tbuckley/cabot-search huggingface dataset:
OS4.5 Working memory deficits in brain tumor patients are related to reduced default mode inhibition
Authors: I T Schouwenaars, M J de Dreu, G J M Rutten, N F Ramsey, J M Jansma
Journal: Neuro-Oncology (2018)

Working memory (WM) is an essential brain function that is involved in many cognitive tasks. Previous functional MRI studies in healthy subjects have shown that WM load correlates with activation in the central executive network (CEN), and deactivation in the default mode network (DMN). Brain tumor patients often have cognitive deficits, which can greatly affect their socio-professional life. In this fMRI study, we examined if these cognitive deficits may be related to impaired working memory function by examining brain activity within the CEN and DMN. Functional MRI scans were acquired in 17 healthy controls (‘HC’; age ± SD: 23 ± 2) and pre-operatively in three different groups of brain tumor patients: 31 meningioma patients (‘MG’; age: 56 ± 11), 17 low grade glioma patients (‘LGG’; age: 43 ± 14) and 16 high grade glioma patients (‘HGG’; age: 50 ± 15). Subjects performed three WM tasks with increasing WM load (low, medium and high), but with identical stimuli (consonants, ISI: 1s). Performance was calculated as a percentage of correct responses. For fMRI, the percentage signal change was calculated for each condition in cube shaped ROIs (15 mm3) overlapping with important regions of the CEN and DMN. Results were tested for linear change over conditions using an ANOVA with linear contrast. A condition by group interaction was found for performance (F = 9.74, p < 0.001). Follow-up analyses showed that each patient group performed worse than HC (MG: F = 19.19, p < 0.001; LGG: F = 18.74, p < 0.001); HGG: F = 30.77, p < 0.001). In the CEN, no condition by group interaction was found (F = 0.78, p = 0.51). Follow-up analyses revealed that each group showed a linear increase in activity within CEN (HC: F = 42.45, p < 0.001; MG: F = 66.32, p < 0.001; LGG: F = 56.75, p < 0.001; HGG: F = 85.48, p < 0.001). In the DMN there was an interaction between groups (F = 9.51, p < 0.001), whereby follow-up analyses indicated that patients had different brain activity patterns than HC. HC showed a linear decrease in activity with increasing WM load (F = 57.77, p < 0.001), that was not present in any of the patient groups (F = 1.05, p = 0.31; LGG: F = 2.92, p = 0.11; HGG: F = 1.27, p = 0.28). Our study found strongly reduced DMN deactivation in brain tumor patients during working memory performance, which was also associated with reduced performance but was unrelated to tumor type or location. Our study suggests that the presence of a brain tumor -either directly or indirectly- reduces the ability to inhibit DMN. We hypothesize that this dysfunction somehow interferes with normal working memory function, leading to reduced performance in these patients, especially for difficult cognitive tasks.
Self-reported adherence to lenalidomide as maintenance therpay for multiple myeloma after autologous stem cell transplantation.
Authors: Ilana Schlam, Garima Gupta, James H. Essell
Journal: Journal of Clinical Oncology (2018)

e20046 Background: Increase availability of oral anticancer drugs has raised concerns about patient adherence. In 2017, lenalidomide was approved as maintenance therapy for multiple myeloma (MM) after autologous hematopoietic stem cell transplantation (HSCT) based on two trials that showed 15 to 18-month progression-free survival advantage. The aim of this study was to determine adherence to this oral medication. Methods: 72 patients taking lenalidomide as maintenance after HSCT were identified. Demographic and clinical data was collected through an anonymous survey, which was mailed to the patients. Results: Out of 72 patients, 36 responded. Five were 51-60 years old, 13 were 61-70, and 18 were older than 70. 29 were Caucasian, six African-American, and one Asian. The mean time since diagnosis was 4.3 years. Twenty-two patients reported they did not miss any doses every month, 14 reported they missed 1-2 doses per month (61, 38% respectively), none of the patients reported missing more than 2 doses a month. Twelve patients reported adverse effects (AE), however only one stopped taking lenalidomide due to AE (fatigue, dizziness, chest pain). The most commonly reported AE are described on table 1. Eight patients reported they forgot to take the medication. Two patients reported they occasionally do not take the medication due to side effects (diarrhea, fatigue). Two patients reported problems with the cost. Twenty patients own a smartphone and only 4 of them reported using applications as reminders to take the pill. Twenty-two patients use a pill box. Interestingly, there was no correlation between compliance and the use of a smart phone or a pill box. Conclusions: Lenalidomide is well tolerated. Patient education is fundamental since this medication improves outcomes significantly in MM patients. The main limitations for this study included the sample size, that the patients that responded the survey are likely to be more compliant with their medications, and overestimation by the patients. Adverse Effect Number of patients (%) Adverse effects 12 (33) Fatigue 9 (25) Dizziness 6 (16) Back pain 4 (11) Joint pain 4 (11) Diarrhea 4 (11) Neuropathy 3 (8) Constipation 1 (2) Itching 1 (2) Chest pain 1 (2)
Adjuvant chemoradiotherapy association in advanced soft tissue sarcoma patients: Safety and outcome in a retrospective series.
Authors: Daniela Greto, Mauro Loi, Irene Giacomelli, Laura Trombetta, Juljana Topulli, Emanuela Olmetto, Rodolfo Capanna, Domenico Campanacci, Cristina Muntoni, Cinzia Ciabatti, Calogero Saieva, Giovanni Beltrami, Guido Scoccianti, Anna Mancuso, Roberta Grassi, Isacco Desideri, Icro Meattini, Pierluigi Bonomo, Lorenzo Livi
Journal: Journal of Clinical Oncology (2016)

