadjuvant chemotherapy followed by radiotherapy versus concomitant chemoradiotherapy.
Authors: Al Saleh Khalid , Safwat Reham , Bedair Ahmed , El-Sherify Mustafa
Published: March 2020

e17008

Background: The optimal treatment of pediatrics and young adolescents with nasopharyngeal carcinoma (NPC) is not clearly addressed in large clinical trials. Systemic failure remains the problem. Our aim is to analyze the profile and treatment outcome of NPC in this age group in Kuwait, and whether the change of practice from neoadjuvant to concomitant chemoradiotherapy (CRT) has an impact on outcome, particularly distant metastasis. Methods: Between 2002-2010, 7 NPC patients aged </=20 years (mean age 16.7 years, SD 3.5) were treated in our institution with concomitant CRT. They represented 4.5% of all NPC cases seen during that time. We analyzed the profile and treatment outcome of that patient cohort, and compared it to our previous results published in 2002, who were treated with neoadjuvant chemotherapy (CTH) followed by radiotherapy (RT). Results: 6 patients were females, and 1 male. All patients had locoregional advanced disease. The median follow-up was 81 ms (r = 25-125 ms). 6 patients (86%) were treated with upfront CRT. Only 1 patient had neoadjuvant CTH followed by CRT. 4 patients had hyperfractionated radiotherapy (RT). The median dose of RT was 70 Gy (r = 66-75.6 Gy). G 3 acute toxicity were as follows. Hematological and skin 29%, mucositis 71%. 57% of patients >10% weight loss. No G 4 acute toxicity was recorded. All patient developed delayed G 2 hypothyroidism, and most developed significant subcutaneous fibrosis. All patient achieved locoregional CR. The only patient that developed distant metastasis was the one who could not tolerate CTH even as adjuvant due to prolonged neutropenia. All patients were alive at time of analysis. Comparing these results to our previous report which included patients between 1991-2001, the general profile of the patients seems to be the same. However, in the former patient cohort, 50% died within the same follow-up period due to distant metastasis. Conclusions: It seems that adoption of concomitant rather than neoadjuvant CTH, and modern RT techniques rather than conventional methods may have an impact on reducing distant metastasis. However, large patient cohort is needed to validate such finding.
Influence of treatment received in long surviving patients of head and neck cancer.
Authors: Taberna Miren , Hierro Cinta , Diez Marc , Canellas Jaime , Olivera Mivael , Vazquez Silvia , Navarro-Perez Valentín , Manos Manuel , Lozano Alicia , Vilajosana Ester , Mesia Ricard
Published: March 2020

e17010

Background: Modification of radiotherapy (RT) schedules or the addition of CT/biologics in patients (pts) with locally advanced head-and-neck carcinomas (LAHNC) have resulted in improving survival, although this means increased morbidity. Our aim was to analyze late toxic effects that present our long survivors pts and how much these may affect their lives. Methods: We have prospectively assessed late toxicity based on the RTOG scoring system in 152 consecutive LAHNC long-term survivors treated from 1994 to 2009 in an outpatient clinic. All of them had received concomitant treatment or fractionated RT with or without induction. Multivariate logistic regressions (logit link) for toxicity were performed to detect toxicity factors, p-values and confidence intervals at 95 % level (CI). Pts also answered about the degree of life-affecting by these sequelae. Results: Median age 63 (29-78), 136 men. All received radical treatment with: RT alone (21%), concomitant RT with cisplatin (P) (51%) or cetuximab (C) (28%). Previous induction platinum-based CT was administered in 56% pts. Median dose RT: 70 Gy (60-80), with different fractionations. All pts had at least one grade 1-2 late effect and 21% experienced grade 3-4 toxicity. The most common toxicities are shown in the Table. Concomitant C was found to be an independent risk factor of decreasing late toxicity compared with P in the adjusted analysis by RT fraction: Grade 1-2 toxicity OR 0.292 (CI: 0.125-0.680, p: ,04) and grade 3-4 toxicity OR 0.299 (CI: 0.0909-0.999, p: ,05). 41% of pts felt their quality of life as no disabling and 17% as very disabling. Conclusions: Having chronic toxicity in long survivors with a LAHNC is very common, but the vast majority of them learn to adapt to it. The type of treatment performed clearly affect this late toxicity: pts treated with concomitant P have significant more late toxicity compared with the association with C. [Table: see text]
Induction chemotherapy with docetaxel, cisplatin, 5 FU, followed by radiotherapy plus cisplatin or cetuximab, in organ preservation in piriform sinus carcinomas.
Authors: Fayette Jerome , Fuchsmann Carine , Tartas Sophie , Favrel Veronique , Pommier Pascal , Zrounba Philippe , Ramade Antoine , Racadot Severine , Ceruse Philippe , Poupart Marc
Published: March 2020

