bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of life and acute radiation toxicity following hypofractionated stereotactic body radiation therapy with concurrent full-dose gemcitabine for unresectable pancreatic adenocarcinoma.
Authors: Gurka Marie Kate , Tse Gary , Unger Keith Robert , Haddad Nadim G , Marshall John , Johnson Colin , Ley Lisa , Slack Rebecca , Pishvaian Michael J. , Collins Sean Patrick 
Published: February 2017

336 Background: Quality of life (QoL) is of paramount importance when cure is not obtainable. The aim of this study is to report QoL outcomes and acute radiation toxicity in patients with pancreatic cancer treated with stereotactic body radiation therapy (SBRT) and concurrent gemcitabine. Methods: This prospective study reviewed the charts of 10 patients with locally advanced, unresectable pancreatic cancer treated with SBRT and 6 cycles of gemcitabine. The primary tumor and adjacent para-aortic nodes received a total dose of 2500 cGy in 500 cGy fractions on consecutive days between cycles 1 and 2 of gemcitabine. QoL was assessed on the 1st day of each cycle using the EORTC QLQ-C30 and EORTC QLQ-PAN26 questionnaires. Wilcoxon rank sum test was used to determine statistical significance between QoL scores. Toxicity was graded by NCI Common Terminology Criteria for Adverse Events, Version 3.0. Results: The median age was 62.5 years. All patients completed the prescribed SBRT. Median overall survival was 13 months (range 5- 17). QoL scores at baseline compared to immediately after SBRT showed an increase in the following symptoms: fatigue, nausea/vomiting (N/V) and anorexia, which were statistically significant (P < 0.05). These were not statistically different from baseline by cycle 3 except N/V. No symptoms were significantly improved after radiation therapy; however, there was a trend towards improvement in back pain, night pain and abdominal discomfort. Functional scales declined after treatment, but not significantly. Global QoL did not significantly change from baseline. There were no grade 3 or 4 acute toxicities related to SBRT. Conclusions: Hypofractionated SBRT with concurrent gemcitabine is feasible for locally advanced, unresectable pancreatic cancer. There is a temporary increase in selected symptoms due to radiation which resolve within one month. This may be an improvement compared to conventional fractionated radiation due to shorter duration of symptoms related to radiation treatment.
90Y radioembolization for neuroendocrine cancers liver metastases provides sustained therapeutic effect with minimal toxicity.
Authors: Kennedy Andrew S. , Elkordy Maha , Campbell Elizabeth Estill , Albertson Brent , Sailer Scott Lee , Deutsch Margaret Ann 
Published: February 2017

343 Background: Radioembolization (RE) is the delivery of radioactive microspheres (90Y) via the hepatic artery, which permanently implant preferentially in metastatic lesions, sparing adjacent normal liver. Metastatic neuroendocrine tumors in the liver are a common clinical problem which can be treated with RE. It is an outpatient procedure performed with increasing frequency worldwide for a variety of solid tumor types. Methods: A single institution retrospective review of all neuroendocrine patients treated with radioactive resin microspheres to control hepatic metastases. Details reviewed included: specifics of treatment and delivery, RECIST response at 3 and 6 months, acute and delayed radiation toxicities by CTC3ae, and analyses of tumor and radiation factors related to response and liver control. Results: A total of 56 patients; 26 male, 30 female, received a total of 85 separate treatments with resin 90Y microspheres. Treatment volume was all hepatic tumors with each treatment, usually selective whole liver in one fraction. Whole liver in 1 treatment comprised 86%, right lobe only in 10% and left lobe in 4%. Thirty-six patients (64.3%) received 1 treatment, 12 patients 2 fractions, 7 patients 3 fractions, and 1 patient 4 fractions. The median activity of 90Y delivered was 1.49 GBq (0.35 – 2.9 GBq). BSA approach was used for pretreatment activity calculations for all patients, with median of 100% planned activity delivered (26% - 147%). No grade 4 toxicities occurred, and only two grade 3 events were found (gastric ulcers). The median follow up is 24.2 mo. (1 – 93.4 mo.). RECIST at 3 and 6 months: CR 6.5%, SD 49.1%, PR 42.6% and PD 1.6%. Delivered activity (GBq) was associated with PR at 3 months (p=0.07, two-tailed t-test). Conclusions: Our experience is consistent with other published reports confirming the efficacy and low toxicity of this liver-directed ablative approach for unresectable neuroendocrine carcinomas. Multiple treatments to the whole liver were well tolerated. The BSA method of pretreatment radioactivity estimation is useful and safe in this tumor type.
Predicting survival in resected pancreatic cancer: A Canadian provincial experience.
Authors: Gresham Gillian , Ng Sylvia , Chang Anderson , Valdez Shannon , Gill Sharlene 
Published: February 2017

