bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic factors of concurrent chemo-radiotherapy in head and neck cancers
Authors: Thankappan K. , Rugmini S. V. , Cohen R. F. , Sunil B. , Samuel J. , Padmanabhan T. K. , Pavithran K. , Sundaram K. R. , Iyer S. , Kuriakose M. A. 
Published: March 2020

16527 Background: Concurrent chemo-radiotherapy either as primary or adjuvant treatment is now the standard of care in high- risk head and neck squamous cell carcinomas. This has improved survival rates and chances of organ preservation. Advanced stage, extra- capsular extension, perineural and lympho-vascular invasion and positive surgical margins were considered as poor prognostic factors with radiotherapy alone. Herein we report the significance of these clinical and pathological factors, with concurrent chemo-radiotherapy regimens. Methods:A retrospective analysis of 54 patients with squamous cell carcinoma of head and neck who underwent either primary (21,39 %) or adjuvant (33,61%) concurrent chemoradiation at Amrita Institute of Medical Sciences, Kochi, India, during January 2004 to May 2005 and followed up to Dec 2006. 6 (11%) patients had stage III and 48 (89 %) had stage IV disease. Prognostic significance of clinical and pathological factors was evaluated. Kaplan-Meir curves for survival analysis, log rank test for univariate and Cox proportional method for multivariate analysis were employed. Results: The median follow up was 22 months. Two-year overall (OS) and disease free survival (DFS) rates were 66 % and 52 % respectively. Univariate and multivariate analysis of T stage, nodal stage, radiotherapy interruptions, completion of chemotherapy, schedule of chemotherapy (week 1,4,7 vs weekly), perineural invasion, extra-capsular extension and positive margins showed no significant difference in OS and DFS. However both univariate (p = 0.019 for OS and p = 0.012 for DFS) and multivariate analysis (p = 0.029, HR 0.16,95 %CI - 0.03 to 0.8 for OS and p = 0.017,HR 0.188,95% CI - 0.04 to 0.74 for DFS) revealed lympho-vascular invasion as a significant prognostic factor. Conclusions: Advanced stage, extra capsular invasion and positive margins were conventionally thought to be poor prognostic markers in head and neck cancer. However in our series of patients treated with concurrent chemo radiation lymphovascular invasion was the only significant poor prognostic factor. Other factors were found to be not significant. No significant financial relationships to disclose.
Combined intra-arterial cisplatin, intravenous chemotherapy, and chemoradiotherapy is an effective program for treating advanced SCC of the head and neck: An analysis of 23 patients with a median follow-up of 6.1 years
Authors: O'Connor T. P. , Batra R. R. , Mobarek D. A. , Kirkel D. M. , Schwarsin A. , Sharma A. , Bank W. O. , Wilson W. R. , Tabbara I. A. , Siegel R. S. 
Published: March 2020