e17011

Background: Only few studies report organ preservation in piriform sinus carcinomas (PSC), with no publication on induction chemotherapy (IC) with docetaxel, cisplatine, 5FU (DCF) followed by radiotherapy plus cisplatin (RTCis) or cetuximab (RTCet). We assessed compliance, survival and organ preservation after IC by DCF followed by RTCis or RTCet in a retrospective multicentric review of patients (pts) with advanced PSC. Methods: We analyzed retrospectively 88 pts with advanced PSC treated between 2005 and 2011 in 3 tertiary care centers with organ preservation protocol strategy ongoing in each center. DCF was followed by RTCet (56.5%) in 1 center and by RTCis(42%) in the 2 others. Primary endpoints were acute toxicity and compliance to IC and RTCis compliance compared with RTCet. Secondary endpoints were overall survival (OS), disease free survival (DFS) and laryngectomy free survival (LFS). Results: Within the 88 pts, 21.6% were stage III and 72.7% stage IV; 81% completed the full course of IC. For 64.8% of pts no toxicity was reported. The main side effect observed was neutropenia (18.2%). Two deaths (2%) were directly related to the IC. Concerning the radiotherapy, 59% of the pts had full dose concomitant cisplatin versus 85% with cetuximab (p<0.001). Mean follow up was 23.5 months. At 5 years, OS rate was 35.5%, [CI 95% 24.6%-50.7%]. At 4 years DFS rate was 24% [CI 95% 15.5%-38%]. Factors affecting survival were IC response (ICR) (p<0.001) and stage of the disease (stage II>stage IV, p<0.001). No significant difference in survival was found between patients with RTCis or RTCet. At 4 years, LFS rate was 73% [IC 95% 56%-87.6%]. Factor affecting this LFS rate was ICR (p<0.05). Conclusions: IC with DPF followed by RTCis or RTCet allowed high organ preservation rates with acceptable toxicities. Cetuximab seemed to be better tolerated than cisplatin, improving compliance to the treatment. OS favorably compared with historical data of concurrent chemoradiation
Compliance and efficacy of induction chemotherapy with cisplatin, docetaxel, and fluorouracil followed by radiotherapy plus cisplatin or cetuximab for locally advanced oropharyngeal tumours.
Authors: Fuchsmann Carine , Fayette Jerome , Tartas Sophie , Favrel Veronique , Pommier Pascal , Zrounba Philippe , Ramade Antoine , Racadot Severine , Poupart Marc , Ceruse Philippe
Published: March 2020

