tbuckley/cabot-search huggingface dataset:
Characteristics of medullary breast carcinoma compared with invasive ductal carcinoma.
Authors: Inhye Park, Jiyoung Kim, Se-Kyung Lee, Min-Young Choi, Su Yeon Bae, Seung Pil Jung, Won Ho Kil, Jeong Eon Lee, Seok Jin Nam
Journal: Journal of Clinical Oncology (2012)

20 Background: Medullary carcinoma (MC) represents a rare breast cancer subtype associated with a rather favorable prognosis compared with invasive ductal carcinoma (IDC). It is characterized by the high-grade structure and lymphocytic infiltration, hemorrhagic necrosis. The purpose of this study is to compare the clinicopathologic characteristics and outcome of MC to IDC. Methods: We retrospectively reviewed the medical records of patients with invasive breast cancer managed with operation at Samsung Medical Center in Korea from January 1995 to June 2010 except patients diagnosed with ductal carcinoma in situ, patients with distant metastasis at diagnosis or neoadjuvant chemotherapy. 52 cases were identified with MC; 5,716 patients with IDC. The clinicopathologic features, disease-free survival (DFS) and overall survival (OS) for patients with MC were compared with those of the IDC patients. Results: The medullary group presented at younger age (43.9 ± 8.8 vs 47.7 ± 9.9, p=0.006). Also the medullary group was significantly associated with higher histological grade (poor; 80.0 vs 38.3%, p=0.003) and nuclear grade (grade3; 82.8 vs 41.7%, p&lt;0.001) as well as negative ER (84.8 vs 31.0%, p&lt;0.001) and PR status (91.3 vs 38.8%, p&lt;0.001) regarded as poor prognostic factors. But lymphatic invasion was rare (0.0 vs 29.8%, p&lt;0.001) and N stage was low (N0; 86.5 vs 58.4%, p&lt;0.001). The DFS and OS were not significantly different between the medullary and IDC groups. (5-yr DFS : 88.0 vs 89.2 %, p=0.917, 5-yr OS : 94.4 vs 93.4%, p=0.502) In multivariable analysis, factors associated with DFS and OS included nuclear grade, histological grade, tumor size, lymph node metastasis, ER/PR/C-erbB2 status, chemotherapy and hormone therapy. When adjusting for other factors, histological type itself did not show significant difference from IDC in DFS and OS. Conclusions: Despite MC present specific clinicopathologic features, prognosis is not different from IDC and determined by already known prognostic factors such as tumor size, lymph node metastasis. Therefore, the patients with MC also need aggressive treatment like IDC.
Outcomes and toxicity of SBRT for patients with unresectable pancreatic adenocarcinoma.
Authors: Erqi L. Pollom, Muthuraman Alagappan, Cato Chan, David Shultz, Pamela L. Kunz, Albert Koong, Daniel Tandel Chang
Journal: Journal of Clinical Oncology (2014)

317 Background: To report updated outcomes and toxicity of stereotactic body radiotherapy (SBRT) for patients with unresectable pancreatic adenocarcinoma treated over the past 11 years from a single institution. Methods: One hundred and ninety-nine patients with primary, unresectable pancreatic adenocarcinoma were treated with SBRT at our institution from 2002 to 2013. One hundred and sixty-four had locally advanced disease, 12 had borderline resectable disease, 21 were medically inoperable, and 2 had resectable disease but refused surgery. Fifteen patients had metastases at the time of SBRT. Forty-six patients were treated with prior RT, 16 of whom were enrolled on a combined IMRT/SBRT trial. Most common treatment regimens were 25 Gy x 1 (51.3%), 6.6 Gy x 5 (25.6%), 6 Gy x 5 (15.0%). Fifty-seven patients had no prior/current chemo while 142 patients had prior/current chemo (134 had gemcitabine-based chemo). BED 10 and BED 3 were defined using the linear quadratic equation assuming an α/β