bluuebunny/crossref_metadata_2025_split huggingface dataset:
What caused the decline in breast cancer incidence rates?
Authors: Chagpar A. B. , McMasters K. M. 
Published: March 2020

1513 Background: Recently, a sharp 7% decline in breast cancer incidence rates among women over the age of 50 was noted in 2003. It has been speculated that this may be due to changes in mammographic screening or in the use of hormone replacement therapy (HRT). The purpose of this study is to elucidate the cause of the decline in breast cancer incidence rate. Methods: The National Health Interview Survey (NHIS) is a population-based personal interview survey conducted annually by the Centers of Disease Control. In 2000 and 2005, a cancer supplement was administered containing information regarding behaviors which may affect breast cancer incidence. These data were analyzed using SAS-callable SUDAAN software to determine trends in the use of mammography, HRT use, and chemoprevention over this period of time in women older than 50. Results: 7147 and 7396 women over 50 were surveyed in 2000 and 2005 respectively. There was a significant drop in the proportion of women reporting current use of HRT between 2000 and 2005 (27.66% vs. 12.09%, p<0.0001). While there was also a drop in the proportion of women reporting current use of tamoxifen (1.34% vs. 0.74%, p<0.0001), there was an increase in the proportion of women reporting current use of raloxifene (0.92% vs. 1.27%, p<0.0001). Overall, there was a slight decrease in the use of chemoprevention between 2000 and 2005 (2.18% vs. 1.99%, p<0.0001). There was a reduction in the proportion of women over the age of 50 reporting ever having had a mammogram (83.85% vs. 82.76%, p<0.0001) or clinical breast examination (81.63% vs. 75.34%, p<0.0001) between 2000 and 2005. Fewer women over the age of 50 reported that their last mammogram was within the preceding 2 years (87.33% vs. 84.68%, p=0.0002). Similar results were seen for clinical breast examination within the preceding 2 years (88.98% vs. 86.22%, p<0.0001). Conclusions: The decline in breast cancer incidence rate is multifactorial, due in part to declining rates of early detection and chemoprevention. The principal etiologic factor, however, is likely the dramatic reduction in the use of HRT. No significant financial relationships to disclose.
A phase II study of chemoradiotherapy in patients with stage II, III esophageal squamous cell carcinoma (ESCC): (JCOG 9906)
Authors: Muro K. , Ohtsu A. , Ishikura S. , Boku N. , Takiuchi H. , Saito H. , Kaneko K. , Miyata Y. , Komatsu Y. , Shirao K. 
Published: March 2020

15137 Background: The study objective was to evaluate the efficacy and toxicity of chemoradiotherapy (CRT) with cisplatin and 5- fluorouracil (5FU) in patients with stage II, III ESCC. Methods: Patients with clinical stage II or III (T1N1 or T2–3N0–1 and M0) thoracic ESCC, age of 70 or younger, preserved organ functions were eligible. Treatment consisted of two courses of cisplatin 40 mg/m2 (day 1, 8) and 5FU 400 mg/m2/day (days 1–5, 8–12), q5w combined with concurrent radiotherapy of 60 Gy in 30 fractions over 8 weeks with 2-week break. For responders, two courses of chemotherapy of cisplatin 80 mg/m2 (day 1) and 5FU 800 mg/m2/day (days 1–5) q4w were added. The primary endpoint was overall survival and the secondary endpoints were response, toxicity, and progression-free survival. Results: From April 2000 to March 2002, 76 patients were accrued from 12 institutions. Characteristics of all patients were as follows: median age of 61 (range 39–70), male/female; 68/8, PS 0/1; 59/17, stage IIA/IIB/III; 26/12/38. There were two ineligible cases with inadequate liver function and T4 disease. Grade 4 neutropenia, leukopenia, and anemia occurred in 1.3%, 1.3% and 2.6%. Grade 3/4 esophagitis, stomatitis and infection occurred in 17%, 8% and 17%. Grade 3/4 late toxicities occurred in the following incidences; esophagus (dysphagia, mucositis, stenosis, and fistula) in 13%, pericardial effusion in 17%, pleural effusion in 8%, and radiation pneumonitis in 4%. There were 4 treatment related deaths due to late toxicities such as esophageal fistula, radiation pneumonitis, and the other cardiopulmonary diseases. Of eligible 74 patients, there were 50 complete responses (CRs) with a CR rate of 68% (95% Confidence Interval (CI): 56–78%). Median survival time was 31 months and the 2, 3-year survival rates were 55% (95% CI: 43–67%), 47% (95% CI: 36–59%), respectively. Conclusion: CRT for stage II, III ESCC is effective with acceptable acute toxicities, however, careful follow up is necessary for late toxicities. No significant financial relationships to disclose.
