bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of miR-506 on pirarubicin sensitivity and on mesenchymal to epithelial transition and DNA damage homologous recombination repair process in leiomyosarcoma.
Authors: Yang Jilong , Li Ting , Li Feng 
Published: March 2020

e22503 Background: MicroRNAs has been shown to be involved in many processes of tumorigenesis. Furthermore, miR-506 has been confirmed to be related to the occurrence of epithelial to mesenchymal transition (EMT) and tumor chemoresistance. However, the role of miR-506 in leiomyosarcoma has not yet been reported. Methods: A retrospective review of the 61 Chinese patients diagnosed with soft tissue leiomyosarcoma from January 2000 to December 2012 was investigated. Patient survival trends were examined by Kaplan-Meier analysis and log-rank tests. In vitro experiments were used to determine the biological function and physiological mechanism of drug sensitivity of miR-506. Results: In Chinese leiomyosarcoma patient cohort, we detected a decreased expression of miR-506 in the tumor tissues than that in marginal normal tissues. Tissue microarray analysis detected and confirmed a novel mesenchymal to epithelial transition (MET) in soft tissue leiomyosarcoma, also this MET phenomena was correlated with survival. In vitro, miR-506 inhibited the proliferation, migration, and invasion of leiomyosarcoma cells by promoting the occurrence of MET. Furthermore, RAD51, RAD52, ATM and ATR, which are defined as DNA damage homologous recombination repair related proteins, were highly expressed and associated with worse overall survival of leiomyosarcoma patients. Through targeting MET and DNA damage homologous recombination repair related proteins, miR-506 promoted the sensitivity of leiomyosarcoma cells to Pirarubicin. Conclusions: The current study reveals a novel mechanism that miR-506 increases the drug sensitivity of tumor cells, which are probably in association with the MET and DNA damage homologous recombination repair process.
Chemotherapy combined with antiangiogenesis drugs in stage IV sarcoma patients: Efficacy data from the largest cohort study from China.
Authors: Ren Zhiwu , Liao Zhichao , Yang Jilong 
Published: March 2020

e22505 Background: Chemotherapy agents such as doxorubicin are not curative and new therapies for metastatic sarcomas are urgently needed. Several anti-angiogenesis therapeutic drugs such as Apatinib and Endostar have been widely used as monotherapy or combined treatments. We performed a retrospective study with the largest Chinese sarcoma cohort to investigate the efficacy of different anti-angiogenesis strategies. Methods: Data of NCT03121833 and NCT03121846 were collected. The information of 119 sarcoma patients in stage IV treated in Tianjin Medical University Cancer Hospital from Oct. 2009 to Aug. 2018 was collected. These sarcoma patients received chemotherapy, anti-angiogenesis therapies, or combined treatments. Chemotherapy was administered with single-agent Adriamycin or combination regimens according to NCCN guideline. Endostar was given at a dose of 15mg once daily by intravenous infusion for 14 days combined with chemotherapy regimens. Apatinib were given at a starting dose of 500 mg daily. Efficacy was evaluated according to RECIST1.1. Treatment-related adverse effects (AEs) were also evaluated. Results: 119 patients (46 bone sarcomas and 73 soft tissue sarcomas) were enrolled into four groups according to different treatment strategies (Table). The ORR had no significantly difference but DCR was significantly different, with the highest rate in chemotherapy plus apatinib group. The mPFS and mOS had no significantly difference. All the AEs were manageable. Conclusions: Chemotherapy combined with anti-angiogenesis drugs such as Apatinib and Endostar significantly increase the response rate. Apatinib is effective and well tolerated for advanced sarcoma patients. As for Apatinib treatment, the patients who suffered hypertension, hand-foot-skin reaction or proteinuria have significant longer OS than those without these AEs, which is first report in sarcoma patients. Clinical trial information: NCT03121833; NCT03121846. [Table: see text]
The long term surgical outcome of spinal giant cell tumor.
Authors: Yoon Joonho , Chung Chun Kee , Lee Sunho , Kim Chiheon 
Published: March 2020

