tbuckley/cabot-search huggingface dataset:
Improved cancer outcomes across multiple institutions using an integrated data system
Authors: W. T. Sause, F. Nkoy, W. Rees, A. Brammer, K. Pinto
Journal: Journal of Clinical Oncology (2004)

6030 Background: Based upon variations found with ongoing monitoring and analysis of outcomes data, we initiated a feedback mechanism resulting in a significant improvement. The rates of breast conservation surgery (BCS) for early stages breast cancer and axillary nodes dissection (AND) in DCIS patients are illustrations of outcomes measures targeted for immediate improvement. Methods: IHC a system of 22 hospitals has developed an integrated oncology data system that is fed by disparate data sources including mammography, pathology, cancer registry, inpatient and outpatient data. Outcomes data were examined longitudinally using statistical process control (SPC) charts to examine trends and it was determine that system-wide BCS rate was at 53%, below the national benchmark. In addition, there was a significant variation among systems and specific clinical factors, more so than patient choice, affects the rate of BCS. The rate of AND for DCIS patients also was examined using the integrated data system to assess the frequency and rationale for this procedure. System wide rate was at 11.4% before the implementation of change and variation observed between facilities resulted in a decision for standardization. Implementation of change in both examples occurred through continual monitoring using SPC charts, presentation of data to the physicians as an education tool as well as leadership provided by local physicians. Results: Breast preservation rate experienced a highly significant increase from 53% to 79% overall. The use of AND for DCIS was significantly reduced from 11.4% to 4.5%. Of those DICS cases with AND, 204 nodes were removed and retrospective review of pathology reports has shown no malignancy. Conclusions: Integrated data systems for multiple institutions, use of validated and accepted data, ongoing monitoring and feedback mechanism of outcomes results in a measurable change in BCS and AND for DCIS patients. In addition, routine AND is not recommended. No significant financial relationships to disclose.
A phase II trial of neo-adjuvant docetaxel (D) and estramustine (E) in patients with high risk/locally advanced prostate cancer
Authors: M. Q. Baggstrom, J. Rosenman, R. Pruthi, Y. Whang, L. Goyal, G. Grigson, P. Godley
Journal: Journal of Clinical Oncology (2004)

4753 Background: Biochemical failure rates after radiation therapy (RT) or radical prostatectomy (RP) in patients (pts) with high risk/locally advanced prostate cancer approach 30% after two years. We evaluated the efficacy and safety of weekly neoadjuvant D and E chemotherapy in patients with high risk/locally advanced prostate cancer. Methods: We report the interim results of a phase II trial of neoadjuvant chemotherapy in high risk/locally advanced prostate cancer examining PSA response to chemotherapy, pathologic stage after RP, and 2 year progression free survival. Eligibility criteria were clinical stage T3, T1–2 + Gleason Score (GS) 8–10, or T1–2 + GS 7 + PSA>10 ng/mL. Three cycles of D (36 mg/m2) days 2, 9, & 16 and E (140 mg TID) on days 1–3 q28 days were administered followed by either RT or RP. All pts were placed on warfarin 2 mg/day. Pathologic response was evaluated after RP. Results: Out of 24 anticipated subjects, 12 pts with a median age of 64 years and PSA of 26 (range 10 - 53) were evaluable. Three pts had clinical stage T1, 7 T2, and 2 T3. GS was ≤7 in 7 pts and ≥8 in 5 pts. All three cycles of chemotherapy were administered to all pts, except for one who died during the first cycle from an unknown cause. Median testosterone baseline and nadir levels were 290 and 10 ng/mL. Therapy was well tolerated. The most common toxicities were grade III dyspnea (17%) and grade III fatigue (17%). All pts had a response by PSA criteria with a median nadir of 0.5 ng/mL. None of the 3 patients undergoing RP were pathological stage P0. Seven pts had RT. Conclusions: Neoadjuvant weekly docetaxel and estramustine is well tolerated, potentially active, and deserves further study in high risk/locally advanced prostate cancer pts. Supported by Aventis. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Pharmaceuticals Aventis Pharmaceuticals
Analysis of recurrence risk by subtype in ≤1 cm breast tumors.