Phase II study of weekly docetaxel in combination with capecitabine (C) in advanced gastric (AGA) and gastro-esophageal adenocarcionma (AGEA)
Authors: Hantel A. , Lo S. , Khorana A. , Javle M. , Hwang J. , Wang H. , Simon S. , Crandall T. , Shayne M. , Ramanathan R. K. 
Published: March 2020

15139 Background: Chemotherapy regimens for AGA and AGEA have shown considerable toxicity and most require continuous IV administration. Both D and C are active agents in AGA. D upregulates thymidine phosphorylase, the enzyme which catalyzes the conversion of C to 5-FU, with preclinical evidence of synergy for the combination. A phase I study of D and C showed acceptable tolerability and activity in patients (pts) with AGA (Ramanathan et al., 2005). This multi-institutional phase II trial evaluates the combination of D and C in 1st or 2nd line treatment of AGA and AGEA. Methods: Pts with AGA/AGEA who received ≤ 1 prior chemotherapy regimen were eligible. D 30 mg/m2 on d 1, 8 and C 825 mg/ m2 BID were administered on days 1–14 of a 21 day cycle. The one stage study design had an accrual goal of 40 pts. The primary endpoint was to detect a 50% improvement in median survival in previously untreated pts to 10 months (mo), by one-sided log-rank test at level a = 0.05. Results: Enrollment is complete with 40 pts, all are evaluable for response and toxicity. Pt characteristics: 79% male; 94% with ECOG performance status 0/1; median age 60 yrs (34–84), 32 pts (80%) were previously untreated. Overall response rate is 25% with 1CR and 9 PR. The projected median time to progression (TTP) and survival are 6.2 and 7.8 mo respectively. Dose modifications were required in 9%. Median cycles administered 4 (range 1–10). Grade 3/4 adverse events include: diarrhea (13%), hand-foot syndrome (13%), dehydration (6%), abd pain, anorexia, fatigue, febrile neutropenia, gastric ulcer, hyperglycemia, vertigo, and vomiting (3% each). Conclusion: The combination of D and C is well tolerated and active. The preliminary TTP (6.2 mo) and survival (7.8 mo) compare favorably with published regimens for 1st line therapy, but did not meet study endpoint. The combination of D and C is an easily administered outpatient regimen for AGA and AGEA and may be worthy of further investigation with a targeted agent. (Funded by Sanofi-Aventis and Roche Pharmaceuticals). No significant financial relationships to disclose.
Effect of complementary alternative medical (CAM) therapy on pain and fatigue in pancreatic cancer patients
Authors: Birdsall T. C. , Levin R. D. , Alschuler L. , Daehler M. , Birdsall S. M. , Martin J. , Dounaevskaia L. , Lis C. G. , Braun D. P. 
