tbuckley/cabot-search huggingface dataset:
Locoregional recurrence risk for women with various molecular subtypes of breast cancer treated with multicatheter interstitial accelerated partial-breast irradiation: Results from Pooled Registry of Multicatheter Interstitial Sites (PROMIS).
Authors: Bethany Marie Anderson, Mitchell Kamrava, Jason Wang, D. Jeffrey Demanes, Margaret B. Snyder, Robert R. Kuske, Peter Y. Chen
Journal: Journal of Clinical Oncology (2014)

73 Background: This study was performed to determine in breast tumor recurrence (IBTR) and regional nodal recurrence (RNR) rates for women with different subtypes of invasive ductal breast cancer treated with multicatheter interstitial accelerated partial breast irradiation (mAPBI). Methods: Data from 5 institutions was collected for patients treated from 1992-2013. We report the outcomes of 821 women with 830 breast cancers, all with ≥ 1 year of follow-up after completion of mAPBI. Molecular subtype analysis was performed for 582 women in whom ER, PR, Her-2, and grade were known. The Kaplan-Meier method was used to calculate overall survival (OS), IBTR and RNR. A univariate proportional hazard model was performed to estimate the risk of IBTR based upon molecular subtype, age, grade, N-stage, T-stage, margin status, tumor size, dose rate, endocrine therapy, and chemotherapy. Results: The median age of our patient cohort was 60 years. 50.0% (n = 415) of women had luminal A, 6.9% (n = 57) luminal B, 5.7% (n = 47) luminal Her-2, 1.8% (n = 15) Her-2, and 5.8% (n = 48) triple negative breast cancer (TNBC); an additional 29.8% (n = 248) could not be subtyped. With a median follow-up time of 6.5 years, the 5-year OS of our patient cohort was 94.8%. The 5-year IBTR was 3.5% for luminal A, 4.1% for luminal B, 5.1% for luminal Her-2, 13.3% for Her-2, 11.3% for TNBC, and 1.7% for non-subtyped women. Positive surgical margins and high grade correlated with risk for IBTR; molecular subtype and other variables did not. The 5-year RNR rates were 0.3% for luminal A, 4.6% for luminal B, 2.6% for luminal Her-2, 34.5% for Her-2, and 2.3% for TNBC. RNR risk was significantly higher for women with Her-2 compared to the other 4 subtypes. In addition, risk of RNR was significantly higher for women with luminal B compared to those of luminal A. Conclusions: Women with Her-2 and luminal B breast cancer may have higher RNR but not IBTR risk after mAPBI, as compared with women with luminal A subtype. Further follow-up, correlation with use of trastuzumab, and comparison of outcomes with whole breast irradiation will be valuable.
Unusually high rates of hypersensitivity to cetuximab in the middle-southern United States: Association with atopic phenotype
Authors: R. M. Allen, R. M. Goldberg, J. Berlin, D. Spigel, T. E. Stinchcombe, H. K. Sanoff, D. N. Hayes, L. Lin, B. H. O'Neil
Journal: Journal of Clinical Oncology (2007)

