bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low-dose cisplatin administration through the superficial temporal artery combined with definitive radiotherapy for maxillary sinus squamous cell carcinoma.
Authors: Masubuchi Tatsuo , Kitani Yosuke , Fushimi Chihiro , Kawakita Daisuke , Takahashi Hideaki , Takeishi Etsuro , Kaneko Tetsuharu , Kanno Chihiro , Yamazaki Morio , Tanaka Junpei , Kitajima Tatsuya , Hanyu Kenji , Toya Kazuhito , Takahashi Akane , Okura Naoki , Akahane Masaaki , Miura Kouki , Kamata Shin-etsu , Tada Yuichiro 
Published: May 2020

e18562 Background: Although patients with locoregional advanced maxillary sinus squamous cell carcinoma (MSSCC) are often treated with surgery followed by postoperative radiotherapy (RT), the cosmetic and functional outcomes are unsatisfactory. Moreover, the efficacy and safety of intra-arterial chemoradiotherapy are controversial. Methods: In this study, we investigated the efficacy and safety of low-dose cisplatin administration through the superficial temporal artery (STA) combined with definitive RT in patients with MSSCC. Between January 2009 and December 2018, 57 patients were administered weekly intra-arterial infusions of cisplatin (30–50 mg/m2/5h) through the STA with simultaneous intravenous infusions of sodium thiosulfate. Overall response rate (ORR), local progression-free survival (LFS), maxillectomy-free survival (MFS), progression-free survival (PFS), overall survival (OS), and safety were evaluated retrospectively. The impact of clinical factors on survival was investigated using the Cox proportional hazard models. Results: The median follow-up time was 44 months (range, 10–80 months). There were 4, 26, 23, and 4 patients with cT2, cT3, cT4a, and cT4b, respectively. All patients completed the planned treatment except for one patient who discontinued owing to facial palsy. The ORR was 98% with 51 and 5 patients having complete and partial responses, respectively. The 3-year LFS, PFS, and OS were 74%, 63%, and 81%, respectively for all patients and 100%, 81%, and 94%, respectively for 22 patients received 70 Gy irradiation. Notably, the 3-year MFS was 95% for all patients and 100% in patients received 70 Gy RT. The most common grade 3 or more toxic event was oral mucositis (22.8%). Additionally, 4 (7.0%) patients had catheter-related infections. Late grade 3 or more adverse events included optic nerve disorder (8.8%), osteonecrosis (7.0%), encephalopathy (1.8%), and increased creatinine levels (1.8%). Salvage surgery including hard palate resection and orbital exenteration were performed in 2 and 1 patients, respectively. No clinical factor was correlated with survival outcomes in our study cohort. Conclusions: Low-dose cisplatin through STA combined with RT, especially 70 Gy RT, was associated with promising tumor response, high organ preservation rate, and tolerable adverse events in MSSCC patients. Further prospective studies are warranted to compare these outcomes with primary surgery.
Treatment failure pattern of oropharyngeal cancer, especially for the aspect of retropharyngeal lymph node.
Authors: Kang Byung-Hee , Kim Jin Ho , Wu Hong-Gyun , Kim In Ah , Eom Keun-Yong 
Published: May 2020

e18565 Background: In radiotherapy for head and neck cancer, it is very important to define the appropriate treatment volumes that determine the treatment outcome and toxicity. We examined the feasibility of omitting elective retropharyngeal (RP) nodal irradiation in oropharyngeal cancer. Methods: We performed a retrospective review from 2009 to 2016; 197 patients with oropharyngeal squamous cell carcinomas were treated with definitive or postoperative radiation therapy at the Seoul National University Hospital or Seoul National University Bundang Hospital. Of these patients, 151 patients (76%) were treated ipsilateral RP nodal areas up to the upper edge of C1 vertebral body, while the other 46 patients (24%) were not. We reviewed patterns of failures, disease free survival, and patient-reported chronic xerostomia status in each patient group. Results: During follow-up period, 2 patient developed RP nodal recurrences (4-108 months, median =46 months). There was no significant between-group difference in disease free survival, with a rate of 80.7% in the high RP nodal-irradiation group and 87.2% in the RP nodal spared group (P=0.17). Patients in the high RP nodal-irradiation group had higher mean ipsilateral parotid gland dose (median 28.7±7.5 Gy vs. 21.3±7.6 Gy, P<0.001) and higher rates of chronic xerostomia (72.2% vs. 58.7%, P=0.030). Conclusions: Only 2 patients with omission of high RP node irradiation developed high RP node failure, and no significant difference in DFS was shown. Omission of high RP nodal irradiation resulted in reduced ipsilateral parotid gland dose, consequently with less chronic xerostomia.
Papillary thyroid microcarcinoma: Analysis of outcomes and features predicting risk of recurrence.
Authors: Dravid Chandra Shekhar , Sr Priya , Pai P. S. , Chaukar D. 
Published: May 2020