Published: March 2020

15142 Background: Pain and fatigue are frequent, difficult to manage, and negatively impact quality of life (QOL) in pancreatic adenocarcinoma patients (PCpts) causing some to seek CAM therapy in place of or in conjunction with conventional analgesics. But the efficacy of CAM on pain and fatigue has not been adequately tested in controlled trials. We employed an alternative strategy by abstracting pain and fatigue scores from the EORTC-QLQ-C30 questionnaire administered to PCpts treated at Midwestern Regional Medical Center, an integrative oncology center offering conventional and CAM treatment. Methods: 50 PCpts treated with chemotherapy and/or radiation clinically appropriate for advanced PC + CAM were evaluated. The CAM group (n=36) had 70%, 11%, and 19% and the nonCAM group (n=14) 71%, 14%, and 15% Stage IV, III, and II tumors respectively. PCpts received narcotic and anti-inflammatory agents consistent with ASCO and NCCN guidelines. CAM treatments included Green Tea Extract; Melatonin; and high-potency multivitamins. Baseline, 3 month(M), and 6M data were analyzed. Results: Median baseline, 3M and 6M pain scores were: 50; 0; 33.3 and 75; 16.6; 83.3 for CAM and nonCAM respectively; not significant (NS) CAM vs nonCAM at any time point by non-parametric tests. Pain control at 3M was improved significantly vs baseline levels for each cohort; p=0.02 (CAM) and 0.03 (nonCAM) by paired 2 tail t tests. The relative numbers of PCpts with manageable pain (≤ 33) were comparable for CAM vs nonCAM at baseline (41% vs 36%) and 3 M (81% vs 90%), but not at 6M (67% vs 22% CAM vs nonCAM respectively, (p<0.05 by ?2 test). Median baseline, 3M and 6M fatigue scores were: 55.5; 33.3; 33.3 and 44.4; 33.3; 66.6 for CAM and nonCAM respectively (NS, CAM vs nonCAM at any time point). By paired 2-tail t tests, 3M (p=0.01) and 6M (p=0.02) values were improved significantly vs baseline in CAM but not nonCAM cohorts. Conclusion: This exploratory study shows that CAM treatment may improve fatigue and extend the period of effective pain control by conventional analgesics in PCpts. Given the negative impact exerted by pain and fatigue on QOL in this difficult to manage malignancy, CAM treatment appears to have efficacy for PCpts. No significant financial relationships to disclose.
Efficacy of sequential use of docetaxel / 5-fluorouracil / cisplatin as first-line, and irinotecan/levofolinate/5-fluorouracil as second-line chemotherapy for advanced gastric cancer
Authors: Sugiyama K. , Ishikawa A. , Sato H. 
Published: March 2020

15150 Background The prognosis for advanced gastric cancer (AGC) is extremely poor, and efficacy of chemotherapy is limited with median survival times of around 9 months. Recently docetaxel (DOC) and irinotecan (CPT-11) seem to be effective for AGC as well as 5-fluorouracil (5-FU) and cisplatin (CDDP). This study was performed to evaluate the efficacy of combination chemotherapy including sequential administration of these all key drugs. Methods Patients (pts) with AGC were treated with the chemotherapy consisted of DOC / 5-FU / CDDP (DOC 50mg/m2 d1 + 5-FU 330mg/m2/bolus d1–4 + CDDP 9mg/m2 d1–4; q4weeks or DOC 50mg/m2 d1 + 5-FU1320mg/m2/48-h infusion over d1–2 + CDDP 18mg/m2 d1–2; q3weeks) as 1st-line until disease progression and/or unacceptable toxicity. 2nd-line therapy was included CPT-11 / levofolinate (l-LV) / 5-FU combination (CPT-11 90mg/m2 d1 + l-LV 75mg/m2 d1 + 5-FU 330mg/m2/bolus d1 followed by 1400mg/m2/46-h infusion over d1–2; q2weeks or CPT-11 30mg/m2 + l-LV 35mg/m2 + 5-FU 330mg/m2/bolus d1,8,15,22; q6weeks). Toxicities and efficacy were evaluated according to the CTCAE v3.0 and the RECIST guidelines. Time to progression (TTP) and overall survival time (OS) was measured from the date of diagnosis. Results Ten pts (4 unresectable stage IV diseases, 6 postoperative metastatic diseases) were enrolled between May 2004 and October 2006. Median age was 72 years. Pts with ECOG PS 1/2 were 8, PS 3 were 2. Metastatic sites were liver 6, peritoneum 3, lymph nodes 5. Histological types were papillary/tubular 2, poorly/mucinous/signet ring 4, mixed 4. Median administered number of cycles were 4.5 for 1st-line, 3.5 for 2nd-line. Toxicities were tolerable, and all pts received 1st-line therapy until disease progression. Objective response rate was 20.0% (2PR, 8 SD). TTP ranges 4.4–14.0 months for 8pts (2pts remained SD). Median OS were not reached, and median observation time was 11.7 months (range; 2.9- 28.0 months) at the date of 31 Dec 2006. Conclusions DOC / 5-FU / CDDP combination as 1st-line, CPT-11 / l-LV / 5-FU combination as 2nd-line treatment appears active against AGC and improve the survival, without severe toxicity. No significant financial relationships to disclose.
