bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.