bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival outcomes of neoadjuvant hormone therapy plus external-beam radiotherapy with relatively early initiation of salvage hormone therapy to patients with T3-4N0M0 prostate cancer.
Authors: Mizowaki T. , Norihisa Y. , Ogura M. , Kamba T. , Inoue T. , Shimizu Y. , Ogawa O. , Hiraoka M. 
Published: February 2017

95 Background: Survival benefits of adding long-term adjuvant hormonal therapy (A-HT) on external beam radiation therapy (EBRT) had reported in patients with locally advanced prostate cancer. However, adverse effects of long-term hormonal therapy are also not negligible. If early initiation of salvage hormonal therapy (S-HT) to patents developed PSA failure after EBRT can realize comparable survival as to giving A-HT across the board, patients who maintain biochemical failure-free status after EBRT will receive hormonal-free benefit. We analyzed outcomes of EBRT combine with neoadjuvant hormonal therapy (NA-HT) to patients with T3-4N0M0 prostate cancer. Methods: Between April 1998 and Mar 2006, consecutive 173 Japanese patients with T3-4N0M0 adenocarcinoma of the prostate were definitively treated by 3D-CRT / IMRT. The median age was 72 years old (range 48-80). Pre-treatment PSA values ranged between 3.7 and 430 ng/ml (mean: 45.3). T-stage was distributed as follows: T3a: 122, T3b: 50 and T4: 1 case. NA-HT (3–17 months, median: 5 months) was given to all cases. Mean delivered dose was 74 Gy in 2 Gy per fraction to the prostate and seminal vesicles (range: 60-78). A-HT was not given to any patients and PSA values were monitored with one to 6 months interval after the treatment. S-HT was essentially started when PSA value exceeded 4 ng/ml. Results: Median follow-up period was 74 months (range: 8–152). So far, S-HT was initiated to 58 patients, and PSA values at the initiation of S-HT ranged 0.1 to 32.2 with a median value of 6.0 ng/ml. Biochemical relapse-free survival by the Phoenix definition and salvage hormonal therapy-free survival rates at 8 years were 60% (95% CI = 51-68) and 63% (95% CI = 56-71), respectively. Prostate cancer-specific and overall survival rates were 94% (95% CI = 89-99) and 85% (95% CI = 78-92), respectively. Conclusions: Survival rates of this cohort of patients treated by EBRT combined with NA-HT were excellent despite no A-HT was given, and more than two thirds of patients maintained hormone-free status at 8 years. This approach may be an alternative to giving long-term A-HT. No significant financial relationships to disclose.
Is it possible to get adequate dose coverage of a clinical target volume (CTV) to account for the possible extra capsular extension in early-stage prostate cancer by low dose rate (LDR) brachytherapy?
Authors: Saibishkumar E. P. , Iupati D. , Borg J. , Fernandes K. 
Published: February 2017

98 Background: There is no consensus for the definition and evaluation of CTV in post-implant setting for LDR prostate brachytherapy to account for extra capsular extension in clinically localized prostate cancer. In this study, we defined a CTV and evaluated its dosimetry in the post implant CT/MR scans done at 1 month after the LDR brachytherapy procedure. Methods: The initial consecutive 71 patients who underwent LDR brachytherapy under a single physician at Princess Margaret Hospital from June 2009 to July 2010 were included in this retrospective study. On the post implant MRI, the CTV was created by adding 3mm uniform margins around the prostate but respecting the anatomical boundaries like bone, bladder and rectum. Post implant dosimetry was based on CT/MR fusion using the dosimetric parameters V80, V90, V100, V150, V200, D80, D90 and D100. Implants were qualified as optimal if their V100 was >85% and D90 was >90% for both prostate and CTV. Univariate analysis was performed to evaluate associations of factors with V100 and D90 for the CTV using Wilcoxon rank sum test and Fisher's exact test. Results: The mean (SD) prostate V100 and D90 were 95.5% (4.2) and 117% (10) respectively with only 1 patient having sub optimal implant (V100 <85% and D90 <90%). The mean (SD) V100 and D90 for the CTV were also acceptable at 90.6% (4.9) and 103% (9), respectively. Six patients had V100 <85% and 7 patients had D90 <90% for the CTV. On univariate analysis, edema and seed implantation technique correlated with sub-optimal implant for the CTV. The mean (SD) edema for patients with V100 <85% was 18% (10) and with D90 <90% was 15% (12). The corresponding values for the optimal implants both in terms of V100 and D90 were 3% (13). Patients implanted with exclusively loose seeds (15 patients only) had higher incidence of sub-optimal implants (26%) compared to patients who had strands on the antero-lateral margins (56 patients; 3.5%). Conclusions: In this study, adequate dose coverage of CTV was achieved in most patients with current technique but implants with optimal dosimetry to prostate still may have sub-optimal D90 and V100 for the CTV. No significant financial relationships to disclose.
Initial experience of focal therapy for prostate cancer using I-125 seed implantation: Unilateral ablation for patients selected by extended biopsy and MRI findings.
Authors: Saito K. , Kihara K. , Numao N. , Masuda H. , Kijima T. , Tatokoro M. , Koga F. , Fujii Y. , Hayashi K. , Shibuya H. 
Published: February 2017

