bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation induced lymphopenia in unilateral versus bilateral radiochemotherapy in treatment of head and neck cancer: A retrospective case-control study.
Authors: Bendavid Jerome , Sun Roger , Blanchard Pierre , Deutsch Eric , Gorphe Philippe , Tao Yungan , Nguyen France , Chaffai Ines , Billard Sandu Camelia , Even Caroline 
Published: June 2023

e18065 Background: Grade 3+ radiation-induced lymphopenia is a frequent biological complication of external beam radiotherapy (RT) in the management of head and neck cancers, likely due to the large irradiated cervical volume. This complication has been shown to be a significant prognostic factor for mortality. The aim of this study is to evaluate the difference in lymphopenia and prognosis between unilateral and bilateral prophylactic lymph node irradiation in head and neck cancers. Methods: This is a retrospective, single center case – control study in patients who received unilateral or bilateral radio chemotherapy for head and neck cancers between 2014 and 2020. Cases (unilateral neck irradiation) were matched to controls (bilateral neck irradiation) according to initial TNM, histology, tumor location, postoperative status. The comparison of the evolution of the lymphocyte count during treatment was evaluated by univariate analysis, as well as the evaluation of the overall survival (OS) and the progression free survival (PFS) between these two groups. Another univariate analysis is used to compare OS and PFS in these two groups between patients who developed Grade 3 or higher lymphopenia during treatment and those who did not. Results: In this retrospective study, 94 patients were analyzed (n = 47 in the RT unilateral group and n = 47 in the RT bilateral group). All patients received concomitant systemic therapy. Median age was 59,3 years in the unilateral group (vs 59 years in the control group). Radiotherapy was given postoperatively in 66% vs 53.2% of patients. Squamous cell carcinoma was the most frequent histological subtype with 93,6% in each RT group. All patients were treated in Intensity modulated radiation therapy (IMRT). Median follow up was 38 months in the case group and 37,6 months in the control group. Biological data from the start of radiotherapy to day 100 posttreatment was available for 90 patients (45 in each group). A linear regression model as a function of time and lymphocyte count estimated a -0.011 G/l decrease in lymphocyte count each day and a higher lymphocyte count with unilateral neck irradiation of 0.16 G/l. This was consistent with a mixed model considering the patient as a random effect. In univariate analysis, the lymphocyte nadir was significantly higher in the unilateral group 0.30 [0.15- 0,42] vs 0.37 [0,26-0.48] p = 0,029, with no significant difference in OS and PFS between these two groups. In each of the two groups, there was no significant difference in OS and PFS according to the presence or absence of grade 3 or higher lymphopenia during the treatment. Conclusions: This study, although retrospective, showed a slight benefit on radiation-induced lymphopenia in the context of unilateral radiotherapy without negative impact on OS and PFS.
Recurrence free survival in patients with HPV+ head and neck cancer treated with TORS and neck dissection.
Authors: Melachuri Manasa , Patel Terral , Awad Daniel , Kim Seungwon , Sridharan Shaum , Duvvuri Umamaheswar 
Published: June 2023

e18076 Background: Prior research has demonstrated that delays to initiation of radiation therapy (RT) in the treatment of head and neck squamous cell carcinoma (HNSCC) after surgery result in poorer survival outcomes. However, there is limited data with little long-term follow up to evaluate whether human papilloma virus (HPV) positive primaries undergoing transoral robotic surgery (TORS) and neck dissection (ND) face a similar decrement in recurrence free survival (RFS) and disease specific survival (DSS). Methods: Single center retrospective chart review of patients diagnosed with HPV positive primary nonmetastatic HNSCC who underwent TORS with ND followed by RT with or without Chemotherapy and/or Immunotherapy from 2012-2022 with data collection from December 2022 to February 2023. 