tbuckley/cabot-search huggingface dataset:
An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. Gastric Cancer Collaborative.
Authors: Gregory C. Dann, Malcolm Hart Squires, Lauren McLendon Postlewait, David A. Kooby, George A. Poultsides, Sharon M. Weber, Mark Bloomston, Ryan C. Fields, Timothy M. Pawlik, Konstantinos Ioannis Votanopoulos, Carl Richard Schmidt, Aslam Ejaz, Alexandra W. Acher, Linda X. Jin, Clifford Suhyun Cho, Emily Winslow, Maria C. Russell, Kenneth Cardona, Charles A. Staley, Shishir Kumar Maithel
Journal: Journal of Clinical Oncology (2015)

120 Background: A recent single institutional study demonstrated that jejunostomy feeding tubes (J-tubes) placed during resection of gastric adenocarcinoma (GAC) are associated with increased complications and no change in receipt of adjuvant therapy. Our aim was to validate these findings in a large multi-institutional cohort. Methods: All patients who underwent resection for GAC at 7 institutions participating in the U.S. Gastric Cancer Collaborative from 2000-2012 were identified. Patients with metastatic disease were excluded. Univariate and multivariate logistic regression were performed to assess the association of J-tubes with postoperative complications and receipt of adjuvant therapy. Subset analysis of patients who underwent total vs subtotal gastrectomy was also performed. Results: Of 965 patients, 837 were included for analysis, of whom 265 (32%) received a J-tube. Patients receiving J-tubes demonstrated greater incidence of preoperative weight loss, lower BMI, greater extent of resection, and more advanced TNM stage. J-tube placement was associated with increased infectious complications (36% vs 19%;p&lt;0.001), including surgical site infections (14% vs 6%;p&lt;0.001) and deep intra-abdominal infections (11% vs 4%;p&lt;0.001). On multivariate analysis, J-tubes remained independently associated with increased risk of infectious complications (HR=1.93;p=0.001), surgical site infections (HR=2.85;p=0.001), and deep intra-abdominal infections (HR=2.13;p=0.04). J-tubes were not associated with increased receipt of adjuvant therapy (HR=0.82;p=0.34). Subset analysis of patients undergoing total and subtotal gastrectomy similarly demonstrated an association of J-tubes with increased risk of infectious outcomes andno association with increased receipt of adjuvant therapy. Conclusions: J-tubes placed during resection of gastric adenocarcinoma are independently associated with increased postoperative infections and are not associated with increased receipt of adjuvant therapy, despite being placed in patients with advanced TNM stage tumors. Selective use of J-tubes is recommended.
How accurately can clinicians predict the Oncotype DX DCIS score?
Authors: Sarah Patricia Cate, Alyssa Gillego, Manjeet Chadha, John Rescigno, Paul R. Gliedman, Agnes Radzio, Susan K. Boolbol
Journal: Journal of Clinical Oncology (2013)

90 Background: The Oncoype DX DCIS Score was developed to assess the risk of recurrence for ductal carcinoma in situ, as well as an invasive breast cancer. It is a 12 gene assay performed on an individual patient’s tumor and is used to predict the ten year local recurrence risk of an ipsilateral breast event, which can be either an invasive breast cancer or ductal carcinoma in situ. It is also used to predict the 10 year risk of an invasive cancer. The DCIS Score was clinically validated using patients from ECOG 5194. The purpose of this study was to investigate how often clinicians, (medical oncologists, breast surgical oncologists, and radiation oncologists) can predict the DCIS Score. Methods: In this IRB approved study, we retrospectively reviewed the charts of 27 patients at our institution who underwent unilateral or bilateral partial mastectomy for DCIS from April 2012 to February 2013 and who had their pathology specimens submitted for DCIS Scores. Patient age range was 40-79 years old, with a mean of 56.8. All patients underwent consultation with radiation oncology. A chart was compiled to include the patient’s age and tumor histology. This included grade of DCIS, extent of DCIS, presence of necrosis, margin width, and hormone receptors. We then removed all identifying factors from the patients’ data, and surveyed our radiation oncologists, medical oncologists, and breast surgical oncologists on whether patients had a low, intermediate, or high DCIS Score. Results: Breast surgical oncologists accurately predicted the DCIS score 49% of the time. Medical oncologists predicted the DCIS score 35% of the time, while radiation oncologists were accurate 51% of the time. Conclusions: This study demonstrates the difficulty in predicting the DCIS Score. The information obtained from the DCIS Score is specific to the genetic behavior of each individual tumor, whereas traditional methods of predicting risk of recurrence and benefit of radiation are based on standard pathologic and clinical criteria. Further studies on larger patient populations need to be performed prior to wide scale acceptance of this genomic test. [Table: see text]
Circulating bone marrow-derived stem cells in patients with pancreatic cancer.
