bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of leucovorin on radiation-induced brain injury and tumor radiosensitivity in patients of NPC: A retrospective analysis.
Authors: Liang ZiBin , Wang Siyang , Yang Shuai , Long Feiyu , Jiang Lifeng , Zou Yanfei , Pan Jinmei , Lin Zhong , Cheng Zhibin 
Published: May 2020

e18552 Background: Nasopharyngeal carcinoma (NPC) is a typical type of head and neck cancers with its high prevalence areas in Southeast of China. On account of the prolongation of life, the severe complications developed such as radiation encephalopathy (REP). Currently many methods are used to cure REP but the outcomes are limited, such as corticosteroids, hyperbaric oxygen, antiplatelet agents and so on. The aim of this study is 1) to evaluate the protective effect of Calcium leucovorin (LV), a reduced folic acid, on REP in NPC patients. 2) to investigate the progression-free survival (PFS) and overall survival (OS) in NPC treated with or without LV. Methods: We conducted a retrospective, observational cohort study using de-identified, curated data in the Fifth Affiliated Hospital of SYSU included 1075 patients diagnosed as NPC of Stage II, III, or IVa who had been treated from December 2002, through February 2014. The Leucovorin-Group (LV-Group) of 163 NPC patients were matching the preceding criteria and agreed to receive PFL chemotherapy (cisplatin 80 mg/m², 5-fluorouracil 1000 mg/m²/d, and leucovorin 120 mg/m²) every 3 weeks. The Non-leucovorin-Group (NLV-Group) of 913 patients with similar disease status who did not receive leucovorin during the same period. Histologically there were 260 patients of PF chemotherapy (PF-Group) and 653 patients of other regimen chemotherapy (NPF-Group) in NLV-Group. REP were evaluated according to MRI and CT scan imaging studies. Time to progress (TTP), the real-world local control rate (rwLCR) and OS were compared across the two cohorts using the log-rank test. REP were compared using Chi-Square and Fisher’s Exact Test. Results: The TTP of the LV-Group as compared to the NLV-Group at 3, 5, 8, 10,12 and 16 years were 98.96% vs 94.97%, 95.57% vs 90.08%, 92.01% vs 85.22%, 90.67% vs 84.39%, 88.59% vs 84.26% and 88.54% vs 81.06%, respectively. The incident of REP in LV-Group is lower than that of the NLV-Group significantly( P= 0.0413). The OS of LV-Group as compared to PF-Group at 3, 5,10 and 12 years were 97.42% vs. 91.24%, 94.61% vs. 87.44%, 88.74% vs. 81.98%和88.74% vs. 78.57%, respectively. The OS of LV-Group got higher than that of PF-Group ( P= 0.0269). The OS of LV-Group was significantly higher than that of PF-Group with 90.83% vs. 82.12% in stage I-III(P = 0.0348). The rwLCR of LV-Group as compared to PF Group were 97.06% vs. 73.91% in stage T4 ( P= 0.0133). Conclusions: Leucovorin can significantly reduce the incidence of REP of NPC combined with PF regiment. It may improve the tumor radiosensitivity in NPC patients.
Carboplatin versus cetuximab chemoradiation in cisplatin ineligible locally advanced head and neck squamous cell carcinoma.
Authors: Thanikachalam Kannan , Krishnan Jayasree , Siddiqui Farzan , Ali Haythem Y. , Sheqwara Jawad 
Published: May 2020

