bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Irish Programme for Stratified Prostate Cancer Therapy (iPROSPECT).
Authors: Greene John Patrick , Casey Orla , O'Leary Karen , Fahey Ciara , Bracken Suzanne , Glynn Sharon A. , Perry Antoinette , Watson William , Finn Stephen , McDermott Ray 
Published: February 2017

335 Background: iPROSPECT is a prospective longitudinal translational study, funded through the Irish Cancer Society in partnership with Movember that is examining blood and tissue markers that might correlate with treatment response and survival and aid future stratification of metastatic prostate cancer (mPCa) patients with regard to optimal personalised treatment regimens. Methods: Patients with metastatic prostate cancer who are beginning or changing treatment are eligible for inclusion. Nine hospital sites supported by four research laboratories are open to recruitment. Cohort 1 (n = 15) includes patients with newly diagnosed mPCa who are beginning treatment with androgen deprivation therapy (ADT). Cohort 2 (n = 45) includes patients with CRPC who are beginning or changing treatment. All enrolled patients have blood drawn for plasma, serum and CTC analysis at baseline and thereafter every 4 months. All eligible patients with metastatic bone disease are offered an optional substudy of bone marrow biopsy performed prior to starting treatment. Any patient with visceral or nodal disease is offered a targeted CT guided biopsy. All patients are offered the PCa Research Consortium questionnaire, FACT-P and the Brief Pain inventory short form. Results: Between March and August 2015, 15 patients within cohort 1 (100%) have been enrolled and 22 patients in cohort 2 (48.8%). In cohort 1, the median age of patients was 66, median PSA at entry was 9.2 with an average Gleason score of 8. In cohort 2, the median age of patients was 68, median PSA at entry was 236.4 with an average Gleason score of 8. Eight patients underwent bone marrow biopsy, and 2 patients underwent CT guided biopsies. All patients had archival FFPE tissue collected. Questionnaires were collected from all eligible patients. Conclusions: The recruitment rate to date has indicated successful implementation of this study. Results will identify how clinical and biological patterns change over time and relate to each individual’s treatment response and progression of disease. [Table: see text]
Sequencing of treatments in metastatic CRPC for patients who have completed all therapeutic interventions.
Authors: Steinberger Allie E. , Ledet Elisa M. , Feibus Allison H. , Premkumar Vikram J. , Dotiwala Aryeneesh , Stolten Michael D. , Lewis Brian E. , Sartor A. Oliver 
Published: February 2017

339 Background: The current treatment paradigm for metastatic, castrate-resistant prostate cancer (mCRPC) has rapidly changed and six therapies [abiraterone (Abi), enzalutamide (Enza), docetaxel (Doc), cabazitaxel (Cab), radium-223 (Ra-223), and sipuleucel-T (Sip-T)] have now been proven to prolong overall survival. Though sequential therapy is the norm, few studies have reported on the variety and prevalence of these agents over the course of patient's lifetime. Herein, we sought to describe the temporal frequencies of mCRPC therapies in patients who completed all of their therapies. Methods: Retrospective chart reviews were conducted on 119 patients who died from mCRPC at Tulane Cancer Center from 2008-2015 (thus completing all possible therapies). Many patients were not treated with multiple life-prolonging therapies given the timing of their death. Post-mCRPC therapies were longitudinally sequenced and a frequency table was generated for first, second, third, etc. line of therapies. Results: Median duration from initial androgen deprivation therapy to mCRPC was 29 months (range: 0-252) and 34.4% of the cohort presented with distant metastatic disease (M1) at diagnosis. The most common front line mCRPC therapies were nilutamide, Doc, Abi, and ketoconazole (Keto) in that order. Keto, Doc, dexamethasone, and Abi were the most common second line therapies. Abi, Doc, DES, and Cab were the most prevalent third line therapies. Doc, Abi, Cab, and Ra-223 were most common fourth line therapies. The median overall survival for our cohort was 69 months (range: 5-270 months) from initial diagnosis. Conclusions: This retrospective analysis provides a temporal snapshot of the timing and frequency of treatments for men dying from mCRPC from 2008-2015. More recent patients are likely to have greater access to contemporary therapies.
Risk of secondary urinary bladder cancer (UBC) in patients receiving radiotherapy for rectal cancer, prostate cancer, and gynecologic malignancies.
Authors: Bergerot Paulo Gustavo , Nelson Rebecca A. , Ye Da-Wei , Grivas Petros , Singh Parminder , Agarwal Neeraj , Choueiri Toni K. , Pal Sumanta K. 
Published: February 2017

