bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Age and Colony-Stimulating Factor Use on Hospital Length of Stay for Febrile Neutropenia in CHOP-Treated Non-Hodgkin's Lymphoma
Authors: Chrischilles Elizabeth , Delgado David J. , Stolshek Bradley S. , Lawless Grant , Fridman Moshe , Carter William B. ,   for the Oncology Practice Pattern Study Working Group
Published: August 2017

Background In intermediate-grade non-Hodgkin's lymphoma (NHL) patients, full-dose CHOP improves survival but increases myelosuppression, causing febrile neutropenia hospitalization (FNH) in 28% of patients 65 years of age or greater. Several risk factors for FNH are known, but their relationship to length of stay (LOS), an indicator of the total burden of FNH, is unclear. Methods We conducted a study to identify factors associated with the incidence, recurrence, and duration of hospitalizations for FN and to describe the frequency of administration of colony-stimulating factor (CSF) as primary and secondary prophylaxis and its association with repeated hospitalization episodes. Results Compared with patients who did not experience hospitalizations for FN, those who did were significantly older, had more comorbid conditions, were planned for standard dose intensity, and received CSF less often during the first 5 days of cycle 1 (early CSF). Overall, 73% of these hospitalizations occurred within the first 2 cycles of chemotherapy, with 56% occurring within the first cycle. Patients age ≥65 years accounted for 66% of cycle 1 FNH. Patients receiving early CSF were less likely to experience repeated hospitalizations (0% vs 12%; P.05). Multiple regression analysis of those hospitalized found a 3.9-day longer LOS for patients age ≥65 years and a 5.13-day longer LOS for those not receiving early CSF. Conclusions Older NHL patients have a higher risk of hospitalization for FN and longer LOS. The majority of hospitalization days occur in the first 2 cycles of chemotherapy. Early CSF use is associated with decreased risk of repeated hospitalizations and shorter total LOS. Secondary CSF use is also associated with reduced risk of repeated FNH.
Molecular Genetics of Head and Neck Cancer
Authors: Gleich Lyon L. , Salamone Frank N. 
Published: August 2017

BackgroundHead and neck cancers have multiple genetic abnormalities that influence tumor behavior and may be useful in developing new treatments.MethodsGenetic alterations implicated in head and neck cancer oncogenesis and behavior are reviewed, and molecular techniques for detection and treatment are evaluated.ResultsThe large number of genetic changes present in head and neck cancer cells precludes meaningful use of simple molecular tests and treatments. Detection of abnormalities in multiple genes provides better prognostic information than the detection and assessment of single mutations. Screening tests that rely on amplification of genetic material present in bodily fluids are hindered by the genomic complexity of head and neck cancer. Introduction of genetic material into head and neck cancer cells for gene therapy has shown some efficacy.ConclusionsHead and neck cancers comprise a complex genetic disease. Although much has been learned about the molecular genetics of head and neck cancers, continued study of multiple genes is critical for further progress. Gene therapy, although promising, must also overcome this complexity.
Trastuzumab Use in Breast Cancer: Clinical Issues
Authors: Horton John 
Published: August 2017

BackgroundOverexpression of the epidermal growth factor 2 HER2 in breast cancer tissue is associated with shorter survival. Trastuzumab, a monoclonal antibody against HER2, can induce tumor responses when given alone and enhances the effectiveness of several chemotherapeutic agents.MethodsThe recent clinical data on outcomes regarding testing for HER2 overexpression and the tolerance, toxicity, and antitumor effects of trastuzumab are reviewed.ResultsTrastuzumab use is indicated either alone or with chemotherapy only in patients with IHC 3+ or FISH+ test results and survival is prolonged in patients with metastatic disease. Cardiac toxicity differs from anthracycline cardiac toxicity and is often reversible.ConclusionsThe safety and efficacy profile of trastuzumab in patients with metastatic disease has led to large-scale testing of addition of the intervention in the adjuvant setting.
Hematopoietic Stem Cells and Hematopoiesis
Authors: Smith Clayton 
Published: August 2017

Background The highly orchestrated process of blood cell development and homeostasis is termed “hematopoiesis.” Understanding the biology of hematopoietic stem cells as well as hematopoiesis is important to developing improved treatments for hematologic malignancies, congenital disorders, chemotherapy-related cytopenias, and blood and marrow transplants. Methods The author reviews the current state of the art regarding hematopoietic stem cells and hematopoiesis. Results Several new concepts, including stem cell plasticity, suggest the possibility that stem cells may have the ability to differentiate into other tissues in addition to blood cells. Conclusions While much is known about hematopoietic stem cells and hematopoiesis, much remains to be clarified about the environmental and genetic processes that govern the growth and development of the blood system. In addition, careful studies remain to be conducted to determine whether hematopoietic stem cells can differentiate into extra-hematopoietic tissues.
Intense Immunosuppression and Stem-Cell Transplantation for Patients with Severe Rheumatic Autoimmune Disease: A Review
Authors: Van Laar Jacob M. , Tyndall Alan 
Published: August 2017