248 patients met inclusion criteria and were analyzed for DSS and RFS. Kaplan-Meier survival analysis with Log-rank testing was used to assess the impact of time intervals between diagnosis, TORS, radiation initiation and radiation completion on survival. Univariable and Multivariable Cox proportional hazards regression analysis was performed to identify factors associated with RFS and DSS and adjust for potential confounding variables. Subgroup analysis was completed with high risk (lymph nodes > 4 with extracapsular extension) and low risk population. Results: Median follow-up time was 47.22 months (1452.07 days). Of 248 patients, 17 had a recurrence and 12 died due to disease. In patients who underwent radiation therapy for a time frame (TR1-R2) of 5-7 weeks compared with those who had a shortened or prolonged course of RT, RFS (140.116 months, p-value = .012) and DSS (142.641 months, p-value = .016) were improved. Although time from diagnosis to TORS did not impact RFS (p-value = .195), improved RFS persisted in patients who underwent time from diagnosis to radiation completion (TD-R2) or total treatment package time (TTPT) between 17-20 weeks (109.155 months, 95% CI: 105.276-113.034, p-value = .057) compared to patients with TTPT less than 17 or greater than 20 weeks. When the population is stratified into high risk and low risk groups, patients in the high risk group who underwent Chemotherapy had improved RFS compared to no chemotherapy (HR: 7.19, p-value = .09). On Univariate Analysis, TR1-R2 < 5 weeks and > 7 weeks, TD-R2 < 17 weeks and > 20 weeks, extracapsular extension, smoking history, and age > 70 were associated with increased risk of recurrence. Conclusions: For HPV positive patients with OPSCC undergoing TORS and Neck dissection, time to radiation initiation may not be as critical in improving OS, DSS, and RFS as other patient populations. However, the length of radiation time between 5 to 7 weeks and overall treatment time from 17-20 weeks may improve recurrence free survival and disease specific survival.
Malignant glomus tumor of the head and neck: A National Cancer Database analysis.
Authors: Anderson Quinton , Hsia Beau , Tuman Jaylin , Wu Xinxin , Sinai Erin , Silberstein Peter T. , Keirns Darby 
Published: June 2023

e18078 Background: Malignant glomus tumors of the head and neck are rare malignancies originating from glomus bodies found within the skin, soft tissues, and mucosa of the head and neck. Malignant glomus tumors often arise from benign glomus tumors and rarely metastasize. In cases where metastasis had ocurred it was typically fatal. Another review of the malignant glomus tumor cases indicated that only a minority developed metastases. These findings, along with a general lack of knowledge regarding demographic and socioeconomic factors on glomus tumors warrants further investigation. The National Cancer Database (NCDB) was analyzed to identify demographic factors among patients and better understand the epidemiology of these tumors. Methods: A retrospective cohort analysis was performed using the 2004–2020 National Cancer Database including patients with a histologically confirmed malignant glomus tumor diagnosis (N = 42). Demographic factors such as race, age, sex, Hispanic status, insurance status, Charlson-Deyo score, facility type, and distance to facility were analyzed by descriptive statistics. Results: A total of 42 patients with a confirmed malignant glomus tumor diagnosis were identified in the National Cancer Database (NCDB) between 2004 – 2020. The average age of diagnosis was 60.9 years (SD = 13.7, range = 36 - 90 years). The aortic body and other paraganglia were the most common primary tumor sites (57.1%). Most patients were White (69.0%) or Black (28.6%). Most individuals (88.1%) had a Charlson-Deyo comorbidity score of 0. A higher percentage of patients were in the bottom quartile of income earners (31.4%). Fewer patients lived in metropolitan counties with populations less than 1 million compared to those that lived in counties with a population greater than 1 million (52.5%). More patients were privately insured (47.6%) relative to those who were insured by Medicare/Medicaid or uninsured. The most common treatment facility type was an academic/research program (57.5%) and patients lived an average of 40.1 miles (SD = 65.6, range = 0.6 – 265.4) from their treatment facility. Conclusions: Before this study, there had been no previous report on the socioeconomic profile of patients with malignant glomus tumors. However, our findings indicate that these patients are more prone to having a low income and that White patients are more likely to be affected. No obvious connection exists between metastases and racial minority status. Additional research is needed to grasp how socioeconomic factors, such as low income and minority status, affect the risk, diagnosis, treatment, and overall survival of individuals with malignant glomus tumors.
