bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemotherapy (Ctx) use and adoption of new agents in older versus younger patients (pts) with metastatic colorectal cancer (mCRC).
Authors: Vijayvergia Namrata , Li Tianyu , Wong Yu-Ning , Hall Michael J. , Cohen Steven J. , Dotan Efrat 
Published: February 2017

674 Background: The treatment of mCRC has changed substantially in the last 2 decades but adoption of new drugs has not been well studied in older pts. We explored the effect of age and comorbidities on the adoption of irinotecan (Iri) and oxaliplatin (Ox) in mCRC pts over a 15 year timespan. Methods: mCRC pts receiving 5-Fluorouracil (5FU) based Ctx between 1995-2009 were studied using the LifeLink Health Plan Claims Database, and evaluated based on age (>70 vs ≤70y). Pts were identified by ICD-9 / HCPCS (J) codes. The fraction of pts receiving Ctx was calculated at yearly intervals and any other agent received with 5FU defined combination Ctx. Charlson Comorbidity Index (CCI) was used to assess comorbidity burden. Wilcoxon's and χ2test were used in univariate and logistic regression in multivariate analyses (MVA). Results: 16087 pts were identified with a median age of 61y and 55% males. The difference in proportions of older vs younger pts receiving Ctx for mCRC remained stable over the 15 year period. There was an increase in the fraction of pts with CCI>1 over time (14% in 1996; 40% after 2004 (p<0.05). Older pts had higher rate of CCI>1 (Table). Use of single agent 5FU declined in both groups over time. After FDA approval, use of Iri was lower in older pts (15 vs 38% in 1998, p<0.05), but this difference resolved by 2002 (62% both groups, p=0.9). Similarly, Ox was used more frequently in younger pts after initial approval (15% vs 22% in 2003), with decrease in this difference by 2009 (60% vs 64%,p=0.9). Older pts were less likely to get >2 agents when compared to younger (15 vs 22%, 29 vs 39% and 11 vs 16% in 2003, 2006 & 2009 respectively, p<0.001). On MVA, likelihood of receiving combination Ctx increased over time [OR 1.2; 1.18-1.26; p<0.01], but was lower in older pts [OR 0.65;0.59-0.71, p<0.001] and pts with CCI>1 [OR 0.84;0.77-0.91; p<0.001]. Conclusions: In a group of commercially insured pts, a lower fraction of older pts are treated for mCRC and adoption of new agents into the treatment of older pts appears to lag behind that of younger pts. However, oncologists have become more comfortable treating older pts with comorbidities over time. [Table: see text]
Impact of prophylactic treatments of cetuximab-based skin reactions in patients with metastatic colorectal carcinoma (mCRC): Interim analysis of the German noninterventional study ERBITAG.
Authors: Sahm Stephan , Goehler Thomas , Hering-Schubert Christiane , Janssen Jan , Schwittay Michael , Zahn Mark-Oliver , Stenzel Karsten Guenter , Steinbach-Buechert Alma Katharina , Overkamp Friedrich 
Published: February 2017

675 Background: Prophylactic treatments are widely used to ameliorate skin reactions induced by EGFR inhibition. Randomised studies have shown a positive impact of prophylactic antibiotics. Methods: Patients (Pts) with KRAS-wt and later RAS-wt mCRC treated with a first-line chemotherapy regimen plus cetuximab with written informed consent were eligible for this prospective, non-interventional study. Physicians were requested to complete a questionnaire and document any applied prophylactic and reactive skin toxicity treatment for every pt. Different prophylactic treatment regimens were categorized in 5 groups: systemic antibiotics (SA), skin care without antibiotics or corticosteroids (SC), other topical treatments (OT) (e.g. antibiotics or corticosteroids), any prophylaxis (P), and no prophylaxis (NP). Results: Data from 497 pts at 178 centers were finally collected and evaluable at data cut off. For all reported skin reactions the maximum NCI-CTCAE grade per patient and prophylactic treatment group was evaluated (table). Although none of the prophylactic regimens were significant different from NP, SA showed a numerically lower rate of all skin reactions by 8.1% (p=0.06) and of rash acneiforme by 5.3% (p=0.134) versus NP. 96.2% of reactive treatments of skin toxicities were done without consultation of a dermatologist and the medication was topical or systemic in 60.9% and 32.3%, respectively. Response to reactive treatment was complete remission or significant improvement of the skin reactions in 68.6% (topical) and 66.0% (systemic). Conclusions: Pts given prophylactic SA showed numerically fewer grade 3-4 skin reactions in comparison to NP (7.6% vs. 15.7%), but without significance. An important reason for failing significance may be the low number of pts receiving prophylactic SA (only in 18.5% of pts). Reactive treatment (systemic or topical) of skin toxicities led to an improvement in the majority of pts. Clinical trial information: http://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb/nis-details/_455. [Table: see text]
Clinicopathologic characteristics that affect the treatment and recurrence of rectal carcinoid tumor in Korea.
Authors: Lee Dong Ho , Park Young Soo , Hwang Jae Jin , Jung Hyun chae 
Published: February 2017

