bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.