bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is there a correlation between serum Epstein-Barr virus DNA level and tumor metabolic activity, TNM staging and tumor load in nasopharyngeal cancer patients?
Authors: Ahmedova Aysel , Ozkaya Kubra , Tambas Makbule , Gezer Ugur , Ozgur Emre , Sahin Dilek , Sanli Yasemin , Altun Musa 
Published: September 2018

e17543 Background: To investigate the relationship between pretreatment Epstein-Barr virus (EBV) DNA copy number and tumor metabolic activity, TNM stage and tumor volume in nasopharyngeal cancer (NPC) patients. Methods: Blood samples were collected 0-3 weeks before treatment and number of EBV DNA copies were determined by PCR . MRI and PET-CT were performed 0-4 weeks before treatment. The primary tumor volume (TVnp) and total volume of metastatic lymph nodes (TLV) were delineated separately on MRI by the same radiologist by the aid of program “Osirix” and recorded in cm3. Maximum SUV values of primary tumor (Tsuv) and metastatic lymph nodes (LNsuv) were determined with each PET-CT images. Kruskal Wallis test and Spearman's Correlation Analysis were used for the comparison of 3 or more groups with no normal distribution and the evaluation of the inter-parameter relations, respectively. Results: The study included 50 NPC patients treated between 2011 and 2015. There was no significant relation between serum EBV DNA copy number and the distribution of T stage (p = 0.81), N stage (p = 0.08), TVnp (r:0.009; p = 0.95), and Tsuv (r:-0.007, p = 0.96). However, a significant correlation was detected between EBV DNA copy number and both LNsuv (r:0.337; p = 0.017) and TLV (r:0.579; p = 0.001) (LNsuv and TLV increased as virus load increased). Conclusions: There is no significant relation between pretreatment EBV DNA load and T and N stages and TVnp in NPC patients. However, EBV DNA load has a significant correlation with TLV and LNsuv. These results may imply that TLV can be included in nodal staging and together with LNsuv be integrated in treatment planning.[Table: see text] [Table: see text]
Endovascular treatment for locally advanced head and neck tumors.
Authors: Aedinova Irina V. , Chernyak M. N. , Ulianova Yulia , Volkova Viktoriya L. , Chertova Natalia A. , Bauzhadze Mamuka 
Published: September 2018

e17554 Background: Treatment of locally advanced head and neck tumors is an extremely difficult task. Preoperative polychemotherapy allows improving the efficiency of combined treatment in most cases. We performed 6 chemoembolization procedures for locally advanced head and neck cancer in order to increase the effectiveness of chemotherapy with minimal systemic side effects and to reach cytostatic concentrations in tumors higher than at their intravenous administration. Methods: We performed the standard puncture femoral approach and selective catheterization of the external carotid artery followed by angiography. Superselective catheterization of targeted vessels using 2.6 F microcatheter was performed after evaluation of blood supply to the affected area. Chemoembolization was performed with platinum drugs (cisplatin at a mean dose of 50 mg/m2) in an oil emulsion with Lipiodol (4 patients) and saturable microspheres (2 patients). Results: All patients showed a severe pain syndrome during embolization with its increase by the evening of the day and its regression on the third day after surgery; general toxic symptoms were not observed. Significant perioperative complications were not registered. A marked necrosis of the tongue base tumor was observed in one patient after 10 days. All patients showed a partial positive response to the therapy which allowed radical surgical treatment. Conclusions: Chemoembolization with polymeric microspheres provides a longer (up to one month) contact between malignant cells and antitumor agents; chemoembolization is not accompanied by the development of adverse reactions and complications or immunosuppressive effect which allows its use in the most serious cases.
Induction chemotherapy followed by concurrent chemotherapy and proton beam for sinonasal undifferentiated carcinoma.
Authors: Lu Yue Christine , Adams Judith A. , Clark John Ross , Liebsch Norbert , Chan Annie W 
Published: September 2018

