bluuebunny/crossref_metadata_2025_split huggingface dataset:
Voxel-based radiomics outlines spatial heterogeneity of cerebral radiation necrosis (RN) associated with bevacizumab (Bev) response in head and neck radiotherapy (RT) patients.
Authors: Tan Hong Qi , Cai Jinhua , Sim Adelene Y.L. , Huang Luo , Chua Melvin L.K. Lee Kiang , Tang Yamei 
Published: June 2022

e18063 Background: RN is a debilitating toxicity of head and neck RT, with incidences of 4% to 24%. Bev is a promising drug for managing RN, but there is currently no biomarker that could predict a priori if a patient would benefit from Bev. Here, we aimed to use radiomics to predict Bev response. However, current radiomics tools suffer from issues of interrater contouring variability and explanability of the radiomics models. We therefore investigated a voxel-based radiomics approach to characterize the spatial heterogeneity of RN, and define subregions that are associated with Bev response. Methods: 118 consecutive nasopharyngeal carcinoma (NPC) patients who were diagnosed with RN post-RT, and were treated with Bev between Jul 2012 and Mar 2019 at the Sun Yat-Sen Memorial Hospital were enrolled into the study. 77 patients with 101 brain lesions treated between Jul 2012 and Dec 2017 were assigned to the training set, and 41 patients with 51 brain lesions treated between Jan 2018 and Mar 2019 were used for validation. All patients received Bev prescribed at 5 mg/kg every fortnightly for up to 4 courses. We extracted voxel-based radiomics features from each segment drawn on T2 FLAIR MRI images, followed by a 3-step analysis (individual- and population-level clustering, before delta-radiomics) to obtain a clustered heat map of subregions within the RN lesion. Anatomical correlation to areas of edema, necrosis, and their interphase was performed. Delta-radiomics tracked the ∆ of each cluster to Bev. Features were then extracted from each radiomics cluster for model building. Results: 71 (70.3%) and 34 (66.7%) lesions had documented radiological responses to Bev in the training and validation sets, respectively. Responders (N = 105) and non-responders (N = 47) showed a 71.8% (IQR: 54.7-87.5) and 13.2% (IQR: 7.98-21.4) reduction in RN volumes, respectively. Five optimal clusters were determined using the shoulder method with ΔK metric. Spatial analyses revealed that 2 of the 5 clusters were associated with the edema areas, with 92.6% and 74.3% of the voxels located within this anatomic subregion. The two corresponding clusters were significantly associated with a response to Bev (Odds ratio [OR]: 11.12 (95% CI: 2.54-73.47), P = 0.004; OR: 1.63 [1.07-2.78], P = 0.042). Finally, we developed and validated a clinicoradiomics model based on features extracted from the 2 clusters that improved the prediction of Bev response, compared with a clinical-only model for both the training (AUC 0.852 vs 0.755) and validation (AUC 0.816 vs 0.691) cohorts. Conclusions: Our spatial radiomics approach revealed anatomic subregions that contain relevant radiomics features that could predict Bev efficacy in the treatment of RN in NPC patients. This method would improve the interpretability of radiomics, compared with current methods that lack spatial resolution.
Oncological safety of harvesting local flaps from the neck in clinically node positive patients with oral squamous cell carcinoma.
