bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impending Impact of Molecular Pathology on Classifying Adult Diffuse Gliomas
Authors: Macaulay Robert J. 
Published: August 2017

BackgroundProgress in molecular oncology during the last decade has enabled investigators to more precisely define and group gliomas. The impacts of isocitrate dehydrogenase (IDH) mutation (mut) status and other molecular markers on the classification, prognostication, and management of diffuse gliomas are likely to be far-reaching.MethodsClinical experience and the medical literature were used to assess the current status of glioma categorization and the likely impact of the pending revision of the classification scheme of the World Health Organization (WHO).ResultsIDH-mut is a defining event in most adult fibrillary astrocytomas (FAs) and nearly all oligodendrogliomas (ODs). The IDH-mut status of most gliomas can be established by immunohistochemistry for the most common mutant of IDH1 (R132H). IDH wild-type (wt) diffuse gliomas include several familiar entities — in particular, glioblastoma (GBM) and most pediatric gliomas — as well as an assortment of less well-defined entities. The codeletion of 1p/19q distinguishes OD from FA, which, by contrast, shows frequent loss of the α thalassemia/mental retardation syndrome X-linked protein. Mixed oligoastrocytomas are typically classifiable as either OD or FA using molecular testing.ConclusionsThe current practice of designating IDH-mut WHO grade 4 astrocytoma as secondary GBM will likely be discouraged, and primary or de novo GBM, which is always IDH-wt, may lose this qualification. Histologically, low- or intermediate-grade IDH-wt gliomas with molecular changes characteristic of GBM might justify the designation of GBM WHO grade 3. Mixed oligoastrocytoma is losing popularity as a diagnostic term because most cases will fall into either the FA or OD category. Distinguishing IDH-mut from IDH-wt tumors in clinical trials is likely to clarify sensitivity rates or tumor resistance among subgroups, thus suggesting opportunities for targeted therapy.
Use of Immunohistochemical Stains in Epithelial Lesions of the Breast
Authors: Khazai Laila , Rosa Marilin 
Published: August 2017

Background During the last few decades, immunohistochemistry (IHC) has become an integral part of pathology. Although hematoxylin and eosin (H & E) stain remains the fundamental basis for diagnostic pathology of the breast, IHC stains provide useful and sometimes vital information. Moreover, considering the role of hormonal therapy in hormone receptor–positive breast tumors, as well as the availability of targeted chemotherapeutic agents for HER2-positive cases, IHC studies represent a major part of workups. Methods A literature search was performed to explore the uses of IHC stains related to the diagnoses of breast lesions and prognostic/predictive information. Results Selective use of IHC stains in conjunction with H & E examination helps resolve most diagnostic issues encountered by surgical pathologists during their day-to-day practice. Pathologists should be familiar with the use of each immunostain and its limitations to avoid interpretative errors. Conclusions IHC stains help guide the differential diagnosis of challenging epithelial lesions of the breast. They should be selectively and judiciously used and their findings must be interpreted with the differential diagnoses in mind and with an understanding of possible pitfalls.
Special Technologies for Ex Vivo Analysis of Cancer
Authors: Kreahling Jenny M. , Altiok Soner 
Published: August 2017

Background Predictive assays for cancer treatment are not new technology, but they have failed to meet the criteria necessary for standardized use in clinical decision-making. Methods The authors summarize the use of predictive assays and the challenges and values associated with these assays in the clinical setting. Results Predictive assays commercially available in the clinical setting are not standardized, have significant obstacles to overcome, and cannot be relied upon by health care professionals due to the limited value these assays provide to the decision-making process for the treatment of patients. Conclusions A method that more closely recapitulates the human tumor microenvironment and accurately predicts response with high reproducibility would be beneficial to patient outcomes and quality of life.
Cost Effectiveness of Colorectal Cancer Screening Strategies
Authors: Patel Shaan S. , Kilgore Meredith L. 
Published: August 2017

