tbuckley/cabot-search huggingface dataset:
Is neoadjuvant chemoradiation important in borderline resectable pancreatic cancer (BRPC)? Clinical and surgical outcomes associated with preoperative FOLFIRINOX alone in BRPC.
Authors: Sunhee S. Kim, Eric K. Nakakura, Zhen J. Wang, Grace E. Kim, Carlos U. Corvera, Hobart W. Harris, Kimberly S. Kirkwood, Ryutaro Hirose, Margaret A. Tempero, Andrew H. Ko
Journal: Journal of Clinical Oncology (2016)

351 Background: Neoadjuvant therapy is recommended to increase the likelihood of margin-negative (R0) resection for BRPC. However, there is no consensus regarding the optimal treatment paradigm, including the respective roles of chemotherapy and radiation (RT), in this setting. Methods: Retrospective analysis was conducted of BRPC pts treated with neoadjuvant FOLFIRINOX followed by surgical resection at a single tertiary care referral center over a 4-year period. Data collected included baseline pt characteristics, toxicity profiles, radiographic and serum CA19-9 response, perioperative complication rate, R0 resection rate, histopathologic response, and frequency and patterns of recurrence. Results: 26 BRPC pts received neoadjuvant FOLFIRINOX, 22 w/o addn RT. Abutment of the SMV (n = 9, 40.9%), SMA (n = 4, 18.2%), CHA (n = 4, 18.2%), and narrowing of the SMV (n = 4, 18.2%) were the most common vascular involvement. 9 (40.9%) pts had both arterial and venous involvement. Median baseline CA19-9 level was 278.5 U/ml. Pts received a median of 9 treatment cycles (range, 4-12). Radiographic response was categorized as shrinkage (n = 11, 50%), stable (n = 9, 40.9%), or progression (n = 2, 9.1%). The Whipple procedure was the most common operation performed (n = 17, 77.3%), with 12 pts (54.5%) requiring vascular reconstruction. Clavien-Dindo complication rates of grade 0, I, II, and IIIa occurred in 25.9%, 11.1%, 44.4%, and 14.8% of pts, respectively. R0 resection rate was 90.9%, with 13 (59.1%) having negative lymph nodes. Treatment response of Evans grade III or IV, corresponding to &lt; 10% residual tumor cells, was seen in 8 pts (36.4%), including one pathologic CR (4.5%). AJCC Stage: ypT3N0 (36.4%), ypT3N1 (18.2%), ypT1N1 (18.2%). With a median f/u time of 22.1 months, 8 pts (36.4%) have progressed, inc 7 (87.5%) with distant disease. Median PFS is 22.5 mos. Conclusions: This is one of the largest series to report on the use of neoadjuvant chemotherapy w/o RT in BRPC pts. FOLFIRINOX alone in this setting is associated with high R0 resection rates and favorable clinical outcomes, and should be further assessed in prospective study design for BRPC.
Phase II trial of neoadjuvant axitinib in patients with locally advanced nonmetastatic clear cell renal cell carcinoma.
Authors: Jose A. Karam, Catherine E Devine, Diana L Urbauer, Marisa Lozano, Kamran Ahrar, Pheroze Tamboli, Nizar M. Tannir, Christopher G. Wood
Journal: Journal of Clinical Oncology (2014)

441^ Background: Previous studies have shown minimal impact of tyrosine kinase inhibitors on primary renal tumors. In this phase II trial, we investigate the safety and role of the axitinib in downsizing tumors in patients with non-metastatic clear cell renal cell carcinoma (RCC) prior to surgical resection. Methods: Patients with clinical stage T2-T3b N0 M0 biopsy-proven RCC were eligible for this study. Patients received axitinib daily for 12 weeks prior to surgery. The primary outcome was objective response rate. Secondary outcomes included safety, tolerability, feasibility of administration of axitinib and quality of life (using FKSI-15). A dedicated radiologist independently reviewed all CT scans to evaluate for response using RECIST. Results: Twenty-four patients were treated between 2011 and 2013. All patients had biopsy-proven clear cell RCC. Twenty-three patients continued axitinib for 12 weeks, and underwent surgery as planned without delay. One patient stopped treatment before 12 weeks due to adverse events (AEs) and was taken to surgery early. Median reduction of primary renal tumor size was 28.3% (range 5.3-42.9%). Eleven patients (45.8%) experienced a partial response by RECIST, and 13 patients had stable disease. There was no progression of disease while on axitinib. The most common AEs were hypertension, fatigue, oral mucositis, hypothyroidism, and hand-foot syndrome. No grade 4 AEs were observed. Intraoperatively, no complications or unusual bleeding were encountered. Postoperatively, 2 grade 3 and 13 grade 2 complications were noted, while no grade 4 or 5 complications occurred. FKSI-15 did change over time (p &lt; 0.0001), with quality of life worsening in comparison to the screening assessment by week 7 (p = 0.0004). However, by week 19, quality of life was not found to be statistically different from screening (p = 0.3344). Conclusions: Axitinib was clinically active and well tolerated in the neoadjuvant setting in patients with locally advanced non-metastatic ccRCC. Clinical trial information: NCT01263769.
ACRIN 6688 phase II study of fluorine-18 3′-deoxy-3′ fluorothymidine (FLT) in invasive breast cancer.
Authors: P. R. Jolles, L. Kostakoglu, H. D. Bear, M. O. Idowu, K. A. Kurdziel, L. Shankar, D. A. Mankoff, F. Duan, D. L'Heureux
Journal: Journal of Clinical Oncology (2011)

