tbuckley/cabot-search huggingface dataset:
Dosimetric comparison of 3D-field-in-field technique and inverse planning IMRT for large-breasted patients treated in prone position.
Authors: Rafi Kabarriti, Michelle K. Savacool, Shyamal Patel, Linda Hong, Wolfgang A. Tome, Jana Lauren Fox, Shalom Kalnicki
Journal: Journal of Clinical Oncology (2013)

79 Background: Whole breast irradiation (WBI) leads to acute and late toxicities, which can be worse with plan dose inhomogeneities. This has been of clinical concern for large-breasted patients, especially with hypofractionation. Two approaches of 3D modulation of the radiation beam profile to optimize dose distribution and improve homogeneity are commonly employed. One is field-in-field forward planning wherein up to 3 or 4 subfields are generated within the initial radiation field. The other is inverse-planning IMRT, which typically utilizes 5 or more segments. In this study, we compare dosimetric parameters of WBI using the field-in-field technique with up to 3 subfields (3D-FiF) compared with inverse planning IMRT in large breasted patients. Methods: 10 large-breasted patients (planning target volume [PTV] &gt;2500cc) treated between 2007-2013 with WBI in the prone position with hypofractionation (42.4 Gy in 16 fractions) were selected. For each, an inverse planning IMRT and a 3D-FiF plan were created for the treated breast. Plans were normalized so that V95% PTV coverage was the same. Dose-volume histograms were evaluated for volumes receiving &gt; 105% (V105) and &gt;107% (V107) of prescribed dose, and maximum dose (Dmax). Results: Median PTV was 3443cc (2675-3875) and median separation distance at the chestwall posterior field edge was 25.9cm (23.7-27.3). IMRT significantly (p&lt;0.005, wilcoxan) reduced the volume receiving V105 and V107. Mean V105 and V107 for IMRT were 124cc (6-266) and 1.3cc (0-11.8), respectively. Mean V105 and V107 for 3D-FIF were 525.6cc (259-765) and 86 (6-171). IMRT also significantly reduced Dmax from a mean of 109.4% to 106.7%. 3D-FiF was able to limit max dose below 110% in 9 of 10 patients. Conclusions: 3D-FiF can achieve a maximum point dose under 110% of prescribed dose with similar target coverage to IMRT for most large breast patients. However, IMRT can significantly reduce the V105 and V107 in these women. Improved dose homogeneity is expected to provide a benefit in terms of acute skin toxicities and late breast fibrosis in such large breasted women receiving WBI with hypofractionation; however further study is needed to prove its true clinical benefit.
Distress measurement and positive affect in patients with gynecological cancers.
Authors: H. Pulaski, M. Faikh, D. Patel, X. Xu, A. Prossin, C. Johnston, J. R. Liu
Journal: Journal of Clinical Oncology (2011)

e15540 Background: High levels of distress have a detrimental impact on quality of life and are associated with rapid tumor growth and poor outcomes in gynecologic cancers. We sought to determine the prevalence of distress in these patients and to identify factors for future interventions which correlated with increased distress. Methods: All patients seen in the gynecologic oncology clinic at the University of Michigan in a 30 day period were asked to complete anonymous surveys that included demographic and disease information, the NCCN distress thermometer (DT), positive and negative affect scale (PANAS) and the Brief Symptoms Inventory (BSI). 285 of 401 (71%) distributed survey were completed. Chi-square analysis and Fishers exact t tests were used to determine the relationship between distress measured with the DT and the BSI, and to explore the relationship between distress, positive affect, and demographic and clinical variables. Results: Out of 401 eligible patients, 62 gave a partial response and 223 completed the survey. 45% of patients reported significant distress on the DT. DT scores were validated against the BSI with a specificity of 66%, sensitivity of 84%, PPV of 43% and NPV of 93% (p<0.0001). A high DT score correlated with low positive affect and high negative affect (p<0.05). Surprisingly, there was no correlation between cancer type or stage with a positive DT or BSI screen. However, patients who considered their disease life threatening, regardless of the actual prognosis, were much more likely to feel distressed (p<0.0005). Other factors associated with a high distress score included a history of psychiatric disorders and lack of religious affiliation (p=<0.05). Education, marital status, and income were not significantly related to high levels of distress. Conclusions: The DT is a short and valid tool for screening gynecologic oncology patients for distress. A significant proportion of gynecologic oncology patients experience distress and this is highly correlated with a patient’s sense of the severity of their disease. These results support ongoing studies to elucidate whether better intervention and education of disease prognosis could impact patients’ quality of life and disease outcomes.
Multicenter double-blind randomized phase II: FOLFOX + ziv-aflibercept/placebo for patients (pts) with chemo-naive metastatic esophagogastric adenocarcinoma (MEGA).
Authors: Peter C. Enzinger, Nadine Jackson McCleary, Hui Zheng, Thomas Adam Abrams, Matthew B. Yurgelun, Christopher G. Azzoli, James M. Cleary, Douglas Adam Rubinson, Gabriel Brooks, Jennifer A. Chan, Lipika Goyal, Jeffrey A. Meyerhardt, Kimmie Ng, Deborah Schrag, Diane M. F. Savarese, Christopher Graham, Margaret M. Carey, Charles S. Fuchs
Journal: Journal of Clinical Oncology (2016)