Authors: Saha Aditi Subrata , A Anoop , Vijay Sandeep , Nair Raveena , Thomas Linu , George Rithin 
Published: June 2022

e18065 Background: Reconstruction of complex orofacial defects following tumour resection has always posed as a challenge for clinicians for providing functional and morphological outcomes. Though microvascular free flaps revolutionized reconstruction, local flaps provide a viable alternative in resource constraint settings. Oncological safety of harvesting local flaps has always been a matter of debate in oral squamous cell carcinoma due to proximity of nodal stations. Available literature on oncological safety is limited to clinically node negative patients. The purpose of this study was to evaluate the oncologic safety of local flaps in clinically node positive patients. Methods: Retrospective analysis of data available of all patients diagnosed with clinically node positive oral squamous cell carcinoma who underwent modified radical neck dissection at Malabar Cancer Centre during the period January 2012 to December 2017 was done. Demographic profile, tumour characteristics and pathological outcomes were compiled. The factors included were pathological tumour, nodal stage, levels of nodes involved, extranodal extension, choice of flap and site of recurrence. Fisher's exact test was used to compare recurrence patterns between local and regional flaps. Results: A total of 309 clinically node positive patients were analyzed with a median follow up of 4 years. Overall incidence of pathologically proven nodal metastases to ipsilateral levels Ia Ib, II, III, IV and V were 8.1%, 35.3%, 39.5%,15.5%, 2.9% and 1.3% respectively. Level Ia was most commonly involved in buccal mucosa and tongue cancers. Levels Ib, II, III were most commonly involved in tongue and buccal mucosa cancers. Level IV was commonly involved in tongue cancers while level V in cancer of retromolar trigone. Local flaps analyzed were submental flap (2.6%), supraclavicular flap (2.6%), infrahyoid flap (2.6%), sternocleidomastoid muscle flap (4.5%), nasolabial flap (1.3%), facial artery myomucosal flap (1.6%). Pathological nodal positivity was 60% and 52% in local and regional flaps respectively. Amongst the patients who had reconstruction with submental flap there were no nodal recurrences at level Ia, only 1 patient had recurrence at flap site. Amongst the patients who had reconstruction with supraclavicular flap there was 1 patient with pathological involvement of level V as per histopathological report but no nodal recurrences at level V. There was no difference in pattern of nodal recurrence between local and regional flaps (p = 0.436). Conclusions: This retrospective analysis is the first of its kind analysing the oncological safety of harvesting local flaps in clinically node positive oral squamous cell carcinoma. Thus, with appropriate management of the levels Ia and V nodal compartment, oncologic outcomes are not compromised, thereby making it oncologically sound to harvest local flaps in N+ neck.
Neoadjuvant trial with toripalimab, albumin paclitaxel, and cisplatin on pathological response in locally advanced resectable oral squamous cell carcinoma (Illuminate Trial).
Authors: Zhong Lai-Ping , Huang Ying-ying , Sun Jing-jing , Li Jun , Dong Min-jun , Zhu Guopei , Li Jiang , Ju Wu-tong 
Published: June 2022

e18067 Background: In patients with locally advanced resectable oral squamous cell carcinoma (OSCC), major pathological response (MPR) to neoadjuvant therapy may translate into improved survival. The combination of anti-PD-1 and chemotherapy as neoadjuvant protocol has not been well reported in OSCC. Methods: The prospective single arm trial (NCT04473716) was performed to evaluate the neoadjuvant therapy with anti-PD-1 (Toripalimab) and chemotherapy (albumin paclitaxel/cisplatin) in OSCC patients at clinical stage III and IVA (AJCC 2018). The patients received two cycles (21 days each) of intravenous albumin paclitaxel (260mg/m2), cisplatin (75mg/m2) and Toripalimab (240mg) on day 1 and day 22. Radical surgery was performed within two weeks after neoadjuvant therapy. Post-operative radiotherapy/chemoradiotherapy was performed within 1.5 months after surgery. The primary endpoints were MPR and safety. Primary tumors were assessed for the percentage of residual viable tumor cells on HE staining, and tumor with no more than 10% viable tumor cell was considered as MPR. Results: From Nov. 2020 to Apr. 2021, 20 patients were enrolled, including 16 males and 4 females, at clinical stage III (16) and IVA (4). They aged from 19 to 75 (median 54) years . The primary tumor site was eight tongue, six mouth floor, three gingiva, two retromolar trigone and one buccal mucosa. The neoadjuvant therapy was well-tolerated with low incidence of grade 3-4 adverse events (AEs) including 5% grade 4 neutropenia, 10% grade 3 leukopenia, 5% grade 3 neutropenia, hypokalemia, vomiting, and rash each. Common grade 1-2 AEs included baldness/rash/itch/pain/fatigue, AST/ALT/uric acid elevation, nausea/vomiting/diarrhea, hyperbilirubinemia, proteinuria, neutropenia/leukopenia. All AEs were relieved after expectant treatment, the subsequent standard treatment was not delayed. According to pathological evaluation, the MPR rate was 60% (12/20), including 30% (6/20) pCR. According to RECIST 1.1, radiological evaluation on neoadjuvant therapy showed two CR, ten PR, seven SD and one PD. It was significantly consistent between pathological and radiological evaluation in linear regression analysis ( P＜0.0001). Combined positive score (CPS) of PD-L1 expression in biopsy was evaluated in 19 patients, MPR was archived in all 4 patients with CPS≥10, in 6 out of 8 patients (75%) with CPS≥1, and in 5 out of 11 patients (45.5%) with CPS < 1. Conclusions: Neoadjuvant therapy with combination of Toripalimab, albumin paclitaxel, and cisplatin in resectable OSCC patients is safe and well-tolerated, with high MPR rate. Clinical trial information: NCT04473716.