9051 Purpose: To confirm the anecdotal observation that pts in North Carolina (NC) and Tennessee (TN) treated with cetuximab (C-mab) experience hypersensitivity reactions (HSR) at a much higher rate than that reported nationally and internationally (= 3%). Methods: Data from pts treated with C-mab on clinical trials (CTs, n = 88) at 3 research sites in TN and NC were analyzed for grade 3 or 4 HSR. Additional information was obtained from medical records under IRB approval at the University of North Carolina (UNC) for 90 pts (including 35 pts on CTs) to determine whether history of other significant allergy was a risk factor for HSR. Prior allergy was defined as history of H1 antagonist use, or notation in the medical record of significant drug allergy (excluding narcotic allergies), bee sting allergy, eczema, allergic reactive airways disease, or food allergy. Pearson's or Fisher's exact tests were used for comparison of proportions. Results: Data for 88 pts on CTs and an additional 55 pts treated outside of CTs was included in this analysis. Pts had a variety of tumor types, the most frequent being colorectal and lung For the CT group (n = 88), the overall rate of grade 3 to 4 HSR was 21.6%, significantly higher than the rate noted in any large published trial (p &lt; 0.0001 for comparison to data from Cunningham et al). All HSRs occurred during the first dose. There was no apparent protection from HSR afforded by premedication with dexamethasone in either the CT cohort or the overall UNC cohort. Upon examination of medical records of 90 pts treated at UNC (14.4% gr 3/4 HSR overall), there was a strong relationship between prior allergy history and chance of HSR; 10/28 pts with any HSR vs. 7/62 without allergy history (p = 0.006), and grade 3/4 HSR occurred in 8/28 versus 5/62, respectively (p = 0.01). Conclusions: At the sites in neighboring Southern US states studied, HSR was far more common than reported in national studies. History of prior allergy is a strong predictor of HSR, although is not specific enough to be used as the sole means of excluding pts from therapy. Further investigation of more specific predictors of HSR in the US Middle South is warranted, and pts being treated with C-mab in the region should be observed particularly closely during their first infusion. No significant financial relationships to disclose.
Immunophenotypic clustering of B-Cell chronic lymphocytic leukemia (B-CLL) reveals a good prognosis disease subset characterized by the coordinated over-expression of CD62L, CD54, CD49c, CD25 And CD55
Authors: V. Gattei, M. Degan, S. Russo, R. Bomben, M. Dal Bo, M. Rupolo, F. Buccisano, G. Del Poeta, P. Sonego, A. Zucchetto
Journal: Journal of Clinical Oncology (2004)

6567
Genomic Alterations in Liquid Biopsies from Patients with Bladder Cancer
Authors: Karin Birkenkamp-Demtröder, Iver Nordentoft, Emil Christensen, Søren Høyer, Thomas Reinert, Søren Vang, Michael Borre, Mads Agerbæk, Jørgen Bjerggaard Jensen, Torben F. Ørntoft, Lars Dyrskjøt
Journal: European Urology (2016)
Double Minutes in Human Carcinoma Cell Lines, With Special Reference to Breast Tumors<xref ref-type="fn" rid="fn2">2</xref>
Authors: P E Barker, T C Hsu
Journal: JNCI Journal of the National Cancer Institute (1979)

Small DNA-containing particles called double minutes (dm) were observed in metaphases during a survey of human tumor cell lines. Detection of dm in uncultured malignant effusions, in a series of 14 breast carcinoma cell lines, and in a cervical carcinoma cell line, and a literature survey indicated that dm may be more common among human malignant cells than previously suspected. Some of the human breast carcinoma cell lines showed a high incidence of dm, which permitted a series of cytochemical studies. The dm stained identically with euchromatic regions of human chromosomes. Unlike typical chromsomes, dm contained neither C-bands nor Cd bands indicative of paracentromeric heterochromatin and centromeres, respectively. The dm were observed to cluster at the ends of chromosomes, and individual dm adhered to chromosomes. This clustering behavior allows dm to pass through cell division in the absence of centromeric regions. These results should alert tumor cytogeneticists to the possibility that their material may contain a low incidence of undetected dm.
Comparison of hot versus cold biopsy forceps in the diagnosis of endobronchial lesions
Authors: Shahram Firouzbakhsh, Soroush Seifirad, Reza Dinparast, Shervin Taslimi, Saeideh Azari, Enayat Safavi
Journal: European Respiratory Journal (2011)