99 Background: Focal therapy for prostate cancer could be a minimally invasive therapeutic option with the preservation of genitourinary function to reduce treatment associated complication under the appropriate selection of patients. We have reported the good predict ability to unilateral prostate cancer by extended prostate biopsy combined with transperineal and transrectal approaches (Eur Urol supple, 2009). Among the candidate ablative, brachytherapy which has been proved as a definitive therapy and applied worldwide has been thought to have potential for focal ablation due to its ability of dose and location adjustment by seed implantation under real-time monitoring. Based on the findings, focal therapy with hemiablation using I-125 seed implantation has been started in our instituion. The aim of study is to describe the initial experience of focal therapy for patients selected by extended biopsy and MRI findings. Methods: The eligible criteria for focal therapy to prostate cancer are as follows. Clinical stage is T2a or less. The positive cores of cancer are proven within unilateral lobe by extended prostate biopsy. There was no cancerous lesion in contralateral lobe by MRI. Gleason score in positive cores was 3 + 4 or less. Maximum cancer length was less than 5 mm. PSA value is less than 10 ng/mL. On the treatment, I-125 seeds were implanted to ablate the unilateral lobe with 160 Gy of the prescription dose. The protocol has been approved by the institutional ethics commit. Results: At present, 3 patients were enrolled in this study and underwent focal therapy with written informed consents. In all three cases, I-125 seeds implanted (number od seeds: 43, 39, and 37) to unilateral lobe without severe acute complication such as acute urinary retention. In one case that has been followed over 3months among the initial three cases, PSA values decreased to 2.07 mg/ml at 3 months after the seed implantation. Conclusions: To our knowledge, this is the first report about focal therapy by brachytherapy with hemiablative technique. In our initail experience, severe treatment associated complication has not been observed. No significant financial relationships to disclose.
Randomized phase II multicenter study of the efficacy and safety of sunitinib on the 4/2 versus continuous dosing schedule as first-line therapy of metastatic renal cell carcinoma: Renal EFFECT Trial.
Authors: Motzer R. J. , Hutson T. E. , Olsen M. R. , Hudes G. R. , Burke J. M. , Edenfield W. J. , Wilding G. , Martell B. , Hariharan S. , Figlin R. A. 
Published: February 2017

LBA308 Background: In a randomized phase III trial, sunitinib 50 mg/d on Schedule 4/2 (4 wk on treatment [Tx], 2 wk off) showed superior progression-free survival (primary endpoint) to IFN-α (11 vs. 5 mo; p<0.001) as first-line metastatic renal cell carcinoma (mRCC) therapy with a median overall survival (OS) of >2 yr (Motzer 2009). Continuous dosing of sunitinib 37.5 mg has demonstrated antitumor activity with a manageable safety profile in first- and second-line mRCC (Barrios; Escudier, 2009). Methods: This randomized phase II trial compared sunitinib 50 mg/d on Schedule 4/2 (Arm A) vs. 37.5 mg continuous once-daily dosing (Arm B) in first-line mRCC. Eligible patients (pts) had clear cell locally recurrent or mRCC; measurable disease; and Karnofsky performance status ≥70%. Randomization (1:1) was stratified by MSKCC risk groups. Sunitinib was continued until progression, unacceptable toxicity, or up to 2 yr. The primary endpoint was time to tumor progression (TTP) by Kaplan-Meier estimate. Secondary endpoints included objective response rate (ORR), OS, and adverse events (AEs). Results: Between January 2007 and June 2008, 292 pts were randomized. As of October 2010, 289 pts had received sunitinib, and all pts were off therapy. Median age was 62 yr. 65% were male. By MSKCC criteria, 28%, 61%, and 11% were favorable, intermediate, and poor risk, respectively. Pts received a median 4 and 5 Tx cycles in Arms A and B, respectively; median relative dose intensity was 90.8% and 77.5%. Dose delays, reductions, and interruptions occurred in 30% vs. 13%, 36% vs. 43%, and 65% vs. 62%, respectively; 11% and 15% discontinued due to Tx-related AEs. Median TTP was 9.9 vs. 7.1 mo in Arms A and B, respectively (HR=0.773, 95.1% CI, 0.572, 1.044; p=0.090). ORR was 32.2% vs. 28.1% (p=0.444). Median OS was 23.1 vs. 23.5 mo (p=0.615). The most common Tx-related AEs were fatigue (both 62%), nausea (56% vs. 49%), and diarrhea (56% vs. 64%). Conclusions: In this randomized phase II mRCC trial, there was a trend toward inferior TTP with continuous dosing. ORR, OS, and AE profiles were similar for the approved sunitinib 50 mg/d dose on Schedule 4/2 vs. 37.5 mg continuous dosing. [Table: see text]
Optimal indications for second-line chemotherapy in advanced gastric cancer.
Authors: Hasegawa Hiroko , Fujitani Kazumasa , Nakazuru Shoichi , Hirao Motohiro , Mita Eiji , Tsujinaka Toshimasa 
Published: February 2017