Metronomic systemic PCm (paclitaxel, carboplatin + metronomic) neoadjuvant chemotherapy in head and neck cancer.
Authors: Singh Gunjesh Kumar , Prabhash Kumar , Patil Vijay Maruti , Noronha Vanita , Joshi Amit , Menon Nandini Sharrel , Singh Pragya , Qayyumi Burhanuddin , Singh Ravikant 
Published: June 2022

e18073 Background: Neoadjuvant chemotherapy (NACT) in head and neck cancers (HNC) with taxane, platinum, 5-FU (TPF) regimen is both toxic as well as difficult to use in resource-constrained settings. We used a novel combination of weekly chemotherapy and oral metronomic chemotherapy (OMCT) and assessed the efficacy and safety of this combination as NACT in locally advanced HNC patients. Methods: This is a retrospective analysis of prospectively maintained data. 56 patients with technically unresectable HNC received NACT with paclitaxel (80mg/m2) plus carboplatin (AUC2) - weekly schedule and OMCT (methotrexate 9mg/m2 once a week, celecoxib 200mg twice daily, and erlotinib 150mg once daily) - PCm regimen. Patients were assessed clinically and radiologically after a minimum of six cycles for resectability. The radiological response was evaluated as per RECIST 1.1. We report the response rate, resectability, survival, and tolerance of this NACT regimen. Results: The median age of the patients was 41 years. Fifty-two patients (92.9%) were male. Buccal mucosa (60.7%) and oral tongue (17.9%) were the commonest sites of primary seen followed by alveolus (10.7%), the floor of mouth (5.4%), and larynx (5.4%). AJCC 2017 stage IVA and IVB disease were present in 64.3% and 35.7% of patients respectively. Edema up to zygoma (44.6%), high ITF involvement (19.7%), technically unresectable nodal disease (16.1%) and disease reaching up to vallecula (12.5%), or hyoid bone (5.4%), and nodal encasement (180-270 degree) of the internal carotid artery (1.8%) were the reasons for technical unresectability. The median number of NACT administered was six. The tumor showed partial response in 54 (96.4%) patients, 2 (3.6%) patients had stable disease and none of the patients had tumor progression. Surgery was planned in 47 (83.9%) patients after NACT, however due to logistic issues only 35 (62.5%) patients could undergo surgery. Pathological complete response was seen in 27 (48.21%) patients. After a median follow-up of 7.36 months, median PFS was not reached in the whole cohort and surgery group of patients, whereas it was 5.23 (95% CI, 4.08 -6.38) months in the non-surgery group. Median OS was not reached in our cohort. Common grade 3/4 toxicities (CTCAE 5.0) observed were oral mucositis in 6 (10.7%) patients, diarrhea in 4 (7.1%), and febrile neutropenia in 1 (1.7%) patients. Conclusions: Weekly scheduled PCm is an efficacious and well-tolerated regimen and can easily be administered in resource-constrained settings.
Factors associated with baseline quality of life in patients with oral cavity and oropharyngeal cancer.
Authors: Deng Jie , Murphy Barbara A. , Andersen Lucy , Dietrich Mary S. 