16535 Background: Aggressive chemotherapy combined with radiation increases organ preservation and provides locoregional control in advanced head and neck (H&N) cancer. Intra-arterial (IA) cisplatin can provide higher dose intensity but does not control distant disease. We evaluated a program that consisted of intra-arterial and intravenous chemotherapy combined with chemoradiotherapy. Methods: The course of 23 patients treated with four weekly IA doses of cisplatin (150 mg/m2) with IV sodium thiosulfate rescue, then two cycles IV paclitaxel (175 mg/m2, day 1), ifosfamide (1,000 mg/m2 and mesna 600 mg/m2, days 1–3), and cisplatin (60 mg/m2, day 1) (TIP), and followed by radiation to 70 Gy combined with weekly paclitaxel (30 mg/m2) and amifostine (740 mg/m2 TIW) was analyzed. One patient received one cycle of cisplatin/5-FU and one cycle of TIP instead of 2 cycles of TIP. Endpoints were recurrence free survival (RFS) and overall survival (OS). Results: Of twenty-three patients, 20 were men. The median age was 57 years (range 45–70) and median follow-up was 6.1 years (range 4.1–7.9). Eighteen had long smoking histories. Seventeen completed treatment (74%). Of the 6 who did not complete the program, two had resistant tumors, one had an adverse reaction to IA therapy, and three were noncompliant. Of 23 patients, 14 are alive, 13 without evidence of disease recurrence; one patient recurred and was salvaged by surgery. Five patients recurred and died of metastatic H&N cancer. One patient recurred, was salvaged with surgery and later died of lung cancer without evidence of H&N cancer. The RFS is 56.5% and the OS is 60.8%. Adverse events were infrequent and included 1 patient who had facial swelling during IA therapy and 2 patients who developed osteonecrosis of the mandible, one while continuing to smoke 6 months after therapy and the other 3 years after therapy following tooth extraction. Conclusions: A program consisting four doses of intra-arterial cisplatin followed by two cycles of IV TIP and chemoradiotherapy is effective in treating locally advanced SCC of the H&N and was generally well tolerated. No significant financial relationships to disclose.
Phase I/II study of concurrent erlotinib and chemoradiation for post-resected locally advanced squamous head and neck cancer (HNSCC): A GICOR study
Authors: Arias de la Vega F. , Herruzo I. , de las Heras M. , de la Torre A. , del Rio L. , Contreras J. , Prieto I. , Garcia J. A. , Amador M. L. , Calvo F. A. 
Published: March 2020

16544 Background: Concurrent chemoradiation is considered the optimal treatment for advanced HNSCC, including post-resected status. Erlotinib is an oral EGFR TKI, with activity in recurrent and metastatic HNSCC.The Spanish Group of Clinical Research in Radiation Oncology (GICOR) leads a phase I/II study to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of adding erlotinib (e) to chemoradiation to patients (p) with surgically resected locally advanced HNSCC Methods: p had surgically resected advanced HNSCC, with a least one of the following criteria: T3 or T4 primary lesion (except T3N0 with negative resection margins), pathologic N2-N3 disease, and poor prognostic findings (i.e. extranodal spread, positive resection margins, perineural or perivascular involvement). Additional eligibility criteria included: age 18–70 y; life expectancy = 12 w; PS 0–1; no evidence of metastasis; adequate organic function; and written informed consent. Dose-escalating phase I study consisted on 3 cohorts of 3–6 p each, with increasing doses of erlotinib (100–150 mg po qd) and cisplatin (30–40 mg/m2, iv, d 1) for 7 w. Radiotherapy was delivered as a fixed standard regimen of daily 1.8 Gy (5 fractions/w) to a total dose of 63 Gy in high risk areas along 7 w. Results: By the time of this analysis, 7 p have entered the phase I component of the study. Median age: 52 y; male 100%. Complete data for 4 pats included in cohort 1 (e 100 mg/d, c 30 mg/m2) are available. One p withdrew prematurely the study due to a grade 2 toxicity (not considered DLT) and was considered unevaluable by the Scientific Committee. Among evaluable p, 2 developed mucositis (1g.3), vomiting (g.1) and nausea (g.1). All p developed skin rash (mild in all the cases). Haematological toxicities were single cases of anaemia, leukopenia and thrombocytopenia (g.1). All 3 p completed 7 weeks of treatment and no dose reduction was required. No DLT as per protocol has been described and study went subsequently further to cohort 2. Conclusions: This study demonstrates the safe addition of erlotinib to chemoradiotherapy in the treatment of this p population. Full data from the phase I study will be presented. No significant financial relationships to disclose.
Chemotherapy for advanced and recurring basal cell carcinoma (BCC) with docetaxel and cisplatin
Authors: Buarque E. J. 
Published: March 2020

