bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combination chemotherapy with temsirolimus and trabectedin in patients with heavily pretreated clear cell carcinoma of the ovary.
Authors: Takano Masashi , Kouta Hiroko , Sasaki Naoki , Kudoh Kazuya , Kita Tsunekazu , Kikuchi Ryoko , Oda Katsutoshi , Goto Tomoko , Furuya Kenichi , Kikuchi Yoshihiro 
Published: March 2020

e16519 Background: Clear cell carcinoma (CCC) of the ovary showed exceedingly chemo-resistant phenotype, especially in the case with recurrent or refractory to previous therapy. An inhibitor against the mammalian target of rapamycin (mTOR), temsirolimus, has been reported to be effective in renal CCC. Additionally, a marine natural product, trabectedin, had activity against recurrent ovarian cancers. We evaluated the effect of combination therapy with temsirolimus and trabectedin for patients with recurrent/refractory CCC of the ovary. Methods: Patients with recurrent/refractory CCC of the ovary were treated with weekly regimen using two drugs: 10mg/m2 of temsirolimus and 0.15mg/m2 of trabectedin (3 weeks, one week rest) with written informed consents. Treatment was continued until development of progressive disease (PD) or unmanageable adverse effects. Responses were evaluated by RECIST criteria, and adverse effects were analyzed by NCI-CTCAE v4.0. Results: A total of 12 patients treated with the regimen, and there were no cases that discontinued the therapy due to toxicities. Median age was 60 years (range: 42-69), and median number of previous chemotherapy was 3 (range: 1-5). All cases were assessable by RECIST and CTCAE. One patient (8%) had a complete response (CR), and another (8%) achieved a partial response (PR), and 4 patients (33%) had stable disease (SD) beyond three months, resulting in clinical benefit rate (CBR; CR+PR+SD>3month) of 50%. Median response duration in CBR case was 3.5 months (range: 3-12+). There were no cases that developed toxicities more than grade2. Conclusions: The present preliminary study demonstrated combination therapy with temsirolimus and trabectedin was effective in patients with recurrent/refractory CCC of the ovary. These results warrant further study in such clinical settings.
Impact of comorbidities on recurrence rates and survival in patients with endometrial cancer.
Authors: Kucukoztas Nadire , Dizdar Omer , Rahatli Samed , Tarhan Cagla , Haberal Nihan , Dursun Polat , Yalcin Selim , Ozen Ozlem , Yildiz Ferah , Altundag Ozden , Ayhan Ali 
Published: March 2020

e16528 Background: The aim was to determine the clinical characteristics, comorbidities, tumor features, and survival outcomes in patients with uterine carcinoma treated in our institution. Methods: Charecteristics of 410 patients underwent initial abdominal surgery for primary endometrial cancer in our institution between 2006 and 2012 were reviewed. Demographic features, histologic types, stage, type of surgery, comorbidities, treatment modalities and patient outcomes in terms of relapse-free survival (RFS) and overall survival (OS) were assessed. Results: Patient characteristics are shown in the Table. Nearly all patients (97%) were initially treated surgically with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Median follow up was 26 mos. 3 year RFS was 90%. 3 year RFS was 97% at stage 1, 80% at stage 2, 62% at stage 3 and 4. 3 year OS was 91%. 3 year OS was 96% at stage 1, 85% at stage 2, 64% at stage 3-4. The only significant independent predictor of RFS was disease stage (HR 5.7, 95% CI 2.1-15.3, p<0.0001) while histologic grade also bordered significance (HR 2.3, 95% CI ,8-6.4, p=0.085). Independent predictors of OS was age (HR 4.5, 95% CI 1.5-13.7, p<0.007), presence of diabetes mellitus (HR 4.5, 95% CI %1.1-6.7, p=0.019) and stage (HR 5.2, 95% CI 2.2-12.6, p<0.0001). Conclusions: Our data shows that older age (>60 years) and advanced stage patients with endometrial cancer have significantly decreased overall survival. Presence of diabetes mellitus is not associated with recurrence rates but is associated with worse overall survival. Stage and grade are considered independent risk factors for recurrence [Table: see text]
Efficacy and safety of neoadjuvant paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy in locally advanced squamous cell cervical carcinoma followed by radical surgery: A single institution experience.
Authors: Scandurra Giuseppa , Scibilia Giuseppe , Banna Giuseppe Luigi , Lipari Helga Maria Alessandra , D'Agata Gabriella , Scollo Paolo 
Published: March 2020

