bluuebunny/crossref_metadata_2025_split huggingface dataset:
The accuracy of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of newly diagnosed nasopharyngeal carcinoma: A systematic review and meta-analysis.
Authors: Vellayappan Balamurugan A. , Soon Yu Yang , Earnest Arul , Zhang Qing , Koh Wee Yao , Tham Ivan Weng Keong , Lee Khai Mun 
Published: March 2020

5553 Background: The specific role of FDG-PET/CT in pretreatment staging of nasopharyngeal carcinoma (NPC) remains to be validated. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of staging FDG-PET/CT for newly diagnosed NPC with reference to conventional staging modalities and/or clinical follow up. Methods: We searched MEDLINE, Cochrane central register of controlled trials, proceedings of ASTRO and ASCO as well as Chinese databases (Chinese National Knowledge Infrastructure and CBMdisc) from the date of inception to September 2011 for relevant studies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist. We determined the sensitivities and specificities across studies, pooled diagnostic odds ratios (DOR) and constructed summary receiver operating characteristic curves using hierarchical regression model. Results: We found 15 relevant studies (of which seven were in English) including 851 patients. Of the 15 studies: five addressed primary tumor (T), nine addressed regional lymph nodes (N) and seven addressed distant metastasis (M). The combined sensitivity estimate for FDG-PET/CT in T classification was 0.77(95% confidence interval (CI) 0.59-0.95). The combined sensitivity estimate for N classification was 0.88 (95% CI 0.86-0.90), specificity 0.85(95% CI 0.83-0.88), DOR 82.4 (23.2 to 292.6) and Q-index was 0.90. For M classification, the combined sensitivity estimate was 0.82(95% CI 0.65-0.93), specificity 0.98 (95% CI 0.96 – 0.99), DOR 120.9 (43.0 to 340.0) and Q-index was 0.89. Conclusions: FDG-PET/CT showed good accuracy in N and M but not T classification for newly diagnosed pre-treated NPC. FDG-PET/CT, together with Magnetic resonance imaging (MRI) of the nasopharynx, should be part of the routine staging investigations for NPC. Future research should evaluate the accuracy of FDG-PET/MRI fusion as a single staging modality for NPC.
Organ preservation with daily concurrent chemoradiotherapy using a new superselective intra-arterial infusion for stage III, IV tongue cancer.
Authors: Tohnai Iwai , Mitsudo Kenji , Kioi Mitomu , Koizumi Toshiyuki , Oguri Senri , Iwai Toshinori , Hirota Makoto , Fuwa Nobukazu 
Published: March 2020

5556 Background: Combined radiotherapy and intra-arterial chemotherapy, which delivers a very high concentration of anticancer agent to the tumor, is currently used to treat advanced head and neck cancer. However, chemotherapy and radiotherapy cannot be performed simultaneously on a daily basis under conventional methods because long-term catheterization is not possible. Therefore, we developed a new method using superselective intra-arterial infusions via the superficial temporal artery and the occipital artery, and used it to perform daily concurrent chemoradiotherapy for the treatment of advanced tongue cancer. Methods: Seventy-two patients with advanced tongue cancer underwent chemoradiotherapy using this superselctive intra-arterial infusion method. Catheters were inserted superselectively to the feeding arteries of the tumor via the superficial temporal artery and the occipital artery. Long-term catheterization is possible in this method. Daily concurrent combined therapy with radiotherapy (total dose: 60 Gy), superselective intra-arterial chemotherapy using DOC (total dose: 60 mg/m2) and CDDP (total dose: 150 mg/m2) was performed. The anticancer agent was injected in a bolus through the intra-arterial catheter simultaneously with radiotherapy. Results: No major complications were observed. Clinical efficacy was CR in 64 (88.9 %) patients and PR in 8 (11.1 %). With a median follow-up period of 31 months (range 6 to 72 months), the overall survive rate was 74.8 % and the local control rate was 93.7%. Conclusions: This superselective intra-arterial infusion allows for long-term catheterization, unlike the conventional method, so that chemotherapy can be performed simultaneously with radiotherapy on a daily basis. This treatment method promises to be the strategy of choice for the treatment of advanced tongue cancer.
Gemcitabine versus cisplatin concurrent with radiation therapy in locally advanced head and neck squamous cell carcinoma.
Authors: Mostafa Magda , Atif Hesham , Fawzy Mahmoud , Sakr Amr Yehia , Alashwah Ahmed 
Published: March 2020

