tbuckley/cabot-search huggingface dataset:
Effect of ProSpare (PS), a rectal obturator, on inter- and intrafraction prostate motion and anorectal doses in prostate radiotherapy (RT).
Authors: Julia Murray, Helen McNair, Emma Alexander, Tuathan O'Shea, Karen Thomas, Simeon Nill, Sarah Gulliford, David P. Dearnaley
Journal: Journal of Clinical Oncology (2016)

e633 Background: PS is a single use, self-insertable endorectal device designed as a daily image-guidance tool for prostate cancer RT. Rectal filling is a significant factor in prostate motion. We investigated the effect of PS on inter- and intrafraction prostate motion and its effect on anorectal dosimetry. Methods: 19 patients with localized prostate cancer were randomized to receive prostate RT with PS either in the 1st or 2nd half of treatment. For each patient two planning CT scans were acquired, without and with PS. Contours were delineated by one physician and planned with a forward multi-segment technique to a dose of 74Gy/37F. Dose surface histograms were created (VODCA). In all patients, 3 electromagnetic transponders (EM) were implanted into the prostate and daily online image-guided RT was performed using either cone-beam CT (Elekta) or Calypso–based localization with tracking. Interfraction systematic (Σ) and random (σ) errors were estimated for bone matching without and with PS using EM position as reference. CTV-PTV margins were generated using the Van Herk formula. In-house code was used to analyse intrafraction motion recorded by Calypso of the EM centroid in the RL, SI and AP planes for individual fractions. A 2-way ANOVA test (SPSS v22) was used to determine if PS had an effect on maximal intrafraction prostate displacement. Results: See Table. Conclusions: PS affects the dosimetric pattern to the anal canal and rectum and this may impact GI toxicity. Also, PS stabilizes the prostate, which could enable reduced planning margins. PS will now be assessed in post-prostatectomy RT within a randomized controlled trial, POPS. Clinical trial information: 11814. [Table: see text] [Table: see text] [Table: see text]
Clinicopathologic features of patients with breast cancer under teatment of bisphosphonate at the time of diagnosis: Retrospective analysis.
Authors: D. S. Dede, C. Arslan, S. Aksoy, O. Dizdar, E. Dogan, A. Alkan, I. H. Gullu, Y. Y. Ozisik, K. Altundag
Journal: Journal of Clinical Oncology (2011)

e11016 Background: Addition of zolderonic acid to neoadjuvant chemotherapy provided a significant tumor shrinkage compared to neoadjuvant chemotherapy alone was shown in AZURE trial. We aimed to compare the clinicopathological features of breast cancer patients under treatment of bisphophonates due to osteoporosis with an age match control group, retrospectively. Methods: The data of 1127 patients followed at our center between years 2004 – 2009 were analyzed retrospectively. Patients were taking bisphosphonates at least for 6 months (n=35) and never used bisphoshonates (n=140) were matched according to age. Median age at diagnosis, histopathological parameters, and menopausal status were analysed. Results: A nuber of 175 patients were included to the study. Median age of diagnosis was 57 (min-max: 33-77). Median ages were similar in patients bisphosphate receiving or not. The number of patients at stage T1 were higher in bisphosphonate teated group than not treated (42,4 vs 24,6%, p=0,12). Similarly, number of patients at stage N3 were lower in bisphosphonate receiving compared to none receiving (5,9 vs 18,3%, p=0.13). Number of patients at stage III and IV were higher in bisphosphonateun-treated (41,4 vs 33,4%, p=0.42). Estrogen receptor (ER) positivity were more frequent in oral bisphosphonate treated group (87,9 vs 69,4, p=0.047). There were no statistical differences in menopausal status at the time of diagnosis, histopathological subtypes and grade, lymphovascular and perineural invasion, extracapsular extension, progesteron and HER2 receptor positivity and body weights between groups receiving bisphosphonates or not. Conclusions: Breast cancer patients receiving oral bisphosphonates due to osteoporosis were shown to be diagnosed at earlier stages. This finding might be related with more frequent participation of oral bisphosphonate receiving patients to screening programs and aggravation of soft tissue calcification due to bisphosphonates. Furthermore question remains about the higher frequency of ER positivity in bisphosphonate receiving patients if it was related with bisphosphonate treatment or etiopathogenesis of osteoporosis.
Stereotactic body radiation therapy versus high-dose conventional radiation therapy in early-stage NSCLC: A retrospective study on local failure and survival rates.
Authors: S. Jeppesen, T. Schytte, H. R. Jensen, C. Brink, O. Hansen
Journal: Journal of Clinical Oncology (2011)