e22510 Background: GCT is a benign and locally aggressive tumor that occur infrequently in the mobile spine. The radical excision is generally agreed for treatment of GCTs. Methods: We performed retrospective analysis of 20 GCTs in the mobile spine from 2005 to 2013. Verteberal involvement was classified with Weinstein-Boriani-Biagini grading system. Surgery types were classified into 3 groups; partial excision, gross total removal (GTR), and en-bloc resection. We analysis by GTR versus non-GTR group, and enbloc versus non-enbloc group in GTR group. The log rank test was used for comparison of factors, and a P value of less than 0.05 was deemed significant. Results: After first surgery of the 20 patients, 17 additional surgery performed for 10 (50%) patients. There were 7 (35%) local recurrences and 3 (15%) distant metastasis. The time to recurrence or progression of tumor ranged from 5 months to 39 months. Two (10%) patients had additional surgery for instrument failure. One (5%) patient died from the complication of the surgery. The follow up duration ranged from 24 months to 141 months. The local recurrence was associated with partial resection (P < 0.01) and history of recurrence (P = 0.39). There was no significant difference between non-en bloc GTR and en bloc GTR in local recurrence (p = 0.101). Conclusions: Gross total resection should be considered for GCTs of the mobile spine. The choice of en bloc resection must be balanced with risks of the procedure. En bloc resection or radical excision could be challenging in many cases. In that cases, the gross total removal by intralesional resection is considerable for local control.
Advanced epithelioid haemangioendotelioma: Fever, pain, and pleural effusion predict a worse outcome.
Authors: Vincenzi Bruno , Frezza Anna Maria , Brunello Antonella , D'Ambrosio Lorenzo , Baldi Giacomo G. , Badalamenti Giuseppe , Grignani Giovanni , Napolitano Andrea , Valeri Sergio , Improta Luca , Spalato Ceruso Mariella , Silletta Marianna , Dei Tos Angelo Paolo , Gronchi Alessandro , Stacchiotti Silvia 
Published: March 2020

e22540 Background: Epithelioid hemangioendothelioma (EHE) is an exceedingly rare soft tissue sarcoma subtype. EHE often presents as a multifocal/ multivisceral disease and its clinical behavior is highly unpredictable from indolent to very aggressive forms. A common choice in advanced patients is a close, active surveillance (AS), considering a treatment only in case of disease progression. Our retrospective study aimed to identify clinical features associated with a more aggressive behavior. Methods: Patients affected by advanced EHE treated in 6 centers of the Italian Rare Cancer Network were retrospectively reviewed. Diagnosis was confirmed by a sarcoma expert pathologist and molecular analysis was performed. Baseline clinical features were evaluated, including the presence of systemic symptoms (fever, weight loss, anorexia) and/or tumor related pain. Number of organs involved (1 vs > 1 and 1-2 vs > 2, mitotic index (< 2 vs ≥= 2 mitosis/10 high power fields - HPF). Results: 74 patients were identified (M:F = 42:32; mean age = 44 yrs - range = 16-81, median number of mitosis/10 HPF = 2 - range 0/8, systemic simptoms Y:N = 30:44; fever Y:N = 21:53; tumor related pain Y:N = 23:51; pleural effusion Y:N = 11:63). All patients had metastatic disease; 29 showed the involvement of one organ while 45 had multivisceral disease (18 of them > 2 viscera). At the time of diagnosis, all patients were naive from any systemic therapy and underwent exclusive AS. At a median FU of 32 months (range: 3-212), 48 (65%) patients progressed while 26 (35%) remained stable. No spontaneous regressions were observed. Median PFS was 30 months (range 2-115). Median OS was 54 months (range 3-151). Age, gender, mitotic index, number of involved organs, anorexia and weight loss did not correlate with median PFS (m-PFS). Fever correlated with shorter m-PFS (8 vs 45 months, P= 0.004), as well as pain (10 vs 42 months, P= 0.02) and the presence of pleural effusion (5 vs 46 months, P= 0.0001). In addition, fever and pleural effusion correlated with a shorter m-OS, respectively 29 vs 60 months (P = 0.03) and 11 vs 77 months (P < 0.001). The presence of pain corresponded to a not significant worse m-OS (39 vs 54 months, P= 0.16). Conclusions: Despite the small number of cases, this retrospective study suggests that in advanced EHE patients the presence of fever and/or tumor related pain and/or of pleural effusion can be associated with a more aggressive clinical behavior. Pleural effusion seems to be associated with the worse outcome, with a m-OS of 12 months. These data are worth confirming on a larger patient population.
Olaratumab plus anthracyline in advanced/metastatic soft tissue sarcoma: Data of real-world utilization in Austria.
Authors: Kocher Florian , Seeber Andreas , Weiss Lukas , Romeder Franz , Szkandera Joanna , Kuhr Thomas , Kostner Susanne , Pichler Petra , Jäger Thomas , Greil Richard , Brodowicz Thomas 
Published: March 2020

