bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation pneumonitis (RP) in lung cancer patients treated with chemotherapy (CT) and thoracic radiation (TR): Retrospective analyses of patients treated at a comprehensive cancer center
Authors: Vishnu P. , Srinivasan S. , Heilbrun L. , Venkataramanamoorthy R. , Wozniak A. , Soubani A. , Gadgeel S. M. 
Published: March 2020

19642 Background: Combined CT and TR is the current standard for locally advanced non-small cell lung cancer (NSCLC) and SCLC. Severe RP, an important adverse effect of TR, is reported in clinical trials to occur in 10% of patients receiving CT and TR. The rate in routine care may be higher as patients are not selected based on lung function. We conducted a retrospective study to assess the incidence of RP in lung cancer patients treated with CT and TR. Methods: Retrospective identification of patients who underwent combined modality therapy (concurrent or sequential CT and TR) for lung cancer (NSCLC & SCLC) at our cancer center between January 2001 and December 2004. Demographic features, RP incidence and grade (RTOG criteria), hospitalization rate and overall survival (OS) were assessed. Results: 51 patients who met the selection criteria were analyzed. The demographic features were - males 61%; Caucasians - 53%; African Americans - 39%; history of pulmonary disorder - 45%; NSCLC - 82%; CT - 62% received Cisplatin/Etoposide, while 24% received Carboplatin/Paclitaxel; 92% received concurrent CT and TR. The median dose of TR was 5940 cGy. 20 patients (39%) developed RP; 13 (25%) had grade = 3 RP. Median time to development of RP was 4.4 months. Rate of RP in females and males was 50% vs. 32% (p=0.25). Rate of RP in patients with pulmonary disorder at baseline was 52% vs. 29% in others (p=0.15). 1 year hospitalization rate was 75% and 42% in RP and non-RP patients (p=0.025). For all 51 patients, the median overall survival (OS) was 16.4 months (95% CI 11.8 - 23.3). Length of OS did not differ significantly (p = 0.36) between the 20 patients who had RP vs. the 31 who had no RP (median OS: 22.2 vs. 14.5 months, respectively). Conclusions: The RP rate in these 51 lung cancer patients treated off- protocol with CT and TR is higher than that reported in clinical trials. Despite higher morbidity in patients with RP (i.e., increased hospitalization), survival duration did not differ significantly based on RP status. No significant financial relationships to disclose.
Multidimensional geriatric evaluation in elderly cancer patients and its relationship with age
Authors: Molina-Garrido M. , Guillén-Ponce C. , Carrato A. 
Published: March 2020

19651 Background: Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Older patients are not simply old, but are geriatric patients because of interacting psychosocial and physical problems. As a consequence, the health status of old persons cannot be evaluated by merely describing the single disease or the group of age. We tested the performance of a new Comprehensive Geriatric Assessment (CGA) and its relationship with groups of age in cancer patients. Methods: Between June 2006 and December 2006, a total of 64 oncologic patients older than 75 years were approached to enrol in our study to analyze their functional, physical, mental, pharmacotherapeutic and socio-economic status and to correlate them to some groups of age: youngest-old (75 to 80 years-old), old-old (80 and 85 years-old) and oldest-old (older than 85 years). They were analysed Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, Grade of Fragility measured by Barber Scale, cognitive evaluation measured by Pfeiffer Test, and medication intake. A Chi Squared test was used for statistical analysis; p-value <0,05 was considered significative. Results: Sixty-four oncologic patients age > or = 75 years were recruited. Median age was 80.24 years (range 73.88 to 86.94). 51.6% female. Breast cancer was the most frequent diagnosis (30.2%), followed by lung cancer (19%). 29 patients (45.3%) were aged between 75 and 80 years old; 27 patients (43.5%) were between 80 and 85 years- old. There were statistic significative association between groups of age and Pfeiffer Test (p=0.037), Barber Scale (p=0.031) and medication intake (p=0.021). However, there was not a significative relationship between groups of age and Barthel Scale (p=0.052), Lawton-Brody Scale (p=0.2425), Cruz-Roja Scale (p=0,1485) or number of geriatric syndromes (p=0.129). Conclusions: This abstract reviews the findings regarding the correlation between a comprehensive geriatric assessment (CGA) and groups of age in older patients with cancer. Age per se must not be the only criterion for medical decision as it is not correlated to the health status of older cancer patients. No significant financial relationships to disclose.
A brief measure of patients self-reported chemotherapy-related memory problem: Psychometric studies
Authors: Jean-Pierre P. , Morrow G. R. , Fiscella K. , Parrella M. , Kohli S. , Khanna R. , Jacobs A. D. , Issell B. 
Published: March 2020

