tbuckley/cabot-search huggingface dataset:
Relation of inflammatory markers, disease stage and control, and chemotherapy in patients with breast cancer.
Authors: O. Dizdar, C. Arslan, S. Aksoy, O. Atmaca, Y. Tekinel, E. Sener, I. H. Gullu, Y. Y. Ozisik, K. Altundag
Journal: Journal of Clinical Oncology (2011)

e21159 Background: We aimed to research whether a relation exists between serum inflammatory markers and stage, disease control, and chemotherapy of breast cancer patient (BCP)s. Methods: A cross sectional study was held on BCPs being followed at Hacettepe University Institute of Oncology. Serum cell reactive protein (CRP), eryhtrocyte sedimentation rate (ESR), ferritin, lactate deydrogenase (LDH), B2 microglobulin levels and complete blood count (CBC) were checked. Patients with concurrent malignities, active radiotherapy or infection were excluded. Results: 553 female breast cancer patients were included to the study. Mean diagnosis age was 45±11.4 years. Mean follow up time was 32.6±15.6 months. Receptor status were as; ER+/PR+: 73%/69%, HER-2+:26% (+), triplenegative:5.6%. Tumor stages were as T1/2/3/4: 25/50/20/5%, N0/1/2/3: 43/26/18/13. Disease was under control at 489 (88%) patients. 122 (22%) patients were metastatic when enrolled to the study. Metastasis sites were as; soft tissue:44(8%), brain:19(3,5%), visceral organ:64(11,5%), bone:31(5,5%). Treatment status were as; no treatment:215(39%), endocrine:198(36%), chemotherapy:107(19%), endocrine+bisphosphonate:11(2%). LDH and ESR levels were higher in metastatic patients (378.3±140.2 vs 464.2±307.2 and 20.2±17.3 vs 31.3±26.2, respectively, p≤0.001). CRP and LDH levels were higher in patients in whom diseases were under control (16.7±9.9 vs 4.06±2.9, 503±404.7 vs 383.1±138.6; p=0.007/p<0.001). LDH levels were higher in visceral metastasis than bone metastatic patients (502.5±378 vs 385.5±129.3, p<0.001). ESR levels were higher in patients receiving chemotherapy than endocrine treatment and no-treatment (33.6±25.5, 19.2±16.2, and 20.6±18.3, p<0.001). LDH levels were higher in patients receiving chemotherapy than endocrine treatment and no-treatment (458.9±303.7, 378.5±178.8, and 380.6±126, p=0.01). Conclusions: Scarce data exists about the relation of inflammatory markers and prognosis, survival, and chemotherapy response in breast cancer patients. This trial has shown that serum inflammation markers might be related with disease stage and control, and tumor bulk.
Long-term update of U.S. GI intergroup RTOG 98-11 phase III trial for anal carcinoma: Disease-free and overall survival with RT+5FU-mitomycin versus RT+5FU-cisplatin.
