tbuckley/cabot-search huggingface dataset:
Effect of body mass index on operative complications after robotic-assisted Ivor-Lewis esophagogastrostomy: Retrospective analysis of 133 cases at a single high-volume tertiary care center.
Authors: Matthew R. Thau, Tobin Joel Crill Strom, Khaldoun Almhanna, Nadia Saeed, Sarah E. Hoffe, Ravi Shridhar, Richard C. Karl, Kenneth L. Meredith
Journal: Journal of Clinical Oncology (2014)

109 Background: The impact of body weight on robotic-assisted surgical morbidity has not been studied in esophageal cancer. We thus examined operative outcomes in patients according to their body mass index (BMI) following robotic-assisted Ivor-Lewis Esophagogastrostomy (RAIL) at a high-volume tertiary-care referral cancer center and evaluated the safety of robotic surgery in patients with an elevated BMI. Methods: We retrospectively studied patients who underwent RAIL for pathologically confirmed malignancy in the distal esophagus and assessed morbidity and intraoperative outcomes relative to BMI. We evaluated operative complications from surgery to discharge, including average operating time, estimated blood loss (EBL), pneumonia, atrial fibrillation, pulmonary embolism, deep vein thrombosis, wound infection, and surgical leaks. Median ICU days after surgery and 30 day operative mortality was assessed. Wilcoxon Rank-Sum and Spearman Coefficient were used. Results: Of 134 total patients, 106 were male and 28 were female, with an average age of 67 years. Among patients, 76% (N=102) received neoadjuvant therapy. According to BMI, 3 patients were underweight, 35 were normal weight, 62 were overweight, and 34 were obese. All patients had R0 resection, with a median of 19 lymph nodes removed. Among evaluated surgical complications, anastomotic leak rate was significantly higher in patients with high BMI (p=0.01). Median operating time was 407 mins and EBL was 150cc. High BMI was significantly associated with increased operation time and EBL (p=0.01 &amp; p=0.05, respectively). Conclusions: This retrospective study shows that patients with distal esophageal cancer and an elevated BMI undergoing RAIL have increased operative times and EBL during the procedure. An elevated postoperative risk for anastomotic leak also exists and must be carefully monitored. However, BMI does not affect the quality of oncological resection as determined by the number of harvested lymph nodes and rates of R0 resection, suggesting similar outcomes irrespective of BMI among all patients undergoing RAIL at a high volume tertiary center.
Systemic pro- and anti-inflammatory responses in cachectic patients with gastric and colorectal cancer correlates with nutritional impairment, immune suppression, and poor prognosis.
Authors: M. Shibata, K. Gonda, T. Shimura, I. Nakamura, S. Ohki, K. Sakurai, S. Takenoshita
Journal: Journal of Clinical Oncology (2011)

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Improved overall survival after the addition of rituximab to chemotherapy alone as first-line therapy for mantle cell lymphoma (MCL): Evidence from SEER-Medicare.
Authors: M. H. Dreyling, R. Griffiths, M. Gleeson, M. Danese, J. Mikhael
Journal: Journal of Clinical Oncology (2011)

e18500 Background: Combination of chemotherapy and the B-lymphocyte specific antibody rituximab improves overall survival in both diffuse large B-cell lymphoma and follicular lymphoma. However, so far this benefit has not been demonstrated in MCL. Methods: We used SEER-Medicare data to identify a cohort of patients aged 66 years or older who were diagnosed with MCL between 01/99 and 12/05, and who began first-line chemotherapy with or without rituximab within six months after diagnosis. Patients were followed from the date of diagnosis until death or the end of the study period (12/07), whichever came first. Medicare claims were used to identify chemotherapy, rituximab, and radiation. The date and cause of death (classified as all-cause or cancer-related) were obtained from Medicare administrative data. Multivariate (MV) Cox proportional hazards models were used to examine patient demographic, disease, and treatment factors associated with overall survival. Survival was evaluated over the entire observation period as well as after two years. Results: There were 652 patients who met the eligibility criteria. The mean age at diagnosis was 75 years; 58% had Stage IV disease; 67% had extranodal involvement; and 58% received rituximab. The median survival was 25 months for chemotherapy alone compared to 37 months for chemotherapy plus rituximab (P<0.001). In MV survival analysis, rituximab plus chemotherapy compared to chemotherapy alone was associated with statistically significantly lower all-cause mortality over the entire observation period (Hazard Ratio [HR] 0.60; 95% Confidence Interval [CI] 0.48-0.74). Results were similar when limiting the analysis to two years of follow-up (HR 0.54; 95% CI 0.41-0.71), or to cancer-specific mortality during the entire observation period (HR 0.62; 95% CI 0.41-0.71). Conclusions: First-line chemotherapy including rituximab is associated with significantly improved overall survival in older patients diagnosed with MCL compared to chemotherapy alone. These findings should be confirmed in prospective clinical trials.
Results of the MARS study on the management of antiangiogenics’ renovascular safety in renal cell carcinoma.
Authors: Isabelle Laure Ray-Coquard, Nicolas Janus, Francois Goldwasser, Olivier Mir, Stephane Oudard, Florian Scotte, Jean-Philippe Spano, Jean Christophe Thery, Philippe Beuzeboc, Catherine Daniel, Jean-Baptiste Rey, Christelle Jouannaud, Joseph Gligorov, Jean F. Morere, Michel Azizi, Richard Dorent, Gilbert Deray, Vincent Launay-Vacher
Journal: Journal of Clinical Oncology (2014)