11034 Background: The aim of this study was to analyze if the association of Chemotherapy and Radiotherapy in adjuvant treatment of soft tissue sarcoma (STS) is safe in terms of toxicities and if it could be feasible without delays in treatment plan completion. Overall Survival (OS), Local recurrence (LR) and Distant Recurrence (DR) related to the adjuvant treatment were reported. Methods: From June 1994 to November 2014 a total of 158 patients affected by STS were treated with radical surgery and adjuvant radiotherapy alone or associated with chemotherapy. Toxicities were collected in accordance with the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. The late toxicity was assessed during the follow up by the RTOG/EORTC criteria for the Late Radiation Toxicity. Overall Survival (OS),Local Relapse Free Survival (LRFS) and Distant Relapse Free Survival (DRFS) were calculated with the Kaplan–Meier method. Results: Mean follow up was5.4 years (range 0.2-21.1 years). All patients underwent postoperative radiotherapy, in 54 (34.2 %) high risk patients chemotherapy was administered. Anemia G2-G3 occurred in 26 % of patients followed by leucopenia that occurred in 11, 4% of patients, G2-G3 in 8 cases and of G4 in 4 cases . The skin acute toxicity was G1 in 24.7% of patients,G2 in 19.6% and G3 in 12.7 %, respectively . Acute dermatitis determined interruption of the radiotherapy treatment in 19 (12 %) patients. 22 patients (13.9%) developed G1 fibrosis and 19 patients (12 %) a moderate G2 fibrosis . Mild and moderate joint stiffness was recorded in 16 (10.1%) patients. Local Recurrence Free Survival (LRFS) was found to be 79.1 %. Distant Relapse Free Survival (DRFS) was 76.4 %. At the time of our analysis 30 (19%) patients were died, overall survival (OS) was 64.6%. Conclusions: Postoperative radiotherapy in locally advanced STS is a well tolerated treatment, the addition of the chemotherapy did not increase local acute and late toxicity. Prospective study are necessary to well define the timing of chemotherapy administration in relation to radiotherapy, the chemoradiotherapy association could be a good option to avoid treatment delay and possible reduction of disease local control.
Postoperative radiation for tumor control and overall survival in thymic epithelial tumors (TET): A matched-pair analysis.
Authors: Feng Ming Kong, Yong Zang, Weili Wang, Hong Zhang, Jessica Smith, Sunil S. Badve, Kenneth Kesler, Patrick J. Loehrer
Journal: Journal of Clinical Oncology (2017)

