bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of optimal (<1cm) surgical debulking on survival at the time of recurrence in patients with uterine leiomyosarcoma (LMS)
Authors: Martino M. A. , Patrick K. , Wenham R. , Palmer J. , Cantor A. , Twitty P. , Rajaram L. , Lancaster J. , Hoffman M. S. 
Published: March 2020

16067 Objective: Uterine leiomyosarcoma (LMS) is an uncommon female malignancy with limited treatment options. To evaluate whether there exists a role for surgery at the time of recurrence, we performed an outcomes analysis from over 25 years of treating LMS at a single institution. Methods: Patients with uterine leiomyosarcoma who presented for treatment at the H. Lee Moffitt Cancer Center from 1981–2005 were identified from the cancer registry database. Patients who underwent surgery (with or without adjuvant treatment) at the time of first recurrence were compared to those patients who did not undergo surgery and were managed medically. Cox regression analysis (multivariate) was used to evaluate whether demographic or pathologic characteristics were associated with survival. Survival curves were estimated using the Kaplan-Meier method and p-values with 95% confidence intervals were generated using the log rank test. Results: Forty-six charts were reviewed to identify forty-one patients with leiomyosarcomas arising from the uterus and treated during 1981–2005. Of the forty-one patients identified, only 7% (N=3) are currently in remission, with a mean follow-up of 40 months from the time of first recurrence. Sixteen patients underwent surgery at the time of first recurrence, with 60% (N=10) of these patients having an optimal cytoreduction (<1cm). On multivariate analysis, post-menopausal status (p=0.011), the presence of tumor necrosis (p=0.038) and high pathologic grade (p=0.056) were significant variables associated with decreased survival. Median survival for optimally cytoreduced patients compared to patients medically managed patients was 55.5 months and 20 months, respectively. A trend towards improved survival in the optimally cytoreduced group was suggested but was not statistically significant (P=0.26) Conclusions: Uterine leiomyosarcoma is a disease with a poor prognosis and a high likelihood of recurrence. We have identified post-menopausal status, tumor necrosis, and pathologic grade as significant predictors of survival. Given the limited treatment options available and with a suggested trend toward improved survival, cytoreductive surgery at the time of recurrence may be worthy of future investigation. No significant financial relationships to disclose.
The expression of P-gp, Bcl-2 and VEGF in epithelial ovarian carcinoma and their significance
Authors: Gang W. , Luo F. , Li G. L. , Cheng J. , Shi X. 
Published: March 2020

16075 Background: To investigate the expression of P - gp,Bcl-2 and VEGF in epithelial ovarian carcinoma as well as their significance. Methods: Expression of P- gp,Bcl-2 and VEGF were examined in 72 epithelial ovarian carcinoma by immunohistochemisty (method of S - P) . Results: The positive expressions of P - gp,Bcl-2 and VEGF in patients with ovarian carcinoma were 51.4%,54.2%,56.9% respectively .Compared with those in ovarian benign tumors and normal controls, such expression level were significantly higher ( P < 0.05). The expression of P - gp was positively correlated with the expression of VEGF( P <0. 05) while the expression of VEGF was positively correlated with the expression of Bcl-2 ( P <0. 05). Univariate analysis showed worse disease-free survival in the patients with positive expression of P-gp or VEGF than in those with negative expression of P -gp or VEGF( P < 0. 05). Multivariate analysis of clinical and pathological data by Cox-regression method showed that the expression of P - gp or VEGF and co- expression of these three indexes were correlated with poor prognosis. Conclusions: Over-expression of P - gp,Bcl-2 and VEGF is correlated with drug resistance of clinical chemotherapy and survival rate in ovarian cancer . To examine these 3 indexes in ovarian cancer is helpful to evaluate response to clinical chemotherapy as well as to predict the prognosis. No significant financial relationships to disclose.
Concurrent platinum-based chemotherapy with intensity modulated radiation therapy (IMRT) for locally advanced squamous cell carcinoma of the head and neck (SCCHN): A retrospective single institution analysis
Authors: Saba N. F. , Gaultney J. , Edelman S. , Tighiouart M. , Davis L. W. , Khuri F. R. , Chen A. , Grist W. , Shin D. M. 
Published: March 2020