e17557 Background: The optimal treatment of sinonasal undifferentiated carcinoma (SNUC) remains to be defined given its aggressiveness and dismal outcome with traditional treatment. We examined the treatment outcomes of SNUC treated with combined proton beam with concurrent chemotherapy +/- induction chemotherapy. Methods: Between 2005 and 2016, 15 patients with SNUC were treated at our institution. All patients had T4 disease, with 20% had nodal involvement and 87% with orbital invasion. Forty-seven percent of patients underwent induction chemotherapy followed by concurrent chemoradiotherapy (sequential group) and 53% underwent or concurrent chemoradiotherapy alone. All patients underwent proton beam for the primary site and upper neck, and photon irradiation for the lower neck. The median dose to the primary site was 70Gy(RBE). Locoreigonal control, freedom from distant metastasis, disease-free survival, and overall survival were estimated by the Kaplan-Meier method. Results: With a median follow-up of 25 months, there were 2 local, 2 regional, 4 distant, and 5 dural-leptomeningeal failures. The 2-year locoregional control rates were 100% and 60% (95%CI:33%-100%) for the sequential and concurrent alone groups, respectively, (p=0.10). The 2-year overall survival was 100% for the sequential group and 58% (95%CI:31%-100%) for the concurrent group (p=0.03). The 2-year distant-metastasis-free survival was 83% (95%CI:58%-100%) and 31% (95%CI:10%-96%) for the sequential and concurrent group, respectively (p= 0.03). Furthermore, the sequential group has a 2-year disease-free survival rate of 100% compared with 58% (95%CI:31%-100%) for the concurrent group (p=0.02). Conclusions: Induction chemotherapy followed by concurrent chemotherapy and proton beam results in promising outcome in patients with SNUC.
Addition of concurrent chemotherapy to adjuvant radiotherapy versus radiotherapy alone for resected salivary gland cancers: A systematic review and meta-analysis.
Authors: Sogono Paolo Generato , Mejia Michael Benedict A. , Agas Ryan Anthony Francisco 
Published: September 2018

e17563 Background: Surgery remains to be the standard definitive treatment for malignant tumors of the salivary gland. Post-operative radiotherapy (RT) is warranted for high risk individuals having tumors with high grade, advanced disease or inadequate resection, showing local control and survival benefit. Despite lack of evidence, adjuvant chemoradiation (CRT) has been suggested for worse prognosis patients. Two recent population-based studies showed that adding chemotherapy to RT did not demonstrate a survival advantage, and no randomized study answers this question. Our aim is to review current evidence comparing RT with and without concurrent chemotherapy in non-metastatic, resected salivary gland cancer. Methods: Literature was searched using: CINAHL plus, EBSCOhost, Medline Complete, Science Direct, Proquest, Scopus, and Pubmed. Eligible studies were experimental or observational which compare adjuvant radiotherapy alone versus radiotherapy with concurrent chemotherapy after primary surgery. Pooled analysis for eligible studies was conducted utilizing the Mantel-Haenzel model (random effects) for the outcomes of interest. The NHMRC of Australia Body of Evidence Framework was used to provide an overall evidence recommendation. Results: Eight retrospective studies were included in the qualitative analysis and two were cancer database studies. Pooled analysis from 4 studies showed inferior 3-year overall survival in patients receiving adjuvant CRT(RR 2.15, 95% CI 1.23-6.75). There were no significant differences in 3-year LRC, DMFS or PFS between both groups, although a trend for worse 3-year DMFS and PFS was observed in the CRT group. G3 hematologic toxicity was worse in patients receiving adjuvant CRT vs RT alone (RR 8.63, 95% CI 1.69-44). Critical appraisal revealed that more patients with adverse risk features (T3-T4, node positive, LVSI, PNI, close or positive margins) received CRT. Conclusions: The addition of concurrent chemotherapy to RT in resected salivary gland cancer does not improve overall survival is associated with worse outcomes and greater toxicity.
Floor of mouth window to improve surgical access for trans-oral cancer surgery.
Authors: Chung Jeffson Chia-Hsien , Bender-Heine Adam , Lambert H. Wayne 
Published: September 2018