e16532 Background: The management of locally advanced squamous cell cervical carcinoma includes chemoradiotherapy or neoadjuvant cisplatin based chemotherapy followed by surgery, that may offer specific advantages a better potential activity. Porpouse: To evaluate efficacy and safety of TIP neoadjuvant chemoregimen in patiens affects by local advanced squamous cell cervical carcinoma. Methods: July 1997 - December 2011 were treated at our institution 165 patients with locally advanced squamous cell cervical carcinoma of whom 143 are evaluable. Regimen: Ifosfamide 5000 mg/mq ev day 1 iv in 24 h ; Mesna 5000 mg/mq ev day 1 iv in 24 h ; Paclitaxel 175 mg/mq ev day 2; Cisplatin 75 mg/mq ev day 2; every 3 weeks for a total of three courses. Tumor extension was assessed clinically and by abdominal MRI, PET WB and 3D ultrasound at baseline and after three courses.The operable patients after TIP chemoterapy underwent radical hysterectomy and pelvic lymphadenectomy. The median age 53 ( range 24-79 yrs), clinical FIGO stage Ib 2 2 pts(1%) , IIb 59 pts(41%), IIb bulky 68 pts (48%), III-IV 14 pts (10%), histological subtype SCC 138 pts (96%) and adenocarcinoma 5 pts ( 4%). Results: After neoadjuvant chemiotherapy 132 pts (92%) underwent surgery. Post-chemotherapy pathological response was pCR 25 pts (19%), PR1 16 pts (12%), PR2 80 pts (61%), SD 10 pts (7%), PD 1 pt (1%). Median numbers of courses of TIP administrated was 3 ( range 1-3). Treatments was delay or withdrawal in 22 pts ( 16%). Treament limiting toxicities were, Neutropenia 11 pts (52%), Anemia 10 pts (45%),Thrombocytopenia 7 pts (33 %), Renal failure 3 pts (14 %), Allergic reaction 3 pts (14%), Vomiting 3 pts (14%), Febrile neutropenia 2 pts (10%), Hypopotassiemia1 pt (5%), Atrial fibrillation 1pt( 5%), Pneumonia 1 pt (5%). Conclusions: In our experience neoadjuvant TIP was feasible, effective with 92% resection rate and active in an older and higher stage disease enriched series than reported in previous clinical trials.
Adjuvant image guided (IGRT) intensity-modulated Arc radiotherapy for vulvar cancer.
Authors: Mathiesen Hanne From , Banner-Voigt Marie Louise Vorndran Coeln , Lassen Soeren , Mirza Mansoor Raza 
Published: March 2020

e16541 Background: A retrospective analysis to determine the efficacy and toxicity of PET-CT image guided intensity modulated arc radiotherapy (arctherapy) with concomitant weekly cisplatin as adjuvant treatment of vulvar cancer patients (pts) with high-risk of relapse after primary surgery. Methods: Pts were identified as high-risk of relapse after primary surgery (free-margins of vulvar tumor <8mm; positive sentinel node/nodes). Pts were treated with radiation (RT) plus weekly cisplatin. All pts were planed by PET-CT scan. Target volumes were delineated together with onc-radiologist. The decision to irradiate vulva and/or unilateral/bilateral nodes was made independently. Principal of one-plus nodal region was applied. 46-50,7Gys were delivered in 23-27 daily fractions by arctherapy. Results: 25 consecutive pts (median age 64 years) were treated during 01.09.2008-30.09.2012. In the initial period IMRT was used (4 pts). Vulva was treated in all pts; unilateral nodal RT in 8 pts and bilateral nodal RT in 17 pts. No grade ≥2 toxicities were recorded. 24 pts are relapse-free with a median follow-up of 14.8 months. 1 pt had early relapse with later fatal outcome. Conclusions: Image guided arctherapy is highly effective and well tolerated. Further experience and long-term data with this technique is to be attained.
A protocol with adjuvant chemotherapy (CT) and radiotherapy (RT) for endometrial cancer: Results.
Authors: Romeo Margarita , Capdevila Laia , Cros Sara , Tarrats Antoni , Takeuchi Maya , Torrent Juan Jose , Carballas Elvira , Sastre Josep Maria , Gomez Maria Carmen , Tuset Victoria , Tapia Gustavo , Balana Carmen 
Published: March 2020