Authors: L. L. Gunderson, K. A. Winter, J. A. Ajani, J. E. Pedersen, A. B. Benson, C. R. Thomas, R. J. Mayer, M. G. Haddock, T. A. Rich, C. G. Willett
Journal: Journal of Clinical Oncology (2011)

4005 Background: On initial publication of GI Intergroup RTOG 98-11, concurrent chemo-radiation (RT) with 5FU+mitomycin (MMC) decreased colostomy failure (CF) when compared with induction plus concurrent 5FU+cisplatin (CDDP), but did not significantly impact disease free or overall survival (DFS, OS). The intent of the current analysis is to determine the long-term impact of treatment on survival (DFS, OS, colostomy-free[CFS]), CF and relapse (local-regional [LRF], distant [DM]) in this patient group. Methods: Stratification factors included gender, clinical node status, and primary size. DFS and OS were estimated univariately by Kaplan-Meier method and treatment arms compared by log-rank test. Time to relapse/CF were estimated by cumulative incidence method and treatment arms compared by Gray’s test. Multivariate analyses were done with Cox proportional hazard models to test for treatment differences, after adjusting for stratification factors. Results: Of 682 patients accrued, 649 were analyzable for outcomes. 5-yr DFS and OS were statistically better for RT+5FU/MMC vs RT+5FU/CDDP (67.7 v 57.6%, p=.0044; 78.2 v 70.5%, p= .021) and trends toward statistical significance for CFS, LRF, CF (71.8 v 64.9%, 20 v 26.5%, 11.9 v 17.3%, p=.053, .089, .075). Similar results were seen in multivariate analysis. Conclusions: Concurrent chemoRT with 5FU/MMC has a statistically significant impact on DFS and OS versus induction + concurrent 5FU/CDDP and remains the preferred standard of care. Potential strategies to improve outcomes include treatment intensification & individualized molecular-based treatment. Supported by RTOG grant U10 CA21661 and CCOP grant U10 CA37422 from the NCI. Treatment No. of pts FS OS CFS LRF DM CF TF 5y,% TF 5y,% TF 5y,% TF 5y,% TF 5y,% TF 5y,% RT+5FU/MMC 325 117 67.7 80 78.2 101 71.8 67 20.0 45 13.1 38 11.9 RT+5FU/CDDP 324 156 57.6 108 70.5 126 64.9 86 26.5 60 17.8 55 17. p value* .0044 .021 .053 .089 .12 .075 Abbreviations: pts, patients; TF, total failures.
The Absolute Monocyte Count Predicts Overall Survival In Patients Newly Diagnosed with Follicular Lymphoma
Authors: Ryan A. Wilcox, Kay M. Ristow, Thomas M. Habermann, David J Inwards, Ivana N. Micallef, Patrick B. Johnston, Joseph P. Colgan, Grzegorz S. Nowakowski, Stephen M. Ansell, Thomas E. Witzig, Svetomir N. Markovic, Luis F. Porrata
Journal: Blood (2011)
Site of death, place of care, and burdensome transitions among patients with advanced solid tumor malignancies or leukemia between 2000 and 2010.
Authors: Elizabeth Horn Prsic, Joan M. Teno, Pedro Gozalo
Journal: Journal of Clinical Oncology (2015)

144 Background: Early palliative care has been associated with improved outcomes in oncology patients. However, there is limited data on end-of-life (EOL) care in hematology patients over time. We describe site of death, place of care, and transitions at the EOL among leukemia and advanced solid tumor malignancy (ASTM) patients. Methods: Retrospective cohort study of fee-for-service Medicare beneficiaries 66 years and older who died in 2000 (n = 40,805) and 2010 (n = 43,547) with leukemia or advanced lung, colorectal, or pancreatic cancer. Based on Medicare billing data, we identified site of death, place of care, and burdensome transitions (BT). Examples of BT include multiple hospital admissions for expected complications, referral to hospice in the last 3 days of life (DOL), and EOL transfers. Results: The rate of acute hospital death decreased for leukemia and ASTM patients over time (adjusted rate decreases 8.4% in leukemia vs. 8.2% in ASTM, p &lt; .001). However, acute hospital death was more likely in leukemia patients in 2010 (adjusted rates 35.8% vs. 19.0% in ASTM, p &lt; .001). Intensive care unit (ICU) admission in the last 30 DOL increased in both groups, and was more likely in leukemia patients in 2010 (adjusted rates 34.2% vs. 23.4% in ASTM, p &lt; .001). Transitions in the last 3 DOL increased over time, and occurred more frequently in leukemia patients compared to ASTM patients in 2010 (adjusted rates 24.5% vs. 19.0% in ASTM, p &lt; .001). Multiple admissions for expected complications increased similarly for patients in both groups over time (adjusted rate increases 2.7% in leukemia vs. 2.9% in ASTM, p &lt; .001). There was a striking increase in freestanding hospice inpatient unit care before death over time (increasing from 4.5% to 11.5% in leukemia and 7.5% to 15.9% in ASTM). Conclusions: Between 2000 and 2010, the rate of acute hospital death decreased in both leukemia and ASTM patients. However, there were increased rates of ICU and multiple admissions for expected complications in both groups, particularly in leukemia patients compared to ASTM patients. A similar increase was also observed in the use of freestanding hospice units before death for both groups.
