bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oxaliplatin and capecitabine (XELOX) as first-line therapy for metastatic or relapsed squamous cell carcinoma of the head and neck
Authors: Silva O. E. , Tolba K. , Farfan N. , Karr M. , Calfa C. , Raez L. E. 
Published: March 2020

16524 Background: Prognosis is very poor when patients with head and neck (H/N) squamous cell carcinomas (SQCC) present with systemic metastasis or disease relapse after primary therapy. (Survival less than 6 months despite palliative therapy). Capecitabine (Xe) is a rationally designed, oral, tumor-selective fluoropyrimidine that mimics continuous 5-FU infusion. Oxaliplatin (Ox) is an alkylating agent that is not generally cross-resistant to cisplatin or carboplatin, and it was shown to be more effective that cisplatin and with increase the antitumor activity of 5-FU in tumor models. Methods: The objective of this study was to determine the safety and efficacy of this new combination (XELOX) for pts with H/N SQCC. Based in two phase I studies with solid tumors we choose the combination of Ox: 130mg/m2 IV day 1, and Xe: 850 mg/m2 PO BID day 2 to 15 every 21 days. Pts were treated until there is disease progression or received a maximum of 6 cycles. All pts had metastatic or relapsed H/N SQCC and they had not received chemotherapy yet for their metastatic or relapsed disease. Results: We have enrolled 16 pts. The enrollment was slower than predicted because several patients that were elegible were not enrolled because they were not able to swallow Xe due to the presence of feeding tubes. The median age was 61 years (range 46–78), most of them were males (10/16), smokers (13/16), whites (13/16), with ECOG PS 1 (11/16), and with Hispanic heritage (10/16). Eleven of them had metastasis to the lungs already and most of the pts had already received chemotherapy (9/16) or radiation therapy (14/16) during the initial therapy. Two pts withdraw consent and were not treated. From the 14 eligible pts to asses response we had 2 partial responses and 6 disease stabilizations. From 47 cycles administered we have seen few grade ¾ adverse (all of them less 10%) events including: leucopenia, hyponatremia, hoarseness, hyperglycemia, depression, and respiratory failure. Two pts reported grade 3 tumor pain. Conclusion: This study shows that the XELOX combination is probably safe and might be effective in the palliative therapy of patients with relapsed or metastatic SQCC of the H/N with these poor prognostic features. No significant financial relationships to disclose.
Effects of intralesional 32P in refractory patients with head and neck tumors
Authors: Dempke W. C. , Gunawardena B. , Hesselt B. , Linke R. , Alimi K. A. 
Published: March 2020

16529 Background: The clinical outcome of refractory head and neck cancer patients remains poor despite novel treatment strategies. In this pilot study we investigated the efficacy of intratumoral injection of 32-P chromic phosphate in 14 patients with refractory head and neck cancers in terms of response rates and overall survival. Methods: Fourteen patients (median age: 59 years) with either cytostatic drug-resistant tumors or tumors known to be primarily chemotherapy-resistant were entered into the study. After sonographic determination of the tumor volume, 32-P chromic phosphate (74–555 MBq) was injected into the central part of the tumor under sonographic guidance. Follow-up investigations included serial scintigraphy, sonographic examinations, and hematologic studies. Results: Injection of 32-P chromic phosphate into refractory head and neck tumors resulted in remarkable regression. The median survival of all patients was 7.8 months (range: 4–16). The response rate (partial response) was 57% (8 patients). However, 6 patients (43%) did not respond to the treatment. In 3 patients thrombocytopenia (grade I/II) was observed, but no other side effects were apparent. Significant pathologic and anatomic changes within the tumor tissue were demonstrated. In all cases examined, formation of a cyst within the area of central activity, surrounded by a centrifugal necrotic ring and a marginal fibrotic structure, was found. Conclusions: Lack of persistent systemic or local side effects, as well as noteworthy efficacy, are properties of this novel regional treatment modality with 32-P chromic phosphate. This modality deserves consideration for further clinical trials. No significant financial relationships to disclose.
Toxicity induced by radiochemotherapy with weekly paclitaxel versus weekly cisplatin in patients with advanced head and neck cancer
Authors: Stanculeanu D. L. , Tache A. , Cringeanu A. , Mitulescu D. , Scheusan R. , Dragomir M. 
Published: March 2020