of 10 and 3, respectively. Results: Median follow-up was 7.1 months (0.13-63.58). The 6- and 12-month cumulative incidence of local recurrence (CIR) were 7.93% (4.07-11.80%, 95% CI) and 12.48% (7.68-17.28%, 95% CI), respectively. Three patients converted to resection after SBRT. BED 10 (median 87.5, range 19.5-97.5), prior RT, prior/current chemo, and tumor location did not predict for CIR. OS rates at 6 months and 12 months were 71.23% (65.02-78.0%, 95% CI) and 36.23% (29.54-44.4%, 95% CI), respectively. Median OS from date of diagnosis was 14.27 months (13.25-16.90 95% CI). Patients who received prior/current chemo had better OS (p=0.0035). There were 26 (13%) recorded GI ulcers/strictures/bleed (5 acute, 21 late) after treatment. BED 3 (median 233.3, 30-233.3) predicted for these toxicities (OR 1.01, 1.00-1.01 95% CI, p=0.022), while age, prior RT, prior/current chemo, tumor location did not. Conclusions: SBRT for pancreatic adenocarcinoma is effective for local control with associated risk of toxicity. The risk of GI toxicity is correlated with BED 3 . Survival is associated with the use of chemotherapy. SBRT may be advantageous due to its good local control with shortened treatment duration that minimizes interruption in chemotherapy.
Extended duration of response with second-line intraperitoneal platinum-based therapy for epithelial ovarian cancer.
Authors: M. E. Skaznik-Wikiel, J. L. Lesnock, W. C. McBee, S. D. Richard, J. L. Kelley, K. K. Zorn, T. C. Krivak, R. P. Edwards
Journal: Journal of Clinical Oncology (2011)

5073 Background: For epithelial ovarian cancer (EOC), a longer duration of response after second-line intravenous (IV) therapy as compared to first-line (IV) platinum therapy occurs in only 3% of patients (Markman et al., 2004). The purpose of this study was to examine the time to progression interval (TPI) in patients treated with surgery and intraperitoneal (IP) chemotherapy for first recurrence of their disease. Methods: We retrospectively reviewed the medical records at our institution for women treated with second-line IP chemotherapy between January 2005 and April 2010. TPI was defined as the time from the end of previous therapy to the start of next therapy for both first-line and second-line platinum therapy. Results: We identified 56 women who received second-line IP chemotherapy for their EOC recurrence. All patients had previously undergone primary surgical cytoreduction (82.3% were considered optimally cytoreduced) followed by IV platinum-based chemotherapy. The mean age was 56.7 years (range 43-79). All patients underwent secondary cytoreduction at the time of IP port placement for treatment of recurrent disease and 65.3% of patients were considered optimally cytoreduced (< 1 cm residual disease) at the end of the secondary debulking surgery. In 13 patients (23.2%) a longer TPI after second-line IP chemotherapy was observed compared to TPI after primary IV chemotherapy. The median first-line TPI for those 13 women was only 8 months, while median TPI after second-line IP chemotherapy was 24 months. In comparison, the 43 patients with shorter TPI after IP chemotherapy had median TPI of 22.5 mos after first-line IV chemotherapy and 8 months after IP chemotherapy. Conclusions: A longer duration of second-line response was observed in 23.2% of patients treated with IP chemotherapy after IV chemotherapy and the duration of response was clinically significant. The use of IP platinum treatment for recurrent EOC should be further studied in a prospective trial in women who do not do receive front-line IP platinum chemotherapy.
Quantification of physician workload for radiotherapy planning, and possible associations with performance.