e18555 Background: Squamous cell carcinomas (SCC) of Head and neck are associated with tobacco, alcohol use and HPV infection. About 60% of patients with head and neck cancers(HNC) are locally advanced on diagnosis. Concurrent chemoradiation (CCRT) is standard of care in inoperable locally advanced HNC(LA-HNC), high risk adjuvant setting and organ function preservation. While cisplatin (CDDP) is the standard of care for CCRT, alternatives are carboplatin alone or cetuximab alone or carboplatin in combination with 5-FU or paclitaxel CCRT in CDDP ineligible setting. Methods: Patients with LA-HNC (SCC), from 01/01/2013-12/31/2018, who were ineligibile for CDDP CCRT and who received either carboplatin or cetuximab CCRT were included. Patients who received induction chemotherapy and had nasopharynx primary were excluded. 68 patients were analyzed to evaluate outcomes in patients who received carboplatin CCRT and cetuximab CCRT. Progression free survival (PFS) and Overall survival (OS) were calculated by Kaplan Meier analysis with SPSS v26. Results: There was a trend toward improved PFS in CarboRT group among oropharynx HNC patients who were P16 Negative(-ve) (59.5 months(m) vs 37.7 m, p value – 0.069). Among oropharynx HNC patients who were p16 positive, there was no statistically significant difference in PFS among CarboRT vs CetuximabRT (45.8 m vs. 39.77 m, p value – 0.51). OS was favorable towards carboRT in oropharynx SCC p16-ve group (59.5 m vs. 40.97 m, p value – 0.41). There was no difference in OS in p16+ve Oropharynx SCC group, who received CarboRT and CetuximabRT (45.74 vs. 45.94 m, p value – 0.77). When patients were analyzed regardless of their p16 status, site or stage, patients who received CarboRT had a higher OS at 56.30 m (95% CI 45.10-67.50%) vs. 38.11 m (95% CI 28.84-47.38%) among patients who received CetuximabRT (p value-0.048). Though PFS clinically favored carboRT group, when compared to CetuximabRT (55.43 m vs. 36.75 m), it was not statistically significant (p value – 0.10). Conclusions: In our analysis, patients who received single agent carboplatin CCRT had higher OS when compared to cetuximab CCRT. Though other outcomes favored carboplatinRT including PFS among entire group and p16-ve group, OS in p16-ve patients, it was not statistically significant, which is likely due to low power. Based on our analysis, for LA-HNC, carboplatin CCRT should be favored over cetuximab CCRT for patients ineligible for CDDP, particularly in P-16 -ve disease. Further randomized clinical trials can shed more data in this reduced intensity regimen.
Lymphnode metastasis patterns in primary sites of hypopharyngeal cancer: A retrospective analysis from multicenter data.
Authors: Zhang Xiwei , An Changming , Sun Ying 
Published: May 2020

e18559 Background: Understanding the pattern of lymph node metastasis (LNM) in hypopharyngeal cancers (HPC) could help both surgeons and radiologists make decisions in the management of cervical lymph node. Our objective is to identify the pattern of nodal spread and the relationship between features of primary tumor and LNM in HPC. Methods: 244 newly diagnosed HPC patients during 2014 to 2017 were recruited from 3 specialized cancer hospitals in mainland China. All patients underwent head and neck magnetic resonance imaging(MRI) and received definitive radiotherapy ± concurrent chemotherapy. The features of primary tumor (tumor size, primary location, and extent of invasion) and the involvement of lymph nodes in each level were reassessed. According to the incidence of LNM, these levels were sequenced and sorted into drainage stations. Meanwhile, univariate and multivariate analysis was used to determine the risk factors for bilateral and regional lymph node metastasis. Results: The cohort consisted 195 piriform sinus cancers (PSC), 47 posterior wall cancers (PWC), 2 Post-cricoid cancers (PCC). 176 patients (72.1%) presented with MRI-detectable LNM. The overall LNM rates for level II-VI and retropharyngeal lymph nodes (RPLNs) were 59.0%, 52.9%, 14.3%, 1.6%, 2.9% and 14.7% respectively. Based on the prevalence of LNM in each level, we suppose that the lymphatic drainage of PSC was carried out in sequence along three stations: Level II & III (61.0% & 55.4%), Level IV & RPLN (15.9% & 10.3%), and Level V & VI(1.5% & 3.1%). While, for PWC the lymphatic drainage is carried out along two stations: Level II, III & RPLN (48.9%,40.4% & 34.0%), and Level IV-VI (6.4%, 0% and 2.1%). According to univariate analysis, primary subsite, posterior wall, post-cricoid and non-pyriform sinus invasion were correlated with bilateral LNM. The presence of RPLNs was correlated with larger tumor size(>4cm), primary subsite, posterior wall and non-pyriform sinus invasion. In further multivariate analysis, posterior wall invasion was significantly correlated with bilateral LNM (P = 0.030, HR = 2.853 95%CI, 1.110-7.338). Tumor size > 4cm(P = 0.017, HR = 2.545, 95%CI,1.180-5.488) and posterior wall invasion(P = 0.017, HR = 2.880 95%CI, 1.209-6.862) were correlated with RPLN metastasis. Conclusions: Different primary sites of HPC have different lymphnode metastasis patterns. Piriform sinus cancer tends to metastasize to the ipsilateral Level II&III. Posterior wall cancer tends to metastasize bilaterally to Level II, III and RPLN.
The role of routine surveillance imaging in detecting oral cavity cancer recurrence in asymptomatic patients.
Authors: Chi Jeffrey , Chung Su Yun , Lopez Carlos Alberto , Frank Douglas K. , Pereira Lucio , Gabalski Edward Z. , Teckie Sewit , Ghaly Maged , Seetharamu Nagashree 
Published: May 2020

