tbuckley/cabot-search huggingface dataset:
Are we getting better at treating patients with rectal cancer? A 15-year trend analysis.
Authors: Ulrich Guller, Dieter Koeberle, Rene Warschkow, Bruno Schmied, Thomas Cerny, Ignazio Tarantino
Journal: Journal of Clinical Oncology (2012)

589 Background: The objective of this trend analysis was to assess whether clinical outcomes following rectal cancer resection have improved over a 15-year time period. Methods: The present study is based on the colorectal database of the authors` hospital, one of the largest tertiary care centers of Switzerland. All patients undergoing a rectal cancer resection for stage I - IV disease were consecutively included between 1991 and 2005. The 15-year time period was subdivided into five 3-year periods, among which different outcomes were compared. All tests were two-sided, the level of statistical significance was set at 0.05. Results: Overall, 682 consecutive patients undergoing a rectal cancer resection for stage I - IV disease were included. Mean age was 65 years (range: 24 to 93 years), 62.1% of patients were male, median ASA physical status was 2 (range 1 – 4). Among the various time periods, there were no significant differences regarding patients` demographics as well as tumor stage. All following outcomes significantly decreased over time: operating room time (max. 217minutes to 164 minutes, P-trend: &lt;0.001), rate of abdomino-perineal resections (from 20.5% to 7.6%; P-trend &lt; 0.001), rate of R1/2 resections (from 16.9% to 8.6%; P-trend: 0.008), rate of intraoperative complications (from 16.9% to 4.9%; P-trend: 0.018), rate of general postoperative complications (from 59% to 35.1%; P-trend &lt;0.001), and rate of local recurrence (8.4% to 4.9%; P-trend:0.033). 5-year overall survival did not significantly change over time, neither in the overall patient cohort (P-trend: 0.476), nor in the subsets of stage I-III (P-trend: 0.675) and stage IV patients (P-trend: 0.486). Conclusions: This first study in the literature based on a large cohort of consecutive stage I – IV rectal cancer patients provides compelling evidence that that operating room time as well as rates of abdomino-perineal resections, R1/2 resections, intra- and postoperative complications, as well as rates of local recurrence have significantly decreased from 1991 – 2005. However, there was no significant improvement of overall survival, neither in the overall cohort nor in the subsets of stage I-III versus stage IV rectal cancer patients.
Human papilloma virus in head and neck squamous cell cancer.
Authors: I. A. Kermani, S. Seifi, A. Asvadi Kermani, R. Dolatkhah, E. Sakhinia, A. Lotfi, G. Mohammadi, N. Naderpour, S. Hajipour, S. Dastgiri, H. A. Esmaili, A. Ebrahimi, A. Asghari Haggi
Journal: Journal of Clinical Oncology (2011)

e16011 Background: Epidemiologic and molecular evidence have established the strong link between high-risk types of human papilloma virus and a subgroup of head and neck squamous cell carcinoma. We evaluated the frequency of HPV positivity in HNSCC and its relationship to demographic and some risk factors variables in an open case-control study. Methods: Fourteen newly diagnosed patients of squamous cell cancer of oral cavity, oropharynx, hypopharynx and larynx aged between 18-50 year were examined from 2008-2010 in hematology and Oncology Research Center of Tabriz University of Medical Sciences. HPV DNA was extracted from paraffin-embedded block of each patient for evaluating by PCR. Saliva samples of 94 control cancer free subjects were collected for DNA analysis also. Multivariable logistic regression was used to calculate odds ratio for case-control comparisons. Results: High-risk HPV was detected in 6 (42.8%) of patients and 6 (5.3%) of control subjects, which statistically was significant (P<0.0001). HPV-18 was the most frequent type both in the case and control groups. HPV-16 DNA was detected in two patients and none of control subjects. The relation between demographc and risk factor variables was not statistically significant. Conclusions: HPV infection has significant impact on HNSCC, although has been shown, HPV-16 has the greatest role, however HPV-18 could be the cause of malignant degeneration in such cancers in some communities that needs greatest caution for health care systems of such communities in making immunization program.
ICORG 07-11: A phase II trial evaluating the efficacy of a radiobiological based re-irradiation strategy for patients with malignant spinal cord compression.
Authors: P. G. Thirion, A. Clayton-Lea, M. Parker, J. Coffey, J. G. Armstrong, D. Hollywood
Journal: Journal of Clinical Oncology (2010)