Background Several screening tests are available to detect colorectal cancer (CRC) and reduce the incidence and mortality of CRC. The purpose of this review was to determine how current CRC screening strategies for CRC compare with no screening and whether agreement exists with regard to the cost effectiveness of different strategies. Methods Databases were searched for cost-effectiveness analyses focused on CRC screening strategies in the United States and published between May 2007 and February 2014. We analyzed the uses of fecal occult blood, fecal immunochemistry, and stool DNA tests, as well as sigmoidoscopy, colonoscopy, and virtual colonoscopy. A paired comparison of each screening strategy with no screening across each of the studies reviewed was conducted. A series of paired comparisons of the results reported in each of the studies is also included. Results When compared with no screening, all CRC screening strategies evaluated in this review were cost effective. There was disagreement as to which screening strategy was the most cost effective. However, sigmoidoscopy combined with fecal blood testing always dominated either strategy alone. Studies comparing colonoscopy with fecal blood testing, sigmoidoscopy, or both had mixed results. Conclusions Compared with no screening, all CRC screening strategies are more cost effective. Study results disagree as to which screening strategy should be the preferred method.
Stereotactic Body Radiotherapy for Recurrent Unresectable Head and Neck Cancers
Authors: Strom Tobin , Wishka Christian , Caudell Jimmy J. 
Published: August 2017

Background Treatment of locoregional, recurrent head and neck cancers following definitive radiotherapy has evolved during the past 30 years. Brachytherapy as well as protracted courses of systemic therapy and chemoradiotherapy result in 12-month survival rates of 40% to 50% but have high rates of severe toxicity. Given the advancements in radiotherapy targeting and delivery, stereotactic body radiotherapy (SBRT) has been investigated as an alternative treatment option with the potential advantages of reduced treatment time and rates of toxicity. Methods The authors reviewed prospective trials and retrospective reports from the past decade addressing the management of locoregional, recurrent, previously radiated head and neck cancers, focusing on SBRT. Results The body of evidence is growing in support of reirradiation using SBRT for the treatment of recurrent head and neck cancers. The 1-year survival rates associated with SBRT are promising and similar to those seen with chemotherapy alone and concurrent, conventionally fractionated radiotherapy and chemotherapy. Treatment-related adverse events of reirradiation using SBRT are also similar to other palliative therapies. Late carotid rupture is a relatively rare but concerning late toxicity associated with reirradiation using SBRT. Conclusions SBRT is a promising treatment for locoregional recurrent head and neck cancers. It also offers a logistical advantage over other palliative treatments, as it only requires 1 to 2 weeks of treatment.
Racial Disparity in Time between First Diagnosis and Initial Treatment of Prostate Cancer
Authors: Kinlock Ballington L. , Thorpe Roland J. , Howard Daniel L. , Bowie Janice V. , Ross Louie E. , Fakunle David O. , Laveist Thomas A. 
Published: August 2017

Background Disparities among patients with prostate cancer exist across the continuum of care. The interval of time that lapses between first diagnosis and treatment is another disparity that may exist but has not been fully explored. Methods Our study looked at the data of 749 men (353 black and 396 white) who were 40 to 81 years of age when they entered the North Carolina Central Cancer Registry during the years 2007 and 2008. Our dependent variable was the amount of months that had passed between first diagnosis and treatment. Our main independent variable was self-reported race. Covariates included age, income, level of education, insurance status, treatment received, Gleason score, and level of medical mistrust. We used negative binomial regression analysis to determine the association between the amount of time that lapsed between a diagnosis of prostate cancer and treatment by race. Results Compared with white men, black men were more likely to experience a longer wait time between diagnosis and treatment of prostate cancer (incidence rate ratio [IRR] 1.19; 95% confidence interval [CI], 1.04–1.36). Controls for demographical, clinical, and psychosocial variables (IRR 1.24; 95% CI, 1.04–1.43) did not explain this difference between the races. Conclusions These results suggest that the amount of time that lapses between first diagnosis and treatment of prostate cancer is longer for black men compared with white men. Our findings have identified an under-reported racial disparity in the disease continuum of prostate cancer.
Advances in the Endoscopic Diagnosis of Barrett Esophagus
Authors: Davis-Yadley Ashley H. , Neill Kevin G. , Malafa Mokenge P. , Peña Luis R. 
Published: August 2017

