bluuebunny/crossref_metadata_2025_split huggingface dataset:
Calculation of an immunoscore based on extensive flow cytometry analysis of PBMCs from metastatic breast cancer patients treated with docetaxel alone or in combination with vaccine.
Authors: Grenga Italia , Donahue Renee Nicole , Kim Peter Sungwhan , Dempsey Brendan , Gulley James L. , Heery Christopher Ryan , Madan Ravi Amrit , Schlom Jeffrey , Farsaci Benedetto 
Published: February 2017

31 Background: Therapeutic vaccine is emerging as a potentially efficacious and safe treatment for cancer patients. However, markers are not available to identify patients more likely to benefit from this treatment. Aim of this retrospective study was to analyze before treatment immune subsets that correlated with clinical outcome in metastatic breast cancer patients treated with docetaxel alone or in combination with vaccine. Methods: We applied multi-color flow cytometry analysis of PBMCs harvested prior to treatment from patients (n=43) enrolled in a small randomized phase II study of docetaxel alone (n=20) or in combination with PANVAC-V (Vaccinia) and PANVAC-F (Fowlpox) encoding for the tumor-associated antigens CEA and MUC-1, along with a TRIad of COstimulatory Molecules (B7-1, ICAM-1, and LFA-3; called TRICOM) (n=23). Frequency of more than 200 immune sub-populations before treatment was measured by flow cytometry. Each of the resulting subsets was ranked in tertiles. For immune subsets that correlated directly with PFS, 2 points were assigned if the frequency fell in the highest tertile, 1 point if in the middle, and 0 if in the lowest tertile. For subsets that correlated inversely with PFS, the points were assigned in the opposite order. An immunoscore was calculated based on the sum of points assigned to each subset. Log-Rank analysis, with the cutoff based on the median of the immunoscores, was performed to evaluate differences in PFS between patients with a low and high immunoscore. Results: In vaccine plus docetaxel arm, 10 immune subsets from PBMCs before treatment correlated with PFS and were used for the calculation of the immunoscore. Patients with an immunoscore above the median showed a statistically significant longer PFS compared to those with lower score in vaccine plus docetaxel arm (p<0.001, HR=0.1466, 95% CI= 0.0478-0.4375) but not in docetaxel alone arm (p=0.097, HR=0.418, 95% CI=0.147-1.172). Conclusions: Calculation of an immunoscore from PBMCs before treatment based on flow cytometry screening of immune subsets may identify patients that will most likely benefit from vaccine combination immunotherapy.
Quantitative analysis of breast parenchymal background enhancement (BPE) on magnetic resonance (MR) imaging: Association with mammographic breast density and aggressiveness of the primary cancer in postmenopausal women.
Authors: Ahn Hye Shin , Kim Sun Mi , Jang Mijung , Yun Bo La 
Published: February 2017

38 Background: To evaluate semiautomated quantitative analysis of the BPE in postmenopausal women who were diagnosed breast cancer and to correlate it with mammographic breast density and aggressiveness of the primary cancer. Methods: Informed patient consent was waived after institutional review board approved this study. Four hundred eighty two breast cancer patients performed breast MRI in our institution during 16 months, and 84 postmenopausal women of them were included in this study (median age, 67.2 years; range, 60-76 years). Ordinary values of BPE and breast density were described by an experienced breast radiologist using the BIRADS lexicon. The BPE was calculated with semiautomated quantitative method for quantitative analysis: BPE coefficient (BEC = SI1-SI0 / S0 × 100), where SI is signal intensity, SI1 is the SI enhancement measured in the largest dimension of the sagittal plane at the first postcontrast image, and S0 is the SI before contrast injection. On surgical pathology, pathologic subtype, nuclear and histologic grade, estrogen receptor (ER), progesterone receptor (PR), HER2≠neu, venous and lymphatic invasion, lymph node metastasis was evaluated. And then, the mean BEC of the patients who diagnosed local or systemic recurrence on follow-up was calculated and compared with that of the patients without recurrence. The statistical analysis was performed using Kruskal-Wallis test and Mann-Whitney U test. Results: The mean BEC of the postmenopausal women was 3.96 ± 6.71 in right breast and 3.41 ± 8.09 in left breast. There was no significant difference in the BEC between mammographic breast density groups (P > 0.05). There was no significant correlation between BPE and aggressiveness of the primary breast cancer. However, the mean BEC was higher in the recurrent patient group (n = 6, mean=16.23 ± 19.88) compared with the patients without recurrence (n = 78, mean=2.44 ± 5.62). Conclusions: No association was found between BPE and aggressiveness of the primary breast cancer, BPE and breast density. However, the mean BEC was higher in the patients who diagnosed local or systemic recurrence.
Perceived stress to predict for acute radiation-induced skin toxicity: The mind-body connection.
Authors: Eaton Bree Ruppert , Liu Tian , Yang Xiaofeng , Mister Donna , Zhao Yize , Miller Andrew H. , Long Qi , Torres Mylin Ann 
Published: February 2017