7049 Background: To compare differences in local control rates, overall survival rates and disease-free survival rates for medically inoperable patients, in performance status 0-1 vs. 2, with early non small cell lung cancer (NSCLC) treated with Stereotactic body radiotherapy (SBRT) or conventional radiotherapy (RT) at our centre. Methods: From September, 2005 to December, 2009, 51 medically inoperable patients were treated with SBRT. 3 fractions (F) of 15 Gy. Planned treatment duration was 9 days. 31 medically inoperable patients were treated with conventional RT with 80 Gy/35-40F in the period of February, 1999 through December, 2004. We used 3-D conformal radiotherapy. The prescribed dose was 80 Gy in 35-40F to cover 95% of the PTV. All tumors were histological or cytological proven NSCLC T1-2N0M0. Results: The potential median follow-up time was 28.9 months for the SBRT group vs. 111.3 months in the conventional RT group. The median overall survival (mOS) for patients in PS 0-1 was 39.4 months vs. 30.9 months for SBRT and conventional RT respectively (p = 0.04) and for patients in PS=2 mOS was 25.3 months vs. 8.8 months (p=0.24). Disease free survival rates for patients in PS 0-1 at 1 year and at 3 years were 100% vs. 95.2% and 84.8% vs. 73.6%, SBRT and conventional RT respectively (p = 0.21) and for patients in PS=2 87.8% vs. 64.8% at 1 year and 43.4% vs. 32.4% at 3 years (p=0.30). Local failure free rates at 3 years in were in PS 0-1 group 85.8% vs. in 54.9% PS=2 group (p=0.092). SBRT PS 0-1 local failure free rates of 93.4% vs. 77.1% in the conventional group (p=0.21). For PS=2 66.5% vs. 50%, SBRT vs. conventional RT (p=0.85). In a Cox analysis only female gender and PS 0-1 were significant factors while stereotactic treatment was of borderline significance (p=0.056). Conclusions: SBRT offers excellent local control and survival superior to high-dose conventional RT in patients with good PS. SBRT is a cost-effective treatment and is the more convenient treatment for the patients.
Monitoring treatment wait times for cancer patients in Japan.
Authors: Yukiko Watanabe, Momoko Iwamoto, Takahiro Higashi
Journal: Journal of Clinical Oncology (2014)

289 Background: Treatment wait times for cancer patients is among the key performance indicators of cancer policy in Japan, but has never been measured across a large number of patients. We aimed to measure treatment wait times for cancer patients across a large number of hospitals in Japan using health claims data. Methods: We developed a database of claims data (Jan 2011 - Dec 2012) linked to 2011 hospital-based cancer registry data of breast, cervical, colorectal, liver, lung, prostate and stomach cancer patients from 126 designated cancer hospitals in Japan. Treatment wait time was defined as the number of days between the date of diagnosis (the date on which a pathological test or imaging exam that contributed the most to the diagnosis was performed) and initiation of treatment. Dates of diagnostic tests, therapeutic procedures, and chemotherapy (chemo) administration were obtained from health claims data. We calculated wait times by cancer type, treatment, and stage, and investigated if these factors were significantly associated with wait times even after adjusting for age using multiple linear regression. Results: Among 44,102 cancer patients who received cancer treatment, the median wait time was 31 days (IQR=18-50) for all patients, and 32, 42, 31, 22, 22, 55 and 31 days for breast, cervical, colon, liver, lung, prostate and stomach cancer patients, respectively. Wait times were longer for surgery (36 days) compared to radiation (22 days) and chemo (21 days), and shorter for later stage patients: 48, 36, 35, 23, and 14 days for stages 0, I, II, III, and IV, respectively. Cancer type, treatment type, and stages were all independently and significantly associated with treatment wait times even after adjusting for age (p&lt;0.05). Conclusions: This is the first study to investigate treatment wait times across a large number of cancer hospitals in Japan. Treatment wait times were particularly longer for cervical and prostate cancer patients. While the effect of prolonged treatment wait times on clinical outcomes is unknown, longer treatment wait time increases the psychosocial stresses of cancer patients. Continuous monitoring and feedback of study findings to hospitals are required for improvements in the future.
Impact of Infusion Rate on the Early Engraftment Following Allogeneic Intra Bone Marrow Infusion of Hematopoietic Stem Cells in a Canine DLA-Identical Reduced Intensity Transplantation Model
Authors: Stephanie Schaefer, Juliane Werner, Sandra Lange, Katja Neumann, Christoph Machka, Hugo murua Escobar, Catrin Roolf, Gudrun Knuebel, Iris Lindner, Heike Vogel, Mathias Freund, Christian Junghanss
Journal: Blood (2015)
Utilization and contemporary results of renal mass biopsy.
Authors: David Cahn, Caitlin Lim, Rosaleen Parsons, Benjamin T. Ristau, Alexander Kutikov, David Y. T. Chen, Richard Evan Greenberg, Rosalia Viterbo, Marc C. Smaldone, Robert G. Uzzo
Journal: Journal of Clinical Oncology (2016)