e18561 Background: The optimal surveillance approach for patients who were definitively treated for oral squamous cell carcinoma (OSCC) is unclear, but it includes physical exams (PE) and surveillance imaging (SI) studies at intervals that vary amongst institutions. At our institution, patients are seen in office and underwent PE monthly for the first 3-6 months then every 3 months thereafter. SI is performed every 3 months during the first 2 years, every 6 months till year 4, and yearly thereafter. Concerning symptoms or findings resulting from PE or SI may trigger further tests including biopsies as deemed necessary by treating team. In this study, we investigated value of SI in detecting recurrence of OSCC. Methods: Retrospective chart review was performed for the patients who were diagnosed with OSCC from 2014 to 2017 at our institution. Eligible patients included those who underwent definitive treatment (surgery, chemotherapy, radiation) of OSCC with curative intent. Patients without evidence of disease on post treatment imaging were included. Results: Two hundred OSCC patients were treated definitively. 138 (69%) patients had local disease and 62 (31%) patients had regional disease. 183 patients (%) had no clinical evidence of disease on post treatment baseline imaging. Patients who had residual disease on post-to scab were excluded from further analysis. The median follow-up was 29 months. 2-year overall survival was 87.4%. 82 patients underwent biopsy for suspicious findings and 44 patients had confirmed recurrence. 37 (84.1%) of the recurrences occurred in the first two years. 28 (63.6%) of recurrences were local, 13 (29.5%) were regional and 3 (6.8%) were metastases. 31 (70.6%) of patients with disease recurrence presented with clinical symptoms or had suspicious findings on PE. 13 (29.4%) of the recurrences were detected by SI alone (PPV=54.2 %) in asymptomatic patients most of which (92.3%) occurred within first 2 years. Conclusions: Majority of OSCC recurrence were detected due to clinical symptoms or positive findings on PE. However, 29.4% of recurrences were detected by SI alone in asymptomatic patients suggesting a role for SI for the first 2 years post-treatment of OSCC. Larger prospective studies are needed to determine the optimal frequency of SI.
Comparative efficacy of primary treatment approaches in anaplastic thyroid carcinoma (ATC): An updated network meta-analysis.
Authors: Gallagher Kevin M. , Haddad Philip A. , Hammoud Dalia A. 
Published: May 2020

e18566 Background: ATC is a rare tumor accounting for around 5% of all thyroid cancers. With survival measured in months, ATC is often fatal despite combined therapeutic approaches. Several studies reported on ATC treatment modalities indicating different outcomes and occasionally conflicting results. This analysis was conducted to update and expand our existing knowledge of the relative efficacy of the available therapeutic modalities in this rare disease. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of (i) English language, (ii) diagnosis of ATC, (iii) treatment with complete resection (SX), radiotherapy (RT), surgery and radiotherapy (SRT), chemoradiotherapy (CRT), and combined surgery, radiation, and chemotherapy (COMB), and (iv) comparative studies reporting survival rates. A frequentists network meta-analysis was conducted using netmeta package and random-effects model. Results: Six studies comprising a total of 476 participants were included. SX, RT, CRT, SRT, and COMB approaches demonstrated significant survival advantage over no treatment and/or palliative care. Using odds ratio for analysis, COMB ranked highest followed by SRT, SX, CRT, and RT in a decreasing order. Inconsistency analysis did not reveal any significant differences between direct and indirect estimates. Conclusions: This network meta-analysis is the first to compare and rank commonly used treatment modalities in ATC. It indicates that SX and RT remain the backbone for any treatment approach that significantly impacts survival in ATC.
A phase II randomized clinical trial and mechanistic studies using improved probiotics to prevent oral mucositis induced by concurrent radiotherapy and chemotherapy in nasopharyngeal carcinoma.
Authors: Jiang Chunling 
Published: May 2020