TPS317 Background: Malignant Spinal Cord Compression (MSCC) represents the 2nd most common cancer- related neurological complication, with an estimated 1 to 6% lifetime risk for all cancer patients (pts). Radiotherapy (RT) is broadly used in treatment of MSCC, and has been occasionally proposed in context of re-irradiation. Due to increased survival and use of RT, the number of pts developing MSCC in previously irradiated areas is increasing (Thirion, 2008). Preclinical and clinical data suggest that the spinal cord maximal tolerable cumulative radiation dose (MTD) depends on the received radiation schedules (total dose, dose-per-fraction [#]) and interval between treatments (Nieder, 2006). The efficacy and toxicity, especially the risk of radiation-induced myelopathy (RIM), of re-irradiation for MSCC has not been prospectively evaluated. The objective of ICORG 07-11 is to establish the efficacy and safety of a radiobiological based re-irradiation strategy in pts with MSCC occurring in a previously irradiated area. Methods: Patient eligibility criteria are: histologically proven malignancy, MRI-established non-operable MSCC, previous RT to the MSCC area delivering a Biological Effective Dose (BED) ≤ 90 Gy2, KPS > 30 and age > 18. The present accrual is 5 pts (n=25). Based on hypothesized spinal cord MTD BED ≤ 100 Gy2 and ≤ 130 Gy2 for treatment intervals of respectively ≤ 6 and > 6 months, RT is delivered up to MTD (using 3 Gy/# RT schedule; from 18 Gy/6# to 30Gy/10#). A Phase II trial Gehan's two-stage design is used, with efficacy and toxicity interim analysis. The Stage 1 sample size is 14 pts. The continuation rules are minimum overall response rate (defined as improved/stable mobility) ≥ 20% and Nieder-defined low and intermediate risk group RTOG/SOMA RIM grade > 2 incidences of respectively < 3% & < 25%. The second stage sample size is 11 pts (Response rate estimation with SE <0.1). The primary end-point is efficacy, evaluated by changes in Tomita mobility scale score (baseline, week 1 and 5, then 3-monthly). The secondary end-points are Quality of Life (EORTC/QLQ-C15-PAL, v1.0) and nonspinal radiation-induced toxicity (RTOG criteria). No significant financial relationships to disclose.
Impact of a novel inflammation-based prognostic system on patients undergoing surgery for hepatocellular carcinoma: A retrospective study of 398 Japanese patients.
Authors: M. Ishizuka, K. Kubota, J. Kita, M. Shimoda, K. Rokkaku, M. Kato, T. Sawada
Journal: Journal of Clinical Oncology (2010)

4111 Background: Few studies have investigated the Glasgow Prognostic Score (GPS) in patients with hepatocellular carcinoma (HCC). Methods: To compare the prognostic value of the GPS and Cancer of the Liver Italian Program (CLIP) score in patients undergoing surgery for HCC. Kaplan-Meier and uni- and multivariate analyses were performed to compare the GPS with the CLIP score. Results: Three hundred ninety-eight patients were evaluated retrospectively. Kaplan-Meier analysis and log rank test revealed that a higher GPS was associated with overall survival after surgical treatment of HCC (p < 0.001) as well as CLIP score (p < 0.001). In addition, GPS can classify not only patients with HCC (p < 0.001) but also such patients with lower CLIP score (p < 0.001) into three independent groups. Univariate analyses using clinico-laboratory factors selected GPS (odds ratio, 2.994; 95% CI, 1.372-6.534; p = 0.006) as one of the predictive factors associated with overall survival after surgical treatment of HCC, as well as the CLIP score (odds ratio, 2.075; 95% CI, 1.295-3.326; p = 0.002). Multivariate analysis using these two scoring system disclosed that both GPS (odds ratio, 2.500; 95% CI, 1.124-5.561; p = 0.025) and CLIP score (odds ratio, 1.886; 95% CI, 1.164- 3.056; p = 0.010) were associated with overall survival after surgical treatment of HCC. Conclusions: GPS is not only a simple and convenient system for preoperative classification of patients with HCC, but also an important predictor of overall survival after surgical treatment of HCC. No significant financial relationships to disclose.
Outcomes following interval debulking surgery in primary peritoneal carcinoma.
Authors: C. Connolly, K. K. Chan, K. Singh, S. Sundar, D. Luesley, M. S. Anwar, I. N. Fernando
Journal: Journal of Clinical Oncology (2011)