4 Background: FOLFOX has RR 53% and PFS 6.8 months in MEGA (CALGB 80403). VEGF inhibition has improved survival in some but not all randomized trials in MEGA. Ziv-aflibercept binds VEGF-A, B and PlGF and has improved survival in refractory metastatic colorectal cancer. Methods: All pts received mFOLFOX6 q14d. Pts were randomized 2:1 to A) ziv-aflibercept 4mg/kg/d1 or B) placebo. Pts were restaged every 8wks. Primary endpoint: 6mos PFS. Results: 64 pts enrolled (Jan 2013-Apr 2015): sex: 55M/9F; age (median): 32-83 (62); ECOG PS 0/1/2: 33/28/3; primary tumor: esophagus 26/GEJ 18/gastric 20; measurable/evaluable: 52/12; metastases: LN 48/liver 25/lung 15, other 12/adrenal 4/bone 3. Of 64 pts: 34 POD, 9 off for tox, 4 died on tx, 3 withdrew, 4 other, 10 on tx (see Table). Conclusion: Ziv-aflibercept did not significantly improve the efficacy of FOLFOX. HTN was predictive of response to ziv-aflibercept. Except for HTN, there was no significant difference in toxicity between tx arms. Clinical trial information: NCT01747551. [Table: see text]
Early initiation of chemotherapy after histological diagnosis to improve the prognosis of metastatic pancreatic ductal adenocarcinoma.
Authors: Rei Suzuki, Tadayuki Takagi, Takuto Hikichi, Ai Sato, Ko Watanabe, Jun Nakamura, Naoki Konno, Yuichi Waragai, Hitomi Kikuchi, Katsutoshi Obara, Hiromasa Ohira
Journal: Journal of Clinical Oncology (2015)

273 Background: Since pancreatic ductal adenocarcinoma (PDAC) shows aggressive progression, we speculate that prolonged waiting time after detection of disease until initiation of treatment may relate to prognosis of patients with advanced diseases. Methods: We included patients diagnosed to have metastatic PDAC in Fukushima Medical University between September 2006 and January 2014. All patients underwent more than 2 cycles of gemcitabine treatment (1,000 mg/m2 on days 1, 8, and 15 of a 28-day cycle) after confirming histological diagnosis. We classified waiting time as Time A (detection-to-diagnosis waiting time) and Time B (diagnosis-to-treatment waiting time). Each period was further divided into 2 groups (shorter [-short] or longer [-long] waiting time than median length of each waiting time group). Kaplan-Meier methods, log-rank test and Cox proportional hazard methods were used to analyze overall survival (OS). Results: Twenty three patients were included. Median age was 64 (49-75) and length of waiting time was 19.5 days (4-78) in Time A and 9.0 days (2-34) in Time B. Regarding Time A, there was no significant difference in median OS between Time A-short and Time A-long (198.5 vs. 197.0 days; hazard ration [HR] 1.096; 95% confidential interval [CI] 0.4822-2.537; P=0.81). On the other hand, median OS was significantly better in Time B-short than Time B-long (median OS 290 vs. 160 days; HR, 0.381; 95% CI, 0.096-0.622; P= 0.0078). Conclusions: We foundthat waiting time between disease detection and diagnosis didn’t impact on prognosis of metastatic PDAC contrary to our speculation. However, patients with short waiting time (less than 9 days) after diagnosis until initiation of first chemotherapy had better prognosis than patients who had long waiting time. These findings suggest that early initiation of chemotherapy after histological diagnosis can improve the prognosis of metastatic PDAC.
How Does Self-Perceived Unsteadiness Influence Balance and Gait in People With Diabetes? Preliminary Observations
Authors: Neil D. Reeves, Steven J. Brown, Milos Petrovic, Andrew J.M. Boulton, Loretta Vileikyte
Journal: Diabetes Care (2017)