363 Background: Radiotherapy proximal to the bladder mucosa may incite malignant transformation. We investigated this phenomenon using a large population-based national database. Methods: The SEER13 database from 1992 to 2012 was reviewed for bladder cancer patients who had a history of any previous cancer, including solid tumors and hematologic malignancies. Data regarding the use of radiotherapy was reviewed. Information was analyzed using standardized incidence ratios (SIRs), defined as the ratio of observed to expected cases adjusted by person years at risk. SIRs are considered statistically significant if corresponding 99% exact confidence intervals (CIs) exclude 1.0. All results were standardized using a referent population matched to the index cases based on age, sex, race, and time period. Results: A total of 20,341 patients with secondary UBC were identified. A higher incidence in secondary UBC was seen amongst rectal, prostate cervical and uterine cancer patients receiving radiotherapy (see Table). Patients with lung cancer had a higher incidence of secondary UBC irrespective of radiotherapy use. Compared to patients with secondary UBC and no prior radiotherapy, patients with secondary UBC with prior radiotherapy had a higher rate of localized disease (79% vs 75%, P < 0.0001) and had poorer survival on multivariate analysis (HR 1.06, 95%CI 1.05-1.06; P < 0.0001). Conclusions: Patients with selected abdominal and pelvic tumors who received radiotherapy had a higher rate of secondary UBC. Further study is needed to determine whether these cancers represent a biologically distinct entity. [Table: see text]
Exploring multidisciplinary practice patterns in the management of muscle invasive bladder cancer (MIBC) across the U.S. and Canada in 2015.
Authors: Harshman Lauren Christine , Kaag Matthew , Efstathiou Jason A. , Apolo Andrea B. , Hoffman-Censits Jean H. , Stadler Walter Michael , Yu Evan Y. , Bochner Bernard H. , Skinner Eila C. , Downs Tracy , Kiltie Anne E , Bajorin Dean F. , Guru Khurshid , Shipley William U. , Steinberg Gary D. , Hahn Noah M. , Sridhar Srikala S. 
Published: February 2017

368 Background: Effective treatment of MIBC requires a multidisciplinary (multiD) approach including surgical, radiation, and chemotherapeutic modalities, which are further supported by pathology, radiology, nursing, social work, nutrition, pharmacy, and psychologic expertise. As surgical and bladder preservation approaches have not been directly compared, practice patterns are heterogeneous. Our primary objective was to catalogue the different styles of multiD approaches or lack thereof in the management of MIBC. Secondary objectives were to assess physician interest, capture examples of successful approaches, and describe barriers to implementation. Methods: We conducted an international online survey regarding the type of multiD approach and available resources used by clinicians managing MIBC. We collaborated with the Bladder Cancer Advocacy Network and the Genitourinary Medical Oncologists of Canada to reach a wide variety of academic and community practices. Results: Of the 101 clinicians surveyed, most practiced at NCI designated comprehensive cancer centers (46%) or Canadian academic institutions (29%). The median number of cases per month was 5 (0-40).Of the different multiD styles, sequential (separate) visits on different days was the most common (60%) followed by sequential same day (41%), concurrent (one visit with all providers, 23%), and none (5%). However, most preferred a sequential same day (44%) or concurrent (28%) approach. Although most academic practices had some form of multiD approach, reported barriers for implementing the preferred strategy were lack of clinic space (63%), funding (46%), staff (46%), and time (34%). The majority felt a multiD approach enriched their practice. Conclusions: Most surveyed practitioners at academic centers integrate a multiD strategy in the management of MIBC. The major barriers are not attitudinal but rather insufficient resources and time. Thus, most physicians employ a sequential rather than a concurrent approach. Future goals include developing strategies to overcome these obstacles and integrating these results with patient preferences to optimize the management of MIBC patients.
Adjuvant pelvic radiotherapy for pathological high-risk muscle-invasive bladder cancer: A multicenter retrospective study.
Authors: Sargos Paul , Latorzeff Igor , Flechon Aude , Roubaud Guilhem , Brouste Veronique , Gaston Richard , Piechaud Thierry , Richaud Pierre , Orre Mathieu 
Published: February 2017