Background Intense immunosuppression plus stem-cell transplantation (SCT) has emerged as a new treatment modality for patients with refractory, severe rheumatic autoimmune disease. Its rationale is based on eliminating autoaggressive lymphocytes by lympho- or myeloablative conditioning followed by stem-cell rescue. Preclinical studies in animal models of autoimmune disease and observations in patients with rheumatoid arthritis (RA) who were cured after allogeneic bone marrow transplantation for concomitant hematologic malignancy have provided support for the concept. Methods The authors reviewed the results of recent phase I/II studies and data from the EBMT/EULAR Registry on more than 400 patients with autoimmune diseases including RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and juvenile idiopathic arthritis (JIA). Results Toxicity resulting from stem-cell grafting depended on underlying disease and the intensity of the conditioning regimen. Treatment-related mortality was low in RA (1.4%) but relatively high (>10%) in patients with JIA, SLE, and SSc, possibly related to visceral involvement in these patients. With the application of uniform and strict criteria, safety has improved. Long-term remissions up to 4 years have been observed in SSc and JIA, while relatively more relapses have occurred in patients with SLE and RA. Sensitivity to anti-rheumatic drugs was restored in RA and SLE patients, however, resulting in improved disease control. Conclusions Intense immunosuppression and SCT may be an effective therapy for selected patients with severe rheumatic autoimmune disease. Its merits need to be proven via multicenter phase III studies by comparing efficacy and safety with conventional therapy.
Sexual Function after Surgery for Prostate or Bladder Cancer
Authors: Miranda-Sousa Alejandro J. , Davila Hugo H. , Lockhart Jorge L. , Ordorica Raul C. , Carrion Rafael E. 
Published: August 2017

Background Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer. Methods The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems. Results Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation. Conclusions Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.
Human T-Cell Leukemia Virus Type I Induces Adult T-Cell Leukemia: From Clinical Aspects to Molecular Mechanisms
Authors: Yasunaga Jun-Ichirou , Matsuoka Masao 
Published: August 2017

Background Human T-cell leukemia virus type I (HTLV-I) is a causative virus of adult T-cell leukemia (ATL), HTLV-I-associated myelopathy/tropical spastic paraparesis, and HTLV-I-associated uveitis. ATL is a neoplastic disease of CD4-positive T lymphocytes that is characterized by pleomorphic tumor cells with hypersegmented nuclei, termed “flower cells.” The mechanisms of leukemogenesis have not been fully clarified. Methods The authors reviewed the virological, clinical, and immunological features of HTLV-I and ATL and summarized recent findings on the oncogenic mechanisms of ATL and therapeutic advances. Results Multiple factors, such as viral genes, genetic and epigenetic alterations, and the host immune system, may be implicated in the leukemogenesis of ATL. Among them, viral genes, tax, and HBZ have been thought to play important roles. The prognosis of aggressive-type ATL remains poor, regardless of intensive chemotherapy. Effectiveness of allogeneic stem cell transplantation for ATL has been recently reported. Conclusions Although the precise mechanism of leukemogenesis of ATL remains unclear, recent progress provides important clues in oncogenesis by HTLV-I. Future research should focus on the composition of novel therapeutic strategies, including prevention, based on the evidence in the leukemogenic mechanisms.
Management Options after Prophylactic Surgeries in Women with BRCA Mutations: A Review
Authors: Allain Dawn C. , Sweet Kevin , Agnese Doreen M. 
Published: August 2017

Background Although breast cancer is relatively common, only about 5% of cases are due to inheritance of highly penetrant cancer susceptibility genes. The majority of these are caused by mutations in the BRCA1 and BRCA2 genes, which are also associated with an increased risk of ovarian cancer. Increased surveillance, chemoprevention, and prophylactic surgeries are standard options for the effective medical management of mutation carriers. However, optimal management of female carriers who choose to undergo prophylactic surgeries is still poorly understood. Methods The authors provide an overview of the current literature regarding medical management options for women carriers of BRCA1 and BRCA2 gene mutations and the implications for those individuals who have chosen to undergo prophylactic surgeries. Results BRCA mutation carriers who opt for prophylactic surgeries are still at risk for development of malignancy, and appropriate monitoring is warranted. Conclusions There are limited data on the appropriate medical management for BRCA mutation carriers after prophylactic surgeries. However, a management plan can be extrapolated from the general management recommendations for surveillance and other risk-reducing strategies in BRCA-positive individuals.
Health Disparities in Receipt of Screening Mammography in Latinas: A Critical Review of Recent Literature
Authors: Wells Kristen J. , Roetzheim Richard G. 
Published: August 2017

