tbuckley/cabot-search huggingface dataset:
A phase II trial of accelerated radiotherapy using weekly stereotactic conformal boosts for supratentorial glioblastoma multiforme. RTOG-0023
Authors: R. Cardinale, M. Won, A. Choucair, M. Gillin, A. Chakravarti, C. Schultz, L. Souhami, A. Chen, H. Pham, M. Mehta
Journal: Journal of Clinical Oncology (2005)

1511 Background: Malignant gliomas undergo molecular changes during radiation therapy (RT) that lead to accelerated proliferation. This phase II trial was performed to assess the feasibility, toxicity, and efficacy of dose-intense RT employing weekly fractionated stereotactic radiotherapy (FSRT) boosts for patients with glioblastoma multiforme (GBM). Methods: Patients with histologically confirmed GBM with postoperative enhancing tumor plus tumor cavity diameter ≤ 60 mm were enrolled. 50 Gy of standard RT was given in daily 2 Gy fractions. In addition, patients received four FSRT treatments, once weekly, during weeks 3–6 in lieu of standard RT to the postoperative tumor bed plus enhancing tumor plus 5 mm (PTV). FSRT dosing of either 7 Gy (PTV≤40 mm) or 5 Gy (PTV>40 mm) per fraction was given for a cumulative dose of 70 or 78 Gy in 29 (25 standard RT + 4 FSRT) treatments over 6 weeks. A relocatable frame and shaped conformal fields were used for FSRT. Following the RT course, BCNU at 80 mg/m2 was given for 3 days, q 8 weeks, for 6 cycles. The sample size was calculated to compare survival with RTOG-RPA class using one-sided p-values and calculated hazard ratios. Results: 76 patients were analyzed. Significant RT toxicity included: one grade 4 acute (lethargy) and one grade 3 late (necrosis). The median survival time (MST) was 12.5 months. No survival difference is seen compared to the RTOG historical database. Matched pair cox regression also showed no significant survival difference. For RPA class IV patients (50% of total) the MST was 14.7 mos. compared to 11.3 mos. for historic controls (p=0.15). Patients with gross total resection (41%) had a MST of 16.1 mos. vs. 12.0 mos. for historic controls (p=0.19). RT quality control was favorable with 90% compliance. Conclusion: This initial RTOG trial employing FSRT was feasible and well tolerated. There appears to be no significant survival benefit for GBM patients using this dose-intense, accelerated RT regimen although RPA class IV and gross total resection patients trended toward improved outcome. No significant financial relationships to disclose.
Discussions about end-of-life care planning between physicians and patients with stage IV lung or colorectal cancer.
Authors: J. W. Mack, A. Cronin, N. Taback, H. Huskamp, N. L. Keating, J. Malin, C. Earle, J. C. Weeks
Journal: Journal of Clinical Oncology (2011)

6026 Background: National guidelines recommend that physicians discuss end-of-life (EOL) care planning with cancer patients whose life expectancy is less than one year. Previous studies typically rely on patient reports of discussions, even though patient and physician perceptions can differ, and usually as a one time assessment. We know little about the true incidence of EOL discussions or about where, when, or with whom they take place. Methods: We evaluated EOL discussions among 2155 patients with stage IV lung or colorectal cancer enrolled in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system-based prospective cohort study. Discussions were reported in patient and surrogate surveys and in a comprehensive medical record abstraction over the first 15 months after diagnosis. Medical record data included the location, provider, and timing of discussions. Results: 73% of patients had EOL discussions reported by patients or surrogates or documented in medical records. Among patients who died during the 15 month follow-up period (N=1524), 86% had EOL discussions, compared with 42% of patients who were alive at the end of follow-up (N=631). Among first EOL discussions documented in the medical record (N=1081), 55% occurred in the hospital and 45% in the outpatient setting. Medical record data included medical oncology visits for 85% of patients (median 6 visits), but oncologists documented EOL discussions with only 27% of their patients. Medical oncologists participated in 46% of EOL discussions for which provider specialty was known (N=860); other specialties were general medicine (34%), other medical specialties (14%), radiation oncology (4%), and surgery (3%). Of 983 patients who lived at least a month after diagnosis and died during follow up, 50% had a first documented EOL discussion before the last month of life, 32% during the last month of life, and 18% had no EOL discussions before death. Conclusions: Although most patients with stage IV lung or colorectal cancer have discussions with physicians about EOL care planning before death, many discussions occur in the setting of acute hospital care, with non-oncology providers, and late in the course of illness.
Renaissance of contact radiotherapy with RT 50 papillon machine: Preliminary data on first 100 patients treated at Clatterbridge.
Authors: A. Sun Myint
Journal: Journal of Clinical Oncology (2011)

