tbuckley/cabot-search huggingface dataset:
The influence of radiotherapy on sleep disturbances in breast cancer patients.
Authors: Sheela Hanasoge, Xiaojing Wang, Zhengjia Chen, Donna Mister, Andrew H. Miller, Mylin Ann Torres
Journal: Journal of Clinical Oncology (2014)

1092 Background: Sleep disturbances are distressing and common among breast cancer patients during treatment. However, few studies have examined the impact of radiotherapy (RT) on sleep quality. The goal of this study was to prospectively assess breast cancer patients before, during, and after RT to determine the impact of RT on sleep. Methods: Following breast conserving surgery, 80 breast cancer patients were enrolled on a prospective, longitudinal study of sleep before, during, and after whole breast RT. All patients received a dose of 50 Gy followed by a 10 Gy boost. Subjects completed the Pittsburgh Sleep Quality Index (PSQI) before (i.e., baseline), at week 6 of RT, and 6 weeks after RT completion. Demographic, patient- and treatment-related factors were also recorded. Paired t tests were used to test longitudinal differences in PSQI between time points. Linear mixed models were used to identify predictors of higher PSQI scores and poor sleep (i.e., PSQI score >5). Results: Before, during, and after RT, 61%, 56%, and 59% of subjects were poor sleepers, respectively. PSQI scores did not significantly change during or after RT compared with baseline measures. On univariate analysis, significant predictors of higher PSQI scores were prior chemotherapy treatment, African American race, and having less than a college education (all p<0.01). Tumor stage, axillary lymph node dissection (vs. sentinel lymph node biopsy only), patient age, marital status, and income were not significant predictors of poor sleep. On multivariate analysis, African American race (p<0.006) and having less than a college education (p<0.004) remained significant predictors of higher PSQI scores at each time point. Conclusions: Our findings indicate that sleep disturbances are prevalent during breast cancer treatment. Nevertheless, it appears that RT does not contribute to poor sleep while patient baseline characteristics including African American race and low educational level are associated with higher PSQI scores throughout and after RT. Studies aimed at developing interventions for these patients at risk for sleep disturbances during breast cancer treatment are warranted.
Postchemoradiotherapy (CRT) pathologic stage classified by American Joint Committee on Cancer (AJCC) staging system to predict prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC).
Authors: Jhe-Cyuan Guo, Ta-Chen Huang, Chia-Chi Lin, Min-Shu Hsieh, Chin-Hao Chang, Jang-Ming Lee, Jason C. Cheng, Hsiu-Po Wang, Kun-Huei Yeh, Ann-Lii Cheng, Chih-Hung Hsu
Journal: Journal of Clinical Oncology (2015)

158 Background: Preoperative CRT followed by surgery is a curative treatment option for patients with locally advanced ESCC. Whether post-CRT pathologic staging can predict the outcomes of these patients is uncertain. Methods: Among 194 patients enrolled in three phase II clinical trials of preoperative CRT for patients with locally advanced ESCC (clinical T3N0-1M0 or T1-3N1M0 or M1a according to AJCC 6 th edition), 140 patients were included. All patients received preoperative CRT comprised with twice weekly paclitaxel/cisplatin-based regimens and radiotherapy 40Gy given in 20 fractions, and esophagectomy. Post-CRT pathologic staging was classified according to AJCC 7 th edition. Clinicopathologic factors were analyzed for their impacts on patients' overall survival (OS) and progression-free survival (PFS). Results: One hundred and thirty two men and 8 women were enrolled. The distribution of the post-CRT pathologic stages according to AJCC 7 th edition and their median survival times were listed in Table 1. In univariate analysis, gender, performance status (PS), tumor location, pathologic N, pathologic stage, extranodal extension (ENE), and pathologic complete response (pCR) were statistically significant factors associated with PFS; PS, tumor location, pathologic N, pathologic stage, ENE, and pCR were statistically significant factors associated with OS. In multivariate analysis, PS (P &lt; 0.001), tumor location (P = 0.016), and ENE (P = 0.024) were independent prognostic factors for PFS; PS (P &lt; 0.001) and post-CRT pathologic stage (P = 0.027) were independent prognostic factors for OS. Conclusions: Post-CRT pathologic staging classified by AJCC 7 th edition could predict the survivals of patients with locally advanced ESCC who underwent preoperative paclitaxel/cisplatin-based CRT followed by esophagectomy. (The work was supported by the Grant of MOST 103-2314-B-002-092.) [Table: see text]
Germline pharmacogenomics in patients with dihydropyrimidine dehydrogenase (DPD) deficiency.