First-line paclitaxel and cisplatin in patients with advanced squamous-cell carcinoma of the esophagus
Authors: Zhang X. , Shen L. , Li J. , Li Y. , Li J. , Jin M. L. 
Published: March 2020

15157 Objectives: To evaluate response rate, survival and toxicities of paclitaxel/cisplatin combination in patients with advanced or metastatic squamous-cell carcinoma of the esophagus. Methods: Thirty-nine patients with definite measurable indices and no prior chemotherapy were enrolled. Patients were treated with paclitaxel 175 mg/m2 by 2-hour infusion day 1 and cisplatin 75 mg/m2 infusion day 1. Treatment was repeated every 21 days. Results: Thirty-nine patients were enrolled. 35 patients were eligible to be evaluated for response. The overall response rate was 48.6% (95% confidence interval [CI], 0.31∼0.65) with complete and partial response rates of 2.8% and 45.7%, respectively. The median time to progression(TTP) was 7 months, and median survival time of all patients was 13 months. There was a significant difference in median overall survival between the patients who had received responding versus those who had not (p = 0.006). Median survival was 17 (95% CI, 11.9–22.0) and 10 months (95% CI, 7.6–12.35) for responding patients and non-responding patients, respectively. The 1-yr survival probability was 39%. Relief of dysphagia and pain were observed in 86.2% of the all patients. The most common toxicities were neutropenia and alopecia. There were no grade 4 clinical toxicities and treatment-related deaths were recorded in all patients. Conclusions: Paclitaxel and cisplatin is a promising treatment for patients with squamous-cell carcinoma of the esophagus. The toxicity of this regimen is within acceptable range. No significant financial relationships to disclose.
The role of adjuvant chemoradiotherapy (CRT) in Turkish patients with gastric carcinoma
Authors: Gumus M. , Dane F. , Kaya S. , Ozturk M. A. , Yumuk P. F. , Atasoy B. M. , Basaran G. , Salepci T. , Yaylaci M. , Turhal N. S. 