Excess Late Gastrointestinal Toxicity Associated with Leam Conditioning Compared to BEAM for Autologous Stem Cell Transplantation in Lymphoma, a Single Institution Experience
Authors: Jaimal Kothari, Michael Foley, Karl S Peggs, Kirsty Thomson, Emma Morris, Kirit M Ardeshna, Andres E. Virchis, David C Linch, Jonathan Lambert
Journal: Blood (2014)
Pattern of regional recurrence after curative resection in locally advanced adenocarcinoma of gastroesophageal junction: Implication for elective lymphatic target delineation of radiotherapy.
Authors: Jiajia Zhang, Jing Jin, Wang Xin
Journal: Journal of Clinical Oncology (2016)

158 Background: To investigated the regional recurrence pattern of Siewert type II/III AGE patients after curative resection and refine the clinical target volume (CTV) delineation of radiotherapy. Methods: From 2009 to 2013, 78 patients who were histopathologically diagnosed with locally advanced AGE (T3/4 or any N + , Siewert II/III) after curative resection and confirmed of regional recurrence in follow-up CT images were retrospectively reviewed. First regional recurrence was recorded and one diagnostic radiologist with specialty of gastrointestinal tract investigated. Pattern of regional failure at each node station were analyzed. Reference CT images were obtained from a healthy volunteer. We then delineated the epicenters of recurrence sites at the equivalent location, based on the same vessels of reference CT images compared with the recurrence CT images on Pinnacle planning system. The combined contour of all recurrence sites was presented on a digitally reconstructed radiograph (DRR) image. Results: Most recurrence occurred within 2 years of follow-up (Median, 10.9 m). Of all, 35 (44.9%) patients had regional failure (RF) only; 24 (38%) had RF simultaneous with distant failure; 11 (14.1%) were locoregional, and 8 (10.3%) had concurrent distant and locoreginal failure. The most common recurrent node stations were No.16 (62.8%), No. 9 (32.1%), No. 11 (24.4%), No. 8 (17.9%), No. 7 (16.7%), No. 112 (12.8%), No. 4 (12.8%) and No. 12 (10.3%), respectively. 11 patients (14.1%) had recurrence at mediastinal lymph nodes. There was no significant difference of NF between Siewert type II and III AEG except for No. 9 (42.2% vs 18.2%, P = 0.027). The frequency and location of RF was shown by CT and digitally reconstructed radiograph (DRR) images. A three-dimensional (3D) atlas based on vessel delineation and distribution of RF was established. Conclusions: The most prevalent regional recurrence in Siewert type II/III AEG patients after curative resection was along the abdominal aorta, celiac artery and splenic artery. Our findings suggest a modified elective lymphatic target volume for IMRT contours in those patients.
Kaizen quality initiative to improve patient satisfaction and throughput in an academic cancer center.
