tbuckley/cabot-search huggingface dataset:
Single fraction stereotactic radiosurgery (SFSR) for lung tumors - A phase I dose escalation trial
Authors: Q.-T. Le, A. Ho, C. Cotrutz, H. Wakelee, S. T. Kee, J. Donington, R. I. Whyte
Journal: Journal of Clinical Oncology (2004)

7231 Background: Although stereotactic radiosurgery is well established for the treatment of intracranial neoplasms, its use for lung tumors is novel. We report preliminary results of SFSR in patients with inoperable lung tumors in a phase I study. Methods: Eligible patients included those with inoperable early stage (T1–2N0) non-small cell lung cancers (NSCLC) or solitary lung metastases. Treatments were delivered via a linear accelerator mounted on a computer-control robotic arm (Cyberknife, Accuray, CA). Before treatment, all patients underwent CT-guided metallic fiducial placement in the tumor for image guided targeting, which when combined with breath-holding ensures accurate tumor targeting. All radiation treatments were delivered in a single fraction. 9 to 10 patients were treated per dose cohort starting at 15 Gy/fraction followed by dose escalation of 5–10 Gy/fraction. A minimal 3 month period is required between each dose level for monitoring toxicity. Results: Nineteen patients (11 NSCLC and 8 metastatic tumors) were enrolled to date. The median age was 74 (range: 22–83). Tumor size ranged from 1.5 to 5 cm in maximal dimension. Nine patients received 15 Gy and 10 received 25 Gy. There were 2 complications related to fiducial placement - 1 pneumothorax requiring chest tube insertion and 1 emphysema exacerbation. One patient with prior thoracic irradiation for a separate esophageal cancer developed grade 3 radiation pneumonitis at 3 months post treatment. She subsequently died at 6 months post treatment with an enlarging pleural effusion in the face of both radiation-pneumonitis and tumor progression. For the remaining patients, there was no obvious clinical decline in pulmonary function. 17 patients were evaluable for radiographic response, which was scored as stable in 1, minor in 6, partial in 6 and complete in 4. 3 complete responders received 25 Gy. At a median follow up of 8 months (range 1–32), 4 have relapsed locally, all in the 15 Gy dose group. Conclusions: SFSR is feasible and well tolerated for the treatment of selected lung tumors. Additional dose escalation is underway to determine the optimal radiation dose and overall treatment efficacy. No significant financial relationships to disclose.
Incorrect Conclusions Concerning Antibiotics and Asthma Exacerbation
Authors: Sebastian L. Johnston, Adel Mansur, Anoop Chauhan
Journal: JAMA Internal Medicine (2017)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Gemcitabine (G) and Doxorubicin (DXR) as first-line treatment of metastatic breast cancer (MBC): Preliminary results
Authors: A. Bensalem, K. Bouzid
Journal: Journal of Clinical Oncology (2004)

762 Background: G has demonstrated efficacy in a variety of solid tumors, including breast cancer. Forty to 50% of chemonaive patients (pts) with MBC achieve an objective regression after monochemotherapy with anthracyclines. This study evaluated the response rate and toxicity of G and DXR in non-pretreated pts with MBC. Methods: Chemonaive women aged between 18–75 years; an ECOG performance status (PS) 0–2; histologically or cytologically proven diagnosis of mammary carcinoma; adequate bone marrow reserve, renal and hepatic function; measurable disease; and written consent received G 1250 mg/m2 and DXR 25 mg/m2 on days 1,8, every 3 weeks. Results: To date, 19 pts with a median age of 42.9 years (range, 31–56) have been enrolled. Fifteen pts (78.9%) had PS 1. All pts had visceral disease: two with 3 localizations (bone, liver, lung); twelve with 2 localizations (bone, liver); and five with diffuse bone metastases. Pts received a median of 3 cycles (range, 2–4). Preliminary efficacy and safety data are available for 13 pts. So far, 9 objective responses (7 complete responses, 2 partial responses) with a rate of 69%, 3 stable disease and 1 progressive disease have been confirmed. Three of the 5 evaluable pts with liver metastasis responded completely after 4 cycles and were evaluated 1 month after the fourth cycle by CT scan. Nonhematologic WHO toxicity included grade 4 cutaneous in 1 pt (second cycle), grade 3 alopecia in 14 pts, and grade 1 nausea/vomiting in 6 pts. Hematologic toxicity were grade 2 neutropenia in 5 pts, grade 2 anemia in 3 pts, and grade 2 thrombocytopenia in 2 pts. Conclusions: This regimen seems to be well tolerated and active outpatient therapy for the treatment of metastatic breast cancer. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Centre P & M Curie Algiers; Hosp. University Constantine Centre P & M Curie Algiers; Hosp. University Constantine
Distant metastases in squamous-cell head and neck carcinoma (SHNC) patients who achieved loco-regional control (LRC)
Authors: S. Pernas, X. Leon, A. Lopez-Pousa, M. Quer, C. Orus, R. Guardeño, R. Nadal, T. Macarulla, O. Gallego, J. Lopez-Lopez
Journal: Journal of Clinical Oncology (2004)

