tbuckley/cabot-search huggingface dataset:
Clinical use of a three-dimensional tissue marker to target postlumpectomy radiation.
Authors: Cary Steven Kaufman, William H. Hall, Greg M Wolgamot, Laurie Hill, Rebecca Caro, Sid Nix, Erik Evans, Karen Zacharias, Carol Mahon, Karen Ness, Nancy Schnell, Nancy Schnell
Journal: Journal of Clinical Oncology (2015)

53 Background: A three dimensional bioabsorbable coiled tissue marker has been developed to facilitate targeting for radiation therapy post lumpectomy. Proposed advantages are a) clarified targeting of closest margins to the excised tumor, b) providing a three dimensional structure that allows fibrosis to add volume to contribute to cosmesis, c) aiding in re-excision localization. Our experience has demonstrated the array of clinical findings after placement, the imaging findings over time, and pathologic findings for early and late removal. Methods: Consecutive lumpectomy patients who were candidates for targeted radiation therapy were implanted with the 3-D bioabsorbable marker from May 2014 to June 2015. After informed consent, each of 36 patients were followed to gather clinical, imaging and pathologic findings. Standard breast cancer management decisions were made (NCCN). Patients requiring re-excision were examined for pathologic findings related to the device. Routine imaging with mammography and ultrasound were obtained at 6 and 12 months post lumpectomy. Results: The use of the spiral tissue marker with the fixed array of six titanium clips provided a predictable target for radiation treatments. As the tissue marker was sewn to the closest tumor bed, inadvertent dissection planes caused by oncoplastic techniques could be avoided. Clinically the lumpectomy site was firm/dense in 94% of patients at 3 months (n = 36), but in only 60% at one year (n = 21). Two patients who underwent re-excision for positive margins were guided by the 3-dimensional device. Two patients had removal at one month and at 12 months for reasons unrelated to the tissue marker. Histologic examination demonstrated typical foreign body reaction and organization (fig 1b). Mammography at one year demonstrated marker clips coalescing as the bioabsorbable device dissolves with maintenance of the volume of the cavity in 50% of patients(fig 1c). Cosmetic outcome has been good to excellent measured at 6 and 12 months. Conclusions: Clinical, radiologic and pathologic findings during use of a novel bioabsorbable 3-dimensional tissue marker were presented. A national registry to further define these attributes will soon be started.
Molecular prognostic prediction by support vector machine integrated approach for local advanced nasopharyngeal carcinoma.
Authors: X. Wan, X. Wu, X. Fan, H. Cai, M. Chen, J. Xu, M. Hong, Q. Liu
Journal: Journal of Clinical Oncology (2011)

5514 Background: Accurate means to refine the prognosis of local advanced nasopharyngeal carcinoma (NPC) will improve the selection of patients for tailored therapy. Here, we addressed this issue by developing a mathematical algorithm, Support Vector Machine (SVM), by integrating pathological multibiomarkers. Methods: Ninety-seven local advanced NPC patients (stage III and IVa) in a randomized controlled trial (RCT), consisting of 48 cases serving as the training set and 49 cases as testing set of SVM models, with a 5-year follow-up were selected and studied. We designed 3 SVM models by selecting the variables from 38 tissue molecular biomarkers and 3 EBV related serological biomarkers. Results: The SVM1 displayed highly prognostic sensitivity (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were 88.0%, 81.9%, 62.9%, 95.2% and 83.5%, respectively) by integrating 7 molecular biomarkers (Aurora-A, Beclin 1, Ki-67, N-cadherin, nm23-H1, P27, and TIMP 2). The SVM2 model showed highly prognostic specificity (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were 84.0%, 94.5%, 84.0%, 94.4% and 91.8%, respectively) by grouping 12 molecular biomarkers (nm23-H1, Pontin, cyclin D1, N-Cadherin, 14-3-3s, Ki-67, Aurora-A, Bcl-2, Beclin 1, MMP 2, EZH2 and TIMP 2) and 3 EBV related serological biomarkers (EA-IgA, VCA-IgA and AER). The SVM3 model, constructed by combination SVM1 with SVM2, displayed a high prognostic capacity (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were 88.0%, 90.3%, 75.9%, 95.6% and 89.7%, respectively). Moreover, Cox multivariate regression analysis confirmed that these 3 SVM models were each the significant independent prognostic model (SVM1, HR: 70.745, P = 0.000; SVM2, HR: 145.080, P = 0.000; SVM3, HR: 113.594, P = 0.000) for overall survival in testing set and overall patients. Conclusions: Our SVM prognostic models designed in the RCT displayed strong power in refining patient prognosis for local advanced NPC, potentially directing future target therapy against the correlated signaling pathways.
Characterization of aggressive interventions within 30 days of death in lung cancer patients at Smilow Cancer Hospital (SCH).
Authors: Bingnan Zhang, Kerin B. Adelson, Salimah Velji, Joan Rimar, Peter Longley, Brian Keane, Anne C. Chiang, Rogerio Lilenbaum
Journal: Journal of Clinical Oncology (2014)

