tbuckley/cabot-search huggingface dataset:
Rates of pathologic complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with or without regional pelvic hyperthermia for locally advanced rectal cancer.
Authors: Cihan Gani, Christopher Schroeder, Ulf Lamprecht, Michael Bamberg, Bernhard Berger
Journal: Journal of Clinical Oncology (2012)

622 Background: Regional pelvic hyperthermia is frequently added to neoadjuvant radiochemotherapy for locally advanced rectal cancer. The present retrospective study is the first to evaluate the impact of hyperthermia on rates of complete pathologic response and sphincter-sparing surgery in the context of a standard up-to-date neoadjuvant radiochemotherapy scheme. Methods: Between 2007 and 2010, 85 consecutive patients with locally advanced cancer (cT3, cT4, cN+) of the middle and lower rectum received neoadjuvant radiochemotherapy at our institution. 45 of 85 patients (“RCT group”) received standard treatment consisting of radiotherapy to the pelvis with 5040 cGy in 28 fractions of 180 cGy and 5-fluorouracil as a continuous infusion with 1000 mg/m² over 120 hours during the first and fifth week of treatment. 40 of 85 patients (“HRCT group”) received the same treatment with at least four treatments of weekly regional hyperthermia. Target temperature was 40.5°C for at least 60 minutes. Total mesorectal excision was routinely performed. Results: No significant difference in the distribution of age, gender, clinical stage and tumor grade was observed between both groups. Complete pathologic response was seen in 6.7% of patients in the RCT group and 22% of patients in the HRCT group (p=0.034). Overall rates of sphincter-sparing surgery were 64% in the RCT group and 65% in HRCT. However for deep seated tumors located within 4 cm of the anal verge (based on initial staging), sphincter sparing surgery was achieved in only 11.1% of patients in the RCT group but 35.7% of patients in the HRCT group (p = 0.19). Conclusions: The addition of regional hyperthermia to neoadjuvant radiochemotherapy significantly increases the rate of complete pathologic response, with a tendency towards higher rates of sphincter-sparing surgery for deep seated tumors.
Impact of extrascrotal symptoms on treatment outcome in patients with nonseminomatous germ cell tumor with intermediate or poor prognosis.
Authors: Shigeyuki Yamada, Hideo Saito, Koji Mitsuzuka, Akihiro Ito, Yoichi Arai
Journal: Journal of Clinical Oncology (2014)

384 Background: The International Germ Cell Consensus (IGCC) classification is based on primary tumor localization, presence of non-pulmonary visceral metastases, and serum tumor marker levels, not the general condition of patients. The present study aimed to identify novel prognostic factors for nonseminomatous germ cell tumors (NSGCTs) with IGCC intermediate or poor prognosis. Methods: We retrospectively analyzed 399 patients with germ cell tumors (GCT) treated at Tohoku University Hospital between 1979 and 2011. Of these, 52 and 61 patients with NSGCTs were classified as having intermediate and poor prognosis, respectively. Several clinical parameters were reviewed, including age, IGCC prognosis group, kind of induction chemotherapy, and extra-scrotal symptoms at presentation. Extra-scrotal symptoms were defined as symptoms other than scrotal swelling, such as abdominal pain, lumbago, and dyspnea. Survival was estimated using the Kaplan-Meier method. A Cox proportional hazards model was used to assess potential predictors of outcome. Results: The median age of the 113 patients was 30. Median length of follow-up was 57 months. At presentation, 12 (23%) patients with intermediate prognosis and 32 (52%) patients with poor prognosis had extra-scrotal symptoms. In the intermediate prognosis group, the five year overall survival (OS) of patients with extra-scrotal symptoms was significantly worse than that of patients without symptoms (95% vs. 63%, p= 0.0008), but there was no significant difference in five year OS between patients with and without extra-scrotal symptoms in the poor prognosis group (60% vs. 66%, p= 0.265). On multivariate analysis, the presence of extra-scrotal symptoms (hazard ratio [HR] = 2.48, p= 0.0184) and induction chemotherapy not including etoposide (HR = 12.0, p&lt; 0.0001) were independent predictors of inferior OS. Conclusions: The presence of extra-scrotal symptoms was associated with inferior OS, particularly in patients with intermediate prognosis. Intermediate-prognosis patients with extra-scrotal symptoms should be recognized as having poor prognosis.
Radiation therapy for breast cancer (BC) with central nervous system (CNS) metastases: A contemporary experience at Memorial Sloan-Kettering Cancer Center (MSKCC).
Authors: Aki Morikawa, Adi Diab, Sujata Patil, Victoria Forte, Brian Blum, Robert J. Young, Kathryn Beal, Clifford Hudis, Andrew David Seidman, Heather L. McArthur
Journal: Journal of Clinical Oncology (2013)