5519 Background: One of the reasons for failure in patients with SHNC who achieve loco-regional control with treatment is the appearance of distant metastases. The objective of this study was to evaluate the frequency of distant metastases, and to determine the relative role of several prognostic factors in the subsequent development of distant metastases in this group of patients. Methods: We performed a retrospective study from 2539 SHNC pts treated with curative intent and collected in a prospective data base from 1984 to 2001. Patients with oral cavity, pharynx or larynx carcinoma who achieved loco-regional control were analyzed to evaluate the frequency of distant metastases and the influence of different variables in their appearance. Results: 224 (8.8%) of the 2539 pts had distant metastases (M1): 141/852 (16.5%) pts with local and/or regional relapse and 83/1687 (4.9%) pts with loco-regional control (LRC) were M1 (p<.00001). In the univariate study, the only variables that influenced the appearance of distant metastases in LRC pts were tumor site, T-stage, N-stage and histological differentiation. On the multivariate analysis variables that increased the risk of distant metastases in LRC pts were N-stage (N0 vs N+), T-stage (T1 vs T>1), and the tumor location in the hypopharynx and the supraglottis. Eighty % of the M1 appeared within the 2 years and no M1 patients were diagnosed after 4 years of the primary diagnosis (median time from diagnosis to M1=14 months). In the group of 557 patients with locally advanced tumors who started treatment with chemotherapy the probability of M1 was 2.2% for CR (137 pts), 10.3% for PR (233 pts) and 19.7% for non-responder (137 pts) pts (p<.001). Median survival for M1 pts was 3.9 m. Conclusions: Factors that significantly increased the risk of distant metastases in SHNC patients who achieved LCR were advanced local and regional extension of the tumor, and the location at the hypopharynx or supraglottis. No significant financial relationships to disclose.
Weekly topotecan is well tolerated in the third-line or later treatment of patients with epithelial ovarian carcinoma (EOC) and may prolong time to disease progression
Authors: S. M. Bhoola, J. M. Estes, C. A. Leath Iii, T. O. Kirby, P. Bunch, M. N. Barnes Iii, E. E. Patridge, R. D. Alvarez
Journal: Journal of Clinical Oncology (2004)

5067 Background: To determine the tolerability and treatment benefit of weekly topotecan in pts with recurrent EOC. Methods: IRB approval was received for a retrospective review of pt records. Eligible pts had received ≥ 2 prior cytotoxic chemotherapy regimens before receiving weekly topotecan for EOC. Follow-up data were obtained by review of medical records. All pts who received topotecan were evaluable for toxicity, and pts who completed ≥ 4 weeks of topotecan therapy were considered evaluable for tumor response. Results: Thirty eligible pts were identified; 24 (80%) had stage ≥ 3 EOC, 20 had received 2 prior chemotherapy regimens, 4 had received 3, and 6 had received ≥ 4. All pts had received paclitaxel/carboplatin as first- or second-line chemotherapy, and 22 (73%) were platinum sensitive. All pts had measurable disease at baseline, with a median CA-125 of 421 U/mL (range, 13 - 7,200). All pts started at topotecan 4 mg/m2. A total of 464 weeks (116 cycles) of topotecan were administered. No grade 3 or 4 nonhematologic toxicity occurred; the only grade 2 event was neuropathy in 2 pts. Hematologic toxicity was acceptable, with no grade 4 toxicity or neutropenic fevers. Grade 3 toxicities included anemia in 8 (27%) pts, neutropenia in 5 (17%) pts, and thrombocytopenia in 1 (3%) pt. Hematologic toxicity was managed by dose reduction to 3.5 mg/m2 in 5 (17%) pts. Twenty-eight pts who received a median of 11 weeks (range, 4 - 77) of therapy were evaluable for response. Three (11%) pts had a partial response and 11 (39%) had stable disease. In these 15 pts, mean time to progression was 6 months (range, 1 - 17). Treatment resulted in CA-125 decreases (median decline, 41%) in 18 (64%) pts. Of note, 2 pts had stable disease of 60 and 77 weeks' duration. Conclusions: Heavily pretreated pts with EOC are especially susceptible to hematologic toxicities associated with the standard topotecan regimen. However, weekly treatment with topotecan 4 mg/m2 was well tolerated in heavily pretreated pts and showed favorable activity in this retrospective analysis. Further investigations in the third-line or later settings are recommended. No significant financial relationships to disclose.
A multicenter phase III comparison of docetaxel (D) + prednisone (P) and mitoxantrone (MTZ) + P in patients with hormone-refractory prostate cancer (HRPC)
Authors: M. A. Eisenberger, R. De Wit, W. Berry, I. Bodrogi, A. Pluzanska, K. Chi, S. Oudard, T. Christine, N. James, I. Tannock
Journal: Journal of Clinical Oncology (2004)