Background:  Traditionally cold biopsy forceps were used for endobronchial biopsy; recently electrocautery (hot) bronchoscopy biopsy forceps are introduced. It is hypothesized that hot biopsy forceps may decrease procedure related bleeding and also may decrease the quality of obtained samples.   Methods:  Patients with different indications for endobronchial biopsy underwent three hot and three cold endobronchial biopsies with a random fashion. All biopsies were obtained with a single biopsy forceps with and without the application of an electrocoagulation current, set on soft coagulation mode (120W). A four point scale was used for quantification of bleeding. A single pathologist blinded to the patients9 history was requested to review all samples. A three point scale was used to assess electrocoagulation damage.   Results:  A total of 240 biopsies were obtained from 40 patients. Frequency of positive concordance between the two methods was 85%. The degree of electrocoagulation damage of the samples was as follows: grade1=52.5%, grade 2=32.5%, and grade3=15%. The average bleeding score following hot biopsy was significantly lower compared to the cold biopsy (p=0.006). The concordance between diagnostic yield of hot and cold biopsies was 85%. There was no significant difference between the diagnostic yields of two biopsy methods (p=0.687).   Conclusions:  In this study, hot biopsy forceps significantly decreased the procedure related bleeding and minimally impaired the quality of samples. Regarding low prevalence of bleeding following endobronchial biopsy, routine use of hot bronchoscopy forceps is not reasonable. However, familiarity of bronchoscopists with this method may improve bronchoscopy safety.
The Success Story of LDL Cholesterol Lowering
Authors: Terje R. Pedersen
Journal: Circulation Research (2016)

We can look back at &gt;100 years of cholesterol research that has brought medicine to a stage where people at risk of severe or fatal coronary heart disease have a much better prognosis than before. This progress has not come about without resistance. Perhaps one of the most debated topics in medicine, the cholesterol controversy, could only be brought to rest through the development of new clinical research methods that were capable of taking advantage of the amazing achievements in basic and pharmacological science after the second World War. It was only after understanding the biochemistry and physiology of cholesterol synthesis, transport and clearance from the blood that medicine could take advantage of drugs and diets to reduce the risk of atherosclerotic diseases. This review points to the highlights of the history of low-density lipoprotein-cholesterol lowering, with the discovery of the low-density lipoprotein receptor and its physiology and not only the development of statins as the stellar moments but also the development of clinical trial methodology as an effective tool to provide scientifically convincing evidence.
Main oncologic endpoints of the TROG 03.04 (RADAR) Trial for men with locally advanced prostate cancer
Authors: James William Denham, David John Joseph, David S Lamb, Nigel Spry, Gillian M. Duchesne, John Matthews, Chris Atkinson, Keen Hun Tai, David Christie, Lizbeth M. Kenny, Sandra Turner, Nirdosh Kumar Gogna, Terrence Diamond, Brett Delahunt, John Attia, Allison Steigler
Journal: Journal of Clinical Oncology (2014)