Authors: Sarah V. Colonna, Ashantice K. Higgins, JoAnn Alvarez, Benjamin R. Saville, Julia Lawrence, Vandana Gupta Abramson
Journal: Journal of Clinical Oncology (2013)

1034 Background: Triple-negative breast cancers (TNBC) comprise 15% of breast cancers and lack ER, PR, and HER2 expression. TNBC is biologically aggressive with high rates of recurrence, but little is known about the prognosis of small (≤1cm) TNBCs compared to similarly sized breast cancers with other receptor profiles. The role of adjuvant chemotherapy for TNBC that is ≤1cm remains unclear. Methods: Electronic medical records of all women aged ≥ 18 years with ≤1 cm, node negative, invasive breast cancer from 1997-2007 diagnosed or treated at Vanderbilt or Wake Forest were reviewed. Tumor grade, receptor status, treatment details, and follow up and recurrence information were tabulated. Rates of local and distant recurrence among three different receptor subtype categories, ER+ or PR+, HER2 negative; ER-/PR-, HER2 negative; or any ER/PR, HER2 positive were compared using chi-square tests. Results: 437 women with ≤1cm breast tumors were identified. Women with TNBC not given chemotherapy were more likely to have distant recurrence at 9% compared to 2% for ER+ or PR+, HER2 negative and 4% for any ER/PR, HER2 positive. There were no recurrences among the 14 women with ≤1cm TNBC who received chemotherapy. Conclusions: Based on our two institution review, women with ≤1 cm TNBC are at an increased risk for distant recurrence compared to other subtypes when not treated with adjuvant chemotherapy. Further studies to determine the benefit of adjuvant chemotherapy in this population are needed. [Table: see text]
A phase I/II trial investigating weekly docetaxel and carboplatin (DC) given neoadjuvantly and then concurrently with concomitant boost radiotherapy (CB-XRT) for locally advanced squamous cell carcinoma of the head and neck
Authors: D. L. Schwartz, B. Yueh, R. B. Montgomery, M. Donahue, R. Canby, Y. Anzai, R. Buelna, L. Anderson, K. Keegan, C. Boyd
Journal: Journal of Clinical Oncology (2004)

5543 Background: This study assessed the safety and efficacy of induction DC given weekly x 4, followed by weekly DC and CB-XRT. Methods: Eligible patients had Stage III or IV (M0) disease of the oropharynx, supraglottic larynx, or hypopharynx identified by ENT examination, contrast-enhanced CT, chest x-ray, and serum panels. Patients also had a baseline FDG-PET scan. Eligible patients could have resectable or unresectable disease. Patients initially received D 20 mg/m2 and C AUC 2 weekly x 4 and were reevaluated by direct laryngoscopy and CT. Given the short duration of induction, only patients with evidence for disease progression during induction were removed from study for salvage. Patients subsequently received D 10–20 mg/m2 and C AUC 1 weekly x 5 with CB-XRT (1.8 Gy qd x 15 days, followed by 1.8/1.5 Gy bid x 13 days). 19 patients have enrolled. Results: Fifteen patients are evaluable (5 Stage III, 10 Stage IV). Patients are currently receiving the target dose level of D 20 mg/m2 weekly with radiation. No dose limiting toxicities have been seen. Maximum toxicity during chemoradiotherapy has been limited to grade 3 mucositis, dysphagia, and/or fatigue. Five patients have required supportive G tube alimentation more than 4 months after treatment. Primary site responses following induction include 3 PR, 9 SD, and 3 patients who progressed. Twelve patients continued on to chemoradiotherapy, with 4 clinical CR and 8 PR at the primary site per follow-up CT. 7/8 patients with a radiographic primary site PR were shown to be disease free via direct laryngoscopy and biopsying. One patient had persistent disease and underwent salvage resection. 12/12 patients completing all treatment have remained disease free, with median follow-up of 13 months. Conclusions: This regimen has promising activity and acceptable toxicity. Patient accrual at the D 20 mg/m2 dose level during radiation is ongoing, and we continue to collect toxicity and outcome data. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Oncology Aventis Pharmaceuticals
Outcomes and prognostic factors in marginal zone lymphoma: Case comprehensive cancer center cumulative experience of 358 cases.