684 Background: The increase of colonoscopy procedures has led to an increase in the diagnosis of rectal carcinoid tumors. The aim of this study was to evaluate the clinical and pathological characteristics that affect the treatment and recurrence of rectal carcinoid tumors. Methods: Between 2003 and 2014, the medical records of patients with rectal carcinoid tumors were retrospectively reviewed. Patient and tumor characteristics, treatment and recurrence were analyzed. Results: The mean age was 51.7 ± 11.7 (range, 22-80 years) and the male to female ratio was 1:0.58. The mean tumor size was 8.7 ± 4.9 (3-27) mm. Four hundred-seven out of 424 patients were treated by endoscopy (mean size of tumor: 8.6 ± 3.6 mm) and 17 were treated by surgery (mean size of tumor: 12.5 ± 5.7 mm, p = 0.023). However, the histology showed that 87 patients treated by endoscopy had positive resection margins; 68 cases (16.0%) had a polypectomy and 19 cases (4.4%) had a endoscopic mucosal resection (p = 0.033). The mean follow-up duration was 29.1 ± 31.3 months, and there were five recurrences of rectal carcinoid tumors.All cases of recurrence of rectal carcinoid tumor were successfully re-treated by additional endoscopic resection. Conclusions: Endoscopic resection was an effective method for the treatment of rectal carcinoid tumors. Moreover, even for small rectal carcinoid tumors, follow-up examination should be performed to evaluate for tumor recurrence.The recurrence of rectal carcinoid tumor should be successfully controlled by additional endoscopic resection.
Innovation or disparity? National trends in nonoperative management of rectal adenocarcinoma.
Authors: Ellis Clayton Tyler , Samuel Cleo A. , Stitzenberg Karyn B. 
Published: February 2017

688 Background: While surgical resection has always been the cornerstone of curative treatment for rectal cancer, preoperative chemoradiation for stage II/III rectal cancer results in up to 49% of patients with a clinical complete response. As a result, many have questioned whether surgery can be omitted for this group of patients. Currently, there is insufficient evidence on the safety and efficacy of chemoradiation-only, or non-operative management (NOM), to support the wholesale adoption of this treatment paradigm. Despite this, anecdotal evidence suggests there is a trend for increased use of NOM. Our objective was to examine trends in the use of NOM for rectal cancer over time as well as patient- and facility-level factors associated with its use. Methods: We included all incident cases of invasive, non-metastatic, rectal adenocarcinoma reported to the National Cancer Data Base (NCDB) from 1998–2010. We performed univariate and multivariate analyses to assess NOM use over time as well as patient- and facility-level predictors of NOM. Results: 146,135 patients met inclusion criteria: 5,741 had NOM and 140,394 had surgery +/- additional therapy. From 1998-2010, the use of NOM doubled from 2.4% to 5% of all cases annually. Patients who were Black (AOR=1.71, 95%CI=1.57-1.86), uninsured (AOR=2.35, 95%CI=2.08-2.65), Medicaid-enrolled (AOR=2.10, 95%CI=1.90-2.33), and those treated at low-volume facilities (AOR=1.53, 95%CI=1.42-1.64) were more likely to receive NOM than White, privately insured, and high-volume facility patients, respectively. Additionally, NOM was more common in the South (AOR=1.53, 95%CI=1.32-1.76) and Pacific (AOR=1.82, 95%CI=1.57-2.12) as compared with the Northeast. Conclusions: NOM is an innovative approach that demonstrate promise in the treatment of rectal cancer. Pursing this approach in the context of a clinical trial and with well-informed patients would be appropriate. We observed evidence of increasing NOM utilization; however, this increase is occurring more frequently in Black and uninsured/Medicaid patients, raising concern that increased NOM use may actually represent increasing disparities in rectal cancer care rather than innovation.
Changes in treatment patterns for patients with locally advanced rectal cancer in the United States over the past decade: An analysis from the National Cancer Data Base (NCDB).
Authors: Sineshaw Helmneh M. , Jemal Ahmedin , Mitin Timur 
Published: February 2017

