tbuckley/cabot-search huggingface dataset:
Dose escalation using dose-painted IMRT in locally advanced rectal cancer.
Authors: Maged Ghaly, Lili Vijeh, Mihaela Marrero, Vincent Vinciguerra, Luz Paulina Angel, Mansoor Nasim, Beatrice Bloom
Journal: Journal of Clinical Oncology (2013)

582 Background: After preoperative chemo-radiation, clinical response and tumor pathologic downstaging showed a close correlation with improved outcomes. We report our initial experience in dose escalation using dose-painted intensity-modulated radiation therapy (DP-IMRT) in patients with locally advanced rectal cancer. Methods: Fifteen patients with locally advanced rectal cancer (T3-4,N0-1) were prospectively identified. Tumors were staged using the cTNM classification by PET/CT, EUS &amp; MRI. All received preoperative 5-FU and DP-IMRT. Doses were prescribed as follows:56 Gy/2.0 Gy fractions (fxn) to the planning target volume (PTV) and 47.6Gy/1.7Gyfxn to elective nodal PTV. Surgery was performed 6-8 weeks after chemo-radiation. The surgical procedure was tailored to tumor downstaging. The choice of sphincter-preserving surgery was based on the distance between the lower tumor pole and the anorectal ring “ after” chemoradiation. All were reevaluated for tumor response, preoperatively by imaging studies (ycTNM) and by pathological staging (ypTN) following surgery. Acute and late toxicities were monitored by the treating physician. Results: All patients completed therapy. Tumors were in the lower 1/3 in 3 patients, middle 1/3 in 7, and upper 1/3 in 5. With preoperative endorectal US, PET/CT and MRI, the clinical staging of the tumors was: 13 (T3N0) and 2 (T4N0). Acute toxicity was limited to a moderate proctitis (RTOG acute toxicity scoring system, G1 ) in all patients, with two patients with tumors extending into the anal canal having G 3 dermatitis. Complete clinical response was obtained in 10 of 15 patients.All 15 underwent surgery; 6 had pathological pT0N0, 4 had residual micro foci of carcinoma (pT1N0), and 5 had residual disease limited to the muscularis propria (pT2N0). No difference in perioperative complications was seen. Conclusions: Preoperative dose-escalation using dose-painted radiation therapy (DP-IMRT) seems to be safe. Moderate local acute toxicity was seen with very low-lying tumors. This modality provides a high rate of tumor downsizing especially for patients with lesions in the lower 2/3 of the rectum with a possible potential for an increased ability to perform sphincter-preserving surgery.
Survival in patients with esophageal cancer treated with surgery after chemoradiotherapy.
Authors: Ravi Shridhar, Jessica Freilich, Sarah Hoffe, William J. Fulp, Michael Chuong, Khaldoun Almhanna, Richard C. Karl, Kenneth Meredith
Journal: Journal of Clinical Oncology (2013)

98 Background: Chemoradiotherapy (CRT) followed by surgical resection is the standard of care for treating advanced esophageal cancer. However, the role of surgery has come into question in recent studies. The purpose of this study is to compare outcomes of patients treated with CRT with or without surgery. Methods: An IRB-approved database was queried to identify esophageal cancer patients treated with CRT with or without surgical resection between 2000 and 2011. Overall survival (OS) and disease-free survival (DFS) were calculated by the Kaplan-Meier method and log-rank analysis. Multivariate analysis for OS and DFS were calculated with a Cox proportional hazard ratio model. Results: We identified 232 patients treated with CRT (122 without surgery, 110 with surgery). Surgery was associated with a significant increase in OS and DFS. Median and 5 year OS for surgical versus nonsurgical patients was 42.2 months, and 42.3% versus 20.4 months and 29%, respectively (p = 0.0003). Median and 5 year DFS for surgical versus nonsurgical patients was 16.8 months and 29% versus 8.4 months and 22.8% (p &lt; 0.001). MVA for OS revealed that lower stage (p = 0.0098), tumor length &lt;5 cm (p = 0.0059), and surgery (p&lt;0.0001) were prognostic for significantly decreased mortality, while age, gender, histology, tumor location, radiation dose, and radiation technique were not prognostic. MVA for DFS showed that tumor length &lt;5 cm (p = 0.0112), radiation technique (p = 0.0023), and surgery (p = 0.0007) were prognostic for significantly decrease mortality, while lower stage (p = 0.069) and squamous histology (p = 0.055) were trending for decreased mortality. Age, gender, radiation dose, and tumor location were not prognostic for DFS. Conclusions: Surgery after CRT is strongly associated with increased OS and DFS in our esophageal cancer patient population. While we highly recommend surgical resection as part of trimodality treatment, it should only be performed in high volume centers. Longer followup in the already conducted randomized trials involving squamous cell carcinomas are needed to better qualify the initial negative results and randomized trials are need to address the role of surgery for adenocarcinomas.
Induction (I) or consolidation (C) chemotherapy with docetaxel (D) and gemcitabine (G) plus concomitant chemoradiotherapy (CT/TRT) with docetaxel and carboplatin (Cb) for unresectable stage III non-small cell lung cancer (NSCLC) patients (p). Initial report of the randomized phase II trial SLCG 0008
Authors: P. Garrido, B. Massutí, F. Cardenal, T. Moran, V. Alberola, I. Maeztu, M. Dómine, D. Isla, A. Arellano, A. Ramos
Journal: Journal of Clinical Oncology (2005)