Authors: Teresa Starzynska, Krzysztof Dabkowski, Wojciech Blogowski, Ewa Zuba-Surma, Daria Salata, Marta Budkowska, Barbara Dolegowska, Wojciech Marlicz, Jerzy Lubikowski, Mariusz Ratajczak
Journal: Journal of Clinical Oncology (2013)

200 Background: Various experimental studies suggest that bone marrow-derived stem cells (BMSCs) may be involved in the development and progression of pancreatic cancer. However, these observations require further studies, and delineation of exact mechanisms responsible for mobilization of BMSCs from the bone marrow to peripheral blood. Methods: A total of 23 patients with newly diagnosed pancreatic cancer (17 with distal metastases) and 15 healthy individuals were recruited to this study. Using fluorescence-activated cell sorter circulating hematopoietic (HSPCs), mesenchymal (MSCs), endothelial (EPCs), and very small embryonic/epiblast-like stem cells (VSELs) were enumerated and sorted. Plasma levels of various growth/inhibitory factors (hepatocyte [HGF], vascular-endothelial [VEGF], leukemia [LIF]), stem cells’ chemoattractants (stromal-derived factor-1 [SDF-1], sphingosine-1-phosphate [S1P]), and complement molecules (anaphylatoxins [C3a, C5a] and complexes [C5b-9/MAC]) were measured. Results: Significantly higher numbers of circulating VSELs and MSCs were detected in pancreatic cancer patients (in both p&lt;0.05), while the numbers of circulating HSPCs and EPCs were comparable between the analyzed groups. Among analyzed biochemical and immunomodulatory factors, levels of C5a, C5b-9/MAC, HGF and S1P, but not of SDF-1, LIF nor VEGF were associated with observed mobilization of BMSCs. Conclusions: In patients with pancreatic cancer selective mobilization of BMSCs from the bone marrow to peripheral blood is observed. This seems to be strongly associated with increased levels of immunomodulatory substances. Our study also highlights that it is S1P and HGF but not SDF-1 that seem to be associated with BMSCs mobilization from the bone marrow to peripheral blood in patients with pancreatic cancer. (MNiSW grant 402 423038).
Elimination of second-hand smoke (SHS) exposure after a lung or head and neck (HN) cancer diagnosis and subsequent patient smoking cessation.