e15515 Background: Primary peritoneal carcinoma (PPC) has a poor prognosis with a median survival of 12-25 months. Unlike ovarian cancer, there is no published data on the effectiveness of interval debulking surgery (IDS) in PPC and it is not routine practice. Our series aimed to compare outcomes in patients with PPC treated with IDS following chemotherapy compared with patients treated with chemotherapy alone. Methods: A retrospective case note analysis was undertaken of all patients' of two consultants in 4 hospitals in the West Midlands diagnosed with PPC between May 2000-Nov 2008 identified through medical records. Data was analysed for age, performance status, response to chemotherapy, surgical outcomes, subsequent treatments, site of relapse, median time to progression (TTP), and median overall survival (OS). Analysis for TTP and OS was undertaken using both Kaplan-Meier and log rank analysis. Results: We identified 44 patients with histologically proven PPC between May 2000-October 2008. 41 patients received chemotherapy. 19 received Carboplatin alone, 20 Carboplatin-Paclitaxel and 2 Carboplatin-Gemcitabine. 17/44 patients (39%) went on for IDS following chemotherapy and 15/17 had optimal debulking. 3/17 had a complete pathological response. To date 11/17(65%) patients have recurred in the interval surgical group compared with 24/27(89%) in the non-interval surgery group. Median TTP was 25m (range = 8-33m) vs. 9m (0-30m) p=0.0001. 14/17(82%) in the surgical group have reached 2-year survival vs. 10/27(37%) in the non-surgical group. Median OS was 48 months in the interval surgery group vs. 21 months in the non-surgical group, p=0.0006. The median OS for all patients was 36 months. Conclusions: The median OS for all patients was 36m which compares favourably with previously published survival data of 12-25 months. IDS in selected cases of PPC seems to improve median OS and TTP in PPC and should be considered in all patients who have a good response to chemotherapy.
The reality of pancreas cancer care from access to delivery.
Authors: A. A. Abraham, W. B. Al-Refaie, H. M. Parsons, V. Dudeja, S. M. Vickers, E. B. Habermann
Journal: Journal of Clinical Oncology (2011)

241 Background: Prior literature has identified significant demographic differences in surgically treated patients with pancreas cancer (PC). Therefore, we hypothesized that disparities in socio-demographics exist in critical parameters throughout the continuum of PC care. Methods: We compiled a retrospective cohort of AJCC Stage I-IV PC from the California Cancer Registry. We used logistic regression to study sociodemographics as predictors of: 1) resectability at diagnosis or treatment (defined as absence of pre- or postoperative features of advanced or metastatic disease), 2) undergoing pancreatectomy, and 3) receipt of adjuvant chemotherapy (with/without radiotherapy) after surgery, while adjusting for confounders. Results: Of 20,312 patients with PC (1994-2008), 37% presented with resectable disease. Of those, only 40% received pancreatectomy. At multivariate analysis, race did not predict resectability, yet independently predicted undergoing pancreatectomy and receiving adjuvant therapies. Whites were 1.5 times as likely as blacks to undergo pancreatectomy and, following surgery, were more likely to receive chemotherapy with or without radiotherapy (for all, p &lt;0.01). Blacks were more likely to carry Medicaid than whites (10% vs. 5%, p&lt;0.01). Compared to those with other insurances, Medicaid recipients showed lower odds of undergoing pancreatectomy (Table). Conclusions: Our results suggest that race and insurance continue to influence the continuum of optimal PC care. Going forward, further policies and research should identify effective strategies to neutralize disparities in PC care. [Table: see text] No significant financial relationships to disclose.
Role of a second chemotherapy in recurrent malignant glioma patients who progress on a bevacizumab-containing regimen
Authors: E. Quant, A. D. Norden, J. Drappatz, A. Ciampa, L. Doherty, D. LaFrankie, S. Kesari, P. Y. Wen
Journal: Journal of Clinical Oncology (2008)