Published: March 2020

15159 Background: Increased disease free and overall survivals were seen in curatively resected patients with gastric and gastroesophageal adenocarcinoma treated with postoperative adjuvant CRT compared to surgery alone. There is no study analyzing the outcome of gastric cancer patients who received adjuvant CRT after curative resection in Turkish patients. Thus, we aimed to analyze the treatment outcome of postoperative CRT, and the prognostic significance of various parameters in these patients. Material Metod: Overall 130 patients with gastric cancer staged IB to IV(M0) were treated with chemoradiotherapy after curative resection, in two outpatient clinics in Istanbul. The chemotherapy consisted of fluorouracil 425 mg/m2 plus leucovorin 20 mg/m2 for 5 days, followed by 4500 cGy of radiotherapy for 5 weeks with fluorouracil (400 mg/m2) and leucovorin (20 mg/m2) on the first 4 days and the last 3 days of radiotherapy. Two 5-day cycles of chemotherapy with the doses used in the first cycle were given 4 weeks after the completion of radiotherapy. The demographic features and histopathological characteristics of the patients were analyzed as prognostic factors. Results: The median follow up was 13 months (range: 1–77) starting from surgery date. The median age was 58 years (range:33–75). About 28 % of the patients were female. ECOG performance score (PS) was =1 in 92.9 %, whereas it was 2 in the remaining 7.1%. Twenty-one patients had gastroesophageal junction and 109 had gastric primaries. The rates of T1, T2, T3, and T4 tumors were 3.8%, 26.9%, 61.5%, and 7.7%, respectively. A hundred and nine (83.8%) patients had regional node involvement. The 3 year disease free survival and overall survival for all patients were 50.1%, and 61.7%, respectively. The median overall survival was 54 months. In multivariate Cox regression analysis; nodal status (p: 0.003) was the only independent prognostic factor for overall survival. Tolerance was acceptable, and the main toxicity was related to gastrointestinal system. Conclusion: The adjuvant CRT after curative resection of gastric cancer was feasible, with acceptable toxicities in our Turkish patient population. No significant financial relationships to disclose.
Gastrointestinal stromal tumors: A monoinstitutional experience
Authors: Di Battista M. , Pantaleo M. A. , Astorino M. , Brandi G. , Saponara M. , Di Scioscio V. , Santini D. , Castellucci P. , Catena F. , Biasco G. 
Published: March 2020

15161 Background: Optimal management of GIST pts required a multidisciplinary approach. Novel tyrosine kinase inhibitors provide an improvement of disease treatment. Methods: We report the clinical results of 67 pts treated in our institution from January 2003 to October 2006, including 41 men and 26 women. Their ages ranged from 28 to 86 yrs (mean 65). 24% of pts were classified into low risk categories, 22% intermediate risk, 54% high risk. At diagnosis, 53/67 patients (79%) presented a localized disease and underwent to surgery, and 14/67 patients (21%) patients presented a metastatic disease. Among these 14 metastatic patients, 8 underwent to surgical removal of primary tumor and metastatic site before treatment with imatinib (2 patient R0) and 6 patients were inoperable at diagnosis and received treatment with imatinib. In total, 61/67 (91%) of patients underwent surgery, R0 resection was achieved in 51 patients. Among 61 operated patients, 24 patients developed a recurrence and received medical treatment with Imatinib. In total, 30/67 (44,7%) patients were treated with Imatinib, and 27 were enrolled in a clinical studies of second line treatment with Sunitinib because of progression or intolerance to treatment with Imatinib. Results: After a follow-up of 42 months we report a median DFS of 14.5 months for radically operated patients. The 3 year-DFS rate was 28.6%. The differential analysis according to risk showed a median DFS of 16.5 months with 16.7% of pts disease free at 3 yrs for the high risk category (36 pts); in the low-intermediate risk categories (31 pts), a median DFS of 21 months with 38% of patients disease-free at 3 yrs was observed. Considering all 38 metastatic pts, 14 at diagnosis and 24 with recurrence, a progressive disease was seen in 94% (median 12 months). In first line of treatment with Imatinib we recorded a median TTP of 17 months with 30% of responders after 2 yrs of treatment. Conclusions: Surgery remains the only curative treatment for localized disease. imatinib is the standard of care for patients with metastatic Gist. For imatinib-resistant GISTs a novel agent such as Sunitinib appears promising. No significant financial relationships to disclose.
A single institution experience with neuroendocrine tumors
Authors: Badari Badari A. , Javle M. , Pak Y. , Khoury T. , Ramnath N. , Gibbs J. , Kuvshinoff B. , Iyer R. 