Authors: Adam Starr, PingFu Fu, Paolo Fabrizio Caimi, Erica Leigh Campagnaro, Brenda W. Cooper, Marcos J.G. De Lima, Hillard M. Lazarus, Stanton L. Gerson, Howard Meyerson, Deepa Jagadeesh, Mitchell Reed Smith, Robert M. Dean, Brad L. Pohlman, Brian Thomas Hill, Basem M. William
Journal: Journal of Clinical Oncology (2015)

8554 Background: MZL are uncommon B-cell lymphomas. The outcomes and prognostic factors of MZL remain poorly defined. Methods: We retrospectively identified 485 cases of MZL diagnosed between 1994-2014 from 2 institutions. Diagnoses had been confirmed by expert hematopathologists. We excluded 127 cases because of limited data and overlapping features with other lymphoma subtypes. Results: Of the 358 patients (pts) included in the analysis, 216 (60%) had extranodal MZL (EMZL) with most EMZL arising from stomach (32%), 56 (16%) nodal MZL (NMZL), 64 (18%) splenic MZL (SMZL), and 22 (6%) had typical MZL phenotype but were unclassifiable. Median age was 66 (range 13-95) years, 171 (48%) pts had stage III/IV disease at diagnosis. B-symptoms were present in 33 (9%) pts and 65 (18%) had > 4 nodal sites (LN) involved. Median time from diagnosis to treatment was 33 (2-1883) days and median duration of follow-up was 40.3 (2.2-236.4) months. Among treated pts, initial treatment was rituximab (R) (33%), chemotherapy +/- R (22%), radiation (16%), surgery (16%), and antibiotics (13%). Progression-free survival (PFS) and overall survival (OS) for the whole group was 5.15 (95% confidence intervals; C.I. = 2.8-10) and 19 (95% C.I. = 10-19) years respectively and there was no significant difference in PFS or OS between EMZL, NMZL, SMZL, or atypical MZL. On univariate analysis, age > 60 (p = 0.002), elevated serum lactate dehydrogenase (LDH) (p = 0.003), involvement of > 4 LN (p = 0.019), follicular lymphoma International Prognostic Index (FLIPI) score (p = 0.0005), and hemoglobin (Hb) level < 12 g/dL at presentation (p = 0.003) were associated with inferior OS. In a multivariate analysis, only age (hazard ratio (HR) = 5.48, p = 0.002) and Hb (HR = 2.97, p = 0.009) retained significance. Transformation to aggressive lymphoma occurred in 29 (8%) pts and was associated with high serum LDH and higher FLIPI at diagnosis. In pts treated with R +/- chemotherapy, R maintenance was associated with improved OS (p = 0.04). Conclusions: In our MZL series, one of the largest reported, prognosis of MZL is good with a median OS of over 19 years. Age > 60, Hb < 12 g/dL, elevated LDH, and > 4 LN involved are associated with inferior OS.