361 Background: Surgical resection offers the only hope for long-term disease control in patients (pts) with pancreatic adenocarcinoma. Randomized trials (ESPAC 1, ESPAC3) further support a role for adjuvant chemotherapy (AC) in the management of pancreatic cancer (PC). Trial outcomes may not reflect clinical reality due to pt selection bias, and it is often difficult to predict which pts are most likely to benefit from adjuvant intervention. Methods: Consecutive pts between 2003 and 2008 referred to the BC Cancer Agency (BCCA) with operative intent at diagnosis (dx) were retrospectively reviewed. Results: 145 pts were identified; median age 65 years (y) (range 38-84), male/female (45.5%, 54.5%). EUS/PET staging was performed in 21% of pts. Median CA19-9 value at dx was 210 ku/L. Pancreaticoduodenectomy was performed in 65% of pts. Complete resection (RO) of tumours occurred in 87 pts (60%) overall. 66% of pts were node positive. 43% of pts were subsequently treated with adjuvant therapy (AT) where 5% of these pts received chemoradiotherapy and 95% received AC (65% gemcitabine). There was no statistically significant difference in either OS (p=0.39) or DFS (p=0.28) amongst resected pts who were treated by sx alone versus pts who received AC. In subgroup analysis, AC was associated with significantly improved OS in pts (n=58) with positive margins (R1) (median 17.3 mos vs 8.9 mos, p=0.0045) but benefit was not seen in R0 pts (n=87) (22.9 mos vs 22.4 mos, p=0.20). In multivariate analysis, poor performance status (ECOG 3-4), weight loss of more than 10% of initial body weight, baseline CA19-9 value greater than 210 ku/L, positive nodes, R1 status and histological grade 3-4 were significant adverse prognostic factors. Conclusions: PC continues to have poor outcomes with a 5yOS of 5% in pts treated with sx alone. Among pts with resectable PC treated at the BCCA, AC tended towards increased DFS and OS. Although R1 status was associated with inferior OS, the benefit of AT was greater in this subgroup. [Table: see text]
Comparison of the efficacy between the gemcitabine/cisplatin (GP) and capecitabine/cisplatin (XP) for the advanced biliary tract cancer: Retrospective analysis in a single institution.
Authors: Lee Ji Eun , Lee Myung Ah , Hong Tae Ho , Lee In Seok , You Young Kyoung 
Published: February 2017

365 Background: Bile duct cancers (BTC) are known to be the chemotherapy resistant cancer, and more common in old-age group. Gemcitabine and cisplatin (GP) has been widely used as first line treatment for unresectable BTC. Capecitabine and cisplatin (XP) combination chemotherapy has been also used as another option treatment. We retrospectively compared the efficacy of GP and XP for advanced BTC. Methods: Between Jan, 2009 and Jun, 2011, Fifty five patients who were diagnosed with unresectable BTC at Seoul St. Mary’s hospital were enrolled for analysis of the efficacy in the present study. All the patients had recurrent disease or metastatic cancer, confirmed by histologically adenocarcima. In GP group, gemcitabine was given with 1,000mg/m2, I.V for 30min on d1 and d8, and cisplatin was injected with 75mg/m2, d1, repeated every 21 days. In XP group, capecitabine was administered by orally 2,000mg/m2, divided dose d1-14, and cisplatin was administerd with 75mg/m2, d1, repeated every 21 days. Response evaluation with CT scan was taken after 2 cycles. Results: Of the 55 patients enrolled, 28 patients were treated with GP and 27 patients were treated with XP. Median age was 69 years old in GP, 65 years old in XP. Median number of cycle was 2.5 in both groups. There was no difference in patients’ characteristics between two groups in terms of sex, age, number of cycle and disease status. In analysis of the response rate, Partial response rate was 38.5% in XP, and 7.1% in GP, and stable disease was achieved in 23.1% in XP, 42.9% in GP (p=0.004). Median time to progression was 2.0 mon in GP, and 4 mon in XP (P=0.147). However, median survival time was 6 months vs. 4. 3months in GP and XP, respectively (p=0.510). There was no difference in toxicity between two groups. Conclusions: GP and XP showed similar clinical outcome, such as TTP or OS, although XP had significantly better response rate. These two regimens had modest activity, but not effective in terms of TTP or OS. Median number of cycles was only 2.5 in both groups because most patients were over 65 years old, and had poor performance status. Development of new effective regimens in advanced BTC should be warranted.
Patient-reported symptoms from patients with advanced pancreatic cancer undergoing gemcitabine-based chemotherapy.
Authors: Wang Xin Shelley , Fogelman David R. , Shi Qiuling , Eng Cathy , Bokhari Raza H , Huang Furong , Mobley Gary M. , Gilmore Katherine R. , Cleeland Charles S. 
Published: February 2017