144 Background: Many of the well-studied prognostic factors for patients with breast cancer (BC) brain metastases (BM) are based on data from an era when stereotactic radiosurgery (SRS) was not commonly used. In this study, we examined patient characteristics and outcomes for patients with CNS metastases who recently underwent cranial radiation at MSKCC. Methods: 173 consecutive BC patients with CNS metastases receiving SRS or WBRT from January 2009 to December 2011 were identified. Clinico-pathologic and treatment information was obtained by retrospective review. Patient characteristics and associations were evaluated. Time from BM to death was evaluated by Kaplan-Meier and log-rank tests. Results: Of 173 patients (2 missing HER2 status), the subgroups were: HR+HER2-: 77 (45%), HR+HER2+: 28 (16%), HR-HER2+: 17(10%), and HR-HER2-(TNBC): 49 (29%). 121 had whole brain radiotherapy (4 with prior SRS), and 50 had SRS only. The use of SRS differed by subtype (overall Fisher’s exact p=0.02): 59% (HR-HER2+), 33% (TNBC), 29% (HR+HER2+), 21% (HR+HER2-). There were a total of 110 deaths. The median follow-up for survivors was 19mo (range: 6-67mo). The median time from BM to death for all patients was 17.5mo (95% confidence interval: 14-20mo): 41mo (HR-HER2+), 63mo (HR+HER2+), 14.5mo (HR+HER2-), 14mo (TNBC; log-rank test p=0.0001). Conclusions: Although HER2+ and TNBC subtypes are associated with a higher risk of BM, we noted a higher prevalence of HR+HER2- disease in BC patients with CNS metastasis, a group currently understudied. The prognostic information for time from BM to death differs according to subtype and may be important for future planning of clinical trials. Further evaluation of factors related to these outcomes is ongoing.
<i>Pneumocystis</i> pneumonia in patients with lymphoma: Who should receive prophylaxis?
Authors: B. M. Solomon, S. G. Holtan, L. Letendre
Journal: Journal of Clinical Oncology (2010)

e18554 Background: Pneumocystis pneumonia (PCP) is an opportunistic infection to which immunocompromised patients such as those with lymphoma are known to be susceptible. Although effective PCP prophylaxis exists, it is often not prescribed to patients with lymphoma. Herein we describe the clinicopathologic correlates of PCP infection in 58 consecutive patients with lymphoma in order to determine potential patient groups who would benefit most from PCP prophylaxis. Methods: The medical records of all adult patients with lymphoma who developed PCP between 1990 and 2007 at our institution were reviewed. Several potential risk factors for PCP infection were evaluated, including demographic data, WHO classification, disease/treatment status at the time of PCP diagnosis, concurrent treatment regimens, absolute lymphocyte count (ALC) at the time of PCP diagnosis, and PCP prophylaxis status. Results: The most common lymphoma classification was diffuse large B-cell lymphoma (36%; n=21). 86% (n=50) of patients had lymphoma of B-cell origin. 88% (n=51) had active lymphoma and were not in remission at the time of diagnosis with PCP. 76% (n=44) were receiving concurrent chemotherapy. 79% (n=46) were being treated with corticosteroids, and 61% (n=28) of these were on a cyclic steroid regimen. The median ALC at the time of diagnosis with PCP was 0.5 × 109/L. Only 3% (n=2) were receiving PCP prophylaxis before developing PCP. 28% (n=16) died within 30 days of PCP infection. Conclusions: We present, to our knowledge, the largest case series to date of patients with lymphoma and PCP. We estimate that the incidence of PCP infection in our patients with lymphoma is 2%. Potential risk factors for PCP include ALC <0.5 × 109/L, corticosteroid use, and aggressive lymphoma classification. Most patients in our series were not receiving PCP prophylaxis. PCP prophylaxis, which is generally well- tolerated, should be considered in select patients, given that PCP is a largely preventable cause of morbidity and mortality. No significant financial relationships to disclose.
Accuracy of manual and automated rectal contours using helical tomotherapy image guidance scans during prostate radiotherapy.
Authors: Jessica Elizabeth Scaife, Karl Harrison, Amelia Drew, Xiaohao Cai, Juheon Lee, Carola-Bibiane Schonlieb, Michael Sutcliffe, M Andy Parker, Sue Freeman, Marina Romanchikova, Simon Thomas, Raj Jena, Amy Bates, Neil Burnet
Journal: Journal of Clinical Oncology (2015)