105 Background: It remains uncertain whether every patient with advanced gastric cancer (AGC) who progresses after first-line chemotherapy should receive second-line chemotherapy. We conducted the present study to identify the optimal indications for second-line chemotherapy. Methods: In this retrospective study, 101 patients were included in univariate and multivariate analyses to identify clinicopathological variables independently associated with longer survival post progression (SPP), defined as the time from recognition of disease progression on first-line chemotherapy to death from any cause or last follow-up. Results: Median SPP of all patients was 340 days. On multivariate analysis, both performance status (PS) 2 (hazard ratio (HR), 14.234; 95% confidence interval (CI), 2.766–73.258), serum albumin (Alb) level < 3.5 g/dl (HR, 2.088; 95% CI, 1.047–4.060) at initiation of second-line chemotherapy, and time to progression (TTP) < 170 days on first-line chemotherapy (HR, 2.497; 95% CI, 1.227–5.083) were identified as independent prognostic factors for shorter SPP. Median SPP was 496, 375, and 232 days in patients with 0, 1, and 2 of these 3 negative prognostic factors, respectively (p = 0.0002). Conclusions: The present study suggests that second-line chemotherapy would be less beneficial in patients with 2 or more of the following 3 negative prognostic factors: PS 2, Alb < 3.5 g/dl at initiation of second-line chemotherapy, and TTP < 170 days on first-line chemotherapy.
Effect of technologic advancements in radiotherapy on postoperative pulmonary complications after neoadjuvant chemoradiation in esophageal cancer.
Authors: Myles Bevan H. , Wei Caimiao , Komaki Ritsuko , Vaporciyan Ara A. , Mehran Reza J. , Swisher Stephen , Hofstetter Wayne Lewis , Ajani Jaffer A. , Liao Zhongxing X. , Cox James D. , Lin Steven H 
Published: February 2017

110 Background: Although 3D conformal radiation therapy (3D-CRT) is currently the de facto standard for the treatment of esophageal cancers, technologies such as Intensity Modulated Radiation Therapy (IMRT) or Proton Beam Therapy (PBT) are increasingly being used, but the evidence for the clinical benefits of these technologies are lacking. We hypothesized that radiation technology influences perioperative complications in esophageal cancer patients treated with neoadjuvant chemoradiation. Methods: We evaluated 423 patients (3D-CRT (n=208, 1998-2008), IMRT (n=165, 2004-2011), and PBT (n=50, 2006-2011)) treated with surgical resection after chemoradiation from 1998-2011 at M. D. Anderson Cancer Center. Postoperative complications (Pulmonary, GI, cardiac, wound healing) were recorded up to 30 days postoperatively. Kruskal-Wallis tests and Chi-square or Fisher’s exact tests assessed associations between continuous and categorical variables and the radiation technology, respectively. Logistic regression model tested the association between treatment technologies and complications adjusting for other significant patient characteristics. Results: While radiation modality was not significantly associated with postoperative GI (leak, ileus, fistula), cardiac (MI, AF, CHF), and wound complications, there was a significant reduction in postoperative pulmonary complications (ARDS, pleural effusion, respiratory insufficiency, pneumonia) for IMRT compared to 3D-CRT (OR 0.46, 95%CI 0.25, 0.83) and PBT compared to 3D-CRT (OR 0.26, 95%CI 0.09, 0.70), but not when IMRT was compared to PBT (OR 1.74, 95%CI 0.66, 4.61) after adjusting for preRT DLCO level. The median length of hospital stay was also significantly different between treatment modalities (12, 10, and 8 days for 3D-CRT, IMRT, and PBT, respectively, p<0.0001). There was no significant association between treatment year with pulmonary complication rates. Conclusions: Radiation technologies such as IMRT and PBT reduced postoperative pulmonary complication rates compared to 3D-CRT in esophageal cancer patients. This result needs to be confirmed in larger prospective studies.
Effect of online education on use of molecular markers to guide treatment selection for advanced gastric or gastroesophageal (GE) cancer.
Authors: Obholz Kevin , Van Cutsem Eric , Press Michael F. , Bowser Andrew , Mortimer Jim A. , Wasserstrom June , Grothey Axel 
Published: February 2017