394 Background: MARS is a prospective multicentric study conducted to assess the renovascular tolerance of anti-VEGF drugs (AVD) in the clinical setting in France, in a number of different tumor types. Methods: Patients (pts) from 8 centres were included when they were 1) naïve of any AVD and 2) about to start treatment with an AVD, from 2009 to 2012, with a follow-up (f/u) of 1 year. Data collected included: gender, age, serum creatinine (SCr), HTN, hematuria (Hu) and dipstick Pu, at baseline and at each visit during f/u. This sub-group analysis presents the results for renal cell carcinoma (RCC) pts receiving sunitinib. Results: 1,124 pts were included. 137 had RCC and 112 received sunitinib. Median age: 61.0 years. Visceral, bone and cerebral metastasis frequencies were 71.4, 42.0 and 12.5%, respectively. All except 3 pts, had at least one kind of metastasis. At inclusion, HTN prevalence was 43.8%. Baseline renal assessment retrieved: Pu 15.6%, Hu 8.1%, mean aMDRD 69.4 ml/min/1.73m 2 . The incidence of de novo Pu and HTN during f/u was 75.0 and 21.4% (Table). All pts with Pu at inclusion improved or remained stable. Among pts with de novo Pu, 75.8% afterwards improved/normalized. Mean aMDRD was 72.2 at the end of f/u. 0.7% had grade 3 SCr increase (no grade 4). No thrombotic micro-angiopathy (TMA) was reported. Conclusions: These results on the renovascular safety of AVD in RCC patients showed that 1) TMA is rare, 2) Pu develops in 75.0% of the pts, 3) 21.4% developed HTN, Furthermore, in case of a renovascular effect, investigators followed the recommendations from the French Society of Nephrology (Halimi JM. Nephrol Ther 2008) and no treatment withdrawal for unmanageable renovascular toxicity occurred. [Table: see text]
Folfiri-bevacizumab as first line treatment for advanced colorectal cancer (ACRC): Results from 77 consecutive unsellected patients
Authors: A. Ruiz de Lobera, J. M. Mañé, G. López-Vivanco, A. Muñoz, G. López de Argumedo, J. Ferreiro, I. Diaz de Corcuera, N. Fuente, A. Moreno, I. Rubio
Journal: Journal of Clinical Oncology (2008)