5557 Background: In locally advanced head and neck squamous cell carcinoma (HNSCC) weekly cisplatin concurrent with radiation therapy is the standared treatment. However some patients cannot tolerate cisplatin. So we conduct a prospective randomized trial comparing cisplatin versus gemcitabine. Methods: This trial was done in Kasr El-Ainy Center of Clinical Oncology and Radiation therapy (NEMROCK), during the period from March 2010 till June 2011. Sixty patients with locally advanced HNSCC were randomized to receive Cisplatin (30 mg/m2) weekly for 6 consecutive weeks (30 patients) or Gemcitabine (50 mg/m2) weekly for 6 consecutive weeks (30 patients) both concomitant with radiation therapy reaching a dose of 70 Gy over 7 weeks. Primary end points include response rate, progression free survival and toxicity. Toxicities were graded according to NCI-CTCAE v3.0. Results: Thewhole study group included 48 (80%) males and 12 (20%) females. Mean age was 47.9 (± 6.5) years (range 26-61). Both arms were comparable regarding their age, gender, performance status and stage. There were 9 (30%) CR, 7 (23.3%) PR, 2 (6.7%) SD and 12 (40%) PD in cisplatin arm versus 12 (40%) CR, 4 (13.3%) PR, 1 (3.3%) SD and 11 (36.7%) PD in gemcitabine arm. Median progression free survival (PFS) in cisplatin arm was 9 months versus 11months in gemcitabine arm with a hazard ratio of 0.08 (95% CI 0.005 – 1.47). We did not reach median overall survival. Radiotherapy induced skin toxicity (slight or patchy atrophy), nausea, vomiting, mucositis, salivary gland affection and weight loss were equally distributed in both arms. Dysphagia and fatigue were markedly higher in gemcitabine arm. While infection and neutropenia were slightly higher in cisplatin arm. Conclusions: Weekly gemcitabine 50mg/m2 concomitant with radiotherapy was found to be of equal efficacy and toxicity comparable with weekly cisplatin in the treatment of locally advanced HNSCC.
Nomogram for prediction of prognosis in patients treated for oral cavity squamous cell carcinoma.
Authors: Montero Pablo H. , Yu Changhong , Patel Purvi D. , Palmer Frank L. , Ganly Ian , Shah Jatin P. , Kattan Michael W. , Patel Snehal G. 
Published: March 2020

5562 Background: TNM staging is an effective tool for prognostic prediction in patients with oral cavity cancer, but it disregards variables such as the anatomic subsite, medical comorbidity, lifestyle, etc. A nomogram has the ability to take into account many factors predictive of outcome for an individual patient, beyond the traditional TNM. We have developed a nomogram to accurately predict overall mortality (OM) and disease specific mortality (DSM) in individual patients treated for oral cancer. Methods: Demographic, host, and tumor characteristics of 1,617 oral cancer patients treated with surgery and adjuvant treatment between 1985 and 2009 were available from a preexisting database. Recurrent disease was recorded in 509 patients, 328 died of cancer-related causes and 542 died of other causes. The median follow-up was 42 months (range 1-300 months). Cox proportional hazards regression model was used for OM and competing risk regression was used for DSM. Death from other causes was treated as competing risk for DSM. Missing values in the predictors were multiply imputed before analysis. Variables analyzed as prognosis predictors included age, gender, race, alcohol/tobacco use, anatomic subsite, comorbidity, tumor size/thickness, bone/deep muscle invasion, nodal status/level, grade, vascular/perineural invasion, margin status and adjuvant therapy. Step-down method was used to select the statistically most powerful predictors for inclusion in the final nomogram for each outcome. Results: Age, severe comorbidity, subsite, tumor size, bone/deep muscle invasion, margin status, vascular and perineural invasion, nodal status and level, and adjuvant therapy were the variables with highest predictive value for OM. The most influential predictors of DSM were gender, tumor size, nodal status and location, subsite, margin status, grade and vascular invasion. Nomograms were generated for prediction of OM and DSM. The nomograms were internally validated with correction for over-fitting; bias-corrected concordance index for OM was 75% and DSM 76%. Conclusions: We have developed nomograms that can accurately estimate OM and DSM based on tumor and host characteristics of an individual patient treated for oral cancer.
The impact of advanced age on outcomes in squamous cell carcinoma of the head and neck.
Authors: Moye Virginia Ann , Chandramouleeswaran Sindhu , Zhao Ni , Muss Hyman , Weissler Mark C , Brossoie Susan M , Hayward Michele C , Hayes David N. 
Published: March 2020