Authors: Lawson Eng, Devon Alton, Yuyao Song, Delaram Farzanfar, Olivia Krys, Tom Yoannidis, Robin Milne, Steven Habbous, M Catherine Brown, Ashlee Vennettilli, Frances A. Shepherd, Natasha B. Leighl, Andrew J. Hope, Doris Howell, Jennifer M. Jones, Peter Selby, Wei Xu, David Paul Goldstein, Meredith Elana Giuliani, Geoffrey Liu
Journal: Journal of Clinical Oncology (2016)

183 Background: Exposure to SHS after a cancer diagnosis is associated with continued smoking in lung and HN cancer patients (PMID: 24419133, 23765604). However, smoking is a social activity. We evaluated whether elimination of SHS exposure around and after a diagnosis of lung or HN cancer is associated with smoking cessation in the cancer patient. Methods: Lung and HN cancer patients from Princess Margaret Cancer Centre (2006-12) completed questionnaires at diagnosis and follow-up (median 2 years apart) that assessed smoking history and SHS exposures (cohort study). Multivariate logistic regression analysis evaluated the association of elimination of SHS exposure after a diagnosis of cancer with subsequent smoking cessation, adjusted for significant covariates. A cross-sectional study (2014-15) of 183 lung and HN smoking patients assessed consistency in associations and interest in SHS cessation programs. Results: For the cohort study, 261/731 lung and 145/450 HN cancer patients smoked at diagnosis; subsequent quit rates were 69% and 50% respectively. 91% of lung and 94% of HN cancer patients were exposed to SHS at diagnosis while only 40% (lung) and 62% (HN) were exposed at follow-up. Elimination of SHS exposure was associated with smoking cessation in lung (aOR = 4.76, 95% CI [2.56-9.09], P&lt; 0.001), HN (aOR = 5.00 [1.61-14.29], P&lt; 0.001), and combined cancers (aOR = 5.00 [3.03-8.33], P&lt; 0.001). The cross-sectional study has similar cessation and SHS exposure rates and a similar association for elimination of SHS with smoking cessation (aOR = 3.42 [1.16-10.10], P= 0.03). However when asked directly, only 26% of patients quit smoking with another individual and 13% of patients exposed to SHS had at least 1 interested party in joining a SHS cessation program. Conclusions: Elimination of SHS exposure around patients is significantly associated with smoking cessation in lung and HN cancer patients, but few patients quit smoking together with others around them, despite the ‘teachable moment’ with a cancer diagnosis. Clinicians should encourage patients and their household/friends to quit smoking together to improve cessation rates in cancer patients and those around them.
Cetuximab plus radiochemotherapy in locally advanced anal cancer: Interim results of the French multicenter phase II trial ACCORD16.
Authors: E. Deutsch, C. Lemanski, E. Paris, A. Delarochefordiere, I. Martel-Lafay, E. Rio, L. Miglianico, Y. Becouarn, J. Pignon, J. Berille, P. Ezra, D. Azria
Journal: Journal of Clinical Oncology (2011)

4098 Background: The combination of radiotherapy and chemotherapy is a mainstay for anal cancer. Improving local control could avoid mutilating salvage. We evaluate the role of an intensified strategy combining radio-chemotherapy with 5FU-cisplatinum and cetuximab for locally advanced anal cancer in the setting of a multicentric phase II trial. Methods: This study aimed to evaluate the response rate after radiotherapy and a concurrent 5FU-cisplatinum regimen combined to cetuximab. Patients (pts) with locally advanced anal cancer treated by radiotherapy combined to cisplatinum, 5FU and cetuximab. The primary end-point was local response rate 2 months after therapy. Secondary endpoints were progression-free survival, overall survival, colostomy-free survival and safety. A two-step design was used. Results: Between 03/09 and 05/10, 16 patients were included in 7 centers. All patients presented locally advanced tumors (5 extended to the vagina, 1 to the bladder). All were squamous cell carcinoma. Only 8 pts receive both the 6 cetuximab administrations and the two 5FU-cisplatinum cycles. Accrual was suspended after 10 pts after the occurrence of 10 serious adverse events (SAE) in 7 patients of which 6 SUSAR. The protocol was amended : decrease the 5FU and the cisplatinum dose, mandatory IMRT. After accrual of 6 additional pts, 6 SAE in 5 pts. Severe toxicities were: lymphopenia (8 pts), diarrhea (6 pts), fatigue (6 pts), neutropenia (5 pts), acneiform rash (4 pts), thrombopenia (4 pts), hypoNa or K (4 pts); radioepithelitis 3 pts. 3 pts had severe toxicity between 3-6 months follow-up: radio-necrosis pelviperineal (1 pts); mucitis and acneiform rash (1 pts); febrile syndrome (1 pts). After exclusion of the 3 pts with early withdrawal and with a 14 months median follow-up, median PFS is 9 months and one-year survival rate 91%. (local failure (4 pts), metastasis (1 pts). 4 patients had colostomy (2 for local relapse, 2 for fistulisation). Conclusions: The IDMC decided to stop the trial after the first 16 patients for a high rate of toxicity and an insufficient efficacy. This regimen is not recommended combined with RT even in case of locally advanced disease.