16511 Background: Randomized clinical and meta-analysis data support the use of concurrent chemoradiation for treatment of locally advanced (SCCHN). IMRT is increasingly being used in treating SCCHN. We present outcome data from Emory University Winship Cancer Institute (WCI) with concurrent platinum based chemotherapy and IMRT, and analyze results according to primary site and nodal status. Methods: Between February 2003, and November 2005, 87 patients with locally advanced SCCHN underwent concurrent IMRT and platinum based chemotherapy. A total of 62 patients were treated with Cisplatin 100 mg/m2 d1,21,43, while 19 were treated with paclitaxel and carboplatin weekly for 7 weeks. Five patients were treated with other platinum based regimens. Follow up was documented in all cases with a median of 520 days (range 107 - 1269 days). Results: Patients were distributed among primary sites as follows: Hypopharynx (HP) 7 (8.0%), Larynx (L) 11(12.4%), Nasopharynx (NP) 13 (14.6%), and Oropharynx (OP) 56 (63.0%). T stage distribution was: T1: 16 patients (18.0%); lesions more advanced than T1 (>T1): 68 (76.4%). N stage distribution was, N0 :16 patients (18.0%), N1: 8 (9.0 %),nodal stage N2a or higher: 61 (68.5%). Median age was 57 years (range 32–75), and 63 patients (71.0%) were male. The median overall survival (OS) and disease-free survival (DFS) post-therapy was not reached. The 3 year OS rate for the entire cohort was 86% (L 82%, NP 89 %, OP 86 % HP 80%). The 3 year DFS rate for the entire cohort was 74%, (L 85%, NP 60%, and OP 75%, HP 76%). There was no correlation between OS and T or N stage (p=0.143 and 0.44 respectively), or between DFS and T-stage (p=0.4). A significant correlation was found between DFS and N stage (p=0.008). Conclusion: With moderate follow up, this retrospective analysis reveals an excellent outcome for patients with locally advanced SCCHN treated with chemotherapy and IMRT concurrently, supporting concurrent therapy as the current standard of care. The significant correlation of DFS and nodal status suggests a possible greater impact future approaches such as induction therapy may have on patients with advanced nodal disease. No significant financial relationships to disclose.
MR-sialography as functional separate imaging of salivary gland for evaluation of radiation-induced xerostomia
Authors: Yokokawa M. , Uchida N. , Wada A. , Kawaguchi A. , Notani M. , Kitagaki H. , Uchida K. , Hara S. 
Published: March 2020

16522 Background: For head and neck cancer (HNC) patients who receive curative irradiation (RT), RT-induced xerostomia is a frequent and troublesome adverse event diminishing quality of life. In this prospectve study, morphological changes in salivary glands were evaluated by means of MR volume calculation and examination of the functional changes in MR-sialography as compared with subjective symptoms. Materials and Methods: Sixteen HNC patients (15 squamous cell carcinomas and 1 lymphoma) scheduled to receive more than 44 Gy to the primary tumor were registered (median dose to salivary glands: 60 Gy). MRI was performed prior to start of RT (pre-RT), as well as 2–4 weeks after completion of RT (post-RT). Evaluations were undertaken as follows: 1) Subjective symptoms of oral dry sensation were scaled by visual analogue scale (pre-RT VAS, post-RT VAS); 2) Changes in depictions of MR-sialography (heavy T2WI) following tartaric acid stimulation were graded into three categories (good,fair, poor); and, 3) Changes in salivary gland volume were measured as reduction ratio(%) = (pre-RT volume - post -RT volume) / pre-RT volume × 100. Results: Post-RT VAS of oral dry sensation was greater than that of pre-RT (p=0.001). Clinical symptoms (changes in VAS) did not correlate with salivary gland reduction ratio nor radiation dosage for either the parotid (PG) or submandibular glands (SG). RT dosage and reduction ratio correlated well (r=0.62). Reactivity of MR-sialography stimulated by tartaric acid became poor after RT. The mean RT dosages to PG and SG of the poor group were higher than those of the good group (p<0.05). Conclusions: MR-sialography after RT showed a poor response to secretion stimulation, which correlated with RT dosage. Moreover, MR- sialography with secretion stimulation may have the potential to be a non-invasive and sensitive method by which to assess the severity of xerostomia of each gland separately as ‘functional MR - sialography‘. More cases and longer follow up, and dose-volume histogram evaluation of each salivary gland are required to confirm the results. No significant financial relationships to disclose.
Pilot phase I study of gefitinib (GEF) in combination with paclitaxel (PAC) and radiation therapy (RT) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) and effects on epidermal growth factor receptor (EGFR) signaling pathway
Authors: Morris J. C. , Allen C. , Citrin D. , Gius D. , Chen Z. , Colevas A. D. , Harold N. , Rudy S. , Singh A. K. , VanWaes C. 
Published: March 2020