e17012

Background: This study aimed to assess compliance and survival after induction chemotherapy (IC) with docetaxel, cisplatin, fluorouracil (DCF) followed by radiotherapy plus cisplatin (RTCis) or radiotherapy plus cetuximab (RTCet) in a retrospective multicentric series of 121 patients with locally advanced oropharyngeal cancer. One of the issues of these chemotherapy regimens is the toxicity that adversely affects the compliance to the concomitant radiochemotherapy treatment. We also evaluated feasibility and completion of radiochemotherapy treatment comparing efficacy and toxicity between RTCet and RTCis. Methods: Multicentric retrospective review of 121 consecutive patients with non resectable or non operable oropharyngeal carcinomas treated between 2005 and 2011 in 3 tertiary care centers with protocol ongoing in each center. In one center DCF, is followed by RTCet, in the 2 other centers, DCF is followed by RTCis. Primary endpoints were acute toxicity of IC and compliance to the RTCis compared with RTCet. Secondary endpoints were overall survival, disease free survival and locoregional control. Results: Within the 121 patients, 20.7% were stage III and 79.3% were stage IV. 81.8% of the patients completed the full course of IC. 50% of the patients had full dose concomitant cisplatin versus 77% of the patients that had full dose concomitant cetuximab (p=0.017). Mean follow up was 23.5 months. Median overal survival was 20.7 months, median disease free survival was 18.6 months. The 3 and 5 year overall survival rates were respectively 52.5% and 46.4%. The 3 and 5 year disease free survival rates were 44.2% and 38.3%. The only significant factor affecting survival was IC response (p<0.05). No statistically significant difference in survival was found between patients with concomitant cisplatin or cetuximab. Conclusions: Induction chemotherapy with DCF followed by RTCis or RTCet allowed good survival rates with acceptable toxicities. Cetuximab seemed to be better tolerated than cisplatin improving compliance to the treatment.
Is second-line targeted therapy beneficial in patients (pts) with differentiated thyroid cancer (DTC) after first-line sorafenib (SOR) failure?
Authors: Dadu Ramona , Devine Catherine E , Hernandez Mike , Busaidy Naifa , Waguespack Steven , Ying Anita , Habra Mouhammed Amir , Thosani Sonali , Hu Mimi I-Nan , Cabanillas Maria E.
Published: March 2020

e17016

Background: SOR has demonstrated efficacy in phase II trials but responses are not durable. 2nd line therapy is used in clinical practice however there are no data showing clinical benefit with this approach. We sought to determine if 2nd line targeted therapy was beneficial after SOR failure. Methods: Adult pts with DTC treated with 1st line SOR for >3 months were included. We compared overall survival (OS) in pts who received only 1st line SOR (grp 1) with pts treated with 2nd line therapy after 1st line SOR failure (grp 2). OS was defined as time after SOR failure until death. SOR failure was defined as discontinuation due to progression or intolerable toxicity. Results: We identified 62 DTC pts from 2006-2012 who were treated with 1st line SOR. 10 pts in grp 1 were excluded due to missing data, secondary unrelated cancers and <3 mo on SOR. We included 52 pts: 31 in grp 1 and 21 in grp 2. Baseline characteristics were similar between groups (Table). FTC was more frequent in grp 2. 2nd therapy included sunitinib, pazopanib, vemurafenib, and other investigational drugs. Median time on treatment with 2nd line therapy was 14.5 mo. Median OS in grp 1 and grp 2 was 6 and 50 mo, respectively (p=0.002). After excluding pts for death <3 mo after SOR end, median OS was 20 and 50 mo; there was a trend toward significance (p=0.07). Response and updated analysis will be reported at the meeting. Conclusions: Our study shows that pts receiving 2nd line therapy after SOR failure had a long OS despite more pts with FTC in this group. Acknowledging the limitations of a retrospective study, we conclude that in DTC pts, salvage targeted therapy after SOR failure appears to be beneficial and a promising strategy. [Table: see text]
Significance of plasma osteopontin (OPN) as a biomarker in squamous cell carcinoma of tongue.
Authors: Bhatt Madan Lal Brahma , Srivastava Vikas Kumar , Mishra Durga Prasad , Goel Madhu Mati , Mehrotra Divya , Srivastava Kirti , Gara Rishi Kumar
Published: March 2020