Prostate brachytherapy as salvage for local failure after external beam radiation.
Authors: Brian Christopher Baumann, John Charles Baumann, John Paul Christodouleas, Edward M Soffen
Journal: Journal of Clinical Oncology (2016)

125 Background: Local failure (LF) after external beam radiation (EBRT) for prostate cancer is a serious problem. Most patients receive non-curative androgen deprivation therapy (ADT), but there is a subset with LF who are still potentially curable. There is limited evidence to suggest that prostate brachytherapy (BT) is an effective, potentially curative salvage therapy with acceptable toxicity. We hypothesize that salvage BT following EBRT can achieve high rates of biochemical control with acceptable toxicity. Methods: We analyzed 39 consecutive patients treated from 1998-2013 with salvage BT at 2 centers. All patients had pathologically confirmed LF following previous EBRT without distant mets &amp; a disease-free interval of ≥ 18-24 mo. Salvage BT to the whole prostate was delivered to 29 patients using low-dose rate I-125 or Pd-103 seed implants (median dose 100 Gy with Pd-103) while 10 received HDR BT (median 30 Gy in 6 fractions). Cases were planned as if de novo but to a lower dose. 33 (85%) received neoadjuvant and/or adjuvant ADT as part of their salvage therapy. Biochemical failure (BF) was defined using the Phoenix criteria. Risk factor analysis was conducted to identify characteristics that predict BF after salvage BT. Results: For the 39 patients, median PSA at diagnosis was 8.4, and 21 (54%) had high-risk disease. Median EBRT dose was 70 Gy with 11 patients (28%) receiving ADT. Median PSA nadir following EBRT was 0.8 (range 0 – 2.6). Median time to recurrence was 53 mo (range 18 – 150), and median pre-salvage PSA was 4.8. Median follow-up after salvage BT was 60.1 mo (range 7 – 150). Biochemical failure-free survival, DMFS and OS at 5 &amp; 7 yrs were 76% &amp; 67%; 91% &amp; 85% and 92% &amp; 84%, respectively. On univariate analysis, PSA nadir after EBRT &amp; pre-salvage PSA were significant predictors of BF (p&lt; 0.01 for both). On multivariate analysis, only pre-salvage PSA was a significant independent predictor of BF (p&lt; 0.01). Freedom from late grade 3 GU toxicity at 3 yrs was 83%. There were no late Grade 3 GI toxicities. Conclusions: This is the largest series reporting on salvage prostate brachytherapy plus ADT for local-only failures after EBRT &amp; suggests that salvage BT with ADT offers selected patients prolonged disease-free survival with acceptable toxicity.
Significance as a recurrence predictor of postoperative neutrophil-lymphocyte ratio in patients with stage II/III gastric cancer: A retrospective study.
Authors: Hiroaki Tanaka, Kazuya Muguruma, Katsunobu Sakurai, Takahiro Toyokawa, Naoshi Kubo, Masaichi Ohira, Kosei Hirakawa
Journal: Journal of Clinical Oncology (2015)

45 Background: Tumor markers such as carcinoembryonic antigen (CEA) and CA 19-9 are both widely used in the follow up of patients with gastric cancer. However, there are no definitive predictive markers for postopetrative recurrence. It has been reported that preoperative neutrophil lymphocyte ratio (NLR) was associated with prognosis of patients with gastrointestinal cancer. The aim of this study was to examine the impact of postoperative NLR on prediction for postoperative recurrence of gastric cancer. Methods: We retrospective reviewed data from 318 patients with Stage II/III gastric cancer who underwent curative surgical resection followed by adjuvant chemotherapy for between 2006 and 2013. Patients treated with preoperative chemotherapy or multiple cancers were excluded. Results: We found 118 recurrent diseases which mainly included 47 cases with peritoneal dissemination, 27 with distant lymph node metastasis and 24 with liver metastasis. Postoperative NLR was calculated every 6 months and the data at the time of recurrence or last survival were used for analysis. In univariate analysis, histological diffuse type, mascroscopical type 4 cancer, regional lymph node metastasis, lymphatic invasion in primary tumor, tumor diameter, elevated CEA or CA19-9, and elevated NLR were associated with poor prognosis. In multivariate analysis, we found that elevated CA19-9 and NLR were independent predictive markers. Increased NLR was associated with diffuse type, peritoneal dissemination, elevated CEA and preoperative NLR but not with adverse effect of adjuvant chemotherapy. Conclusions: The postoperative NLR might be one of the surrogate markers for recurrence after curative surgery for patients with Stage II/III gastric cancer.
