tbuckley/cabot-search huggingface dataset:
Indication of sentinel lymph node biopsy with breast-conserving surgery for ductal carcinoma in situ considering lymphatic flow.
Authors: Ayane Yamaguchi, Shigeru Tsuyuki, Miru Okamura, Yukiko Kawata, Kosuke Kawaguchi, Nobuko Kawaguchi, Yukihiro Kohno
Journal: Journal of Clinical Oncology (2012)

192 Background: Ductal carcinoma in situ (DCIS) has been regarded as curable with resection, but axillary lymph node metastases have been reported in 2% of DCIS patients. Even when DCIS has been diagnosed by preoperative core needle biopsy (CNB), 8% to 38% of the patients have been found to have invasive ductal carcinoma (IDC) on the basis of pathological diagnosis after surgical treatment. The indication of sentinel lymph node biopsy (SLNB) and breast-conserving surgery (BCS) for DCIS is still controversial. Methods: SLNB is a standard surgical technique for early breast cancer treatment, and indocyanine green (ICG) fluorescence method is remarkable in terms of the visualization of lymphatic flow. We analyzed the variation in lymphatic drainage routes from the nipple to the SLN (sentinel lymphatic routes) by using the ICG florescence method in early breast cancer patients and investigated the effects on the localization of the tumor to the sentinel lymphatic routes after BCS. Results: From November 2010 to April 2012, we recorded the sentinel lymphatic routes in 118 patients. All the routes passed through the upper outer quadrant (UOQ) area, and there were more than 2 routes in 53 cases. Of these routes, 73% passed through only the UOQ area and 27% passed through the UOQ via the upper inner, lower inner, and/or lower outer quadrant area. Conclusions: We should confirm the sentinel lymphatic routes by using the ICG florescence method before BCS for preoperatively diagnosed DCIS. If the lymphatic routes do not pass over the extent of resection of BCS, we can omit SLNB in the first surgical treatment and await the final pathological result. However, we should perform SLNB in addition to BCS in cases in which the lymphatic routes pass over the tumor in the region except the UOQ area.
Pathologic tumor and normal mucosa responses after hyperfractionated versus hypofractionated preoperative radiotherapy for rectal cancer.
Authors: Rafal Suwinski, Ewa Stobiecka, Ewa Chmielik, Mariusz Kryj, Andrzej Chmielarz, Maciej Widel, Adam Idasiak, Marcin Bialas, Jerzy Wydmanski, Iwona Wzietek
Journal: Journal of Clinical Oncology (2013)

556 Background: The aim of the study is to assess radiation-induced tumor and normal mucosa responses in patients who underwent preoperative radiotherapy according to two different fractionation protocols. This research constitutes one of the secondary endpoints of a prospective randomized trial. Methods: Pathological samples after preoperative radiotherapy and surgery were obtained from 106 patients: 50 were treated with hypofractionation 39 Gy in 3.0 Gy per fraction (HYPO) and 56 with accelerated hyperfractionation 42 Gy given in two daily fractions of 1.5 Gy with a minimal interfraction interval of 6 hours (HART). This sample represents approximately 30% of an overall trial size. Over 50 pathological features were assessed for each sample including tumor/nodal response, normal mucosa and cellular matrix response, ulceration and morphology of tumor cells. The observed grades of responses in HYPO vs. HART were compared using U Mann-Whitney test. Results: The primary tumor downstaging was observed in 41% vs. 35% of the patients treated with HYPO and HART respectively, the difference was not significant (p=0.5). By contrast, a trend towards improved nodal response among the patients treated with HYPO was recorded, with 94% achieving complete or major nodal response, compared to 73% in HART (p=0.03). Mucosal atrophy and edema were significantly higher in HYPO (p=0.003 and p=0.02, respectively). A trend for increased mucosal inflammation was also recorded in HYPO (p=0.06). Tumor/nodal responses were not significantly influenced by time-interval radiotherapy-surgery (below or above the median of 11 days), however, more cellular injury to normal mucosa (atrophy, ulceration) was observed at short RT-surgery intervals (p=0.01). Conclusions: Radiation-induced tumor and normal mucosa responses differ significantly according to fractionation schedule, with more mucosa injury observed in HYPO. Pathological responses of mucosa are also influenced by time-interval radiotherapy-surgery.
Patterns of failure after radical cystectomy for pT3-4 bladder cancer: Implications for adjuvant radiation therapy.
Authors: Abhinav V. Reddy, Joseph J. Pariser, Shane M. Pearce, Ralph R. Weichselbaum, Norm D. Smith, Gary D. Steinberg, Stanley L. Liauw
Journal: Journal of Clinical Oncology (2016)