370 Background: The symptoms reported by patients being treated for advanced pancreatic cancer (PC) could be driven by disease and treatment. Few clinical studies have addressed the interaction between disease, treatment, and symptom burden. We conducted a longitudinal study tracking multiple symptoms to provide an evidence-based symptom profile for patients with advanced PC receiving gemcitabine-based chemotherapy. Methods: From start of the first chemotherapy cycle (baseline), patients rated symptoms weekly during chemotherapy via the M. D. Anderson Symptom Inventory (MDASI), then continued symptom assessment every two weeks for up to 40 weeks. Longitudinal symptom responses were analyzed by mixed-effect modeling. Results: Among 100 PC patients enrolled, 87% were treatment-naïve. The median age was 65 yrs old (range 35-85). Half of the sample was female; 32% received opioids for severe pain. The three most severe MDASI symptoms at baseline were fatigue, lack of appetite, and pain. Poor performance status and opioid use were significantly related to severity of these baseline symptoms (all P<.05%). The marginal means of severity for these three symptoms were significantly higher over time in patients who discontinued therapy < 9 weeks, compared with those who remained on study for 26-40 weeks (fatigue, P=.028; lack of appetite, P=.012; pain, P<.0001). Over time, lack of appetite improved significantly (P=.039), while pain and fatigue tended to worsen (P=NS). Compared with patients who remained on study, patients discontinued treatment earlier had significantly worse baseline pain (P=.005) and a non-significant trend towards greater fatigue and lack of appetite. Conclusions: Our results suggest that standard gemcitabine-based chemotherapy plus active palliative care for advanced PC was associated with significant improvement in appetite. However, worsening fatigue suggests a need to provide active intervention to minimize this symptom for PC patients. Patients suffering from greater symptom burden at baseline and overtime, seems consistent with greater disease burden, may be expected to discontinue treatment earlier.
Treatment and characteristics of patients treated for hepatocellular carcinoma (HCC) by physician types in the United States.
Authors: Seal Brian S. , Foltz Boklage Susan H , Asche Carl V 
Published: February 2017

375 Background: This study provides a description of the characteristics of patients treated for HCC and how they differ in terms of those treated by 1 type of physician vs. those treated by ≥ 2 physicians. Methods: This was a longitudinal, retrospective analysis of claims from the Thomson Reuters MarketScan database for patients treated for incident HCC. The patients were selected based upon those being treated for malignant neoplasm’s of the liver as their primary diagnosis (ICD-9 code 155.00) and they were required to have continuous eligibility around their initial liver cancer incidence data for 6 months prior and ≥ 12 months subsequent to treatment. Excluded were those having evidence of HCC and any other type of tumor in the prior 6 months. The study period was from 01/01/2006 until 06/30/2010. Descriptive analysis was used to draw comparisons between patients seen by 1 vs. ≥ 2 specialists. Results: 967 patients were analyzed, of whom 631were seen by 1 and 336 were seen by ≥2 physicians. The groups were similar except for age (75.8% of 1 physician were aged 45 to 64 years vs. 89.9% ≥ 2 physicians), gender (55.8% males for the 1 vs. 75.3% ≥2 physicians), not having Hepatitis C (75.4% in the 1 vs. 57.4% ≥2 physicians), not having Cirrhosis (70.4% in the 1 vs. 56.3% ≥2 physicians), not having other diseases of the liver (56.6% in the 1 vs. 47.6% ≥2 physicians), not having chemotherapy (92.6% in the 1 vs. 71.4% ≥2 physicians), not having TAE (86.2% in the 1 vs. 60.7% ≥2 physicians), not having ablation (95.3% in the 1 vs. 84.2% ≥2 physicians), and not having resection (93.3% in the 1 vs. 84.2% ≥2 physicians). The top physicians consulted were: Internal Medicine (16.3%); Medical Doctor (16.03%); Gastroenterology (14.37%); Multispecialty Physician Group (13.65%); Oncology/Hematology (13.35%); Family Practice (9.41%); and Surgeon (7.86%). Conclusions: It was found that the HCC patients treated by 1 vs. ≥ 2 physicians were younger, predominantly female [Odds Ratio (OR) of 1.977], less likely to have Hepatitis C (OR of 0.649], and less likely to have ≥ 1 selected treatment (OR of 0.224). The patients were seen by Internal Medicine, General Medical, Multispecialty Groups, and Family Practice more often than Oncologists.
Capecitabine plus oxaliplatin (XELOX) versus bolus 5-fluorouracil/leucovorin (5-FU/LV) as adjuvant therapy for stage III colon cancer: Survival follow-up of study NO16968 (XELOXA).
Authors: Schmoll Hans-Joachim , Tabernero Josep , Maroun Jean Alfred , De Braud Filippo G. , Price Timothy Jay , Van Cutsem Eric , Hill Mark , Hoersch Silke , Rittweger Karen , Haller Daniel G. 
Published: February 2017