16534 Background: Head and neck cancers represent about 8 % of the total solid cancer cases. For advanced head and neck cancer (HNC) patients, the effects of disease and the side effects of aggressive treatments have the potential to severely affect quality of life. Combined chemoradiotherapy increase rates of locoregional control, but it may cause severe side effects, mainly painful mucositis. In our study we evaluated the chemoradiotherapy induced toxicities in patients treated with concomitant radiochemotherapy using weekly paclitaxel or cisplatin for advanced head and neck cancer. Methods: From April 2003 to December 2005 46 patients with locally advanced head and neck cancer were enrolled onto this study. Patients characteristics: 35 male and 11 female; mean age 62,5; performance status ECOG 0–1, carcinoma histological confirmed. All patients received external beam radiation using DT= 45 Gy, 1,8 Gy/fr, 5 fr/week in combination with chemotherapy: arm A (20 pts) - Paclitaxel 35 mg/mp days 1,8,15,22,29; arm B (26 pts)- Cisplatin 20 mg/mp days 1,8,15,22,29. Results: 40 patients have completed the planed treatment; 4 patients have interrupted treatment because of toxicity; there were 2 toxic death due to neutropenic sepsis and metabolic disorders in arm A. Toxicity grade 3–4 was hematological - neutropenia - 14, 6 % pts in arm A vs. 7, 8 % pts in arm B; gastrointestinal - nausea 6,7 % pts in arm A vs. 5,6% pts in arm B; neurological - neuropathy 5,4 % pts in arm A vs. 0 pts in arm B; dermatological - radic dermitis 4,3% in arm A vs. 4,1% in arm B; oral mucositis 33,6% in arm A vs 27,8% in arm B. All this patients received analgesics and anti-inflammatory drugs, systemic and/or topical. Other toxicities were not significantly related. Conclusions: This study confirmed that radiochemotherapy has shown to provide clinical benefit response and disease stabilization in patients with locally advanced head and neck cancer. Unfortunately, this concomitant therapy was significantly associated with hematological toxicities and oral mycosis. The most severe side effect was oral mycositis grade 3–4, especially in the paclitaxel arm. No significant financial relationships to disclose.
Epidemio-clinic and evolutionary profile of laryngeal cancer at oncology department of Mohamed VI University Hospital
Authors: Benhamidoune M. , Tahri A. , Aiterraisse M. , Derhem N. , Bouras N. , Tahiri F. 
Published: March 2020

16536 Background: Larynx cancer is one of the most frequent cancers of the superior airways. Narrowly linked to the chronic tobacco use, often associated with other addictive behaviours notably chronic alcoholism. It touches males in more than 90% of cases, with preponderance between 40 and 59 years old. It is often epidermoïd carcinoma of which the overall prognosis is one of the better within the cancers of the superior airways. Methods: Our study concerned 58 cases of larynx cancer treated at the oncology department of Mohamed VI university hospital in Marrakech between October 2002 and December 2005. Results: The mean age was of 55 years. 90% patients were males and 62% of urban origin. The tobacco use was discovered in 91% of the cases and the alcoholism in 40%. Symptoms at diagnosis were essentially dysphonia in 95% and dyspnea in 88% of case the lather having necessitated a tracheotomy in urgency in 55% of cases. The pathology showed that it was exclusively an epidermoïd carcinoma, well differentiated in 80% of the cases, 80% of the patients were initially locally advanced (T3 - T4), while 5% only had a localized stage . 27% of patients received a radiation therapy after surgery (total laryngectomy + lymphadenectomy in all cases) and 61% an exclusive radio-chemotherapy. 5% were lost from view before the beginning of the radiotherapy. On the assessable patients, 73% were in complete remission. Conclusions: The delay to the diagnosis in our country strongly darkened the prognosis of this cancer. The adoption of an information and sensibilisation strategy (anti-tobacco campaign) is necessary. No significant financial relationships to disclose.
Concurrent radiation therapy and weekly docetaxel in elderly patients with oropharyngeal carcinoma
Authors: Minea L. N. , Anghel R. , Oprea L. , Georgescu T. , Bacinschi X. , Isacu I. , Tarlea A. 
Published: March 2020