e14149 Background: Local contact radiotherapy is an option for early rectal cancer. However, the old Philips machine is obsolete and many centres are unable to continue treating patients using this technique. A new RT 50 Papillon machine is now commercially available and there is a new hope for elderly patients and others who whish to avoid major surgery and permanent stoma. We present our preliminary data on the first 100 patients. Methods: Between Oct 15, 2009 and Oct 15, 2010, 100 patients were treated at Clatterbridge centre for Oncology (CCO). Curative intent in 85% of cohort includes Males (61) and Females (24) with median age 72 yrs (range 33-99). T1=31, T2 =33, T3=19 and T4=2. N0 =65, N1=15, N2=5. Papillon was offered (radical) as part of post-op RT in 36(42%), pre-op in11 (12.9%) and no surgery in 38 (44.7%) elderly patients. Based on this preliminary data on accrual, we are due to start observational CONTEM trials shortly. CONTEM 1 evaluate contact RT role after TEMS for <2cm low rectal T1N0 cancer polyps. CONTEM 2 evaluate contact RT role after CRT for <5cm T2N0M0 rectal cancers. CONTEM 3 evaluate contact RT role after RT for elderly with T1-T3a /N1low rectal cancers. Results: International collaborative ICONE group is setting up CONTEM trials which will treat patients with multimodality approach using both contact RT and TEMS. These trials are in final planning stages and due to start shortly but have not been activated yet. Conclusions: At present approximately 30% of patients with early (T1N0) low rectal cancer (<6cm) are over treated with APR. Revival of contact radiotherapy allows multimodality treatment which could avoid major surgery and considerable morbidity. This treatment modality should be available as an option for the elderly and high risk patients with early low rectal cancer in all specialist colorectal centres.
Circulating tumor cells (CTC) in mesothelioma and its cytomorphological and immunohistochemical correlation with the primary tumor specimens.
Authors: M. Wendell, L. Bazhenova, A. Morgan, S. Boisot, D. Marinucci, M. Luttgen, J. J. Nieva, P. Kuhn, K. Bethel
Journal: Journal of Clinical Oncology (2011)

e21170 Background: Circulating tumor cells (CTCs) are emerging as a valuable tool for monitoring cancer patient prognosis and response to treatment in some solid tumors. Commercially available CTC assay identifies CTCs via EPCAM dependent immunomagnetic-enrichment, which may not detect certain subsets of cells. We report a cohort of mesothelioma patients in whom CTCs were measured using a cytometric, enrichment free immunofluorescent protocol and correlated the findings with primary tumor specimens. Methods: Blood samples for CTC analysis were collected from 8 mesothelioma patients at baseline, 3 weeks, 3 months, 6 months, 9 months, and 1 year. CTCs were identified via immunofluorescence and cytometric, enrichment free analysis. We also reviewed primary tumor specimens in all patients and correlated cytomorphologic appearance of the CTCs to their corresponding primary tumor. Results: A total of 8 mesothelioma patients were included in the analysis. All had non-sarcomatoid histology. Median follow up was 20.1 months. Median survival is 13.3 month. At some point during the disease course CTCs were identified in 8 of 8 (100%) patients. At the time of the diagnosis CTCs were present in 6 out of 8 patients but only 2 patients had distant metastasis at the time of the diagnosis and one additional patient developed metastatic disease during the disease course. Four of 8 patients (50%) were alive at the time of data analysis. Using CTC/ml cut off of 2 CTCs/ml, patients can be divided into 'remain favorable' (baseline draw <2, last draw <2), 'convert to favorable' (baseline draw >2, last draw <2), remain unfavorable (baseline draw >2, last draw >2), and convert to unfavorable (baseline draw <2, last draw >2). Median survival is 709 days for the remain favorable/convert to favorable group and 374 days for the remain unfavorable/convert to unfavorable group. Conclusions: This small case series shows that CTCs can be effectively enumerated in mesothelioma patients. There appears to be a separation in outcomes based on CTC kinetics. However, due to the small sample size further studies are warranted to further clarify this association.
Efficacy and safety of endoscopic resection for gastric subepithelial tumors.
Authors: Kyoungwon Jung, Ji Yong Ahn, Do Hoon Kim, Eun Jeong Gong, Charles J. Cho, Hee Kyong Na, Jeong Hoon Lee, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim
Journal: Journal of Clinical Oncology (2016)