623 Background: Renal mass biopsy (RMB) for localized renal masses (RM) is being re-evaluated to improve risk stratification and minimize morbidity from over-treatment. We review our institutional experience with RMB to identify performance characteristics and highlight opportunities to improve management. Methods: Using our prospectively maintained database, we identified patients who underwent core RMB +/- fine needle aspiration (FNA). We describe performance characteristics and assess pathologic concordance. Using the University of Michigan (UM) algorithm, we reviewed the potential that RMB influenced therapeutic decision-making. Results: We noted 374 RMBs performed from 1999-2015 (66% within last 5 years). Core RMB (+/- FNA) was performed in 65.2% (244/374) of cases, of which 41% (99/244) underwent surgical resection. Initial core RMB was non-diagnostic in 9% (9/99) of surgical cases and subsequently diagnosed with RCC. RCC diagnosed on core RMB that underwent surgical resection demonstrated histologic and grade concordance of 94.3% and 62.5%. All discordant grades were upgraded at surgery. 11% of all RMB were benign and no surgical intervention occurred. In our cohort, 19% of all RMB patients treated surgically had tumors classified as favorable or intermediate &lt; 2cm using the UM algorithm and might otherwise have been candidates for AS. Conversely, 42% of all surgically treated patients had UM favorable characteristics but had tumors &gt; 4cm and therefore underwent surgical resection based on size criteria in the context of RMB results. Conclusions: RMB is effective in the evaluation of RM with minimal morbidity. Our histologic/grade concordance is consistent with published data and underscores that RMB harbors clinical uncertainties. Clinical management pathways incorporating RMB may decrease over-treatment but also may risk under-treatment based on poor grade concordance. Using the UM algorithm, 30% of lesions in our cohort were AS candidates after RMB (over-treatment risk). Conversely, 18% of surgically treated lesions were UM AS candidates after RMB and upgraded on final pathology, demonstrating the risk of under treatment. RMB may be considered in patients where results would influence clinical decision-making.
Long-term outcomes after bladder-preserving combined-modality therapy for patients with muscle-invasive bladder cancer.
Authors: Nicholas J Giacalone, Rebecca Helen Clayman, William U. Shipley, Andrzej Niemierko, Niall M. Heney, M Dror Michaelson, Francis J. McGovern, Donald S. Kaufman, Anthony L. Zietman, Jason A. Efstathiou
Journal: Journal of Clinical Oncology (2016)