111 Background: Trastuzumab in combination with chemotherapy is recommended for advanced gastric cancer positive for human epidermal growth factor receptor 2 (HER2) overexpression. Despite this recommendation, an informal pilot survey suggested that many oncologists do not include HER2 testing as part of routine practice to identify patients most likely to benefit from adding trastuzumab to chemotherapy. Methods: An interactive online educational activity was developed to provide expert guidance on HER2 testing and use of HER2-targeted agents in gastric or GE cancer. Pre- and post-education surveys were administered as part of the activity to measure changes in participant competence. In addition, 3 months after completing the educational activity, participants were sent another follow-up survey by email to assess changes in practice. Results: To date, pre-and post-education surveys have been obtained for 122 oncologists and 3-month follow-up surveys obtained from 14 oncologists. In the pre-education survey, only 46% said they were testing all of their patients with advanced gastric or GE cancer for HER2 overexpression. However, immediately after participating in the educational intervention, this proportion increased to 93%. Importantly, a follow-up survey indicated that HER2 testing of all patients with advanced gastric or GE cancer was now part of routine practice for 79% of those surveyed. A final analysis of pre- and post-education and 3-month follow-up surveys will be presented. Conclusions: Expert guidance on HER2 testing and use of HER2-targeted agents in gastric or GE cancer provided through an interactive online educational intervention substantially improved oncologist competence and practice patterns.
Cardiac toxicity associated with dose and gender in patients undergoing chemoradiation for esophageal carcinoma.
Authors: Tait Lauren Marie , Meyer Joshua E. , McSpadden Erin , Cheng Jonathan D. , Philip Philip Agop , Scott Walter J. , Baciewicz Frank , Meropol Neal J. , Shields Anthony Frank , Crawford Kevin , Cohen Steven J. , Wozniak Antoinette J. , Gadgeel Shirish M. , Choi Minsig , Konski Andre A. 
Published: February 2017

112 Background: The purpose of this study was to identify factors associated with symptomatic cardiac toxicity in patients treated with chemoradiotherapy (CRT) for esophageal carcinoma. Methods: One-hundred and forty-four patients with adenocarcinoma or squamous cell carcinoma were treated from 7/2002 - 6/2011 at 2 academic institutions with pre-operative, definitive or palliative CRT. Chemotherapy and radiation therapy was administered at the discretion of the treating oncologist. Altogether, 120 patients had sufficient dose volume histogram (DVH) data for analysis and ≥3 month follow up from treatment completion. Association of cardiac toxicity with a number of variables was investigated, including heart disease, cardiac bypass/angioplasty, diabetes, insulin use, smoking, and tumor location (upper/middle vs. lower/GE junction). T-test assessed risk of cardiac toxicity secondary to age. Percentage of heart volume receiving >20, 30, 40, and 50 Gy (V20-V50) and its association with cardiac toxicity was evaluated for each patient. Fisher’s exact test was used to test for an association between dose volume parameters and cardiac toxicity. Results: Patient population included 93 males and 27 females with a mean age of 63 years. Any cardiac toxicity occurred in 27 patients, 8 of which were symptomatic. T-test comparing age to toxicity was not significant; however, female patients were 3.57 times more likely to have cardiac toxicity ([95% Confidence Interval 1.42-9.01], p=0.005). A significant difference in V40 existed between patients with cardiac toxicity and those without (p=0.05). Patients above the median cut-off for V40 (54%) had 2.48 increased odds of developing cardiac toxicity ([95% Confidence Interval 1.02-6.02], p=0.04). None of the other investigated variables were associated with an increased risk of developing cardiac toxicity. Conclusions: Female patients were found to have an increased risk of cardiac toxicity subsequent to receiving CRT for esophageal carcinoma. V40 greater than 54% was associated with increased cardiac toxicity. These data suggest exercising increased care when designing radiation fields in women undergoing CRT for esophageal carcinoma.
Clinical availability of endoscopic submucosal dissection for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma.
Authors: Inadomi Kyoko , Watanabe Masayuki , Nagai Yohei , Nonaka Koichi , Sakurai Koichi , Ida Satoshi , Iwagami Shiro , Iwatsuki Masaaki , Baba Yoshifumi , Miyamoto Yuji , Baba Hideo 
Published: February 2017