Authors: Moh'd M. Khushman, Peter Joel Hosein, Daniel Cameron, David Roland Clarkson, Thomas Wayne Butler, Mary A. Vu, Carole Wiseman Norden, Wilma Baliem, Vanessa Jones, Sanjyot Bhadkamkar, Cindy Nelson, Frances Lee, Ajay Singh, William R. Taylor
Journal: Journal of Clinical Oncology (2016)

521 Background: DPD deficiency is a pharmacogenetic syndrome associated with dose-limiting toxicity to fluoropyrimidines. Oncologists are expected to recognize and diagnose this syndrome, as toxicities could be fatal. Over 40 single nucleotide polymorphisms (SNPs) and deletions have been identified within the DPYD gene. IVS14+1G&gt;A (DPYD*2A) is the most common (40-50%) and best studied of these SNPs. Yet, it showed a median sensitivity of 30% and is absent in Japanese, Korean and African Americans. Overall, the data on DPYD testing is insufficient to provide enough guidance to diagnose DPD deficiency. Herein we describe our experience with germline pharmacogenomics in patients with DPD deficiency. Methods: Between 2011 and 2015, 35 patients with gastrointestinal malignancies were tested for DPYD mutations; 17 were tested after developing toxicities to treatment and 18 were tested prior to treatment. IVS14+1G&gt;A (DPYD*2A) was tested in all patients. DPYD c.85T&gt;C (DPYD*9A), DPYD c.1679T&gt;G (DPYD*13A), DPYD c.-1590T&gt;C, and DPYD c.2846A&gt;T were tested in 24 patients (69%) only. We explored the association between DPYD mutations and fluoropyrimidine-related toxicity using Fisher’s exact test. Results: Median age was 60 years, 43% were male, 80% were Caucasian and 20% were African American. Capecitabine-based regimens (71%) and 5-Fluorouracil-based regimens (29%). 14 out of 35 patients (40%) had DPYD mutations. Grade 3 toxicities were encountered in 64% of patients with DPYD mutation and 48% of patients with no DPYD mutation. In patients who received full dose fluoropyrimidines (57% of patients with DPYD mutation and 81% of patients with no DPYD mutation), DPYD mutations were associated with a significantly higher rate of grade 3 diarrhea (p=0.026). In patients with DPYD mutation, 2 (14%) had DPYD*A2 mutation and 12 (86%) had DPYD*9A mutation. Conclusions: In patients treated with fluoropyrimidines, the rate of grade 3 diarrhea was significantly higher in patients with mutated DPYD gene. Testing for DPYD*2A alone to diagnose DPD deficiency is suboptimal. Testing for other DPYD mutation variants including DPYD*9A provides a more comprehensive approach. These data should further be validated in prospective clinical trials.