16526 Background: The over expression of EGFR in HNSCC stimulates tumor cell proliferation, inhibits apoptosis, and increases resistance to chemotherapy and radiation. We examined the toxicity and maximum tolerated dose (MTD), and the downstream signaling and cellular effects in tumor biopsies in locally advanced HNSCC patients (Pts.) treated with GEF+PAC and RT. Methods: Pilot phase I dose escalation study initiated at GEF 250 mg/d + PAC 45 mg/m2 weekly x 6 with concurrent RT to 72 Gy. Eligibility: Stage III-IVB HNSCC, age=18 years, no prior RT or chemotherapy, ECOG =2, adequate organ function and informed consent. Endpoints: MTD determination, analysis of tumor biopsies for treatment effect on phospho-EGFR, Akt, Erk1/2, STAT3, NF-κB p65, Ki67 expression, TUNEL assay, serial measurement of serum IL-6, IL-8, VEGF, HGF and GROa. Results: 10 Pts., median age 60.7 yrs. (range, 41–83), 7 men and 3 women were treated. The MTD was GEF 250 mg/d + PAC 36 mg/m2 weekly x 6 with concurrent RT. Grade 3/4 toxicities included prolonged (>8 wk duration) mucositis in 7 Pts., infection (1) and interstitial pneumonitis (1). Two Pts. experienced protracted painful oral dysesthesia. There were 5 CR's and 1 PR. Of 7 Pts. undergoing serial biopsy, 1 Pt. showed a significant decrease in phosphorylated-EGFR expression, decreased downstream phosphoprotein signaling and cellular proliferation within 8 days of initiating GEF. Conclusions: Severe and prolonged mucositis was dose-limiting for this schedule of GEF+PAC and RT in locally advanced HNSCC. Inhibition of EGFR activation and downstream signaling by GEF was observed in a minority of Pts. on serial tumor biopsy specimens obtained during treatment. No significant financial relationships to disclose.
Role of surgery in the management of carcinoma larynx and hypopharynx
Authors: Varghese B. T. 
Published: March 2020

16528 Background: With the advent of chemoradiation the role of surgery in management of cancer of larynx and hypopharynx has come down considerably. Aim: To evaluate the overall outcome of surgery for carcinoma of the larynx and hypopharynx, with a view to establish its role in management of cancer of larynx and hypopharynx. Patients and Methods: All patients who have undergone laryngectomy at the Division of Surgical Oncology RCC from June 1995 to Dec 2005 were included in the study which retrospectively recorded the age and sex distribution TNM staging, the indications and types of laryngectomy, and reconstructive options used. The influence of preoperative chemotherapy, radiotherapy, and tracheostomy, systemic illness like diabetes melletus and COPD on the surgical outcome was assessed. Results: The ages of the patient ranged from 23 years to 75 years with a mean ± s.d of 55 ± 9.5 years. Out of a total of 167 cases, 123 (74%) cases had salvage surgery for failed chemo RT/Radical RT and 44 (26%) had primary surgical treatment. Conservation surgery was undertaken in 4 cases, Near total laryngectomy/laryngopharyngectomy (NTL/NTLP) was done in 14, Total laryngopharyngo esophagectomy (TLPE) with gastric pull up was done in 5 and total laryngectomy (TL) or TL with partial or subtotal pharyngectomy was done in 142 cases. 62 (37 %) patients had postoperative leaks, 5 leaks persisted to form pharyngocutaneous fistulae. 2 were repaired and in 2 cases speech prosthesis insertion was possible due its anatomical position. 1 patient refused further surgical closure after a previously failed repair. Fifty-six (34%) patients recurred locoregionally. Four (2.3%) patients developed second primary and 5 (2.9%) had distant metastasis. Wound infection, previous radiation and diabetes melletes were the predominant predisposing factors for the leaks and wound related complications were the commonest cause for prolongation of postoperative hospital stay. Seventy-nine patients were alive at the time of study. Conclusions: Hypopharyngeal cancers warrant a closer follow up after an organ preservation protocol, to detect recurrence at the earliest and plan for an effective salvage surgery. No significant financial relationships to disclose.
Predictors of toxicity to concurrent chemoradiation (CRT) in patients (pts) with locally advanced head and neck squamous cell cancer (HNSCC)
Authors: Yelamanchili R. , Hotte S. , Julian J. , Wright J. 
Published: March 2020