4 Background: Docetaxel-based regimens have shown encouraging anti-tumor activity in phase II trials in HRPC. This study compared two schedules of D+P to MTZ+P, an accepted standard in HRPC. Methods: Patients (pts) with histologically-proven metastatic HRPC, testosterone <50 ng/ml, adequate hematologic and organ function, clinical and/or biochemical (PSA) progression, and no antiandrogens within 6 wk, were stratified by pain and KPS and randomized to daily prednisone (5mg po bid) plus D (ARM A-75mg/m2 q3wk x 10 cycles; ARM B-30mg/m2/wk x 5 of 6 wk x 5 cycles) or MTZ (ARM C-12mg/m2 q3wk x 10 cycles). Primary endpoint was survival; secondary endpoints included PSA response (≥50% decrease for at least 4 wk), pain response, and toxicity. A modified Bonferroni method was used to adjust for multiple comparisons. Results: 1,006 pts were randomized. Median follow up was 20.7 mo. Pts in all arms had similar baseline characteristics. Planned treatment was delivered to 98%, 96% and 99% pts in A, B, and C, respectively. Grade 3/4 toxicities (% pts A, B, C): overall (45.8%, 43.0%, 34.6%), including bone pain (7.8%, 7.3%, 9.9%), infection (5.7%, 5.5%, 4.2%), fatigue (4.5%, 5.5%, 5.1%), and diarrhea (2.1%, 4.8%, 1.2%). The most common laboratory grade 3/4 toxicity was neutropenia (32.0%, 1.5%, 21.7%). Conclusions: The D q3wk +P schedule improved overall survival and increased pain response and PSA response vs MTZ+P. It was well tolerated, but with more grade 3/4 neutropenia than MTZ+P. This is the first phase III study to show a significant survival benefit in HRPC. (Supported by Aventis) Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Aventis Aventis Research
Pleural and serum DNA in patients with cancer and pleural effusion: A quantitative diagnostic tool
Authors: S. Benlloch, J. M. Galbis, B. Massutí, J. M. Rodríguez-Paniagua, S. Romero, J. L. Martí, J. Sánchez-Payá, J. J. Mafé, C. Martín
Journal: Journal of Clinical Oncology (2004)