Correlations between overall response rate, progression-free survival and overall survival with kinase inhibitors in radioiodine-refractory differentiated thyroid cancers: A systematic review and meta-analysis.
Authors: Ilerhunmwuwa Nosakhare Paul , Wasifuddin Mustafa , Hakobyan Narek , Tahir Muhammad , Avezbakiyev Boris 
Published: June 2023

e18087 Background: Differentiated thyroid cancer (DTC) has a good prognosis; however, about 30% of patients will experience a recurrence after treatment and become refractory to radioiodine therapy. Some studies, including randomized controlled trials (RCTs), have shown the efficacy of kinase inhibitors in these patients, but whether overall response rate (ORR) can predict progression-free survival (PFS) and/or overall survival (OS) has not been well established in the literature. We examined the correlations between ORR and PFS/OS with kinase inhibitors in radioiodine (RAI)-refractory DTC. Methods: PubMed, SCOPUS, Embase, and ClinicalTrials.gov were queried for studies that used kinase inhibitors in RAI-refractory DTC. Eligibility included a clinical diagnosis of RAI-refractory DTC, the use of kinase inhibitors, and articles published in English. ORR, PFS, and OS data were manually retrieved from the studies, and correlative analyses using Spearman's rank correlation coefficient ( rs) were conducted to determine their relationships. Results: Two hundred ninety articles were identified from the literature search; after removing duplicates and screening for relevance and eligibility, 24 studies (6 RCTs and 18 observational), consisting of 1,791 participants, were included for analysis. The kinase inhibitors used were: sorafenib, lenvatinib, donafenib, apatinib, sunitinib, cabozantinib, and vemurafenib. There was no significant correlation between ORR and PFS or OS, and between PFS and OS. However, a sub-analysis of the 6 RCTs (n = 410) alone showed a significantly strong positive correlation between ORR and PFS ( rs = 0.92, p = 0.003) with a 20% increase in ORR corresponding to a prolonged PFS by about five months. No significant correlation was found between any two endpoints in the observational studies. Conclusions: Overall response rate is a predictor of PFS and can be used as a surrogate endpoint for the latter (PFS) in RCTs with kinase inhibitors in RAI-refractory DTC, especially when the time to reach PFS data may be protracted, costly, and delayed treatment. The lack of correlations between ORR and PFS or OS in the observational studies may be due to different populations with varying responses, less controlled settings, time to reach OS data, and probably smaller sample sizes.
The influence of grade on mortality risk in salivary gland malignancy.
Authors: Bastien Amanda J , Luu Michael , Balzer Bonnie , Aro Katri , Jang Julie , Mita Alain C. , Scher Kevin , Mallen-St. Clair Jon , Vasquez Missael , Epstein Joel , Lin De-Chen J , Chen Michelle , Zumsteg Zachary Stephan , Ho Allen S. 
Published: June 2023

e18100 Background: Salivary malignancies are amongst one of the most difficult malignancies to classify.Currently, the impact of histologic variants has not been well described. The objective of this study was to evaluate histologic subtype and grade in salivary cancer staging. Methods: Salivary cancer histologies were collected from the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable models were used to adjust for clinicopathologic covariates and assess for relationships between histologic subtype, grade, and survival. Results: Histologic variants have a wide range of mortality risk (e.g., acinic cell carcinoma has a favorable 5-year survival, in opposition to salivary duct carcinoma) on univariate analysis(p < 0.001). Using multivariable analysis, the survival differences disappeared. However, worsening grade corresponded signficantly with deteriorating survival (5-year OS of 89% [95% CI 88-90%] (low-grade), 81% [95% CI 79-82%] (intermediate-grade), 45% [95% CI 44-47%] (high-grade) (p < 0.001)), on both multivariable analysis and propensity score matching. Recursive partitioning analysis incorporating grade into current staging generated a TNM+G schema (c-index 0.75, 95% CI 0.745-0.755) superior to the existing system (c-index 0.73, 95% CI 0.723-0.736). Conclusions: Grade is a significant factor in determining mortality risk in salivary cancers. Including grade into staging will improve current staging systems.
Demographic and socioeconomic factors of patients with nonencapsulated sclerosing carcinoma: An NCDB analysis.