People with diabetic peripheral neuropathy (DPN) exhibit marked unsteadiness during gait (1), increasing their risk of falling 20-fold compared with their matched counterparts without diabetes (2). Unsteadiness and associated restrictions in activities of daily living predict depressive symptoms in patients with DPN (3), highlighting the negative spiral between DPN, unsteadiness, falls, and psychological distress (4). However, because unsteadiness has been assessed by self-report in most previous studies, it remains unknown whether a person’s perception of unsteadiness actually correlates with objective measures of balance and gait. This study aimed to assess self-perceived unsteadiness in patients with and without DPN as compared with people without diabetes and to investigate how self-perceived unsteadiness influences gait and balance control.

Three groups were investigated: patients with DPN (DPN group; neuropathy disability score [NDS] ≥6, vibration perception threshold [VPT] ≥25 V), patients with diabetes but no neuropathy (DM group; NDS ≤3, VPT ≤15 V [5]), and matched control subjects without diabetes (Table 1). Self-perceived unsteadiness was assessed using two items from the neuropathy-specific quality of life questionnaire (Neuro-QoL) asking about problems with balance experienced during walking and standing (6 …
A randomized controlled trial to determine the effect of triptorelin on reduction of prostate volume preradiotherapy compared with standard therapy (goserelin).
Authors: Amit Bahl, Amarnath Challapalli, Susan Masson, Serena Hilman, Katrina Hurley, Rajendra Persad
Journal: Journal of Clinical Oncology (2016)

30 Background: Hormone therapy in combination with radiotherapy is a curative treatment option for prostate cancer (CaP). Neoadjuvant goserelin is known to reduce prostate gland volume by about 26%, such that radiotherapy treatment volumes are smaller, reducing the risk of damage to bladder and rectum. Triptorelin is 100 times more potent than native LHRH and has a longer half life than both native LHRH and goserelin. This study evaluated the equivalence of cytoreductive efficacy of neoadjuvant triptorelin and goserelin. Methods: Seventy-onepatients with localized CaP who have chosen radical radiotherapy had been randomized by stratified block design, toreceive either triptorelin (n=37) or goserelin (n=34) with bicalutamide cover. Prostate volume was measured at baseline and 14 weeks after start of therapy on transrectal ultrasound (TRUS). PSA, testosterone levels, and EQ5D, QLQ-PR25, QLQ-C30 questionnaires were completed at baseline, 6, 10, and 14 weeks after start of therapy. All the patients had subsequent radical radiotherapy and followed up as per departmental protocol. Changes in TRUS volume and time to castrate levels of testosterone were evaluated. Results: The mean (±S.D) baseline prostate volume in the goserelin and triptorelin groups was 38.1(±12.8) cc and 39.4(±17.5) cc, respectively. The mean (±S.D) reduction in the prostate volume after 14 weeks of goserelin and triptorelin was 36.8(±18.4)% and 32.5(±20.9)%, respectively (p=0.36: Analysis of Covariance). Twenty-nine out of 34 in the goserelin group and 33 out of 37 patients in the triptorelin group achieved castrate levels of testosterone (£0.5nmol/L). The median time to castration was 6.1 (95% CI: 5.8-6.5) and 6.4 (95% CI: 5.9-10.0) weeks for goserelin and triptorelin, respectively (p=0.72: log rank). Conclusions: Goserelin and triptorelin both caused a reduction inprostate volume and achieved castrate levels of testosterone. The cytoreductive efficacy of neoadjuvant triptorelin was equivalent (non-inferior) to that of goserelin. To our knowledge, this is the first reported prospective randomized data demonstrating the equivalence of goserelin and triptorelin in the neoadjuvant setting. Clinical trial information: 2008-007028-25.
Baseline blood neutrophil-lymphocyte ratio to predict treatment response in gastric cancer.
Authors: M Diaz Romero
Journal: Journal of Clinical Oncology (2015)