16546 Background: Up to 85% of all BCC are localized in head and neck region and can usually be cured by surgery. The recurrent BCC (rBCC) may grow under normal skin and have a more agressive behaviour. Sometimes, when it is discovered could be unresectable or lead to a great deformity if removed. Methods: Between December 2000 and December 2003 we have treated 3 patients (pts), 2 male/1 female with invasive rBCC with osseous involvement in retro-orbital region, invasion of paranasal and ethmoidal sinus, nasal cavity and orbital bone. Medium size 7 cm. Two pts have already received radiotherapy (RXT) one and two years before. Therapy consisted of docetaxel 35 mg/m2 and cisplatin 25 mg/m2 D1,D8 and D15 with one or two weeks interval. Results: They achieved complete response at the 6th cycle and received more 3 cycles- total of nine cycles.The pt that not had RXT before, received 5000 cGy as consolidation. Reconstrutive surgery was not necessary and two pts recovered the vision of the affected eye. Toxicity was mild in all pts with no grade 3 or 4. All pts are in complete remission until now. Conclusions: Contrary to previous reports, advanced BCC is responsive to chemotherapy with a longlasting response even after RXT, improving the quality of life and perhaps survival of pts with rBCC. No significant financial relationships to disclose.
Redefining evidence
Authors: Brouwers M. 
Published: March 2020

17000 Background: In the last decade, the Program in Evidence-based Care (PEBC), the guideline initiative of the cancer system in Ontario, Canada, has evolved dramatically. In addition to providing recommendations to facilitate decisions of clinicians (clinical practice guidelines), PEBC reports provide recommendations to facilitate decisions regarding universal drug funding, resource allocation, models of care, and the organization of the cancer system. For many of these issues, there is little in terms of traditional evidence, regardless of study design. As such, extending and building upon traditional notions of evidence and methodologies to gather new kinds of evidence have been required. Methods and Results: The PEBC has evolved the way it which conceives of evidence, the methods used to assemble and appraise evidence, and the role of evidence in decision making. To this end, environmental scan and consensus methods, in addition to standard systematic review methodology, are employed. The environmental scan methodology we use includes systematic and transparent internet searches of, and/or direct inquires to, organizations in jurisdictions determined, a priori, to be generalizable to the Ontario experience. Here, evidence comes in the form of organizational reports, case studies and evaluation data. These methods continue to be refined and tested. The consensus methodology we use is a modified Delphi technique. To date, these methods have been applied to various topics including standards for diagnostic assessment programs, surgical oncology and systemic therapy models of care, patient education, multidisciplinary case conferences, patient safety, and treatment of rare diseases. Evaluations of these reports have been generally positive (approval rating range: 56% to 75%) but noticeably more varied than approval ratings of our clinical practice guidelines that have relied primarily on traditional systematic review methodology (approval ratings rarely below 80%). Conclusions: The PEBC's notions of evidence continue to evolve as does the refinement and testing of new methodologies. Through this evolution, we are now able to provide advice on issues we would otherwise be unable to using traditional methods only, while still remaining true to our core principles of being participatory, rigorous, systematic and transparent. No significant financial relationships to disclose.
Performance in a Scottish cancer network (SCAN) against ASCO/NCCN clinical quality measures for breast and colorectal cancers
Authors: Dodds C. , Chetty U. , Wilson G. , Muir P. , Gregor A. 
Published: March 2020

17001 Performance in a Scottish cancer network (SCAN) against ASCO/NCCN Clinical Quality Measures for breast and colorectal cancer. Background: South East Scotland Cancer Network (SCAN) aims to improve care, treatment, and equity for all cancer patients in the 1.4m population under its care ( www.scan.scot.nhs.uk ). Clinical care is delivered by multidisciplinary teams in 7 hospitals and one regional cancer centre. Key function of the network is prospective audit collecting externally validated information on evidence-based performance indicators. Method: Cohorts of 624 breast and 359 colorectal cancer patients diagnosed over a 12-month period in Lothian have been analysed against the ASCO/NCCN measures. Conclusions: SE Scotland Breast and Colorectal services compare favourably with the ASCO/NCCN standards of care on most measures. Use of radiotherapy in rectal cancer conforms to Scottish guidelines. [Table: see text] No significant financial relationships to disclose.
Reducing radiotherapy delays after surgery for breast cancer in five radiotherapy departments
Authors: Woynar S. P. , Burban P. , Le Prisé E. , Romestaing P. , Maylin C. , Mazeau V. , Cauterman M. , Vendrely V. 
Published: March 2020

