tbuckley/cabot-search huggingface dataset:
Implementation of transesophageal ultrasound (EUS-FNA) for lung cancer staging
Authors: J. T. Annema, S. A. Burgers, M. Smits, B. Taal, K. F. Rabe
Journal: Journal of Clinical Oncology (2008)

7605 Background: Transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) demonstrated to be an accurate and minimally invasive method for the diagnosis and staging of lung cancer, resulting in a reduced need for surgical staging in around half of patients. Although EUS-FNA is part of lung cancer staging algorithms in recent guidelines, no data exist whether the reported EUS findings—obtained by experts—are reproducible in community hospital settings. Methods: Prospective non-randomized multicenter diagnostic implementation trial. Nine physicians from 5 hospitals participated in a dedicated EUS implementation program including indication assessment and on-site training in 45 patients. Patients with (suspected) non- small cell lung cancer in whom surgical staging of the mediastinum was indicated were eligible. Consecutive patients underwent EUS-FNA in the 5 implementation centers as well as the single expert center. In case of the absence of tissue proven N2/N3 metastases at EUS-FNA, surgical staging or thoracotomy with mediastinal dissection was performed. Primary outcomes were: 1) sensitivity and accuracy regarding mediastinal staging and 2) prevented surgical interventions. Results of implementation centers were compared to that to the expert center. Results: 527 patients were included, 334 (63%) in the implementation and 193 (37%) in the expert center. Sensitivity and accuracy for mediastinal staging (implementation vs expert centers) were 83% and 89% vs 81 and 87% respectively. Surgical staging was spared due to endosonography in 47% (implementation) vs 46% (expert) of patients. Non representative FNA samples were identical (7%) in both groups. One major complication occurred in each group. No differences in the major outcomes were found in the implementation centers comparing results of the first with the second year after introduction of EUS-FNA. Conclusions: Chest physicians without prior (endo)sonography experience obtained the same sensitivity, accuracy and impact on patient management as experts, in performing EUS-FNA for the diagnosis and staging of lung cancer. The proposed implementation program might qualify as a model to facilitate large scale dissemination of EUS-FNA for lung cancer staging. No significant financial relationships to disclose.
Physician order for scope of treatment (POST) in South Carolina (SC).
Authors: Mark Allen O’Rourke, Matthew F. Hudson, Janet B. Craig, John C. Ropp, Karen Reeves
Journal: Journal of Clinical Oncology (2012)

21 Background: Physician Order for Life-Sustaining Treatment (POLST, www.POLST.org ) is a process and tool that translates patients’ goals of care into medical orders in a highly visible, portable way. Trained providers meet with seriously ill patients (or the surrogates) and discuss the available treatment options in light of their current condition, and help clarify the patient’s preferences. The physician then documents those preferences on a standardized medical order form, which travels with the patient if he or she changes settings of care. The POLST form is 1. a physician order, 2. signed by the patient, 3. after consultation with the physician, 4. facilitated by a person trained in advance care planning, 5. directed toward people with serious, chronic illness such that death in the next year would not be a surprise, 6. addressing the decision at a moment of medical crisis to a. hospitalize with full therapeutic intervention, or b. hospitalize with limited therapeutic intervention (such as no CPR), or c. provide supportive, palliative care in the present setting (home or nursing facility), 1. addressing further decisions such as feeding tube, parenteral (IV) hydration, or antibiotics, 2. documented in a widely publicized, recognized and understood form with a distinct pink color, and 3. accepted by EMS responders, hospices, nursing facilities, and hospitals across the state. Methods: The SC Coalition for the Care of the Seriously Ill is comprised of clinical and administrative leaders representing key statewide organizational partners, healthcare entities, and individuals. The Coalition proposes a template order for statewide integration to be called POST. The target population is persons with serious illness for whom death in the next year would “not be a surprise.” Results: Presently, the Coalition is working with state government to undertake a three-county pilot study of POST. Challenges include creating a legal framework, IRB approval, and education of providers and the public. Conclusions: POST may facilitate patient-centered advanced cancer care. Implementation of the POST in SC will require collaboration by stakeholders. Collaboration will require responsiveness to constituents’ concerns in order to facilitate patient-centered care.
Interaction of the progesterone receptor expression with other prognostic factors in primary breast cancer.
Authors: J. Salmen, P. G. M. Hepp, J. K. Jueckstock, M. Guenthner-Biller, B. K. Rack, P. A. Fasching, M. W. Beckmann, W. Janni, S. Mohrmann
Journal: Journal of Clinical Oncology (2011)