e18569 Background: Papillary thyroid microcarcinoma (PTMC) is an enigmatic entity - diverse opinions exist on its clinical course and management. We aimed to analyse disease outcomes and to identify high-risk factors in PTMCs. Methods: This is a retrospective analysis of patients of PTMC treated in our hospital between 2000 and 2014. Clinico-radiological features, treatment details, long term outcomes and recurrence patterns were noted; these were analysed statistically. Results: 160 patients were studied; 61% were females; 86% were aged 55 years or below; 95% cases presented with an enlarged neck node or thyroid nodule or distant metastasis while 5% were incidentalomas. Total thyroidectomy with radioiodine ablation was done in 77% while hemithyroidectomy was done in 23% patients. Follow up ranged between 2 and 238 months. There were 11 (7%) disease related events (nodal or distant metastases or death due to persistent disease). 4 (2.5%) patients died of disease. On univariate analysis, a larger thyroid primary (p 0.001), pre-operatively radiologically identifiable disease in the thyroid (p 0.02) and the lesion not being an incidentaloma (p 0.01) were associated with development of adverse events. Multivariate analysis confirmed the latter two factors as high risk (p 0.05 and 0.00). Nodal metastasis increased with a larger primary (p 0.001), which was multifocal (p 0.00), bilateral (p 0.01) and showed extrathyroid extension (p 0.00). Distant metastases were related with advanced age (p 0.02), presence of involved nodes (p 0.04), larger primary tumour (p 0.15), multifocal tumour (p 0.17), bilateral foci (p 0.02) and extrathyroidal extension (p 0.06). Correspondingly, Kaplan Meier curves showed a better overall survival (OS) and disease free survival (DFS) with incidentalomas as compared to cases presenting with symptoms (Median OS 84 months vs 78 months; Median DFS 79 months vs 77 months) and cases where the lesion was not seen on radiology (Median OS 80 months vs 76 months; Median DFS 80 months vs 75 months). However neither was significant statistically. Addition of Radioiodine ablation did not confer survival advantage (p 0.6). Conclusions: PTMCs are associated with adverse events despite the size of the primary lesion. Stratification as per the above risk factors can improve event free survival. Conversely, aggressive treatment may be deferred in cases of lesions discovered incidentally or on routine screening.
CTNNB1, PIK3CA, EIF1AX, and PTEN polymorphisms found in aggressive types of differentiated thyroid cancer.
Authors: Adilbay Dauren , Adilbayev Galym , Orazgalieva Madina , Shipilova Viktoria , Kidirbayeva Gulzhan , Sloneva Nina , Amandosova Aizhan , Ossikbayeva Saniya 
Published: May 2020

e18578 Background: Thyroid cancer incidence is rapidly increasing in all developing and developed nations. Despite the benign nature of most thyroid cases, there are aggressively behaving subgroups that need proper attention and tailored treatment. As of today, thyroid cancers stratified using the latest AJCC 8th edition staging system, which dramatically changed the staging system. Despite the implementation of the new system, there is still a need for better stratification of patients to groups that will benefit from extensive treatment. Methods: Retrospective analysis of 23 patients with papillary and follicular thyroid cancer treated in a tertiary cancer center in 2012 and 2013. All patients underwent different types of surgical treatment, FFPE blocks are obtained from pathology archives and additionally reviewed by two independent pathologists. DNA extracted from 20 patients FFPE blocks; 3 cases excluded. DNA analyzed by NGS on the MiniSeq Illumina platform using a custom panel of 14 genes and 200 SNPs associated with thyroid cancers. Results: All identified polymorphisms were selected based on the COSMIC registry. After excluding all types filtered based on frequency, 1329 polymorphisms identified. Fifty-two types are pathologic based on ClinVar database. All benign cases based on Polyphen and Clinvar excluded from the analysis. In patients with aggressive types of papillary and follicular thyroid cancer NRAS and HRAS identified in 8.33% cases, EIF1AX in 25% cases, PIK3CA in 58.33% cases, KRAS in 41.66 cases, TSHR in 33.3% cases and BRAF in 50% cases. Conclusions: We identified mutations in genes probably associated with the aggressive behavior of differentiated thyroid cancer. These mutations can be used as stratification criteria in the future after more data and trials confirm the results.
Cancer in Belize: Characteristics of patients presenting to a public oncology clinic.
Authors: Valtis Yannis , Pierson Leah , Garrity Philip , Yacab Ramon Argenes , Huang Franklin W. 
Published: May 2020

