tbuckley/cabot-search huggingface dataset:
Fractures of Lower Extremity in Football
Authors: H HESS, R DAUM
Journal: JAMA (1963)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Second malignancies after CMF for resectable breast cancer.
Authors: P Valagussa, G Tancini, G Bonadonna
Journal: Journal of Clinical Oncology (1987)

From June 1973 to May 1978, a total of 845 women with resectable breast cancer and positive axillary nodes were entered into two consecutive randomized studies evaluating adjuvant chemotherapy. All patients were subjected to radical or modified radical mastectomy, none received postoperative radiation, and 666 were administered adjuvant CMF (cyclophosphamide, methotrexate, and fluorouracil). After a median follow-up in excess of 10 years, no cases of acute nonlymphocytic leukemia were detected, but 21 second solid tumors other than contralateral breast carcinoma were documented. The cumulative frequency was 4% +/- 1.9% after surgery alone, and 4.2% +/- 1.03% following adjuvant CMF. No differences were observed between patients aged up to 50 years (surgery, 3.1% +/- 2.2%; CMF, 3.3% +/- 1.3%) or older than 50 years (surgery, 4.5% +/- 2.6%; CMF, 5.2% +/- 1.8%). During the same period, a total of 29 contralateral breast carcinomas were documented for a cumulative frequency of 3.7% +/- 1.7% after surgery alone and of 5.2% +/- 1.4% following adjuvant CMF, respectively. We conclude that, at present, there is no evidence for an increased risk of second malignancies following adjuvant CMF as given in this series. Our findings would suggest that second tumors documented so far cannot be entirely ascribed to treatment with adjuvant chemotherapy, but they could be due to a chance association.
A phase I trial of escalating doses of the anti-IGF-1R monoclonal antibody (mAb) cixutumumab (IMC-A12) and sorafenib for treatment of advanced hepatocellular carcinoma (HCC).
Authors: R. O'Donnell, A. B. El-Khoueiry, H. Lenz, D. R. Gandara
Journal: Journal of Clinical Oncology (2010)

TPS212 Background: This phase I study of cixutumumab and sorafenib in HCC patients is being conducted through a co-operative agreement between the California Cancer Consortium and the NCI. Sorafenib is the only approved drug for advanced HCC; median survival in the SHARP trial was nearly 3 months longer for sorafenib-treated HCC patients than controls. Cixutumumab (ImClone Systems) is a fully human IgG1 mAb that blocks the interaction of Type I Insulin-Like Growth Factor Receptor (IGF-1R) with its ligands (IGF-1 and IGF-II), and induces internalization and degradation of IGF-1R. Cixutumumab inhibits tumor growth in a wide range of human cancer models as a single agent and when combined with chemotherapy, or molecularly targeted agents. An initial study showed that cixutumumab was well tolerated at doses up to 10 mg/kg/week; the most prevalent adverse event was hyperglycemia. Preclinical experiments using in vivo HCC models showed activated IGF signaling and antitumor effects due to cixutumumab. Given the cross-talk between the IGF and VEGF pathways, the combination of cixutumumab and sorafenib was chosen for study. Methods: Study objectives are to: 1) establish the MTD of the sorafenib/cixutumumab combination in patients with advanced HCC; 2) evaluate toxicity; 3) determine the impact of cixutumumab on the IGF-1R/IGF pathway; and 4) obtain preliminary efficacy data. All patients in three cixutumumab dose escalation groups (2, 4, or 6 mg/kg/week) will also be treated with sorafenib (400 mg twice daily). Additional patients will be treated at the MTD. Correlative studies will be performed on 24 patients at the MTD: tumor IGF-1R expression and gene copy number by silver in situ hybridization (SISH), plasma IGF-1R ligands and binding protein levels, hepatocyte growth factor, and c-Met phosphorylation. Eligibility criteria include: unresectable HCC; no prior systemic therapy, ECOG 0 or 1, platelets > 75,000/mm3; albumin > 2.8 g/dl; and Child-Pugh cirrhosis A or B (up to 7 points). Two patients have been accrued to the study thus far. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Response Genetics Amgen, AstraZeneca, Biodesix, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, ImClone Systems, Lilly, Merck, Novartis, Pfizer, sanofi-aventis Bayer Abbott Laboratories, Bayer/Onyx, Bristol-Myers Squibb, Genentech, ImClone Systems, Lilly, Merck, Novartis, Pfizer
Distress as a quality indicator of cancer care
Authors: M. M. Buso, C. S. Decat, A. Nonino, T. C. Araujo, J. N. Matos Neto, P. W. Schorn
Journal: Journal of Clinical Oncology (2009)