19655 Background: Memory is a central component of individuals’ functional systems of behavior, (i.e., cognition, emotionality, and executive functioning) that can be deleteriously affected by cancer treatment. It is important to identify and understand the effects of cancer treatment on memory in order to develop effective interventions to ameliorate these problems. This study involves structural and reliability analyses of a brief measure of chemotherapy-related memory problem to facilitate prompt and reliable preliminary assessments in oncology research and practice. Methods: Patients (N = 821) included in this analysis were part of a larger randomized clinical trial on cancer-related fatigue. These patients completed the Fatigue Symptom Checklist (FSCL) at four time points. Five items from the FSCL that assess memory problems were aggregated into a brief self-report memory problem measure (SRMP). Results: Reliability assessment of the SRMP revealed a Cronbach coefficient alpha of 0.90. The data was found suitable for latent structure analysis using various criteria: Kaiser-Myer-Olkin, Bartlett’s Test of sphericity, Kaiser’s (1959) simplest criterion test of γ >1, and the presence of item-correlation coefficients of r = .30. Principal components analysis showed one component with eigenvalue (γ) exceeding 1, that explained 72% of the variance. Subsequent reliability assessments of the SRMP revealed Cronbach coefficients alpha of 0.90 and above, all with a single component explaining 71.36% to 73.36% of the variances. Conclusions: The results supported the use of the SRMP as a reliable one- dimensional measure of cancer treatment-related memory problem. The SMRP could be used for preliminary assessment of possible underlying memory problems that might need further examinations. Studies to establish the construct validity of the SRMP are under way. Supported by NCI grant R25CA102618. No significant financial relationships to disclose.
Dosimetric evaluation and comparison of small-field non-coplanar multi-arc radiotherapy (SMART) and intensity-modulated radiotherapy (IMRT) in treatment of tumor-related bronchial/superior vena cava (SVC) obstructions
Authors: Figura A. T. , Montebello J. , Wang J. , Zhang H. , Mayr N. , Gupta N. , Grecula J. 
Published: March 2020

19668 Background: Rapid and cost-effective palliation is of great importance in patients with complications from lung cancer progression. To offer immediate treatment for a tumor-related obstructed bronchus or SVC, we have implemented the SMART technique which has been shown to be effective and safe in the primary and re-treatment of malignant bronchial/SVC obstructions. The purpose of this study was to determine if the dose coverage to the obstructed bronchus/SVC and normal tissue sparing achieved by SMART compare favorably to the lengthier and more expensive IMRT technique. Methods: Treatment planning CT’s from 9 patients with a bronchial obstruction and 1 with SVC were studied. The planning target volume (PTV) consisted of the clinical target volume (CTV = obstructed bronchus or SVC) plus a 1 cm margin. For SMART, a dose of 10 Gy in a single treatment to the target was computed using 18 MV photons with 5 to 8 non-coplanar arcs with field sizes ranging from 4 cm2 to 8 cm2. For a dosimetric comparison using the same planning CT, an IMRT plan with 5 to 9 fields using 6 MV photons with 95% CTV coverage was computed to deliver the same dose. Dose volume histograms (DVH), treatment delivery time based on monitor units (MUs), and mean doses to the CTV, PTV, heart, lungs, spinal cord, and total body dose were compared using Student’s t-test. Results: Pooled DVH analysis of SMART and IMRT showed that SMART provided slightly better, but not statistically significant, coverage of the CTV (97±1.1 vs. 92±5%) and PTV (94±2 vs. 89±5%). There was no difference in normal tissue sparing between SMART and IMRT with respect to the mean lung dose (9±7 vs. 9±7%), heart dose (7±10 vs. 3±5%), cord dose (37±13 vs.30±13%), and total body dose (8±4 vs.7±4 Joules). However, SMART delivery was faster requiring significantly less MUs compared to IMRT (1,284±65 vs.1984±90, p<0.002). Conclusions: IMRT showed no advantage over SMART in dose coverage of the CTV/PTV and sparing of critical normal tissues. Therefore, less complex planning and faster treatment delivery of SMART maybe clinically preferable for rapid palliation of critically ill patients with an obstructed bronchus/SVC. No significant financial relationships to disclose.
Usefulness of frailty markers in the assessment of the health and functional status in older cancer patient referred for chemotherapy
Authors: Retornaz F. G. , Monette J. , Monette M. , Sourial N. , Wan-Chow-Wah D. , Batist G. , Bergman H. 
Published: March 2020