Published: June 2022

e18079 Background: Baseline quality of life (QOL) predicts for survival in head and neck cancer patients. The purpose of this study was to identify factors contributing to baseline QOL in patients with newly diagnosed oral cavity or oropharyngeal cancer (OCOPC) in order to identify potential targets for intervention. Methods: 115 patients with OCOPC completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, Hospital Anxiety and Depression Scale, and Brief Health Literacy Screen (BHLS). Pearson correlation and ANOVA statistics were used to analyze the data. Results: The median global health-related QOL score was 66.7 (IQR: 50, 83.4); 35.7% of participants reported anxiety and 18.3% reported depressive symptoms (HADS ≥8); 30.8% of patients had BHLS values of ≤ 9. Factors associated with significant decrease in global health-related QOL score: household income of < $20,000/year (p = .010); low health literacy (p = .021); having symptoms of anxiety (p < .001); having depressive symptoms (p < .001); and non-HPV associated cancer (p < .001). Increased tumor stage, older age, single/widowed marital status, and unemployment were associated with the lower scores on the physical QOL subscale (p < .05). Increased tumor stage was associated with lower scores on role and social QOL subscales (p < .05), and younger age was associated with lower scores on emotional QOL subscale (p < .05). Conclusions: Baseline QOL is associated with socioeconomic and disease-related determinants. Clinical trial information: NCT02412241.
Perceptions towards breast and cervical cancer development and screening in transgender and nonbinary persons.
Authors: Roznovjak David , Petroll Andrew , Lakatos Anne , Narayan Raj , Cortina Chandler Scott 
Published: June 2022

e18500 Background: Approximately 1.4 million adult Americans identify as transgender (TG) or non-binary (NB), a number that has steadily increased over time. In this population, cancer risk is unclear, and screening and treatment guidelines are lacking. We sought to assess TG and NB persons’ perceptions towards breast and cervical cancer screening, risk of cancer development, and thoughts towards gender-affirming hormone therapy in the setting of a hormone-receptor positive breast cancer. Methods: A single-institution online survey was administered from October 2021-January 2022 at our comprehensive LGBTQ+ Inclusion Health Clinic. Participants with female sex at birth were asked about breast and cervical cancer, while those assigned male sex at birth were exclusively asked about breast cancer. A 5-point Likert scale was used to assess attitudes toward cancer screening and concerns regarding cancer development. Results: 40 patient responses were collected: 13% were TG women, 45% TG men, 23% NB, and 20% identified as other (i.e., agender, genderqueer, etc). 71% were assigned female sex at birth (59% of whom had chest masculinization surgery), 27% were assigned male sex at birth, and one individual was intersex at birth. 52.5% were age < 30, 84% were Caucasian, 65% had at least a bachelor’s degree, and all but one respondent had health insurance. The majority reported they were not familiar with breast (77%) or cervical (60%) cancer screening recommendations for their sex-assigned at birth or current gender identity. 23% reported concern regarding breast cancer development and cited family history as the primary reason. In patients age > 40, 50% had a mammogram (MMG) in the past 10 years. When presented with information regarding screening MMG and automated breast ultrasonography (ABUS), 78% reported they would prefer ABUS over MMG for breast cancer screening. 84% of respondents were currently using or had previously used gender-affirming hormone therapy, and of these, 61% reported they would stop therapy in the event they developed a hormone-receptor positive breast cancer. In patients assigned female sex at birth, 25% had a hysterectomy and, in those who still had a cervix, 50% reported having a Pap smear in the past 5 years and 38% were concerned about cervical cancer development. Conclusions: This survey identified that > 60% of TG and NB individuals are unaware of breast and cervical cancer screening guidelines, > 20% are concerned about breast and cervical cancer development, and < 50% of patients eligible for breast and cervical cancer screening had undergone screening in recent years. Additionally, in the setting of a hormone-receptor positive breast cancer, only 61% would consider stopping gender-affirming hormone therapy. Further data on the risk of breast and cervical cancer development and incidence in TG and NB persons is needed to inform optimal screening and treatment guidelines.
Improvements in myeloma specific survival over the last two decades.
Authors: Mankan Nidhi , Nooka Ajay K. 