e20686 Background: Distress is present in every phase of cancer. This high prevalence of distress showed the necessity of acting strategies that may favor the reduction or elimination of possible psychological and psychiatric disturbances. Facing this reality, the National Comprehensive Cancer Network suggested Distress Management in 1997. Today the oncological units need not only acting strategies, but also methods of evaluation of assistance quality. Methods: This study main goal was to evaluate the assistance offered in a private cancer treatment center in Brazil, using the distress prevalence during all the phases of the treatment as a quality indicator. Patients (N = 169) of both genders (37.9% male and 62.1% female), with age between 17 and 86 years (median = 53), with 18 types of cancer, took a part in this investigation. The research was authorized by an ethics committee. The procedure of gathering data included the consent of patients and the application of the Distress Thermometer (DT). The evaluation was made in three distinct stages of chemotherapy: beginning, middle and end of treatment. The data were analyzed according to the criteria defined in literature and with the software SPSS 15.0. Results: In the first stage of the evaluation, the major part of the patients showed a significative level of distress (69.8%), which is similar to literature data - In this phase the patients live with pain, losses and incertitude in relation to the prognoses. During the treatment, there was a progressive reduction in the second (32.4%) and in the last phase of evaluation (14.3%). Such fall was due to: 1) the routine of monitoring distress, the identification of the nature of distress and the intervention; 2) integration of the health team in a interdisciplinary work. Conclusions: The significative reduction of distress during the treatment points out to a good quality of cancer care. During the research it was possible to identify improvements and to reconsider some attitudes and conducts. There was a non automatization in the assistance, making it more human, individual and specific for each necessity. This result suggests the importance of DT as a quality indicator of cancer care. No significant financial relationships to disclose.
タバコ消費と心臓起源の院外心停止(OHCA):All‐Japan Utstein Registryデータ(JCS‐ReSS)から
Authors: Uehara Yoshinari, Zhang Bo, Suematsu Yasunori, Miura Shinichiro, Saku Keijiro, Yonemoto Naohiro, Nonogi Hiroshi, Nagao Ken, Kimura Takeshi
Journal: Circulation (2013)
The expression patterns of STAT-3, phosphorylated STAT-3, P38 MAP-kinase, and phosphorylated P38 MAP-kinase in triple-negative breast cancers and their prognostic significance.
Authors: E. Yaman, I. I. Gonul, S. Buyukberber, U. Coskun, D. Yamac, A. Sevinc, F. Dane, A. Uner, B. Ozturk, A. O. Kaya
Journal: Journal of Clinical Oncology (2010)

636 Background: Triple-negative breast cancers behave diffrently from other breast cancers. In this study, we aimed to investigate the expressions and prognostic significance of STAT-3, p38 MAPK ve EGFR in triple negative breast cancers which may be related with agressive clinical behaviour. Methods: Fifty six triple-negative breast cancer patients were taken into the study. Twenty ER/ PR positive, cerb B2 negative and 20 ER/PR negative, cerb B2 positive breast cancer patients were chosen as control group. Results: In 31 of patients (55.4%) cytoplasmic STAT-3 expression was detected. Fourteen (%25) patients had cytoplasmic and 10 patients (17.9%) had nucleer phosphorylated STAT-3 expressions. In 13 patients (23.2%) cytoplasmic and in 9 patients (16.1%) nucleer p38 MAPK expressions were observed. Cytoplasmic fosforile p38 MAPK expression was present in 13 patients (23.2%) while no nucleer expression was detected. EGFR expression was observed in 10 patients (17.9%). Triple-negative breast cencer patients had more commonly expressed cytoplasmic STAT-3 and nuclear phosphorylated STAT-3 compared to controls. Similarly, cytoplasmic STAT-3 and nucleer phosphorylated STAT-3 expressions had more commonly detected in basal like tumors. Nucleer phosphorylated STAT-3 expression was higher in node positive patients. EGFR expression was correlated with cytoplasmic STAT-3 and cytoplasmic p38 MAPK expressions. Patients with EGFR expression had shorter DFS times while there was no difference in overall survival. Conclusions: We found cytoplasmic STAT-3 and nucleer phosphorylated STAT-3 were more commonly expressed in triple-negative tumors. EGFR cascade was found in a close relation with STAT-3 and p38 MAPK pathways in these tumors. However, longer follow-up periods are required to evaluate the exact impact on prognosis. No significant financial relationships to disclose.
Oncologic significance of pathologic T2 positive surgical margin in robotic-assisted laparoscopic prostatectomy
Authors: A. Levinson, D. S. Berkman, E. T. Goluboff, D. B. Samadi
Journal: Journal of Clinical Oncology (2007)