62 Background: Previous studies have reported that breast cancer patients with high stress levels at diagnosis develop more frequent and severe side effects of chemotherapy treatment. However, the relationship between stress and radiotherapy (RT) related treatment toxicity has not been evaluated. We investigated whether baseline stress is associated with worse acute skin toxicity in women undergoing breast RT. Methods: Between March 2010 and April 2013, 80 post-lumpectomy breast cancer patients were enrolled on a prospective study prior to undergoing definitive whole breast RT (50 Gy plus a 10 Gy boost). Prior to RT (baseline), at week 6 of RT (T2), and 6 weeks post RT (T3), subjects completed the Perceived Stress Scale (PSS) and underwent objective ultrasound measurements of epidermal thickness over the lumpectomy cavity and in all four quadrants of the treated breast. A skin thickness ratio (STRA) was generated by normalizing for measurements taken of the untreated breast. RT-induced skin toxicity was assessed by measuring the change in STRA from baseline to T2 and T3. Results: Mean STRA increased by 23% (SD 27%) and 33% (SD 25%) from baseline to T2 and T3, respectively. Univariate analysis revealed PSS score at baseline (p=.04), body mass index (p=.03), maximum RT dose (Dmax) (p=.02) and whole breast volume (p<.001) were significantly associated with increased changes in STRA during RT. Depression, fatigue, race, chemotherapy, patient age, and tumor stage were not associated with changes in STRA. On multivariate analysis, PSS (p=.05), breast volume (p=.004), and Caucasian race (p=.04) were associated with greater acute changes in STRA from baseline to T2. Breast volume (p=.01), but not PSS, predicted for greater changes in STRA 6 weeks after RT was completed. Conclusions: In women with breast cancer, a high level of perceived stress prior to RT is associated with more severe acute skin toxicity during RT but not after RT is completed. Strategies to reduce stress prior to RT may improve tolerance of treatment.
Early clinical results of intraoperative radiation therapy (IORT) during breast conservation using an electronic brachytherapy (EBX) technique.
Authors: Arterbery V. Elayne , Johnson Pamela 
Published: February 2017

83 Background: Intraoperative radiation therapy (IORT) as an alternative to whole breast irradiation (WBI) has been described for patients with early-stage breast cancer. The randomized phase III TARGiT trial demonstrated similar recurrence rates to WBI and a lower overall toxicity profile. IORT-related effects and early postoperative outcome were assessed. We report our clinical experience using a 50 Kv EBX HDR radiotherapy delivery system using a balloon technique. We assessed institutional postoperative complications, clinical outcome and histological findings in patients undergoing IORT for breast cancer on a physician sponsored study. Methods: 22 patients (median age 71 years, negative LN and tumor less than 3 cm) underwent lumpectomy, sentinel lymph node (SLN) biopsy, and concurrent IORT from December 2010 to January 2013. 18 were treated on the study and 4 refused enrollment and elected to be treated off protocol. Patients received IORT (20 Gy) during breast conserving surgery using an EBX technique. WBI was added according to clinical guidelines. Cosmetic results and quality of life were evaluated. Results: Postoperative complications and toxicity was rare without grade 3/4 toxicities. The most frequent postoperative side effects were palpable seroma (8.3%). Erythema grade 1-2 of the breast was found in (13%); whereas in some (3.4%), mastitis. In 80% of the cases patient had IFDCA, the remainder DCIS and tumor size ranged between 0.7 and 2.6 cm (median = 1.0cm). At median 1 year follow-up, no patient suffered a local recurrence. Cosmetic outcome was perceived excellent in most patients and 100% would recommend the procedure. One patient required WBI due to close margins at re-excision. No patient had positive SLN on final path. Conclusions: IORT using electronic brachytherapy as part of breast conservation is safe. The potential advantages of IORT are minimal time needed for cellular repopulation between surgery and radiation treatment, cosmetic outcome and significant logistical advantages and reduced cost. Careful surgical assessment minimizes the need for WBI. Longer follow-up will determine clinical results for cosmetic outcome and local control.
Accelerated partial-breast irradiation using strut-based brachytherapy in ductal carcinoma in situ patients: A report on 321 patients with median 25-month follow-up.
Authors: Einck John Paul , Finkelstein Steven E. , Han Ben , Hong Robert , Komarnicky Lydia T. , Kuske Robert R. , Mahalingam Sudha B. , Mantz Constantine , Morcovescu Serban , Nigh Stephen S. , Perry Kerri L. , Pollock Jondavid , Reiff Jay E. , Scanderbeg Daniel , Strasser Jon F. , Yashar Catheryn M. ,   SAVI Collaborative Research Group
Published: February 2017