TPS125
Increased rates of hypertension (HTN) among patients with advanced carcinoid treated with bevacizumab
Authors: J. E. Mares, S. Worah, S. V. Mathew, C. Charnsangavej, H. Chen, J. A. Ajani, P. M. Hoff, A. T. Phan, J. C. Yao
Journal: Journal of Clinical Oncology (2005)

4087 Background: HTN is associated with VEGF inhibition. Frequency of CTCv2 G3/4 HTN with bevacizumab (BVZ) therapy was reportedly 11–21% (Hurwitz, NEJM 2004; Yang, NEJM 2003). We conducted a phase II trial on which patients with advanced carcinoid tumors were treated with BVZ (15mg/kg q21 days) and noted an increased rate of HTN. Methods: 44 patients on a stable dose of octreotide were randomly assigned to therapy with BVZ or PEG interferon alpha-2b (PEGI) for 18 weeks. After 18 weeks, patients received both drugs. 38 patients were evaluable for blood pressure (BP) control. HTN therapy failure was defined by need for addition or change in drug, treatment delay, or hospitalization for BP control. Results: 17 patients (9 BVZ arm, 8 PEGI arm) had history of baseline HTN. 7 patients developed new onset HTN while onstudy. 13/17 patients with baseline HTN required either dose escalation or addition of a new drug. An increased rate of G3/4 HTN was noted in BVZ arm compared to the PEGI arm during 18 weeks of monotherapy (CTCv2, 68% vs 21%; P<.05) (CTCv3, 53% vs 16%; P<.05). The G3/4 HTN rate including periods of therapy with both drugs is 63% by CTCv2 and 53% by CTCv3. Only 2 of these patients had G4 HTN and discontinued therapy. 4 patients developed proteinuria > 2 gm/24hrs (reversible with dose delay). All of these patients developed G3/4 HTN. Various HTN regimens were used initially (3 beta blocker, 1 alpha blocker, 1 diuretic, 13 Ca channel blocker, 2 ACE inhibitor, 1 A2RB, 1 diuretic/beta blocker, and 2 Ca channel blocker/ACE inhibitor). No significant change in renal BF was observed among 7 patients assessed by functional CT. Rates of HTN therapy failure were 50% for nifedipine and 78% for other regimens. Conclusions: Patients with carcinoid, especially those with history of HTN, are more likely to develop G3/4 HTN following BVZ therapy. HTN can be controlled in most patients but may require multiple agents. Further investigation into the mechanism and optimal therapy of BVZ associated HTN is warranted. No significant financial relationships to disclose.
Reliability of magnetic resonance imaging (MRI) to determine the grade (high versus low) of extremity fatty tissue tumors.
Authors: C. Valverde
Journal: Journal of Clinical Oncology (2010)

e20504 Background: Soft tissue tumors are a heterogeneous group of malignancies, ranging from low growing benign tumors to highly aggressive malignancies. Clinical, radiological and pathologic findings are used to correctly classify them in order to help to plan the local surgery properly. Tumor grade is one of the most important pathologic information for prognosis and treatment planning. In the present study we will evaluate the reliability of MRI to determine the grade of extreminity fatty tissue tumors. Methods: Between January 2000 and June 2009, 32 patients with fatty tissue tumors arising in the extremity, with preoperative MRI available, were included. MRI reports were reviewed: percentage and characteristics of the fatty and non-fatty components were used to classify the tumors in high or low grade. Fisher's exact test was used to correlate MRI with pathologic findings of the surgical sample and the presurgical biopsy. Results: MRI correctly classified 87.5% of tumors (Fisher's exact test p<0.00002). All 4 misclassified cases were low grade tumors incorrectly classified as high grade. In 3 of these 4 cases the presurgical biopsy correctly reclassified the tumor. Conclusions: MRI could avoid the performance of a presurgical biopsy in the fatty tumors of the extremity classified as low grade tumors, without detriment to the oncologic result. However, presurgical biopsy is still mandatory in the tumors classified as high grade. No significant financial relationships to disclose.
High-risk group for locoregional recurrence in patients with stage IB-IIB squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy.
Authors: M. Hirakawa, Y. Nagai, T. Toita, W. Kudaka, M. Inamine, K. Ogawa, S. Murayama, Y. Aoki
Journal: Journal of Clinical Oncology (2010)