7129 Background: Standard treatment for unresectable stage III NSCLC p includes CT and XRT but the optimal sequence and the integration of new CT agents in the concurrent approach are not well defined yet. Methods: P with unresectable stage III NSCLC with IK ≥ 70 and weight loss < 5% were initially randomized to sequential treatment (arm A), concurrent CT/TRT followed by consolidation CT (arm B) or induction CT followed by CT/TRT (arm C). Based on RTOG 9410 results, arm A was removed and the study continues with two concomitant arms (B, C). All p receive 2 cycles of D 40 mg/m2 d1, 8 plus G 1200 mg/m d1, 8 as I or C therapy. Concomitant treatment includes D 20 mg/m and Cb AUC 2 weekly plus 60 Gy TRT. Results: From May 01 to Dec 04 102 p were included. An interim analysis was provided when a half of p were recruited (N: 70). Preliminary data of these p (arm A: 18, arm B: 27, arm C: 28) are available although only results of both concomitant arms are presented. All groups are well-matched for baseline disease characteristics. Toxicity grade 3–4 by CTC and RTOG criteria (27 p arm B/28 p arm C) was: esophagitis 22% (arm B) and 20% (arm C); neumonitis 3.7% (arm B) and 10% (arm C). Neutropenia during I or C therapy: 22% (18 p, arm B) and 7% (28 p, arm C). Trombocytopenia 11% (arm B) and 7% (arm C). Neutropenia during concomitant therapy: 3.7% (27 p, arm B) and 5% (20 p, arm C). No thrombocytopenia or anemia severe were found during CT/TRT. The reduction rate was superior in consolidation (39%) than in induction (7%) CT. The preliminary response rate were 68.7% (arm B, 18 p analyzed) and 50% (arm C, 20 p analyzed). Nine p (13.6%) withdrawn the study due to toxicity and there were two treatment related deaths. Conclusions: Concomitant TRT with weekly Docetaxel and Carboplatin is feasible without increasing toxicity. Non-platinum CT can be used as induction or consolidation in stage III p. A trend for a better response rate in arm B without statistically significance has shown and the recruitment continues to define the better approach (I or C) in terms of response and pattern of relapse. No significant financial relationships to disclose.
Palliative treatment of obstructive esophageal cancer by vascular targeted photodynamic therapy (VTP): Preclinical study in orthotopic rat model.
Authors: Ronny Uzana, Dina Preise, Lilach Agemy, Rachel Elmoalem, Varda Belkin, Keren Sasson, Tamar Yechezkel, Yoram Salomon, Avigdor Joshua Scherz
Journal: Journal of Clinical Oncology (2016)