Authors: Lukasz M. Mazur, Prithima Mosaly, Ellen Jones, Lesley Hoyle, Bhishamjit S. Chera, Timothy Zagar, Lawrence B. Marks
Journal: Journal of Clinical Oncology (2012)

245 Background: Workload is a hypothetical construct representing the overall human cost incurred during a task. Across disciplines, the NASA Task Load Index (TLX) has been used as a subjective measure of workload. It quantifies six dimensions of work (mental, physical, and temporal demands, frustration, effort, and performance) on a scale of 1-100 scale, with scores &gt;55 (i.e. overworked) associated with lesser performance. We herein quantify differences in physician workload for planning a relatively “simple” (palliative 2 field opposed lateral brain) versus relatively “complex” (curative 4 field pancreas) case. Further, we explore the association between workload and performance to define TLX levels where performance could be expected to decline. Methods: Nine physicians planned two cases, each case involving three tasks (i.e., task 1 - review written patient medical records; task 2 - review diagnostic images and design of treatment fields; and task 3 - review and approval of the treatment plan). After completing each case, TLX scores of each case/task was collected. Differences in workload between cases/tasks were assessed via ANOVA. The association between workload and performance (assessed using time-to-task completion and self-assessments) was assessed via Pearson’s correlation test. Results: 54 TLX workload and performance assessments were obtained. Workloads for the simple brain case/tasks averaged 41-48, versus 62-69 for the complex pancreas case/tasks (p&lt;0.001 via ANOVA). There were no differences between tasks for the individual cases (p&gt;0.1). There was a correlation between TLX scores and time-to-complete (r=0.54, p&lt;0.001), and with physician self-assessments (r=-0.74, p&lt;0.001). There was a trend towards reduced performance with TLX scores &gt; 55. Conclusions: Physician workload levels are markedly lower for “simple” versus “complex” cases, indicating that TLX is a reliable tool to quantify workload. Performance appears to decline at TLX levels &gt; 55, which is consistent with findings from other industries. Thus, we propose workload assessment (via TLX) to be considered as an independent quality measure to assess the quality assurance (QA) of processes used to deliver radiation therapy.
Cell cycle progression score to predict metastatic progression of clear cell renal cell carcinoma after resection.
Authors: Eric J. Askeland, Vincent A. Chehval, Ryan W. Askeland, Zaina Sangale, Placede Gangnang Fosso, Nafei Xu, Saradha Rajamani, Steven Stone, James A. Brown
Journal: Journal of Clinical Oncology (2014)

442 Background: Clear cell renal cell carcinoma (ccRCC) is primarily treated surgically when organ confined, but requires close follow-up to evaluate for recurrence. Expression levels of cell cycle progression (CCP) genes have prognostic value in certain cancers. We evaluated the prognostic value of the CCP expression in surgically resected ccRCC. Methods: Medical records were retrospectively reviewed. Patients with metastasis or lymph node involvement at surgery were excluded. Cases developed metastasis within 5 years of resection; controls were followed for at least 4.5 years without recurrence. Specimens were re-reviewed by a single pathologist. Tumor FFPE slides were macrodissected and RNA extracted. CCP score, sex, age, T stage, Fuhrman Nuclear grade (FNG), tumor size, smoking status, lymphovascular invasion (LVI), and time to metastasis were available for analysis. Univariate and multivariate analyses were used to evaluate association with metastatic progression. Subsequently, the tumor transcriptome was interrogated for other informative biomarkers using next-generation sequencing (NGS). Funding was by Myriad Genetics. Results: Twenty-six cases and 38 controls were evaluated. Median time to metastasis was 1.68 years (IQR 1.06-3.69) for the case group. Median follow-up was 6.69 years for controls. Univariate analysis revealed that LVI (OR 4.64, p=0.005), FNG (OR 4.16, p=0.0099) and CCP score (OR 2.65, p=0.0091) were significantly associated with progression to metastasis. In multivariate analysis, age (p=0.026), tumor size (p=0.022) and CCP score (p=0.026) were statistically significant. A step-wise multivariate model including age, CCP, tumor size and LVI had an AUC of 0.84, which decreased to 0.78 if CCP score was excluded. CCP scores calculated by qPCR and NGS were correlated (rho = 0.91). However, no other genes showed a significant association with metastasis or TNM stage (after correcting for multiple testing) in univariate analysis or after adjusting for CCP score. Conclusions: The cell cycle progression score predicts metastatic progression after resection of ccRCC and appears to add significant prognostic information to standard clinical and pathological variables.