92 Background: Limited data are available on the treatment of ductal carcinoma in situ (DCIS) with accelerated partial breast irradiation (APBI). The American Society for Radiation Oncology (ASTRO) consensus guidelines on APBI classify patients with DCIS as “cautionary”. We present the largest series of DCIS patients reported to date treated with APBI using strut-based brachytherapy. Methods: The SAVI Collaborative Research Group (SCRG) database was used to identify APBI patients with DCIS at 15 institutions treated with strut-based brachytherapy. All patients had a histologic diagnosis of DCIS and received monotherapy APBI (34 Gy in 10 fractions). Data on patient age and margin status, implant dosimetry, device size, disease status and toxicity in this population were analyzed. Results: From 2007-2011, 321 patients (322 breasts) with DCIS received APBI using strut-based brachytherapy. Patient ages ranged from 40-88 with a median age of 62. 51 patients were under 50 years of age. Detailed dosimetry data were reported on 245 patients. Long-term follow up was available on 221 breasts (median F/U = 25 months). Sixty patients have been followed for >3 years. Skin spacing was a challenge in a significant number of patients including 52 with skin spacing ≤ 5mm and 20 with skin spacing ≤ 3mm. Median maximum skin dose in those patient groups were 87% and 84% of prescription dose (PD), respectively. Overall reported dosimetry (n=245) was excellent: median percent of target volume receiving 90% PD was 96.9%, median maximum skin dose was 83.2%, V150% and V200% (volume at 150% and 200% PD) were 25.2 cc and 12.7 cc respectively. The ipsilateral recurrence rate was 2.2% (1.1% TR/MM). Late toxicity (grade ≥ 2) was low: hyperpigmentation = 0.0%, telangiectasias =1.4%, seroma = 3.2%, and fat necrosis in 1.8%. Conclusions: APBI using strut-based brachytherapy appears to be an effective treatment for patients with DCIS with acceptably low ipsilateral breast recurrence rates and low rates of late toxicity. 52 patients in our series had skin spacing 5 mm or less. APBI using brachytherapy may not have been possible for these women with other single-entry devices.
Second-look axillary ultrasound after breast MRI for enhanced preoperative nodal staging in newly diagnosed breast cancer patients.
Authors: Hieken Tina J. , Jones Katie N. , Boughey Judy Caroline , Shah Sejal , Glazebrook Katrina N. 
Published: February 2017

98 Background: Concomitant with widespread adoption of axillary ultrasound (AUS) with ultrasound-guided needle biopsy (USNB) of suspicious lymph nodes (LN) for preoperative nodal staging of breast cancer patients, utilization of breast MRI, which includes axillary imaging, has increased. Little is known about the added value of MRI imaging of the axilla in this context. We undertook this study to assess the role of breast MRI in preoperative axillary nodal staging. Methods: We studied 988 consecutive invasive breast cancers in patients undergoing primary operation including axillary surgery, without neoadjuvant therapy, from 2010-2011. Results: 505 patients (51%) underwent MRI of which 168 (33%) demonstrated suspicious findings in the axilla. Abnormal axillary MRI findings included cortical thickening, edema, enhancement, hilar effacement, and/or altered shape and size. 114 patients had findings concordant with AUS. 54 patients had suspicious LNs on MRI either without a preceding AUS (33 cases) or after an initially negative AUS (21 cases). Second look AUS was performed in 29 of these cases and was abnormal in 3 (10%) in whom USNB confirmed metastatic adenopathy. Of the 54 cases with MRI-detected suspicious LNs 20 (37%) were node positive at operation with a pN stage of N0 (63%), N0i+ (5%), N1mic (4%), N1 (20%), N2 (6%), N3 (2%); extranodal extension was seen in 7 of 20 node-positive patients (35%). Conclusions: Second look AUS, when performed secondary to suspicious axillary MRI findings, identified LN metastasis preoperatively in 10% of patients. When MRI is done to evaluate the breast in newly diagnosed breast cancer patients, axillary findings can enhance the accuracy of preoperative nodal staging. We recommend second look AUS when MRI demonstrates suspicious axillary LN findings. [Table: see text]
Real-time extraction of breast cancer treatment process and outcome measures from an EPIC electronic health record (EHR).
Authors: Kuznetsov Julie Lawrence , Bailey Kathryn , Bombach Pacharintra K. , Carmichael Stacey , Chen Xuemei , Herberg Maja Lichstein , Owen Terri , Wilson Jorge , Blayney Douglas W. 
Published: February 2017