17011 Background: An interval superior to 8 weeks between surgery and radiotherapy increases the risk of recurrence for patients with early stage breast cancer treated with conservative surgery and breast irradiation and without chemotherapy. Five French radiotherapy departments launched simultaneously a quality improvement project aimed at reducing the delay to radiotherapy for all types of cancers concerned. Breast cancer radiotherapy delays were used as the principal proxy to evaluate overall progress. Methods: Teams focused their efforts on reducing the interval between the first appointment with the radio-oncologist and the start of the radiotherapy, interval on which they had control. Between May and December 2005, consultancy firms financed by the Ministry of Health, helped the teams (radio-oncologists, physicists, radiographers and nurses) to realize an organizational audit: identifying the processes of treatment, analysing the patient flow and the staff and equipment capacity. Concerning breast cancer, target intervals were set based on the 8 weeks standard. An action plan that included matching capacity and demand (better allocation of staff time during the week), standardising treatment processes and patient programming was implemented between January and December 2006. Results: The five radiotherapy departments reduced the delays to radiotherapy for breast cancers as well as for the majority of the other cancer types. Concerning breast cancer, the average of the five departments intervals between the first appointments and the start of the radiotherapy dropped from 4.9 weeks to 2.3 weeks, reducing in the same time the interval between surgery and radiotherapy. Furthermore, the teams’ cohesion, motivation and sense of responsibility increased, key elements for the sustainability of the improvements. These results were obtained without an increase of the departments resources. Conclusion: By redesigning their organisation with a patient centred goal, the five radiotherapy departments were able to meet the standards of practice. Following these results, ten new departments have joined the program financed by the Ministry of Health. No significant financial relationships to disclose.
Improving breast cancer screening for indigent minorities: A county hospital cancer center's experience
Authors: O'Brien T. E. , Peacock A. , Stevenson J. T. 
Published: March 2020

17020 Background: Indigent, minority women with breast cancer present with later stage disease, often because of lack of access to affordable screening tests. Breast exam and mammography are effective at early detection. A screening program targeting minority women is important, especially in an area with a high poverty rate. The most effective way to reach this population, though, has not been well established. Methods: From 11/03–7/05, 4 breast cancer screenings were performed at our cancer center which targeted poor, minority populations in the Cleveland area. Despite culturally appropriate advertisements and free exams by physicians, only 42 women were screened. To improve upon this, a bilingual community breast liaison was hired. An advisory council of community representatives was established which led to collaborations with over 100 neighborhood agencies. The venue for the screenings was changed to easily accessible locations (churches, shelters) and transportation was provided. Free clinical breast exams (CBE) were performed by experienced physicians and on-site mammograms (mam) were done. From 10/05–10/06, 7 community breast screenings were held. 403 women were screened and over 2000 were educated. Results: 98% were impoverished; 94% had an annual income of <$25,000. 78% had no health insurance. Median age=46 (range 35–89). 31% Latino; 46% AA; 16% Caucasian. Many pts had not had a mam (91%) or CBE (84%) within the past year; many never had either screening test before (31% never had a mam and 17% never had a CBE). The most common reason for this was lack of insurance (60%). “Too young” was the second most common reason (7%). Most common reason for coming to screenings: free services (49%). Of 403 pts screened, 27/371 had abnormalities on CBE and 26/293 mam were abnormal. Thus far, 2 cases of breast cancer have been diagnosed (stages I and II). Conclusion: Indigent minority women do not receive adequate breast cancer screening due to many barriers, including cost. To reduce this disparity, our center targeted this population. After adjusting our approach, screening attendance markedly improved, increasing from 42 to 403 pts screened. This improvement was due to cancer center services being brought out to the community and an active engagement of community organizations. No significant financial relationships to disclose.
Evaluation of barriers to clinical trial enrollment through a novel pharmacy quality assurance tool
Authors: Vamos D. C. , Kane M. P. , Nishioka J. , Lisi S. , Neceskas J. R. , Rubin E. H. , Aisner J. , Shih W. , Todd M. , Goodin S. 
Published: March 2020