MDM2 SNP309 and melanoma risk among women
Authors: E. Firoz, M. A. Warycha, R. L. Shapiro, R. S. Berman, H. Kamino, F. Darvishian, L. Rolnitzky, J. Goldberg, I. Osman, D. Polsky
Journal: Journal of Clinical Oncology (2008)

11099 Background: Melanoma incidence rates vary with respect to age and gender. While melanoma incidence is higher in women than in men prior to 50 years of age, this trend reverses after age 50. This suggests that estrogen may impact melanoma development in young women. A single nucleotide polymorphism in the MDM2 gene (SNP309), which is involved in estrogen signaling, has been shown in other cancers to correlate with age at tumor onset in premenopausal women. Analysis of MDM2 SNP309 in melanoma has not been previously reported. Methods: 286 melanoma patients (121 female, 165 male, 57.5 median age) prospectively enrolled in the NYU Interdisciplinary Melanoma Cooperative Group were studied. DNA was isolated from human blood leukocytes and analyzed for SNP309 status by PCR-RFLP. Associations between SNP309 genotypes, age at tumor onset, and clinicopathologic features of melanoma were analyzed using chi-square, Fisher’s exact, Wilcoxon, and Kruskal Wallis tests. Results: The distribution of SNP309 genotypes was significantly different between women <50 years of age (n=39, GG: 33.3%) and women ≥50 years of age (n=82, GG: 15.9%) (p=0.035). Women with a GG genotype had 2.82 times the chance of being diagnosed at <50 years of age as compared to women with TG+TT genotypes (95% CI: 1.05,7.82). Women with a TT genotype had 2.57 times the chance of being diagnosed at ≥50 years of age as compared to women with GG+TG genotypes (95% CI: 1.01,6.84). Of women with primary melanoma (n=89), the age of onset was 13 years earlier among those with a GG genotype (median 46 years) as compared to TG+TT genotypes (median 59 years) (p=.185). There was no association between SNP309 and melanoma age of onset among men, or clinicopathologic features of melanoma among men or women. Conclusions: Our data suggest that premenopausal women with a GG genotype at MDM2 SNP309 may be at increased risk for the development of melanoma. Also, among postmenopausal women, the TT genotype may be a risk factor for melanoma. No significant financial relationships to disclose.
End-of-life discussions with noncurable lung cancer patients: A patients' and oncologists' qualitative study.
Authors: Olivier Huillard, Pascale Vinant, Isabelle Colombet, Vincent Montheil, Marie Yvonne Guillard, Nathalie Chaillot, Nathalie Moreau, Francois Goldwasser
Journal: Journal of Clinical Oncology (2014)

151 Background: Discussions concerning patients’ (pts) preferences regarding end-of-life (EOL) care can improve the quality of care in non-curable-cancer-pts. Nevertheless having such discussions is difficult for health care providers and discrepancies exist regarding the frequency of such discussions. Methods: We conducted a single center qualitative study exploring oncologists’ attitudes and practices toward EOL discussions and the feasibility of an intervention designed to explore and collect pts’ preferences regarding EOL care. For oncologists, the intervention consisted in a semi structured interview and in a questionnaire concerning pts included. For pts, semi-structured-in-depth-interviews were conducted to assess their opinion about EOL discussions and the feasibility of exploring and collecting their preferences regarding EOL care in our practice setting. Resulting anxiety was measured. Results: Oncologists’ interviews (n=5), revealed that EOL discussions were rare, more likely to be initiated by pts and to arise lately in the evolution of the disease. Main barriers invoked were the difficulty of having such conversation, the limited time available, the risks of maleficence (mainly anxiety and loss of hope) and the uncertainty concerning expected benefits. Pts’ interviews (n=10) revealed that most of them were willing to be part of medical decisions concerning their EOL care. Few preferences regarding EOL-care were actually collected but the resulting in-depth discussions help mentioning a great variety of unusual topics as well as emotional, cultural and spiritual issues. Anxiety as a side effect was uncommon. Interviewers and oncologists often overestimated pts’ anxiety which is consistent with a projection of their own anxiety. Conclusions: Discussions concerning EOL care are uncommon in the setting studied and four main barriers were identified. Having these conversations was feasible and led to unexpected in-depth interviews concerning topics rarely addressed in our current practice. This intervention could help clarifying pts’ preferences and identifying psychosocial issues that could trigger palliative care team referral.