e15519 Background: To identify predictive factors for locoregional recurrence in patients with FIGO stage IB-IIB cervical cancer treated with concurrent chemoradiotherapy (CCRT). Methods: We analyzed 123 patients with FIGO stage IB-IIB squamous cell carcinoma of the cervix treated with CCRT between 1997 and 2007 at University of the Ryukyus Hospital. Eligibility for CCRT included tumor size larger than 4 cm and/or lymph node enlargement over a minimum diameter of 1 cm. Patients with para-aortic lymph node enlargement were excluded. The dose of external beam radiotherapy was 50 Gy, and high-dose rate intracavitary radiotherapy was delivered with a fraction dose of 6 Gy for three times. Patients received cisplatin 20 mg/m2 for 5 days every 3 weeks. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier method. Cox proportional hazard model was used for multivariate analysis. Results: The median age and follow-up period were 47 years (range: 25–70 years) and 51 months (range: 8–125 months), respectively. The 5-year OS and DFS of the patients were 82.7% and 74.3%, respectively. Thirty of 123 patients were diagnosed as having recurrent tumor, in which 15 patients had distant failure, two patients had both distant and locoregional failure, and the remaining 13 patients had locoregional recurrence. Tumor size (5.2 cm and larger) and age (under 48 years) were independent predictive factors for locoregional recurrence by multivariate analysis (OR [95% CI]; 5.8 [0.12–1.46], p = 0.01, and 9.3 [0.34–2.60], p = 0.002, respectively). Based on these two factors, the patients could be divided into low-risk (n 91) and high-risk (n = 32) groups for locoregional recurrence. The 5-year PFS for the low-risk group was 95.3%, which was significantly better than the high-risk group (65.5%, p < 0.0001). Locoregional recurrence occurred in 10 of 32 high-risk patients, and there were only 4 locoregional recurrences in the 91 low-risk patients. Conclusions: To improve locoregional control in the high-risk patients, it may be worthwhile to consider CCRT using new radiosensitizing agents, adjuvant hysterectomy or adjuvant chemotherapy. No significant financial relationships to disclose.
Motivation and mortality in geriatric patients with early stage breast cancer.
Authors: Clark DuMontier, Kerri Clough-Gorr, Rebecca A Silliman, André Moser
Journal: Journal of Clinical Oncology (2015)

105 Background: Evidence suggests that an older patient’s motivation and life outlook are associated with health outcomes. A measure of motivation called the Getting Out of Bed Scale (GOB) was previously validated in a cohort of geriatric patients with early stage breast cancer. The aim of our project was to assess the association between GOB and mortality, both all-cause and breast-cancer specific, using the same dataset. Methods: We evaluated 660 women ≥ 65-years old diagnosed with stage I-IIIA primary breast cancer in four geographic regions in the US. Data were collected over ten-years of follow-up from consenting women’s medical records, telephone interviews, National Death Index, and Social Security Death Index. To address attrition bias, a multiple imputation approach using two-fold fully conditional specification was used to generate a complete dataset and allow for sufficient power in our statistical testing. Results: Using this dataset, a cox regression survival analysis found no significant association between GOB and mortality, both all-cause [5 years HR (95% CI): 0.76 (0.50,1.15), 10 years: 0.77 (0.59, 1.01)] and breast-cancer-specific [5 years: 0.92 (0.48, 1.73), 10 years: 0.84 (0.53, 1.33)]. This observation held true even after adjustment for other validated health-related quality of life measures of mental health, physical functioning, and socioeconomic status. Notably, patients with high mental health scores as measured by the Mental Health Index Short Form had significantly lower mortality, both all-cause [5 years: 0.42 (0.27, 0.65), 10 years: 0.59 (0.44, 0.79)] and breast-cancer specific [5 years: 0.42 (0.20, 0.90), 10 years: 0.52 (0.31, 0.89)]. Conclusions: These results suggest that GOB does not predict mortality in geriatric patients with early stage breast cancer; however, more research is needed to assess hope and outcomes in geriatric cancer patients. This study would not have been possible without the multiple imputations approach, which allows for greater power in researching longitudinal datasets that would otherwise suffer from loss to follow up.
Communities of practice: A jurisdictional approach to improving the quality of care in radiation medicine in Ontario.
Authors: Elizabeth Lockhart, Michelle Ang, Lindsay Elizabeth Reddeman, Michael Sharpe, Margaret Hart, Carina Simniceanu, Stephen Breen, Joon-Hyung J. Kim, Dani Scott, Khaled Zaza, David D'Souza, Michael F. Milosevic, Stewart Gaede, Andrea Marshall, Brian P Yaremko, Katharina Sixel, Nicole Harnett, Eric Gutierrez, Padraig Richard Warde
Journal: Journal of Clinical Oncology (2016)