Background Barrett esophagus (BE) continues to be a major risk factor for developing esophageal adenocarcinoma. Methods We review the risk factors, diagnosis, and management of BE, with an emphasis on the most current endoscopic diagnostic modalities for BE. Results Novel diagnostic modalities have emerged to address the inadequacies of standard, untargeted biopsies, such as dye-based and virtual chromoendoscopy, endoscopic mucosal resection, molecular biomarkers, optical coherence tomography, confocal laser endomicroscopy, volumetric laser endomicroscopy, and endocytoscopy. Treatment of BE depends on the presence of intramucosal cancer or dysplasia, particularly high-grade dysplasia with or without visible mucosal lesions. Conclusions Recent advances in endoscopic diagnostic tools demonstrate promising results and help to mitigate the shortcomings of the Seattle protocol. Future research as well as refining these tools may help aid them in replacing standard untargeted biopsies.
Management of Oropharyngeal Cancer in the HPV Era
Authors: Naghavi Arash O. , Strom Tobin J. , Ahmed Kamran A. , Echevarria Michelle I. , Abuodeh Yazan A. , Venkat Puja S. , Frakes Jessica M. , Harrison Louis B. , Trotti Andy M. , Caudell Jimmy J. 
Published: August 2017

Background Historically, oropharyngeal cancer (OPC) has been attributed to risk factors such as smoking and alcohol use. The increased incidence of OPC has been driven by human papillomavirus (HPV) infection. Methods A search of the literature involving HPV infection and OPC was performed, along with a search of ongoing clinical trials regarding HPV-positive OPC. Results This review summarizes the differences in epidemiology and prognosis of HPV-positive OPC compared with non–HPV-related OPC. It will also discuss use of de-escalating treatment to minimize toxicity while maintaining excellent outcomes. Disease management is also addressed, including prevention and follow-up recommendations for this cohort of patients. Conclusions HPV-positive OPC is a distinct disease, and efforts should be made to personalize its management. Preventive measures and vaccinations, along with de-escalation of treatment, may help optimize outcomes in this population.
Management of BCC and SCC of the Head and Neck
Authors: Strom Tobin J. , Caudell Jimmy J. , Harrison Louis B. 
Published: August 2017

Background For decades radiotherapy (RT) has been shown to treat skin cancers; however, the indications, delivery methods, and techniques for RT continue to evolve. Methods Relevant prospective and retrospective reports were reviewed that addressed outcomes with, indications for, and delivery techniques used with RT for the management of cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the head and neck. Results Rates of local control higher than 90% are typically achievable for early-stage BCC and SCC of the head and neck. RT is often recommended for tumors located in cosmetically or functionally sensitive areas of the face, for patients who cannot tolerate anesthesia, for those taking anticoagulants, or for patients who prefer RT to other treatment options. A wide range of radiation doses, daily fractionation schedules, and radiation techniques have been shown to be effective for management. In general, postoperative local radiation is recommended following excision for patients with high-risk factors, including those whose tumors have close or positive margins, perineural invasion, invasion of the bone or nerves, or those with recurrent disease. Conclusions RT plays an integral role in the treatment of primary and postoperative cutaneous BCC and SCC of the head and neck. Prospective trials are in progress to address the roles of concurrent systemic therapy and RT for both cutaneous BCC and SCC.
Practical Issues for Retroperitoneal Sarcoma
Authors: Pham Vicky , Henderson-Jackson Evita , Doepker Matthew P. , Caracciolo Jamie T. , Gonzalez Ricardo J. , Druta Mihaela , Ding Yi , Bui Marilyn M. 
Published: August 2017