Authors: Stewart Laura , Wu Xinxin , Keirns Darby , Silberstein Peter T. , Hsia Beau 
Published: June 2023

e18103 Background: Nonencapsulated sclerosing carcinoma (NSC) is a rare and aggressive variant of papillary thyroid carcinoma (PTC) that accounts for 0.7-6.6% of its cases. It is associated with greater rates of vascular invasion, metastasis, and relapse compared to classic PTC. With prompt initiation of aggressive treatment including radical surgery, lymph node resection, and possible radioiodine treatment, NSC has a 10-year survival rate of 93%. Given the importance of proper diagnosis and selection of aggressive treatments, data regarding its epidemiology could further improve patient outcomes. The demographics of NSC patients were analyzed using the National Cancer Database (NCBD). Methods: Data from NCDB was queried and patients with a confirmed diagnosis of NSC between 2004 and 2020 were identified for a retrospective cohort analysis (N = 1,130). Yearly diagnosis rates were analyzed using regression analysis. Factors including patient age, sex, race, insurance status, urban/rural residence, surgical treatment approach, treatment facility type, and 90-day mortality were identified and evaluated via descriptive statistics. Results: The NCDB contained a total of 1,130 patients with a confirmed diagnosis of NSC from 2004 – 2020. The incidence rate of new diagnoses remained stable over this time (R2 = 0.0). Women were much more likely to be diagnosed (78.5%) compared to men (21.5%) with an average age at diagnosis of 44.0 years (SD = 18.7, range = 6 – 90 years). Most patients were White (86.0%), lived in metropolitan areas with a greater than 1 million population (56.5%), and were privately insured (68.9%). The vast majority of patients were treated surgically (99.9%). A complete thyroidectomy was the most common surgical approach (89.3%), more so than subtotal thyroidectomy or lobectomy. For the patients with valid data, the most common treatment facility type was an academic/research program (42.6%) followed by comprehensive community cancer programs (33.8%). Most patients survived at least ninety days after their primary surgery (98.2%) and were still alive at the date of last contact (88.4%). Conclusions: NSC is an aggressive subtype of PTC, but it generally has a good prognosis with initiation of aggressive treatment. The findings of this research corroborated previous studies showing that NSC is much more common in females than males, is most commonly treated with complete thyroidectomy, and has high 90-day survival rates. In examining the demographic features of this patient population, it was found that the majority of patients were White, lived in large metropolitan areas, and were privately insured. This may suggest that a relative ease of access to healthcare aided in their diagnosis. Future research should focus on understanding how demographic and socioeconomic factors may contribute to the timing of diagnosis, chosen treatments, and overall mortality rates of patients with NSC.
An audit of neoadjuvant chemotherapy in sinonasal teratocarcinosarcoma from an academic tertiary care centre in India.
Authors: Peelay Zoya Ravish , Patil Vijay Maruti , Noronha Vanita , Singh Ajaykumar Chandrabhan , Prabhash Kumar , Shah Minit Jalan , Menon Nandini Sharrel 
Published: June 2023

e18109 Background: Sinonasal teratocarcinosarcoma (SNTCS) are rare types of sinonasal malignancies, incidence is approximately 3% of all head and neck cancers and less than 1% of all tumors. There is very limited literature available on SNTCS and most of the literature available is in the form of case reports and small case series. The management of these tumors is complicated because of the location and paucity of data available in such scenarios where resection becomes difficult in extensive disease and the role of neoadjuvant chemotherapy (NACT) becomes significant. This audit was performed to study the tolerance and outcomes with NACT followed by surgery(Sx) in these treatment protocols. Methods: A retrospective analysis of a prospectively maintained database approved by the IEC of TMH. The baseline characteristics, extent of tumor, type of NACT, adverse events was curated from the EMR and patients' hospital files. Patients with clinically or radiologically extensive/inoperable disease at presentation were planned for NACT for a duration of 6-8 weeks. Post NACT these patients underwent axial imaging for response assessment.