2008 Background: Bevacizumab is a humanized VEGF monoclonal antibody with promising activity in recurrent glioblastomas, alone and in combination with irinotecan. Patients who progress on this regimen are frequently maintained on bevacizumab and the concurrent chemotherapeutic agent is changed. The benefit of this therapeutic strategy is unknown. Methods: We retrospectively reviewed the clinical features and radiologic studies of 44 patients with recurrent malignant glioma who progressed on a bevacizumab-containing regimen and were then treated with an alternate bevacizumab-containing regimen. All patients received bevacizumab 10 mg/kg IV every 2 weeks. As the initial bevacizumab-containing regimen, 37 patients received irinotecan, 4 bevacizumab alone, 1 temozolomide and 2 carboplatin. As a second bevacizumab-containing regimen, 32 patients received carboplatin, 6 irinotecan, 2 BCNU, 1 CCNU, 1 etoposide, 1 erlotinib/rapamycin and 1 erlotinib. There was no limit on the number of prior therapies. Clinical characteristics and outcomes were reviewed. Tumor progression was determined by a combination of clinical status and radiographic changes. Results: Patient characteristics were 28 male, 16 female; median age 49 years (range 22–72); median KPS prior to receiving both regimens 70 (range 60–100 with first regimen and 40–100 with second regimen); median prior chemotherapy regimens including the first bevacizumab-containing regimen was 3 (range 2–5). Median PFS on first bevacizumab-containing regimen was 123.5 days. 6 month PFS was 33%. Median PFS on the second bevacizumab-containing regimen was 40 days (range 14 to 359 days). 6 month PFS was 2%. The number of grade 3/4 adverse events was similar between the two groups (7 with the first regimen and 8 with the second regimen). Conclusions: Patients with malignant gliomas who progress following treatment with a bevacizumab-containing chemotherapeutic regimen generally respond poorly to a second chemotherapy combined with bevacizumab. Other therapeutic options should be considered for these patients. No significant financial relationships to disclose.
Unwarranted variation in time to initiation of adjuvant chemotherapy in a statewide collaborative.
Authors: Jennifer J. Griggs, Thomas Braun, Andrew W. Dick, David H. Gorski, Jessica Miley Bensenhaver, Tara M. Breslin, Norah Lynn Henry
Journal: Journal of Clinical Oncology (2016)

264 Background: The purpose of this study was to investigate clinical and non-clinical factors associated with time to initiation of breast cancer adjuvant chemotherapy following the final definitive surgery in a state-wide collaborative. Methods: We collected prospective data from all patients who received adjuvant chemotherapy for Stages I - III breast cancer in 25 health systems in the Michigan Breast Oncology Quality Initiative (MiBOQI) between 2006 - 2014. MiBOQI is a Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored quality collaborative. The dependent variable was time to initiation of adjuvant chemotherapy. Time to chemotherapy was examined according to clinical and non-clinical patient and treatment factors and by health system, both with and without adjustment for patient and treatment variables. Results: Complete data were available for 7,513 of 8,236 eligible (91%) patients. The mean time to chemotherapy was 43 days (range 5-390). In multivariate analyses, clinical factors independently associated with longer time to chemotherapy included increasing age, greater comorbidity, and obesity (p value &lt; 0.0001 for all). Higher stage disease was associated with shorter time to chemotherapy (p &lt; 0.0001); there was no association with hormone receptor or HER2 status. Treatment factors associated with longer time to chemotherapy were breast reconstruction, receipt of genomic assays, and receipt of advanced imaging (p value &lt; 0.0001 for all). Non-clinical factors—minority status, higher area-level poverty, and non-private insurance—were also independently associated with longer time to chemotherapy (p value &lt; 0.0001 for all). In addition, time to chemotherapy varied significantly between health system (p &lt; 0.0001); this difference persisted after adjustment for all patient and treatment factors. Conclusions: Clinical and non-clinical factors, including site of care, are associated with variation in time to initiation of chemotherapy. Identifying patient-level factors and processes of care that facilitate or impede timely initiation of chemotherapy may decrease unwarranted variation in care delivery across a collaborative network.
Ongoing trial of electrochemotherapy as palliative treatment for chest wall recurrence of breast cancer.
Authors: L. W. Matthiessen, C. Kamby, H. W. Hendel, H. H. Johannesen, J. Gehl
Journal: Journal of Clinical Oncology (2010)