Microsatellite instability (MSI), p53 expression and intratumoral microvessel density (IMD) in gastric carcinoma (GC): Correlations with clinicopathological parameters and survival rates
Authors: S. Meditskou, P. Stravoravdi, I. Boukovinas, I. Stergiou, G. Geromichalos, T. Toliou, V. Kotoula, G. Karkavelas
Journal: Journal of Clinical Oncology (2005)

4158 Background: MSI is observed in 10–45% of GC pts, reflecting hypermethylation of DNA mismatch repair (MMR) genes promoter MLH1, MSH2. High IMD and/or overexpression of p53 result in poor prognosis. We evaluated the MSI status, the expression of p53 protein and CD34 antigen (for IMD). Findings were correlated to each other, with clinicopathological parameters and survival. Methods: GCs from 45 pts (M/F:29/16; mean age 59; 8 of pts < 50 years old) were studied. The histological type was classified according to Lauren as: intestinal 28(62.2%); diffuse: 17 (37.8%) and to Carneiro as: glandular 19 (42,2%), isolated 14 (31,1%) and mixed 12 (26,7%). TNM stage was: I: 3 pts;II:17; III:19; IV:6. The pts were followed-up up to 10 years. MSI was assessed on paraffin sections, using monoclonal antibodies against MMR gene proteins MSH2–1, MSH2–2 and MLH1. Tumors with loss of at least one protein expression were defined as MMR (-). IMD refers to nr of CD34 positive microvessels/mm2 and p53 expression to the % of positive nuclei of the cancer cells. Results: TNM stage and invasion were independent prognostic factors. Loss of at least one protein expression was verified in 17% of GCs; 75% of these cases were of the diffuse type (p<0.05) and 87.5% of the isolated (75%) or mixed (25%) type (p<0.05). Complete or partial loss of expression of MSH2–1 and MSH2–2 proteins was correlated with diffuse or isolated type. High IMD (more than the cut-off value of 142 vessels/mm2) was noticed in 13 cases of the diffuse type and in 19 of isolated or mixed type while it did not correlate with survival and was not an independent prognostic factor. High expression of p53 (>50% of tumor cells) was observed in 21 tumors, mainly in MMR (+) cases and correlated with worse survival. Low p53 expression was noted in most (10/12) MMR (-) cases. Conclusions: Complete or partial loss of expression of MMR genes was associated with lower TNM stage, diffuse or isolated histological type, low IMD and nil or low p53 expression. MMR (-) cases constitute a particular group of sGC with different prognosis and distinct clinicopathological characteristics. No significant financial relationships to disclose.
Geographic variation in patient follow-up after curative-intent treatment for rectal carcinoma
Authors: F. E. Johnson, D. M. Neils, E. M. Grossmann, W. E. Longo, K. Ode, U. S. Shariff, T. Papettas, A. E. McGarry, S. R. Gammon, R. A. Audisio, K. S. Virgo
Journal: Journal of Clinical Oncology (2005)

3713 Background: In wealthy societies, most patients with rectal cancer treated with curative intent enter some type of follow-up regimen. A recent survey of the members of the American Society of Colon and Rectal Surgeons (ASCRS) disclosed appreciable variation in follow-up practices. We sought to determine whether geographic factors could account for this variation. Methods: The surveys were sent to all 1,782 members of the ASCRS in 2002. Details have been published elsewhere. Four potential predictors of variation in follow-up intensity were tested (US census region, consolidated metropolitan statistical area (MSA), primary MSA, and managed care organization (MCO) penetration rate) using repeated-measures analysis of variance. Results: There were 566 responses (32% response rate), of which 346 provided evaluable data. There was a significant (p < 0.05) main effect of census region on frequency of use of office visit, CBC, CEA level, colonoscopy, flexible sigmoidoscopy, chest x-ray, intra-rectal ultrasound, and CT of abdomen-pelvis; there was no significant main effect of census region on frequency of use of liver function tests. Five other infrequently used modalities were not evaluable. There were significant main effects of MCO penetration rate on frequency of use of office visit and CT of abdomen-pelvis, but no other modalities. Consolidated MSA and primary MSA were not significant predictors of follow-up intensity for any modality. Conclusions: Census region and MCO penetration rate account for some, but not most, of the variability in rectal cancer patient follow-up by ASCRS surgeons. These data should be valuable in designing controlled trials of post-treatment follow-up regimens for rectal cancer patients. No significant financial relationships to disclose.