15056 Background: Bevazicumab (BV) combined with IFL (Irinotecan, bolus 5FU and Leucovorin) improves response rate (ORR) and overall survival (OS) in patients (p) with ACRC. Nowadays, infusional 5FU based combinations are considered the optimal schedules. In EU, only irinotecan based combinations are approved for the use in combination with B in the first line setting. We analysed the efficacy and toxicity of a consecutive cohort of unselected patients with ACRC treated with FOLFIRI-BV. Methods: From Aug-05 to Mar-07, 77p with unresectable ACRC received BV 5mg/kg d1, Irinotecan 180mg/m2 d1, Leucovorin 200mg/m2 d1 y 2, 5FU 400mg/m2 bolus and 600mg/m2 CI of 22h d1 and 2, every 14 days (FOLFIRI-BV). There were 50 males and the median age was 63 y (29–83). ECOG 0/1/2: 34/40/3. Primary tumor: colon 43p, rectum 33p, 1p doble primary. Median number of metastatic sites was 1.5 (1–4). According to Khöne risk classification, there were 60% of low risk patients, 35% of intermediate rist and 5% of high risk. Results: A total of 834 courses were administered (median 10, range 1–29). Intention to treat ORR was 52% (95% CI: 40.8–63.1), with 6 CR, 34 PR and 31 SD. Two patients progressed at the first evaluation and 4 were not evaluated due to early withdrawal. Salvage surgery was performed in 15p (20%). Grade 3/4 toxicity per patient: anemia 3/1, thrombopenia 1/1, neutropenia 8/3, febrile neutropenia 3/0, emesis 11/0, diarrhoea 11/0, mucositis 3/0, intestinal subocclusion 4/0. BV-related grade 2/3/4 toxicities: hypertension 6/0/0, proteinuria 5/0/0, cephalalgia 2/0/0, hemorrhage 4/2/0, wound complication 1/0/0, GI fistula 0/1/0, anastomosis leak 0/1/0, GI perforation 0/1/0. There was one toxic death because of urinary septic shock without neutropenia. Sixty days mortality rate was 1.3%. Median progression free survival was 10.9 months (95% CI: 9–12.8), and median OS was 22.1 months (95% CI: 14.6–29.5). Conclusions: FOLFIRI-BV is a safe and very active regimen for unselected patients with ACRC. This activity is correlated with a large rate of surgical rescue and with a long survival. BV toxicity profile seems similar to the described in clinical trials. No significant financial relationships to disclose.
The effect of MRI or PET fusion in radiotherapy treatment planning on the pathological complete response rate in rectal adenocarcinoma.
Authors: Zaker Hamid Rana, Robert Hong, Joon Han, Isaac Chen, Mohammed Nurhussien, Nadim Munir Nasr
Journal: Journal of Clinical Oncology (2015)

523 Background: A pathological complete response rate of 10% to 30% has been noted to occur following preoperative chemoradiation with CT-based treatment planning in patients with rectal cancer. Fusion of the treatment planning CT with other imaging modalities like MRI or PET may help identify tumor location and improve tumor coverage. This retrospective study sought to evaluate the effect of adding MRI or PET imaging to CT-based treatment planning and its impact on pathological complete response rates in patients with rectal cancer. Methods: A retrospective analysis was performed on 39 patients, who received neoadjuvant chemoradiation for rectal adenocarcinoma from February 2009 to September 2013. Patients were divided into two groups. The first group was treated using CT-only based treatment 3D-Conformal or IMRT planning (n=9) and the second was treated using either PET or MRI fusion with the simulation CT scan (n=30). Patients were treated to a total of 5,040 cGy in 28 fractions. Pathological complete response rates (ypT0N0M0) were assessed using postoperative pathologic reports following resection. Results: 39 patients with a median age of 62 received preoperative chemoradiation with an interval to surgery ranging from 34-162 days and a median of 70 days. Patients treated with PET or MRI fusion treatment planning showed a complete pathological response rate at the primary site of 60% and a complete lymph node pathological response rate of 70.83% compared to 22.22% at the primary site and 66.66% at lymph node sites in patients with CT-only treatment planning. In patients treated using MRI or PET fusion, middle rectal cancer showed the best complete pathological response rate at 80%, followed by lower rectal cancer at 41.66%, and upper rectal cancer at 37.5%. Conclusions: Although the sample size was small, utilization of MRI or PET fusion resulted in a higher pathological complete response rate when compared to CT-only based treatment planning, especially in middle rectal cancers. Further studies are needed to accurately identify those patients with a complete pathologic response which may ultimately alter their treatment course.
Radiosensitivity differences between liver metastases based on primary histology suggest implications for clinical outcomes following SBRT.
Authors: Kamran A. Ahmed, Jimmy J. Caudell, Ghassan El-Haddad, Anders E. Berglund, Sarah E. Hoffe, Jessica M. Frakes, Steven A. Eschrich, Javier Torres-Roca
Journal: Journal of Clinical Oncology (2016)