370 Background: In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods: Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariable analysis for association with LF and overall survival. Results: 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 and median follow up was 11 months. On univariate analysis, margin status, pT stage, pN stage, and gender were all associated with LF (p &lt; 0.05), however, on multivariable analysis, only pT and pN stage were significantly associated with LF (p &lt; 0.01). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external/internal iliac LNs and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions: Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.
Autologous Stem Cell Transplantation (ASCT) Versus Oral Melphalan and High-Dose Dexamethasone in Patients with AL (Primary) Amyloidosis: Results of the French Multicentric Randomized Trial (MAG and IFM Intergroup).
Authors: A. Jaccard, P. Moreau, V. Leblond, X. Leleu, L. Benboubker, O. Hermine, C. Recher, M. Malphette, B. Lioure, B. Royer, B. Grosbois, J. Jaubert, P.M. Preux, M. Cogne, J.P. Fermand
Journal: Blood (2005)
Adjuvant pelvic radiotherapy for pathological high-risk muscle-invasive bladder cancer: A multicenter retrospective study.
Authors: Paul Sargos, Igor Latorzeff, Aude Flechon, Guilhem Roubaud, Veronique Brouste, Richard Gaston, Thierry Piechaud, Pierre Richaud, Mathieu Orre
Journal: Journal of Clinical Oncology (2016)

369 Background: Radical cystectomy (RC) and pelvic lymph-node dissection (PLND) are standard procedures in the management of non-metastatic muscle invasive bladder cancer (MIBC). Loco-regional recurrence (LRR) is a common early event associated with a poor prognosis. The aim of this study is to evaluate adjuvant radiotherapy (RT) for pathological high-risk MIBC. Methods: We retrospectively reviewed data from patients treated by RC from 3 institutions. Inclusion criteria were MIBC, histologically proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. LRR free-survival, overall survival (OS) and metastasis-free survival (MFS) were evaluated. Acute toxicities were recorded according to CTCAE V4.0 scale. Results: Between January 2000 and December 2013, 57 patients with a median age of 66 years (45-84) were included. Post-operative pathological staging was pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% of pN0, 26% of pN1 and 42% of pN2. For 2 patients, no PLND was performed. Median number of lymph-nodes retrieved was 10 (2-33). Forty-eight patients (84%) received platin-based chemotherapy, 7 in neo-adjuvant and 41 in adjuvant setting. For RT, clinical target volume 1 (CTV 1) alwyas encompasses pelvic lymph nodes and cystectomy bed for 37 patients (65%). Median dose for CTV 1 was 45 Gy (4-50). Dose complement of 16 Gy (5-22) corresponding to CTV 2 was achieved in 53 of cases, depending on pathological features. Intensity Modulated RT was performed in one third of patients. With a median follow-up of 40.4 months, LRR occurred in 8 patients (14%). Three-year loco-regional free survival, MFS and OS were 45% (IC 95%: 0.30-0.60), 39% (IC 95%: 0.25-0.52) and 49% (IC 95%: 0.33-0.63), respectively. Acute grade ≥ 3 toxicities were observed in 5 patients (9%). One patient died with intestinal fistula in septic context. No survival or toxicity predictive factor was identified. Conclusions: Adjuvant radiotherapy for pathological high-risk MIBC is safe and may have oncological benefits. Thus, new prospective trials evaluating this approach with modern RT techniques should be undertaken.
Long-term outcome after high-dose 3D conformal RT for stage III NSCLC: A single-institution experience.
Authors: R. J. Ellis, J. Greskovich, S. V. Dill, C. Kan, P. Fu, Y. Jiang, A. Dowlati, M. Machtay
Journal: Journal of Clinical Oncology (2011)