Background Increased use of screening mammography is associated with lower death rates from breast cancer in the United States. Despite recommendations that women over 40 years of age should obtain regular screening mammography at least every 2 years, many women do not adhere to these guidelines. Historically, women from underserved and minority populations have been less likely to receive screening mammography. Methods A critical review of recent research literature was conducted to evaluate whether Latinas are less likely to receive screening mammography, determine whether disparities in screening mammography persist when controlling for other variables, and examine what other variables are associated with screening mammography. The articles were obtained from a search of the PubMed database. Results Fifteen published articles met the inclusion criteria and were critically reviewed. The unadjusted odds ratios (ORs) of the association between Hispanic ethnicity and screening mammography ranged from 0.40 to 0.93. For the most part, the ORs adjusted for other variables in multiple logistic regression analyses increased (range: 0.3 to 1.67). Age, education, income, health insurance, having a usual source of care, and having a recent visit to a physician were consistently related to screening mammography in multiple logistic regression analysis. Conclusions Hispanic ethnicity is a risk factor for lack of adherence to screening mammography. However, other demographic, socioeconomic, and health system variables account for some of the disparity related to Hispanic ethnicity.
Practical Issues of Intraoperative Frozen Section Diagnosis of Bone and Soft Tissue Lesions
Authors: Bui Marilyn M. , Smith Prudence , Agresta Samuel V. , Cheong David , Letson G. Douglas 
Published: August 2017

Background Intraoperative pathologic diagnosis of bone and soft tissue lesions is an important yet challenging tool in clinical musculoskeletal oncology practice. There is limited information in the literature addressing the practical issues commonly encountered regarding intraoperative frozen section of musculoskeletal lesions. Methods A literature review and retrospective review of practical experience in intraoperative pathology consultation at our institute's sarcoma program were conducted to investigate the pitfalls and limitations of frozen section and potential solutions to overcome these problems. Results Frozen section evaluation is an essential and reliable procedure for guiding intraoperative decisions. Intraoperative cytology as an adjunct to frozen section enhances the accuracy of diagnosis of bone and soft tissue lesions. Cytology can accurately diagnose certain entities alone and is superior to frozen section for certain tumor types and for evaluating bone marrow margins. It is also invaluable in triaging cases for ancillary studies and for tumor banking. Practical working protocols can be developed to optimize the usefulness of intraoperative pathologic consultation. Conclusions Intraoperative pathology consultation should be done in an interdisciplinary approach by correlating clinical, radiologic, and pathologic information. As an adjunct to frozen section, cytology and gross examination enhance the accuracy of diagnosis of musculoskeletal lesions.
Advanced-Technology Radiation Therapy for Bone Sarcomas
Authors: Patel Samir , Delaney Thomas F. 
Published: August 2017

Background Bone sarcomas are rare primary tumors. Radiation therapy (RT) can be useful in securing local control in cases where negative surgical margins cannot be obtained or where tumors are not resected. Recent technical advances in RT offer the opportunity to deliver radiation to these tumors with higher precision, thus allowing higher doses to the tumor target with lower doses to critical normal tissues, which can improve local tumor control and/or reduce treatment-related morbidity. Methods The authors conducted a survey of recent technical developments that have been applied to the RT for bone sarcomas. Results RT techniques that show promise include intensity-modulated photon radiation therapy, 3-D conformal proton RT, intensity-modulated proton RT, heavy charged-particle RT, intraoperative RT, and brachytherapy. All of these techniques permit the delivery of higher radiation doses to the target and less dose to normal tissue than had been possible with conventional 3-D conformal radiation techniques. Protons deliver substantially less dose to normal tissues than photons. Conclusions Data from clinical studies using these advanced radiation techniques suggest that they can improve the therapeutic ratio (the ratio of local control efficacy to the risk of complications). This is expected to improve the treatment outcome for these challenging tumors.
The Molecular Biology of Endometrial Cancers and the Implications for Pathogenesis, Classification, and Targeted Therapies
Authors: Bansal Nisha , Yendluri Vimala , Wenham Robert M. 
Published: August 2017