5577 Background: Limited data are available regarding outcomes in elderly head and neck cancer patients. This retrospective study was designed to characterize head and neck cancer in geriatric patients in the UNC Tumor Registry. Methods: Of 1,598 patients identified from the registry, 1,291 patients were <70 years old (young group, YG) and 307 patients were > 70 (elderly group, EG) at diagnosis. Both overall survival (OS), calculated from diagnosis to death or the last follow up, and relapse free survival (RFS) were censored at 60 months. Log-rank test was used to compare survival difference. Cox proportional hazard model was used to estimate hazard ratio, adjusting for potential confounding factors. All tests were performed in R 2.13.1. Results: EG patients were more likely to present at an early stage with 25% presenting at stage I and 37% presenting at stage IV compared to 17% and 51% respectively in YG. EG had a median OS of 35 months (95% CI: 28-41 months) compared to approximately 60 months in YG (p < 0.0001 log rank test). The median RFS for EG and YG are 25 (95% CI: 20-32 months) and 44 (95% CI: 38-52 months) months respectively (p < 0.0001 log rank test). When controlling for possible confounders, EG patients were nearly twice as likely to die (HR 1.94, 95% CI 1.635-2.302, p<0.0001) and 70% more likely to relapse in 5 years compared to YG (HR 1.704, 95% CI 1.449-2.004, p<0.05). The median life expectancy for elderly patients in our study was nearly 5 years for stage I/II and <2 years for stage III/IV. Conclusions: Poor OS and RFS in elderly patients compared to younger patients in this study indicate a need for further investigation considering comorbidities and aggressiveness of treatment. Significant differences in life expectancy in elderly patients with early versus late disease may help guide patients and clinicians in determining how aggressively to treat.
Sentinel lymph node biopsy for clinically N0 oral squamous cell carcinoma.
Authors: Goda Hiroyuki , Nakashiro Koh-ichi , Oka Ryota , Shintani Satoru , Hamakawa Hiroyuki 
Published: March 2020

5584 Background: Regionallymph node metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Sentinel lymph node biopsy (SLNB) is a widely accepted procedure in various human malignancies. In clinically N0 (cN0) OSCC cases, SLNB has received considerable attention for its role in deciding whether to perform neck dissection. In this study, we assessed the efficiency of SLNB for cN0 OSCC case in a single-institution experience. Methods: 100 patients with cN0 OSCC underwent SLNB between 2001 and 2011, of which 95 were clinically T1 and T2. The primary site was tongue, gingiva, oral floor, buccal mucosa, and lip in 50%, 36%, 8%, 5%, and 1%, respectively. The location of sentinel lymph node (SLN) was determined by radioisotope (RI) method with preoperative lymphoscintigraphy and intraoperative use of a handheld gamma probe and/or dye method, and evaluated by histopathological examination and genetic analysis. Results: SLNB was performed with RI and dye method (79%), only dye method (14%), or only RI method (7%). SLN was successfully identified with RI method (100%) and dye method (71%). The average number of SLN was 2.5 with dye method and 1.9 with RI method. The rate of SLN identified side was 84% in ipsilateral, 10% in bilateral, and 6% in contralateral. Fifteen of 100 patients (15%) had metastasis-positive SLN, and 3 patients was up-grade to stage III and others to stage IVA. Eight patients with negative SLN developed latent neck lymph node metastasis. The sensitivity, specificity, accuracy, and negative predictive value was 65% (15/23), 100% (77/77), 92% (92/100) and 91% (77/85). Disease specific survival rate for SLNB-negative patients were 98% (79/81), and for SLNB-positive patients were 73% (11/15), respectively. Conclusions: SLNB is a minimally invasive and highly reliable means of staging the cN0 neck for patients with OSCC. Patients with negative SLNB showed more excellent neck control rate and SLNB provides more accurate staging than elective neck dissection or wait and see.
TPF induction chemotherapy and pathologic response for patients with locally advanced and resectable oral squamous cell carcinoma.
Authors: Zhong Lai-ping , Zhang Chen-ping , Zhang Zhi-yuan , Ren Guo-xin , Guo Wei , Tu Wen-yong , Sun Jian , Zhu Han-guang 
Published: March 2020