e17515 Background: We are reporting retrospective outcomes for patients using high dose 3D radiation therapy (RT). Methods: Between 4/2002 - 5/2007 51 patients were treated definitively, with mature outcome data at 6 years. Median follow-up for the cohort was 12.7 months (range 3.8-106.5), 77.9 months for 6 living patients. The cohort includes 28 males and 23 females. Histology included 17 Adenocarcinoma, 16 Squamous, and 17 Large cell/NSCLC-NOS. There were 22 stage IIIA and 29 IIIB cases. RT prescription doses ranged from 61 Gy - 79 Gy (median 72 Gy). PET was not routinely used for staging or treatment planning. RT planning and delivery were uniform, but chemotherapy guidelines were not. Forty patients had chemotherapy (generally platin-based), including seven with sequential chemo and 33 with concurrent +/- induction/adjuvant chemo. Patients were routinely reviewed at a Multidisciplinary Tumor Board, and were not surgical candidates. Results: For the entire cohort, overall survival (OS) rates at 2, 3, 4 and 6 years were 31%, 20%, 16% and 11%. The respective disease-free survival (DFS) rates were 22%, 18%, 16% and 11%. In OS Stage IIIA was favorable over IIIB (p=0.048), at 23% vs. 10% at 4 years; and Adenocarcinoma had a better OS at 35% than other histologies (p=0.021). Local failure free survival (FFS) was significantly higher in IIIA vs. IIIB at 84% vs. 45% (p=0.020). Regional FFS was significantly higher for N0-2 disease vs. N3 disease at 59% vs. 22.5% (p=0.041). On Multivariate analysis stage IIIA vs. IIIB remained a significant factor for OS with hazard ratio (HR) 2.58 (p=0.012), as did age (per year increase) HR 1.04 p=0.021. Likewise both local and regional failure free survival were significant for IIIA vs. IIIB HR 11.29 (p=0.017) and 3.89 (p=0.021) respectively. Severe late toxicity was (8%) for 1 grade 3 fistula and 3 pneumonitis (2 grade 3, 1 grade 5). Conclusions: High dose 3D RT appears to improve local control (and perhaps long term survival) compared with historical data, particularly for inoperable stage IIIA disease. Our data support the importance of the ongoing phase III randomized trial of standard versus high dose RT with uniform staging and chemotherapy, RTOG 0617/CALGB 30609/NCCTG N0628.
Patterns of care for adjuvant therapy for colorectal cancer
Authors: D. P. Cronin, L. C. Harlan, L. X. Clegg, A. L. Potosky, M. M. Mooney
Journal: Journal of Clinical Oncology (2005)

6080 Background: Over the past decade, international clinical trials have proved the efficacy of several treatments for colorectal cancer (CRC). Dissemination of these treatments should improve population-based mortality statistics. This study tracks changes in patterns of care and survival for stage II and III CRC patients for adjuvant therapy. Methods: We conducted a stratified randomly sampled, population-based study of adjuvant chemotherapy and radiotherapy for patients diagnosed in 2000 with CRC in the US and follow-up through 2001. Blacks and Hispanics were over-sampled. Factors associated with receipt of adjuvant therapy in colon stage III & rectal stage II & III patients were analyzed using logistic regression models. Data was pooled with a previous study that included patients diagnosed in 1990, 1991 and 1995. Cox Proportional Hazards regression models were used to study risk factors associated with survival. Results: Most patients diagnosed in 2000 received 5-FU with leucovorin (47%), rather than levamisole (3%). As age increased, likelihood of receiving appropriate treatment decreased (P<0.001). Youngest patients were more likely to receive treatment than the oldest group (OR=8.5, 95% CI 3.7–19.6). Rectal patients were less likely to receive guideline treatment (P=0.01) than stage III colon cancer patients. Although not significant overall, our results suggested patients with co-morbid conditions were less likely to receive guideline treatment. All-cause mortality was lower in patients who received standard therapy (P<0.001). Survival was poorest among the oldest patients, those with poor or undifferentiated histological grade, and those with co-morbidity scores. Conclusions: In 2000, the most frequent treatment for stage III colon cancer was 5-FU with leucovorin. In contrast to earlier years, in 2000, race/ethnicity was not significantly associated with receipt of treatment or mortality. Despite little evidence of greater toxicity among the aged and those with more co-morbidity, there is persistent under-use of adjuvant therapy, and poorer survival in these population groups. Determining underlying causes of these practice patterns is the next crucial step in the process of increasing dissemination and reducing mortality. No significant financial relationships to disclose.
Utility of 2D-speckle tracking echocardiography in diagnosis of left ventricular dysfunction in anti-ErbB2 therapy.
Authors: Nicola Maurea, Giovanna Piscopo, Clemente Cipresso, Domenica Rea, Emanuela Esposito, Immacolata Capasso, Carlo G. Tocchetti, Claudio Arra, Carmela Coppola
Journal: Journal of Clinical Oncology (2013)