15607 Background: A positive margin (PM) after radical prostatectomy (RP) in organ confined (pT2) prostate cancer (CaP) is considered a surgical error. In addition, capsular incision may occur at a higher frequency with robotic and laparoscopic techniques than with traditional open RP. However, the mechanism and significance of capsular violation may be different between open RP and Robotic Assisted Laparoscopic Prostatectomy (RALP). We sought to determine biochemical disease free survival (BDFS) for patients (pts) who underwent RALP at our institution who had a pT2 PM and compared them to those who did not. Methods: We reviewed our prospective IRB approved database for RALPs performed by a single surgeon. To permit adequate follow-up only cases prior to March 2006 were included. Biochemical failure (BF) strictly defined as any PSA &gt;0.1ng/ml. No pt received adjuvant therapy without a BF. Results: Since Jan 2003, 435 consecutive pts underwent RALP for clinically localized CaP. 211 of these cases were before March 2006, of which 194/211 (92%) had sufficient data for analysis. Mean follow-up was 9.8 mos (range 0.7–41.6). Mean age, preoperative PSA, and path Gleason Score were 60 yrs, 6.6 ng/ml, and 6.9, respectively. Pathologic stages: pT2 77%; pT3a 13%; pT3b 7%, pT4 3%. Overall, 7.2% (14/194) experienced BF at a median of 2.5mos (0.7–15.3). BDFS rates by pathologic stage were pT2 95.3% (142/149), pT3a 91.7% (22/24), pT3b 76.9% (10/13), and pT4 71% (5/7). pT2 pts with a PM had the same rate of BF, (4.4% 1/23), as pT2 pts with negative margins (NM) (4.8% 6/126, p=0.932) and pT3 NM (0% 0/19, p=0.36), but was statistically less than pT3 PM (27.8% 5/18, p=0.035). In multiple linear regression analysis, preoperative PSA &gt;10ng/ml was the most predictive variable of BF even after adjusting for Gleason sum, pathologic stage, and surgical margin status. Conclusions: There may be a different mechanism between a PM in organ confined open RP pts and RALP pts. In our series of RALPs, only one of 23 pT2 PM pts suffered a biochemical recurrence. BDFS for these pts was 95.7%, and did not vary significantly from pT2 NM nor pT3 NM pts. A larger series with longer follow-up will determine whether the oncologic significance of a PM in pT2 RALP pts is different than that of open RP pts. No significant financial relationships to disclose.
Erectile function following proton therapy for prostate cancer in men 60 years and younger.
Authors: Bradford S. Hoppe, Romaine Charles Nichols, Randal H. Henderson, William M. Mendenhall, Robert B. Marcus, Christopher G. Morris, Christopher R Williams, Joseph A Costa, Zuofeng Li, Nancy Price Mendenhall
Journal: Journal of Clinical Oncology (2012)

49 Background: A recent investigation into male sexual health and function provided comparative data on sexual function in men treated with EBRT, prostatectomy, and brachytherapy using the PROSTQA database. However, there was a disproportionate percentage of men below 60 years old in the EBRT (N=34, 14%) and brachytherapy (N=54, 21%) subsets compared with surgery (N=249, 49%). Thus, we investigated erectile dysfunction (ED) in young men treated with proton therapy (PT). Methods: 190 men, 60 years old or younger were treated for prostate cancer with definitive PT without androgen deprivation therapy (ADT) on a University of Florida Proton Therapy Institute IRB-approved protocol. Before treatment and q 6 months, men answered the Expanded Prostate Index Composite (EPIC) questionnaire. Men were excluded from analysis because of lack of baseline EPIC (n=10) or follow up EPIC at 2 years (n=23), leaving 157 men for analysis. Potency was defined as a positive response to having “erections firm enough for intercourse,” and sexual function (SF) scores were calculated for EPIC-26. Results: Potency rates prior to treatment and 2 years following treatment were 89% and 72%, respectively. A multivariate analysis showed that dose &gt;78 CGE (p=0.0141) and baseline SF score (p=0.0002) were significantly associated with potency outcome. Potency rates by risk factor stratification are reported in the table. Conclusions: The present study results suggest comparable potency rates following PT in younger men with data recently reported for prostatectomy. We are currently working to provide additional information on potency rates following PT for patients facing these difficult treatment decisions. [Table: see text]
Interim results of the Multicenter Selective Lymphadenectomy Trial (MSLT-I) in clinical stage I melanoma
Authors: D. L. Morton, J. F. Thompson, A. J. Cochran, R. Essner, R. Elashoff
Journal: Journal of Clinical Oncology (2005)