52 Background: Several studies have shown that the neutrophil to lymphocyte ratio (NLR) in peripheral blood is a prognostic factor of various cancers. Some biomarkers have been associated with response and prognosis in gastric cancer (GC)identify depends specimens on biopsies and limits their use in clinical practice.Pheripheral blood tests at the time of diagnosis can reflect evolution within the tumor. We evaluated whether the NLR would predict response in patients with GC with treatment neoadyuvant or palliative. Methods: We retrospectively analyzed 190 patients with GC (2011-2013) in National Cancer Institute Mexico. 73 patients were treated with chemotherapy neoadjuvant, 30 with chemoradiotherapy neoadjuvant and 117 patients palliative chemotherapy. NLR were calculated from complete blood counts in laboratory test at diagnosis, cutt of values for the NLR were &gt; 2.5 and &lt; 2.5 using median values reported in previous studies. Results: Characteristics of Patients: male 107, female 83, mean age 54 (20-81).The median number of cycles of chemotherapy before of assess response by tomography was 4. The response rate was partial 20.5%, stable disease 36.3% and progression 43.2%.The median NLR :2.9 (1.1-15.2).84 patients were detected with NLR &lt; 2.5 and 106 patients with NLR greater 2.5. Low NLR group patients had a better disease control (partial response and stable disease) in 68 % vs. 47.1% than high NLR( p = 0.028). Progression of disease was reported in 32 %( n=27) with low NLR and 52.9 %( n=56) of group high NLR (P=0.002). Patients with neoadjuvant treatment 50 underwent surgery 30 with NLR ratio lesser 2.5 and 20 high.There are more advanced disease in patients greater 2.5 NLR than &lt; 2.5 80 vs 56 (p=0.036). Response pathological complete after surgery in 2 patients with a lower value and 1 patient with 2.5. Overall survival in low NLR is longer than in group patients NLR &gt;2.5, 11.3 vs. 9.1 months (p=0.49). Conclusions: These data give evidence that baseline NLR could be predictive marker of response and prognosis in patients with GC undergoing treatment. Limitations to our analysis are a small number of patients, short follow-up and will need to be stratified according to patient characteristics and treatment.
Implementation of team training in outpatient breast oncology.
Authors: Craig A. Bunnell, Anne Gross, Michael Kalfin, Ann H. Partridge, Sharon Lane, Harold J. Burstein, Barbara Fine, Nancy Hilton, Clare Sullivan, Lynn Colicchio, Erin Hagemeister, Anne Kelly, Audrea Szabatura, Eric P. Winer, Susan Mann, Saul Weingart
Journal: Journal of Clinical Oncology (2012)

83 Background: Team Training (TT) principles, used in high-risk industries to reduce errors and improve communication and task coordination, have been applied in several areas of medicine, but not in outpatient oncology. We piloted a TT program in a large, academic, clinical breast cancer program. Methods: Observations, interviews, and anonymous adverse event reporting systems were used to identify areas of vulnerability for intervention: Communication of changes in same-day chemotherapy orders (“change orders”); Missing treatment orders on days patients were not also scheduled with physician (“unlinked” visits); Follow-up and communication to other team members on important patient issues (e.g., pending test results or changes in patient status); Conflict resolution between providers and staff. Agreements about roles, responsibilities, and behaviors were made to address vulnerabilities. Using a train-the-trainer model, clinical leaders trained all providers and staff in TT principles, behavioral agreements, and the tools to support them. Results: The program was assessed six months after implementation. There was insufficient power to detect a significant difference in communication of change orders because of infrequency of events (&lt; 2% pre- and post-training). However, 100% of providers reported it was easier to communicate change orders and 87% of infusion nurses reported a decrease in non-communicated changes. The incidence of missing orders for unlinked visits decreased from 38%to 2%. Press-Ganey patient satisfaction scores highlighted improvements in perception of care coordination. Providers, infusion nurses, and support staff all reported strongly positive perceptions of improvement in the efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of patient care. Similarly, all groups reported improved relationships and more respectful behavior among team members (91%, 85%, 93%). Conclusions: Team Training improved communication, task coordination and perceptions of efficiency, quality, safety, and interactions among team members and patients’ perceptions of care coordination. Widespread implementation of TT across the entire Adult Service is ongoing at our institution.
Primary systemic chemotherapy in stage II-IIIb breast cancer: Independent prognostic value of molecular phenotype and the MDACC residual cancer burden—A single-institutional experience.
Authors: E. M. Aguirre Ortega, M. Taberner Bonastre, S. Morales Murillo, E. Iglesias Martinez, C. Canosa Morales, M. L. Pon Cladera, J. A. Carceller Vidal, D. Marquez-Medina, M. J. Panades Siurana, F. Vilardell Villellas, S. Gonzalez Falco, V. Garcia Reglero, A. Llombart Cussac
Journal: Journal of Clinical Oncology (2011)