Authors: David Dougherty, Patti Murray, Julie Ann Berkhof, Lynn Levandowski, Alok A. Khorana
Journal: Journal of Clinical Oncology (2012)

78 Background: Lean management principles have long been employed in manufacturing to improve operational efficiency but have only recently been adopted into healthcare settings. To address prolonged wait times and inadequate performance on patient satisfaction surveys, our cancer center utilized a Kaizen event as part of a quality improvement initiative. Methods: We utilized methods of Kaizen philosophy to evaluate all processes related to the patient experience in the outpatient facilities of the James P. Wilmot Cancer Center of the University of Rochester. The Kaizen initiative was conducted by a multidisciplinary group and consisted of an intensive 5-day induction period to identify problems within the system of care followed by regular quality improvement meetings. The group developed immediate solutions to some problems and identified priorities for the longer term. Changes in patient throughput times (time from clinic check-in to check-out) and patient satisfaction (utilizing Press-Ganey surveys) were tracked before and after initiating Kaizen and this report evaluates results over the first 12-month period. Results: Our Kaizen initiative involved a group of 17 faculty and staff who assembled during the induction period and met bi-monthly over the 12-month period from May 2011 to June 2012. Prior to the Kaizen intervention, mean throughput time for a 30-minute clinic visit was 80.34 minutes (n = 259; median 76; range 18 to 261) and mean overall patient satisfaction score for the quarter preceding the Kaizen was 89.3 (43 rd percentile AHA Region 2). Over the 12 months following the Kaizen, mean throughput time reduced to 57.85 minutes (n = 249; median 53; range 11 to 205) and patient satisfaction scores improved to 91.9 (p&lt;0.05; 63 rd percentile). Conclusions: Utilizing continuous process evaluation and Kaizen methodology, we reduced patient throughput times by 28% and improved patient satisfaction percentile rank by 20%. Ongoing efforts focus on utilizing continuous quality improvement to improve patient and family-centered cancer care. Kaizen is an effective, resource-neutral method for improving operational efficiency and patient-centered outcomes in an academic oncology practice.
An evaluation of the risk/benefit ratio of low molecular weight heparin to reduce the high risk of venous thromboembolism in acute leukemia.
Authors: G. L. Simmons, B. E. Hillner, T. J. Smith
Journal: Journal of Clinical Oncology (2011)

6566 Background: A variety of case series have consistently reported an increased incidence of venous thromboembolism (VTE) and/ or pulmonary embolism (PE) during induction and consolidation therapy for acute leukemia (AL). Low (or standard) dose coumadin (with target INR 2-3) has been shown to be ineffective. To date there are no reported randomized controlled trials (RCT) investigating the efficacy of low molecular weight heparin (LMWH) vs. placebo in reducing VTE in AL. Our purpose is to make sample size projections for a RCT and to inform practitioners of the frequency of VTE. Methods: Medline literature search from years 2004 to 2009 of English language reports with abstracts using key words such as acute leukemia, heparin, venous thromboembolism and major hemorrhage. For sample size estimation the relative efficacy of LMWH was assumed to reduce incidence of VTE and PE by 50% and increase serious bleeding by 50%, Results: 7 series were found. The sample size range was 71 to 7876 (median 379 patients). The studies did distinguish between AL initial therapies vs. relapsed/recurrent disease. The incidence of VTE was consistently found to be highest in the first month of therapy. The median VTE incidence of VTE was 5.6% (range 2.1-12.0%) in the first 3 months. VTE appears to be even more common with promyelocytic leukemia. In 1 series involving 255 patients, warfarin showed no evidence of benefit. Our sample size and event projection suggest that serious bleeding with LMWH would be increased from 0.2% (no therapy) to 0.3% (LMWH). A RCT comparing LMWH to placebo would require at least 318 patients to show a reduction of VTE from 5.6% to < 2.8%. Conclusions: AL has the highest rate of VTE within first 3 months of diagnosis. The risks of major hemorrhage associated with LMWH in AL appear to be ~20 fold lower then the risk of VTE. Our sample size calculation suggests that a multi-center RCT would be required. For guidance in absence of evidence, our standard practice is to use LMWH until the platelet count falls below 50,000/mm3.