107 Background: Because small gastric subepithelial tumors (SETs) less than 2.0 cm might have malignant potential, ambiguous cases should be removed for optimal diagnosis and treatment. With the recent advances in endoscopic technique, endoscopic resection (ER) has been attempted for pathologic confirmation of gastric SETs. Herein, we aim to investigate the clinical usefulness and safety of ER of gastric SETs. Methods: A total of 115 subjects who underwent ER for gastric SETs from January 2005 to December 2014 were eligible for the study at the Asan Medical Center, Seoul, Korea. Patient’s demographic status, tumor related factors, procedure related factors, and clinical outcomes were retrospectively reviewed by using electronic medical record. Results: Among the 115 patients, 53 were male (46.1%) and the mean age was 51.59 ± 14.59 years. The mean size of all tumors was 18.58 ± 10.71 mm. Complete endoscopic resection was achieved in 108 of 115 tumors (93.9%). The final histopathologic diagnoses included 38 gastrointestinal stromal tumors (GISTs) (33.0%), 21 heterotopic pancreas (18.3%), 18 neuroendocrine tumors (15.7%), 11 leiomyoma (9.6%), 10 inflammatory fibroid polyp (8.7%), and others tumors (n = 17, 14.8%). Perforations occurred in 12 patients (10.4%) and they were successfully managed with endoscopic clipping. Severe bleeding during endoscopic resection occurred in 13 patients (11.3%) and they were treated by endoscopic management. Six patients underwent sequential wedge resection or gastrectomy of stomach because of non-curative resection and the pathologic evaluation revealed residual tumors in 3 patients. There was no recurrence or metastasis during mean follow-up of 44.96 ± 32.62 months (range 3-120.7 months). The rate for complete resection in relation to the final pathology was lower in GISTs (86.8%) than others (97.4%, p = 0.026). The rate of perforation was significantly higher for the fundus (66.7%) than for other locations (0% for the cardia, 16.7% for high body, 8.3% for mid body and 8.3% for antrum) (p &lt; 0.001). Conclusions: ER of gastric SETs may be feasible and safe method for pathologic confirmation and further strategy.
A quality improvement project to increase compliance with indicated prechemotherapy pneumococcal vaccination.
Authors: Wilfred P. Delacruz, Sandra Terrazzino, Brian R. Haney
Journal: Journal of Clinical Oncology (2016)

218 Background: Severe pneumonia is associated with high morbidity and mortality in cancer patients. The most common pathogen is S. pneumoniae, responsible for 2/3 of pneumonia-related deaths. Current guidelines recommend routine use of 13-valent (Prevnar 13) and 23-valent (PPSV23) pneumococcal vaccine for immunocompromised patients (cancer patients). Of the 110 patients younger than 65 years old who started chemotherapy in our clinic from July 2013 to June 2014, only seven patients received the pneumonia vaccine through our clinic. We conducted a quality improvement (QI) project to improve compliance of pneumonia vaccination in patients who will start on chemotherapy in our outpatient clinic. Methods: We reviewed the current guidelines for pneumonia vaccinations in cancer patients with our physicians and encouraged them to prescribe the pneumonia vaccination to their patients prior to therapy. In addition to educating the primary provider, we took a multidisciplinary approach and recruited our clinic nurse practitioner who meets all patients for chemotherapy teaching to prescribe the vaccine to patients less than 65. Results: Of the 90 patients (median age 60, 20-86) who started chemotherapy during the study period, 58 were less than 65 years old of which three patients were already vaccinated prior to their diagnosis. Twenty five (45.5%) patients were vaccinated through our QI project. We have improved our compliance with pneumonia vaccination guidelines by 39%. Conclusions: We have improved compliance of pneumonia vaccination in cancer patients starting chemotherapy in our clinic through a QI project. We found that screening and intervention are best accomplished by a single person who is able to see all patients. This practice is now being conducted as standard of care in our clinic.
OUTCOME of Allogeneic Hematopoietic CELL TRANSPLANTATION for AML: A Single CENTER Retrospective ANALYSIS.
Authors: Ioanna Sakellari, Chrisa Apostolou, Despina Mallouri, Anastasia Athanasiadou, Ioannis Batsis, Christos Smias, Evangelia Yannaki, Chrisavgi Lalayanni, Antonia Syrigou, Niki Stavrogianni, Chrisanthi Vadikolia, Riant Saloum, Athanasios Fassas, Achilles Anagnostopoulos
Journal: Blood (2010)
Preliminary results of a telomerase-based circulating tumor cell assay in prostate cancer patients undergoing definitive radiotherapy.
Authors: Kelly M. MacArthur, Gary D. Kao, Stephen M. Hahn, John Paul Christodouleas, Justin E. Bekelman, Jay Fitzgerald Dorsey
Journal: Journal of Clinical Oncology (2014)