239 Background: Increasing evidence in the management of oligometastases with stereotactic body radiotherapy (SBRT) reveals differences in outcomes based on primary histology and dose selection. We have previously identified a multigene expression index for tumor radiosensitivity (RSI) with validation in multiple independent cohorts. In this study, we assessed RSI in liver metastases and our clinical outcomes following SBRT based on primary histology. Methods: Patients were identified from our institutional IRB approved prospective observational protocol. A total of 444 metastatic liver lesions were obtained from a de-identified meta-data pool. Gene expression was from Affymetrix Hu-RSTA-2a520709. The RSI 10 gene assay was run on tissue samples and calculated using the previously published algorithm. A cohort of 33 patients with 38 liver metastases treated with SBRT using 50 Gy or 60 Gy in 5 fractions was used for clinical correlation. Results: The median RSI for all liver lesions was 0.42 (Q1, 0.28; Q3, 0.49). The most common primary histology for liver metastases were colorectal (n = 374; 81%), pancreas (n = 18; 4%), and breast (n = 15; 3%). There were significant differences in RSI of liver metastases based on histology. The median RSIs for liver metastases in descending order of radioresistance were skin (0.54), colorectal (0.43), stomach (0.43), pancreas (0.42), lung (0.35), breast (0.34), small intestine (0.22), and anal (0.21); p = 0.0003. A total of 57 patients had multiple liver tissue samples. When averaging RSI values from the same patient, significant differences continued to be noted based on primary histology: colorectal (0.43), lung (0.43), breast (0.34), and anus (0.20); p = 0.008. The 12 and 24 month Kaplan-Meier rate of local control (LC) for colorectal lesions was 79% and 59% compared to 100% for non-colorectal lesions (p = 0.019), respectively. Conclusions: In this first analysis assessing the radiosensitivity of liver metastases, we find significant differences based on primary histology. As we move towards an era of personalized radiation delivery, this study suggests primary histology may be an important factor to consider in SBRT dose selection.
Effect of sunitinib (SU) administration on post-treatment survival in patients with metastatic renal cell carcinoma (mRCC) treated on the upfront randomized phase III trial of sunitinib or interferon alfa (IFN).
Authors: K. B. Blagoev, J. Wilkerson, W. D. Stein, R. J. Motzer, S. E. Bates, A. T. Fojo
Journal: Journal of Clinical Oncology (2011)

4634 Background: Drugs targeting VEGFR are approved for, or under investigation in, cancer treatment. Animal experiments suggest such therapies may accelerate metastases (Ebos et al, Cancer Cell. 2009). We sought to address whether treatment with a VEGFR agent might accelerate tumor growth after its discontinuation. Methods: We compared the time on treatment (TOT), post-treatment survival (PTS), overall survival (OS), and tumor growth rate constants (g) of patients (pts) with mRCC randomized to either SU or IFN. We used linear regression models to evaluate associations between these measures. Results: Although reported response rate and progression free survival were better in the SU arm [Motzer et al., NEJM 2006], pts randomized to IFN had a longer PTS than pts randomized to SU (medians: 29.1 v 18.7 wks, p=.006). While acquisition of a growth-retarding immune response following IFN cannot be excluded, ≈ 60% of IFN pts eventually received SU or another VEGFR agent and this may have caused the longer PTS following IFN. That randomization to SU was not detrimental is supported by the observation that longer TOT did not reduce PTS (slope of regression line =-0.054, 95%CI -0.189,0.048) indicating increased SU exposure does not adversely impact PTS. Furthermore, tumor response defined as minimum sum of the longest diameters (LD) divided by initial sum of LD, and thus analyzed as a continuous variable, modestly correlated with TOT (Rsq=0.28, p < 0.001), but not at all with PTS (Rsq= 0.027, p=0.02). Similarly, the g calculated while pts received on-study treatment was correlated with TOT (Rsq=0. 68; p<0.0001) and OS (Rsq = 0.40; p<0.0001) but not PTS (Rsq=.008; p=.27). Conclusions: Neither the duration of SU treatment nor its anti-tumor activity, reflected in tumor response and g, had an effect on PTS. Thus, SU reduces tumor growth while administered, improves OS, and appears unlikely to alter tumor biology after treatment discontinuation. Concerns arising from animal models do not appear to apply to pts receiving SU.
Chemotherapy (Ctx) use and adoption of new agents in older versus younger patients (pts) with metastatic colorectal cancer (mCRC).
Authors: Namrata Vijayvergia, Tianyu Li, Yu-Ning Wong, Michael J. Hall, Steven J. Cohen, Efrat Dotan
Journal: Journal of Clinical Oncology (2016)