e11509 Background: By applying short electric pulses to cells, the cell membranes can become permeabilised. This can be used to augment the effect of chemotherapy, by providing direct access to the cell cytosol (electrochemotherapy). For the drug bleomycin, the enhancement of effect is several hundred folds. This method has proven highly effective in palliative treatment of cutaneous metastases less than 3 cm in diameter, but has not yet been systematically investigated for larger cutaneous metastases. Locoregional recurrence of breast cancer after mastectomy remains a clinically challenging problem. Uncontrolled local recurrence can be to severe psychological distress for the patient, and may be very difficult to treat. The aim of this study is to evaluate the efficacy and safety of electrochemotherapy as treatment for locoregional recurrence of breast cancer where other treatments have failed. Methods: This is an investigator initiated phase II clinical trial. The planned sample size is 28 patients. Patients are treated in general anaesthesia with a standard dose of bleomycin (15 U/m2 i.v.). Electric pulses are administered within a second using a square wave electroporator. Needle electrodes are inserted into the tumor moved around to cover the treatment volume. Retreatment can be administered three times. Results: 8 patients have been treated in the protocol. All patients hadpreviously received radiotherapy and several chemotherapy regimens (median 4.5 range 2-7). CT volume measurements show significant tumor reduction, from 34% to 99% in the treated area. PET-scans correspondingly show decreasing SUV values. Patients noted symptom relief, in particular for those with ulcerated lesions, where haemorrhaging and exudation was significantly reduced. Transient pain after treatment has been observed but otherwise no serious adverse events have been observed. Conclusions: In this group of heavily pretreated patients with breast cancer with symptomatic chest wall recurrence, electrochemotherapy efficiently alleviated symptoms, in particular when tumors were ulcerated and associated with odor, exudates, and bleeding. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration iClin Solutions
Implementation of a visual appointment system to enhance oncology infusion suite efficiency at Norris Cotton Cancer Center (NCCC).
Authors: Evelyn Schlosser, David Gladstone, Deborah Scribner, Jennifer Snide
Journal: Journal of Clinical Oncology (2012)

301 Background: Infusion suite patients were experiencing excessive delays for administration of chemotherapy, blood products, and hydration. Manually collected data revealed that 80% of patients did not start their infusion appointments on time, though there was limited additional data available for further analyses. The scheduling system allowed for booking a "start time" for infusion therapy, but there was no connection between the appointment slots and the actual number of infusion stations, length of the infusions, and available nursing staff. There was an identified need for 1) a “visual” scheduling system that would aid in better matching available resources with patient demand and 2) real time collection of electronic timestamps to better understand patient flow and improve efficiency. Methods: An already existing and supported visual scheduling system was introduced to the infusion schedulers. This system works by assigning patients to available resources (chairs and nurses) and timeslots. The system was piloted for four months before fully implemented. An electronic interface was created between the existing scheduling system and the visual system, eliminating the need for dual entry. Nursing began using the system to record the actual arrival and discharge times for patients. Scheduling guidelines were updated and additional functionality within the system was employed. Results: Adherence to the arrival and discharge processes are tracked on a monthly basis and shared with the infusion suite leadership and nursing staff. As compliance with check-in/out processes increase, actual utilization of the infusion suite by oncology service and treatment regimen is being evaluated. These data are useful in the identifying opportunities to reduce treatment delays and improve efficiency. Conclusions: Maximizing efficiency and utilization of infusion suite services is a goal of NCCC. Access to detailed electronic data that facilitates understanding of the demand for services and capacity of the system is critical to achieving this goal. It is our belief that a more efficient infusion suite will result in less treatment delays for patients.