e21132 Background: Primary systemic chemotherapy (PSC) induces significant rates of tumor downstaging and breast-sparing surgery. However, classical histological prognostic markers are lost. The pathological Complete Response (pCR) and the residual cancer burden (RCB) score (Symmans WF, JCO.2007) have shown correlation with DFS and OS following PSC, but not in association with molecular phenotypes. Methods: Between January 1998 and April 2008, 134 consecutive patients with stage II-IIIB breast cancer were treated with PSC including anthracyclins and taxanes in our institution. 29 cases were excluded because: lack of tumor samples, lost of follow-up or prior tumor history. A new pathological evaluation for pCR, defined as absence of invasive carcinoma in the breast and regional lymph nodes, was performed. RCB was categorized as low (RCB grades 0 and I) or high (grades II and III). Phenotypic determination by IHC categorized examples as luminal A (LA), HR+/HER2-/Ki67<12%; luminal B (LB), HR+/HER2+-/Ki67>12%; triple negative (TNBC), HR-/HER2-; or HER2, HR-/HER2+. Results: The median age was 50 years (26-80): median tumour size 42 mm (20-100). cN -/+: 43.2%/56,8%. LA: 12 (13.6%); LB 27 (30.7%); TNBC 24 (27.3%); HER2 25 (28.4%). At surgery 11% (12 cases) demonstrated pCR; the RCB was low in 28 cases (31.8%), and high in 60 (68.2%). With a mean follow up of 39 months, we observed 35 events and 23 deaths; with a 3-year relapse free survival of 67% and an overall survival of 77%. In univariant analysis cT, cN, RH, molecular phenotype, pT, pN and RCB score II-III were found to be significant for both: RFS and OS. In the multivariate analysis, there was significant difference in phenotype (p= 0.007) for OS and phenotype (p= 0.001), clinical stage (p= 0.003) and RCB- Score (p= 0.035) for RFS. Conclusions: As other authors have shown, an aggressive molecular phenotype (HER2 and/or TN) and poor pathological response (RCB score II-III) identifies a very poor behaviour to PSC.
Long-term toxicity: A comparison between surgery plus radiotherapy and exclusive chemoradiation therapy regimes in oropharyngeal cancer patients.
Authors: L. Raimondo, M. Garzaro, G. Riva, G. Pecorari, C. Giordano, M. Airoldi
Journal: Journal of Clinical Oncology (2011)

5535 Background: Treatment of head and neck tumours negatively affects speech, swallowing, and quality of Life (QoL). Our aim was the evaluation of long term toxicity comparing surgery + radiotherapy (S+RT) and exclusive chemo-radiation therapy (CH-RT) regimes in oropharyngeal cancer. Methods: Seventy-two patients, homogeneous for demographic and TNM characteristics were affected by a tumour of oropharynx; 36 underwent S+RT and 36 received exclusive CH-RT. Late effects of treatment assessment included: Radiation Therapy Oncology Group (RTOG)-European Organisation for Research and Treatment of Cancer (EORTC) late radiation morbidity scoring system, DISCHE morbidity recording scheme. Results: According to AJCC TNM 7th edition, in S+RT group 58% of pts was T1/T2, 42% T3/T4, 39% N0/N1, 61% N2/N3, 22% stage I/II, 78% stage III/IV, 64% G1-G2 and 36% G3. In CH-RT group 55% of pts was T1/T2, 45% T3/T4, 41% N0/N1, 59% N2/N3, 19% stage I/II, 81% stage III/IV, 62% G1-G2 and 38% G3. CT-RT group received three neoadjuvant cycles with carboplatin + taxol followed by weekly carboplatin+taxol during 70 Gy RT. After median follow-up of 63 months, CT+RT vs S+RT was as follows: severe RTOG skin toxicity (19% vs 11%), moderate-severe subcutaneous fibrosis (18% vs 72%), taste impairment (39% vs 31%), severe salivary consistency (54% vs 31%), severe mouth dryness (57% vs 17%) . Long term dysphagia: soft diet required (28% vs 42%), fluids only and naso-gastric tube feeding (8% vs 22%). Long term depression was 46% vs 56% ; there was a strong correlation between dysphagia and QoL and depression scores. Conclusions: A different pattern of long term toxicity was observed in CT+RT vs S+RT. Salivary function is more compromised by CT-RT approach. Dysphagia is a frequent complication of S+RT and had a long term impact on QoL and depression. Late toxicity should be discussed with the patient and his psychological mood should be considered in treatment tailoring.