Comparison of clinical benefits for each enrollment type treated with EGFR TKI for advanced non-small cell lung cancer (NSCLC) for the purpose of determining the selective suitability for use with unselected patients.
Authors: N. Prasongsook
Journal: Journal of Clinical Oncology (2011)

e15121 Background: The following refers to the standard guideline for recent treatments with EGFR TKI for all enrollment types. Patients who have EGFR mutation obviously showed the predicted clinical outcome from first-line (1st) treatment. In contrast, there is still limited data of the predictive marker in correlation to the clinical benefits for second-line (2nd) and third-line (3rd) treatments. Consequently, the purpose of this study is to evaluate the clinical benefits for each enrollment type treated with EGFR TKI and in determining the selective suitability for use with unselected patients. Methods: Patients with advanced NSCLC who have received all lines of EGFR TKI during January 2006 to December 2010 were analyzed by the Comptroller General’s Department of the Ministry of Finance. This is a retrospective-cohort analysis of mainly the clinical benefits in response rate (RR), time to progression (TTP) and overall survival (OS) for each line of treatment. Results: Four-hundred and eighty-seven Thai patients diagnosed with advanced NSCLC with unknown EGFR mutation status were registered for EGFR TKI. Thirty, one-hundred and thirty-five, three-hundred and five and seventeen patients were registered for 1st-line, 2nd-line, 3rd-line and more than 3rd-line treatments, respectively. Results for 1st-line treatment of patients were partial response (PR) 36.7% and stable disease (SD) 23.3%. Results for 2nd-line treatment were PR 30.4% and SD 31.1% with results for 3rd-line treatment being PR 28.2% and SD 31.1%. TTP of 1st-line, 2nd-line, 3rd-line were 9, 6 and 4 months, respectively. There are not significantly different in TTP (p-value=0.59). The median OS of 1st-line, 2nd-line and 3rd-line were 10, 11 and 10 months, respectively. OS was not significantly different in each enrollment types treated with EGFR TKI (p-value=0.85). Conclusions: The results from all lines of EGFR TKI treatment shows that there is no significant difference in clinical benefits (RR, TTP and OS) for each enrollment type treated. Thus all lines of EGFR TKI treatment are suitable unselected patients with advanced NSCLC.
Combined HDR brachytherapy boost plus external beam radiotherapy by IMRT versus external beam radiotherapy alone IMRT in intermediate- and high-risk prostate cancer: Dosimetric analysis from a randomized control trial.