Published: June 2022

e18503 Background: Improvement in overall survival (OS) have been observed among myeloma patients over the last several decades, mainly due to improvement in therapeutic options. For a disease, more common in the elderly (median age of diagnosis of 70), and a median reported OS exceeding 10 years (Joseph et al JCO 2020), reaching normal life-expectancy for a myeloma patient has become more realistic now than ever before. In this context, where the competing risks for mortality for myeloma patients are higher, we have evaluated the changes in the myeloma specific survival (MSS) using a population-based database Surveillance, Epidemiology, and End Results (SEER)-18 database. Methods: Interrogation for International Classification of Diseases (ICD) for Oncology 3rd edition histology codes 9731/3 resulted in 65848 cases. After excluding 1360 cases of extraosseous plasmacytoma and 2011 cases of solitary plasmacytoma of bone, a total of 62477 cases of myeloma were found. 9322 cases were excluded due to myeloma not being the primary malignancy, leaving a total of 53155 cases with active follow for the primary analysis. OS and MSS were estimated using the Kaplan-Meier method. Improvements in OS and MSS were compared by 4 eras (1975-88; 1989-1998; 1999-2008; 2009-2018) by race and gender. Results: White patients (40040 -75.3%) and males (28104 -52.9%) comprised majority of the study population. 9495 black patients (17.9%) and 3004 Asian/Pacific Islanders (5.7%) were the other major racial groups included in the analysis. The median OS for myeloma patients in the era 1975-1988 was 24 months (95% CI 23.22-24.77) while the simultaneous median MSS was 32 months (95% CI 31-32.99). Significant improvements in OS occurred by the era of 2008-2018 (56 months (95% CI 54.31-57.69). Improvement in MSS was more prominently observed during this era - 87 months (95% CI 83.2-90.80). The OS and MSS for each of the groups by gender and race have been tabulated in table. Conclusions: OS and MSS have improved over the last two decades, more prominently in the last decade. Improvement in MSS clearly highlights the fact that myeloma as the primary cause of death has declined over the last two decades among most groups of patients and it is encouraging to see the benefit extending to the minorities. Future studies may incorporate MSS as an endpoint, which might accurately reflect the benefit offered by the newer safer therapeutics.
The effect of race, employment, and poverty on outcomes in chimeric antigen receptor therapy for DLBCL patients.
Authors: Johnson Grace , Patel Kedar , Jain Michael D. , Blue Brandon Jamaal 
Published: June 2022

e18506 Background: Limited information is known about how socioeconomic (SES) factors contribute to outcomes after CAR T-cell therapy for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). While racial and SES disparities have been demonstrated to effect outcomes after Autologous Stem Cell Transplant for DLBCL patients, little is known about this association after CAR T. Methods: Using data from Moffitt Cancer Center's electronic medical record system, we retrospectively evaluated patients diagnosed with DLBCL at our center who underwent CART therapy (n = 200). Data was analyzed by residential area deprivation index (ADI) for patients receiving CAR T therapy for R/R DLBCL at a single tertiary care center. Survival and CAR T-related toxicity outcomes were evaluated based on patient baseline characteristics, disease features, and demographics using multivariable Cox proportional-hazards (PH) regression model and multivariable logistic regression model. Patient socioeconomic status was represented by area deprivation index ranking mapped through 9-digit zip codes. Results: The study included 200 patients receiving CAR T therapy at Moffitt Cancer Center for R/R DLBCL; median age was 65; 46.8% were female, 53.2% male; 89.8% white, 10.2% non-white; median ADI rank of 4. As for disease characteristics; 18.9% had double/triple hit lymphoma by FISH for MYC and BCL2 or 6 translocations; 83.6% had extranodal disease sites. Patients were treated with a median of 3 prior lines of therapy, and most patients (81%) had stage III/IV lymphoma at time of leukapheresis for CAR T. 8.38% of patients experienced grade 3 or higher cytokine-release syndrome (CRS), and 34.6% of patients experienced grade 3 or higher neurotoxicity. Area deprivation index and education level did not significantly contribute to overall survival when adjusted for other clinical features on multivariable Cox PH regression analysis. However, unemployment negatively impacted overall survival (HR = 4.296, P = 0.0243). Progression-free survival was unaffected by ADI, education level, or employment. In terms of CAR T-related toxicities, demographic features did not affect the risk for grade 3 CRS on multivariable logistic regression model. On Wilcoxon rank testing, area of deprivation indices did not significantly differ among patients with or without grade 3 CRS. Conclusions: These results suggest that ADI and other SES factors do not significantly contribute to progression free survival, CRS or neurotoxicity. This study shows unemployment was a significant predictor for poor overall survival after CAR T in patients with DLBCL. This is the first study to evaluate the significance of SES, race, and employment on DLBCL patients after CAR T. Future efforts should be used to investigate measures to increase employment and understand factors associated with unemployment.