5004 Background: To determine whether 18 months androgen suppression (AS) plus radiotherapy (RT) ± 18 months zoledronate (Z) is more efficacious than 6 months AS plus RT ± 18 months Z, and is associated with a widely acceptable morbidity profile in men with locally advanced prostate cancer (PC). Methods: Between 2003 and 2007 1071 men with locally advanced PC were randomly allocated in a 2X2 factorial trial design in a 1:1:1:1 ratio to short-term (6 months) neo-adjuvant AS using leuprolide (22.5mg i.m. every 3 months) and radiation (STAS) either alone, or followed by intermediate term (12 months) AS (ITAS) (22.5mg i.m. every 3 months), or accompanied by 18 months of zoledronate (4mg i.v. every 3 months) (STAS+Z), or by both (ITAS+Z). Eligibility included T2a-4, N0, M0 adenocarcinoma of the prostate, with PSA ≥10 and Gleason score (GS) ≥7 in T2a cases. The primary endpoint is time to prostate cancer specific mortality (PCSM). Secondary endpoints include time to PSA, all distant and bony progressions (PSAP, DP and BP), time to starting secondary therapeutic intervention (STI) and all-cause mortality (ACM). Analysis was by intention-to-treat. All endpoints were assessed using competing risks methodology (unadjusted Fine and Gray models) except ACM where the log-rank test was used. RESULTS: Median follow-up was 7.4 years IQR [6.5-8.4]. Important bi-directional interactions were identified. Compared to STAS, STAS+Z significantly increased BP SHR 1.85 [1.11-3.10] p=0.02. Compared to STAS, ITAS+Z significantly reduced PSAP SHR 0.71 [0.53-0.95] p=0.02 and STI SHR 0.67 [0.48-0.94] p=0.02, and further still in subjects with GS>7 tumours: PSAP SHR 0.59 [0.37-0.94] p=0.03 and STI SHR 0.49 [0.29-0.83] p=0.01 respectively. ITAS was superior to STAS only in subjects with GS≤7 tumours; PSAP SHR 0.65 [0.43-0.98] p=0.04, STI SHR 0.49 [0.29-0.84] p=0.01. Corresponding reductions in DP, PCSM and ACM did not reach significance. Apart from two mandibular osteonecroses, no increases in morbidity or adverse patient reported outcomes were attributable to 18 months AS or Z. CONCLUSIONS: Ten year data is required to confirm and quantify reductions in DP, PCSM and ACM from the use of ITAS and ITAS+Z. STAS+Z cannot be recommended. Clinical trial information: NCT00193856.
Efficacy and safety of routine intravenous iron replacement therapy for chemotherapy-induced anemia in the community setting
Authors: K. Sen, W. C. Taylor, T. C. Shea, J. L. Peterson, J. Logue-Hunter
Journal: Journal of Clinical Oncology (2009)

e20563 Background: Anemia occurs frequently during cancer chemotherapy and contributes to the development of fatigue. Erythropoiesis-stimulating agents (ESAs) are successfully utilized in this setting but recent studies have raised concerns regarding their potentially harmful effects. Iron deficiency, real or functional is a common problem among cancer patients. In addition to bleeding and poor oral intake new studies have hypothesized that cancers as well as chemotherapy can lead to overproduction of the hormone hepcidin that shifts usable iron to the storage pool. We hypothesized that chemotherapy induced anemia (CIN) could be reversed simply by increasing the supply of usable iron by intravenous iron infusion and adopted this practice empirically at our UNC affiliated community practice. Methods: We conducted a retrospective chart review of 50 patients with documented CIN. Each received treatment with intravenous iron preparations to provide between 1,000–4,000 mg of elemental iron over a period of 1–4 weeks based on serum iron and % saturation. The goal was to identify the frequency of transfusion, ESA use, adverse events and overall cost effectiveness of this approach. Results: Intravenous iron therapy (IIT) led to an average 3g/dL increase of hemoglobin in 80% of all patients with a hemoglobin level at or below 10g/dL during chemotherapy. Transfusion could be avoided in 95% cases. Total usage of ESAs to maintain the target hemoglobin level above 10g/dL during chemotherapy was reduced by 50% of the standard recommended dose. Total cost of infusing 1,000 mg of IIT was roughly 60% of a single 40,000 unit dose of erythropoietin. We recorded a 4% incidence of grade I-II and 2% incidence of grade III-IV adverse events but no fatalities. Adverse events were significantly more frequent among young females and Hispanics. Conclusions: A prospective study should be designed to confirm the encouraging result of this review. IIT may become a standard component of anemia management during chemotherapy. It appears to be safe and cost effective, can be given alone or in combination with ESAs and we found it suitable for routine use in community cancer clinics. No significant financial relationships to disclose.
Different Effect of Various Mutant MITF Encoded by mi,Mior, or Miwh Allele on Phenotype of Murine Mast Cells
Authors: Dae-Ki Kim, Eiichi Morii, Hideki Ogihara, Young-Mi Lee, Tomoko Jippo, Shiro Adachi, Kazutaka Maeyama, Hyung-Min Kim, Yukihiko Kitamura
Journal: Blood (1999)
Differences in psychosocial factors among diverse women enrolled in a phase III cooperative group metastatic breast cancer trial (CALGB 40502/Alliance).
Authors: Blase N. Polite, Jacob B Allred, Hope S. Rugo, Toni Marie Cipriano, Constance Cirrincione, Sarah J. Gehlert, Electra D. Paskett, Clifford Hudis, Eric P. Winer
Journal: Journal of Clinical Oncology (2013)