5593 Background: The role of induction chemotherapy in locally advanced and resectable oral squamous cell carcinoma has not been well issued. Methods: A prospective, open label, parallel, and interventional randomized control trail has been performed to evaluate the induction chemotherapy of TPF protocol in resectable oral squamous cell carcinoma (OSCC) patients at clinical stage III and IVA. The patients received two cycles of TPF induction chemotherapy (75 mg/m2 docetaxel d1, 75mg/m2 cisplatin d1, and 750mg/m2 5-fluorouracil d1-5) followed by radical surgery and post-operative radiotherapy with a dose from 54 to 66 Gy (the experimental group) or surgery and post-operative radiotherapy (the control group). Post-surgical pathologic examination was performed to determine a positive response or negative response. A positive response was defined as absence of any tumor cells (pathologic complete response) or presence of scattered foci of a few tumor cells (minimal residual disease with <10% viable tumor cells). The primary endpoint is the survival rate; the secondary endpoint is the local control and safety. This study has been approved by institutional ethics committee at Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University. Survival analysis was conducted with the Kaplan-Meier method. Results: 256 patients were enrolled in this trail and 224 patients (111 in experiment group and 113 in control group) finished the whole treatment protocol. After a median follow-up of 21 months (ranging 6-43 m). The pathologic positive response rate was 29.7% (33/111), and negative response rate was 70.3% (78/111). The patients with positive response had a better disease free survival (38.5±2.1m, 95%CI 34.4-42.6m, P=0.003) compared with those with negative response (24.6±2.1m, 95%CI 20.6-28.7m) and control group (31.0±1.6m, 95%CI 27.9-34.1m). The toxicity of induction chemotherapy could be tolerated. Conclusions: Pathologic positive response to TPF induction chemotherapy could benefit the patients with locally advanced and resectable OSCC. However, further long-term follow-up is needed to confirm the benefit on survival and local control.
Progressive increasing in the risk of second and subsequent malignant tumors in patients with a head and neck cancer: A validation study with SEER data.
Authors: Leon Xavier , Lopez-Pousa Antonio , Villatoro J Carlos , Quer Miquel , Sullivan Ivana , Murata Paola , Stradella Agostina , De Vega Josep M. , Farre Nuria , Gallego Rubio Oscar , Quintana Maria Jesus , Barnadas Agust , Alonso Martinez Milagros ,   Hospital Sant Pau
Published: March 2020

5595 Background: Patients with a head and neck squamous cell carcinoma (HNSCC) index tumor have a increased risk (2-4% per year) for appearance of a second malignant neoplasms (SMN) and higher risk for successive malignant tumors during the follow-up. The objective of our study was to validate this concept with data of patients included in the Surveillance Epidemiology and End Results (SEER) program (1973-2008). Methods: We performed a population-based cohort study of 149.328 patients with a primary oral cavity, oropharynx, hypopharynx and larynx squamous cell carcinoma index tumor, included in the SEER program, to analize the actuarial survival-free of second and successive tumors. A total of 11.948 (8%) patients had one or more malignant tumors before the diagnosis of HNSCC. Results: During the follow-up period, a total of 31.507 new SMN appeared. There was a progressive and significant increase in the risk of SMN. The annual hazard ratio for 2nd to 7th successive SMN was 2.3%, 2.7%, 3.9%, 5.4%, 8.9% and 19.1% annual risk respectively. Additionally 11 patients had 8th SMN. We observed a progressive increase in the risk of appearence of new malignant tumors located in and outside the aerodigestive tract. The increase in the risk of SMN was higher for tumors located in the aerodigestive tract than tumors located outside aerodigestive tract. It was a tendency towards the increase in the proportion of HNSCC with the appearance of new tumors, with a decrease in the proportion of the malignant tumors located in the lung and in locations outside the aerodigestive tract. There were significant differences inthe risk of SMN between second and third, third and fourth, fourth and fifth, and sist and seventh tumors (p<0.0001). Conclusions: In patients with HNSCC there is a progressive increase in the risk of appearance of successive tumors. Previous tobacco and alcohol consumption, persistence in the exposure to carcinogens and individual susceptibility (genetic) could play a role in the increased risk of SMN. We have validated this concept with data from the SEER program.
Clinical outcomes and prognostic factors of 582 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy.
Authors: Lang Jin Yi , Wang Weidong , Xu Peng 
Published: March 2020