16540 Background: A number of studies have evaluated the impact of prognostic factors on survival but very few have studied their role as determinants of toxicity, especially outside of the context of clinical trials. We set out to identify patient characteristics that are likely to predict toxicity to chemotherapy (CT) with daily cisplatin 6mg/m2 and radiation therapy (RT) in pts with locally advanced HNSCC. Methods: Retrospective chart review of above pts at the Juravinski Cancer Center from 2000 through 2004. A number of pt characteristics were analysed. Toxicity outcomes evaluated were completion of CT and of RT, rise in serum Cr , hematologic suppression, need for extra hydration, and need for extra antiemetics. Results: The charts of 108 pts were reviewed. Median follow-up was 36 months. Five year projected OS and PFS were 78% and 57% in our study compared to 53% and 47% in a published EORTC trial (NEJM, 2004). Median duration of PFS was 64 months in our study compared to 55 months in the EORTC trial. Median OS was not reached in our study. Nineteen percent completed CT and 81% completed RT, 17% had full course of CRT. Thirty-nine percent required extra hydration and 50% required extra antiemetics. Twenty four percent had elevated creatinine levels and 20.4% had hematologic suppression. Logistic regression was used to search for significant correlations between pt characteristics and outcomes. Pts with occasional alcohol intake were more likely to complete RT than heavy alcohol abusers (OR 8.9; P 0.04). Pts with occasional alcohol intake were more likely to get extra hydration than heavy alcohol abusers (OR 5.1; P 0.008).Hematologic suppression was more likely with increasing age (OR 1.08;P 0.015).No significant difference in toxicity outcomes was observed between males and females. Conclusions: This review demonstrated that CRT with daily cisplatin is associated with significant toxicity and most pts are unable to receive full treatment . A number of pt variables might predict increased susceptibility to toxicity. This should be validated in a prospective study. Median PFS in our series appear to be at least as good as previously published reports of CRT using daily cisplatin as well as dose schedules but toxicity does not appear greatly reduced. No significant financial relationships to disclose.
Significance of stress myocardial perfusion scans in predicting cardiovascular events and mortality in cancer patients
Authors: Chandra S. , Tong A. T. , Wei Wei A. , Yusuf S. W. , Javaid S. , Liu D. , Durand J. , Lenihan D. J. 
Published: March 2020

17009 Background: Cardiac risk assessment in cancer patients has not extensively been studied. We evaluated the role of stress myocardial perfusion scan (SMPS) in predicting cardiovascular outcomes in cancer patients. Methods: A retrospective chart review was performed on 787 patients who had a SMPS from 01/2002 - 03/2003. All patients were followed for at least 1.5 years. Cox proportional hazard model was used to determine the time-to-first event [cardiac death, myocardial infarction (MI) and coronary revascularization]. Cardiac death was defined as documented cardiac death or sudden unexplained death. Results: A total of 501/787 (64%) patients had normal SMPS, whereas 286/787 (36%) had abnormal SMPS. Adenosine [430/787 (55%)] and dobutamine [144/787 (14%)] were used for chemical stress while 213/787 (23%) patients underwent exercise testing. Mean age was 66±11 years and median follow-up duration was 1.8 years. The 3- year event-free survival rate was 0.71 (0.64–0.78) for abnormal SMPS and 0.87 (0.8–0.94) for normal SMPS (p<0.0001). Of all abnormal scans (n=286), 3-year event free-survival rate based on type of vascular defects varied from 0.79(0.67–0.93) for fixed defects, 0.68 (0.58-.08) for reversible defects and 0.63 (0.5–0.8) for co-existent fixed and reversible defects (p<0.0001). Other factors adversely affecting event-free survival were male gender (p=0.025), cardiomyopathy (p=0.001), coronary artery disease (p<0.0001), previous MI (p<0.0001), congestive heart failure (p=0.001) and hypercholesterolemia (p<0.0001). When we analyzed cardiac death as a separate event, SMPS results still made a significant difference with 3-year cardiac-survival rate of 0.79 (0.69–0.91) for abnormal scan group versus 0.88 (0.81–0.95) for normal scan group (p=0.05). Furthermore, the 3-year cardiac-survival rate in patients with both fixed and reversible defects was 0.4 (0.1–1), which was much worse than those with fixed [0.87 (0.76–0.99)] or reversible [0.85 (0.74–0.99)] defects alone (p=0.028). Conclusions: SMPS is a highly useful modality for predicting cardiac events and mortality in cancer patients. The characteristics of the perfusion defect further stratifies the patients at higher risk. No significant financial relationships to disclose.
Access to care and patient satisfaction for surgically-treated breast cancer
Authors: Porter G. A. , Murdoch J. M. , Inglis K. M. , Veugelers P. J. 
Published: March 2020