e19000 Background: Belize is a middle-income country in Central America with significant inequality. To date, data on the oncologic burden of disease has been imputed from mortality data. The first-ever public oncology program was started in 2018, which allowed us to analyze the presenting characteristics of patients with cancer. Methods: 284 patients were seen at the Karl Heusner Memorial Hospital (KHMH) oncology clinic between April 2018 and July 2019. We performed a retrospective chart review and extracted patient characteristics to understand the burden of cancer in Belize. Results: Of 284 patients seen, 63% had a confirmed pathologic diagnosis of cancer and the remaining were clinically suspected to have cancer. 56% were female and the median age was 55. Breast, cervix, colon, and prostate were the most common types of cancer seen. Breast and cervical cancers disproportionately affected young women with a median age at presentation of 51 and 45 respectively. 28% of patients presented with Stage IV disease. 43% of patients were deemed candidates only for comfort care. Conclusions: The burden of oncologic disease in Belize is significant and represents a wide variety of cancers. Breast and cervical cancers disproportionately affect young women in Belize. A significant proportion of patients presented with late stage disease, likely due to the lack of screening programs and cancer awareness in the country. Addressing the country’s cancer burden will require strengthening local pathology and surgical oncology capabilities, establishing a public chemotherapy treatment program, and referring patients to radiation oncology in nearby countries.
Profiling and prognostic implications of variants of unknown significance (VUS) in solid tumors.
Authors: Sadaps Meena , Estfan Bassam N. , Wei Wei , Sohal Davendra , Kruse Megan Lynn 
Published: May 2020

e19012 Background: While precision oncology is becoming increasingly integrated into standard of care for most incurable solid tumor malignancies, there is paucity of data regarding the clinical significance of VUS. In this study, we aim to evaluate whether the number of VUS is associated with overall survival (OS). We also analyze racial disparities pertaining to the number of VUS present and identify which, if any, genes possess prognostic implications. Methods: This is a retrospective review of 389 consecutive patients seen at Cleveland Clinic from 2014 to 2016 with incurable solid tumor malignancies, for whom next-generation sequencing (NGS) was ordered using Foundation One™ (Cambridge, MA). Demographics, number of VUS, genes involved, and race were summarized. OS was estimated by Kaplan-Meier and compared by log rank test. Results: Median age was 60 years, 202 (52%) patients were female, 338 (86.7%) were Caucasian, and 31 (8.0%) were African American. On NGS, 376 (97%) patients had VUS reported. The median number of VUS was 9 (range 1-116). When dichotomized at the median, the number of VUS did not affect OS. Genes most commonly implicated in reported VUS were LRP1B (88, 22.6%), MLL3 (83, 21.3%), MLL2 (73, 18.8%), ARID1B (70, 18.0%), PRKDC (60, 15.4%), PREX2 (58, 18.7%), and SPTA1 (56, 14.4%). Patients found to have a variant of unknown significance in MLL2 had worse median OS as compared to those who did not (2.61 vs 3.76 years respectively; p = 0.033). When profiled by race, Caucasians had lower numbers of VUS (p = 0.002; Table). Conclusions: We did not find a clear association between the number of VUS and OS. MLL2, a gene known to predict poor prognosis as a pathogenic variant, was seen in our study to have similarly poor prognostic implications as a variant of unknown significance. Racial disparities in genomics exist as African Americans are under-represented and have greater numbers of VUS as compared to Caucasians. Further research is warranted to elucidate these disparities. [Table: see text]
Neighborhood disparities in timeliness of treatment for early stage lung cancer patients.
Authors: Obrochta Chelsea A , Gibbons Joseph , Nara Atsushi , Murphy James Don , Thompson Caroline A. 
Published: May 2020