8572 Background: Due to lack of randomized trials, the role of postoperative radiation therapy (PORT) in thymic epithelial tumors (TET) remains controversial. This study aimed to evaluate whether PORT improves tumor control and overall survival (OS) in patients with resected TET in a large single institution database. Methods: This is a retrospective study of all TETs seen at Indiana University between 1975 and 2016. Patients with resected thymoma (T) or thymic carcinoma (TC) were eligible disregarding their margin status or stage. Study endpoints were progression free survival (PFS) and OS. Age, gender, race, tumor size, stage, pathology, grade, completeness of resection and adjuvant treatment modality were analyzed for significance on PFS and OS. Multivariate Cox model was used to identify significant factors for propensity score matching. Differences between the PORT and surgery alone group were estimated using stratified log-rank test. Results: A total of 478 patients with previous surgical resection were eligible. Masaoka Stage was: I-86 (22%); II-87 (23%); III-107 (28%); and IV-106 (27%), respectively. Multivariate analysis demonstrated that gender (HR = 1.4, p = 0.03), stage (HR = 1.3, p = 3×10 -3 ), TC (HR = 1.6, p = 0.03) and PORT (HR = 1.6, p = 0.002) were significantly associated with PFS. Age (HR = 1.1, p = 4×10 -7 ), TC (HR = 3.2, p = 3×10 -5 ), stage (HR = 1.4, p = 0.003) were associated with OS. PORT was given to 126 (26%) patients. Propensity score matching based on independent prognostic factors identified 99 patients for PORT, matched to 285 patients without. The 5-/10-year intra-thoracic progression free rates were 77%/69% and 85%/68%, for patients with and without PORT (p = 0.009), respectively. The 5-/10-year PFS rates were 39%/18% and 61%/32%, for patients with and without PORT (p = 0.002), respectively. The median survival, 5-/10-year OS rates for patients treated with PORT were 150 (95%CI 111~277) months, 87%/57% and respectively, compared to 192 months (95%CI 167~279), 88%/69% for patients receiving surgery alone ( p = 0.13). Conclusions: This matched-paired analysis from a single institution suggests that PORT does not impact the PFS or OS in a selected population of resected TET.
Germline BRCA1 mutations and pancreatic adenocarcinoma: A literature review.
Authors: Ahmad Al-Taee, Ammara Gill, Suzanne M. Mahon, Bassel Jallad
Journal: Journal of Clinical Oncology (2017)

e15716 Abstract Background: Pancreatic adenocarcinoma (PAC) is the fourth leading cause of cancer-related deaths in the United States. Although the vast majority of cases are sporadic, up to 10% of cases are related to a hereditary cancer predisposition syndrome, the most common of which is germline BRCA mutation. Although BRCA2 mutation has been well described in the literature, data on BRCA1 mutation-associated PAC is limited. This work aims at reviewing the literature on BRCA1 mutation-associated PAC and discussing the relevant findings. Methods: We have searched the Pubmed database for articles using the search terms “pancreatic”, “BRCA”, BRCA1”, “adenocarcinoma” or any combination of these keywords. Data about epidemiology, staging, prior history of other tumors, and management were collected. Systematic data extraction and assessments of quality were carried out by two reviewers, and good agreement was found. Results: A total of 13 studies were selected for review and included a total of 149 patients. The prevalence rate of PAC among patients with germline BRCA1 mutations ranged between 0.002% and 0.03%. Moreover, the prevalence of BRCA1 mutations in patients with BRCA-related PAC was found to be between 27% and 30%. Of note, PAC was diagnosed as the first tumor in 74% of patients with BRCA1-related PAC. The most common stage at diagnosis was stage 4 (56%) followed by stage 2 (22%). Conclusions: Germline BRCA1 mutation-associated PAC is an under-recognized entity when compared to BRCA2 mutations. Given the incredibly poor prognosis and the growing interest in targeted therapies, physicians need to be familiar with BRCA1 mutations as a possible etiology of PAC. A significant number of patients with BRCA1 mutation-associated PAC were diagnosed with PAC as the first tumor. Therefore, upper gastrointestinal screening should be considered in patients with germline BRCA1 mutations.
Role of SBRT with VMAT technique and FFF beams for lymph-node metastases in oligometastatic patients from genitourinary malignancies.
Authors: Giuseppe Roberto D'Agostino, Ciro Franzese, Elena Clerici, Pierina Navarria, Paolo Andrea Zucali, Rodolfo Hurle, Stefano Tomatis, Pietro Mancosu, Luca Cozzi, Marta Scorsetti
Journal: Journal of Clinical Oncology (2016)