e17020

Background: Osteopontin (OPN) is an integrin-binding glycoprotein and its upregulation plays an important role in cancer progression. We analysed plasma OPN levels in squamous cell carcinoma of tongue (SCCT) patients, and healthy controls. We evaluated the relationship between plasma OPN level and outcome to therapy in the patients. Methods: Plasma OPN levels in 54 patients of SCCT and 18 healthy controls were measured by ELISA method. All participants gave written consent to participate in the study. Patients were subjected to chemo-radiotherapy using tele-cobalt radiotherapy machine (Theratron 780 C, AECL, Ottawa). A dose of 70 Gy of radiation was delivered to all the patients in 7 weeks with 2 Gy fraction size, 5 days a week by shrinking field technique. Chemotherapy was given in the form of Inj cisplatinum 30 mg/m2 IVI weekly, during the course of treatment with hydration, diuresis and anti-emetics. The data was analysed by using SPSS version 11.5 software. A value of p < 0.05 was considered statistically significant. Results: The plasma OPN levels of the SCCT ranged from 29.53 ng/mL- 514.52 ng/mL (mean and SE; 229.94 ± 21.96 ng/mL), which were significantly higher (p < 0.0001) than those of the controls which ranged from 12.45 ng/mL- 109.46 ng/mL (mean± SE; 50.69 ± 6.83 ng/mL). The patients with advanced T stage (T3/T4 vs.T1/T2) and positive N status (N +ve vs N-ve) had significantly higher plasma levels of OPN (p < 0.0001 and 0.001 respectively). The Kalpan-Meier survival curves for overall survival of patients with advanced T stage, positive N status or advanced TNM stage were significantly lower than that of patients with early T stage, negative N status or early TNM stage, respectively. Multivariate Cox regression analysis showed that OPN may be a predictive biomarker for poor outcome to radio-chemotherapy (95% CI = 0.081–0.293, p < 0.005). Conclusions: Our results suggested that the evaluation of plasma OPN levels may be a useful biomarker for diagnosis and prediction of response to radio-chemotherapy in SCCT.
Ir-192 pellet source HDR brachytherapy using wax surface mould applicators in head and neck cancer: A single institute experience.
Authors: Yengkhom Indibor singh
Published: March 2020

e17029

Background: Surface mould brachytherapy is suitable for radiation treatment of superficial lesions in head and cancer and it is the choice of radiotherapy technique. Various isotopes viz, Radium, Cs-137, Ir-192 wire, co-60, Sr-90 has been used. Earlier customized acrylic mould with hollow needle or catheters were used. With the advent of Ir-192 HDR pellet source we used tissue equivalent thermo malleable wax surface moulds. Single plane was used but in lips, pinna and ala of nose double planar sandwich technique was used with good dosimitry and cosmetic effect. BED is calculated by using LQ model. Methods: A retrospective analysis of 20 cases superficial H & N epithelial cancers treated with surface mould Brachytherapy using wax mould during 2008 to 2010 at RIMS is retrieved from the archive. HDR Ir-192 pellet source surface mould was used by positioning the flexible catheters in proper positions without distortion of geometry. The mould is made with wax plates by warming upto 70 degree Celsius in thermal water bath. The thickness of the slab is 1 cm and catheters embedded on surface and kept 1 to 1.5 cm gap and parallel to each other which can be bent or curved according to the surface contour. The fixation is reinforced with transpore /cellotapes. The dose delivered varies 500cgy 6 to 8 doses or daily 300 cgy for 5 to 7 fractions with BED calculated for LDR 2500cgy to 3000 cgy. Results: 20 cases were analysed: 8 Basal cell ca on face. SCC inner canthus 2, lips 2, pinna 1, ala nasi 2, alveolus 1, 1 hard palate, and 4 cheeks. One lip and one cheek has undergone resection with margin not free. All had disease less than 4 cm size and infiltration less than .5 cm. and clinically Node negative. At median follow up of 30 months 18 had no evidence of disease with good cosmesis and one patient with Ca. hard palate had local failure and one upper eyelid has recurrence after 9 months. Conclusions: The study though small in number indicates practicability and satisfactory results of using locally available tissue equivalent wax surface mould application therapy of HDR pellet source for very superficial T1 N0 lesions as primary mode or adjuvant radiotherapy in head and neck areas.
PEG status and outcomes in head and neck cancer patients treated with chemoradiotherapy.
Authors: Lazarus Cathy L , Husaini Hasan , Hu Kenneth , Culliney Bruce , Li Zujun , Urken Mark L , Jacobson Adam , Buchbinder Daniel , Persky Mark , Tran Theresa , Pitman Michael , Concert Catherine , Palacios Daisy Maria , Bennett Bridget , Kumar Mahesh , Metcalfe-Klaw Robin , Harrison Louis Benjamin
Published: March 2020