Regulatory and Naïve T Cells in Unmanipulated Donor Grafts Are Not Associated with Acute Graft Vs Host Disease in Matched Sibling Transplants for AML
Authors: Jahan S. Khalili, Rima M Saliba, Lisa St. John, Amin Alousi, Eric D. Wieder, Marcos De Lima, Richard Champlin, Jeffrey J. Molldrem, E. J. Shpall, John McMannis, Krishna V. Komanduri
Journal: Blood (2008)
Experience with yttrium 90 ibritumomab tiuxetan after autologous stem cell transplant (ASCT) in patients with non-Hodgkin’s lymphoma (NHL)
Authors: J. Joyce, M. W. Schuster, B. McCook, F. Torok, N. Avril, N. Vidnovic, S. A. Jacobs
Journal: Journal of Clinical Oncology (2005)

6669 Background: Yttrium 90 ibritumomab tiuxetan (90Y IT [Zevalin]) is approved for the treatment of relapsed or refractory B-cell NHL achieving durable responses in heavily pretreated patients. Prior ASCT or impaired bone marrow reserve excluded patients from 90Y IT therapy in registrational trials. However, the safety and efficacy of radioimmunotherapy in NHL patients with prior ASCT was confirmed for 131I tositumomab (Blood 2000;96:1259–66). We report our experience using 90Y IT in the post-transplant setting at several academic medical centers. Methods: Eligibility criteria included relapsed or refractory B-cell NHL, age ≥18 years, platelets ≥100,000/mm3, bone marrow cellularity ≥15%, and lymphomatous involvement ≤25%. All patients were rituximab-refractory and received at least 3 prior regimens (range 3–7). Eleven patients with prior ASCT received standard 90Y IT. The therapeutic dose of 90Y IT was 0.4 mCi/kg (6 patients with baseline platelet count >150,000/mm3) and 0.3 mCi/kg (the initial case and 4 patients with platelets ≤150,000/mm3). Responses were assessed by pre- and post-treatment PET/CT scans; toxicities were classified using CTCAE v.3.0 criteria. Results: Subjects presented with follicular NHL (n = 4), diffuse large B-cell lymphoma (DLBCL; n = 6), and mantle cell lymphoma (n = 1). Of the 10 assessable patients, 1 had a CR, 1 had a mixed response, 2 patients with DLBCL had a PR, and 1 had no evidence of disease at 9 months. Nonhematologic toxicities were not observed; 4/11 and 2/11 patients experienced grade 4 thrombocytopenia and neutropenia, respectively. Febrile neutropenia occurred in 2 patients. Conclusions: Yttrium 90 IT is feasible and safe in NHL patients with a history of ASCT. Responses were seen in both follicular and large cell lymphoma. Further research will characterize clinical responses fully and assess optimal timing of 90 Y IT after ASCT to avoid dose-limiting myelotoxicity. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration BioGen IDEC, Millenium Speakers Bureau Biogen IDEC, Millenium
Phase II study of combined modality treatment for patients with potentially curable esophageal carcinoma
Authors: R. Adumala, M. Sharma, M. Khan, V. Gadiyaram, S. Gayam, G. Hobbs, S. Kurian, T. Hogan, G. M. Higa, M. L. Auber
Journal: Journal of Clinical Oncology (2008)

15602 Background: In an IRB approved, non-randomized phase II study, we investigated treatment for esophageal carcinoma patients (pts) consisting of neoadjuvant chemo-radiation, esophago-gastrectomy, then adjuvant chemotherapy. Methods: Patients had adenocarcinoma or squamous cell carcinoma of mid or distal esophagus and/or regional nodes potentially resectable for cure, with no prior treatment, >18 years old, adequate end-organ function, and ECOG-PS 0–2. The treatment plan had 3 phases: 1) Following endoscopic ultrasonography (EUS) and Positron Emission Tomography (PET) scan, neoadjuvant treatment with radiation therapy (3 weeks, 4500cGy), concomitant 5-Fluorouracil (5-FU) 225 mg/m2/day continuous IV infusion was given. 2) Then restaging with EUS and PET scan followed by esophago-gastrectomy. 