674 Background: The treatment of mCRC has changed substantially in the last 2 decades but adoption of new drugs has not been well studied in older pts. We explored the effect of age and comorbidities on the adoption of irinotecan (Iri) and oxaliplatin (Ox) in mCRC pts over a 15 year timespan. Methods: mCRC pts receiving 5-Fluorouracil (5FU) based Ctx between 1995-2009 were studied using the LifeLink Health Plan Claims Database, and evaluated based on age (&gt;70 vs ≤70y). Pts were identified by ICD-9 / HCPCS (J) codes. The fraction of pts receiving Ctx was calculated at yearly intervals and any other agent received with 5FU defined combination Ctx. Charlson Comorbidity Index (CCI) was used to assess comorbidity burden. Wilcoxon's and χ 2 test were used in univariate and logistic regression in multivariate analyses (MVA). Results: 16087 pts were identified with a median age of 61y and 55% males. The difference in proportions of older vs younger pts receiving Ctx for mCRC remained stable over the 15 year period. There was an increase in the fraction of pts with CCI&gt;1 over time (14% in 1996; 40% after 2004 (p&lt;0.05). Older pts had higher rate of CCI&gt;1 (Table). Use of single agent 5FU declined in both groups over time. After FDA approval, use of Iri was lower in older pts (15 vs 38% in 1998, p&lt;0.05), but this difference resolved by 2002 (62% both groups, p=0.9). Similarly, Ox was used more frequently in younger pts after initial approval (15% vs 22% in 2003), with decrease in this difference by 2009 (60% vs 64%,p=0.9). Older pts were less likely to get &gt;2 agents when compared to younger (15 vs 22%, 29 vs 39% and 11 vs 16% in 2003, 2006 &amp; 2009 respectively, p&lt;0.001). On MVA, likelihood of receiving combination Ctx increased over time [OR 1.2; 1.18-1.26; p&lt;0.01], but was lower in older pts [OR 0.65;0.59-0.71, p&lt;0.001] and pts with CCI&gt;1 [OR 0.84;0.77-0.91; p&lt;0.001]. Conclusions: In a group of commercially insured pts, a lower fraction of older pts are treated for mCRC and adoption of new agents into the treatment of older pts appears to lag behind that of younger pts. However, oncologists have become more comfortable treating older pts with comorbidities over time. [Table: see text]
Surgical management of synchronous colorectal liver metastases: Simultaneous versus staged resections.
Authors: Igor Shchepotin, Andrii Lukashenko, Olena Kolesnik, Anton Burlaka
Journal: Journal of Clinical Oncology (2014)

616 Background: Surgical treatment of metastatic colorectal cancer remains the only method that improves overall 5-year survival. This study aimed to compare the surgical outcome and survival benefit between synchronous and staged resection of liver metastases from colorectal cancer. Methods: Clinicopathologic data, treatments, and postoperative outcomes from 110 patients who underwent simultaneous (48 patients, group A) or staged (62 patients, group B) colorectal and hepatic resections at clinic of National cancer institute in period of 2008-2013 were reviewed. Results: Postoperative complications in patients with simultaneous resections (group A) were observed in 13 cases (27.1%), including 5, 1, 4, 2, 0, and 1 of grades I, II, IIIa, IIIb, IV, and V, respectively. Similar results have been reported in group B after staged resections, where overall postoperative complications registered in 16 patients (25.8 %), including 4, 3, 6, 3, 0 of grades I, II, IIIa, IIIb, and IV respectively. Overall level of post-operative complications in the groups A and B after surgical stages finishing did not differ statistically (p=0.96). Shorter operative intervention duration was registered in the group A – (311±10.1) min, whereas in the group B it was (496.6±16.2) min (р&lt;0.001). Patients after staged resection stayed in clinic for a longer time – 23.9±0.8 bed-days, when simultaneous resections provided with shorter recovery terms in post-operative period – 9.8±0.5 bed-days (p&lt;0.001). Overall 3-year survival in the group of patients with simultaneous resections (group А) was 42 % and in the group B 55 % (р=0.22). Conclusions: Analysis of our research indicated necessity of the development of differentiated approach in management of synchronous colorectal liver metastatic cancer. Simultaneous resections of colorectal cancer primary lesions and hepatic metastases were safe and could serve as a primary option for selected patients. Subsequent research should be directed towards study of prognosis factors and criteria for patients’ selection for surgical treatment groups, assessment of economic effect, and patients life quality.