e17030

Background: Patients undergoing concomitant chemoradiotherapy may or may not undergo prophylactic PEG placement, depending on baseline weight, medical status and presence of dysphagia. We examined quality of life, performance status and oral outcomes in patients with or without PEG at baseline and 3 months post-treatment. Methods: Thirty-three patients with head and neck cancer were treated with chemoradiotherapy. All were seen baseline and 3 months post-tx. Assessments included the Performance Status Scale (PSS), Karnofsky Performance Status Scale (KPSS), tongue strength, jaw opening, and saliva weight. Patient-rated QOL utilized the MD Anderson Dysphagia Inventory (MDADI) and Eating Assessment Tool (EAT-10) with significance at p<.05. Results: Weight loss from baseline to 3 months post-tx was 15.16 % (p=0.000) and 10.41% (p=0.046) for those without and with PEGs, respectively. At 3 months post-tx, the PEG group performed significantly worse than the no-PEG group on the EAT-10;(p=0.050), worse on the MDADI (p=0.089) and saliva weight (p=0.032). In the no-PEG group, significant decreases from baseline to 3 months post-tx were seen for KPSS (p=0.014), Normalcy of Diet (p=0.001), Eating in Public (p=0.004),tongue strength (p=0.002), jaw opening (p=0.000), saliva weight (p=0.000), EAT-10 (p=0.001) and MDADI (p=0.016). For the PEG group, statistically significant decreases were noticed from baseline to 3 months post-tx in Normalcy of Diet (p=0.027), tongue strength (p=0.034), jaw opening (p=0.027), and saliva weight (p=0.018). Conclusion: Concomitant chemoradiotherapy for treatment of head and neck tumors can result in impaired performance outcomes and QOL over the first 3 months post-tx. However, performance status, tongue strength, jaw ROM and eating QOL were only mildly impaired by 3 months post-tx. Differences were observed in weight loss, performance status, oral outcome variables and QOL for PEG vs. no-PEG groups. However, the magnitude of the differences was not significant with the exception of the EAT-10 & saliva weight, with greater impairment in eating QOL and lower saliva weight in the PEG group.
A new symptom measure in gastrointestinal stomal tumors.
Authors: Williams Loretta A. , Araujo Dejka M. , Mendoza Tito R. , Sailors Mary L , Ali Nazim N , Huang Furong , Trent Jonathan C. , Cleeland Charles S.
Published: March 2020