19673 Background: In order to properly support clinical decisions, geriatric assessment (GA) is recommended for older cancer patients. However, the best form of GA remained unknown and recent studies demonstrated that usual GA tools may have a ceiling effect in detecting adverse outcomes to cancer treatment. Frailty has emerged as a concept characterizing cumulative declines across multiple physiologic systems, leading to increased vulnerability and risk of adverse outcomes. Consequently, the concept of frailty may represent a more sensitive way to better characterize health and functional status and to detect potential vulnerability to adverse outcomes in older cancer patients. The purpose of this pilot study was to explore the usefulness of frailty markers in older cancer patients. Methods: This cross- sectional study included 50 cancer patients, (70 years and older) referred to an oncology clinic for chemotherapy. Chronic diseases, IADL and ADL disabilities, and seven domains considered as frailty markers (nutrition, mobility, strength, energy, physical activities, mood and cognition) were assessed. Patients were classified into hierarchical groups based on the results of their assessment. Results: While 15 (30%) patients had at least one disability in IADL and 8 (16%) patients had at least one disability in ADL, 27 patients (54 %) were completely independent for IADL and ADL. Among those patients with no IADL nor ADL disability, 21 patients (42%) presented at least one frailty marker. In the whole cohort, 44 patients (88%) had at least one frailty markers. The most prevalent of the frailty markers were nutrition, mobility and physical activity (respectively 62%, 58% and 42%). Conclusion: Markers of frailty add substantial information to the usual GA tools in detecting potential vulnerability in older cancer patients. Additional studies are needed to determine if the addition of the frailty markers to the usual GA tools can help to better characterize the older cancer population and predict risk of toxicities and adverse outcomes due to cancer treatment. No significant financial relationships to disclose.
Patient weight and event-free survival for children under 2 years of age at diagnosis with favorable histology Wilms tumor
Authors: Fernandez C. V. , Anderson J. , Breslow N. , Dome J. , Grundy P. , Perlman E. , Green D. 
Published: March 2020

20002 Background: Over- and underweight have been associated with excess mortality in certain childhood cancers. The impact of the child’s weight at diagnosis on event-free survival (EFS) in favorable histology Wilms tumor (FH WT) is unknown. Methods: Patients with FH WT under 2 years of age at enrolment on NWTS-5 were included. This age group was analyzed by body weight in kilograms because body mass index (BMI) norms do not exist for individuals less than 2 years old. Outcomes by BMI for children older than 2 years of age with FH WT will be analyzed separately. CDC 2000 growth charts were used. Patients were stratified for risk based on stage and chemotherapy protocol [EE4A = vincristine/dactinomycin] [DD4A = vincristine/doxorubicin/ actinomycin]. A univariate analysis of the relationship of weight-for-age and EFS was calculated. A Cox proportional hazards model was fitted for EFS examining four subsets of weight-for-age by percentiles: a) less than 5%, b) 5–9.9%, c) 90–94.9% and d) more than 95% and adjusting for risk/treatment groups via stratification. Results: 594 patients met the study criteria. 567 had weights recorded. Median follow-up was 4.7 years. 10% of patients had a weight for age percentile of 5.6 or below and 10% had a weight percentile of 94.1 or above. A univariate analysis of the relationship of weight-for-age and EFS showed no relationship (p=0.40, log-rank test). A Cox proportional hazards model, stratified by risk/treatment groups, showed that low or high weight-for-age was not predictive of outcome (p=0.24). Conclusions: There was no evidence that low or high weight-for-age was predictive for EFS among patients less than 2 years old with FH WT. There were more patients with lower or higher weight than would be expected. [Table: see text] No significant financial relationships to disclose.
Effect of race on the quantity and timing of end-of-life discussions in pediatric oncology
Authors: Baker J. N. , Hinds P. S. , Zawistowski C. A. , Rai S. , Ma Y. , Althoff J. , Smalls A. , West N. , Kane J. R. 
Published: March 2020