388 Background: The MOSAIC trial demonstrated that adding oxaliplatin to 5-FU/LV (FOLFOX4) improved 3-year disease-free survival (DFS) compared to infusional and bolus 5-FU/LV as adjuvant therapy in patients (pts) with stage II/III colon cancer [André et al. NEJM 2004]. A significant survival advantage for FOLFOX4 versus 5-FU/LV was not evident until after median duration of follow-up had exceeded 6 years [André et al. JCO 2009]. Study NO16968 demonstrated that XELOX was superior to bolus 5-FU/LV as adjuvant therapy in pts with stage III colon cancer in terms of DFS at 57 months median follow-up (HR 0.80; 95% CI 0.69–0.93; p=0.0045) [Haller et al. JCO 2011]. The difference between treatment groups in overall survival (OS) was not significant at 59 months median follow-up (HR=0.87; p=0.1486). Data from the planned final analysis of NO16968 are presented. Methods: Pts with resected stage III colon cancer were randomized to receive XELOX (8 cycles, 24w) or bolus 5-FU/LV (Mayo Clinic, 6 cycles; 24w or Roswell Park, 4 cycles; 32w). The primary study endpoint was DFS. Secondary endpoints included OS. Results: The ITT population included 1886 pts (XELOX, n=944; 5-FU/LV, n=942). After a median follow-up of 74 months, the HR (XELOX vs 5-FU/LV) for DFS was 0.80 (95% CI 0.69–0.93; p=0.0038). Seven-year DFS rates were 63% for XELOX and 56% for 5-FU/LV. After a median follow-up of 83 months, the HR for OS was 0.83 (95% CI 0.70–0.99; p=0.0367). Absolute 7-year OS rates were 73% with XELOX and 67% with 5-FU/LV. After adjusting for stratification and prognostic variables, HRs remained essentially unchanged for both DFS (0.79; 95% CI 0.68–0.91; p=0.0016) and OS (0.84; 95% CI 0.71–1.00; p=0.0477). Locoregional / systemic treatments after recurrence were given in 230 (24%) XELOX pts and 308 (33%) 5-FU/LV pts. Conclusions: The combination of oxaliplatin and capecitabine improves OS significantly compared with 5-FU/LV in the adjuvant treatment of stage III colon cancer after a median follow-up of 83 months; these data are comparable to those achieved with FOLFOX4 in the MOSAIC trial. XELOX is an effective adjuvant therapy option for pts with resected stage III colon cancer.
Update of AMC 0101 study: A phase III trial of intraperitoneal cisplatin and early mitomycin-C plus long-term doxifluridine plus cisplatin (iceMFP) versus mitomycin-C plus short-term doxifluridine (Mf) as adjuvant chemotherapy for grossly serosa-positive advanced gastric cancer (NCT00296322).
Authors: Kang Yoon-Koo , Ryoo Baek-Yeol , Chang Heung-Moon , Zang Dae Young , Kim Tae Won , Yang Dae Hyun , Jang Se Jin , Yook Jeong Hwan , Oh Sung Tae , Kim Byung Sik 
Published: February 2017