Let air out of the bowel to allow more air in the lungs: surgical treatment of weaning failure
Authors: Hugh Ip, Wen Ling Woo, Amir Darakhshan, Nicholas Hart
Journal: Thorax (2017)

A 79-year-old man was electively admitted for a Whipple's procedure for a pancreatic cancer. Following surgery, he was extubated, but subsequently developed a hospital-acquired pneumonia with multiple organ failure requiring admission to the intensive care unit for organ support. After a protracted period of failed weaning from mechanical ventilation, he was transferred to a regional weaning centre 7 months after the initial operation. Since the surgery, the patient had complained of abdominal bloating and discomfort with distended bowel loops observed on the plain abdominal film. Because of frailty of the patient, a conservative management approach was taken, including high positive extrinsic pressure to enhance lung volume and the use of prokinetics, low-volume enteral feeding, regular aspiration of air from the nasogastric tube, sitting …
The Expression of Protein Kinase C Beta II (PKCβ) by Immunocytochemistry Is Predictive of the Disease Free Survival (DFS) in Diffuse Large B-Cell Lymphoma (DLBCL).
Authors: Rony Schaffel, Irene Biasoli, Adriana Scheliga, Jose C. Morais, Sergio Romano, Wolmar Pulcheri, Nelson Spector
Journal: Blood (2004)
Treatment patterns of castration-resistant prostate cancer: A retrospective claims database analysis.
Authors: Tanya Burton, April H. Teitelbaum, Cat N. Bui, James Robert Spalding
Journal: Journal of Clinical Oncology (2012)

198 Background: Prostate cancer is the most commonly diagnosed malignancy among men in the US; mortality rates are highest among those with castration-resistant prostate cancer (CRPC). Observational data on CRPC are limited. This study examined CRPC treatment patterns relative to NCCN guidelines in a large US health plan. Methods: This was a retrospective claims database analysis of commercial and Medicare Advantage enrollees with evidence of prostate cancer (ICD-9: 185.xx) between 07/01/06 – 03/31/11. CRPC patients were then identified based on prostate-specific antigen (PSA) progression (≥2 PSA increases based on ≥3 PSA values) and/or use of chemotherapy: docetaxel (DOC), mitoxantrone (MIT), estramustine (EST), or cabazitaxel (CAB). The CRPC index date was the first date of PSA progression or chemotherapy. Patients were continuously enrolled for 6 months before (baseline) and ≥6 months after the index date until 09/30/2011 or until death, if sooner (follow-up). Results: A total of 1651 patients met the CRPC selection criteria. Mean (SD) age was 70 ± 9 years, 1085 (66%) received DOC on the index date, and 467 (28%) died during follow-up. A third of patients with DOC received additional CRPC therapy during follow-up: 160 (15%) received MIT, EST, or CAB, and 239 (22%) received a secondary hormonal therapy (SHT: antiandrogens, aminoglutethimide, GnRH/LHRH antagonists, estrogen, or abiraterone acetate). Among 566 patients without DOC, 99 (17%) received a different chemotherapy (MIT = 45; EST = 52; CAB = 2), and 178 (31%) received a SHT. More than half 311 (55%) without DOC did not receive any other CRPC therapy during follow-up, of which 40 (13%) received bone-directed therapy (BDT: denosumab = 0; bisphosphonates = 27; radiation = 13). Conclusions: Consistent with NCCN guidelines, DOC was the most commonly used therapy. However, two-thirds of patients with DOC and over half of patients without DOC did not receive additional CRPC therapy after the index date. In addition, only 13% of patients with no CRPC therapy received any follow-up BDT. Additional research is warranted to understand whether clinical rationale, patient preference, or access to care may have resulted in patients not receiving additional therapy.
Prognostic stratification in esophagogastric adenocarcinoma in the revised AJCC staging (7th edition).