20004 Background: Clinicians and parents report that end-of-life (EoL) care discussions and decision making are complex, difficult and affected by personal, family, and disease and treatment factors. The influence of race on EoL discussions and decision making has not been carefully examined in a large pediatric oncology study. The purpose of this study was to assess if race (white, black, Hispanic) influenced the quantity or timing of end-of-life care discussions and decisions. Methods: This abstract represents a retrospective chart review leading to the creation of an EoL database of pediatric oncology patients at St Jude Children’s Research Hospital who died during the time period of July 01, 2001 to February 28, 2005. Eligibility criteria were oncologic diagnosis, and patient age less than 21.99 years of age at the time of death. After strict application of the eligibility criteria, a total of 380 patients met study inclusion criteria. The effect of race on the quantity and timing of EoL discussions and decision making was then analyzed from the database. All extracted data were validated by a different team member as was the accuracy of all entered data. The association of race with other factors was assessed using regression analysis and chi-squared testing statistics. Results: None of the following differed by race: the total number of EoL discussions before an EoL decision was made (p=0.58); the total time from the first such discussion to a specific EoL decision (p=0.23–0.68), the total time from the first discussion to the patient’s death (p=0.105), or having a DNR in place at the time of death (p=0.55). Conclusions: In this cohort of patients from a tertiary referral center, race is not a significant factor on the quantity and timing of EoL discussions and decision making in pediatric oncology patients. [Table: see text] No significant financial relationships to disclose.
Effects of multiple courses of oral gefitinib, topotecan, and cyclophosphamide in poor risk neuroblastoma
Authors: Donfrancesco A. , De Ioris M. , Jenkner A. , Ilari I. , De Sio L. , Castellano A. , Fidani P. , Serra A. , Cozza R. , De Laurentis C. , Dominici C. 
Published: March 2020

20009 Background: Gefitinib (G) has shown potent inhibitory activity on neuroblastoma (NB) cell proliferation in in vitro models. Experimental data have also reported that the addition of G to cytotoxic drugs can increase in vitro and in vivo antitumor activity in several tumor models, but if this will translate in significant clinical benefits, with respect to survival, is still unclear. We evaluated the feasibility of administering an oral regimen including G combined with topotecan (TPT) and cyclophosphamide (CPA) in heavily pretreated pts with relapsed/resistant metastatic NB. Methods: Patients received oral CPA (50 mg/m2/day) followed by TPT (0.8 mg/m2/day) plus G (at the fixed dose of 250 mg/day) for 14 consecutive days in an outpatient setting. Courses were repeated every 28 days until progression, and response was evaluated every second course. Expression of EGFR mRNA in primary tumors was assessed by real-time RT-PCR. Results: Six pts (1M/5F), median age 5.4 years (range 4.1–8.2), were enrolled between October 2004 and October 2006. All pts were relapsed after high-dose chemotherapy and hemopoietic rescue with PBSCs. At the time of inclusion, 3 pts were in PR after 8 courses of second-line therapy, whilst 2 pts had achieved SD after 1 and 8 courses of second-line therapy, resp; 1 pt had PD right after PBSC rescue. Significant levels of EGFR mRNA were detected in 4/6 tumors. A median of 7.5 courses (range 1–24) per pt were administered. In 4 pts, the dose of TPT and CPA was reduced by 25% after the first course. After a median follow-up of 12 months (range 1–26), 1 pt is DOD at 15 months since the inclusion and 5 pts are alive, 1 in VGPR (26+ months) and 5 with SD (26+, 1+, 4+, 9+ and 18+ months). Median PFS is 7.5 months (range 1–26). Neutropenia grade 4 was observed in 4/6 pts; rash grade 2 in 2 pts, and hepatic (LFT increase) grade 3 toxicity in 1. Conclusions: The regimen was feasible and well tolerated in this series of heavily pretreated pts. PFS is encouraging, but deserves further evaluation and longer follow-up. Additional molecular studies are ongoing aimed at identifying the subset of NB pts most likely to benefit from the synergy between G and cytotoxic drugs observed in preclinical models. No significant financial relationships to disclose.
Is local lymph node involvement a prognostic factor in paediatric renal cell carcinoma?
Authors: Indolfi P. , Bisogno G. , Cecchetto G. , Ferrari A. , Piva L. , Carli M. , Donofrio V. , Schiavetti A. , De Salvo G. , Donfrancesco A. 
Published: March 2020