Statin use and prostate cancer risk
Authors: J. Shannon, M. Garzotto, A. J. Palma
Journal: Journal of Clinical Oncology (2004)

4596 Background: One in seven men over age 60 will be diagnosed with prostate cancer. Improvements in screening and diagnostic procedures allow clinicians to better identify men at high risk of having prostate disease, but no established means of preventing prostate cancer are currently available. Statins are a group of drugs used to control high cholesterol through inhibiting HMG CoA reductase and interfering in the mevalonate pathway. Recent research has demonstrated that in a number of tumor types, statins also induce apoptosis and growth arrest. The purpose of this pilot study was to evaluate the association between statin use and prostate cancer risk in a population of older veterans enrolled in a case-control study of diet and prostate cancer risk. Methods: Cases were recruited upon referral for prostate biopsy and frequency age-matched; PSA normal controls were identified from the VA primary care clinic. Statin use was determined from medical record review. Years of use, type of statin, dose and any changes were recorded. Years of use were categorized as > or <= 3 years of use of any single or combined statin. Dose was categorized as > or <= 40mg/day, based on the highest dose prescribed. Results: Records from 47 incident prostate cancer cases and 142 PSA normal clinic controls were reviewed. After adjusting for age and body mass index, men with any recorded statin use had a 56% lower risk of prostate cancer as opposed to non-users (odds ratio (OR) 0.44, 95% confidence interval (CI) (0.22–0.88)). When statin use was grouped by duration and dose, those with the longer duration of use (>3 years) and higher dose (>40mg/day) were at lower risk of prostate cancer as compared to non-users (OR=0.35, 95% CI=0.12–1.00). Conclusions: Results of this pilot study suggest that any statin use is associated with a reduced risk of prostate cancer and that use for a longer period of time at a higher dose may confer the most risk reduction. This study is limited by a small sample size and lack of control for additional comorbid factors. If these results are confirmed in a larger prospective study they may provide necessary evidence to consider the use of statin drugs in prostate cancer prevention. No significant financial relationships to disclose.
A systems approach identifies time-dependent associations of multimorbidities with pancreatic cancer risk
Authors: P. Gomez-Rubio, V. Rosato, M. Márquez, C. Bosetti, E. Molina-Montes, M. Rava, J. Piñero, C.W. Michalski, A. Farré, X. Molero, M. Löhr, L. Ilzarbe, J. Perea, W. Greenhalf, M. O’Rorke, A. Tardón, T. Gress, V.M. Barberá, T. Crnogorac-Jurcevic, L. Muñoz-Bellvís, E. Domínguez-Muñoz, A. Gutiérrez-Sacristán, J. Balsells, E. Costello, C. Guillén-Ponce, J. Huang, M. Iglesias, J. Kleeff, B. Kong, J. Mora, L. Murray, D. O’Driscoll, P. Peláez, I. Poves, R.T. Lawlor, A. Carrato, M. Hidalgo, A. Scarpa, L. Sharp, L.I. Furlong, F.X. Real, C. La Vecchia, N. Malats
Journal: Annals of Oncology (2017)
Point-of-care capture of clinical interventions for metastatic colorectal cancer (mCRC) to develop and validate novel markers of the quality of cancer care.
Authors: Hui-Li Wong, Kathryn Maree Field, Jeremy David Shapiro, Joseph James McKendrick, Allan Solomon Zimet, Desmond Yip, Louise M. Nott, Ross Jennens, Gary Edward Richardson, Lara Rachel Lipton, Greg Stefanou, Jeanne Tie, Suzanne Kosmider, Phillip Parente, Rachel Wong, Lionel Lim, Prasad Cooray, Ben Tran, Jayesh Desai, Peter Gibbs
Journal: Journal of Clinical Oncology (2014)

e17637 Background: The ever-increasing focus on the quality of cancer care delivery is driving multiple initiatives to collect and analyse data related to quality indicators, with a major focus on the process of care. To develop and measure markers of quality that directly impact on patient (pt) outcomes, we have examined point of care data for pts entered into an mCRC registry. Methods: Data itemsincluded in an ongoing Australian mCRC registry were reviewed. Consensus was obtained regarding measured components of care considered likely to impact quality of life and/or survival. Data from 8 sites were examined. Results: Data on 1,059 pts diagnosed from July 2009 to January 2014 were analysed.Median age was 67.9 years (range 18-97), 58% were male and 68% of cases were metachronous. Substantial variation was noted for all interventions analysed, including clinical trial participation (1-19%), resection of liver (10-19%) or lung (1-11%) metastases, use of first-line chemotherapy (63-85%) and use of bevacizumab with first-line chemotherapy (39-72%). Median overall survival varied from 19-33 months. Asymptomatic metachronous disease detection (65-88%) (a marker of appropriate follow-up care for pts with a prior early stage CRC) and screening for HNPCC (MMR studies) in pts aged ≤ 50 years (10-38%) also varied widely. Analysis of pt prognostic factors, including age, performance status and comorbidity (modified Charlson index), to determine the contribution (if any) to this variation is being examined, along with confirming the prognostic significance of each intervention. Conclusions: The care delivered to pts with mCRC, as measured by interventions considered to directly determine pt outcomes, varies widely. Analysis of pt factors that might contribute to this and validation of the clinical impact of these interventions are in progress. Future plans include providing clinicians with details of their hospital performance related to these putative point of care quality markers and how this compares with other (de-identified) hospitals. Data collection continues and will examine how providing this data to clinicians might impact on the management of future pts.