Reasons for delay in time to initiation of adjuvant chemotherapy (AC) for colon cancer (CC).
Authors: David Warren Wasserman, Majdi Boulos, Christopher M. Booth, Wilma Hopman, Rachel Anne Goodwin, James Joseph Biagi
Journal: Journal of Clinical Oncology (2013)

e14553 Background: AC improves survival among patients with colon cancer. Two meta-analyses have demonstrated a decrease in survival with increasing time to AC (TTAC). Here, we examine the predominant factors leading to delay in TTAC. Methods: Individual medical records of 565 patients with CC who initiated AC Aug 2005-Nov 2010 in Eastern Ontario were reviewed to capture patient and treatment characteristics including: medical comorbidities, post-operative complications, the reason if AC was not ordered after initial medical oncology (MO) consultation, dates of surgery, referral to MO, MO consult, central venous catheter (CVC) insertion, and first cycle of AC. Patients were then categorized into two groups: (i) medical/surgical reason for delay (MSRD), defined as post-operative complications or intercurrent illness, and (ii) No MSRD. No MSRD patients were further subcategorized as post-MO delay (PMOD), defined as AC deferred at time of consultation due to patient preference or further investigations required, vs. No PMOD. A multivariate logistic regression model was used to determine factors associated with TTAC &gt; 8 weeks (w). Results: In the No MSRD group (n= 423), 25% (n=107) were subdivided into the PMOD subgroup. On multivariate analysis, TTAC &gt;8w was significantly associated with the presence of a MSRD [OR = 2.4 (1.6-3.9), p = &lt;0.001] or PMOD [OR = 3.3 (1.9-5.6), p = &lt;0.001]. No other significant associations were found, including oral vs. IV AC. Proportion of cases with TTAC &gt;8w in the subgroups were: MSRD 76.1% (n = 108); PMOD 80.4% (n = 86); No PMOD 57.6% (n = 182). Conclusions: MSRD and PMOD are strong predictors of increased TTAC; however, the majority of patients have no MSRD or PMOD. TTAC in this group is 9 weeks. This suggests that TTAC is modifiable, and likely reflects delays in referral, consultation, and chemotherapy booking. [Table: see text]
Phase I/II study of S-1 combined with gemcitabine in elderly patients with advanced non-small cell lung cancer: Thoracic Oncology Research Group (TORG) 0502
Authors: T. Seto, T. Yamanaka, H. Okamoto, T. Ogura, M. Shibuya, Y. Takiguchi, N. Masuda, T. Shinkai, Y. Ichinose, K. Watanabe
Journal: Journal of Clinical Oncology (2008)

19050 Background: Optimal treatment for elderly patients with NSCLC has been under active investigation. This study evaluated the safety and initial efficacy of a novel combination regimen of oral fluoropyrimidine S-1 plus gemcitabine (GEM) for elderly patients (pts) with advanced NSCLC. Methods: A phase I/II study in 11 participating centers examined S-1 plus GEM combination in pts with 70 years of age or older, stage IIIB or IV previously untreated NSCLC. The starting dose was 60 mg/m2/day (days 1 to 14) for S-1 and 800 mg/m2 for GEM (days 8 and 15), with the cycle repeated every 3 or 4 weeks. GEM was increased to 1000 mg/m2 at level 2 and S-1 was increased to 80 mg/m2/day at level 3. Phase II portion of the study assessed the efficacy and tolerability of the combination regimen at the dose determined in the phase I portion. The primary endpoint was objective response rate. Results: Patients were registered in the study between May 2005 and December 2006. A total of 19 evaluable pts were enrolled in the phase I portion: 6 pts on dose level 1, 7 on dose level 2, and 