20014 Background: RCC in childhood is rare. Children with RCC tend to have a similar overall prognosis when compared with adults, where prognosis worsens with increasing stage, although direct comparisons of adult and paediatric data isn’t easy. The aim of our study is to identify the prognostic significance of local lymph node involvement in children with Renal Cell Carcinoma (RCC). Methods: On the basis of a retrospective study, the recently founded Italian Association for Paediatric Hematology and Oncology-Rare Tumors Paediatric Age (AIEOP-TREP) identified 16 patients (9 females) with RCC and local lymph node involvement at 10 of these centers. The cases were observed among 59 paediatric RCC, corresponding to 27.1% of RCC presenting in Italy from January 1973 to May 2006. Results: Overall, 9 patients were alive and disease free at last follow-up: eight patients had regional lymph node dissection (RLND) from the diaphragm at the aortic bifurcation, and one had the para-aortic lymph nodes removal. Six patients died: one had RLND (died from progression of disease), three had the renal hilum lymph nodes removal, and two the para-aortic lymph nodes dissection. One patient was lost to follow-up after relapse: this patient had para-aortic lymph node removal at diagnosis. Estimated 25-year DFS and OS rates for all patients were 64.2% and 50.5%, respectively. Given the small number of patients, little can be said about the value, if any, of adjuvant immunotherapy in this group of RCC. Conclusions: Children with lymph node positive RCC had a relatively unfavourable long- term prognosis. In our experience the RLND improves the prognosis. Further investigation of the biologic differences is warranted. Because of the very low incidence of paediatric RCC, an international clinical trial will be required to establish optimal therapy for children with RCC. No significant financial relationships to disclose.
Concordance and evaluation among IGCCCG and POG staging systems in pediatric germ cell tumors
Authors: Robles-Castro J. , Rivera-Luna R. , Calderon-Elvir C. , Leal-Leal C. A. 
Published: March 2020

20019 Background: The knowledge regarding treatment and prognosis of pediatric germ cell tumors has been taken from the development of these in the adult population. The object of this work was to compare the International Classification (IGCCCG) used in adults versus the POG classification used traditionally in a pediatric population. Methods: We reviewed clinical records from March 1994 through June 2003 with the diagnosis of malignant germ cell tumor of testis, retroperitoneal and mediastinum. All patients completed the treatment proposed initially with a follow up of more than 24 months. They were staged with the POG classification at diagnosis and with the International Classification for this study. Results: We obtained 61 patients with a 4 year follow up. They were all male, with germ cell tumor of testis or mediastinum. There were no retroperitoneal primary tumors. The age range was from 4 months to 188 months with an average of 48.7 months. Prognosis and treatment with the POG and the IGCCCG classifications had concordance of 0.0004 and 0.0371 respectively. Conclusions: We found limitations such as diverse chemotherapy protocols used in patients within the same risk group. Biological tumor Markers sampling play an important role in the the initial approach to allocate staging and risk based treatment protocols. It is necessary to carry out new studies with a homogeneous based population with similar diagnosis, treatment protocols and staging system to corroborate the utility and implementation of the International Classification in order to ameliorate morbidity and mortality of our pediatric patients. [Table: see text] No significant financial relationships to disclose.