e16136 Background: Stereotactic body radiotherapy (SBRT) is an interesting therapeutic approach for several sites of metastatic disease but few published data exist on local control rates in the context of isolated or limited lymph node metastases. We analyzed the outcome of oligometastatic patients suffering from genito-urinary primary neoplasms and treated with SBRT on isolated lymph-node metastases. Methods: Patients with a maximum of 5 lymph-nodal metastases (diameter < 5 cm) -were included in this analysis. Radiotherapy was delivered with Volumetric Modulated Arc Therapy Rapid-Arc (VMAT-RA) and flattening filter-free (FFF) beams; median prescribed dose was 45 Gy (range 20 – 48 Gy) in median 6 fractions (range 4 – 6). Clinical response was evaluated according to RECIST criteria v. 1.2. We analyzed acute toxicity (CTCAE 3.0), local control of disease and overall survival. Results: From December 2008 to May 2015, 43 patients with 62 lymph-node metastases, were submitted to SBRT. Primary malignancies were prostate (n = 39, 62.9%), kidney (n = 13, 20.9%), bladder (n = 5, 8.1%), ureters (n = 4, 6.5%) and testicle (n = 1, 1.6%). At the post-treatment re-evaluation, complete response was achieved in 35 lesions (56.4%) and partial response in 21 lesions (33.9%). A stable disease was observed in 5 cases (8.1%) while 1 (1.6%) lesions showed disease progression. The overall clinical benefit rate was 98.4% (61/62 lesions). Acute toxicity was mild, 13 (30.2%) patients having experienced a G1 nausea and fatigue; no heavier toxicities were reported. At a median follow-up of 22 months (range 5 – 63 months), in-field progression of disease was observed in 9 sites (14.5%) after a median time of 6 months (range 3-20). Fourteen patients experienced an out-field lymph-node progression (32.5%) while distant metastases occurred in 8 cases (18.0%). Local control, and overall survival at 1 year were 83% and 93%, respectively. Conclusions: Our results confirm that SBRT with VMAT-RA and FFF beams can be considered a safe and effective approach for oligometastatic patients with isolated lymph-node metastases from genito-urinary tumors.
Study of microflora in stomach cancer and gastritis.
Authors: Tatiana Zykova, Oleg Ivanovich Kit, Yuri Gevorkyan, Vladislav Legostaev, Olga A. Bogomolova
Journal: Journal of Clinical Oncology (2017)

e15516 Background: The purpose of the study was to compare the rates of bacterial and fungal colonization of the mucosa in stomach cancer and gastritis. Methods: 59 tumor and healthy tissue samples in stomach cancer and 33 stomach mucosa bioptates in gastritis were studied. DNAs were extracted by the adsorption method. DNAs of Enterobacteriaceae, Staphylococcus spp., Streptococcus spp., Candida spp., Bacteroides spp. were determined by real-time PCR. Results: 40.0% of 30 patients with stomach cancer had adenocarcinoma, 13.3% – signet ring cell carcinoma, 6.7% – undifferentiated cancer, 6.7% – NHL, 3.3% – squamous cell carcinoma, 6.7% – combined signet ring cell carcinoma and neuroendocrine or undifferentiated cancer, 23.3% – combined adenocarcinoma and neuroendocrine, signet ring cell or undifferentiated cancer. The comparison group included 33 patients with morphologically verified superficial gastritis. DNA of Bacteroides spp. was found in tumor and healthy tissues of 80.0% of cancer patients; it was not found in gastritis. DNA of B. fragilis was found in all tumor tissue samples, BFT – in 8.3% of them. The mean amount of Enterobacteriaceae in tumor tissue was 6.7x10 5 copy/ml, in healthy tissue – 7.0x10 5 copy/ml, in bioptates in gastritis – 4.0х10 2 copy/ml; Staphylococcus spp. – 3.4х10 2 copy/ml, 2.6х10 2 copy/ml and 8.7х10 1 copy/ml, Streptococcus spp. – 9.1х10 5 copy/ml, 1.3х10 5 copy/ml and 5.1х10 3 copy/ml, respectively. Thus, the amount of Enterobacteriaceae in tumor tissue in stomach cancer exceeded the value in gastritis by 1675 times, Staphylococcus spp. – by 3.9 times, Streptococcus spp. – by 178 times. Genes of resistance to the penicillin class TEM were found in 50.0% of patients with stomach cancer and in 8.7% of patients with gastritis. DNAs of Candida spp. in stomach cancer were found in 40% of patients in tumor tissue and in 31.0% in healthy tissue, in gastritis – in 8.3% of patients. Conclusions: Enterobacteriaceae and Streptococcus spp., mostly combined, dominate among microflora colonizing gastric mucosa in stomach cancer. The established differences in microbiocenosis in stomach cancer in comparison with gastritis suggest the possible involvement of aerobic and anaerobic microflora in the process of malignant transformation.
A comparison of liver cancer patients receiving palliative care at two Veteran Affairs Medical Centers.
Authors: Sarah Lee, Zhen Wang, Sejal Kothadia, Yucai Wang, Ellen Olson, Yeun-Hee Anna Park, David Klein, Fengming Zhong, Victor Tsu-Shih Chang
Journal: Journal of Clinical Oncology (2016)