e17508

Background: Symptom burden is the combined impact of disease- and treatment-related symptoms on daily functioning. A major barrier to effective symptom management in gastrointestinal stromal tumors (GIST) is inadequate assessment. Our aim was to develop a short, valid, reliable patient-reported outcome measure of GIST symptoms for research and practice. Methods: After giving IRB-approved informed consent, 110 patients with GIST completed the 13 symptom severity and 6 interference items of the core MD Anderson Symptom Inventory (MDASI) plus 9 GIST-specific symptom items generated from patient and expert input. Items were measured on a 0-10 scale (0 = none, 10 = worst imaginable). 65 patients completed the same items 1 day later. Patients also answered a single overall quality-of-life (QOL) question. Demographic and disease information was collected on all patients. Psychometric procedures determined reliability and validity of the MDASI-GIST. Results: Mean subject age was 59.2 years (standard deviation [sd] = 11.9). 54% of the subjects were female, 85% were white, 47% were employed, 55% were on imatinib, and 30% had no evidence of disease. Mean overall QOL rating was 8.1 (best = 10, sd = 2.0). Symptoms reported as most severe were fatigue (mean [M] = 2.65, sd = 2.66), drowsiness (M = 2.36, sd = 2.55), disturbed sleep (M = 2.18, sd = 2.55), and muscle soreness/cramping (M = 2.18, sd = 2.67). Two items (abdominal swelling and malaise) were eliminated for redundancy. Internal consistency (Cronbach α) and test-retest reliability of the 20 symptom items were 0.94 and 0.93, respectively, and of the 6 interference items were 0.94 and 0.87, respectively. The mean severity of the 20 symptom items was significantly correlated with QOL rating (correlation = -0.7, P < 0.001). Mean GIST-specific symptom severity and symptom interference discriminated between patients who were employed and patients who were disabled (P = 0.05 and 0.03, respectively). Conclusions: We have validated an analytic tool, the MDASI-GIST, to quantify GIST symptom burden, assess side effects in treatment trials, and monitor symptoms in clinical care. Additional research on the longitudinal symptom burden of GIST, including differences based on type of therapy and response to therapy, is ongoing.
Adherence (adh) to and beliefs about oral anticancer medications (OAMs) in metastatic renal cell carcinoma (mRCC) patients (pts): A single-center pilot study in the United States.
Authors: Geynisman Daniel M. , Hlubocky Fay J. , Kocherginsky Masha , Duster Sarah M. , Gomez Joseline X. , Stadler Walter Michael , Daugherty Christopher
Published: March 2020

e17511

Background: Suboptimal adh to drugs is a problem in chronic diseases. In mRCC, OAMs are the mainstay of treatment (tx). Adh and its determinants in exclusively mRCC pts has not been studied in the US. This study aimed to evaluate adh to OAMs in mRCC pts, and describe pts understanding and beliefs about OAMs and their disease. Methods: Single center, cross-sectional study of pts on OAMs for at least 60 days. Planned study size is 50 pts. Standardized assessment instruments used: Adh—MMAS-8 questionnaire (Q); beliefs and expectations regarding OAMs—Beliefs about Medicines Q (BMQ) and Brief-Illness Perception Q (IPQ); Quality of Life (QOL)—BSI-18, FKSI. Semi-structured interviews assessed financial burden, barriers to adh, understanding of prognosis and goals of therapy. Results: To date, 40 pts have been studied. Median age 66 (range 36-85), 75% male, 78% Caucasian, 43% college graduates, 58% with income ≤ 60K. OAMs used: 43% sunitinib, 25% pazopanib, 23% everolimus, 8% axitinib. 1st line tx: 45%; 2nd line tx: 30%; 3rd or beyond: 25%. MMAS-8: 7.4 ± 1.1 (range 3-8); 10% low adheres, 30% intermediate, 60% high. 36% reported not receiving counseling on taking OAMs. BMQ-Necessity: 20 ± 4 (range 8-25); BMQ-Concern: 12 ± 4 (range 5-24). IPQ: 40 ± 13 (range 6-71). QOL: BSI 10 ± 9 (range 0-38); FKSI 44 ± 8 (range 26-60). 18% reported financial difficulty paying for OAMs; 25% paid ≥ $100/mo. No significant difference between adherers and non-adherers in regard to demographic, QOL or belief variables was detected. 23% did not believe OAMs are chemotherapy. 67% believed mRCC is a chronic disease, 46% believed that their OAM may be able to cure them and 44% strongly agreed or agreed with “I expect to be free of cancer in the future.” 52% reported not discussing prognosis with their MD. Conclusions: Our data suggest that self-reported adh in mRCC is much better than in other diseases. Most pts felt mRCC was a chronic disease and almost 50% believed they could be cured. Further research is needed addressing the development of an oncology-specific adh tool and defining an optimal adh benchmark for OAMs via prospective studies of self-reported adh, serum drug levels and outcomes.