3) Post-op, pts received 6 cycles of adjuvant carboplatin (AUC 6), paclitaxel (200 mg/m2) on day 1 and 5-FU (225 mg/m2/day) for 7 days on a 28 day cycle. Overall survival, disease-free survival and survival post-resection were calculated. Results: 26 pts were enrolled, 3 were inevaluable. Pre-treatment, of the 23 pts, 10 pts (44%) had stage III disease, 6 pts (26%) had stage IIB, 3 pts (13%) had stage IIA and 4 pts (17%) had PET scan but no EUS (insurance denial). 22 of 23 pts had adenocarcinoma and only 1 pt had squamous cell carcinoma of esophagus. Post-radiation, 4 pts (17%) developed distant metastases. The remaining 19 pts had esophago-gastrectomy with clear margins. 9 of those 19 pts (47%) had adjuvant chemotherapy, 5 completing all 6 cycles. There were no toxic deaths. Time (median # weeks, range): Diagnosis to chemo-radiation = 5 weeks (2–8) Diagnosis to Surgery = 13 weeks (10–21) Surgery to adjuvant chemotherapy = 7 weeks (5–17) Survival (median # months): Overall survival (N=23) = 21.6 months Disease-Free survival (N=19) = 19.3 months Overall survival post-resection (N=19) = 46 months. Conclusions: This combined modality treatment achieved excellent survival of 46 months after surgery for pts with predominantly stage III and IIB esophageal adenocarcinoma. The treatment was well tolerated. No significant financial relationships to disclose.
Assessing associations between symptoms and survivorship care plans among long-term cancer survivors.
Authors: Diana Tisnado, Neil Steers, Katelynn Peirce, Anne M. Walling
Journal: Journal of Clinical Oncology (2015)

246 Background: Nearly 14 million Americans are cancer survivors, and numbers are increasing. Common long-term and late effects reported by survivors include anxiety, depression, fatigue, pain, and others. In order to address potential long-term and late effects of cancer and its treatment, the IOM recommends that patients receive a Survivorship Care Plan (SCP), a record of care received and important disease characteristics and a follow-up care plan incorporating available evidence-based standards of care. Our aims were to assess prevalence of self-reported moderate-severe symptoms and worry, and test for associations with SCP receipt. Methods: We used data from CanCORS II, a national study of lung and colorectal cancer patients. Long term survivors were diagnosed in 2004, and showed no sign of disease seven years post-diagnosis. We included 888 lung and colorectal cancer survivor respondents to the CanCORS II Long Term Survivor Survey. We examined moderate-severe pain (3, 4, or 5 on the SF-36 pain interference item), fatigue (less than 40 on the SF-36 vitality score), depressive symptoms ( &gt; 6 on CESD-8), and worry about recurrence. SCP receipt was defined as receipt of a treatment summary, follow-up care plan, or both. Multivariable logistic regression was used to test for associations between SCP and symptoms and worry. Results: In all, 27% of survivors had 0, and 26% had both SCP components. Moderate-severe pain was reported by 32% of colorectal and 42% of lung cancer survivors, and fatigue by 15% of colorectal and 30% of lung cancer survivors. Moderate-severe depressive symptoms were reported by 12% of colorectal cancer and 16% of lung cancer survivors. Less than ¼ (23%) reported worry about recurrence sometimes, often or always. In analyses adjusting for demographics and health status, receipt of both SCP components was associated with lower odds of moderate-severe pain (OR = 0.78, p = 0.004), fatigue OR = 0.42, p = 0.006), and depressive symptoms (OR = 0.48, p = 0.03). Conclusions: Receipt of a complete SCP was associated with lower odds of moderate-severe pain, fatigue, and depressive symptoms. We found no association with worry. However, only 26% of survivors reported receipt of both SCP components as recommended.
Biochemical outcome of small volume or insignificant prostate cancer treated with radical prostatectomy.