e16549 Background: The classic adjuvant treatment for high-risk endometrial cancer is RT. Several phase III trials explored the role of CT, as single treatment or added to RT sequentially (ST) or concurrently (CR), but design heterogeneity hampers conclusions. We report the results of a single-institution protocol with adjuvant CT + RT for advanced stages or type II histologies. Key points: (1) ST and CR permitted. (2) CT used pre-, post- and/or during RT: carboplatin AUC 5 + paclitaxel 175 mg/m2 (150 during RT) Q3W, 4-6 cycles (“carbotaxol”). (3) since 2010, cisplatin 50 mg/m2 was used for CR (on day 1 and 28 of RT). CR was preceded/followed by carbotaxol. Methods: All patients (PT) included in the protocol between 1/2005 and 9/2011 were retrospectively revised. Endpoints were survival and toxicity grade 3-4. Kaplan Meier and Fisher test were used. Conclusions: CR-carbotaxol showed a longer progression-free and overall survival than ST without reaching statistical significance (log rank, p= 0.14 and p=0.33). Median survivals with CR-cisplatin were not reached because of shorter follow-up. Statistical differences in toxicities were not found. In the CR-carbotaxol arm, 5 PT had grade 3-4 acute diarrhoea vs none in the others. [Table: see text]
Pregnancy following surgery and chemotherapy for ovarian germ cell tumors.
Authors: Murphy Karen , Alken Scheryll Paula , McCaffrey John , Carney Desmond , O Connor Miriam 
Published: March 2020

e16550 Background: Malignant ovarian germ cell tumours(OGCT) are a rare disease, accounting for 2% of all malignant ovarian tumours diagnosed in Ireland between 1994 - 2010. They affect a younger population than epithelial ovarian cancer, with the highest number of cases in the second and third decade. In this report, we present a review of patients treated in a tertiary referral centre. Methods: We performed a retrospective review over a 26 year period in our institution. We examined clinical records, pathology, pharmacy and surgical databases to identify patients with ovarian germ cell tumours who were treated in our institution. Results: During the period 1986 – 2012, twenty patients were treated and followed at this institution for malignant ovarian germ cell tumor (OGCT). Eighteen patients are alive and well at a median follow up of 14.5 years (range 0.5 – 26). Nineteen patients received platinum based chemotherapy with a median number of four cycles (range 2 – 6) required to achieve complete remission. Twenty percent of patients had yolk sac histology; the next commonest were immature teratomas and mixed germ cell tumour (10 & 15% respectively). The commonest chemotherapy regimen used was BEP (bleomyocin, etoposide and cistplatin). Six patients (30%) underwent resection of residual disease post chemo revealing mature teratoma/necrotic tissue. During follow up, four patients had progressive or recurrent disease. Two patients at resection had mature teratomas found on histological examination. The remaining two patients (10%) had progressive disease and died within a short time period. In our patient population, nine of nine attempting pregnancy have been successful. There have been 12 pregnancies carried to term; mother and child in each case are well. At a median follow up of 14.5 years (range 0.5 – 26), there have been no second malignancies and no toxicities attributable to chemotherapy. Conclusions: We have shown that platinum based chemo in OGCT is associated with preservation of fertility in these young women. In our series there have been no adverse affects in women or their infants. Platinum based chemo highly successful in curing OGCT and this confirms that it is associated with preserved fertility in these young women.
Comparative effectiveness of treatments for recurrent ovarian cancer.
Authors: Bickell Nina A. , Deb Partha , Hayes Monica Prasad , Franco Rebeca , Howell Elizabeth A. , Wisnivesky Juan P. , Sun Ruirui , Egorova Natalia 
Published: March 2020