XPC, XPD/ERCC2, UMPS, CYP1b1 and XRCC5, single nucleotide polymorphisms (SNPs) in head and neck cancer
Authors: J. Carles, M. Monzo, R. Artells, M. Amat, P. Foro, D. Fuster, F. Alameda, J. M. Sanchez, J. Fontane, J. Sanchez
Journal: Journal of Clinical Oncology (2004)

5588 Background: SNPs located in the exonic region of XPC, XPD/ERCC2, UMPS, CYP1b1 and in the 3'UTR region of XRCC5 are involved in nucleotide excision repair and drug metabolism. We analyzed these SNPs and correlated the results with time to relapse (TTR), survival and response in head and neck cancer patients (p). Methods: PCR allelic discrimination (ABI Prism 7700 sequencer detector) was used to examine SNPs in DNA from tumor tissue obtained from 190 head and neck cancer p accrued from June 1985 to July 2002. Results: Characteristics of the initial 190 p: median age, 69 years; 170 PS 0–1, 20 PS >2; stage: I-39, II-24, III-32, IV-95. The most frequent tumor location was larynx (83p). Locoregional tumor progression was observed in 62% of p. 80% of p received concomitant chemoradiotherapy. Frequencies of genotypes: XPC: 82 TT, 105 TG; XPD/ERCC2: 70 AA, 89 AC, 31 CC; UMPS: 142 GG, 48 GC; CYP1b1: 50 CC, 106 CG, 34 GG; XCRR5: 146 AA, 39 AG. A correlation was found between XPD/ERCC2 and XRCC5 (P<0.04). No other correlation between genotypes was observed. TTR for all p was 16.5 months (m) (95%CI, 9.6–23). TTR was 15 m for UMPS GG vs 10 m for UMPS GC at pharynx (P=0.05), 26 m for CYP1b1 CC vs 50 m for CYP1b1 CG+GG at larynx (P=0.008), and 8.3 m for CYP1b1 CC vs 14.6 m for CYP1b1 CG+GG at pharynx (P=0.008). Overall median survival was 30.3 m but has not been reached for p with different genotypes. Response rate in p receiving concommitant chemoradiotherapy was 86% for p with UMPS CC vs 14% for p with UMPS CG (P=0.03), and 14% for p with CYP1b1 CC vs 86% for p with CYP1b1 CG+GG (P=0.04). Conclusions: CYP 1b1 and UMPS are expressed mainly in larynx and pharynx tumors and may be predictive markers in head and neck cancer. No significant financial relationships to disclose.