Background Retroperitoneal sarcoma is rare. Using initial specimens on biopsy, a definitive diagnosis of histological subtypes is ideal but not always achievable. Methods A retrospective institutional review was performed for all cases of adult retroperitoneal sarcoma from 1996 to 2015. A review of the literature was also performed related to the distribution of retroperitoneal sarcoma subtypes. A meta-analysis was performed. Results Liposarcoma is the most common subtype (45%), followed by leiomyosarcoma (21%), not otherwise specified (8%), and undifferentiated pleomorphic sarcoma (6%) by literature review. Data from Moffitt Cancer Center demonstrate the same general distribution for subtypes of retroperitoneal sarcoma. A pathology-based algorithm for the diagnosis of retroperitoneal sarcoma is illustrated, and common pitfalls in the pathology of retroperitoneal sarcoma are discussed. Conclusions An informative diagnosis of retroperitoneal sarcoma via specimens on biopsy is achievable and meaningful to guide effective therapy. A practical and multidisciplinary algorithm focused on the histopathology is helpful for the management of retroperitoneal sarcoma.
Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer
Authors: Hamel Lauren M. , Penner Louis A. , Albrecht Terrance L. , Heath Elisabeth , Gwede Clement K. , Eggly Susan 
Published: August 2017

Background Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial — a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. Methods Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor–patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. Results Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. Conclusion To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.
Determinants of Treatment Delays among Underserved Hispanics with Lung and Head and Neck Cancers
Authors: Borrayo Evelinn A. , Scott Katie L. , Drennen Ava R. , Macdonald Tiare , Nguyen Jennifer 
Published: August 2017

BackgroundEvidence is lacking to explain the reasons why treatment is delayed among disadvantaged Hispanic patients diagnosed with lung and head and neck cancers. Data indicate that treatment delays beyond 46 days increase the risk of death for individuals with these cancers.MethodsA mixed-methods design was used to explore determinants of treatment delays by analyzing data from the medical records of 40 Hispanic patients and data from interviews with 29 Hispanic patients, care-givers, health care professionals, and patient navigators from a safety-net hospital.ResultsOf the 40 Hispanic patients, 35% initiated treatment 46 days or more after being diagnosed, but women experienced longer delays than men (average of 48 days). Women with few comorbid diseases (≤ 4) were more likely to experience treatment delays. Institutional-related determinants at publicly funded hospitals appear to delay treatment for patients at the safety-net hospital, and patient-related determinants common to underserved patients (eg, no health insurance coverage) are likely to further contribute to these delays.ConclusionsDelayed treatment is associated with poor outcomes and low rates of survival in patients with lung and head and neck cancers. Therefore, action should be taken to improve the time between diagnosis and the initiation of treatment for disadvantaged Hispanic patients.
Geographical Factors Associated with Health Disparities in Prostate Cancer
Authors: Gilbert Scott M. , Pow-Sang Julio M. , Xiao Hong 
Published: August 2017

BackgroundTreatment variation in prostate cancer is common, and it is driven by clinical and clinician factors, patient preferences, availability of resources, and access to physicians and treating facilities. Most research on treatment disparities in men with prostate cancer has focused on race and socioeconomic factors. However, the geography of disparities — capturing racial and socioeconomic differences based on where patients live — can provide insight into barriers to care and help identify outlier areas in which access to care, health resources, or both are more pronounced.MethodsResearch regarding treatment patterns and disparities in prostate cancer using the Geographical Information System (GIS) was searched. Studies were limited to English-language articles and research focused on US populations. A total of 43 articles were found; of those, 30 provided information about or used spatial or geographical analyses to assess and describe differences or disparities in prostate cancer and its treatment. Two additional GIS resources were included.ResultsThe research on geographical and spatial determinants of prostate cancer disparities was reviewed. We also examined geographical analyses at the state level, focusing on Florida. Overall, we described a geographical framework to disparities that affect men with prostate cancer and reviewed existing published evidence supporting the interplay of geographical factors and disparities in prostate cancer.ConclusionsDisparities in prostate cancer are common and persistent, and notable differences in treatment are observable across racial and socioeconomic strata. Geographical analysis provides additional information about where disparate groups live and also helps to map access to care. This information can be used by public health officials, health-systems administrators, clinicians, and policymakers to better understand and respond to geographical barriers that contribute to disparities in care.
Disparities in Penile Cancer
Authors: Sharma Pranav , Zargar-Shoshtari Kamran , Pettaway Curtis A. , Schabath Matthew B. , Giuliano Anna R. , Spiess Philippe E. 
Published: August 2017