5597 Background: To evaluate the 5-yrs clinical outcomes and prognostic factors of 582 nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT). Methods: 582 NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from Jan.2001 to Dec.2004 were analyzed retrospectively, including 460 males and 122 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67-76Gy in 30-33 fractions, positive neck lymph nodes (GTVln-R/L) 60-70Gy in 30-33 fractions, The lower neck and the supraclavicular fossae were irradiated with the conventional 2D technique using an anterior field. The Kaplan-Meier method was used to calculate the local-regional control rate (LRC) and overall survival rate (OS). Acute and late toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria, meanwhile analyze the prognostic factors. Results: The median follow-up interval was 66.4 months. The 5-year local control, regional control, distant metastasis-free survival, disease free survival, disease specific survival and overall survival rate was 89.8%, 95.2%, 74.1%, 69.6%, 83.2% and 77.1%. 133 patients died during the follow-up. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 75.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2% respectively.Univariate analysis revealed that gender, T/N stage, clinical stage, radiotherapy interruption, anemia and weight loss was the significant prognostic factor for the OS. Multivariate analysis showed that N stage, radiotherapy interruption, chemotherapy, the volume of GTVnx, age, anemia and weight loss was the independent prognostic factors for the OS. Conclusions: The 5-year local control and overall survival rate of NPC treating with IMRT was 89.8% and 77.1%. The clinical stage, N stage , volume of GTVnx and chemotherapy was the main prognostic factor for the OS. The acute and late toxicities were mainly grade I and II. Distant metastasis was the main pattern of failure.
Prognostic significance of PI3K pathway (PI3Kp) dysregulation in metastatic breast cancer (MBC) patients (pts).
Authors: Navarro Alejandro , Oliveira Mafalda , De Mattos-Arruda Leticia , Sánchez-Ollé Gessamí , Bellet Meritxell , Balmaña Judith , Gómez-Pardo Patricia , Perez-Garcia Jose Manuel , Muñoz-Couselo Eva , Vidal Maria , Ortega Vanesa , Dienstmann Rodrigo , Aura Claudia , Hernandez-Losa Javier , Rodon Jordi , Ramon y Cajal Santiago , Baselga José , Tabernero Josep , Cortes Javier , Saura Cristina 
Published: March 2020

566 Background: PI3Kp dysregulation represents a potential target for therapies that are currently being tested in clinical trials. This observational retrospective study aims to evaluate the prognostic implications of PI3Kp dysregulation in MBC. Methods: MBC pts with PI3Kp status assessment from Sep09 to Sep11 were reviewed. PIK3CA mutation status analyzed in paraffin-embedded tissue by DxS PI3K Mutation Test Kit or Sequenom MassARRAY. PTEN status determined by IHC. PI3Kp status: (a) No dysregulation: PIK3CA wt and PTEN normal; (b) PI3Kp dysregulation: PIK3CA mutation (PIK3CAmut) or PTEN low (HScore≤50). Results: 232 MBC pts screened, median age 49.8 (22.9-83.1) and median MBC lines 4 (1-15). Distribution: HR+/HER2- 99 (43%), HER2+ 52 (22%), triple negative 35 (15%), unclassified 46 (20%). Sites of metastasis: visceral 173 (75%), only skin 10 (4%), only bone 49 (21%). PIK3CA status assessed in 174 pts, 53 (22.8%) bearing a mutation (21 exon9, 32 exon20). PTEN status assessed in 229 pts, PTEN low 61 (26.6%). PI3Kp dysregulation in 103/185 pts (55.6%). Time to progression to first line MBC treatment (TTP) and overall survival after MBC diagnosis (OS) are shown. Disease free survival (DFS) and distant-disease free survival (DDFS) in pts initially diagnosed with early breast cancer (n=193) has also been calculated. Conclusions: These results suggest that PI3Kp dysregulation, either by PIK3CA mutation or PTEN low, does not seem to have impact on disease recurrence, response to first line MBC treatment or overall MBC survival.[Table: see text]