Published: March 2020

15164 Background: ABSTRACT Introduction: . The aim of this study was to analyze demographic, therapy, tumor and clinical outcomes of all cases of neuroendocrine cancer at a tertiary cancer and determine the the markers that may better correlate with outcomes than histologic grade. Patients and Methods: With IRB approval , 126 charts with a diagnosis of neuroendocrine carcinoma were identified between 1–1-1999 and 1–1-2004. Ninety-five cases were selected on the basis of complete availability of baseline, therapy and at least one time point of followup data. Patient demographics, therapy details, TNM stage, tumor marker and survival data were collected. Tumors were graded as well, moderate and poorly differentiated and by site of origin. We attempted to correlate the outcome with NCAM(neural cell adhesion molecule-CD56) status, which is a homophylic binding glycoprotein to have a role in cell adhesion. Descriptive statistics and frequency tables were used to describe the data and kaplan meier methods were used to estimate the median survival. Results: There were 28 patients with lung primaries, 25 had primaries in the gut (extra pancreatic),11 had pancreatic primaries, 31 cases had unknown primaries or primaries at sites other than the lungs or the gastrointestinal tract. The estimated median survival for the whole sample was 34 months.(95% C I :20,54) and the 2 year survival rate was 55.3 %.The estimated median survival for CD56 positive group was 11 months(95% C.I :3,38) and that for CD 56 unknown group was 36(95% C .I :20,n/a). A significant difference in survival between CD56 positive group and CD56 unknown was found,based on log-rank test>(P=.02). Baseline characteristics were as follows: M:F 48:47; 19 were well differentiated, 4 were moderately differentiated and 36 of 95 tumors were poorly differentiated, the differentiation was not known in 36 cases. Surgery with curative intent was done in 52 of the patients(54.74%) and 52 received (54.74%)t chemotherapy, 4 patients(4.2%) received chemoembolization and 2 patients(2.1%) received local ablative treatments. Conclusion: These data summarize our instutions experience with this rare malignancy. In our data survival was as expected in the literature and further investigation of the CD 56 status of all patients is underway. No significant financial relationships to disclose.
Consequences of modifying an adjuvant treatment protocol for resected gastric carcinoma: A retrospective study at a single institution in western Canada
Authors: Bebb D. G. , Ziouzina O. , Lupichuk S. , Stefaniuk M. , Dowden S. , Chan A. , Walley B. , Chan S. , Wong A. , Doll C. 
Published: March 2020

15176 Background: Gastric adenocarcinoma has a poor outcome: surgical resection alone in stage IA-IVA is curative in < 30%. Adjuvant chemo-radiotherapy (INT-0116 protocol) increases median overall survival from 27 to 36 months but is associated with high morbidity with many patients requiring protocol modifications to complete treatment. The benefit of modified protocols in this setting has not been well studied. We set out to compare the morbidity and mortality of the INT-0116 protocol with that of modified protocols in a single institution in Western Canada. Methods: We conducted a retrospective review of stage IA-IVA gastric adenocarcinoma patients treated with adjuvant chemo-radiation at our institution after curative-intent surgical resection. Patients were identified from Tom Baker Cancer Centre records. End points were: survival, completion of therapy, local, regional and distant failure. The modified protocol was defined as: combined modality component postponed from the second to the third or fourth chemotherapy cycle or radiation given alone after two or three cycles of chemotherapy. Results: Twenty three consecutive patients were identified; 11 received standard protocol, twelve a modified protocol. Demographic characteristics / staging at resection of those two groups did not significantly differ. Outcomes are summarized in Table 1 . Conclusions: Many patients were unable to complete the INT-0116 protocol as described, while patients placed on a modified protocol had a greater chance of completing treatment. Survival at 12 and 36 months in patients treated with the modified protocol was at least as good as those who underwent the standard protocol. This limited study at a single institution suggests that modifying the INT 0116 protocol can make this treatment more palatable to patients while not compromising outcome. Further research is warranted. Data on a further nine patients more recently treated is being analyzed and will be presented. [Table: see text] No significant financial relationships to disclose.