Background Understanding and identifying molecular biology and genetics of endometrial cancer are central to the development of novel therapies. This article reviews the molecular basis for genesis of endometrial cancer with regard to pathogenesis, classification, and implications for targeted therapies. Methods Genes and cellular pathways that may have an important role in endometrial cancers, both endometrioid and non-endometrioid cancers, are identified. Recently studied drugs and potential future drugs that target some of these genes and pathways are reviewed. Results The most frequent genetic alteration of endometrioid endometrial cancer is PTEN. PI3CA and K-ras mutations are less common but are often associated with PTEN. Alterations in MLH1 and MSH6 are documented with microsatellite instability. β-catenin has a minor but significant association. Conversely, p53 mutation is more often associated with non-endometrioid cancer; others being inactivation of p16 and/or overexpression of HER-2/neu. Absence of E-cadherin is more often than not present in non-endometrioid cancers and is associated with poor prognosis. Novel agents that target the AKT-PI3K-mTOR pathway and those that inhibit epidermal growth factor receptor (EGFR), vascular endothelial growth factors (VEGF), fibroblast growth factor receptor 2 (FGFR2), and folate receptors are currently being investigated. Conclusions Novel targeted agents, either alone or in combination with cytotoxic agents, may result in superior treatment for patients.
A Review of Triple-Negative Breast Cancer
Authors: Ismail-Khan Roohi , Bui Marilyn M. 
Published: August 2017

Background An estimated 1 million cases of breast cancer are diagnosed annually worldwide. Of these, more than 170,000 are described as triple-negative. Triple-negative breast cancer (TNBC) is defined by the lack of protein expression of estrogen receptor (ER) and progesterone receptor (PR) and the absence of HER2 protein overexpression. TNBC is a subtype of breast cancer that overlaps with the “basal-like” breast cancer. TNBC has significant clinical implications. Methods The epidemiology, diagnosis, clinical course, prognosis, and pathology of this subtype of breast cancer are reviewed. The authors compare the “triple-negative” and “basal-like” definitions of breast cancer. A discussion of both standard and experimental treatments for TNBC is included. Results The poor prognosis of high-grade TNBC relates to poor disease-free interval in the adjuvant setting, shortened progression-free survival in the metastatic setting, and the lack of targeted therapy. However, not all TNBCs are associated with a poor prognosis. Conclusions Although chemotherapy is the main current treatment of this subtype of breast cancer, new agents such as PARP inhibitors, which show promise in the treatment of TNBC, are currently in clinical trials.
Optimizing Cancer Control and Functional Outcomes following Robotic Prostatectomy
Authors: Correa Joséa J. , Pow-Sang Julio M. 
Published: August 2017

Background Since robotic-assisted laparoscopic radical prostatectomy was introduced, different modifications in the technique have been described to improve cancer control and minimize the possibility of erectile dysfunction and incontinence. Methods We reviewed the recent English literature on specific topics including when to preserve the neurovascular bundle (NVB), and we describe techniques to diminish the rate of positive margins and to preserve continence and potency. Results Identifying predictor factors of local advanced disease helps in deciding when to preserve the NVB without compromising cancer control. Techniques to decrease the positive margins based on experience and modifications of the apical dissection are reviewed. Minimal disruption or reconstruction of the anatomic structures of the periprostatic tissues helps to maintain continence. Different degrees of NVB preservation can be performed based on the characteristics of the cancer. Cautery-free techniques and other modifications in the dissection to minimize the NVB injury are also discussed. Conclusions The understanding of the predictor factors of local advanced disease, together with modifications in the technique, helps to not only achieve cancer control but also improve quality of life after robotic-assisted laparoscopic radical prostatectomy.
Immunomodulatory Drugs and Active Immunotherapy for Chronic Lymphocytic Leukemia
Authors: Carballido Estrella , Veliz Marays , Komrokji Rami , Pinilla-Ibarz Javier 
Published: August 2017

BackgroundThe last decade witnessed the emergence of several therapeutic options for patients with chronic lymphocytic leukemia (CLL) for first-line and relapsed settings. The vast majority of patients with relapsed or refractory CLL carry poor prognostic features, which are strong predictors of shorter overall survival and resistance to first-line treatment, particularly fludarabine-based regimens.MethodsThis article highlights the current role of immunomodulatory drugs (IMiDs) and active immunotherapy as treatment options for this select group. The rationale of using IMiDs is discussed from the perspective of lenalidomide as a novel active agent. Relevant clinical trials using IMiDs alone or in combinations are discussed. New immunotherapeutic experimental approaches are also described.ResultsAs a single agent, lenalidomide offers an overall response rate of 32% to 47% in patients with relapsed/refractory disease. Recent studies have shown promising activity as a single agent in treatment-naive patients. The combination of lenalidomide with immunotherapy (rituximab and ofatumumab) has also shown clinical responses. Encouraging preclinical and early clinical data have been observed with different immunotherapeutic approaches.ConclusionsThe use of IMiDs alone or in combination with immunotherapy represents a treatment option for relapsed/refractory or treatment-naive patients. Mature data and further studies are needed to validate overall and progression-free survival. The toxicity profile of lenalidomide might limit its use and delay further studies. Immunotherapy offers another potential alternative, but further understanding of the immunogenicity of CLL cells and the mechanisms of tumor flare reaction is needed to improve the outcomes in this field.