e15644 Background: Liver cancer is a leading cause of death. Lack of data exists on palliative care in this group, and care varies by location. We aim to determine if there are differences in palliative care for liver cancer patients (pts) by VA site. Methods: In an IRB approved protocol, we reviewed medical records of pts at 2 VA medical centers (S1, S2) with liver cancer, who were seen by Palliative Care between 2006 and 2012. Veterans were compared by 1) demographics: Karnofsky performance status > 50 (KPS), marital status, DNR/DNI, 2) palliative intervention: goals of care discussion, referrals to psychology and PT/OT, and 3) outcomes: ED visit within 1 month (mo) of death, ED visit within 6 mo of death, ICU within 30 days of death, and hospice as site of death, time from diagnosis to palliative care, and time from DNR to death. Chi-square, Fisher’s Exact, and T-test were performed with Stata. Results: There were 82 men, 30 from S1 and 52 from S2, median age 61 (35-87) and 63 (54-88) yrs, respectively. Pts were Caucasian 30 (36%), African American 47 (57%), and other 5 (0.1%). Cancer stages were locoregional 15 (50%), metastatic 13 (43%), and unknown 2 (0.1%) at S1 and 28 (54%), 20 (38%), 5 (0.1%) at S2. Differences were seen in KPS > 50: (S1, S2) [10 (33%), 15(29%) p = 0.010], married: (S1, S2) [7 (23%), 24(46%) p = 0.024], DNR/DNI: (S1, S2) [19 (63%), 13(25%), p = 0.001]. Regarding palliative intervention: goals of care discussion (S1, S2) [26 (87%), 44 (85%), p = 0.044], referral to psych (S1, S2) [16 (53%), 42 (81%) p = 0.014], referral to PT/OT (S1, S2) [17 (57%), 15 (29%), p = 0.007]. Finally in regards to outcome: ED visit within 1 mo of death (S1, S2) [7 (23%), 31 (60%), p = 0.001], ED visit within 6 mos of death (S1, S2) [18 (56%), 35 (67%) p = 0.031], ICU within 30 days of death (S1, S2) [0 (0%), 9 (17%) p = 0.019}, and hospice as site of death (S1, S2) [19 (63%), 21 (40%), p < .0001]. Other key differences included median number of days from diagnosis to initial palliative care consult (S1, S2) [97, 39, p = 0.001] and median number of days from DNR to death (S1, S2) [33, 14, p = 0.001]. Conclusions: Results show there are site specific differences between VA medical centers. These data may be important in the comparison of other centers and provide a baseline for future studies.
Prostate clinical outlook visualization for patients and clinicians considering cyberknife treatment: A personalized approach.
Authors: Jihwan Park, Mi Jung Rho, Anatoly Dritschilo, Sean P. Collins, Simeng Suy, In Young Choi, Seong K. Mun
Journal: Journal of Clinical Oncology (2017)

e16549 Background: When a patient presents with localized prostate cancer, referral for radiation oncology consultation includes a discussion of likely outcomes of therapy. Among current radiation treatments for prostate cancers, hypo-fractionated stereotactic body radiation therapy (SBRT) has gained clinical acceptance based on efficacy, short duration of treatment and potential radiobiological advantages. The prostate Clinical Outlook (PCO) visualization system was developed to provide the patient and the clinician with a tool to visualize probable treatment outcomes using institutional, patient specific data for comparing results of treatment. Methods: We calculated the prostate cancer outlooks for each prospective patient using the EPIC-26 quality of life parameters based on clinical outcomes data of 580 cyberknife SBRT treated prostate cancer patients. We applied Kaplan-Meier analysis using the ASTRO method for disease free likely outcome and the PCO nomogram to calculate parameters for quality of life. Open source R, R/Shiny, and MySQL were used to develop a modularized architecture system. Results: PCO presents patient specific risk scores in a gauge chart style and risk free probability bar plots to compare treatment data of cyberknife patients. PCO generates reports, in PDF and HTML, which consist of a comparison chart of risk free probabilities and gauge charts of risk scores. This system is now being expanded as a web-based service to patients. Conclusions: PCO visualized patient specific likely outcomes were compared to treatment data from a single department, helping the patient and the clinician to visualize likely outcomes. The PCO approach can be expanded to other specialties of oncology with the flexible, modularized architecture which can be customized by changing parameter variables for the modules.
TCT-269 Optical Coherence Tomography evaluation of Very Early eNdothelialization after Dual Therapy Drug-eluting Stent with EPC CaptURE (OCT-VENTURE)
Authors: Bryan Yan, William Hau, Lally Chan, Eugene Wu, Joseph Chan, Chi Yuen Chan, Akiko Maehara
Journal: Journal of the American College of Cardiology (2018)