1 Background: In 2011, Stanford Cancer Institute (SCI) clinical leadership began process improvements to enhance patient satisfaction and quality of care. To measure impacts, unnecessary care variation, and outcomes, we recently developed an informatics infrastructure utilizing data from our EHR (epic modules: BEACON, Cadence, OpTime). We report successful initial efforts including real-time cohort identification (comparing with “gold standard” registry data), and improvements in time to treatment. Methods: A cohort of 1,692 patients was defined by 3 criteria: newly evaluated at SCI, AND received treatment [surgery, chemotherapy (chemo), or radiation (XRT)] at SCI, AND had a breast cancer related ICD-9 code. We analyzed data by fiscal year (FY), starting September, 2010 to FY13 year-to-date. “Time to treatment (Rx)” was measured as the interval between first EHR time stamp for SCI patient contact and Rx date. We used discrete data from the BEACON staging module to create sub-cohorts by stage, and used BEACON protocols to identify chemo regimens. Our cohorts were compared with SCI tumor registry data, and presented in a dynamic Qlikview dashboard. Results: 98% of the EHR-defined cohort matched a similarly defined tumor registry cohort. We detected the effect of process improvements (including scheduling a visit on first contact, coordinating among surgical specialties, outside records available pre-visit, etc.), which resulted in an accelerated time to Rx (Table). Discrete BEACON stage is available for 7% of these 1692 patients. The methodology is scalable and has been successfully replicated in GI and thoracic cohorts. Conclusions: Our work demonstrates utility of EHR data to track process improvements. Uniform use of the BEACON staging module will facilitate variation analysis across cancer types and stages, and allow us to explore variation within modalities (chemo, surgery, XRT). We will analyze associated costs and intermediate clinical outcomes (e.g., unplanned emergency visits and hospitalizations) to inform care pathway choice. [Table: see text]
Do pharmaceutical claims accurately reflect oncology prescribing practice? Evidence from an Australian HER2+ early breast cancer cohort (HER2EBC).
Authors: Harris Carole A. , Ward Robyn L. , Daniels Benjamin , Pearson Sallie 
Published: February 2017

100 Background: Pharmaceutical claims are used increasingly to investigate the real-world use and impact of prescribed medicines. Claims databases are established for payment purposes, lack clinical data and only capture prescriptions for which insurers pay a contribution. We compare Pharmaceutical Benefits Scheme (PBS) dispensing claims of HER2EBC patients, with prescriptions written in oncology clinics to determine the accuracy of dispensing data to identify treatment protocols and estimate treatment cycles and durations of therapy. Methods: Our cohort comprised 110 female HER2EBC patients commencing treatment at 4 Sydney cancer centres between 2008 and 2011. Patients consented to medical chart audit and linkage to PBS claims. We constructed protocols from prescribing and dispensing records independently, based on the timing of trastuzumab and cytotoxic treatments; estimated the median number of treatment cycles and duration of therapy by protocol; and compared prescription and dispensing data. Results: Patients’ median age was 53 years (range 21.1-86.2). Based on prescribing data, 67 patients received anthracycline-containing protocols, 43 received taxane only protocols. ACTH and TCH accounted for 90% of all protocols. 75 patients (68.2%) were assigned the same protocols based on prescribing and claims data; 26 did not match as cyclophosphamide falls below the patient copayment for general PBS beneficiaries and is not captured in the claims data. Compared with prescription data, number of treatment cycles was underestimated in dispensing data (ACTH: median 30 vs 44; TCH 26 vs 29); trastuzumab-based treatment is administered weekly in ACTH but only dispensed 3-weekly. Durations of therapy differed by ≤5% in dispensing versus prescription data (ACTH 422 days vs 466; TCH 368 vs 367). Conclusions: PBS dispensing data is reliable for establishing treatment protocols in concessional beneficiaries and duration of therapy in all patients. Claims data underestimates treatment cycles as administration occurs more frequently than dispensing. These limitations must be considered when undertaking population-based studies using claims data in HER2EBC.
HER2-positive early breast cancer (HER2EBC): An Australian pattern of care study.
Authors: Harris Carole A. , Pearson Sallie , Daniels Benjamin , Srasuebkul Preeyaporn , Ward Robyn L. 
Published: February 2017