16539 Background: Orofaringeal cancer is one frequent localization in developing countries like Romania. Our purpose is to evaluate the compliance and efficacy of concurrent weekly docetaxel and radiation therapy as definitive treatment for elderly patients with oropharyngeal carcinoma. Methods: 20 patients, over 65 years of age, with primary oropharyngeal cancer, who were treated with concurrent docetaxel and radiation therapy, were reported between January 2003 and December 2005. The distribution depending on stage was: stage II - 4 patients, stage III - 6 patients, stage IV - 10 patients (IV A - 7 patients and IV B - 3 patients). The total dose of radiotherapy was 70 Gy. Chemotherapy was delivered weekly and consisted in Docetaxel 20 mg/sqm. 4 more cycles of chemotherapy (docetaxel 75 mg/sqm day 1 and cisplatin 75 mg/sqm day 1 every three or four weeks according to hematologic tolerance) were administrated after concurrent radiochemotherapy. Results: Only 2 patients interrupted the radiochemotherapy due to related toxicities, especially acute grade III - IV mucositis. Grade III - IV hematological toxicities were observed in 5 patients, and grade III - IV mucositis in 4 patients. At the time of analysis 18 patients are alive and 11 of them are disease free. Conclusions: Concurrent weekly docetaxel and radiation therapy did not affect patients’ compliance to treatment; acute toxicities were in acceptable limits. Concurrent radio - chemotherapy was well tolerated and results and acute toxicities were comparable with younger patients. Elderly cancer patients should be offered optimal treatment depending on their functional status not on chronological age. No significant financial relationships to disclose.
Implementation of the California Oncology Emergency Preparedness Plan (COEPP): Updated results of an ASCO-supported state oncology society (SOS) project for patient (PT) protection
Authors: Moss R. A. , Presant C. A. , Lamb M. , Tucker S. , Howard F. 
Published: March 2020

17003 Background: Following the Katrina disaster MOASC began developing a plan to provide continuity of care to cancer PT in the event of a disaster. ASCO provided grant support to further develop the plan and begin implementation. COEPP included oncologist (ONC) and PT education and enrollment, developing a simple, portable, PT owned data storage system, ensuring drug availability, establishing offsite data storage, and implementing a communications system. This report updates the progress and problems encountered in this process. Methods: A committee was formed to develop the plan. ONC were educated through the MOASC website and meetings. A PT wallet card (WC) was developed as an initial method to store clinical data. Drug companies were contacted to provide support and emergency drugs. Communication avenues were identified. Attitudes of ONC were surveyed through interviews. Results: ONC readily agreed to join the COEPP. The PT WC have recently begun to be distributed. PT have been enthusiastic to participate. HIPPA compliant digital storage is being explored, but lack of standardization remains a problem. These efforts have required considerable time expenditures by committee members. Drug companies have expressed enthusiasm, and to date, one company has provided a sizable grant. Drug manufacturers and drug wholesalers have separate emergency plans for determining who is responsible for ensuring drug availability to PT and storing current distribution data. However, ONC membership in COEPP continues to increase, and WC have been widely accepted by PT indicating success of the initial part of the program. Educational materials and WC examples will be distributed at the poster. Conclusions: COEPP, while still early in development, is becoming a successful model of emergency preparedness to protect continuity of care for cancer PT. Adequate funding is required for network development, coordination, legal protections, eventual digitization of treatment records, coordination of drug availability, and ONC and PT educational materials. With grants, this model plan can be implemented in other regions by SOS. No significant financial relationships to disclose.
Time to treat: A system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis in a community hospital
Authors: Lo D. S. , Zeldin R. A. , Skrastins R. , Fraser I. M. , Newman H. , Monavvari A. , Ung Y. , Joseph H. , Downton T. , Meharchand J. 
Published: March 2020