17026 Background: Clinical trials offer the best treatment for patients with cancer, yet less than 5 percent of adults and less than 60 percent of children are enrolled on clinical trials. To determine reasons for lack of enrollment on clinical trials and to assess areas for potential trial development, we designed a ‘non-protocol’ form for use at our center. Our goal was to assess deficiencies in our menu of trials, identify other barriers to enrollment, and to indirectly increase awareness of trials. Methods: Completion of a ‘non-protocol’ form was required by the pharmacy with the first set of new chemotherapy orders for all Cancer Institute of New Jersey ambulatory patients who were not enrolled on a clinical trial. The form required completion of one of three areas for lack of enrollment: trial availability, reason for ineligibility, or other reason for not enrolling the patient. Results: From June 2003 through December 2005, 474 forms were collected for patients not enrolled on a clinical trial. The median age of patients not enrolled on trial was 56 years (range 1 to 88 years) and females outnumbered males (69% vs 31%). Lack of trial availability limited enrollment for 51% of patients (n=241) while administration of standard therapy was listed for 10 patients. Of those patients where a trial was available (n=223), 65% (n=145) of patients were not eligible, most commonly due to performance status (n=55). The remaining 78 patients refused participation. To determine if implementation of this pharmacy service changed the reasons for lack of enrollment, the data was evaluated by year: Conclusion: Lack of trial availability has been a rate-limiting factor in enrollment on clinical trials at our center. The data generated from the implementation of this novel pharmacy service is of strategic importance to the center. It is reviewed with the tumor-focused groups of the cancer center to identify areas for developing clinical trials. [Table: see text] No significant financial relationships to disclose.
An analysis of sentinel events after the implementation of a comprehensive information technology system for a new cancer center
Authors: Manno P. J. , Vogelzang N. , Sharma S. , Pomerantz A. , Fink L. , Halterman P. , Caramico S. , Faircloth R. , Murdock S. 
Published: March 2020

17047 Background: The Nevada Cancer Institute (NVCI) is the cancer center for the state of NV conducting basic and clinical research and services in medical oncology, hematology, radiation oncology, laboratory medicine, pathology, and imaging. With the national mandate for electronic medical records (EMR), we focused on selecting a comprehensive EMR/IT system during the planning of the NVCI.. The goal was to have a seamless interface between clinical services and financial management, to maintain an extensive database of pt outcomes linked to demographics for future data mining. We hypothesized that an EMR would lead to improved safety and efficiency in patient care. Methods: Pt visits began 3/05 with paper records while EMR systems were being reviewed. Ultimately, IMPAC Medical Systems, Inc was selected. After extensive testing and re-configuration of an existing IMPAC system by the IT department and extensive training sessions, a rapid transition from paper records to a complete paperless environment occurred 9/05. As of 12/31/06, we have seen 1,271 patients. Since the care plans, lab interface and drug bar coding were in place by 4/06, we reviewed the interval of 4–12/06 for efficacy of charge capture, reduction in medication errors, the tracking of patients in ancillary services, the development of a 3 tier approval system for drug orders, and the voice recognition system for its efficiency in reducing transcription costs and turnaround time. Results: In that interval, we recorded 3617 patient visits in the medical oncology infusion center and 4766 in radiation oncology. There were 0 sentinel events. Only 2 medication errors were made which were attributed to human error but not related to the software itself. Conclusions: These safety data appear superior to comparable error rates in a paper environment.We appear to have enhanced pt safety, reduced the costs of lost revenue, increased access to the patient record and created an opportunity to analyze pt data on a longitudinal basis. We are increasing our future reporting by implementing the IMPAC Quantros Safety and Risk Management System. No significant financial relationships to disclose.