94 Background: Prostate radiotherapy can be delivered using daily image-guided helical tomotherapy. Previous work has shown that contouring the rectum on the kV planning CT scan has a Jaccard conformity index (JCI) of 0.78 for different oncologists (inter-observer variability) and 0.82 for a single oncologist (intra-observer variability) (Lutgendorf-Caucig C et al. Feasibility of CBCT-based target and normal structure delineation in prostate cancer radiotherapy: multi-observer and image multi-modality study. Radiother Oncol. 2011;98(2):154-61.). Using the daily image guidance MV CT scan we have developed automated methods to contour the rectum in order to investigate the dose delivered over a course of treatment. We sought to quantify the accuracy of MV manual and automated contours. Methods: A single oncologist (JES) contoured the rectum on 370 MV scans for 10 participants treated with helical tomotherapy to prostate and pelvic lymph nodes. Accuracy of MV manual contours was tested using a scalar algorithm to enlarge and reduce the contours and intra-observer re-contouring at a 3-month interval. Automated contouring, incorporating the Chan-Vese algorithm, was developed and outputs were compared with manual contours. Results: JES could identify differences in MV manual contour size at the level of ±2.2 mm, equivalent to 1.7 pixels. The median JCI for MV re-contouring was 0.87 with inter-quartile range (IQR) 0.78 to 0.90. When compared with manual contours, automated outputs had a median JCI of 0.79 (IQR 0.74 to 0.79). These results were obtained after 3 iterations, each taking less than 10 seconds. Conclusions: Manual contouring using MV scans was accurate, at a level of approximately 2 mm, and reproducible, with JCI of 0.87. The time taken to contour was approximately 20 minutes per scan. Automated contouring was also reproducible with JCI of 0.79 and, in contrast, took less than a minute per scan. Both manual and automated methods produced results comparable to those for contouring using kV scans. We plan to use auto-contouring to calculate accumulated dose to the rectum in an initial cohort of 100 participants. These doses will be correlated with toxicity as part of the VoxTox Study.
Multidimensional contractile reserve predicts adverse outcome in patients with severe systolic heart failure: a 4‐year follow‐up study
Authors: Ioannis A. Paraskevaidis, Ignatios Ikonomidis, Panagiotis Simitsis, John Parissis, Vasilios Stasinos, George Makavos, John Lekakis
Journal: European Journal of Heart Failure (2017)
Racial/ethnic differences in quality of life and fear of recurrence after diagnosis of breast cancer
Authors: N. K. Janz, M. S. Mujahid, S. T. Hawley, A. S. Hamilton, S. J. Katz
Journal: Journal of Clinical Oncology (2008)

9526 Background: Most studies on quality of life (QOL) of women after breast cancer diagnosis and treatment have not had adequate representation of ethnic minorities. Methods: 2,030 women with non-metastatic breast cancer diagnosed between 8/05–5/06 and reported to the Los Angeles SEER registry were identified and surveyed after treatment (mean of 9 months post-diagnosis). Latina and African American (AA) women were over-sampled. Final sample n=1,338, response rate 71.2%. The FACT-B was used to assess QOL (physical, functional, emotional, social well-being, and breast cancer concerns). Fear of recurrence was measured with 3-items (range 0–15). Higher scores indicate better QOL and more fear of recurrence. Race/ethnicity categories were white, AA, and Latina (two categories indicating low vs. higher acculturation determined by the Short Acculturation Scale for Hispanics). Regression models were used to compare mean QOL and fear scores across race/ethnicity/acculturation, controlling for other sociodemographics, treatment (surgery, radiation, chemotherapy), and clinical factors (stage, co-morbidities). Results: Significant racial/ethnic differences were observed for emotional well-being (EWB), functional well-being (FWB), FACT-B total, and fear of recurrence, (ps <0.05) (See Table). Latinas with low acculturation compared to whites had significantly lower EWB (15.8 vs. 17.8) and higher fear scores (11.0 vs. 8.4) (p<.001). In contrast, AAs had a significantly higher EWB and lower fear scores than whites (EWB: 18.7 vs. 17.8; fear: 7.1 vs. 8.4). Latinas with low acculturation had the worst QOL scores among racial subgroups. No significant differences by race/ethnicity were observed for physical or social well-being. Conclusions: Clinicians must be sensitive to continuing QOL concerns of women after breast cancer, including emotional concerns, and fears about recurrence. Latinas with low acculturation are a particularly vulnerable subgroup. Table 1. QOL and fear scores by race/ethnicity PWB FWB EWB SWB BCS FACT-B Fear Latina-low 18.8 14.6 15.8 20.6 19.8 89.9 11.0 Latina-high 19.6 16.2 17.8 21.0 19.6 94.7 9.1 African Am 19.8 16.0 18.7 21.4 19.7 95.8 7.1 White 19.7 15.8 17.8 21.0 20.2 94.6 8.4 p-value 0.52 0.04 <0.001 0.63 0.30 0.03 <0.001 No significant financial relationships to disclose.
Exploring the proteome as a response predictor for rectal cancer undergoing neoadjuvant radiochemotherapy (RCT)
Authors: F. M. Smith, R. Stephens, E. Gaffney, P. Crotty, E. Petricoin, L. Liotta, J. Kennedy, J. Reynolds
Journal: Journal of Clinical Oncology (2005)