17010 Background: Although recent studies have described timeliness of breast cancer (BC) care and its impact on outcomes, there is little data on patient perception of timeliness. This study examined the association between clinicodemographic factors, timeliness and patient satisfaction for surgically-treated BC patients across defined intervals of diagnosis (Dx) and treatment. Methods: All patients undergoing surgery for primary BC within a single Health District over 24 months were enrolled in a prospective consecutive cohort study. A comprehensive, standardized method of ascertaining specific time intervals, including a patient interview, was used to quantify the timeliness of presentation, Dx and treatment. A validated satisfaction questionnaire was applied to patients 2 weeks after surgery, and following chemotherapy. Multiple linear regression, using the natural logarithm of the time interval as the dependant variable, was performed to examine the association of factors and satisfaction with specific time intervals. Results: Among the 519 patients in the study, 317 (61%) were screen-detected and 202 (39%) presented symptomatically. Complete satisfaction questionnaire responses were obtained in 348 (67%). The median time intervals in days (interquartile range) were: abnormal screen to Dx - 33 (21–48); symptoms to Dx 44 (23–97); Dx to surgery - 31 (22–43); surgery to adjuvant chemotherapy 63 (49–73). On multivariate analysis, the interval from presentation (either abnormal mammogram or symptoms) to Dx was 33% longer for screen-detected patients (p<0.0001) and 38% longer for patients where more than one diagnostic test was performed (p=0.009). Moderate correlation was identified between patient satisfaction and both the intervals from presentation to Dx (r2=0.212;p<0.0001) and from Dx to surgery (r2=0.262;p<0.0001). Controlling for the length of these intervals, younger women (p=0.01) and those with a Dx made via screening (p=0.004) had significantly lower satisfaction scores. Conclusions: The timeliness of care for BC involves several defined components; variations in the relatively short interval from Dx to surgery appeared to have most impact on patient satisfaction. Younger women and those diagnosed via screening were less satisfied with their access to timely care. No significant financial relationships to disclose.
Communication about physical activity in an underserved patient population
Authors: Carroll J. , Epstein R. , Fiscella K. , Jean-Pierre P. , Figueroa-Moseley C. , Morrow G. 
Published: March 2020

17012 Background: Promoting physical activity may help reduce the incidence of several cancers. The 5A model, used to promote other patient behavior changes in clinical practice, may be applicable to physical activity. Our goal was to determine clinicians’ use of the 5A (Ask, Advise, Agree, Assist, Arrange) guidelines when communicating about physical activity and cancer risk with an underserved patient population. Methods: Analysis of 50 audiotaped transcribed office visits with adult patients and their clinicians in two community health centers in Rochester, NY. We conducted post-visit interviews to assess patient recall of communication about physical activity.We used descriptive statistics to assess patient demographics and the frequency of each of the 5As occurring in the audiotaped visits. Analysis of the transcripts of the visits explored other contextual factors related to use of the 5As for communication about physical activity and cancer risk. Results: Patients were predominantly female (70%) and were African American (50%), Caucasian (35%) and other/mixed ethnicity (15%). In the 50 office visits, there were twelve (24%) Ask, twelve (24%) Advise, three (6%) Agree, two (4%) Assist, and one (2%) Arrange statement. Physical activity communication was mostly (92%) clinician-initiated; the only discussion which included all 5As was patient-initiated. No discussion linked physical activity to cancer risk or cancer prevention. Patients recalling the most communication about physical activity with their clinician reported that it was contextualized to their specific health needs, included support and encouragement, and consisted of clear, simple advice. Conclusions: Communication about physical activity incorporating the Agree and Arrange steps of the 5As was infrequent. Cancer prevention interventions should target these steps and prompt the patient to initiate communication to improve physical activity in underserved populations. This project was supported by a grant from the National Cancer Institute, R25- CA102618. No significant financial relationships to disclose.