9519 Background: Pleural effusion is a frequent diagnostic problem in patients with malignancy and may have therapeutic and prognostic impact Methods: Measurement of DNA from pleural liquid (Pl) and peripheral blood (Pb) in patients (p) with pleural effusion (PE) and malignant neoplasm (study group A) and compare the obtained values in p with PE without malignancy (control group B). Group A of 44 samples in p with malignant neoplasm and PE; Group B 19 p with PE without malignancy. DNA were extracted and quantified in 2 simultaneous samples of Pl and Pb collected after 15 min centrifugation at 3000 rpm, aliquoted in 1 ml sterile vials and frozen until DNA extraction. DNA was extracted using DNA blood Qiagen kit. The amount of plasma and pleural DNA was determined by RT quantitative PCR amplification of the human RNase P, a single-copy gene encoding the RNA moiety for the RNase P enzyme. Mann-Whitney test compare the measured values of DNA from Pl and Pb. ROC curve performed to evaluate the diagnostic capacity and the AUC calculated with 95% c.i. Results: Diagnosis of p included in the A group were: Lung Adenocarcinoma (13,6%), Lung Squamous Cell Carcinoma ( 13,6%), other Adenocarcinoma ( 34%), other Carcinoma (25%), Small-Cell Lung ( 9,1%), Mesothelioma ( 2,3%) and Sarcoma ( 2,3%). For the B group the main diagnosis were: CHF ( 73,6%), liver disease-cirrhosis ( 15,7%), hypoproteinemia (5,3%), pulmonary thromboembolism (5,3%). Median concentration of Pb and Pl DNA in ng/ml were respectively 33 (21–95) and 16,5 (4–83) in B group and 102 (55–206) and 97 (21–404) in A group. Median concentration of plasma DNA was three times greater in patients with neoplasia .Median concentration of DNA in pleural effusion was 6x greater in patients with malignancy . The areas under the ROC curve were 0,759 (95%CI=0,622–0,897) and 0,752 (95%CI=0,624–0,880). When the association between DNA measured values from serum and pleural effusion was calculated a positive correlation was found r=0,324 (p<0.05). Conclusions: Median pleural DNA values are greater in p with neoplasia than in pwithout malignancy. This technique could be useful in the diagnostic malignant process of p with pleural effusion. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Spanish Ministry of Health Grant
Prognostic significance of radiologic and histologic response to neoadjuvant chemotherapy in localized synovial sarcoma.
Authors: Camille Chakiba, Philippe Terrier, Dominique Ranchere-Vince, Agnes Neuville, Safae Aarab Terrisse, Jean-Yves Blay, Christophe Perrin, Emmanuelle Bompas, Antoine Italiano
Journal: Journal of Clinical Oncology (2013)

10578 Background: The role of neoadjuvant and adjuvant chemotherapy in localized synovial sarcoma (SS) is still controversial. Histologic response to neoadjuvant chemotherapy is an independent prognostic variable in bone sarcomas. Data regarding the prognostic value of response to noeadjuvant chemotherapy in STS are limited. Methods: 68 patients with localized STS, treated with neoadjuvant anthracycline/ifosfamide-based chemotherapy and assessable for response to chemotherapy were included prospectively in the French Sarcoma Group (GSF) database from 1985 to 2011. All the cases were reviewed by the pathology subcommittee of the GSF. Radiological response to chemotherapy was assessed according to RECIST criteria. Good response was defined as partial response or stable disease according to RECIST and ≤10% recognizable tumor cells in the surgical specimen. Poor response was defined as stable or progressive disease according to RECIST and ≥ 50% recognizable tumors cells in the surgical specimen. All the other cases were defined as intermediate response. Results: Median age was 38 years. Median tumor size was 8 cm (range 2-20). 56% of tumors were located in the limbs and 52% were grade 3. Response to chemotherapy was considered as good in 9 cases (13%), intermediate in 20 cases (29.5%) and poor in 39 cases (57.5%). Median metastasis-free (MFS) and overall (OS) survivals were 45 (95% CI 11-79) and 84 months (95%CI 88-120), respectively. On univariate analysis, grade, tumor size and response to chemotherapy were significantly associated with metastasis-free survival (MFS). Radiological response according to RECIST has no prognostic value. On multivariate analysis, grade was the sole variable independently associated with MFS (HR=3.4, 95% CI 1.5-7.5, p=0.003). On univariate analysis, grade, and response to chemotherapy were significantly associated with overall survival (OS). On multivariate analysis, grade was the sole factor independently associated with OS (HR=2.5, 95% CI 1.2-5.7, p=0.03). Conclusions: Response to neoadjuvant chemotherapy may not have prognostic value in patients with SS. Grade represents the most significant predictive factor of outcome in this setting.
Observation after a positive sentinel lymph node biopsy in patients with melanoma.
Authors: Zubin M. Bamboat, Daniel G. Coit, Ioannis Konstantinidis, Deborah Kuk, Katherine S. Panageas, Charlotte Eielson Ariyan, Mary Susan Brady
Journal: Journal of Clinical Oncology (2013)