369 Background: Radical cystectomy (RC) and pelvic lymph-node dissection (PLND) are standard procedures in the management of non-metastatic muscle invasive bladder cancer (MIBC). Loco-regional recurrence (LRR) is a common early event associated with a poor prognosis. The aim of this study is to evaluate adjuvant radiotherapy (RT) for pathological high-risk MIBC. Methods: We retrospectively reviewed data from patients treated by RC from 3 institutions. Inclusion criteria were MIBC, histologically proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. LRR free-survival, overall survival (OS) and metastasis-free survival (MFS) were evaluated. Acute toxicities were recorded according to CTCAE V4.0 scale. Results: Between January 2000 and December 2013, 57 patients with a median age of 66 years (45-84) were included. Post-operative pathological staging was pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% of pN0, 26% of pN1 and 42% of pN2. For 2 patients, no PLND was performed. Median number of lymph-nodes retrieved was 10 (2-33). Forty-eight patients (84%) received platin-based chemotherapy, 7 in neo-adjuvant and 41 in adjuvant setting. For RT, clinical target volume 1 (CTV 1) alwyas encompasses pelvic lymph nodes and cystectomy bed for 37 patients (65%). Median dose for CTV 1 was 45 Gy (4-50). Dose complement of 16 Gy (5-22) corresponding to CTV 2 was achieved in 53 of cases, depending on pathological features. Intensity Modulated RT was performed in one third of patients. With a median follow-up of 40.4 months, LRR occurred in 8 patients (14%). Three-year loco-regional free survival, MFS and OS were 45% (IC 95%: 0.30-0.60), 39% (IC 95%: 0.25-0.52) and 49% (IC 95%: 0.33-0.63), respectively. Acute grade ≥ 3 toxicities were observed in 5 patients (9%). One patient died with intestinal fistula in septic context. No survival or toxicity predictive factor was identified. Conclusions: Adjuvant radiotherapy for pathological high-risk MIBC is safe and may have oncological benefits. Thus, new prospective trials evaluating this approach with modern RT techniques should be undertaken.
Evaluation of prognostic factors in upper tract urothelial carcinoma (UTUC).
Authors: Emamekhoo Hamid , Gopalakrishnan Dharmesh , Dhillon Puneet , Al taii Haider , Elson Paul , McKenney Jesse , Magi-Galluzzi Cristina , Harper Holly Lynn , Zargar Homi , Rini Brian I. , Stephenson Andrew J. , Gong Michael C. , Fergany Amr Farouk , Haber Georges-Pascal , Campbell Steven C. , Kaouk Jihad , Berglund Ryan Kent , Stein Robert , Garcia Jorge A. , Grivas Petros 
Published: February 2017

372 Background: UTUC is relatively rare (5-10% of UC). Limited data on prognostic factors is available. Methods: A retrospective study of UTUC patients (pts) who had surgery (1995-2014) at Cleveland Clinic (n = 454) was conducted. Univariable (UVA) and multivariable (MVA) analysis (proportional hazards) with a stepwise selection algorithm (p = .10 and .05, as criteria for entry and retention in the model) was used to identify independent predictors of recurrence-free survival (RFS) and overall survival (OS). Results: 192 pts with invasive high grade UTUC were identified; median age at resection was 72; 69% men. 72% of pts had laparoscopic and 17% open nephrouretectomy, 23% had +ve margins (including bladder/ureter cuff), 22% had multifocal tumor. Median tumor size 3.5 cm (0.2-12); 70% had tumors < 5 cm; 65% pT3, 8% pT4 stage; among pts with lymph node (LN) dissection, 25% had +ve LN. All but 3 pts (2 sarcomatoid, 1 small cell) had primarily UC; 28% mixed UC histology; 40% CIS, 54% confirmed lymphovascular invasion (LVI); 10 neoadjuvant, 14 confirmed adjuvant therapy). Among 116 pts with RFS data available 59% had disease recurrence; 8% died with no known recurrence. Estimated median RFS was 13.1 months (m) (95%CI 8.6-18.6). In UVA, age, positive margins, tumor size, smoking history, pT stage, LVI, primary site impacted RFS. In MVA, margin status (p = .04), age (p = .04), pT stage (p = .05) were independently associated with RFS. Among 175 pts with OS data available, 38% died with estimated median OS 44.6 m (95%CI 24.1-107.4); median follow-up was 13.8 m (0.1-185.7) in pts alive at last follow up. In UVA, LVI, tumor size, age, pT stage, tumor location, ECOG PS impacted OS. In MVA, tumor size (p = .002), CIS (p = .004), tumor location (p = .04), LVI (p = .04) independently predicted OS. Using these factors, 3 prognostic groups were identified for each outcome (see table). Conclusions: Clinic-pathological parameters can be prognostic in UTUC; further validation is needed. [Table: see text]
Recurrence pattern after neoadjuvant chemotherapy compared to surgery alone in patients with muscle-invasive bladder cancer.
Authors: Koie Takuya , Ohyama Chikara , Imai Atsushi , Hatakeyama Shingo , Yoneyama Takahiro , Hashimoto Yasuhiro 
Published: February 2017