122 Background: The Radiation Treatment Program (RTP) at Cancer Care Ontario (CCO) established several Communities of Practice (CoPs), with the goal of improving radiation treatment (RT) quality and safety. The RTP identifies variation in practice and quality improvement (QI) opportunities in the 14 Regional Cancer Centres (RCCs) and facilitates the development of CoPs to share best practices and standardize care. Methods: Since 2010, the RTP has formed 7 CoPs ( &gt; 185 members in total): 4 intra-disciplinary (Radiation Therapy, Medical Physics, Advanced Practice Radiation Therapy, Radiation Safety) and 3 inter-disciplinary (Head and Neck (HN), Gynecological (GYNE) and Lung Cancer). Members are recruited with the aim of securing engagement from all RCCs to ensure representation of regional diversity and to facilitate adoption of best practices. CoPs are supported with nominal funding and resources provided by CCO, but are led and driven by members, who identify and prioritize key quality issues and select corresponding QI projects to pursue. The RTP performs regular evaluation activities to assess initiative engagement and impact. Results: RTP CoPs have enhanced the quality and safety of RT delivery in Ontario through QI initiatives, advice documents and tools that have enabled: Improved RT safety (use of safety straps in RT delivery); Adoption of best practices (RT plan evaluation guidance); Education and knowledge transfer – (stereotactic body RT implementation and training framework); and Support for infrastructure improvements (recommendation for additional Magnetic Resonance-guided brachytherapy units) ( https://www.cancercare.on.ca/ocs/clinicalprogs/radiationtreatment/ ). Advice documents have improved alignment with recommended practice (40% and 50% absolute increases in two HN initiatives). Evaluation surveys indicate that members believe the CoPs have enhanced inter-regional communication and collaboration (89%), knowledge transfer/exchange (91%), and professional networking between RCCs (92%). Conclusions: CoPs can be a highly effective model for improving quality of care. The establishment of CoPs should be considered for QI in other areas of the healthcare system.
Salvage stereotactic radiosurgery (SRS) after previous whole-brain radiation therapy (WBRT) for breast cancer brain metastases: Outcomes and prognostic factors including tumor phenotype.
Authors: P. J. Kelly, N. U. Lin, E. B. Claus, S. E. Weiss, B. M. Alexander
Journal: Journal of Clinical Oncology (2011)

581 Background: Salvage SRS is often considered in breast cancer patients (pts) previously treated with WBRT for brain metastases. The goal of this study was to analyze clinical outcomes and prognostic factors for survival in the salvage setting. Methods: We retrospectively examined all breast cancer pts who underwent SRS at DF/BWCC between 2000 and 2010. We identified 79 consecutive female pts who received salvage SRS (interval of > 3 months after initial therapy), 76 of whom (96%) received prior WBRT. Overall survival (OS) and CNS progression-free survival was calculated from the date of SRS using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model. Results: Median age was 50.5 years. Subtype distribution was: ER+, 46; HER2+, 27; triple negative, 8). 97% had a KPS ≥70%. 95% had extracranial metastases at the time of SRS, 81% at other visceral sites (lung/pleura/liver). 48% had stable extracranial disease at the time of SRS. Median interval from WBRT to SRS was 8.4 months. Median follow-up for survivors was 16.7 months. Median CNS progression-free survival was 5.7 months (IQR 3.6-11 months) and median OS was 9.8 months (IQR 3.8-18 months). 82% of evaluable pts received further systemic therapy after SRS. 92% of patients were in RPA class II. RPA class was not found to be a useful prognostic index in this population. Median OS in RPA class II pts was 10.4 months. HER2 status (adjusted HR 2.4, p=0.008) and extracranial disease status (adjusted HR 2.7, p=0.004) were significant prognostic factors for survival on multivariate analysis. Conclusions: In patients with good KPS, salvage SRS at the time of CNS recurrence should be strongly considered. HER2 positivity and status of extracranial disease are prognostic factors for survival following SRS in the salvage setting after prior WBRT. Prognostic factors for OS. Univariate Multivariate HR P value HR P value Age >65 y 3.4 0.02 1.8 0.3 Extracranial disease Progessing 2.9 <0.001 2.7 0.004 Stable 1 HER2+ Yes 1 No 2.3 0.002 2.4 0.008 ER+ Yes 0.73 0.2 No 1 Triple-negative Yes 3.8 0.001 1.6 0.3 No 1 KPS <80% 4.2 <0.001 1.9 0.11 N lesions treated SRS 1.1 0.76 Time to SRS 1.0 0.77
Preoperative bowel preparation for pancreaticoduodenectomy: Is it necessary?
Authors: Timothy E. Newhook, James M. Lindberg, Reid B. Adams, Todd W. Bauer
Journal: Journal of Clinical Oncology (2013)