118 Background: Local failure after chemoradiotherapy (CRT) remains a major problem for patients with esophageal squamous cell carcinoma (ESCC), and there are few curative treatment options available in such cases except salvage esophagectomy. The aim of this study is to demonstrate the clinical efficacy and safety of endoscopic submucosal dissection as a salvage therapy (salvage ESD) for local failure after CRT. Methods: Between 2007 and 2011, 66 patients underwent ESD for superficial ESCC in our hospital. Five of these patients underwent salvage ESD for local failure after CRT, and were reviewed retrospectively. They were treated with CRT, consisting of 60 Gy irradiation and concurrent chemotherapy. The indications for salvage ESD were as follows: 1) absence of lymph-node or distant metastasis after CRT; 2) superficial and endoscopically resectable lesion after CRT; 3) refusal by patient to undergo salvage esophagectomy; 4) written informed consent. Salvage ESD was performed using a flush knife or hook knife with a hyaluronic acid injection into the submucosal layer. Results: The baseline stage before CRT was as follows: T1b/T2/T3 in 3/1/1, N0/1 in 4/1, and M0/1 in 4/1 patients, respectively. These 5 patients had histologically proven local failure, and the stage after CRT was as follows: T1a/T1b in 1/4, N0/1 in 5/0, and M0/1 in 5/0 patients, respectively. Salvage ESD was performed in all patients who had en bloc resection with no complications and pathologically R0 resection. In 5 patients, 2 had a pT1a lesion, and 3 had a pT1b lesion. 1 lesion recurred in other site 3 months after salvage ESD, which was resected successfully by a second ESD procedure. Conclusions: Salvage ESD is an available option for patients with local failure after CRT for ESCC.
Efficacy of weekly paclitaxel in patients with advanced gastric cancer with prior docetaxel-containing chemotherapy.
Authors: Ando Takayuki , Hosokawa Ayumu , Ogawa Kohei , Kajiura Shinya , Itaya Yuko , Ueda Akira , Tsukioka Yuji , Kobayashi Takashi , Horikawa Naoki , Sugiyama Toshiro 
Published: February 2017

127 Background: Efficacy of paclitaxel for docetaxel-refractory gastric cancer is not known, although partial cross-resistance between docetaxel and paclitaxel has been demonstrated in breast and ovary cancers. Therefore, we retrospectively evaluated the efficacy of paclitaxel in gastric cancer patients who had been refractory to docetaxel-containing chemotherapy. Methods: The patients who had received docetaxel-containing regimen were categorized as prior-docetaxel group, and the patients who had never received docetaxel were categorized as non-docetaxel group. Paclitaxel at 80 mg/m2 was administered by intravenous infusion in all patients, and this was repeated weekly for 3 weeks out of 4. The response rate (RR), median progression-free survival (PFS) and overall survival (OS) were evaluated in two groups. Results: 65 patients were included between April 2006 and June 2011. Among them, 26 patients were prior-docetaxel group, and 39 patients were non-docetaxel group. The median age, gender, performance status, histology, history of gastrectomy, metastatic site, and the number of metastatic sites were not statistically different between two groups. In prior-docetaxel group, the RR was 14.2% (3/21) among the patients with measurable lesions, the median PFS was 79 days (95%CI, 47-135 days), and the OS was 123 days (95% CI, 90-215 days) from the initiation of paclitaxel administration. In non-docetaxel group, the RR was 11.5% (3/26) among the patients with measurable lesions, the PFS was 82 days (95% CI, 52-106 days), and the OS was 143 days (95% CI, 121-178 days). There were no significant differences in the RR (P = 0.78), PFS (P = 0.98), and OS (P = 0.51) between two groups. Conclusions: Weekly paclitaxel was modestly active in gastric cancer patients who had been refractory to docetaxel containing chemotherapy. This represents that there was incomplete cross-resistance between docetaxel and paclitaxel in gastric cancer chemotherapy, as previously reported in other cancers.