59 Background: Vascular targeted photodynamic therapy (VTP) based on local sensitization of circulating WST11 (Pd-bacteriochlorophyll), enables effective focal ablation of solid tumors. WST11 clears from the circulation with t1/2 ~40 min (in humans) and does not accumulate in tissues which assures high level of safety and minimal adverse effects. Here we evaluate WST11-VTP for the treatment of obstructive esophageal cancer aiming at developing clinically relevant protocol. Methods: Using endoscopy guided procedure rat esophageal cancer cells (JA) were implanted in the mid esophagus. Following intravenous infusion of WST11, established tumors were illuminated by cylindrical fiber using the same endoscope sleeve. Safety and efficacy were evaluated by monitoring animal weight shift and histology of treated esophageal tissues. Treated animals included control (light/no WST11 or WST11/no light), WST11-VTP and WST11-VTP following treatment with bevacizumab at day -3. Results: WST11-VTP on esophageal tissues resulted in coagulative necrosis of the tumor graft and prolonged survival as evident by Kaplan—Meyer curves. The impact was confined to the illuminated site without signs of perforation or death. Following Bevacizumab, WST11-VTP showed similar results while control groups showed no effect. All treated animals started to regain weight at day 7 after VTP. Esophageal tissue and function was completely restored. Conclusions: WST11-VTP could be safely applied for the treatment of esophageal tumors, with only transient and mild adverse effect that are not affected by previous, clinically relevant treatment such as Bevacizumab application. Importantly, VTP effectively eradicated established esophageal tumors and could be translated into a clinical treatment protocol.
Clofarabine and Clofarabine Plus Low-Dose Cytarabine (ara-C) as Induction Therapy for Patients (pts) ≥ 60 Years with Newly Diagnosed Acute Myeloid Leukemia (AML).
Authors: Stefan Faderl, Farhad Ravandi, Alessandra Ferrajoli, Guillermo Garcia-Manero, Zeev Estrov, Deborah A. Thomas, Susan O’Brien, Srdan Verstovsek, William Wierda, Jorge Cortes, Francis J. Giles, Monica Kwari, Rita Jarmon, Hagop M. Kantarjian
Journal: Blood (2005)
Interdiction of Src Family Kinase Activity as a Therapeutic Option for Aberrant JAK-STAT Signaling: Potential Targeted Therapy of JAK2 V617F in Myeloproliferative Disorders with Currently Available Kinase Inhibitors.
Authors: A.E. Schade, H. Szpurka, A. Jankowska, J. Bauer, E.D. Hsi, M. Kalaycio, J.P. Maciejewski
Journal: Blood (2006)
Phase I Study of RO5072759 (GA101) in Patients with Relapsed/Refractory CD20+ Non-Hodgkin Lymphoma (NHL).
Authors: Gilles Salles, Franck Morschhauser, Thierry Lamy, Noel Milpied, Catherine Thieblemont, Herve Tilly, Gabi Bieska, David Carlile, Guillaume Cartron
Journal: Blood (2009)
Phase II trial of neoadjuvant temozolomide in advanced melanoma
Authors: G. D. Shah, D. G. Coit, M. Brady, J. D. Wolchok, R. D. Carvajal, K. Busam, K. Panageas, R. Roman, A. Viale, N. Socci, P. B. Chapman
Journal: Journal of Clinical Oncology (2008)

9058 Background: Neoadjuvant treatment provides the potential for upfront systemic therapy of micrometastases, an in vivo read-out of drug sensitivity, and tumor samples pre- and post-treatment for analysis. We treated melanoma patients with extended dose temozolomide (TMZ) in the neoadjuvant setting and collected tumor pre- and post-treatment for methylguanine methyltransferase (MGMT) promoter methylation analysis and for oligonucleotide microarray analysis. Methods: Chemotherapy-naive patients who were surgical resection candidates with palpable, measurable stage IIIB, IIIC or IV (M1a) cutaneous melanoma were accrued to this phase II trial from October, 2005 to November, 2007. Prior treatment with interferon, IL-2 or vaccine was allowed. TMZ was administered orally at 75 mg/m2/d for 6 weeks of every 8 week cycle. Cycles were repeated until complete response (CR), progressive disease (PD) or stable disease (SD) x 2 cycles. The primary endpoint was radiographic response rate as determined by WHO criteria. Secondary goals included 1) assessment of MGMT promoter methylation status by pyrosequencing of bisulfite-treated DNA, 2) tumor microarray analysis. Results: 23 patients were consented of whom 20 began treatment. Five of 20 were inevaluable because of withdrawal of consent (2), early progression (2), or mucosal primary (1). Two patients are still on study. Of the 13 treated and evaluable patients, the median number of cycles administered was 1 (range 1–3). There have been 2 CRs and 1 PR (RR 23%). One patient had SD and 9 progressed. Nine patients went on to surgery; 2 with PD were deemed surgically unresectable. The MGMT promoter was unmethylated in all 5 tumor samples analyzed to date including in 2 patients with CR. Pre-treatment tumor microarray results in 8 non-responders and 3 responders revealed significantly increased expression of S100-calcium-binding protein A8 (S100A8) and matrix metallopeptidase-1 (MMP-1) in responders. Conclusions: TMZ can induce CRs in the neoadjuvant setting. MGMT promoter was unmethylated in all tumors tested and did not correlate with response to TMZ. The observation that S100A8 and MMP-1 expression is correlated with response to TMZ merits further testing. We are analyzing the remaining pre- and post-treatment tumor specimens. Supported by Schering-Plough Corporation Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Schering-Plough Corporation
Detection of aberrant drainage after sentinel lymph node mapping and its impact on staging and change of operation in colon cancer.
Authors: S. Saha, S. Sirop, A. Korant, S. Nalluri, O. L. Machek, D. Desai, S. Kaushal, B. Ganatra, J. Badin, D. Wiese
Journal: Journal of Clinical Oncology (2011)