691 Background: Neoadjuvant chemoradiation therapy (NACRT) is widely accepted as the standard of care for treatment of locally advanced rectal cancer in the United States. We sought to examine patterns of treatment for locally advanced rectal cancer in US over the past decade. Methods: Using the National Cancer Data Base (NCDB), we identified 66,197 patients diagnosed with stage II-III rectal adenocarcinoma and treated between 2004 and 2012. We described trends in receipt of treatment based on aggregated data for three time periods (2004-2006, 2007-2009, 2010-2012), using trend test. We analyzed 5-yr overall survival (OS) probabilities for 28,550 patients treated between 2004 and 2007. Results: Receipt of NACRT increased significantly over the past decade from 42.9% in 2004-2006 to 50.0% in 2007-2009, and then to 55.0% in 2010-2012 (p < 0.0001). In contrast, use of adjuvant chemoradiation (CRT) decreased steadily from 16.7% in 2004-2006 to 10.5% in 2007-2009, and then to 6.7% in 2010-2012 (p < 0.0001). Similarly, treatment with surgery alone decreased from 13.1% in 2004-2006 to 8.7% in 2010-2012 (p < 0.0001). Older age, presence of comorbidities, larger primary tumor size, lymph node involvement, non-Hispanic white ethnicity, lack of private insurance, and being treated at a non-high case volume facility were associated with a significantly lower chance of receiving NACRT in multivariable logistic regression analysis. 5-yr OS probabilities for patients treated with NACRT, surgery and adjuvant CRT, surgery alone, and definitive CRT were 72.4%, 70.9%, 44.9% and 48.8%, respectively. Conclusions: Utilization of NACRT prior to surgery in US patients diagnosed with locally advanced rectal cancer has substantially increased over the past decade. However, only about half of these patients currently receive the standard therapy as recommended by national guidelines, and there may be social and economic barriers to receiving the standard of care. Tri-modality therapy is associated with the best outcomes for these patients, and surgery alone or definitive chemo-radiation should only be reserved for patients unable to tolerate tri-modality therapy.
Which is the better prognostic factor in rectal cancer patients who received neoadjuvant chemoradiotherapy: cTNM stage vs. ypTNM stage?
Authors: Kim HyungJin , Kim Gun , Yoo Ri Na , Kye Bong-Hyeon , Cho Hyeon-Min 
Published: February 2017

693 Background: Neoadjuvant chemoradiotherapy (nCRT) in rectal cancer is widely applied in patients with cTNM II and III stage. However, it is still obscure which staging system, either clinical (c) or pathologic (yp), influences in prognosis. This study aims to evaluate the current staging system predicting prognosis in the locally advanced rectal cancer patients. Methods: Among 221 patients who were diagnosed with rectal cancer and underwent curative resection from January 2009 to February 2013, 141 patients who received nCRT were included. The ypTNM stage was categorized: complete remission and stage I to ypI. Results: Mean follow-up period was 36.3 ± 15.1 months. Disease-free survival (DFS) was not associated with age, sex, Anesthesiologists classification, types of operative procedure, tumor cell differentiation, tumor location, tumor infiltration, preoperative CEA level, adjuvant chemotherapy. cTNM stage did not demonstrate any correlation with DFS (cII % vs cIII %, P = 0.266). However, DFS did exhibit statistically significant association with postoperative CEA level (P < 0.001) and ypTNM stage. 3-year DFS rate for each categorized stage is as followed – ypI, 87.9%; ypII, 67.8%; ypIII, 53.3% (ypI vs. ypII P = 0.009, ypI vs. ypIII P < 0.001, ypII vs. ypIII P= 0.185). Conclusions: Oncologic outcome of the patients with locally advanced rectal cancer is associated with pathologic TNM stage. Based on our results, we think that adjuvant chemotherapy given to patients with complete remission or pathologic stage I may be reconsidered.
Fiducial markers vs. PET/CT for esophageal cancer GTV delineation for radiotherapy treatment planning using a standard SUV threshold and background uptake method.
Authors: Oliver Jasmine A , Venkat Puja , Montilla-Soler Jaime , Klapman Jason , Dhadham Gautumy Chikiti , Harris Cynthia L. , Emanuel Karen , Werner Joan , Jin Will , Frakes Jessica M. , Dilling Thomas J. , Zhang Geoffrey , Moros Eduardo G , Hoffe Sarah E. , Latifi Kujtim 
Published: February 2017