Authors: Yasuhiro Hashimoto, Akiko Okamoto, Atsushi Imai, Hayato Yamamoto, Shingo Hatakeyama, Takahiro Yoneyama, Takuya Koie, Chikara Ohyama
Journal: Journal of Clinical Oncology (2014)

279 Background: We examined biochemical outcome of small volume prostate cancers (&lt;0.5 cc, SVCa), and insignificant prostate cancers (&lt;0.5 cc and Gleason scores &lt;7, InsigCa) treated with radical prostatectomy. Methods: Between April 2000 and May 2011, 609 patients with prostate cancer were treated with radical prostatectomy in Hirosaki University Graduate School of Medicine. Of these, 237 were excluded from analysis because of pre-operative adjuvant treatment. The remaining 372 patients were eligible in the present study. Along with the routine pathological assessment, tumor volume (TV) was assessed in all patients. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) levels of greater than 0.2ng/ml. Results: The median age was 68 (48 to 78) and median pre-treatment PSA was 7.50 ng/ml.Average follow up period was 45.9 month. Mean tumor volume (TV) was 2.16 cc. We investigated 372 patients and found SVCa (&lt;0.5 cc) in 60 patients (16.3%), and InsigCa in 14 patients (3.7%). The five year BCR-free survival rate for TV greater than or equal to 0.5 group and SVCa was 67.3% and 87.1% respectively. A significant difference was seen in the log-rank test between the two groups ( p=0.008). We could not identify BCR in InsigCa patients. Conclusions: Despite the limited number of cases, in our study InsigCa were clinically insignificant but in SVCa group 12.9% patients developed PSA failure after radical prostatectomy. SVCa is not identical to InsigCa. Therefore new biomarker is needed to examine what the prognostic relevance is of SVCa.
Exploration of rural disparities in pancreatic cancer staging and mortality to incidence ratio in Illinois.
Authors: Bridget Kistner, Whitney Zahnd, Aman Ali, John D. Mellinger, Sabha Ganai
Journal: Journal of Clinical Oncology (2015)

260 Background: Despite recent impetus towards regionalization of pancreatectomy to high-volume centers, rural disparities have not been explored for pancreas cancer outcomes. Analysis of the National Cancer Database showed less than one third of patients with resectable disease actually undergo surgery, suggesting opportunities for improvement in global systems related to pancreas cancer care, including appropriate referral for surgical resection. We intended to explore the impact of rurality and gastroenterologist (GI) density on staging and mortality for pancreas cancer. Methods: Age-adjusted pancreas cancer incidence and staging proportion were calculated for each county using 1991-2010 data from the Illinois State Cancer Registry. Age-adjusted mortality rates were calculated using SEER*STAT. Choropleth maps were created to illustrate Mortality-Incidence Ratios (MIRs) by Illinois county using ArcGIS. Mean GI density for each county was calculated from the US Area Health Resource File. USDA Economic Research Service rural-urban continuum codes (RUCC) and US census percent rurality data were used to designate county rurality and adjacency to metro counties. Chi-square, ANOVA, and Spearman’s rho calculations were performed. Results: A greater proportion of counties with high MIR were in Southern, more rural, Illinois. No GIs were located in 65 out of 102 Illinois counties (64%) during the time interval analyzed, with a mean density of 1.0 per 100,000. Counties without GIs were significantly more rural, poorer, and less educated than counties with GIs. Unstaged pancreas cancers were inversely correlated with GI density (Spearman’s rho=-0.20; p=0.04). MIR was positively correlated with percent rurality (Spearman’s rho=0.23; p=0.02). MIR was also predicted by RUCC category, and was significantly greater in rural regions not adjacent to metro counties (p=0.02). Conclusions: Higher rates of unstaged pancreas cancer and higher MIR were noted in rural regions, which may be influenced by the availability of gastroenterologists or other specialty services. Further exploration of the impact of distance from high-volume cancer centers on rural cancer outcomes is warranted.