e19017 Background: Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the United States, accounting for approximately 25% of all cancer deaths. The National Comprehensive Cancer Network (NCCN) provides evidence-based cancer treatment recommendations. Evidence suggests that a patient’s receipt of guideline-concordant treatment (GCT) increases survival, especially for screen-detected, earlier stage cancers. Neighborhoods are key determinants of health and the neighborhood social and built environments can influence cancer treatment and outcomes. Minority segregated neighborhoods often have limited health resource availability. The objective of this study is to estimate the relationship between neighborhood segregation on racial and ethnic disparities in timely receipt of GCT in early-stage lung cancer patients in California. Methods: We studied 22,903 patients diagnosed with stage I/II non-small cell lung cancer (2006-2015) in the California Cancer Registry. The primary outcome of the study is receipt of GCT according to the 2016 NCCN guidelines defined as the administration of proper initial and adjuvant treatment(s) according to cancer site and stage, and measured using surgery type, chemotherapy type, and radiation type. The secondary outcome was timely receipt of care as defined as the initiation of surgery, radiation, or chemotherapy within 45 days of diagnosis for initial treatment and the initiation of chemotherapy +/- radiation within 6 months of initial surgery for N1 patients for adjuvant treatment. Multivariable hierarchical logistic regression will be used to estimate the effect of neighborhood segregation on timely receipt of GCT, adjusting for individual- and neighborhood-level covariates, and stratified by patient race/ethnicity. Results: Overall, 81.39% of patients received GCT; 57.63% of them within 45 days of diagnosis. Under-treatment and treatment delay were more frequent in patients who were black or Hispanic, had public insurance, and were of lower socioeconomic status. We hypothesize that increased neighborhood segregation will decrease a patient’s likelihood of adherence to GCT and timely GCT. Conclusions: This research is vital to improving our understanding of cancer-related health disparities and promoting health in vulnerable neighborhoods. With rising numbers of early stage lung cancers due to screening smokers, administration of timely proper treatment is critical.
The use of surgical & interventional procedures for the diagnosis and treatment of pediatric tumors: An example from an upper middle income country.
Authors: Kutluk M. Tezer , Çakmakkaya Kübra , Ahmed Fahad , Akıncı Devrim , Ekinci Saniye , Oğuz Berna , Haliloğlu Mithat , Orhan Diclehan , Akyüz Canan 
Published: May 2020

e19022 Background: The burden of pediatric cancer is more than 300.000 cases per year in children aged 0-19 years globally. Turkey faces almost 4000 cases per yr in the same age group. The survival rates exceeded 80% in high income countries although it is still a challenge in LMICs at different level of low survivals. The availability, accessibility & affordability of advanced techniques such as interventional procedures are major challenges for successful treatment of pediatric cancers in LMICs. Methods: 279 sequentially diagnosed cancer in children aged 0-18 years in a single institution in 2018 were included. Tumors were classified according to the ICCC-3. Leukemias were not included. The types of interventional & surgical procedures used for diagnosis were recorded. The distribution of procedures according to the type of malignancies were examined & descriptive characteristics of patients were compared. Results: The median age was 58/12yrs, M/F=153/126. The most common tumors were CNS tumors followed by lymphomas & neuroblastoma. Among all, surgery was performed in 189 (67.8) children whereas 45 (16.1%) patients were diagnosed by interventional radiology procedures. Radiological diagnosis was made in 42 (15.1%) children. Conclusions: Early diagnosis & access to best available care is the most essential part of the pediatric cancer control. Current global initiatives have a focus on how to improve the survival in LMICs. Here we report the use of surgery vs interventional radiological procedures for the diagnosis of pediatric tumors. The efficient & timely use of the diagnostic procedures save the patients lives in a cost effective ways with less morbidity & mortality. Since there is limited data from the LMICs, we suggest to the pediatric oncology community to do more detailed evidenced based research for the diagnosis pediatric cancers. [Table: see text]
Association of socioeconomic status and molecular testing in stage IV colorectal cancer.
Authors: Punekar Salman Rafi , Griffin Megan Marie , Masri Lena , Makarov Danil V. , Sherman Scott , Becker Daniel Jacob 
Published: May 2020