9581 Background: Previous metastatic breast cancer trials have shown lower overall survival among African American (AA) women. Studies have also shown links between higher comorbidities and lower levels of social support and survival. Whether these factors differ by race and ethnicity is not known. Methods: Breast cancer patients enrolling in a phase III cooperative group metastatic breast cancer trial completed a self-administered survey measuring psychosocial and socio-demographic factors and comorbidities. Results were analyzed by self-identified race/ethnicity and evaluated by other measured variables. Results: 703 out of 799 patients completed the survey (88%). Questions were answered by greater than 95% of participants. The table shows differences broken down by Race/Ethnicity. AA and Hispanic (H) patients were more likely to have trouble paying for medications and have incomes less than 15K per year. AA were less likely to be married, and had lower levels of social support. Differences in income did not mediate these social support differences. Marital status did not mediate lower social support for AA (p=0.79) but did so for whites (p&lt;0.001) Conclusions: Compliance with the questionnaire was quite high. Differences in social support by race were apparent and were mediated by different factors according to race. Future efforts will analyze the impact of these factors on survival and as mediators for potential racial and ethnic differences in survival. [Table: see text]
Abstract 9309: Daily Respiratory Rate Trends are Significantly Elevated Prior to HF Admissions
Authors: Stephan Goetze, Pier Lambiase, Richard Schilling, Hans-Joachim Trappe, Siegmund Winter, Yi Zhang, Nicholas Wold, Ljubomir Manola, Dries Kestens, Julie Thompson, None on behalf of NOTICE-HF investigators
Journal: Circulation (2012)

Introduction: Implantable devices are capable of monitoring respiration by measuring intra-thoracic impedance. Respiratory rate (RR), one of the vital signs, increases with activity, stress, worsening heart failure (HF) and other diseases. We hypothesize that RR is increased in the days leading up to a HF admission compared with those observed at a random time in HF patients. Methods: HF patients indicated for ICD or CRT-D were implanted with INCEPTA TM and followed for 9 months. The device trended daily maximum (max), median (med) and minimum (min) RR up to a year. We retrospectively compared changes in averaged daily RRs (ΔRR) between a baseline and an event window (28-32 and 1-5 days before an index time respectively). The index time was defined as the day of first HF hospital admission in patients who had a HF admission (HF group) and the day of 6-month follow-up (6MFU) in patients who completed the study without a HF admission (control group). Patients who had fewer than 3 valid data points during either of the 5-day windows were excluded. Wilcoxon rank sum test was used to detect non-zero difference in ΔRR between groups. Results: Of the 121 patients enrolled, 100 had sufficient data for the analysis (10 with HF admissions). The figure boxplot shows all 3 RRs were significantly elevated prior to HF admissions. ΔRR (breath/minute) was significantly larger prior to a HF admission in the HF group, than observed prior to the 6MFU in the control group (max ΔRR: 2.4± 2.9 vs. -0.05± 1.8, p = .006; med: 2.2± 2.7 vs. 0.02± 1.1 p = .004; min 1.5±1.9 vs. 0.05±1.2, p = .04). Conclusions: This study showed a significantly larger change in daily RR trends prior to a HF admission than was observed at a random time in patients who did not decompensate. Ambulatory daily RR trends may be a valuable addition to standard management for HF patients.
Abstract 11578: Factors Associated With Delay in Seeking Treatment for Symptoms of Atrial Fibrillation
Authors: Pamela J McCabe, Lori Rhudy, Alanna Chamberlain, Holli DeVon
Journal: Circulation (2013)