398 Background: Transurethral resection of bladder tumor (TURBT), chemotherapy (CT), and radiation therapy (RT) is an established treatment paradigm for muscle-invasive bladder cancer (MIBC). Herein we report long-term outcomes for MIBC patients treated with combined-modality therapy (CMT). Methods: We analyzed 465 patients with MIBC (cT2-T4a) treated on successive protocols at a single center between 1986 and 2012. Patients underwent TURBT followed by concurrent cisplatin-based chemoradiation (CRT). A subset of patients received neoadjuvant CT. Repeat cystoscopy was performed after 40 Gy. Patients with a complete response (CR) received consolidation CRT to 64-65 Gy, while those with less than a CR or invasive recurrence were recommended to undergo salvage RC. Overall survival (OS) and disease-specific survival (DSS) were evaluated using Kaplan-Meier method and Cox proportional hazards regression. Results: Median follow-up was 4.8 years for all patients and 7.5 years for surviving patients. CR to induction CRT was achieved in 76% patients; 84% of patients with a complete TURBT achieved a CR vs. 59% with an incomplete TURBT, p&lt; 0.001. When evaluated in four-year intervals, the CR rate improved from 64% in 1986-1990 to 96% in 2010-2012. Salvage RC was performed in 125 patients (27%), 55 for less than CR and 70 for superficial or invasive recurrence. Among patients with a CR, the 10-year actuarial rates for non-invasive, invasive, pelvic, and distant failure were 32%, 16%, 14%, and 29%, respectively. Median OS was 6.4 years. Five- and 10-year OS rates were 57% and 39% (T2 = 66%, 46%; T3-T4a = 41%, 26%), respectively. Five- and 10-year DSS rates were 66% and 59% (T2 = 75%, 66%; T3-T4a = 50%, 45%), respectively. In multivariate analyses, T2 disease (vs. T3-4; HR 0.55, 95%CI 0.40-0.76) and CR to induction therapy (HR 0.40, 95%CI 0.28-0.55) were significant predictors for improved OS. Age was not associated with DSS (HR 1.01, 95%CI 0.99-1.03). Conclusions: These data support the high rates of CR and bladder preservation in patients receiving CMT, and demonstrate long-term DSS similar to modern cystectomy series. CMT should be considered as an alternative treatment strategy for selected patients with MIBC.
Pattern of utilization of pegfilgrastim in chemotherapy patients: A retrospective analysis of prescription.
Authors: M. Valera Rubio, A. R. Rubio Salvador, J. M. Martinez Sesmero, J. I. Chacon, P. Moya Gomez
Journal: Journal of Clinical Oncology (2011)

e16628 Background: Pegfilgrastim is a long-acting granulocyte colony-stimulating factor (G-CSF) used to reduce the duration of neutropenia and the incidence of febrile neutropenia in patients treated with cytotoxic chemotherapy (CT) for malignancy. This study examined use patterns of pegfilgrastim in our community according to ESMO and ASCO evidence-based recommendations. Methods: We retrospectively analysed pharmacy and medical claims data on patients with cancer treated with CT and pegfilgrastim. The study population included all patients diagnosed with cancer who had received treatment with pegfilgrastim between September 1, 2010, and September 15, 2010. Patients were identified based on their filling prescriptions for pegfilgrastim. Age, sex, diagnosis, cycles of CT and radiotherapy treatment received and white cell counts before pegfilgrastim administration were analysed. Results: We identified 38 patients (55.3% women), median age was 62 years (42.1%>65 years), 36.8% were stage III and 63.2% were stage IV (47.4% breast cancer, 26.3% lung cancer, 26.3% other location). A total of 60.5% of patients were in CT treatment for a first-line (2nd: 26.3%, 3rd: 10.5%, 4th: 2.7%). The number of patients who received pegfilgrastim after the first cycle of CT was 71.1% (13.2% after the 2nd,10.5% after the 3rd, 5.2% after the 4th or 5th cycle). Concomitant radiotherapy was received by 13.2% of patients and 34.2% had previously received CT or radiotherapy. Neutropenia was recorded in 21.1% of patients before treatment with pegfilgrastim. At least one episode of febrile neutropenia had appeared in the past in 13.2% of patients. A total of 94.7% of patients received pegfilgrastim within the first 24 hours after the last day of CT. Prescriptions of 28.9% of patients were adhered to ESMO and ASCO evidence-based recommendations and prescriptions of 26.4% of patients were only appropiate to ASCO recommendations. Conclusions: From this small experience, it appears that pegfilgrastim is prescribed for more situations than recommended by international societies of clinical oncology. A prospective well designed study in a larger number of patients is warranted to study indications and prescriptions in our community.
Identification of patients at risk for delirium on a medical oncology hospital ward.
Authors: Elisabeth Neefjes, Maurice Van Der Vorst, Bertha Verdegaal, Aartjan TF Beekman, Johannes Berkhof, Henk M. W. Verheul
Journal: Journal of Clinical Oncology (2014)