e17568 Background: The increasing incidence of HPV associated oropharyngeal cancer has sparked interest in minimally invasive transoral surgery as a primary treatment modality. However, adequate surgical exposure and access to the tongue base is difficult to achieve. Many complex oral retraction systems have been developed in attempt to solve this problem but none work consistently or efficiently. Methods: This cadaveric study introduces the floor of mouth window – a simple adjunctive procedure done at the time of transoral resection and concurrent neck dissection that greatly improves surgical access to the tongue base while eliminating the need for oral retractors. It involves passing the oral tongue through the floor of mouth into the neck dissection field, thereby creating space for robotic or laser instruments to perform cancer resection. The floor of mouth is closed primarily in layers at the end of the procedure. Results: This study compares the tongue base exposure achievable with existing oral retractors to that achievable utilizing this novel technique. Our finding is that superior surgical exposure is attainable without retractors using the floor of mouth window. In fact, laser resection of the base of tongue was successfully performed in cadavers without the use of any retractors. Conclusions: We believe this technique may have a major impact on the management of oropharyngeal cancers because having a simple, reproducible method to access the tongue base will encourage greater adoption of transoral surgery as a treatment modality. It is a technique that can be helpful regardless of any future advances in robot or laser technology. Furthermore, this technique reduces the reliance on multiple complicated and expensive retraction systems. Finally, the improved exposure and visualization of the tongue base attainable by this new procedure may facilitate clear surgical margins and thus maximize the potential for cure, which is ultimately the objective of all head and neck surgeons.
Relationship between sarcopenia and dose-limiting toxicity (DLT) of sorafenib (SOR) in patients (pts) with advanced radioactive iodine-refractory differentiated thyroid cancer (RAI-R DTC) in the phase III DECISION trial.
Authors: Huillard Olivier , Brose Marcia S. , Jouinot Anne , Tlemsani Camille , ARRONDEAU Jennifer , Meinhardt Gerold , Fellous Marc Mardoche , De Sanctis Yoriko , Schlumberger Martin , Goldwasser Francois 
Published: September 2018

e17594 Background: In the phase III DECISION trial comparing SOR with placebo, pts with advanced RAI-R DTC treated with SOR experienced higher rates of adverse events (AEs) than pts with renal cell carcinoma and hepatocellular carcinoma treated with SOR (Brose et al. Lancet 2014). We hypothesized that long-term thyroxine suppressive therapy might result in a high prevalence of sarcopenia, which is known to be associated with increased toxicity of SOR (Antoun et al. Ann Oncol 2010), and we investigated whether sarcopenia at baseline correlated with DLT. Methods: In DECISION, pts with an analyzable baseline lumbar CT scan were eligible. Skeletal muscle cross-sectional area at the third lumbar vertebra was measured, and the median value for each sex defined the cut-off points for sarcopenia. DLT was defined as any AE leading to dose modification; early toxicities occurred ≤30 days after treatment initiation. Results: Of 365 eligible pts, 199 (55%) were sarcopenic (SOR n = 100, placebo n = 99) with large geographic differences: 65/91 Asians (71%), 29/62 North Americans (47%), and 105/212 Europeans (50%). Sarcopenia was 3-fold more frequent than non-sarcopenia in pts ≥75 years of age (19% vs 6%) and was associated with lower body weight (mean [standard deviation]: 71.3 [16.8] vs 80.8 [19.5]; P < 0.0001). Among SOR pts, 76/180 (42%) experienced early DLT of which 44/76 (58%) occurred in sarcopenic pts (P = 0.6497). Among the 90 males, 61 (68%) were sarcopenic and of the 35 males with early DLT, 27 (77%) were sarcopenic. Median time to DLT in sarcopenic vs non-sarcopenic pts who received SOR was 63 vs 95 days, respectively (log-rank P = 0.5328). Conclusions: In this exploratory analysis from DECISION, approximately half of the pts were sarcopenic. In the overall population, no association between sarcopenia and early DLT or DLT were found. Clinical trial information: NCT00984282.
Oncocontraception in cancer care.
Authors: Radeke Erika K. , Zimmerman Lindsay , Bridge Rebecca , Adam Megan , Patel Ashlesha 
Published: September 2018