e11119 Background: The expression of the estrogen receptor (ER) and the progesterone receptor (PR) is a predictive factor for the response to an endocrine treatment and to chemotherapy in primary breast cancer. Aim of this retrospective study was to analyse the prognostic relevance of PR in interaction with other prognostic factors. Methods: Between 1995 and 2008, data from 5144 patients with primary breast cancer have been collected in 3 German university hospitals. The PR-expression was correlated to clinical-pathological variables like tumor stage, nodal status, grading and the expression of ER. Overall survival (OS), distant disease free survival (DDFS) and local recurrence free survival (LRFS) were the main outcomes of interest. PR was analysed for interaction with each other prognostic factor in cox proportional hazard models. Results: The expression of the progesterone receptor had an effect on overall and distant disease free survival (each < 0,001), but no effect on local recurrence free survival (p = 0,382). The only interaction of the PR status and other prognostic factors was seen for the ER status (p = 0,028). Women with ER negative/PR negative tumors had an worse prognosis than patients with ER negative/PR positive tumors. Women with ER negative/PR positive tumors had an equal prognosis than patients with ER positive/PR positive disease. There is no interaction between the PR status and the tumor stage, nodal status and grading. Conclusions: Expression of PR is an independent prognostic factor. In addition to ER, PR should be analysed to identify subgroups with different clinical outcome.
Use of RNA Electroporated DC for Activation of LRH-1 Specific Cytotoxic T Lymphocytes in the Treatment of Lymphoid Malignancies.
Authors: Ingrid Overes, Hanny Fredrix, Bjorn de Rijke, Agnes van Horssen-Zoetbrood, Han van Krieken, Reinier Raymakers, Robbert van der Voort, T.M. de Witte, Harry Dolstra
Journal: Blood (2006)
Validation study of sentinel lymph node mapping using radio- and dye-guided methods in gastric cancer: 431 cases at a single institution.
Authors: M. Niihara, H. Takeuchi, S. Kamiya, T. Kaburagi, T. Oyama, Y. Saikawa, N. Wada, T. Takahashi, R. Nakamura, Y. Kitagawa
Journal: Journal of Clinical Oncology (2011)

76 Background: Some papers have reported that sentinel lymph node (SLN) concept can be applied in patients with early gastric cancer, in particular clinically T1N0M0 or T2N0M0 with a tumor diameter of 4cm or less. Little is, however, available on the SLN study with the other criteria than listed above. The aim of the present work was to investigate the accuracy of the SLN biopsy of gastric cancer with various stages and evaluate the indication for SLN navigated gastrectomy. Methods: A total of 431 consecutive patients were diagnosed with operable gastric cancer during the period April 1999 through December 2007. Reasons for inclusion were, in principle, T1N0M0 or T2N0M0 gastric cancer. However, several patients diagnosed preoperatively with T3N0M0, T2N1M0, remnant gastric cancer, multiple gastric cancers and additional treatment after endoscopic therapy were also enrolled in this study according to their request. All patients underwent a radical gastrectomy with SLN mapping with an informed consent. The SLNs were identified using both radio-guided and dye-guided method. Results: Detection rate of hot and/or blue node was 95.8% (413/431). The accuracy of metastatic status based on SLN was 97.6% (403/413). In six of 10 false-negative cases, some clinical backgrounds and problems were present; scirrhous gastric cancer, the tumor penetration of serosa, multiple lesions, remnant gastric cancer after partial resection and the technical issue of tracer injection. Nine of these 10 false-negative cases had the metastatic lymph nodes within only the sentinel basins. Specifically, in the group of clinically T1N0M0 untreated gastric cancer with a tumor diameter of 4 cm or less, there were only 3 false- negative cases. In addition, all the metastatic lymph nodes of the 3 cases located within the sentinel basins. Conclusions: Our study suggested that SLN concept for untreated early gastric cancer could be validated. The sentinel basin dissection might be used to advantage to improve curativity for gastric cancer. No significant financial relationships to disclose.
Does interval from histologic diagnosis (Dx) to start of chemotherapy (Ctx) influence survival in advanced pancreatic adenocarcinoma (PC)?
Authors: MinYuen Teo, Anuradha Jayaram, Jarushka Naidoo, Mohd Syahizul Nuhairy Mohd Sharial, Michelle O'Brien, Raazi Bajwa, Felicity McDonnell, Justin Geoghegan, Kevin C. Conlon, William Grogan, Derek Gerard Power, Raymond S. McDermott
Journal: Journal of Clinical Oncology (2013)