17005 Background: Multiple physician visits, numerous investigations, and serial wait times often result in a lengthy process from the onset of lung cancer-related symptoms until diagnosis. An unpublished retrospective chart review from a Toronto community hospital indicated suboptimal delays for patients from onset of symptoms until the diagnosis of lung cancer. Methods: The Time to Treat Program (TTT), consisting of a streamlined referral system and a clerical facilitator to fast-track patients through a diagnostic pathway algorithm, was designed for patients with clinical or radiological suspicion of lung cancer. Data on patient visits and investigations were collected. Pre- and post-implementation data on median wait times were compared. Results: From April 2005 to December 2006 over 120 physicians referred 188 females and 226 males. For the majority of patients (95.2%), the reason for referral was chest x-ray findings suspicious for lung cancer. After TTT implementation, the median time from suspicion of lung cancer to referral for specialist consultation decreased from 19.9 days to 10 days, and the median time from such referral to the actual consultation date decreased from 16.8 days to 5.3 days. The median time from specialist consultation to CT scan decreased from 52.1 days to 4 days and the median time from CT to diagnosis decreased from 39 days to 12.4 days. Overall, the median time from suspicion of lung cancer to diagnosis decreased from 127.8 days to 30 days. For 25% of the patients in the TTT it took 13 or fewer days from suspicion of lung cancer to diagnosis, while for 5% of the patients it took 90 days or more. Half of the patients in the TTT had a diagnosis by 24 days from the time of suspicion. Of all patients in the TTT, 33% were eventually diagnosed with lung cancer. The time from suspicion to diagnosis took longer for patients who eventually had confirmed lung cancer than those who did not: 36.5 days vs. 28.7 days. Conclusions: By addressing process issues in the work-up of lung cancer, the TTT was effective in shortening the time from suspicion of lung cancer to diagnosis and reduced time intervals at each step in the process. Earlier diagnosis of lung cancer may allow increased treatment options for patients. No significant financial relationships to disclose.
Extent of lymphadenectomy and survival in stomach cancer
Authors: Wong S. L. , Ji H. , Birkmeyer J. D. 
Published: March 2020

17008 Background: Based on population-based studies, some investigators have posited that patients undergoing more extensive lymphadenectomy as part of their resection for stomach cancer had improved late survival rates. Such findings have prompted calls for the use of total lymph node counts as a quality indicator for hospitals. However, apparent relationships between number of lymph nodes resected and survival may be confounded by patient selection bias and provider factors. It is not clear that hospitals with higher lymph node counts have better outcomes than other hospitals. The purpose of this study is to examine relationships between total lymph node counts and survival for stomach cancer. Methods: Using the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1992–2002), we first identified all patients undergoing major resections for gastric cancer (n=3,049). Hospitals at which the procedures were performed were categorized into 3 groups (terciles) according to the median number of nodes examined. We then assessed 5-year survival rates for each hospital group, adjusting for potentially confounding patient and hospital characteristics. Results: Hospitals with the highest median lymph node counts had slightly higher 5-year survival rates than those with the lowest node counts (31% vs. 28%; unadjusted HR for mortality 0.90, 95% CI 0.81–1.00). Hospitals with higher lymph node counts tended to treat lower risk patients and had lower procedure volumes. Adjusting for these confounding patient and provider characteristics further weakened the apparent relationship between survival and lymph node counts by hospital (adjusted HR, high vs. low hospital tercile, 0.96; 95% CI 0.85–1.09). Conclusions: Apparent relationships between total lymph node counts by hospital and 5-year survival rates after resection for stomach cancer are relatively weak and explained in large part by confounding patient and provider factors. Stronger evidence should be required before moving forward with this metric as a hospital quality indicator. No significant financial relationships to disclose.
Development of quality indicators for non-Hodgkin lymphoma
Authors: Wennekes L. , Ottevanger P. B. , Raemaekers J. M. , Schouten H. C. , De Mulder P. H. , Grol R. P. , Hermens R. P. 
Published: March 2020