e22550 Background: Olaratumab is a humanized monoclonal anti platelet-derived growth factor receptor α antibody that has been approved in combination with doxorubicin for the treatment of patients with metastatic soft tissue sarcoma (STS). The purpose of this retrospective study was to assess the clinical efficacy in STS patients treated with olaratumab in a real-world setting in Austria. Methods: Retrospectively collected, longitudinal data from patients treated between November 2016 and September 2018 at 9 Austrian centers were obtained from respective medical charts. Eligible patients were all patients who received at least one dose of olaratumab. Parameters of most interest collected were response rates, progression-free survival (PFS) and overall survival (OS). Results: Altogether 55 patients were included into analysis. Median age was 58 years. In total, 65.5% (n = 36), 21.8% (n = 12) and 12.7% (n = 7) received olaratumab as first-, second- or ≥ third-line treatment, respectively. Olaratumab was administered either in combination with doxorubicin (81.8%, n = 45) or liposomal doxorubicin (16.4%, n = 9); 1 patient received olaratumab as upfront monotherapy. Median PFS and OS were 2.6 and 11.4 months. The objective response rate was 11.4 % and the disease control rate was 40.9 %. Conclusions: In this real-world analysis outcome was less pronounced compared to the results of the Phase Ib/II approval trial ( Tap WD et al. Lancet 2016). Thus, the results of the ongoing phase III trial (NCT02451943) are urgently needed to confirm the efficacy of the combination of olaratumab and doxorubicin in STS patients.
Treatment of soft tissue sarcoma with a novel cold plasma jet.
Authors: Cheng Xiaoqian , Blank Alan , Ly Lawan , Murthy Saravana R , Wakefield Connor , Colman Matthew W. , Batus Marta , Gitelis Steven , Keidar Michael , Canady Jerome 
Published: March 2020

e22562 Background: Soft tissue sarcoma is a malignant tumor that most often develops in adults, but can occur in children as well. Treatment with radiation, en bloc surgical resection and chemotherapy have achieved long-term survival rates up to 65% to 80% in non-metastatic disease. Local microscopic tumor cells can still exist despite complete R-0 surgical excision of the tumor. A novel technology Cold Atmospheric plasma (CAP) is an emerging technology that has shown promising anticancer effects i.e anti-mitotic and less effective on non-cancerous tissue. A new field has developed in medicine Plasma Onco-therapeutics. CAP treatment has the potential to improve the outcome of osteosarcoma patients. Methods: CAP was generated using a US Medical Innovations LLC (USMI) SS-601 MCa high-frequency electrosurgical generator (USMI, Takoma Park, MD, USA) integrated with Canady Cold Plasma Conversion Unit and connected to a Canady Helios Cold Plasma Scalpel. Three types of human sarcoma cells, synovial sarcoma (SW982), connective tissue fibro sarcoma (HT-1080), and rhabdomyosarcoma (RD) were used in this study to test the effect of the CAP generated by the Canady Cold Plasma Conversion System. Cells were treated with various CAP settings including different helium flow rates (1 and 3 LPM) and power settings (20-120p) in order to establish an optimal treatment condition for each cell line. Viability was performed on the cells using MTT assay 48 hours after CAP treatment. Student t test was performed on the data (*p < 0.05). Results: The reduction of the viability of all three sarcomas were dose-dependent and significantly reduced at various time and power combinations tested (Figure 1-3). Helium flow alone did not significantly impact cell viability. The decrease in viability of the sarcoma cells when using 1 LPM required a higher dose. About 20 to 40% of viability reduction was seen on the three cell lines. With 3LPM, viability was reduced to 20% using 80p 2 min for SW982 and HT-1080, and 100p 2min for RD. Conclusions: Our data demonstrates that CAP reduced sarcoma cell viability in a time- and power-dependent manner. With optimal dosage for each cancer type, this study provides a promising treatment for future therapeutic interventions for soft tissue sarcomas.
Oncology provider perceptions of shared-decision making.
Authors: Sathe Nila , Polacek Cate , Fenk Sunnie , Rossi Wendy , Christopher Roni 
Published: March 2020