e18018 Background: Focus on fertility preservation has overshadowed other aspects of reproductive health including sexuality and contraception in cancer care. Regardless of future childbearing interest, the first 18-months post-diagnosis of cancer are considered suboptimal for childbearing. We have coined the term, oncocontraception, for the application of contraception in cancer care. To address this need at our institution, we used the novel Family Planning Quotient/Reproductive Life Index (FPQ/RepLI) which allows providers to better understand patients’ reproductive health goals and counsel them towards appropriate family planning services. These tools aid providers in implementing clinical care to prevent pregnancy during this critical time. They are routinely utilized at Stroger Hospital in the Family Planning Clinic for women within the reproductive age, between the ages of 18 and 55. Methods: FPQ and RepLI were adapted for use with oncology patients. They were used to visually depict and quantify a woman’s reproductive life plan and assist health care providers in speaking to a woman regarding family planning as it pertains to and aligns with her cancer treatment. Results: During our study period, 36 reproductive aged women were seen in our family planning clinic after a cancer diagnosis. Our study population was comprised of mostly Hispanic/Latino women (58.3.0%) and 50.0% were between the ages of 31-40. The majority of the study group had breast cancer (77.8%) and were being treated with chemotherapy (52.8%). Among the study population, 80.6% received a form of contraception (44.8% short-term, 55.2% long-term). Conclusions: We established a link between the Oncology and Family Planning Clinics to incorporate contraceptive counseling as an essential piece of comprehensive cancer care. Approximately 45% of the women newly diagnosed with cancer are in the reproductive age range. With improvements in treatments and prognosis, quality of life factors are of increasing importance for these women. With this essential clinical relationship, patient counseling and provider-patient communication regarding contraceptive care in the context of cancer diagnosis will continue to grow and improve.
Prevalence and predictors of active surveillance management for black males diagnosed with low risk prostate cancer.
Authors: Taku Nicolette , Narayan Vivek , Bellamy Scarlett , Vapiwala Neha 
Published: September 2018

e18019 Background: Consensus guidelines recommend that active surveillance (AS) be considered in the management of men with low risk prostate cancer (LRPC). The evidence supporting this recommendation is largely derived from studies in which men of African descent were underrepresented; thus, the appropriate implementation of AS in this population remains controversial. The objective of our study was to evaluate the prevalence and clinical predictors of an AS approach in black men (BM) diagnosed with LRPC following the 2010 inclusion of AS in LRPC management consensus guidelines. Methods: BM (N = 15,242) and non-Hispanic white men (WM) (N = 86,655) diagnosed with LRPC (as defined by PSA ≤ 10 ng/ml, Gleason score ≤ 6, clinical stage T1 – T2a) between 2010 and 2013 were identified from the National Cancer Database. Logistic regression models were used to assess the likelihood of pursuing an AS strategy over time, as well as to examine associations between sociodemographic characteristics (SDCs) and the receipt of AS. Results: Overall, 9% of BM with LRPC were managed with AS. On univariate analysis, the likelihood of BM undergoing AS increased from 2010 and was statistically significant ( p < 0.001) for all subsequent years (2011: OR = 1.54, 95% CI 1.30-1.82; 2012: OR = 2.19, 95% CI 1.82-2.60; 2013: OR = 2.55, 95% CI 2.15-3.02). Uninsured BM were twice as likely as those with private insurance to pursue AS (OR 1.97, 95% CI 1.51-2.58, p < 0.001). BM seen at academic cancer programs were also more likely to be managed with AS, when compared to those seen at community cancer centers (OR 1.47, 95% CI 1.37-1.60, p < 0.001). BM were less likely than WM to receive AS (OR = 0.82, 95% CI 0.77 to 0.87, p < 0.001). On multivariate analysis adjusted for SDCs, there was no significant difference in AS utilization between the two ethnic groups. Conclusions: The utilization of AS for BM with LRPC appears to be increasing, may be influenced by SDCs, and may not differ from the AS utilization for WM with LRPC. Given the observed elevated rates of post-prostatectomy adverse pathologic features among BM, further evaluation of the determinants of AS utilization and scrutinous consideration of the appropriateness of AS in this population is warranted.
Written care plan and patient enablement: Pre-implementation data from the 4R in Oncology Project.
Authors: Trosman Julia Rachel , Weldon Christine B. , Perez Claudia B. , Kulkarni Swati , Khan Seema Ahsan , Hansen Nora , Nelson Valerie , Stein Jennifer , Simon Melissa A. , Strauss Jonathan Blake , Benson Al Bowen , Espino Sasa M. , Bunce Mikele , Pan Wayne , Friedewald Sarah M. , Gradishar William John 
Published: September 2018