500 Background: Sentinel lymph node mapping in colon cancer leads to the detection of micrometastasis in 15- 20% of patients leading to upstaging to stage III disease. Methods: Between 1996-2010, patients diagnosed with colon cancer were enrolled in our study and underwent SLNM at the tim of surgery plus standard oncological resection including regional LN resection. After initial years of experience, exact locations of the SLNs were mapped in relation to the primary tumor. Aberrant drainage was observed when a SLN was detected outside the standard lymph node basin. The primary objective of this analysis is to identify the frequency of detection of such aberrant drainage and the rates of positive aberrant SLNs leading to change of operation and staging. Results: Between 1996-2010, 304 patients were included in the study. The overall success rates of SLNM was 99.7%. The average number of resected LNs was 15.4. SLNM had a sensitivity, negative predictive value, accuracy and false negative rates of 85.3%, 91.7%, 94.4% and 14.6% respectively. Micrometastatic disease was detected in 15.1% of patients with node positive disease. Since 2001, 150 patients were evaluated for the presence of aberrant drainage and potential change of planned surgery. In 27 patients (18%), extended surgery was performed due to aberrant drainage. The nodal positivity in these 27 patients was 59.5%, compared to 46% in the whole group. The average number of lymph nodes in this group was 16 and the average number of SLNs was 4.3. The most common location of the primary tumor was the right colon in 55.6% of patients with aberrant drainage. In 13 patients (8.7% of case), change of operation led to the detection of positive SLNs leading to upstaging to stage IIIA/B diseases. All of these 13 patients had T3 or T4 disease. All node positive patients underwent adjuvant chemotherapy. Conclusions: SLNM in colon cancer is highly successful, sensitive and overall accurate staging procedure. It leads to detection of SLNs outside the regional lymphatic basin and change of surgery in 18% of patients. This results in higher nodal positivity and significant change of planned surgery in 8.7% of cases. No significant financial relationships to disclose.
Palliative care in a Dutch hospital: Developing a digital care pathway for palliative care.
Authors: Annemieke Van Der Padt-Pruijsten, Tanja Oostergo, Carin C. D. Van Der Rijt, Agnes van der Heide, Rineke Leys
Journal: Journal of Clinical Oncology (2015)

17 Background: Awareness is growing that palliative care is an important part in the hospital. It is aimed to improve the quality of life of patients and their relatives in the end-stage of a disease by a multidimensional approach. Prior to the development and implementation of a digital Care Pathway for Palliative Care, we wanted to map the palliative care process during the last hospitalization prior to death of patients with malignancies. Methods: We studied the medical files of patients who died in the period 1 July 2011 – 1 July 2012 within six months after having been admitted to the Department of Oncology and Lung diseases in a general hospital. A checklist was used to collect data about the patients’ diagnosis; the care that was provided during their last stay in the hospital; and about characteristics of the dying process. Results: In total 149 medical records were examined. Most of the patients (78%) were admitted because of complications or progression of the disease. During their last hospitalization, 90% of the patients underwent radiologic tests and 97% underwent blood tests. Furthermore, 38% of the patients received chemotherapy. Of all patients, 55% died during their last stay in the hospital. Medical files contained limited information about the care process: 18% contained information about provision of information to the general practitioner (GP) during admission, 78% contained reports of bad-news conversations. In 36%, the patient’s preference concerning their place of death was unknown. Further, there was no optimal communication with the GP after the patient had died in the hospital; 87% of the GP’s were informed. Conclusions: Palliative care in the hospital was found to involve suboptimal communication on several important topics. A structured medical file to guide palliative care may contribute to improvement of the care process. We are now evaluating the effects of a digital Care Pathway for Palliative Care, that includes ‘marking’ of the palliative phase of a disease and supports adequate communication, advanced care planning, multidisciplinary cooperation and continuity of care.
A phase II study of adjuvant S-1/cisplatin chemotherapy followed by S-1–based chemoradiotherapy in advanced gastric cancer.
Authors: H. Shim, W. K. Bae, J. Hwang, J. Yoon, D. H. Yang, T. Nam, S. Ryu, Y. Park, I. Chung
Journal: Journal of Clinical Oncology (2011)