101 Background: Clinical trials have demonstrated the benefits of trastuzumab in treating HER2EBC. However, in routine care it is unclear which patients are recommended treatment, what chemotherapy partners are used and whether patients receive all of their intended treatments. In this study we describe the real world treatment patterns in HER2EBC patients. Methods: We undertook a clinical audit of patients diagnosed with HER2EBC (stage I-III) at four Sydney-based cancer centres between 2008 and 2011. We identified patients from pathology records and extracted information on patient and cancer characteristics, treatments planned and received from medical notes and medication charts. Results: 203 patients formed the study cohort; median age 55 years (range: 21-91), all but one patient was female. 77 patients had stage I disease, 84 stage II, and 42 stage III. 176 patients (86.7%) were recommended trastuzumab-based treatment and 168 patients initiated therapy. 96 were treated with anthracycline-based chemotherapy and 70 with taxane-based chemotherapy. 76.7% completed the planned number of taxane-based treatments compared with than the 60% receiving anthracycline-based therapies; toxicity being the main reason for not completing treatment. Younger patients (OR 0.89, 95%CI 0.84-0.93, p<0.001) and those with grade 3 tumours compared to grade 1 and 2 combined (OR 3.99, 95%CI 1.31-12.08, p0.014) were more likely to be recommended trastuzumab-based treatment. Younger patients (OR 0.85, 95%CI 0.81-0.90, p <0.001) with a high HER2 gene copy number (OR 4.10, 95%CI 1.06-15.81, p 0.041) multifocal disease (OR 3.53, 95%CI 1.06- 15.82 p 0.023) and stage II and III disease (OR 0.73, 95%CI 0.25-0.90 p 0.011) were more likely to be recommended anthracycline over taxane-based therapy. Conclusions: Trastuzumab-based therapy is standard of care for patients with HER2EBC regardless of patient or cancer characteristics. Whilst chemotherapy partners are determined by patient and cancer characteristics, treatment limiting toxicities also need to be considered in order to maximise patient benefit.
The use of PET scans in the management of non-small cell lung cancer patients relative to evidence-based indications across Canada.
Authors: Bryant Heather E. , Rahal Rami 
Published: February 2017

104 Background: PET scans are playing an increasingly important role in the management of cancer patients, particularly those diagnosed with non-small cell lung cancer (NSCLC). At the same time, the high capital and operating costs of the technology in the publicly funded Canadian health care system presents a strong case for monitoring use of PET scans relative to evidence based indications. This study by the Canadian Partnership Against Cancer reports on the use of PET scans in the management on NSCLC across Canada. Methods: PET scan utilization data from all hospitals providing the service in six Canadian provinces was linked to provincial cancer registry data, which allowed for the identification of demographic, diagnostic/prognostic, and treatment information on each NSCLC patient receiving a PET scan. The indication for each scan was then inferred from the timing of the scan relative to the dates of diagnosis, neoadjuvant therapy, surgery, curative chemo-radiation, or palliative treatment, as relevant for each patient’s care pathway. This way, the scan indications were identified as one of the following: staging, treatment planning, assessing treatment response during active treatment, and assessing metastases following end of curative treatment or palliative treatment. Results: The study results were not yet available at the time of submission of this abstract. Preliminary results and analyses will be available by the November 1, 2013, conference date. The results will include the following indicators for the 2009-2011 timeframe: percentage of NSCLC cases receiving a PET scan by stage; percentage NSCLC PET scans that are performed for each of the identified indications (diagnosis/staging, treatment planning, treatment response, follow up) by stage at diagnosis; variations by province, age group, and sex. Conclusions: This work will identify patterns in the use of PET scans for NSCLC patients across Canada and assess the extent to which this use is consistent with currently supported evidence based indications. The results will help inform more evidence-based use of the diagnostic technology across Canada and will form a baseline for future monitoring as the evidence evolves.