7500 Background: Regional node management remains controversial because 80% of patients undergoing routine elective complete lymph node dissection (CLND) do not have nodal metastases. We developed lymphatic mapping and sentinel node biopsy (LM/SNB) to detect occult nodal metastases and thereby identify patients who might benefit from CLND. MSLT-I is an international, 17-center randomized trial to evaluate the accuracy and clinical impact of LM/SNB in patients with clinically localized cutaneous melanoma. Methods: Patients with primary melanoma were stratified by Breslow thickness (<1.2, 1.2–3.5, or >3.5 mm) and randomly assigned in a 40:60 ratio to wide excision (WE) followed by nodal observation (WEO), or to WE plus LM/SNB followed immediately by CLND only if the sentinel node (SN) contained tumor (SN+) by hematoxylin/eosin or immunostaining. Results: From 1/1/94 to 3/31/02, 797 patients were assigned to WEO and 1204 patients were assigned to LM/SNB. The third of 5 planned analyses was completed in October 2004 at a median follow-up of 54 months. Five-year disease-free survival was 78% with LM/SNB vs. 73% with WEO (p=0.01; HR 0.74). SN tumor status was the most important factor for 5-year survival of LM/SNB patients: survival was 88% for 944 SN- patients vs. 71% for 215 SN+ (p<0.0001, log rank). Nodal metastases were identified in 215 (19%) LM/SNB patients; nodal recurrence developed in 142 (18%) WEO patients. Five-year survival was significantly higher after immediate CLND for SN+ than delayed CLND for clinical nodal recurrence (71% vs. 55%; P = 0.0033, log rank; P = 0.0077, Cox multivariate). Conclusions: SN status is the most important prognostic factor in early-stage melanoma, and LM/SNB allows early and accurate detection of occult nodal metastases. Disease-free and melanoma-specific survival rates are significantly higher after immediate CLND for occult nodal metastases than delayed CLND for clinical nodal recurrence. LM/SNB should become standard for staging and assessment of prognosis in primary melanoma, and for identifying patients who may benefit from immediate CLND. MSLT-II will examine the therapeutic value of CLND vs. SNB alone for patients who are SN+. Supported by NIH CA29605. No significant financial relationships to disclose.
Health-related quality of life/patient-reported outcomes in relapsed ovarian cancer: Results from a randomized phase III study of trabectedin with pegylated liposomal doxorubicin (PLD) versus PLD alone
Authors: C. N. Krasner, A. Poveda, T. Herzog, J. Vermorken, B. Monk, P. Zintl, J. Li, Y. Su, R. Dhawan, S. Kaye
Journal: Journal of Clinical Oncology (2009)

5526 Background: In an open-label, multicenter, randomized phase III study comparing the combination of trabectedin and PLD to PLD alone in patients with relapsed ovarian cancer, the combination demonstrated significantly improved progression free survival and response rates, manageable non-cumulative toxicity, and fewer PLD-associated adverse events. We studied the impact of the combination of trabectedin with PLD on the quality of life (QoL)/patient-reported outcomes (PRO) evaluated as part of the trial. Methods: QoL/PRO questionnaires, EORTC-QLQ C30, OV28, and EQ-5D were completed by patients at screening and on Day 1 of every other treatment cycle starting with Cycle 1, and at the end-of-treatment visit. Global health status/QoL, fatigue, rain subscales from QLQ C30, and abdominal pain/GI symptoms scale from OV28 were chosen a priori for primary analyses. Other scales of the three questionnaires were analyzed on a supportive basis. Results: A total of 672 patients were randomized. 663 (98%) completed at least the baseline questionnaires. Median cycles of treatment was 6 (131 days) for the combination arm and 5 (143 days) for the monotherapy arm. Mixed effects models (using a covariance structure of AR[1]) predicting the score at baseline and follow-up scores as a function of treatment, days after baseline, and interaction between treatment and days after baseline showed no significant differences between the treatment arms for any of the prespecified scales. Similar analyses of other scales, including EQ-5D Health Index scores and Health State on the Visual Analog Scale, support the findings. Conclusions: The addition of trabectedin to PLD results in superior efficacy in patients with relapsed ovarian cancer, with no added decrement to overall health status as assessed by PRO. [Table: see text]
Cost-effectiveness of nanoparticle albumin-bound (nab) paclitaxel (ABX) vs Cremophor-based paclitaxel (CP) in the treatment of metastatic breast cancer (MBC)
Authors: W. Gradishar, S. Wolinsky, T. Vishalpura, B. Nightengale, T. Bramley
Journal: Journal of Clinical Oncology (2004)