e18568 Background: Earlier evidence has proven that probiotic supplements can reduce radiochemotherapy (CCRT) -induced oral mucositis (OM) in nasopharyngeal cancer (NPC). We have recently modified the ingredient of the probiotics by combining Bifidobacterium animalis, Lactobacillus plantarum, Lactobacillus rhamnosus and Lactobacillus acidophilus. This report includes the Phase II clinical trial to evaluate the effect of the modified probiotics along with mechanistic studies. Methods: We enrolled 85 patients with locally advanced NPC who were undergoing CCRT. The patients were randomized (1:1) to receive either probiotic mixture or placebo. The incidence of severe OM (grade 3 or higher) was the primary endpoint to document. We utilized a rat model. We collected rat’s samples from the tongue, blood and fecal and proximal colon tissues on a various days following treatment and tested for the mechanism of probiotics mixture on OM. Results: We found that patients taking the probiotic mixture showed significantly reduced OM. The incidences for Grade 0, 1, 2, 3 and 4 OM in the placebo group and the probiotic mixture group were 0%, 14.7%, 38.2%, 32.4%, and 14.7% and 13.9%, 36.1%, 25%, 22.2%, and 2.8%, respectively. Furthermore, patients in the probiotic mixture group showed lower reduction rate in CD3+ T cells (75.5% vs 81%, P < 0.01), CD4+ T cells (64.53% vs 79.53%, P < 0.01), and CD8+ T cells (75.59% vs 62.36%, P < 0.01) compared with the placebo group. In the rat model, the control group rats showed more severe mucositis, increased histologic changes of the oral mucosa on the 7th, 14th and 21th day, with the 14th day most significant. CCRT also caused an enhanced inflammation response and cell apoptosis in tongue in the control group. Moreover, CCRT increased the intestinal permeability through reducing the zonula occludens-1(ZO-1) and Claudin-1 expression in colon tissues and increasing the inflammation factors in bloods. The structure of gut microbiota was also disturbed in the control group mainly with the increasing abundance of Bacteroidetes and decreasing abundance of Firmicutes. However, probiotics mixture ameliorated the severity of OM, decreased the inflammation response, cell apoptosis, intestinal permeability, and restored the structure of gut microbiota to normal. Conclusions: The modified probiotic mixture significantly reduces the severity of OM through enhancing the immune response of patients and modifying structure of gut microbiota. Clinical trial information: NCT03112837.
BRAF V600E-mutated anaplastic thyroid carcinoma (ATC) and treatment with BRAF-inhibitors: Real-world data from a single-institution, still far from the cure.
Authors: Platini Francesca , Ortolan Elisa , Cavalieri Stefano , Massa Giacomo , Filippini Daria Maria , Alfieri Salvatore , Bergamini Cristiana , Resteghini Carlo , Orlandi Ester , Paolini Biagio , Piazza Cesare , Perrone Federica , Tamborini Elena , Ferrarini Linda , Serafini Mara Serena , Cappelletti Vera , Daidone Maria Grazia , Licitra Lisa F. , Locati Laura Deborah 
Published: May 2020

e18577 Background: ATC is a very aggressive disease. In the last years new insights on molecular profile of ATC have led to novel therapeutic options, primarily BRAF-targeted agents. Methods: From May 2018 to December 2019, data on recurrent/metastatic ATC patients treated at our Institution have been reviewed. BRAF V600E was assessed in each patient. BRAF mutation was tested both on tumor sections and on cell-free DNA (cfDNA). Circulating BRAF V600E was assessed by using Droplet Digital PCR (ddPCR) Technology. BRAF wild-type (WT) patients were treated with standard chemotherapy (adriamicin or taxans or platinum-based regimens). BRAF V600E patients were treated with dabrafenib 300 mg per day and trametinib 2 mg per day (combo regimen) until progression or unacceptable toxicities. Response was assessed by RECIST 1.1; progression-free survival (PFS) and overall survival (OS) were estimated with Kaplan-Meier method and compared with log-rank test. Safety was evaluated according to CTCAE version 5.0. Results: 16 ATC patients were included. Male/female 5/11, median age was 68 years (range 43-80). Eight patients (50%) carried BRAF mutation. Best response in BRAF V600E was 4 partial response (PR), 3 stable disease (SD) and response in 1 patient has not been assessed yet. Combo was well tolerated, the most common adverse events (G2) were fatigue (14%), pyrexia (14%), nausea and vomiting (9%). Only one patient experienced drugs interruptions. Best response in BRAF WT patients was SD for 1, progressive disease for 4 and 3 patients received supportive care. Concordance between circulating BRAF status with tumor tissue was 80%. Assessment of circulating BRAF performed at baseline and at best response was available for 3 patients achieving a PR: mean reduction was -99.48% from baseline (range -99.37 – -99.66%). Median follow up was 22.8 weeks (95% CI 12.8-22.8). Median PFS was 13 weeks in BRAF V600E and 7.4 weeks in BRAF wt patients (p=0.1); in the same groups median OS was 18.4 and 7.8 weeks, respectively (p=0.051). Conclusions: Real-life data with combo regimen showed an ORR of 50%, with short PFS and OS. Reduction of circulating BRAF observed during treatment might be an indirect marker of tumor shrinkage, even if more data are needed to correlate circulating BRAF and disease response.
Pediatric cancer care in Armenia: The results of a qualitative analysis.
Authors: Hovhannisyan Saten , Papyan Ruzanna , Sargsyan Lilit , Danielyan Samvel , Vagharshakyan Lala , Avagyan Anna Artak , Hoveyan Julieta , Tamamyan Gevorg 
Published: May 2020