3573 Background: Recent advances in mass spectrometry allow for investigation into the low molecular weight region of the serum proteome. We sought to discover whether this region of the proteome contained potentially useful diagnostic information that could be used to predict and monitor response to RCT for patients with locally advanced rectal cancer. Methods: After obtaining ethical approval and informed consent, sequential serum samples from 15 patients undergoing RCT were prospectively collected. These were taken pre treatment then at 24hrs, 48hrs, 1, 3 and 5 weeks into RCT and finally pre surgery. Response to treatment was measured by Mandard Tumour Regression Grade (TRG) based on the percentage of residual tumour to fibrosis. All serum samples, batch run in duplicate, were analysed by surface-enhanced laser desorption/ionisation (SELDI) mass spectrometry. This generated protein mass profiles, which were analysed using Biomarker Patterns™ software (Ciphergen). Results: In total, 6 patients demonstrated good response (TRG 1+2), 4 moderate response (TRG 3) and 5 poor response (TRG 4). Time-course analysis of multiple spectra from patients undergoing treatment revealed incremental changes in peak height, which could be directly related to treatment and resolved with the completion of therapy. Furthermore, in pre treatment blood samples, one particular peak at mass/charge (M/Z) ratio of 25640 could be used to differentiate good responders from poor responders with a high degree of precision (p=0.002 t-test). Conclusions: This is the first report that the low molecular weight region of the serum proteome may be used to predict response to RCT. We have shown that treatment-related changes are identifiable in blood over time. These most likely represent up and down regulation of proteins specifically involved in mediating radiation response. More importantly, responders could be prospectively differentiated from non-responders on the basis of pre-treatment serum sample analysis. This technique may therefore offer a non-invasive method of predicting response before or early into treatment. No significant financial relationships to disclose.
Monte Carlo (MC)-based volumetric modulated arc therapy (VMAT) in locally advanced esophageal cancer with potential for dose escalation.
Authors: Shaakir Hasan, Anil Sethi, Jennifer Breunig, Gabriel Axelrud, William Small, Tarita Thomas
Journal: Journal of Clinical Oncology (2014)