4 Background: To improve the adjuvant chemotherapy in serosa-involving AGC, we adopted intraperitoneal and early start of chemotherapy, as well as prolongation of fluoropyrimidine and addition of cisplatin (P) to Mf regimen. The primary efficacy results of AMC0101 study on 3y relapse free survival rate (RFSR) were presented in 2008 ASCO. Now, we update the results with longer follow up. Methods: Pts with serosa-positive AGC who underwent curative resection were randomized to receive either Mf or iceMFP. Pts with postoperative stage I or IV (M1) were excluded. For Mf, 20 mg/m2 of mitomycin-C (M) was injected 3-6 wks after surgery and 4 wks later, 460-600 mg/m2/day of doxifluridine was administered orally for 3 months. For iceMFP, 100 mg of P was administered intraperitoneally for 2 h during surgery and 15 mg/m2 of M was injected 1 day after surgery. Doxifluridine was started 4 wks after surgery and extended for a total of 12 months and 6 shots of monthly 60 mg/m2 of P were added. Results: Between Oct 2001 and Apr 2007, 640 pts were randomized (318 in Mf, 322 in iceMFP). One hundred and nineteen pts (60 in Mf, 59 in iceMFP) were excluded (postoperative stage I in 90, M1 in 13, positive resection margin in 10, and others in 6). Therefore, a total of 521 pts (258 in Mf, 263 in iceMFP) were eligible for intent-to-treat analysis. Postoperative stages were II in 33.4%, IIIA in 31.9%, IIIB in 17.5%, and IV in 17.3% of pts. As of April 2011, with a median follow-up of 6.6 years, iceMFP group had a significantly longer RFS (HR, 0.73; 95% C.I. 0.57 - 0.93; p=0.0092) and overall survival (HR, 0.77; 95% C.I. 0.60 - 0.98; p=0.0365) than Mf group. Conclusions: We could confirm with longer follow up that benefit in 3y RFSR from iceMFP could be translated into benefit in 5y OSR. Considering no benefit of adding cisplatin and prolongation of doxifluridine to Mf chemotherapy in curatively resected AGC pts (AMC 0201), intraperitoneal cisplatin and/or early start of chemotherapy seemed to be responsible for the improved efficacy of iceMFP chemotherapy in this study.
Elevated CEA level in the asymptomatic patient with normal conventional imaging: How useful is PET-CT for the detection of colorectal cancer recurrence?
Authors: Aitken Katharine , Barbachano Yolanda , Sharma Bhupinder , Cunningham David , Cook Gary , Rao Sheela 
Published: February 2017

400 Background: Serum carcinoembryonic antigen (CEA) level can be used as a sensitive marker of recurrence in the follow up of patients with colorectal carcinoma, enabling the early detection of recurrent disease at a stage where further curative therapy may be possible. However a subset of patients with asymptomatic elevated CEA levels will have no evidence of disease recurrence on conventional imaging (CI). Aim: The purpose of this study was to evaluate the utility of 18F-FDG PET CT in detecting occult disease recurrence where CI has failed to demonstrate a cause for a rise in CEA. Methods: 88 consecutive patients on surveillance following treatment for colorectal cancer with an elevation in CEA level (>3ng/ml non-smokers, >5ng/ml smokers) with normal (67) or equivocal (21) findings on conventional imaging (defined as CT+/-MRI, ultrasound or colonoscopy) who had undergone PET-CT between 01.01.2004 and 31.08.2010 were retrospectively identified. Histopathological confirmation or a minimum of 12 months of follow up were used to ascertain disease relapse. Eligibility for further curative treatment was established from clinical notes. Results: Recurrent disease was detected in 56/88 patients (prevalence 64%). The sensitivity of PET-CT to detect recurrence was 49/56 (88%, 95% CI 76-94) and specificity 28/32 (88%, 95% CI 72-95). The positive predictive value (PPV) and negative predictive value (NPV) for recurrence was 93% and 80% respectively. Sensitivity in subgroups with CEA levels 3-6, 6-10 and > 10ng/ml were 91%, 82% and 89% respectively. 27 out of 49 patients (55%) with relapsed disease were eligible for further curative therapy and 26 received treatment with curative intent. The commonest site for PET detected disease relapse was the liver (16/49, 33%). Conclusions: PET-CT is a highly sensitive and specific tool for the detection of occult colorectal cancer recurrence in patients with raised CEA and normal CI thus should be considered mandatory in this setting. In over 50% of patients the recurrent disease detected before CI is positive, is still amenable for curative therapy.