374 Background: Neoadjuvant chemotherapy for patients with muscle-invasive bladder cancer (MIBC) has better survival benefit than radical cystectomy (RC) alone. However, recurrences still occur in many cases and recurrent disease is the most lethal factor associated with death in MIBC. On the other hand, the rate and pattern of recurrences after neoadjuvant chemotherapy in MIBC patients remains unclear. Methods: Eligible patients had histologically confirmed stage T2-T4a muscle-invasive urothelial carcinoma of the bladder without lymph node or distant metastasis in this study. The cohort of neoadjuvant group consists of 130 patients with MIBC. The cohort of RC alone group includes 135 patients with MIBC treated with RC and bilateral pelvic lymph node dissection between May 1994 and July 2007. Propensity score matching was used to adjust for potential selection biases associated with treatment type. Recurrence site was defined as local, LN (lymph nodes), and distant metastases. Results: Propensity score-matched analysis indicated 130 matched pairs from both groups. The 5-year overall survival rate was 91% for neoadjuvant GCarbo versus 49% for RC alone group (P < 0.0001). The disease-free survival rate was 87% for neoadjuvant GCarbo versus 57% for surgery alone (P < 0.0001). The distant metastases were comparable in both groups. The total number of local recurrences or LN mets was markedly decreased in neoadjuvant GCarbo compared with RC alone cohort. Conclusions: The MIBC patients treated with neoadjuvant GCarbo achieved an improved oncological outcome with a different recurrence pattern compared to RC alone.
Primary sarcoma and sarcomatoid carcinoma of the urinary bladder: Comparison of clinical features, treatment, and survival.
Authors: Wang Jue 
Published: February 2017

381 Background: Sarcomatoid carcinoma (SaC), sarcoma (SC) and of the urinary bladder are rare entity. As a result, the natural history of these unusual tumors and the optimal management are uncertain. In addition, no previous studies have directly compared the cancer specific survival of patients with SC and SaC to patients with urothelial carcinoma (UC) of the urinary bladder. Methods: Patients with diagnosis of SC, SaC and high grade UC of urinary bladder were identified in the Surveillance, Epidemiology and End Results program (SEER) (1973 to 2012). Demographic of patients and clinical characteristics at diagnosis were compared. Differences in cancer specific survival were compared using univariate and multivariate analysis. Results: A total of 470 patients with SC, 361 with SaC and 58, 835 patients with high grade UC were identified. Patients with SC were younger (p < 0.001), more commonly in female (p < 0.001); black (p < 0.001), and advanced stage disease (p < 0.001), in comparison with patients with high grade UC. On another hand, Patients with SaC were generally older than those with SC and UC. The 5-year cancer specific survival rate was 51.8 % for patients with high grade UC and 36.4% for SC; 32% for SaC. On multivariate analysis there was an increased mortality risk in patients with SaC vs high grade UC. Conclusions: Even after adjusting for demographic, and treatment characteristics, SaC has worst survival than SC and UC. The current finding support bladder cancer is a heterogeneous group of tumors with distinct clinical behavior, distinct prognostic implications, and should receive tailored treatment.
Contemporary utilization trends and survival outcomes in patients undergoing radical cystectomy and bladder preservation therapy for muscle invasive bladder cancer.
Authors: Cahn David , Handorf Elizabeth , Nordsiek Michael , Churilla Thomas M. , Horwitz Eric M. , Ristau Benjamin T. , Chen David Y. T. , Viterbo Rosalia , Greenberg Richard Evan , Kutikov Alexander , Uzzo Robert G. , Smaldone Marc C. 
Published: February 2017