e19023 Background: The use of EGFR monoclonal antibodies extends life for patients with advanced colorectal cancers (CRC) whose tumors exhibit wild type KRAS. Research suggests that KRAS testing is underused, denying patients access to targeted therapy. We sought to study the role of socioeconomic factors in the application of KRAS testing. Methods: We identified subjects with stage IV colorectal adenocarcinoma diagnosed between 2010 and 2015 in the Surveillance Epidemiology and End Results (SEER) database. We identified clinical and demographic characteristics, including diagnosis year, race, ethnicity, sex, age, geography, median household income (MHI), insurance coverage, tumor grade, and tumor location. We used multivariable logistic regression models to evaluate associations between these factors and the rate of KRAS testing. We constructed Cox proportional hazard models to assess the impact of KRAS testing on survival. Results: We identified 37,676 patients with stage IV CRC, 31.1% of whom were tested for KRAS mutations. The rate of KRAS testing varied from 23.2% to 56.5% across geographic regions. Patients were more likely to be tested if they were younger (OR 5.10 for age 20-29 vs 80+, 95% CI 3.99-6.54, p < 0.0001), diagnosed more recently (OR 1.92 for 2015 vs 2010, 95% CI 1.77-2.08, p < 0.0001), or lived in an area of high MHI (OR 1.24 for MHI of > $69,311 vs < $49,265, 95% CI 1.14-1.35, p < 0.0001). Patients were less likely to be tested if they had Medicaid (OR 0.83, 95% CI 0.77-0.88, p < 0.0001), were unmarried (OR 0.78, 95% CI 0.75-0.82, p < 0.0001), or had rectal cancer (OR 0.79, 95% CI 0.74-0.84, p < 0.0001). The risk of death was decreased in patients who received KRAS testing (HR 0.77, 95% CI 0.75-0.80, p < 0.0001). The median survival for patients who were tested was 20 months (95% CI 20-21), vs 11 months (95% CI 10-11) for patients not tested (p < 0.001). Conclusions: We found a low rate of KRAS testing overall in CRC patients diagnosed between 2010 and 2015. Testing rates increased over the study period, but, even as of 2015, the majority of patients did not have KRAS testing.We found thatpatients with Medicaid and those who lived in areas of lowest income were less likely to have KRAS testing. Prior studies reported that Medicaid was associated with lower utilization of KRAS testing, but ours represents a more contemporary cohort and is the first to evaluate Medicaid and MHI simultaneously. Ideally Medicaid insurance would increase access to molecular testing for patients with limited resources, but our model suggests that income-based disparities persist despite Medicaid insurance.
Implementation science of district cancer care delivery model (Pendharkar model).
Authors: Pendharkar Dinesh , Tripathi Chandramauli 
Published: May 2020

e19024 Background: Health care systems are fighting with issues related to multiple elements of access to care. The problems include non availability of physical facilities and qualified human resource. Here we report successful intervention results of a scalable, replicable, cancer care model starting with two and expanding to nearly 198 districts, using standard processes. This has brought specialised cancer care to government run general district hospitals using existing human resource, through empowerment of alternate oncology workforce, capacity building, decentralisation, and task sharing with impactful outcome. Methods: Government run general district hospitals were involved to train one physician and nurse in principles of oncology care over one month period, followed by constant 24 x7 support and continued training etc. (techno-mentoring). Administrative changes enabled creation of identity of nodal cancer units and organised process of cancer drug delivery. Results: The implementation process was experimented in two hospitals and later on extended to nearly 198 hospitals, over a period of six years (Table). Majority of states have formulated the innovation as state run district cancer care program with published operational guidelines. The state governments designated physicians as nodal cancer officers and created their identity with physical allocation of space and providing cancer drug formulary. The physicians are assisting cancer patients from diagnosis up to end of life care including chemotherapy, palliative care. More then 45000 patients have availed services. Few thousand chemotherapy sessions have been performed by alternate oncology workforce. Drug availability is maintained through routine government supplies by adding anticancer drugs to list of essential medicines. Satisfaction survey conducted amongst patients, has proved its usefulness, acceptability. Conclusions: Impactful implementation at scale is feasible for cancer care delivery, using existing physical infrastructure and empowerment of alternate oncology workforce, through this model. It can ideally serve areas with no access to cancer care, including LMIC. [Table: see text]