306 Background: Pancreatic cancer is known to be aggressive and treatment-resistant. In potentially resectable PC, time from diagnostic imaging to surgery correlates with rates of metastases at laparatomy. In advanced PC, therapeutic benefits of ctx are frequently calculated from start of treatment. In view of its aggressiveness, we investigated if the interval between dx and commencement of ctx influences overall survival (OS) in patients (pts) with advanced PC. Methods: Pts with PC were identified from 4 insitutional databases. Inclusion criteria were unresectable (UPC) or metastatic disease (MPC) and receipt of ctx. Clinicopathologic details were collected. Intervals from histologic dx to ctx were calculated. Analyses were based on receipt of ctx within or after 2 weeks (w), 4w and 6w of dx. OS was presented as hazard ratio (HR) with associated p-value. Results: 212 pts were identified. Median age was 63 years (range: 33 – 83) and 58% were males. 60% of pts had MPC and 24% received doublet ctx. Median number of days from dx to ctx was 24 days (range: 2 – 202). For UPC and MPC, 20 and 31% of pts began ctx within 2w (p=0.08), 48 and 63% within 4w (p=0.03) and 73 and 82% within 6w (p=0.13), respectively. OS for the entire cohort, UPC and MPC were comparable whether ctx was commenced within pre-defined intervals or not (see table). A subgroup of pts treated with doublet ctx was examined. No OS difference was seen when treated within defined time points (HR 1.1, 1.0, 1.5; p=0.76, 0.96, 0.43). For 77% of MPC with hepatic metastases, no improvement in OS in relation to time interval was noted (HR 1.5, 1.0, 1.1; p=0.10, 0.90, 0.85). For 21% of MPC with ≥2 metastatic sites, ctx within 4w and 6w might improve OS but significance was not reached (HR 0.65, 0.61; p=0.43, 0.46). Conclusions: Commencement of ctx for PC could be delayed due pts-, disease- or infrastructural factors. Our data did not suggest a detrimental effect on OS from ctx delay. However, the lack of survival benefit from early ctx might be due to less effective ctx or inherent aggressiveness of the disease. [Table: see text]
Clinical characteristics of recurrent esophageal cancer after definitive chemoradiotherapy for stage II//III (non T4) esophageal squamous cell cancer.
Authors: Akiko Nishikawa, Ken Kato, Yoshitaka Honma, Satoru Iwasa, Atsuo Takashima, Tetsuya Hamaguchi, Yasuhide Yamada, Yasuhiro Shimada
Journal: Journal of Clinical Oncology (2013)

137 Background: Recurrence after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer is associated with poor outcome. No standard treatment strategy exist for recurrence after complete response (CR) to dCRT. We examined patterns of recurrence and clinical outcomes in patients with disease recurrence after dCRT. Methods: We retrospectively investigated 197 patients who had achieved initial CR after dCRT for locally advanced esophageal cancer between January 2000 and December 2008. We analyzed data from the 69 patients who had developed disease recurrence after CR, excluding 11 who died of other causes. Time to event was calculated by the Kaplan-Meier method, and the Cox proportional hazard model was used in univariate and multivariate analyses. Results: Characteristics of the 69 patients were as follows: male: female = 61:8; median age = 65 years (range 47 to 82); clinical stage at diagnosis (UICC 6th edition) IIA/IIB/III = 15/22/32; and performance status at recurrence (0/1/2) = (35/32/2). Primary CRT consisted of 5-FU+cisplatin (n = 66), 5-FU+nedaplatin (n = 2), or S-1+cisplatin (n = 1). The pattern of recurrence was locoregional failure (n = 35), or any distant failure (n = 34). Median time to recurrence from the start of dCRT was 13.6 months, and median survival time after recurrence was 17.4 months. Median survival time according to pattern of failure was 27.5 months (locoregional failure), and 17.4 months (any distant failure). In the univariate analysis, locoregional failure (HR 0.51), time to recurrence &gt;13 months (HR0.38), clinical stage II (HR0.48), and any treatment for recurrence (HR: 0.15) were associated with better prognosis after recurrence. In the multivariate analysis, only time to recurrence (&gt;13 months) was associated with better prognosis with HR 0.31(95%CI:0.14-0.66) Conclusions: Our study suggested that patients with early recurrence have a poor prognosis. More intensive treatment is needed to improve survival.
Phase II trial of pemetrexed (P) and carboplatin (C) in previously untreated extensive stage disease small cell lung cancer (ED-SCLC): A NCCTG Study
Authors: J. R. Jett, A. M. Bernath, N. R. Foster, J. R. Molina, D. A. Nikcevich, P. D. Steen, P. J. Flynn, K. M. Rowland, T. R. Fitch, A. A. Adjei
Journal: Journal of Clinical Oncology (2008)