387 Background: To compare overall survival (OS) in patients undergoing radical cystectomy (RC) and bladder preservation therapy (BPT) for muscle invasive urothelial carcinoma of the bladder. Methods: We conducted a retrospective, observational cohort study in which we reviewed the National Cancer Database (NCDB) to identify patients with analytic stage II-III (N0M0) urothelial carcinoma of the bladder from 2003-2011. BPT patients were stratified as any external beam radiotherapy (EBRT), definitive radiotherapy (RT) [50-80Gy], and definitive RT + chemotherapy. Treatment trends were evaluated using Pearson Chi-square tests. OS was compared between RC and BPT using unadjusted Kaplan Meier curves and Cox regression models adjusted for year of treatment, hospital volume, and patient/tumor characteristics using increasingly stringent selection criteria to identify those undergoing BPT. Results: Of the 603,298 patients with bladder cancer captured in the NCDB from 2003-2011, 9% (n = 54,518) had analytic stage II-III with urothelial histology. 51.1% (n = 27,843) of these patients were treated with RC (70.9%, n = 19,745) or BPT (29.1%, n = 8,098). Of the patients undergoing BPT, stratified by selection criteria, 26.9% (n = 2,176) and 15.0% (n = 1,215) were treated with definitive RT and definitive RT + chemotherapy, respectively. Following adjustment, improved survival in patients undergoing RC was noted regardless of BPT definition employed in multivariate analysis. However, we noted attenuated differences in OS using increasingly stringent definitions for BPT (EBRT: HR 2.2 [CI 2.15-2.29]; definitive RT: HR 1.94 [CI 1.74-2.14]; definitive RT + chemotherapy: HR 1.56 [CI 1.45-1.68]). Conclusions: In the NCDB, receipt of BPT was associated with decreased OS compared to RC in all patients with stage II-III urothelial carcinoma, in part due to selection biases. However, the use of increasingly stringent definitions of BPT attenuated the observed survival differences. Further randomized prospective controlled trials are needed to compare trimodal BPT to RC to identify optimal candidates for bladder preservation.
Carboplatin-based sequential chemotherapy for advanced bladder cancer patient with impaired renal function.
Authors: Yoneyama Takahiro , Mikami Jotaro , Fujita Naoki , Sato Tendo , Kojima Yuta , Iwamura Hiromichi , Imai Atsushi , Hatakeyama Shingo , Hashimoto Yasuhiro , Koie Takuya , Ohyama Chikara 
Published: February 2017

401 Background: We retrospectively evaluated the feasibility and effectiveness of a caboplatin-based sequential chemotherapy for the patients with advanced bladder cancer whose creatinine clearance (Ccr) was 60 ml/min or below. Methods: We treated 68 patients with advanced bladder cancer at our clinic between August 2004 and December 2014. 48 patients with advanced bladder cancer (33 men and 15 women) whose Ccr were 60 ml/min or below were enrolled. Their average age was 72.5 years old (43–83), average Ccr of 43.3 ml/min (14.5–57.0), and an average follow-up period of 24.5 months (5–92). The therapeutic regimen consisted of 2 lines: gemcitabine/carboplatin (GCarbo) therapy as the first line, with two courses as a set; GCarbo/docetaxel (GCarboD) therapy as the second line if the response in the first line was insufficient. GCarbo consisted of 800mg/m2 gemcitabine on days 1, 8, and 15 and carboplatin (AUC 4) on day 2. If this regimen was effective, another 2 courses of GCarbo was performed. If this regimen did not induce any tumor size reduction, we switched to GCarboD, which consisted of 800mg/m2 gemcitabine on days 1 and 8, 70mg/m2 docetaxel on day 1, and carboplatin (AUC 3) on day 2. Results: Of the 48 subjects who had undergone the GCarbo therapy, the response rate was 35.4% (CR+PR) with 3 and 14 subjects exhibiting complete response (CR) and apartial response (PR), respectively; the average response duration was 10.8 months (2–90). The response rates of 9 instances of GCardoD was 33.3%; the overall median survival was 18.0 months throughout the sequential chemotherapy. Adverse events (AE) of grade 3 or higher occurred in 30 of those who had undergone the GCarbo therapy (62.5%). Conclusions: Although the present study is small and preliminary, the present carboplatin-based sequential chemotherapy is safe and active for advanced bladder cancer with impaired renal function. GCarbo regimen achieved acceptable response rate (35.4%) in advanced bladder cancer. The median overall survival of 18.0 months is acceptable when average Ccr of 43.3 ml/min for the subjects is took into consideration.