635 Background: In a randomized phase III clinical trial, the overall tumor response rate in MBC patients was 33% for ABX (260 mg/m2 infused IV over 30 minutes every 3 weeks for a median of 6 cycles) compared to 19% for CP (175 mg/m2 infused IV over 3 hours every 3 weeks for a median of 5 cycles) (p<0.001; SABCS 2003). Likewise, those in the ABX arm experienced a longer time to tumor progression (21.9 weeks vs 16.1 weeks, p=0.03). Methods: A decision analytic model was developed to evaluate the economic impact of these clinical results from a provider and payer perspective. The total cost per course, incremental cost per responder, and incremental cost per progression-free month are reported. Economic inputs were obtained from peer-reviewed literature and other publicly available sources. Utilization and costs considered were those associated with pretreatment medications, drug administration, management of toxicities, and treatment failure. Acquisition costs of ABX and CP were not considered since pricing is not yet available for ABX. Both univariate and multivariate sensitivity analyses were conducted to evaluate the robustness of the results to model inputs. Results and Conclusions: ABX was both more efficacious and less costly, yielding a dominant cost effectiveness strategy. Sensitivity analyses revealed that these results are robust to the primary assumptions. ABX has the potential of generating significant cost savings for payers and providers, and thus being a cost-effective novel treatment option for MBC. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration American Pharmaceutical Partners American Pharmaceutical Partners
Locally advanced breast cancer patients with negative pathological lymph node status after neoadjuvant chemotherapy and conservative surgery: Is lymph node irradiation necessary?
Authors: C. Daveau, D. Stevens, O. Berges, S. Zilberman, M. Gardner, S. Villette, E. Brain, S. Lasry, A. Labib, R. Le Scodan
Journal: Journal of Clinical Oncology (2009)

e11539 Background: The increased use of neoadjuvant chemotherapy (CT) in breast cancer (BC) management has raised new questions regarding the optimal locoregional treatment. The aim of this retrospective study was to compare the outcomes of BC patients (pts) with pathological N0 status (pN0) following primary CT and conservative surgery who received breast radiotherapy with or without lymph node irradiation. Methods: Between 1990 and 2004, 1054 patients received preoperative CT for locally advanced BC. Data from 248 pts (23.5%) with clinical N0 (164 pts) or N1-N2 (84 pts) lymph node status at diagnosis and pN0 status after primary CT were studied. Among them, 93 pts (37.5%) received breast irradiation alone and 155 pts (62.5%) underwent locoregional irradiation. Outcome was assessed in relation to lymph node recurrence, disease-free survival (DFS) and overall survival (OS). Results: Both groups were comparable in terms of baseline characteristics. With a median follow-up of 88 months, 3 pts experienced nodal recurrence in the breast irradiation alone group compared with 2 pts in the locoregional irradiation group (p&gt;.05). Among the 164 N0 pN0 pts, the 5-year DFS and OS rates were respectively 84% and 89% vs 84% and 95%, according to whether they received (n=87) or not (n=77) lymph node irradiation(p&gt;.05). Among the 84 N1-N2 pN0 pts, same outcome values did not show any significant difference according to group of treatment: 72% and 88% in 68 pts treated with locoregional irradiation vs 81% and 81% in 16 pts treated with breast irradiation alone (p&gt;.05). Conclusions: Our results suggest that breast irradiation alone is not associated with a higher risk of regional recurrence in locally advanced BC pts with pN0 status after neoadjuvant chemotherapy. Whether this allows the omission of lymph node irradiation for such strategy should be addressed prospectively. No significant financial relationships to disclose.