Background: Untreated atrial fibrillation (AF) is a major contributor to disabling embolic strokes, heart failure, and exacerbation of existing cardiac conditions. Over 2/3 of individuals with symp...
Characteristics and outcomes of palliative care patients in intensive care unit.
Authors: Renata R. L. Fumis, Otavio Tavares Ranzani, Paulo Sergio Martins, Guilherme De Paula Pinto Schettino
Journal: Journal of Clinical Oncology (2014)

145 Background: Despite the growing palliative care movement, most admissions still occur in Intensive Care Units. The aim of this study was to determine the frequency of palliative care patients admitted in an ICU and assessed their outcomes. Methods: This prospective study was conducted in a tertiary private hospital, in an adult medical-surgical ICU with 22-bed in São Paulo, Brazil. Patients or their family member with ICU stay ≥ 48 hours were invited to participate. They were excluded if they had no conditions to answer the questionnaire or if they refuse to participate. During ICU stay we analyzed through the medical records and questionnaire their clinical condition and their oncologic status. We called them by telephonic assessment to assess their survival. Results: From March 2011 to March 2013 a total of 576 ICU patients were analyzed; of these, 280 were oncologic patients and 95 were palliative care. Of total, the majority was male gender (57.8%), median age was 67[54-79] years, SAPS III score was 54±18.4 points, SOFA was 3.1±3.0 and ICU Length of stay (LOS) was 9.0±11.3 days. ICU mortality was 16.5%, 1-month mortality was 22% and 3-months cumulative mortality was 28.6%. We could observe that palliative care patients were in majority cancer patients (75%vs 43.4%,p&lt;0.001), with metastatic disease(81.7 vs 36.3, p&lt;0.001), had greater mean time of initial diagnosis(3.21±3.7 vs 2.17±2.5, p=0.009), had greater ICU LOS (14.2±16.2 days vs 7.96±9.8, p&lt;0.001) greater mean SAPS III (68.5±16.0 vs p&lt;0.001) and SOFA (4.81±3.2 vs 2.81±2.8, p&lt;0.001) when compared with non palliative patients care. They also needed more mechanical ventilation (50.0%vs32.6%, p=0.001), tracheotomy (11.6%vs 5.0%,p=0.014) and vasopressors (54.7% vs 36.8,p=0.001). The ICU mortality was greater (32.6% vs 6.8%, p&lt;0.001), 1-month (60.0% vs 14.0%, p&lt;0.001) and 3-months (73.5% vs 19.1%). Conclusions: Palliative care suffers most in Intensive Care Unit and we observed a high mortality at 3-months after ICU discharge. We recommend more discussions before palliative care patient’s admissions in ICU to better provide them quality of life.
Choosing who to treat
Authors: Krishna Chinthapalli
Journal: BMJ (2015)

When might it be justifiable to refuse to treat a patient?



“Physicians are not bound to treat everybody who walks through their door,” except in emergencies, argued a US surgeon in 2004.1 He had proposed a resolution to the American Medical Association that doctors refuse treatment to medical malpractice lawyers in response to frustration at mounting malpractice insurance bills. Of course, the measure was denounced, with one wit responding, “What [he] is proposing is egregious, both hypocritically and Hippocratically.”

But are there circumstances in which refusal to treat (apart from emergencies) is justified if alternative care is available? One accepted scenario is refusal to see new patients if a practice is already full. The American Medical Association’s guidelines state that treatment can also be refused if it is beyond the physician’s competence or if it is “scientifically invalid.”2 Physical violence and danger to self may also be valid reasons, at least legally. In 1987 a precedent was set when a US doctor successfully used the 13th Amendment (the one abolishing slavery and involuntary servitude) to argue that he should not be forced to treat an abusive …