70 Background: Often in esophageal targets that move with respiration, endoscopically implanted fiducial markers are placed under ultrasound guidance within 1 cm from the superior and inferior tumor border. Our group has previously reported the stability of this method. 3D 18F-FDG PET/CT is obtained for initial staging of esophageal cancer and has altered the tumor volume in many sites. The correlation of these two methods for GTV delineation is currently undefined. Methods: Twenty-one patients with esophageal cancer were selected for this retrospective, IRB-approved analysis. Each patient underwent fiducial placement (by one of six endoscopists) at the inferior and superior borders of the tumor and received PET/CT prior to Radiotherapy (RTx). PET/CT images were imported into an image analysis software system for measurements. The distance between fiducial markers and MTV defined by 2.5 SUV contour (method 1) and MTV using a threshold above mean liver uptake (method 2) was calculated. The fiducials were located on CT. The distance between the centroid and MTV border was measured. The Concordance Correlation Coefficient (CCC) was calculated to determine the correlation between results from the two methods. Results: In method 1 the median distance between MTV (2.5 SUV) and fiducials was 1.0 cm (0.0 cm - 2.8 cm) and 1.0 cm (0.0 cm - 6.9 cm) for inferior and superior borders, respectively. In method 2 median distance between MTV and fiducials was 1.14 cm (0.0 cm - 2.62 cm) and 1.64 cm (0.33 cm – 6.84 cm) for inferior and superior borders, respectively. The CCC indicated poor agreement between methods for both distances (0.57 and 0.87 for inferior fiducial distance and superior fiducial distance, respectively). There was no correlation between MTV-to-fiducial distances greater than 2 cm and the endoscopist that performed the fiducial implantation. Conclusions: Although the methods of defining the MTV had poor strength of agreement, both methods demonstrated a robust correlation between inferior fiducial marker placement and inferior PET/CT uptake. The superior fiducial marker and MTV border illustrated discordance – unrelated to the endoscopist.
The clinical trial for photodynamic diagnosis mediated 5-ALA for peritoneal metastasis due to advanced gastric cancer.
Authors: Takahashi Tsuyoshi , Miyazaki Yasuhiro , Makino Tomoki , Kurokawa Yukinori , Yamasaki Makoto , Takiguchi Shuji , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro 
Published: February 2017

71 Background: In advanced gastric cancer, the diagnosis of peritoneal metastasis is mandatory prior to the decision of therapy, therefore staging laparoscopy (SL) has gained wider clinical acceptance. However, a false-negative rate of 10% using SL has also been reported, which demonstrates the limitation of optical observation for the dissemination of the cancer nest. Photodynamic diagnosis (PDD) by 5-aminolevulinic acid (ALA) has been proposed for peritoneal metastasis in SL and showed higher sensitivity than that of conventional examination. To evaluate effectiveness and safety of ALA-PDD for the diagnosis of the peritoneal disseminations. Methods: Thirteen advanced gastric cancer that had the signs of peritoneal metastasis pointed out by CT scan prior to the treatment were included. Patients were administered 5-ALA (1g/body) orally 4hours prior to the SL. Several lesions regulated to observe bilateral sub- phrenic peritoneum, bilateral flanks and Douglas’s pouch (conventional examination, PDD each). If the nodules suspected for the metastatic lesion were found, they were diagnosed by laparoscopic biopsy. We evaluate the potential of additional detection rate compared to the conventional examination and safety. Results: The patients characters were as below, gender (male: female) = 8:5, Age (median; range) = 69 years old (39-76). The TNM factor were that cT3:4a = 2:11, cN0:1:2:3 = 2:0:7:4, cM0:1 = 10:3(Japanese classification of gastric carcinoma: 3rd English edition).The additional detection rate was 8.3 %( 1/13) and the incidence of adverse effect was 8.3 %( nausea, Grade 1). Conclusions: The ALA-PDD was effective and safe examination for the peritoneal metastasis of gastric cancer. And furthermore, we are now going to conduct the new investigator initiated trial.
Weekly bolus 5-fluorouracil and bevacizumab in the palliative treatment of metastatic colorectal cancer.
Authors: Cook Michelle Jane , Connor Carole , Khan Mohammed Mojid , Correa Peter Denzil 
Published: February 2017