8066 Background: The primary endpoint of this trial was to evaluate the response rate (RR) of PC in untreated patients with ED- SCLC and obtain preliminary estimates in older patients (≥ 70 years).Toxicity was a secondary endpoint. Methods: Multi-center phase II trial of primary treatment with P (500mg/M2) and C (AUC=5) on day 1 every 21 days for a maximum of 6 cycles. Patients were pretreated with folic acid and B12. Standard pretreatment blood counts and chemistries were mandated and creatinine clearance of ≥ 45 ml/min was required. Toxicity was assesses according to CTCv3. Design was a single stage sample size of 70 with 46 in younger age group (<70) and 24 in the older cohort. The primary endpoint of success was a 60% response rate (RR) with acceptable toxicity.(Ho RR 40% and Ha RR of 60%) Results: 48 eligible patients were enrolled and received treatment (17 ≥ 70 years). The mean age was 65 with 54% males and 85% PS 0 or 1. 46 patients were evaluable for response and 30 of 46 have progressed. 33 of 48 (69%) participants experienced G3 or worse AE, ≥ G3 neutropenia (42%), thrombocytopenia (23%) and fatigue (15%). There was one G5 sepsis event. Toxicity was similar between younger and older patients. The overall RR was 33% (15/46) (95%CI 20–48), all were PRs. RR in older patients was 41% (7 of 17). The median DUR was 3.2 months (95% CI 2.9–9.2). The median TTP was 4.2 months (95% CI 2.8–4.3). Survival results are immature but will be updated for the meeting. Conclusion: This study regimen did not meet the preset RR goal and was closed early. Toxicity in younger and older patients was similar. PC does not seem to offer any advantage over standard therapy for ED-SCLC. No significant financial relationships to disclose.
Association of thymidylate synthase (TS) expression with response to S-1 plus carboplatin (CBDCA) in non-small cell lung cancer (NSCLC) patients (pts).
Authors: M. Takeda, I. Okamoto, M. Fukuoka, K. Nakagawa
Journal: Journal of Clinical Oncology (2010)

e21025 Background: S-1, a novel oral fluoropyrimidine derivative, is active against NSCLC. Phase II studies of S-1 plus platinum compounds have shown activity for first-line treatment of advanced NSCLC. It is important to design an optimal therapeutic strategy according to tumor biology to improve the treatment of NSCLC. In the present study, we evaluated the correlations between immunohistochemical expression of TS, orotate phosphoribosyltransferase (OPRT) and dihydropyrimidine dehydrogenase (DPD), and response to S-1 plus CBDCA in advanced NSCLC pts. Methods: Chemotherapy-naïve pts with advanced stage (IIIB/ IV) NSCLC, ECOG PS of 0-1, adequate organ functions and archival tumor tissue were assigned to receive either CBDCA AUC 5 mg/mL/min on day 1 plus oral S-1 80 mg/m2/day (40 mg/m2 b.i.d.) on days 1 to 14 (22 pts) or CBDCA AUC 6 mg/mL/min plus paclitaxel (PTX) (200 mg/m2) on day 1 every 21 days (26 pts). Association between TS, OPRT and DPD protein expression levels in tumors and response to chemotherapy was evaluated. Results: There was no statistical difference in TS, OPRT and DPD expression level between S-1 plus CBDCA and PTX plus CBDCA. In the S-1 plus CBDCA groups, TS expression of responding tumors was significantly lower than that of nonresponding ones (p = 0.006), whereas no significant difference was observed in the PTX plus CBDCA groups. Furthermore, patients with low TS expression survived longer than those with high TS expression in patients receiving combination therapy with S-1 and CBDCA, but not in those treated with PTX plus CBDCA. Conclusions: Our results suggest that tumor TS expression levels is predictive markers for response to S-1 plus CBDCA chemotherapy in advanced NSCLC pts. No significant financial relationships to disclose.
Impact of blue 465nm LED on suppression of cancer growth.
Authors: Kozo Yoshikawa, Mitsuo Shimada, Jun Higashijima, Toshihiro Nakao, Masaaki Nishi, Hideya Kashihara, Chie Takasu
Journal: Journal of Clinical Oncology (2016)