Authors: Haris Zahoor, James D. Luketich, Benny Weksler, Dan G. Winger, Neil A. Christie, Ryan M. Levy, Michael K. Gibson, Katie S. Nason
Journal: Journal of Clinical Oncology (2014)

92 Background: AJCC esophageal staging assigns prognostic groups based on tumor, node, and metastasis classifications. In 2010, AJCC 7 th ed. separated adenocarcinoma from squamous cell histology and added tumor grade and number of involved regional nodes. Our study aim was to compare survival prognostication for esophagogastric adenocarcinoma between AJCC 7 and AJCC 6 th ed. stage groupings. Methods: We abstracted pathology and survival for surgically-resected esophagogastric adenocarcinoma patients (n=836; 1997 to 2011); 256 received induction therapy. AJCC stage was assigned; overall survival in months (esophagectomy to death or most recent alive contact) was analyzed. Discriminatory ability and homogeneity, by stage, was assessed with Kaplan-Meier (KM) curves. Monotonicity comparisons were evaluated with linear trend chi-squared tests. Overall survival was compared using Cox regression and Akaike Information Criterion (AIC) was used to assess model fit. Results: Compared to AJCC 6, AJCC 7 restaged 165 patients. (Table) KM log-rank statistic indicated stronger differentiation in AJCC 7 curves compared to AJCC 6 (166.128 vs 185.523 overall). Cox likelihood ratio (162.957 vs. 173.951 overall) and AIC (4,831.011 vs 4,820.016 overall) indicated better model fit to the survival data for AJCC 7 versus AJCC 6, overall and for induction subgroups (data not shown). As stage group increases, stronger linear trends for survival were observed at 24, 36 and 60 months using AJCC7 stage groupings, overall and for induction subgroups, compared to AJCC 6. Conclusions: AJCC 7 stage groupings demonstrate superior homogeneity, discriminatory ability and monotonicity compared to AJCC 6. Incorporating the extent of nodal disease, and tumor grade into the revised AJCC 7 stage classification improves prognostic stratification of surgically resected esophagogastric adenocarcinoma patients, including patients who received induction therapy. [Table: see text]
First intravesical α-radioimmunotherapy of human urothelial carcinoma in men as a new therapy for carcinoma in situ after BCG failure.
Authors: Michael E Autenrieth, Florian Kurz, Thomas Horn, Christof Seidl, Alfred Morgenstern, Klemens Scheidhauer, Frank Bruchertseifer, Juergen E. Gschwend, Reintraud Senekowitsch-Schmidtke
Journal: Journal of Clinical Oncology (2016)

427 Background: Failure to respond to BCG in patients with carcinoma in situ (CIS) of the urinary bladder is problematic, since those tumours often have the potential to progress to muscle invasion. radical cystectomy remains the mainstay after BCG failure.Because treatment of mice bearing intravesical human bladder cancer xenografts with Bi-213-anti-EGFR-MAb turned out highly efficient (Pfost B et al. 2009, J of Nucl Med 50:1700-1708), the aim of this pilot study was to evaluate tolerability and safety of the α-emitter radioimmunoconjugate in patients after BCG failure. Methods: The alpha-emitter Bi-213 was eluted from a generator system provided by the Institute for Transuranium Elements (European Commission, JRC, Karlsruhe, Germany) and coupled to the anti-EGFR-mAb (Cetuximab, Merck, Germany) via the chelating agent CHX-A”-DTPA. 7 patients suffering from carcinoma in situ of the bladder who had histologically proven residual tumor after BCG induction therapy were included. After emptying the bladder an activity between 9,9 mCi and 22,2 mCi in 40 ml NaCl of Bi-213-anti-EGFR-mAb via a transurethral catheter was instilled. Distribution of Bi-213-anti-EGFR-mAb was monitored by SPECT/CT. Treatment was terminated by emptying of the radioimmunoconjugate from the bladder 120 min after injection. Efficacy was evaluated via endoscopy and histology six weeks after instillation. Results: All patients showed excellent toleration of the treatment without any side effects. SPECT/CT monitoring clearly revealed location of the Bi-213-anti-EGFR-MAb immunoconjugate only in the bladder without extravasation. Treatment resulted in complete eradication of tumor cells in 3 patients and persistent tumor detection in the other 4 patients. Conclusions: Intravesical instillation of Bi-213-anti-EGFR-mAb is a promising therapeutic option for treatment of in situ bladder cancerafterBCG failure for patients who wish to preserve the bladder.