736 Background: Patients with metastatic colorectal cancer (mCRC) are often elderly with multiple co-morbidities making them poor candidates for combination chemotherapy. Evidence suggests significant benefit from the addition of Bevacizumab (Bev) to single agent fluoropyrimidine chemotherapy in the palliative treatment of mCRC. There is no current trial data to support use of weekly bolus 5-fluorouracil (5-FU) chemotherapy combined with Bev. We present details of our experience with this treatment regimen. Methods: Patients with mCRC treated with weekly bolus 5-FU 370 mg/m2and Bev 5mg/kg every 2 weeks (Weekly-5FU-Bev) as a new line of palliative treatment were reviewed. All were deemed unsuitable for Capecitabine. Data were collected retrospectively from patient records. Survival statistics were calculated from date of treatment initiation using Kaplan-Meier methods. Results: From 2012-2015, 21 patients were treated with Weekly-5FU-Bev. Median age was 80 years (range 56-90 years), 57.1% were performance status (PS) 0, 19% PS 1 and 23.8% PS 2. 61.9% patients were Ras wild-type. Median treatment duration to date is 20 weeks (range 4-117 weeks). Treatment was stopped in 8 due to progressive disease, 1 due to toxicity and 4 for other reasons. Treatment was generally well tolerated with significant fatigue the most commonly reported side effect in 24%. 3 patients experienced venous thrombo-embolic events, 1 developed uncontrolled hypertension and 1 suffered a non-fatal tumour perforation. There were no treatment related deaths. Clinical benefit rate determined by best response to treatment was impressive at 66.7% with 1 complete response, 1 partial response, 1 biochemical response (non-measurable disease) and 12 patients with stable disease. Median progression free survival was 9.3 months (95% CI 2.8-15.8 months). Median overall survival has not been reached with 15 patients still alive. Conclusions: Acknowledging the limitations of this retrospective analysis of a carefully selected patient group, Weekly-5FU-Bev appears to be well tolerated and efficacious in the treatment of elderly patients with mCRC and can be considered an option in patients unsuitable for or intolerant of Capecitabine.
Metastatic lymph node ratio as an independent prognostic factor in stage III gastric cancer after D2 nodal dissection.
Authors: Ying Jieer , Li Cong , Zhang Yigong , Xu Qi 
Published: February 2017

738 Background: The aim of this study was to evaluate the prognostic impact of metastatic lymph node ratio (MLR) in stage III gastric cancer after D2 dissection, and to assess the value of MLR for adjuvant chemotherapy. Methods: A total of 87 patients who underwent radical resection with D2 lymphadenectomy between December 2007 and March 2014 was enrolled in this study. Survival was determined by Kaplan-Meier method and survival curves were assessed by log-rank test. Multivariate analysis was performed using the Cox proportional hazards model. Results: The median age of patients was 60 (range:21 to 83) with a male to female ratio of 2. 83 patients have undergone total gastrectomy (95.4%) and 4 subtotal gastrectomy (4.6%). 57 patients received chemotherapy, including 24 neoadjuvant chemotherapy and 33 adjuvant chemotherapy. All chemotherapy regimens have contained Flouropyrimidines (5-FU or capecitabine). There were only 5 patients received single-agent 5-FU or capecitabine as chemotherapy regimen, while 52 patients received combined-chemotherapy. The median total retrieved lymph node was 35 (range:10 to 104) and the median metastatic lymph nodes was 8 (range: 0 to 71). MLR was classified into 4 groups as follows: Group 1(MLR = 0), Group 2(MLR < 0.1), Group 3(MLR = 0.1-0.25), Group 4(MLR > 0.25). After a median follow-up of 28 months, the median PFS of group 1-4 was 37.1m, 35.9m, 31.5m and 16.9m, respectively (p = 0.025). The median PFS was significantly different in subgroups: 39.2m in low group (MLR < 0.25) with adjuvant chemotherapy, 36.4m in low group without chemotherapy, 17.2m in high group (MLR > 0.25) with chemotherapy and 11.5m in high group without chemotherapy (p = 0.012). The MLR was retained as an independent prognostic factor in multivariable analysis. Conclusions: After R0 resection with D2 lymphadenectomy for stage III gastric cancer, MLR can be a more effective and prognostic indicator. Patients with high MLR may most benefit from adjuvant treatments.