767 Background: Recent studies demonstrate the efficacy of irradiation from light emitting diodes (LED) for wound healing and anti-inflammation and anti-cancertherapies. In this study, the blue LED (465nm) suppressed the tumor growth in various cancers. Methods: &lt; Experiment 1, Effect of blue LED on colon cancer &gt; Human colon cancer cells (HT29 or HCT116) were seeded onto laboratory dishes that were put on LED irradiation equipment with a blue LED (465 nm). Irradiation at 15 or 30 mW was performed 10 min/day, each day for 5 days. Cell counting kit8 was then used to measure cell viability. Apoptosis and expression of several mRNAs (caspase, MAPK and autophagy pathway) in HT29 cultures irradiated with 465 nm LED were evaluated via AnnexinV/PI and RT-PCR, respectively. &lt; Experiment 2, Effect of blue LED on pancreas cancer &gt; Human colon cancer cells (SUIT2) were examined by same way and additionally cell cycle was checked. &lt; Experiment 3, Effect of LED on CSCs &gt; Cancer sphere were seeded onto laboratory dishes that were then put on LED irradiation equipment with a 465 nm-LED. Stemness gene and cell surface markers of CSCs expressions were analyzed by RT-PCR. Results: &lt; Experiment 1 &gt; Viability of HT29 and HCT116 cells was lower in blue LED irradiated cultures than in control cultures. Moreover, the expression of FAS, caspase3, capase8, and JUK were significantly higher in 465 nm-LED irradiated cultures than in control cultures, and expression of ERK1/2 and LC3 was lower in blue LED-irradiated cells. &lt; Experiment 2 &gt; Viability of SUIT2 cells was lower in blue LED irradiated cultures than in control cultures. And the CCND1 mRNA expression was significantly lower in blue LED group (p &lt; 0.05). The cells of phase G2/M was decreased. &lt; Experiment 3 &gt; Cell viability of cancer sphere were significantly decreased by LED irradiation(p &lt; 0.05). And, stemness gene and cell surface markers of CSCs expressions were significantly decreased by LED irradiation (p &lt; 0.05) Conclusions: Blue LED irradiation inhibited tumor growth in various cancer cell lines.
Palliative care for hepatocellular carcinoma: Analysis of the National Cancer Data Base.
Authors: Abdulrahman Y Hammad, Jared Robbins, Kiran Turaga, Kathleen K. Christians, T. Clark Gamblin, Fabian McCartney Johnston
Journal: Journal of Clinical Oncology (2016)

390 Background: Palliative care is provided to a subset of hepatocellular carcinoma (HCC) patients with the aim of symptomatic relief and improving quality of life. The present study sought to assess and compare the prevalence and efficacy of different palliative therapies for HCC from the National Cancer Database (NCDB). Methods: The NCDB, a retrospective national database that captures approximately 70% of all patients treated for cancer, was queried for patients with HCC who were deemed non-resectable from 1998-2011. Patients were stratified by receipt of palliative care. Descriptive analyses were performed. Survival analysis was examined by log-rank test and Kaplan Meier curves, and a multivariate proportional hazards model was utilized to identify the predictors of survival. Results: A total of 3,267 patients were identified; 287 (8.7%) received surgical palliation, 827 (25.3%) received radiotherapy, 877 (26.8%) received chemotherapy, 1,067 (32.6%) received pain therapy, while 209 (6.4%) received a combination of the previous 3 modalities. The median age was 61 (54-72), and 81.3% of the patients were males, and of Caucasian ancestry (72.5%). Difference in the Charlson Comorbidity Index (CCI) existed between the comparison groups (p&lt; 0.001). On a multivariate hazards model, palliative radiotherapy was identified as a positive predictor of survival (Hazards Ratio (HR): 0.71 [95%CI:0.56-0.90]), while pain therapy was a negative predictor of survival (HR: 1.79 [95%CI: 1.43-2.25]). Stratifying by disease stage, palliative radiotherapy provided a significant survival benefit for patients with stage IV disease. Examining the RT cohort, most patients received external beam radiation (80%) and palliative radiation was most frequently delivered to the spine (35%) followed by the liver (19%). The survival benefit was more significant when the liver was targeted (OS: 3.7 months vs. 7.3 months, p= 0.03). Conclusions: Amongst the palliative therapies examined, radiotherapy appear to extend survival and should be considered for patients presenting with late stage HCC. Pain therapy alone acts as a negative predictor of survival and should not be considered as a sole intervention for patients with late stage disease.