9033 Background: The therapeutic benefit of completion lymph node dissection (CLND) in melanoma patients with a positive sentinel lymph node (SLN) remains unknown. This study describes the natural history of selected patients undergoing nodal observation (no-CLND) after a positive SLN biopsy and compares outcomes with those undergoing immediate CLND. Methods: A prospective database was used to identify melanoma patients with a positive SLN biopsy from 1994 to 2012. Patient and tumor characteristics, reasons for not undergoing CLND, patterns of initial recurrence, and melanoma-specific survival data were analyzed. Results: Of 4319 patients undergoing SLN biopsy, 505 (12%) had a positive SLN. 170 (34%) patients underwent nodal observation and 335 (66%) had an immediate CLND. Patients in the no-CLND group were older (65 vs. 56 years, p&lt;0.001) and more likely to have lower extremity lesions (43% vs. 30%, p=0.004). There were no differences in tumor thickness, Clark level of invasion, presence of ulceration, or degree of SLN tumor between groups. In 89% of cases, the reason to forgo CLND was due to doctor and/or patient decision. Median follow up was 23.5 and 78.5 months for no-CLND and CLND groups and median time to first recurrence was similar at 9 and 12 months (p=NS) respectively. There was no difference in regional recurrence rates between groups (20%). Nodal disease as a site of first recurrence occurred in 16% of patients in the no-CLND group compared with 7% of CLND patients (p&lt;0.001). In contrast, systemic disease as first site of recurrence occurred in 8% of no-CLND patients compared with 27% of CLND patients (p&lt;0.001). While median relapse-free survival was better after CLND (34.5 vs. 20.9 months, p=0.02), melanoma-specific survival was similar (not reached, no-CLND vs. 110 months, CLND, p=0.14). Conclusions: Immediate CLND after a positive SLN biopsy is associated with fewer initial nodal basin recurrences but similar melanoma-specific survival. These results support ongoing equipoise in the two arms of MSLT-II.
Risk factors predictive for poor outcomes in patients with human papillomavirus (HPV)-initiated oropharyngeal cancer (OPC).
Authors: Tobenna Igweonu Nwizu, Shlomo A. Koyfman, Trevor B Bledsoe, Emily Hyslop, Chandana A. Reddy, Eric Lamarre, Joseph Scharpf, Robert Lorenz, Mumtaz Khan, Brian Burkey, John Greskovich, David J. Adelstein
Journal: Journal of Clinical Oncology (2014)

6039 Background: Studies have demonstrated better prognosis for patients (pts) with HPV-initiated OPC when compared to OPC caused by smoking. A small subset of pts however experience disease recurrence and have poor outcomes. We report our Cleveland Clinic experience with HPV-initiated OPC in an effort to identify determinants of a poor prognosis. Methods: We identified pts with stage III-IVb HPV-initiated OPC treated with definitive chemoradiotherapy between 2002 and 2012 from an IRB approved registry. HPV-initiated disease was determined by positivity for p16 by immunohistochemistry or HPV DNA by fluorescent in-situ hybridization. Radiation therapy was administered to a total dose of 70-74 Gy. Chemotherapy consisted of either cisplatin and 5-Fluorouracil, cisplatin or cetuximab. Kaplan-Meier estimates of disease-free survival (DFS) and overall survival (OS) were calculated. Univariate (UVA) and multivariate analyses (MVA) using Cox proportional hazards regression were performed to identify variables associated with inferior DFS and OS. Results: Of the 228 patients identified, 17% had T4 disease, 40% had N2c/3 disease, 51% had a smoking history (>10 pack years) while 31% were lifetime never smokers. Median follow up was 40 months. 3-year DFS and OS was 89% and 90% respectively. UVA revealed that DFS was inferior in pts with T4 (HR = 2.525; 95% CI = 1.089 to 5.848; P = 0.03) and N2c-N3 (HR = 2.364; 95% CI = 1.062 to 5.263; P = 0.04) disease. OS was also inferior in pts with T4 disease (HR = 2.123; 95% CI = 1.042 to 4.329; P = 0.04), and pts with a smoking history (HR = 2.475; 95% = CI 1.192 to 5.128; P = 0.02). On MVA, the most important predictors for an inferior DFS were smoking history, T4 and N2c-N3 disease. Patients with 2 or more of these risk factors had a significantly worse 3 –year DFS (77% vs. 94%; HR = 4.082; 95% CI = 1.828 - 9.091; P <0.001) and OS (83% vs. 93%, HR = 2.283; 95% CI = 1.193 - 4.367; P 0.01). Conclusions: Patients with HPV-initiated OPC and at least two high risk features, including T4, N2c/3, or >10 pack years of smoking, had significantly inferior DFS and OS. Such patients should not be considered for treatment de-intensification strategies.