77 Background: Previous attempts at dose escalation in esophagus radiotherapy (RT), mostly based on older planning techniques, have not shown improved outcomes. We aimed to investigate the importance of newer, sophisticated dose algorithms and treatment techniques in escalating target dose and reducing dose to organs at risk (OAR). Methods: Treatment plans for 10 patients were retrospectively evaluated using 3D conformal radiotherapy (3DCRT), MC based intensity modulated radiotherapy (IMRT), and VMAT. Prescription dose was 45 Gy to the planning target volume (PTV) in 25 fractions followed by a 5.4 Gy boost in 3 fractions. PTV (mean±s.d. = 681±236 cc) were planned with BrainLab iPlan 4.1 software as IMRT and VMAT. Dose distributions were calculated with both pencil beam (PB) and MC algorithms. Each PTV was normalized to receive at least 95% of 50.4 Gy or 60 Gy dose. OARs were evaluated as per RTOG1010 dose guidelines. Paired t-tests were used for statistical analysis. Results: IMRT vs. 3DCRT PTV 50.4 Gy: IMRT plans decreased heart and lung average Dmean by 4.7 Gy (p = 0.053) and 1.9 Gy (p = 0.001) respectively when compared to 3DCRT. In addition, average values of lung V5, V10, and V30 also reduced by 7.1%, 5.5%, and 3.6% respectively (p &lt; 0.05). There was a 12.1% decrease in heart V40 (p=0.053) and 3.7% reduction in liver V30 (p=0.08). PTV 60Gy: IMRT plans at 60 Gy led to lower OAR doses compared to 3DCRT at 50.4 Gy. MC based IMRT results did not significantly differ from PB, with the exception of lung V5 which was 4.4% higher (p &lt;0.001). VMAT vs. IMRT PTV 50.4 Gy: VMAT based planning, compared to IMRT, lowered V20 (3.4%, p=0.029), V30 (1.6%, p = 0.013), and spinal cord Dmax (5.4 Gy, p = 0.001). However, lung Dmean, V5, and V10 increased by 1.2 Gy, 11.7%, 16.7% respectively (p &lt; 0.001). PTV 60 Gy: With VMAT planning, all OAR dose parameters were within the RTOG 1010 limits, although lung V5 and V10 exceeded acceptable limits by 1.6% and 2.6% respectively. Conclusions: Compared to 3DCRT, target dose escalation with IMRT and VMAT is possible with improved OAR dose sparing, as evaluated with MC algorithms. Increased dose values for V5 and V10 as seen in MC based VMAT plans call for reassessment of RTOG 1010 guidelines.
Efficacy and safety of direct-acting antiviral regimens in HIV/HCV-co-infected patients – French ANRS CO13 HEPAVIH cohort
Authors: Lionel Piroth, Linda Wittkop, Karine Lacombe, Eric Rosenthal, Camille Gilbert, Patrick Miailhes, Patrizia Carrieri, Julie Chas, Isabelle Poizot-Martin, Anne Gervais, Stéphanie Dominguez, Didier Neau, David Zucman, Eric Billaud, Philippe Morlat, Hugues Aumaitre, Caroline Lascoux-Combe, Anne Simon, Olivier Bouchaud, Elina Teicher, Firouzé Bani-Sadr, Laurent Alric, Daniel Vittecoq, François Boué, Claudine Duvivier, Marc-Antoine Valantin, Laure Esterle, François Dabis, Philippe Sogni, Dominique Salmon
Journal: Journal of Hepatology (2017)
Germline and Somatic Mutations in the Hyaluronan Synthase–1 (HAS1) Gene May Contribute to Oncogenesis in Multiple Myeloma (MM) and Waldenstrom’s Macroglobulinemia (WM).
Authors: Sophia Adamia, Amanda Reichert, Anirban Ghosh, Jennifer Hodges, Patrick Pilarski, Steven Treon, Michael J. Mant, Tony Reiman, Andrew R. Belch, Linda M. Pilarski
Journal: Blood (2007)
Cancer control following focal prostate cryoablation for unilateral prostate cancer.
Authors: M. S. Pitman, M. D. Truesdale, P. J. Cheetham, G. W. Hruby, D. P. Petrylak, A. E. Katz
Journal: Journal of Clinical Oncology (2011)

e15167 Background: Widespread use of PSA screening has resulted in earlier detection of prostate cancer, often in younger patients with small-volume, unilateral disease. Partial-gland cryoablation, sparing healthy tissue and the ipsilateral neurovascular bundle, is an attractive option for patients with unilateral cancer who wish to preserve erectile function and continence. We report our early cancer outcome data for focal prostate cryoablation. Methods: We performed a retrospective review from a single-institution IRB-approved cryotherapy database of over 900 patients. Inclusion criteria: unilateral prostate cancer treated with primary focal cryoablation. Exclusion criteria: prior or concurrent hormonal therapy. Disease-free survival at 3 and 5 years was calculated using the Kaplan-Meier method, and multivariate Cox regression models were performed to determine predictors of cancer outcome. Results: From 2002-2010, 102 men underwent primary focal cryoablation for prostate cancer. Mean age was 69.3 years (standard deviation [SD] 6.7 years); mean follow-up time 30.0 months (SD 24.2 months); mean pre-operative PSA 7.0 ng/mL (SD 5.5 ng/mL); and median Gleason score sum 6 (range 5-9). Overall mean post-treatment PSA nadir was 1.2 ng/mL (SD 1.3 ng/mL). Following treatment, 22 patients underwent transrectal ultrasound-guided (TRUS) biopsy for clinical suspicion of recurrent disease, and 10/22 (45%) had confirmed recurrent prostate cancer. No patients developed metastatic disease at any point during follow-up. On multivariate analysis, preoperative PSA level, preoperative Gleason score, number of positive biopsy cores, and total tumor length were all associated with disease recurrence. Conclusions: Early data show encouraging disease-free survival rates using follow-up TRUS biopsy results. Focal prostate cryoablation is a promising option for carefully selected patients, although further follow-up and long-term disease control will determine its role in prostate cancer treatment.