e19002 Background: In Armenia the incidence of pediatric cancer accounts for around 80-100 cases per year. This qualitative study was conducted in 2018 to evaluate the needs and challenges in a provision of pediatric cancer care in Armenia. Comparative qualitative study was conducted in 2020 to evaluate the progress in the field. Methods: Qualitative research methods were incorporated to evaluate the achievements, needs and challenges in a provision of childhood cancer care in Armenia. Semi-structured in-depth interviews were conducted with selected study participants including pediatric oncologist/hematologists, pediatric surgeons, who also treat cancer patients, and radiation oncologists. Purposive sampling technique and qualitative conventional content analysis methods were used. Results: Data collected in January 2020 has shown significant improvements in the field of pediatric oncology in Armenia. In the 2018 study, some of the major issues included lack of centralized pediatric cancer care, pediatric cancer registry, palliative care center, possibility of providing high-dose methotrexate, limited nursing training, multidisciplinary team approaches and use of central catheters. Within two years, majority of these problems were solved or are in the process. In 2019 all 3 pediatric oncology and hematology units were merged and the Pediatric Cancer and Blood Disorders of Armenia was created; with the support from charitable foundations all children with cancer receive free medical and psychosocial coverage; a 25 year data has been collected from all the possible sites, the first pediatric cancer palliative care is under construction, 4 multidisciplinary cancer teams were created, pediatric oncology and hematology fellowship was created at the Yerevan State Medical University to prepare for the first time "pediatric oncologist-hematologist" as a one profession. The existing major problems include very limited provision of pediatric cancer medications by the government, as well as lack of the official registration of the number of essential drugs included in the WHO list. Conclusions: Twinning programs, multidisciplinary team discussions with international experts, improvement in availability of several resources, professional development of the staff are major tools for the progress of pediatric oncology in Armenia. Poor provision and official registration of anti-neoplastic medications by the government still remain a major obstacle.
Disparities in clinical characteristics and treatment of multiple myeloma in African American patients.
Authors: Mathura Shivam , Lane Daniel , Hansen Eric , Belli Andrew J. , Venkatesan Priya , Wang Ching-Kun , Fung Vicki Kay , Geng Xiaoqi , Norden Andrew D. 
Published: May 2020

e19008 Background: Based upon interesting recent published findings, we characterize disparities in clinical characteristics, treatment patterns, and outcomes for African American (AA) patients with multiple myeloma (MM) using real-world (RW) data. Methods: A random sample of patients diagnosed with MM were selected from the COTA RW database for the retrospective analysis to be stratified by race, AA (n=395) and other (n=396). To adjust for differences in age and gender, case-control matching was performed. Patient characteristics and treatment patterns were summarized. A Cox proportional hazards model was used to evaluate the relationship between patient characteristics and time to stem cell transplant (SCT). Overall Survival (OS) was calculated using the Kaplan-Meier method. Results: Median time from diagnosis of active MM to start of first-line (1L) treatment was longer among AA as compared to the other cohort (23 vs. 17 days respectively, p=0.01); VRD was the most common 1L therapy (17.39% vs. 18.58% respectively). The percent of patients receiving SCT was similar across racial cohorts (64.56% vs. 66.16%), but AA patients had a longer time to first SCT (234 vs. 204.50 days, p=0.01). Among all patients, Charlson Comorbidity index (CCI) score of 0 (HR: 2.85, CI: 1.77-4.58) and CCI score of 1-2 (HR: 2.79, CI: 1.73-4.49) were significantly associated with an increased likelihood of receiving a SCT. MM diagnosis at an older age was associated with a lower likelihood of receiving a SCT (HR: 0.97, CI: 0.96-0.98). AA cohort exhibited a higher incidence of prior history of MGUS (10.63% vs 8.08%). Cytogenetic profile of the AA and other cohorts are shown in the Table below. Median OS was similar between the AA and other cohorts (145.61 vs. 146.50 months, respectively, p=0.88). Conclusions: AA patients had a longer duration of time to 1L therapy and 1st SCT in our RW study. Despite these differences in time to treatment, OS was similar across racial groups. Future studies are needed to explore the significance of our RW findings and other potentially important clinical characteristics. [Table: see text]