169 Background: ErbB2 is overexpressed in about 25% of breast cancers; in the heart, it modulates myocardial development and function. Trastuzumab (T), an anti-ErbB2 inhibitor, has improved the prognosis of patients with breast cancer, but is related to an increased risk of asymptomatic left ventricular (LV) dysfunction (3-34%) and heart failure (2-4%). Conventional measures of ventricular function, such as fractional shortening (FS) and ejection fraction (FE) are insensitive in detecting early cardiomyopathy induced by antineoplastic therapy. Here, we aim at assessing whether myocardial strain by 2D-speckle tracking (ST) is able to identify early LV dysfunction in mice treated with doxorubicin (D) and T, alone or in combination (D+T) and to relate data of cardiac function with tissue alterations. Methods: Cardiac function was measured with FS, by M-mode echocardiography, and with radial myocardial strain with ST in sedated C57BL/6 mice (8-10 wk old) at time 0, 2 and 6 days of daily administration of D (2.17 mg/kg/day), T (2.25 mg/kg/day), D+T (2.17 mg/kg/day + 2.25 mg/kg/day) and in a control group. In excised hearts, we evaluated TNFα and CD68 by immunohistochemistry; interstizial fibrosis was analyzed with picrosirius red staining. Results: FS was reduced in group D and D+T at 2 days (52+0.2% and 49+2%), both p&lt;0.001 vs 60+0.4% (sham), while in group T it decreased only at 6 days (49+1.5% vs 60+0.5%, p=.002). In contrast, after 2 days, myocardial strain was already reduced not only in D and D+T, but also in T alone: 43+3%, 49+1%, and 44+7%, respectively, all p&lt;0.05 vs sham (66+0.6%). Cardiotoxicity was associated with significant alterations in extracellular matrix remodeling as confirmed by an increase of interstizial collagen with D (4.56%), T (2.17%) and D+T (3.77%)at 6 days p&lt;0.05 vs sham (1.17%) and by increased cardiac inflammation in fact the myocytes were positive for TNFα and CD68 cells/mm 2 at 6 days in group D (16.46% and 155), in group T+D (12.35% and 74.16) and in group T (5.65% and 72.32) p&lt;0.01 vs sham (0.56% and 2.3). Conclusions: Myocardial strain identifies LV systolic dysfunction earlier than conventional echocardiography and can be a useful tool to predict cardiotoxicity in this setting.
Significance of thymidylate synthase and thyroid transcription factor 1 expression in patients with nonsquamous non-small cell lung cancer treated with pemetrexed-based chemotherapy.
Authors: J. Sun, J. S. Ahn, K. Park, J. H. Han, M. Ahn
Journal: Journal of Clinical Oncology (2011)