e16551 Background: Traditionally, recurrent ovarian cancer has been treated with chemotherapy. However, increasingly, secondary cytoreductive surgery (SCS) is being performed. We undertook this study to compare survival between SCS vs chemotherapy vs both or neither to treat recurrent ovarian cancer. Methods: Using SEER-Medicare 1997-2007, we identified women age 66+ years with primary late stage epithelial ovarian cancer with fee-for-service Medicare treated with surgery and chemotherapy for their primary cancer who experienced a recurrence. We defined recurrent cancer using claims for chemotherapy, hospice or SCS following a 6 month treatment free window after primary treatment. Survival time is calculated from time of first recurrence. We conducted parametric and semi-parametric multivariate survival analyses to assess comparative treatment survival rates and factors affecting survival. We use propensity score weighting methods to obtain robust estimates of comparative effectiveness. To address the risk that a fraction of patients classified by our algorithms as non-recurrent are, indeed, recurrent, we use finite mixture models. Results: Of the 1,623 women with recurrent cancer, 72% received secondary chemotherapy while 15% receive both chemotherapy and surgery. <2% receive secondary surgery and 12% received hospice with no active treatment. Univariate analyses show that the mean survival time after first recurrence of ovarian cancer is 1,357 days. Multivariate survival models controlling for patient demographics, cancer type and comorbidities show that, compared to patients who received both surgery and chemotherapy, those who received only SCS (-569 days) as well as those who received only chemotherapy (-381 days) had significantly lower survival times. Survival time is negatively associated with black race and age at recurrence and positively associated with date of reoccurrence. Patients with greater comorbidities have significantly shorter survival times. Conclusions: Patients with recurrent ovarian cancer treated with both secondary surgery and chemotherapy survive longer than patients treated with either chemotherapy or surgery. Women who are Black, or older at time of recurrence have worse survival.
Weekly topotecan and biweekly bevacizumab in recurrent and progressive ovarian carcinoma: A single institution experience for third-line or greater treatment.
Authors: Grzankowski Kassondra S , Lele Shashikant B. , Pietkiewicz John 
Published: March 2020

e16553 Background: The toxicity and efficacy of combined weekly topotecan and weekly bevacizumab in women with recurrent and progressive ovarian cancer. Methods: Reviewed data-base from 1/2003-present (1/2013) identified 15 patients who were treated with topotecan 4mg/m2 on days 1, 8, and 15 and bevacizumab 10mg/kg on days 1 and 15 of a 28-day cycle until progressive disease or excessive toxicity warranted discontinuation. The primary endpoint was progression-free survival. Results: Patients (n = 15) received a median of 4 treatment cycles. Mean number of previous chemotherapy regimens was 5 (range 2-9). Toxicity was generally mild, with neutropenia (20%), gastrointestinal toxicity (20%), pain (26%), anemia requiring transfusion (6%) being the most common adverse events. Two patients required dose adjustment secondary to neutropenia. Patients treated with 5 or more prior regimens had more adverse events, 66% vs. 33%, respectively. No febrile neutropenia or treatment-related deaths occurred. Median PFS and OS were 5.6 months and 5.9 months with 6 (40%) patients progression-free for ≥5 months. Two (13%) patients had complete response, 9 (60%) had stable disease or partial response and were still receiving the above mentioned treatment, and 4 (27%) had progressive disease. Conclusions: Treatment of recurrent and progressive ovarian cancer with weekly Topotecan and biweekly Bevacizumab demonstrates a viable efficacy with acceptable toxicity profile in women with previous multiple lines of treatment; as this becomes a more widely used regimen further investigation will be needed to determine early use of this well tolerated chemotherapy.
Treatment of recurrent Langerhans cell histiocytosis of the vulva with lenalidomide.
Authors: Ibrahim Ibrahim Fuad , Naina Harris V. K. 
Published: March 2020

e16555 Background: Langerhans cell histiocytosis (LCH) of the female genital tract is an extremely rare disease. We report a 14 year follow up of a patient with LCH successfully treated with lenalidomide in the relapsed setting. Methods: N/A. Results: A 43 year old Ethiopian woman initially presented to another institution with a nodular lesion on her left vulva with biopsy consistent with LCH. Metastatic workup at the time did not reveal evidence of distant disease. The patient was initially treated with radiotherapy to the vulva and 2 years later she was diagnosed with recurrent disease in the vulva and underwent a wide local excision. Six months afterwards she developed a lesion on her right labium majus consistent with disease recurrence. She was treated with radiotherapy again and underwent a wide radical vulvar excision. She recurred only 3 months later and was started on salvage therapy with thalidomide, 3 years after the initial diagnosis. Within 2 months of starting thalidomide therapy, the patient experienced resolution of vulvar lesions and symptoms. She remained symptom free for 8 years while on thalidomide but then presented to our institution with a new central vulvar lesion after being off therapy for 4 months. Vulvar biopsy confirmed the presence of LCH. She was subsequently restarted on thalidomide and achieved symptom control for an additional 18 months before developing worsening pain and neuropathy associated with therapy. Imaging revealed no evidence of metastatic disease. We then started lenalidomide therapy at dose of 10 mg daily for 21 days in a 28 day cycle and subsequently increased the dose to 25 mg daily continuously. She achieved marked improvement in vulvar symptoms within a month of initiation of lenalidomide. She has tolerated therapy well with no neuropathy or cytopenias. Conclusions: Primary vulvar LCH is a rare disease with no standard therapies. Thalidomide has been described in the literature as an effective treatment option. We describe the use of lenalidomide as an alternative and well tolerated therapy in the relapsed setting. Further investigation is required to determine whether lenalidomide is a viable first line therapy for this rare disease.
Significance of panendoscopy and CT in the follow-up and management of squamous cell carcinoma of the head and neck: A retrospective clinical assessment.
Authors: Muenscher Adrian , Sehner Susanne , Taleh Jegane , Tribius Silke , Dalchow Carsten , Moeckelmann Nicolaus , Gulati Amit , Clauditz Till , Knecht Rainald 
Published: March 2020