139 Background: Circulating tumor cell (CTC) analysis provides a minimally invasive tool to serially assess a primary tumor and its response to treatment, which may assist management. We conducted a pilot study among patients with localized prostate cancer to examine the potential effectiveness of a novel telomerase-based CTC assay for tracking the response to definitive radiotherapy (RT). Methods: The assay relies on processing and exposure of peripheral blood samples to an adenoviral vector, utilizing the human telomerase promoter to drive the expression of a fluorescent reporter. Such a system results in high specificity and sensitivity for prostate cancer cell detection since telomerase is elevated in almost all malignancies, but not in normal cells. Peripheral blood samples from patients with localized prostate cancer were obtained up to one month prior to initiating RT (pre-RT), one-half to two-thirds through completion of the RT course (mid-RT), and after completion of RT (post-RT, 3 to 6 months following completion of treatment). Fifty seven subjects were enrolled on this study, with a mean age of 67 (SD 6.7 years). Fifteen had low-risk, 25 had intermediate risk, and 17 had high risk disease at the time of diagnosis. Twenty subjects received androgen suppression. Results: We successfully detected CTCs in the majority of patients undergoing definitive radiotherapy for localized prostate cancer of varying Gleason scores (GS), risk status, and disease stages. The mean CTC counts per ml of blood were: Pre-RT 20.2 (standard error (SE) 8.5), mid-RT 11.0 (SE 2.5), and post-RT 1.0 (SE 0.4). The difference in CTC counts from pre-RT to post-RT was statistically significant (p&lt;0.03). Conclusions: We have successfully detected CTCs in patients undergoing definitive RT for localized prostate cancer with a novel CTC assay. CTC counts appear to decline after definitive radiotherapy. While these promising results may further aid research of CTCs in prostate cancer, the ultimate implications for subsequent patient decisions and management remain to be studied.
A survey of insurance retention in pediatric patients diagnosed with malignancies in a vertically integrated health care system.
Authors: R. M. Cooper, V. Y. Chiu
Journal: Journal of Clinical Oncology (2011)

9568 Background: A vertically integrated health care system with a comprehensive electronic medical record provides an ideal opportunity to care for pediatric cancer survivors and conduct survivorship research. In this system, patients who are primarily cared for by pediatricians and those who age out of pediatrics and are cared for by adult providers can be tracked in a systematic fashion. Methods: We evaluated the insurance retention of survivors of pediatric malignancies by querying the Cancer Registry and identified 1,688 survivors of pediatric malignancies diagnosed within the system between 1990 and 2005. We looked at the percentage of survivors who were still cared for in our system at certain time points after diagnosis. We then reanalyzed the group by ethnicity, disease, and age at diagnosis. We also looked at what percentages of these patients remained insured into adolescence and adulthood. Results: The retention rate for all patients was 93% at 1 year, 74 % at 5 years, and 54% at 10 years. The retention rates were similar regardless of ethnicity and whether the survivors initially were diagnosed with leukemias or brain tumors. When we looked at the influence of age at time of diagnosis on insurance retention we noted that patients diagnosed under the age of 5 had greater rates of retention at 10 years, 74% then those diagnosed over the age of 11, 47%. We looked at members who were survivors for more than 5 years on Dec 31, 2009 and noted that 46% of all survivors over 15 and 36% of all survivors over 21 were still current members. Conclusions: The lengthy insurance retention of pediatric cancer survivors makes a vertically integrated medical care system an ideal population laboratory for pediatric cancer survivorship research.
Evaluation of the prognostic value of guanylyl cyclase C (GCC) lymph node (LN) classification in patients with stage II colon cancer: A pooled analysis.
Authors: Daniel J. Sargent, Qian Shi, Murray B. Resnick, Stephen Lyle, Michael O. Meyers, Atoussa Goldar-Najafi, Thomas E. Clancy, Sharlene Gill, Jean-Francois Haince, Yves Fradet
Journal: Journal of Clinical Oncology (2012)