Background Although penile cancer is a rare malignancy in developed nations, racial and socioeconomic differences exist in the incidence of the disease and its associated survival-related outcomes. Methods A search of the literature was performed for research published between the years 1990 and 2015. Case reports and non—English-language articles were excluded, instead focusing specifically on large, population-based studies. Results The incidence of penile cancer is higher in Hispanic and African American men compared with whites and Asians. Men with penile cancer also appear to have a distinct epidemiological profile, including lower educational and income levels, a history of multiple sexual partners and sexually transmitted infections, and lack of circumcision with the presence of phimosis. African American men presented at a younger age with a higher stage of disease and worse survival rates when compared with white men. Rates of cancer-specific mortality increased with age, single marital status, and among those living in regions of lower socioeconomic status. Conclusions An understanding of sociodemographical differences in the incidence and survival rates of patients with penile cancer can help advance health care policy changes designed to improve access and minimize disparities in cancer care for all men alike.
Disparities in Adolescents and Young Adults with Cancer
Authors: Isenalumhe Leidy L. , Fridgen Olivia , Beaupin Lynda K. , Quinn Gwendolyn P. , Reed Damon R. 
Published: August 2017

Background Cancer care for adolescents and young adults (AYAs) focuses on the care of patients aged 15 to 39 years. Historically, this group has favorable outcomes based on a preponderance of diagnoses such as thyroid cancers and Hodgkin lymphoma. Improvements in outcomes among the AYA population have lagged behind compared with younger and older populations. Methods We discuss and review recent progress in AYA patient care and highlight remaining disparities that exist, including financial disadvantages, need for fertility care, limited clinical trial availability, and other areas of evolving AYA-focused research. Results Survival rates have not improved for this age group as they have for children and older adults. Disparities are present in the AYA population and have contributed to this lack of progress. Conclusions Recognizing disparities in the care of AYAs with cancer has led many medical specialty disciplines to improve the lives of these patients through advocacy, education, and resource development. Research addressing barriers to clinical trial enrollment in this population, quality-of-life issues, and the improvement of survivorship care is also under way.
Programmed Cell Death (Apoptosis) and Cancer Chemotherapy
Authors: Denmeade Samuel R. , Isaacs John T. 
Published: August 2017

BackgroundProgrammed cell death involves a genetic reprogramming of the cell to promote an energy-dependent cascade of biochemical and morphological changes within the cell that result in its death and elimination.MethodsThe regulations and mechanisms of programmed cell death are reviewed with an emphasis on how derangement of this mechanism may be involved in modulating responsiveness to chemotherapy.ResultsActivation of this programmed death process is controlled by a series of endogenous cell-type-specific signals. In addition, a variety of exogenous cell-damaging treatments (eg, radiation, chemicals, and viruses) and most chemotherapeutic drugs can activate this pathway if sufficient injury to the cell occurs. Resistance to chemotherapy can involve alterations in the ability of a malignant cell to activate the programmed cell death (apoptotic) pathway when damaged by these exogenous agents.ConclusionThe most important determinant of tumor resistance may be a generalized resistance to induction of programmed cell death rather than resistance based on specific alteration in drug/target interactions.