279 Background: Preoperative bowel preparation (PBP) before pancreaticoduodenectomy (PD) is commonly performed; however, the effect of PBP on intraoperative fluid requirements and acute renal failure (ARF) after PD has not been reported. The goal of this study was to determine the effect of PBP on postoperative complications, intraoperative fluid requirements, and ARF after PD. Methods: In this retrospective sequential analysis, all patients undergoing PD consecutively from September 2005 to July 2012 by a single surgeon were identified. Clinical data from patients who received PBP from September 2005 to November 2008 was compared to those without PBP from December 2008 to July 2012. Results: In all, 140 consecutive patients were identified with 49 (35%) having received PBP. There was no significant difference in the frequency of chronic renal failure between groups. The PBP group received a larger total intraoperative fluid volume (9.33 vs 6.54 L, p&lt;0.001) and had a higher incidence of postoperative ARF (22.4% vs. 5.4%, p = 0.003) compared to those without PBP. There was no significant difference in the rates of superficial, deep, or organ space surgical site infections between the two groups. Additionally, there was no significant difference in the rates of pancreatic leak, other GI tract leak, or postoperative ileus between the groups. Conclusions: Surgical site infections are not significantly reduced with PBP prior to PD. In contrast, PBP is associated with a 2.8 L increase in intraoperative fluid administration and a 17% increase in the incidence of postoperative ARF. Thus, PBP should not be offered routinely prior to pancreaticoduodenectomy. [Table: see text]
Caring for adult survivors of childhood cancer: A primary care based adult transition clinic.
Authors: Becky N. Lowry, Kyla Alsman, Wendy McClellan, Jennifer R. Klemp, Hope Krebill, Eyad Al-hihi, Gary C. Doolittle, Joy M. Fulbright
Journal: Journal of Clinical Oncology (2016)

40 Background: Long-term survival is an expected outcome for childhood cancer patients. Caring for adults who are childhood cancer survivors requires dedicated late effects monitoring. Recognizing transition challenges from pediatric to adult and oncologic to primary care settings, we developed a dedicated monthly survivorship transition clinic (STC) in an internal medicine office at the University of Kansas Medical Center. We describe the first year practice experience (2014-2015). Methods: Retrospective chart review was completed on 41 STC patients - age 20 to 52 years. Each survivor self-selected to establish in STC, with either consultative survivorship care (correspondence sent to existing primary care physician (PCP)) or combined primary and survivorship care (if no established PCP). Selections were recorded. Two oncology providers performed blinded independent reviews of treatment summaries and scored these using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Scores were provided to the STC and unblinded. ITR-3 scores were matched with data on subspecialty referral patterns for each survivor to determine if ITR-3 scores correlated with referral needs. Results: Of 41 patients, 26 (63%) requested PCP and survivorship care. Only 15 (37%) had an established PCP. Survivors were grouped by ITR-3 into low (1 or 2) or high (3 or 4) intensity scores. Subspecialty referrals in each group were analyzed as follows: total number of referrals / average referrals per survivor / median referral number. Referral data: low intensity group 14 / 1.27 / 1, high intensity group 96 / 3.56 / 3. Conclusions: Despite complex medical histories and long term follow-up needs, a high percentage of Midwest cancer survivors were in need of survivorship, PCP and subspecialty care emphasizing the importance of intentional transition efforts. ITR-3 scores correlated with subspecialty referral needs. Future research will include an increased number of survivors to determine further predicative value of this scale in estimating survivor needs complexity.