443 Background: Identification of a sensitive and specific prognostic marker would aid in the management of patients (pts) with standard histopathology node negative colon cancer (CC). We conducted a pooled individual pt data analysis to confirm the prognostic value of GCC for disease recurrence in untreated stage II CC. Methods: GCC mRNA was quantified by RT-qPCR using formalin-fixed LN from 310 stage II pts diagnosed from 1991-2006 enrolled in two studies (Sargent 2011 [study1] and Haince 2009 [study2]). Patients were classified by GCC LN ratio (LNR) (high risk: LNR ≥ 0.1; low risk: LNR &lt; 0.1), with LNR defined as number of GCC positive LN divided by number of informative LNs. Clinical outcomes included time to recurrence (TTR), overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Stratified log-rank tests and multivariate Cox models assessed the association between clinical outcomes and GCC LN status. Results: The 5-year recurrence rate in study 1 (n=241) was 15.8%, 24.9% in study 2 (n=69). GCC LNR high risk pts had significantly higher risk of TTR, OS, DSS and DFS, which remained after adjusting for age, T stage, grade, number of LNs examined, and presence of lymphovascular invasion ( Table ). In a secondary analysis of low risk stage II pts (T3, ≥12 LNs examined, and negative surgical margins, n=241), a strong relationship between GCC LNR and each endpoint remained (TTR HR=4.34, 95% CI=2.07 – 9.13, p&lt;0.001). Conclusions: Pts with GCC LNR high risk status have significantly poorer outcomes compared to pts with low risk status, particularly among those traditionally considered to be low risk. [Table: see text]
Survival analyses of adjuvant or neoadjuvant combination of a taxane plus cisplatin and 5-fluorouracil (T-PF) in patients with bulky nodal metastases from squamous cell carcinoma of the penis (PSCC): Results of a single high-volume center.
Authors: Patrizia Giannatempo, Anna Paganoni, Laura Sangalli, Maurizio Colecchia, Luigi Piva, Mario Catanzaro, Tullio Torelli, Elena Farè, Daniele Raggi, Davide Biasoni, Silvia Stagni, Giorgio Pizzocaro, Roberto Salvioni, Nicola Nicolai
Journal: Journal of Clinical Oncology (2014)

377 Background: Bulky nodal metastases (N2-N3) of PSCC represent a negative prognostic factor, yet efficacy of multimodal treatment is not defined. For these patients (pts) we explore T-PF combination in adjuvant and neo-adjuvant setting. Methods: Paclitaxel (120 mg/m2, d1) or docetaxel (75 mg/m2 d1) plus cisplatin (75-100 mg/m2 d1) and 5-fluorouracil (5FU, 750-1000 mg/m2 96h d1) were scheduled prior to or following radical inguino-pelvic dissections in N2-3 M0 pts, according to protocol indications. Primary endpoints were overall (OS) and progression-free survival (PFS); safety and response-rate represented secondary endpoints. Association of survival with treatment setting and pre-specified covariates was explored. Results: From 6/2004 to 10/2012, 47 consecutive pts received neoadjuvant (N=28) or adjuvant (N=19) T-PF. 18 (38.3%) were disease-free after a median follow-up (FU) of 22 mos (IQR 17-42). Durable remissions were more frequently observed in adjuvant (52.6%; median FU: 42 mos) than in neoadjuvant group (28.6%; median FU: 17 mos). Distribution of OS and PFS were statistically in favour of adjuvant T-PF (p=0.01 at Wilcoxon test; p=0.008 at t test). However, Kaplan-Meyer curves did not show significant differences. A model including therapy setting, N category, laterality, pelvic extent and p53 status showed that only adjuvant administration was associated with improved OS (p=0.008), while adjuvant therapy (p=0.002), pelvic extent (p=0.029) and laterality (p=0.086) were associated with PFS. In neoadjuvant group we recorded 43% responses (complete [CR] and partial) and 4 (14%) pathologic CR. Surgery was possible in 18 (64.3%) pts, independently of response. Neither OS nor PFS were associated with response. Tolerability was mild to moderate. Conclusions: Adjuvant chemotherapy was the most important favourable predictor of OS and PFS. Adjuvant T-PF results are among the best available ones. Neoadjuvant T-PF compares with other recent schedules in terms of activity and efficacy. Surgery remains the mainstay treatment for resectable nodal metastases from PSCC.