17017 Background: Indicator development to monitor quality of care for non-Hodgkin lymphoma's (NHL) is difficult because NHL represents variable disorders with different and fast changing treatment policies. This study aimed to generate a set of valid indicators for NHL, using a systematic consensus method. Methods: Recommendations from evidence-based guidelines were collected as potential indicators. A multidisciplinary panel of 14 experts rated and discussed these recommendations on the usefulness as an indicator in three rounds using the Rand-modified Delphi procedure. This procedure was innovated with a flow chart from diagnostics to follow-up that showed which recommendations were crucial for the continuation of the care process. Experts were enforced to develop indicators for diagnostics, treatment and follow-up and the organization of care. Results: From a list of 99 recommendations 10 potential indicators for diagnostics, 10 for treatment and follow-up and 8 for the organization of care were selected. All potential indicators for diagnostics and treatment were crucial according to the flow chart. Six indicators were relevant for only a few patients and were rejected. Another six were merged into two. For diagnostics 8 indicators remained including taking a biopsy, evaluation of morphology and immune phenotype, the World Health Organization- classification, staging with CT-scanning of neck, thorax and abdomen, bone marrow aspirate and crista biopsy according to Ann Arbor, blood counts and the International Prognostic Index. For treatment 3 indicators remained regarding treatment with R-CHOP in optimal dose intensity for diffuse large B-cell lymphoma and response evaluation according to Cheson. For organization of care 7 indicators remained including waiting times, multidisciplinary consultations, adequate reporting and accredited expertise and facilities. Conclusions: This study showed that relevant quality indicators can be developed for a complex malignancy like NHL. Our innovations with the flow chart made a relevant contribution to the selection method and we managed to develop indicators for each part of the care process. They are currently tested for validity and feasibility. The use of these indicators makes it possible to monitor and improve the quality of care for NHL. No significant financial relationships to disclose.
Preferences for breast cancer prevention among BRCA mutation carriers
Authors: Jacobson J. , Patel P. , Bharthuar A. , Hershman D. , Hill K. , Warner E. , Plewes D. , Messner S. , Erichson R. , Grann V. 
Published: March 2020

17018 Purpose: Breast cancer screening with MRI is a new option available to patients with BRCA 1/2 mutations. We analyzed preferences for this modality and 10 other breast cancer- related health states and preventive measures among women without cancer or known high risk and women with BRCA mutations. Methods: Following IRB approval, we administered a time trade-off questionnaire to mutation carriers and to women without breast cancer or known high risk. We used Kruskal-Wallis test to compare the two groups with respect to continuous variables, chi-square tests to compare proportions, and the Wilcoxon signed rank test for pairwise comparisons. We then developed logistic regression models to analyze the association of mutation carrier status and demographic factors with willingness to trade time for each of the 11 health states. Results: Two-hundred-four women (44 mutation carriers and 160 without breast cancer or known high risk) responded to the questionnaire. Both groups assigned the highest preference rating to mammography and the next-highest to MRI, but the differences in ratings were not statistically significant. Both groups assigned the lowest preference ratings to having a child with a mutation and the next lowest to ovarian cancer. In pairwise comparisons, both groups ranked oophorectomy higher than ovarian cancer (p <0.01), but mutation carriers did not rank prophylactic mastectomy significantly differently from breast cancer (p=0.38). In the logistic regression models, mutation carrier status was not a statistically significant predictor of willingness to trade time for any health state, but younger age, lower income, and nonwhite race/ethnicity were associated with willingness to trade time for certain health states. Conclusion: Our data indicate that MRI is as acceptable as mammography to respondents, and that the preferences of BRCA 1/2 mutation carriers are similar to those of other women. Age and other demographic factors may be more important than mutation status in determining preferences. The preference ratings of individuals should not be inferred from demographic characteristics or mutation status. However, such ratings can help to clarify the quality of life implications of clinical decision-making and health care policy regarding breast cancer prevention. No significant financial relationships to disclose.