6 on dose level 3. Median age of the phase I cohort was 75 years (range 70–85). Maximum tolerated dose was the level 3 and dose-limiting toxicities at this level included grade 4 neutropenia (2 pts) and grade 3 rush (4 pts). The recommended dose (RD) was determined to be the level 2 of S-1 60 mg/m2/day and GEM 1000 mg/m2, with which 27 pts were subsequently treated in the phase II portion. The median age of 34 pts treated with the RD was 77 years (range, 70–85). Grade 3 or 4 toxicities were neutropenia (12 pts; 6 with grade 4), thrombocytopenia (4 pts; 0 with grade 4), and rush (3 pts; 0 with grade 4). Ten pts (29%; 95% confidence interval [CI], 15–47%) had a partial response and 19 (56%; 95% CI, 38–73%) had a stable disease. The median survival time and 1 year survival rate were 14.2 months and 52%, respectively. Conclusions: Encouraging antitumor activity and safety of S-1 plus gemcitabine support further development of this combination therapy for elderly patients with advanced NSCLC. No significant financial relationships to disclose.
Adjuvant gemcitabine plus docetaxel followed by 5FU chemoradiation for patients with resected pancreaticobiliary cancers: A single institution phase II study.
Authors: May Cho, Andrea Wang-Gillam, Feng Gao, David Linehan, William G. Hawkins, Rama Suresh, Chloe Fournier, Joel Picus, Benjamin Tan
Journal: Journal of Clinical Oncology (2014)

325 Background: Adjuvant chemotherapy with Gemcitabine for six months has improved overall survival (OS) in resected pancreatic cancer compared to observation alone. The RTOG study showed adding gemcitabine to 5FU chemoradiation therapy showed improved OS in pancreatic head cancer patients. We evaluated the feasibility and safety of adjuvant gemcitabine plus docetaxel followed by radiation with 5FU after curative resection of pancreatic and biliary adenocarcinomas at our institution. Methods: Patients with resected pancreaticobiliary cancers were treated with 2 cycles of gemcitabine with docetaxel. Infusional 5FU at was given with 3-D conformal external beam radiation followed 4 weeks later by 2 more cycles of gemcitabine plus docetaxel. The primary objective was to evaluate the feasibility and safety of this regimen with the secondary aims to describe the toxicities, disease-free (DFS) and overall survival (OS) in these patients. Results: 50 patients were enrolled in the study. Median age was 59 with M;F ratio of 1:1.4 and 12% African-American. 30 patients had pancreatic cancer, 8 patients had ampullary cancer and 12 patients had gallbladder cancers. 30 patients completed all therapy. 4 patients withdrew the study due to non-medically related reasons. 7 patients had early disease recurrence. 6 patients withdrew consent due to side effects. 2 were taken off study after developing infection and 1 patient died of viral pneumonia leading into ARDS. Grade 3-4 Non-hematologic toxicities include diarrhea (12%), fatigue (4%), renal failure (2%), hepatic toxicity (4%). Grade 3-4 hematologic toxicities include neutropenia (30%), anemia (2%) and thrombocytopenia (10%). The median OS and DFS in pancreatic cancer is 17 and 9 months. The OS and DFS in ampullary cancer and gallbladder cancer is 27 and 14.4 months respectively. Conclusions: Adjuvant gemcitabine plus docetaxel followed by concurrent 5FU-CRT is feasible and tolerable. However, outcomes for pancreatic cancer patients appeared to be inferior compared to CONKO and RTOG studies. This regimen may be a reasonable adjuvant option for high risk biliary tract cancers. Clinical trial information: NCT00660699.