(RECIST v1.1). The adverse events due to NACT were noted as per CTCAE v5.0. Results: There were 27 patients of SNTCS. The median age of the whole cohort was 42 years (IQR 30-56) and 85.2% (n=23) were male. The ECOG PS was 0-1 in 24 (88.8%) patients and only 3 (11.1%) patients had ECOG PS 2. 17 patients (63%) had a history of addiction. 7 patients had clinical palpable regional nodes (25.9%) and 1 patient (3.7%) had lung metastasis at presentation. All 27 patients received NACT in view of extensive disease .15 patients (55.6%) had intracranial extension of disease with intradural extension. Only 10 patients (37%) had intraparenchymal disease. 22 patients (81.5%) had Kadish stage C-D disease and the remaining 5 patients (18.5%) had Kadish stage B at baseline. 20 patients (74.1%) received Cisplatin & Etoposide as NACT and remaining 7 received other chemotherapy. Median number of chemotherapy cycles was 2 (Q1 is 2 - Q3 is 3). 1 patient (3.7%) did not complete the planned NACT due to toxicity. The incidence of grade 3-5 toxicity in accordance with CTCAE version 5.0 was 37.03%. There was 1 death (3.7%) due to chemotherapy toxicity. Details of response to NACT are given in the table. 18 patients (77.8%) underwent Sx, 5 patients (18.5%) received CTRT and 2 patients (7.4%) received definitive RT and 2 patients (7.4%) did not receive any local therapy .Post Sx in local node was found in 3 patients (11.11%).The 2 years progression free survival was 53.2%(95%CI 31.3 - 70.9) and 2 years overall survival was 60.9%(95%CI 37.6 - 77.8). Conclusions: NACT improves survival in locally advanced SNTC with significant response rates. [Table: see text]
Tick tock on the stomach clock: Factors affecting time to diagnosis of gastric adenocarcinoma at an urban cancer center with a large East Asian patient population.
Authors: Choi April , Chadha Bhawneet , Doshi Hiten , Edmiston Charly , Gurinovich Anastasia , Elkon Jacob Matt 
Published: June 2023

e18508 Background: Gastric cancer is the fifth most common cancer in the world and disproportionately affects the East Asian population. Various factors contribute to this disparity such as genetics and environmental exposure. Given that language barriers can contribute to reduced quality of healthcare delivery, screening rates, and patient safety, it is important to assess the impact of language on the diagnosis of gastric cancer. Tufts Medical Center’s proximity to Boston’s Chinatown make our patient population unique for analysis of these factors. Here we present a single-institution experience of the factors affecting gastric adenocarcinoma time to diagnosis. Methods: We used ICD-10 codes to retrospectively identify patients at Tufts Medical Center with a diagnosis of gastric cancer between January 2011 and December 2021. We excluded patients that did not have a diagnosis of gastric adenocarcinoma or lacked adequate clinical documentation. We recorded demographic, clinical, and treatment characteristics including race (White, Asian, or other), primary language (English, Asian or other), presenting symptoms, enrollment in hospice, and interpreter status (certified, non-certified, none, or not applicable). Certified interpreters included professional medical services for in-person, video, or phone interpreters. Non-certified interpreters included family members, physicians fluent in the language, or others. We assessed the impact of these on the time between initial presentation to the healthcare system and eventual diagnosis of gastric cancer. Results: 80 patients were included in the analysis. Mean days to diagnosis by race were as follows: White (40), Asian (43), other (25), p = 0.20. Mean days to diagnosis based on language were as follows: English (40), Asian (43), other (6), p = 0.07. Mean days to diagnosis based on interpreter status were as follows: certified (19), non-certified (13), none (73), NA (40) (p = 0.05). When pairwise comparison was done, there was no difference between certified and non-certified interpreter (p = 0.40). There was no difference between certified interpreter and no interpreter (p = 0.06). There was a statistically significant difference between non-certified interpreter and no interpreter (p = 0.04). Presenting symptoms and eventual enrollment in hospice did not significantly impact time to diagnosis. Conclusions: We saw a shorter time from initial presentation to diagnosis of gastric adenocarcinoma in non-English speaking patients who used an interpreter at the initial visit compared to those who did not. One should always consider interpreter availability as an important part of reducing health disparities.