130 Background: Delirium is a distressing experience for patients with cancer. Incidence rates of delirium vary between 5 and 88 percent. We studied the incidence of delirium on our medical oncology ward, along with its predisposing and precipitating factors, in order to identify patients who may benefit from screening and early interventions. Methods: We evaluated patients admitted to our medical oncology ward between January 2011 and June 2012 for delirium. In this period a screening program with the Delirium Observation Screening Scale was initiated. Risk factors for delirium were extracted from the patient’s chart. We developed a prediction model to identify patients who are at risk to develop delirium and optimized this model with a cohort of patients with a delirium diagnosed between June 2012 and September 2013. Results: 1,733 admittances of 574 individual patients were recorded in the study period. Sixty episodes of delirium were identified in 52 patients. The patients had a mean age of 60 years, and most patients (70%) had advanced cancer. The most prevalent predisposing and precipitating factors were age &gt;70, drug intoxication, infection and metabolic imbalances (abnormalities in sodium, potassium, calcium, albumin or glucose levels), which were present in 21, 25, 22, and 18 percent, respectively. The prediction model revealed that patients who were electively admitted had a very low risk to develop delirium (1%), but patients admitted for an emergency with at least one metabolic abnormality, such as hyperkalemia, were at high risk for developing a delirium (delirium risk 33%). Conclusions: Based on our analyses for risk factors of delirium, we developed a new prediction model for the risk for delirium in patients with cancer admitted to an oncology ward that may be used for targeted screening and to study preventive therapy in order to improve their quality of life.
Laser versus electrical en bloc resection of bladder tumors: Results of a European multicenter study (EBRUC).
Authors: Mario W. Kramer, Alexey Martov, Nikolay Baykov, Jan Klein, Jens J. Rassweiler, Lukas Lusuardi, Guenter Janetschek, Rodolfo Hurle, Mathias Wolters, Mahmoud Abbas, Armin Leitenberger, Markus Riedl, Udo Nagele, Axel S. Merseburger, Markus A. Kuczyk, Marek Babjuk, Thomas R. W. Herrmann
Journal: Journal of Clinical Oncology (2015)

310 Background: The quality of transurethral resection of bladder tumors strongly determines patient’s tumor after-care and prognosis. En bloc resection of bladder tumors (ERBT) might improve staging quality, perioperative morbidity and influence tumor recurrence. This is the first European multi-center study which was initiated by ESUT and was conducted to evaluate the safety, efficacy and recurrence rates of electrical vs. laser ERBT. Methods: Transurethral ERBT was performed on 221 prospectively collected patients in six academic centers with either monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative/surgical parameters and 12 months follow-up data were analyzed. Results: 156 and 65 patients were treated with electrical and laser ERBT, respectively. Median tumor size was 2.1 cm with biggest up to 5 cm. Detrusor muscle was available in 97.3%. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3% vs. 1.5%, p&lt;0.001). Median operation duration (25 min), postoperative irrigation (1 day) and catheterization time (2 days) as well as hospitalization (3 days) were similar in both groups. Overall complication rate was low (Clavien ≥3, n=6 (2.7%)). Hemoglobin was significantly more decreased after electrical ERBT (p=0.0013), however overall hemoglobin loss was not clinically relevant (0.38 g/dl). 148 patients with first diagnosis of urothelium carcinoma of the bladder were followed for 12 months of which 33 (22.3%) recurred. 63.6% of recurrences occurred out of the ERBT resection field. No difference was noticed between both ERBT groups. Conclusions: ERBT is safe and reliable regardless of the energy source used and offers high quality resections of tumors &gt;1 cm. Recurrence rates did not differ within both groups although the majority of recurrences were noticed out of the ERBT resection field. Laser device might be an alternative for the treatment of patients with higher risk of postoperative bleeding due to its efficient hemostatic effect.