e18032 Background: The IOM ’11 and ’13 reports recommend a written care plan (WCP) at cancer diagnosisto enable teamwork and patient (pt) engagement. Standardized multimodality WCP is a key part of the 4R model of care planning and pt engagement proposed under “NCI ASCO Teams” Project (Trosman JOP 2016). 4R (Right Information / Care / Patient / Time) is under implementation at 3 centers: academic, community and safety net. As current state assessment prior to implementing 4R and standard multimodality WCP, we surveyed pts not impacted by 4R on care planning, enablement and whether they received any WCP. Methods: Survey of breast cancer stage I-III pts who received care at the three sites Jan ’15 - Mar ’16, prior to 4R. We used simple frequencies and Fisher’s exact test in analysis. Results: Survey response rate: 47%, 241/515. Gaps of > 30% were reported in 7 of 8 aspects of care planning and pt enablement - Table. A non standard WCP was received by 46% of pts. Receiving a WCP impacted whether pts were clear about care (85% with WCP vs 52% without, p < .0001), able to manage own care (79% with WCP vs 58% without, p = .0005) and overwhelmed (35% with WCP vs 49% without, p = .04). Care complexity was a significant factor for feeling overwhelmed by pts without WCP (49% of pts receiving > 6 care services felt overwhelmed vs. 30% of pts receiving < = 6 services, p = .04), but not a significant factor in pts with WCP (45% vs 41%, p = .7). More pts with WCP reported well managed care by providers than pts without WCP (77%, 62%, P = .02). Conclusions: Serious gaps found in care planning and pt enablement at our sites support the need for 4R implementation. Even pre-4R, non standard WCPs improve pt understanding of care and ability to manage it, and reduce the impact of care complexity on pts. Providers using WCP appear to also coordinate care, but WCP itself may be an important factor of patient enablement. [Table: see text]
Racial disparities in receipt of guideline care and cancer deaths for women with ovarian cancer.
Authors: Warren Joan , Cronin Kathleen A , Stevens Jennifer , Howlader Nadia , Trimble Edward Lloyd , Harlan Linda C 
Published: September 2018

e18081 Background: Receipt of guideline care improves survival for women with ovarian cancer yet care may vary by race. We assessed the receipt of guideline care and cancer deaths by race for women with incident ovarian cancer. Methods: This retrospective cohort analysis used the National Cancer Institute’s Patterns of Care data for black and white women diagnosed with all stages of ovarian cancer in 2002 and 2011 (n = 5356) with follow-up through 12/31/14. Data included patient characteristics, type of surgery and chemotherapy, and provider factors. Multivariate logistic regression was used to create the standardized percentages (predictive margins) of women receiving guideline treatment by race group. Cox proportional hazards models were used to assess the unadjusted and adjusted risk of ovarian cancer death by race. Results: At diagnosis, for black women, 35.6% had Stage III and 37.2% had Stage IV disease compared with 44.1% Stage III and 24.2% Stage IV for white women. More black women had surgery in large teaching hospitals (47.6%) than white women (39.7%) but use of gynecologic oncologists (GO) was similar for black women and white women- (62.1% vs 58.8%). In regression models, the standardized percent of black women receiving guideline care was significantly lower than for white women (29.2% vs 38.5%). The unadjusted hazards ratio (HR) for death was significantly higher in black women (HR = 1.32) yet after controlling for patient and provider factors and receipt of guideline care, black women did not have a significantly higher risk of death (HR = 1.08). Conclusions: Rates of guideline care are very low for all women with ovarian cancer, significantly more so for black patients. Low use of guideline care among black women cannot be explained by provider factors as a large percent of black women consulted a GO or received care in large teaching hospitals. Research is needed to address how to increase guideline care among black patients as we found that race was not associated with the risk of death when guideline care was included as a factor in multivariate survival models.