Successful treatment of a patient with unresectable olfactory neuroblastoma: A case report and literature review
Authors: L. Bhupalam, S. Jaggernauth, D. Laber
Journal: Journal of Clinical Oncology (2004)

5620 Background: Olfactory Neuroblastoma (ONB), also known as esthesioneuroblastoma, is a rare neoplasm arising from the olfactory epithelium that commonly invades the orbit, paranasal sinuses and parapharyngeal space. Historically, surgery alone or surgery followed by radiation, have been the treatments of choice. Optimal management of ONB remains to be defined. We present the case of an unresectable Kadish stage C ONB treated with concomitant chemo-radiotherapy. Methods & Case Report: Our patient is a 59 year-old white female who presented with nasal stuffiness and increased lacrimation from the left eye. She was treated with antibiotics for several months but the swelling never improved. MRI showed a 6.4 x 3.7 cm left nasal mass with extensive involvement of the nasopharynx, sphenoid sinus, cavernous sinus, and the muscles of the left orbit. We treated her with radiation using 180 cGy per fraction of 4 MeV photons for a total of 7020 cGy. Concomitant 5-FU (750mg/sqM) was given on days 1 through 4 as a continuous infusion along with cisplatin (75mg/sqM) given over 48hrs on days 2 and 3. After 2 cycles of chemo-radiotherapy, the swelling of her left eye disappeared and she had a complete response verified by physical exam and MRI. We treated her with four cycles of adjuvant chemotherapy using cisplatin (100mg/sqM) on day 2 and etoposide (100mg/sqM) on days 1 through 3. Results/Discussion: Neoadjuvant chemotherapy and radiotherapy has gained attention in recent years but the experience is under reported and fewer than 350 cases have been published worldwide since 1924 (Neurosurgery 2000;11:693). Responses to 5-fluorouracil, VP-16, adriamycin, cyclophosphomide, methotrexate, and vincristine have been attained, but the best results were obtained using cisplatin. Conclusions: This is the first case report of unresectable ONB showing a complete response to concomitant chemo-radiotherapy and we plan to monitor the progression of her disease-free status over time. Much more research needs to be done and we hope that this would serve as an impetus for further study of unresectable ONB using concomitant chemo-radiotherapy. No significant financial relationships to disclose.
Thymus transplantation for complete DiGeorge syndrome: European experience
Authors: E. Graham Davies, Melissa Cheung, Kimberly Gilmour, Jesmeen Maimaris, Joe Curry, Anna Furmanski, Neil Sebire, Neil Halliday, Konstantinos Mengrelis, Stuart Adams, Jolanta Bernatoniene, Ronald Bremner, Michael Browning, Blythe Devlin, Hans Christian Erichsen, H. Bobby Gaspar, Lizzie Hutchison, Winnie Ip, Marianne Ifversen, T. Ronan Leahy, Elizabeth McCarthy, Despina Moshous, Kim Neuling, Malgorzata Pac, Alina Papadopol, Kathryn L. Parsley, Luigi Poliani, Ida Ricciardelli, David M. Sansom, Tiia Voor, Austen Worth, Tessa Crompton, M. Louise Markert, Adrian J. Thrasher
Journal: Journal of Allergy and Clinical Immunology (2017)

Thymus transplantation is a promising strategy for the treatment of athymic complete DiGeorge syndrome (cDGS).Twelve patients with cDGS underwent transplantation with allogeneic cultured thymus.We sought to confirm and extend the results previously obtained in a single center.Two patients died of pre-existing viral infections without having thymopoiesis, and 1 late death occurred from autoimmune thrombocytopenia. One infant had septic shock shortly after transplantation, resulting in graft loss and the need for a second transplant. Evidence of thymopoiesis developed from 5 to 6 months after transplantation in 10 patients. Median circulating naive CD4 counts were 44 × 106/L (range, 11-440 × 106/L) and 200 × 106/L (range, 5-310 × 106/L) at 12 and 24 months after transplantation and T-cell receptor excision circles were 2,238/106 T cells (range, 320-8,807/106 T cells) and 4,184/106 T cells (range, 1,582-24,596/106 T cells). Counts did not usually reach normal levels for age, but patients were able to clear pre-existing infections and those acquired later. At a median of 49 months (range, 22-80 months), 8 have ceased prophylactic antimicrobials, and 5 have ceased immunoglobulin replacement. Histologic confirmation of thymopoiesis was seen in 7 of 11 patients undergoing biopsy of transplanted tissue, including 5 showing full maturation through to the terminal stage of Hassall body formation. Autoimmune regulator expression was also demonstrated. Autoimmune complications were seen in 7 of 12 patients. In 2 patients early transient autoimmune hemolysis settled after treatment and did not recur. The other 5 experienced ongoing autoimmune problems, including thyroiditis (3), hemolysis (1), thrombocytopenia (4), and neutropenia (1).This study confirms the previous reports that thymus transplantation can reconstitute T cells in patients with cDGS but with frequent autoimmune complications in survivors.