e23168 Background: Adoption of shared decision making (SDM), a key strategy for improving patients’ care experience, may be limited. We explored oncology professionals’ SDM perceptions to understand patient-provider decision-making communication. Methods: Semi-structured phone interviews or web-based surveys with purposively recruited participants from a range of perspectives to increase generalizability. Content analysis to identify overarching themes. Results: Respondents (n = 20) valued SDM but described challenges including: Evolving and variable communication needs. Evolving care trajectories constrain full SDM discussions. Differences in goals in curative or palliative situations dictate different approaches. Communication along care continuum. Providers noted that discussions of elements of care occur with multiple providers and staff, potentially in a piecemeal fashion. Communicating about costs. Costs vary considerably in terms of cost to the patient and to the system. Impact on care is more than a simple higher/lower dichotomy. Directing decisions vs. fostering discussion: Most respondents understood a “literature-based” SDM definition, but some conflated patient education and SDM. Some implied “nudging” patients toward choices vs. open discussion. Balancing clinical imperatives and patient preferences. Respondents noted balancing professional imperatives to share information with patient values. External influences on communication. Families were seen as a help and hindrance to SDM, particularly when care goals differ. Cultural meanings ascribed to cancer also vary. Decision making style. Participants suggested that patients approach decision making from overarching mindsets regarding engagement (e.g., prioritizing provider input). Conclusions: Respondents valued communication and SDM but described challenges in exigencies of care delivery, provider attitudes, and patient influences. Respondents’ discussion of challenges suggests that exploiting communication opportunities across the care trajectory and deliberate consideration of patients’ preferences for decision-making conversations could help to inform/prime communication and potentially improve SDM processes.
Unpacking clinical trial offers: A qualitative analysis of interactions with physicians and patients potentially eligible for a prostate cancer trial.
Authors: Hamel Lauren M. , Dougherty David W. , Manning Mark A. , Penner Louis , Albrecht Terrance Lynn , Heath Elisabeth I. , Carducci Michael Anthony , Lansey Dina , Kim Seongho , Eggly Susan 
Published: March 2020

e23169 Background: Clinical trial accrual among cancer patients is low (2-5%). More data are needed to identify barriers to enrollment and inform interventions. One way to identify the greatest barriers is by examining clinical interactions. We investigated whether and under what circumstances patients potentially eligible for a trial at a major cancer center were offered the chance to enroll. Methods: We conducted a qualitative content analysis of 50 recorded interactions with physicians (n = 8) and patients (n = 36) with intermediate- or high-risk prostate cancer who were initially eligible for a trial at two NCI-designated comprehensive cancer centers. We observed and coded the interactions in three steps: 1) classification of all interactions as explicit offer, offer pending, trial discussed but not offered, or trial not discussed; 2) in interactions with no explicit offer, classification of patients who were informed their disease was stable or had progressed; 3) in interactions classified as cancer progressed but no trial offered, identification of factors discussed that may explain the lack of an offer. Results: Of the 50 interactions, 30% were classified as explicit offer; 6% as offer pending; 18% as trial discussed but not offered; and 40% as trial not discussed. Of the 35 interactions with no offer, 54% were with patients whose cancer had not progressed. In the 16 remaining interactions with patients with no offer and whose cancer had progressed, reasons for the lack of offer included: testing needed, no trial/study slot, and comorbidities; but in 25% of these, no reason was provided. Conclusions: Even in this highly selected population, few patients were offered a trial, often because they were ultimately ineligible. Findings support professional recommendations to broaden inclusion criteria to increase the pool of eligible patients. Findings also suggest trial accrual rates could be more accurately calculated by considering patients who are eligible to enroll, rather than all patients with cancer. In 40% of interactions, there was no mention of a trial, suggesting interventions should also be aimed at patient and physician attitudes and clinical communication. Clinical trial information: NCT 02906241.
Delay in time from diagnosis to treatment in metastatic melanoma, lung, and colon cancer.
Authors: Faisal Muhammad Salman , Khattab Ahmed , Jahangiri Vida , Shaikh Hira , Shaikh Soorih , Chaturvedi Abhishek , Raj Moses S. , Finley Gene Grant 
Published: March 2020