e14603 Background: Surgery is the only possible curative treatment of gastric cancer. However, the high recurrence rate makes gastric cancer a disease difficult to cure by surgery alone. Despite the benefit of CRT on local recurrence, the distant recurrence is the leading pattern of failure. We hypothesized that gastric cancer outcome could be improved using a more effective chemotherapy regimen. This study was conducted to evaluate the clinical outcomes and toxicity of adjuvant treatment including S-1/cisplatin chemotherapy followed by S-1 based CRT. Methods: Pts with radically D2 resected adenocarcinoma of the stomach or GEJ in AJCC stage Ib-IV (M0) were eligible for this study. Pts were treated with S-1 (40–60 mg depending on BSA) b.i.d. for 3 wks, and cisplatin (60 mg/m2) iv on day 1, followed by a 2-wk rest period, within a 5-wk cycle. Subsequently, radiotherapy (RT) started which consisted of 25 fractions of 1.8 Gy to a total dose of 45 Gy in 5 wks (5 fractions/wk). On RT days, S-1 (40–60 mg depending on BSA ) b.i.d., 5 days/wk was given. One month after the completion of RT, two 5-wk cycles of S-1/ciplatin chemotherapy were given. Results: Up to August 2010, 33 pts were enrolled. Among them 26 pts (79%) completed the planned adjuvant treatment. The median age was 52 years (range: 29-66); stage II/IIIa/IIIb/IV = 9/10/11/3. During treatment, grade 3-4 hematologic toxicities were observed: leucopenia (12%), neutropenia (42%), thrombocytopenia (6%) and anemia (27%). The most common non-hematologic toxicities were gastrointestinal. Toxicities led to chemotherapy dose reductions in 3 pts and dose-delay in 7 pts. At time of analysis, after a median follow-up of 15 (3-22) months, 29 pts are alive and 4 pts have died. 3 pts died because of progressive disease and one death was caused by sepsis due to an intra-abdominal abscess. Of the 3 pts who relapsed, 2 pts developed peritoneal metastasis and one developed peritoneal and hepatic metastases. Conclusions: This phase II study shows that intensified adjuvant treatment with S-1/cisplatin chemotherapy and S-1-based CRT seems to be effective in reducing recurrence, although this schedule is associated with high incidence of hematologic toxicities.
Sexual health inquiry preferences among gynecologic cancer patients after radiation therapy.
Authors: Gerard Edward Heath, Pamela Fairchild, Mitchell Berger, Anagha Tolpadi, Christina Chapman, Shruti Jolly
Journal: Journal of Clinical Oncology (2016)

87 Background: Following radiation therapy (RT), gynecologic oncology patients report high rates of sexual dysfunction. However, little is known regarding communication of sexual health among these patients and their healthcare providers. The aim of this study was to assess the beliefs/attitudes of patients regarding sexual history taking. Methods: Survey results were obtained from 75 women who presented for follow up care for gynecologic cancers in the radiation oncology department. The surveys assessed patient beliefs about sexual health and its impact on overall quality of life, the role practitioners should play in obtaining an accurate sexual history, and preferences and level of embarrassment regarding sexual history collection. Overall level of sexual functioning was assessed using the Female Sexual Function Index (FSFI). Chi-squared tests were used to analyze categorical variables and logistic regression modeling was used to predict agreement with survey statements. Results: Most subjects were white and married with a mean FSFI score of 9.9 [(SD = 10.3) sexual dysfunction is defined as &lt; 26.5]. 78.7% agreed that sexual function is an important component of overall health, and only 12.0% reported embarrassment about discussing their sexual health with healthcare providers. 62.79% agreed that medical providers should take a sexual history on a regular basis. However, 58.7% and 22.7% of women report never or almost never being asked about their sexual health by their primary care physician or Ob/Gyn, respectively. Approximately two-thirds of women expressed a preference to have a female provider obtain their sexual health history. Conclusions: Gynecologic cancer patients s/p RT report low sexual function scores. A majority agree that sexual function is essential to overall health. They report little embarrassment regarding discussions of sexual health, yet, note limited discussion about the topic with their healthcare providers. This work highlights the need for improvements in communication about sexual health. We suggest that healthcare providers caring for women with gynecologic cancers should more regularly inquire about their patients’ sexual health and function.