e17003 Background: Treatment of patients with head and neck squamous cell carcinomas (HNSCC) require an evidence-based multidisciplinary approach which varies from medical centres. Panendoscopy has been traditionally used as a routine screening examination tool. We discuss and compare its clinical effectiveness, safety and predictive value in patients with computed tomography (CT) scans in a routine outpatient follow up. Methods: Between 2004-2007, in a retrospective study (204 patients; male:156 (76.5%); female:48 (23.5%))with head and neck cancer, fulfilled all inclusion and exclusion criteria were evaluated at the University Medical Center Hamburg-Eppendorf, Germany. Follow-ups were performed every 2 to 3 months for the first 3 years and every 6 month for the following 2 years. UICC-TNM staging system divided patients into seven categories. Results: The mean age of patients was (male: 59.2±9.3 years; female: 59.5±10.2 years), the highest incidence rate was recorded in the 51 to 60 age group (n = 77). There was a male predominance, with a male/female ratio of 3:1. In comparing normal versus abnormal CT a 12-fold higher frequency of recurrence (odds ratio [OR]; 95% CI: 3.99, 37.51; p<0.001) was interpreted.Additionally, patient anamnesis (OR: 3.33; 95% CI: 1.57, 7.07; p=0.002), clinical investigation (OR: 5.85; 95% CI: 3.01,11.36; p<0.001) and recurrence pattern (OR: 4.82; 95% CI: 2.26,10.32; p<0.001) was observed. Conclusions: In staging / follow-up HNSCC patients, CT-diagnostics also provided similar levels of accuracy as panendoscopy. Panendoscopy in patients with HNSCC was avoided (169 out of 364) when the diagnostic parameters remained satisfactory. Higher patient satisfaction, structural information at a high spatial resolution and comfort was noted in the CT group, indicating a gradual move towards CT diagnostics. For safety-related reasons in particular, we recommend panendoscopy for histological evaluation i.e.in predicting cancer recurrence and progression.
Pretreatment characteristics and early indicators of long-term efficacy of cetuximab in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (rmSCCHN).
Authors: Keilholz Ulrich , Knoedler Maren , Redlich Ines , Gauler Thomas Christoph 
Published: March 2020

e17015 Background: Cetuximab has established activity in rmSCCHN as a single agent as well as in conjunction with chemotherapy. Combination treatment protocols lead to significant toxicity. It would be of interest to identify pretreatment characteristics and early indicators of long-term cetuximab efficac. Methods: rmSCCHN patients were analysed, who participated in trials of chemotherapy plus cetuximab, followed by cetuximab maintenance. Patients were stratified into two groups of long term exposure (LTE) and short term exposure (STE) of cetuximab using 6 months as cut-off. Factors considered for analysis included age, sex, performance status, smoking behavior, primary tumor site, time from primary to treatment for rm-disease, number of chemotherapy cycles received, response, toxicity, and reason for treatment discontinuation. Results: In 2 institutions, 61 patients were enrolled in 5 clinical trials between 2008 and 2011. Cetuximab was administered in standard dose and schedule until disease progression or unacceptable toxicity. 27 patients received cetuximab <6 mo (STE, median 1.5 mo) and 34 >6 mo (LTE, median 9 mo). Patients with LTE as compared to STE only differed in 2 characteristics: oral/oropharyngeal primary (56% vs. 41%) and median chemotherapy cycles received (6 vs. 2). Comparing LTE to STE, treatment discontinuation during the chemotherapy phase was due to toxicity in 14 vs. 37% or death in 4 vs. 15%. Median OS in LTE vs. STE was 18 vs. 4 mo. Conclusions: LTE was associated with a huge improvement of OS. Toxicity of chemotherapy was a relevant factor for early discontinuation of combination treatments, limiting the overall efficacy of cetuximab. Results may be improved by further intensification of the already implemented proactive toxicity management, but also by development of less toxic chemotherapy schedules.