Authors: Manikandan Annamalai, Laviraj MA, Haresh Kunhiparambath, Dayanand Sharma, Subhash Gupta, Supriya Mallick, Pramod Kumar Julka, Goura Kishor Rath
Journal: Journal of Clinical Oncology (2015)

134 Background: Dose escalation by IMRT or brachytherapy significantly improves biochemical control in localized prostate cancer. In this prospective randomized study we compared dose conformity between two modalities HDR brachytherapy and IMRT to deliver a boost to the prostate after External beam Radiotherapy (EBRT). Methods: 20 patients with localized prostate cancer were randomized to receive IMRT alone or IMRT plus brachytherapy. After randomization, all patients received EBRT 45Gy/25#/5 weeks by IMRT in phase I. In phase II patients received either HDR brachytherapy 19Gy/2# (Arm A) or EBRT 29Gy/15#/3weeks (Arm B) and EQD2–DVH parameters were calculated for comparison. EQD2 was calculated with α/β ratio of 1.5Gy and 3Gy for prostate &amp; 3Gy for rectum and bladder. Results: The median age, stage distribution, Gleason score, PSA and prostate volume of the cohort were 69.5 years, T2b–T3b, 7, 38.5ng/ml and 47.4cc respectively.The HDR BT delivered higher mean doses to PTV. In phase II, HDR BT vs IMRT the mean EQD2 for 95% of prostate volume, 33% of rectal volume was 45.7Gy vs 28.4Gy, 6.8Gy vs 17.4 Gy respectively; Dmean of rectum and bladder was 7.4 Gy vs 13.5Gy and 5.4Gy vs 12.7Gy respectively. Conclusions: HDR BT produced more conformal plan and lower OAR doses than IMRT. Dose escalation for prostate tumors by HDR BT may be preferred as easily achievable. [Table: see text]
Proteomic Analysis of Immunoglobulin Light Chains (LC) In AL Amyloidosis Shows That the Sequence of Clonal LC Secreted by the Neoplastic Plasma Cells Is Identical to the LC Deposited In the Amyloid Plaques
Authors: David L Murray, Jason D Theis, Julie A. Vrana, Marina Ramirez-Alvarado, Roshini Abraham, Angela Dispenzieri, Jerry A Katzmann, Ahmet Dogan
Journal: Blood (2010)
Utility of a multidisciplinary tumor board in the management of pancreatic diseases.
Authors: David G. Brauer, Matthew S. Strand, Dominic E. Sanford, Maria Majella Doyle, Faris Murad, Daniel Mullady, Vladimir M. Kushnir, Marianna Ruzinova, Jeffrey R. Olsen, Parag J. Parikh, Kian-Huat Lim, Benjamin R. Tan, Steven Alphonse Edmundowicz, Andrea Wang-Gillam, William G. Hawkins, William C. Chapman, Steven M. Strasberg, Ryan C. Fields
Journal: Journal of Clinical Oncology (2016)

319 Background: Multidisciplinary Tumor Boards (MTBs) are a requirement for comprehensive cancer centers and are routinely used to coordinate multidisciplinary care in oncology. Despite their widespread use, the impact of MTBs is not well characterized. We studied the outcomes of all patients presented at our pancreas MTB, with the goal of evaluating our current practices and resource utilization. Methods: Data were prospectively collected for all patients presented at a weekly pancreas-specific MTB over the 12-month period at a single-institution NCI-designated cancer center. The conference is attended by surgical, medical, and radiation oncologists, interventional gastroenterologists, pathologists, and radiologists (diagnostic and interventional). Retrospective chart review was performed at the end of the 12-month period under an IRB-approved protocol. Results: A total of 470 patient presentations were made over a 12-month period. Average age at time of presentation was 61.5 years (range 17 – 89) with 51% males. 61.7% of cases were presented by surgical oncologists and 26% by medical oncologists. 174 cases were the result of new diagnoses or referrals. 78 patients were presented more than once (average of 2.3 times). Pancreatic adenocarcinoma was the most common diagnosis (37%), followed by uncharacterized pancreatic mass (16%), and pancreatic cyst (7%). The treatment plan proposed by the presenting clinician was known or could be evaluated prior to conference in 402 cases. Presentation of a case at MTB changed the plan of management 25% (n = 100) of the time, including MTB recommendation against a planned resection in 46 cases. When the initial plan changed as a result of MTB discussion, the most common new plan was to obtain further diagnostic testing such as biopsy and/or endoscopy (n = 24). Conclusions: MTBs are required and resource-intensive but offer the opportunity to discuss a wide array of pathologies and influence management decisions in a sizable proportion of cases. Additional investigations evaluating adherence rates to MTB decisions and to published guidelines (i.e. National Comprehensive Cancer Network) will further enhance the assessment and utility of MTBs.