e23186 Background: Delay in cancer treatment is anxiety provoking both for the patient and clinician. We conducted the study to evaluate the patterns of delay in treatment of patients with metastatic colon cancer, lung cancer and melanoma from diagnosis to the initiation of the treatment, and to identify the causes of delay. Methods: In this retrospective study, patients with metastatic colon cancer, lung cancer and melanoma diagnosed between 01/01/2016 to 12/31/2016 in a tertiary care network in the United States were studied. Data was collected from electronic health record (EHR) database, ‘Epic’. Variables such as demographic data, including patient age and gender, and type of cancer, and treatment received were analyzed. The causes of the delay were also evaluated when available. Results: Total number of patients in the study was 288. Mean age was 68.3 years (median 69 years) and 36% were alive at the time of data analysis. Male to female ratio was 1.4:1. 66.7% people had lung cancer, 30% had colon cancer and 3% had melanoma. 67 (23.6%) of total analyzed patients had denied definitive treatment and chose to undergo palliative management. Of the rest, most started treatment with chemotherapy (39.5%), followed by surgery (22.6%) and then radiation (14.6%). With the time of pathological diagnosis of the tumor taken as the date of diagnosis, mean delay from the day of diagnosis to the start of treatment in this study population observed was 27.7 days. 67 patients (23.3%) had a delay of more than 30 days, with the most common reason being systemic factors in 39 patients (58.2%), followed by patient factors in 23 patients (34.3%) and physician factors in 5 patients (7.5%). On logistic regression analysis, time from diagnosis to treatment didn’t predict mortality (OR = 0.99, 95% CI P = 0.10(0.97-1.002). Conclusions: Delay in treatment is common and the system factors one of the common reasons as exhibited by our study. Time from diagnosis to treatment didn’t predict mortality.
Simulated patient encounter to assess and improve fellows' ability to manage chemotherapy infusion reactions.
Authors: Zimmerman Danielle Elise 
Published: March 2020

TPS10541 Background: Medical educators have adopted simulation-based exercises (SBEs) because studies of their use in the aviation industry and other technical fields have shown that they reduce human error. While use of simulation has increased in undergraduate and graduate medical education, it hasn’t been used as frequently in educating subspecialty fellows. Fewer than 5% of participants in a survey of different subspecialists indicated that simulations were part of their fellowship curriculum (1) even though simulation-based training is an ACGME program requirement (2). Chemotherapy infusion reactions (CIRs) occur with about 5% of all cytotoxic chemotherapies and even more frequently with biologics (3). These CIRs present significant morbidity and cost. HFS improves knowledge and confidence in medical trainees (4). Therefore, I designed a high fidelity simulation (HFS)-based curriculum to measure fellows’ current medical knowledge and provide a mechanism for gaining increased understanding and confidence. Across subspecialty graduation medical education, only one SBE with IRs has been performed, and that project aimed only to measure existing knowledge (5). This project aims to measure oncology fellows’ knowledge of and confidence in CIR management, measure attitudes regarding SBEs, measure improvement in knowledge following the SBEs, and assess for changes in behavior (management of CIRS) that may occur following these interventions. Methods: The HFS takes place in the VA Hospital Interdisciplinary Simulation and Education Center, which consists of a programmable mannequin that can “talk” through a speaker and convey physical exam signs in an “outpatient clinic.” Participants will interact with the mannequin, who will be a patient experiencing a paclitaxel infusion reaction. An evaluator will be grading the participant’s actions with an OSCE style checklist. Immediate debriefing will be followed by a didactic. Participants will complete post-intervention surveys regarding their confidence in and knowledge of management of CIRS. Participants will later be evaluated on their attitudes regarding the simulation, their knowledge of CIR management, and will also provide critique of the same interaction done by another provider. These HFS-based activities will allow evaluation of fellows’ current knowledge of and comfort with CIRS, fellows’ attitudes regarding the intervention, improvement in knowledge occurred following the intervention, and anticipated change in management.