7579 Background: To evaluate whether thymidylate synthase (TS) or thyroid transcription factor 1 (TTF1) protein expression can predict clinical outcome for pemetrexed-based chemotherapy in patients with nonsquamous non-small cell lung cancer (NSCLC). Methods: Two hundred eighty-five consecutive patients with nonsquamous NSCLC treated with pemetrexed-based chemotherapy were immunohistochemically analyzed for the expression of TS and TTF1. Results: TS and TTF1 expression were successfully analyzed in 193 and 284 cases, respectively. Tumors with TS-negativity or TTF1-positivity was more frequent in groups of female, younger age, adenocarcinoma, or never-smoker. Higher response rates for pemetrexed-based chemotherapy were associated with TS-negativity (33.7% vs. 14.1%, P = 0.002) and TTF1-positivity (28.1% vs. 9.8%, P < 0.001), respectively. In univariate analysis, progression-free survival (PFS) for pemetrexed-based chemotherapy was significantly longer in groups of adenocarcinoma (2.9 vs. 1.4 months, P = 0.001), TS-negativity (4.1 vs 2.0 months, P = 0.001), and TTF1-positivity (3.9 vs. 1.3 months, P < 0.001). In multivariate analysis, TS-negativity (HR = 0.69; 95% CI, 0.50–0.96) and TTF1-positivity (HR = 0.51; 95% CI, 0.35–0.73) were associated with longer PFS, respectively. Patients with TTF1-positive tumors also had significantly longer overall survival time than patients with TTF1-negative tumors (25.4 vs. 14.2 months, HR = 0.55; 95% CI, 0.39–0.77). Conclusions: Low TS or high TTF1 protein expression was significantly associated with better clinical outcomes in nonsquamous NSCLC patients who were treated with pemetrexed-based chemotherapy. The predictive role of TS or TTF1 expression is required to be further validated in a prospective randomized study.
Combination of temozolomide (TMZ) and irinotecan (CPT-11) showed enhanced activity for recurrent malignant gliomas: A North American Brain Tumor Consortium (NABTC) phase II study
Authors: W. K. A. Yung, F. S. Lieberman, P. Wen, I. Robin, M. Gilbert, S. Chang, L. Junck, T. Cloughesy, K. Lamborn, M. Prados
Journal: Journal of Clinical Oncology (2005)

1521
The shortage of medical oncologists and low chemotherapy utilization in Australia.
Authors: B. Koczwara, M. Barton, P. L. Blinman, S. Crossing, P. S. Grimison, E. T. Walpole, N. Wong, K. Francis
Journal: Journal of Clinical Oncology (2010)

6104 Background: With the increased effectiveness of cancer treatments and improved outcomes, concerns arise whether the medical oncology workforce is able to meet the increased demand. We sought to evaluate current workforce capacity in medical oncology and recommend standards of workload for medical oncologists in Australia. Methods: A cross sectional study of medical oncologists in Australia was conducted using a study specific 23 item survey completed by post or online. Medical oncologists in adult clinical practice were identified using the Medical Oncology Group of Australia database and verified using information from “champions” in each state. The survey was sent to all lead clinicians in oncology practices in June 2009, and sought information regarding medical oncology workforce in 2008. Non respondents were followed up with a phone call. Workforce capacity was assessed based on an optimal workload of 150 new patients per FTE per year. Chemotherapy utilisation rate was defined as new patients receiving chemotherapy/new cases of cancer reported to state registries. Results: 94 of 116 eligible responses were received (81%). There were 476 medical oncology positions working as 234 full time equivalents (FTE) with additional 28.5 FTE vacant. 49073 new patients were seen of whom 20529 received chemotherapy. Average new patient intake was 209 per FTE per year (range 144-408). Medical oncologists in 31.3 FTE positions (13% of total FTE) planned to retire over next 5 years. The current national shortage of medical oncologists was estimated to range from 92 to 157 FTE, with a projected increase to 126 to 157 FTE by 2014. Significant shortages of medical oncologists were present in all states, and particularly in rural areas. Based on 106,000 new cases of cancer per year in Australia, the chemotherapy utilisation rate for Australia was 19%, which is well below the evidence- based standard of 50%. Even allowing for under-reporting it is likely that many patients who could benefit from chemotherapy do not receive it. Conclusions: There is a current shortage of medical oncologists in Australia which is expected to worsen in the future. The workforce shortage provides little capacity to increase the low chemotherapy utilisation rate. No significant financial relationships to disclose.