20 Background: Multiple studies have demonstrated that patients with advanced cancer receive overly aggressive care at the end-of-life. With the goal of ultimately reducing overutilization, we sought to characterize the care we provide and identify if the Rothman Index (RI), a validated EMR tool which displays patients’ clinical condition, could predict those in whom aggressive interventions might be futile. Methods: We performed a retrospective chart review on 118 patients with advanced lung cancer who died at SCH in the fiscal year 2012. We extracted: 1. Rates of aggressive interventions including ICU stay, chemotherapy, non-palliative radiation and surgery within 30 days of death; 2. Rate of palliative care (PC) consultation; 3. RI. 4. Readmission rates. Results: 118 lung cancer patients were identified: 88% stage IV, 12% stage III or unstaged. Results are characterized in the Table. Conclusions: Consistent with national trends, utilization of aggressive interventions near the end-of-life is high amongst SCH advanced lung cancer patients. Discordant with ASCO and IOM guidelines, which call for PC in all patients with advanced cancer, PC was involved in only 29% of our study population, which is an opportunity for quality improvement. A RI of 40 appears to be associated with death within 30 days. Further validation of RI may serve as a trigger to direct care toward palliative measures. Going forward we will expand this analysis to our entire cancer population to provide a baseline for future quality interventions. [Table: see text]
Pattern of estrogen receptor (ER)/progesterone receptor (PR)/HER2 expression in older women with primary breast cancer based on core needle biopsies and correlation with short-term clinical outcome.
Authors: N. Simpson, B. M. Syed, D. A. L. Morgan, I. O. Ellis, K. Cheung
Journal: Journal of Clinical Oncology (2011)

e21104 Background: Most reports from the literature on ER/PR/HER2 expression in older women with primary breast cancer were based on small series or larger studies from multiple centers with variations in sampling and/or laboratory methodology. A significant proportion of these patients treated in the UK do not undergo surgery due to frailty and/or patient choice. Recently it has become standard in most UK centers to report on ER/PR/HER2 status as a routine based on core needle biopsies obtained at diagnosis. Methods: Over a period of 3 years, 111 consecutive women age ≥70 years with early operable invasive primary breast carcinoma had diagnostic needle core biopsies in our unit. Based on standard UK pathology guidelines, ER/PR status was measured using immunohistochemistry (IHC) (for the purpose of this study positivity was defined as H-score ≥1). HER2 was measured with positivity defined as IHC 3+ or fluorescent in-situ hybridisation (FISH) score >2.0. ER and PR status was available in all patients and HER2 status was available in 97 patients. Of these, 55 patients received primary endocrine therapy (PET). Results: The pattern of ER/PR/HER2 expression is as shown in the table. For the 55 patients who received PET, all had ER+ tumours. At 6 months, all achieved clinical benefit and there was no correlation seen between ER/PR/HER2 status and the quality of response (objective response versus stable disease). Conclusions: It appears that an invasive breast carcinoma from an older woman is most likely ER+/PR+/HER2–, followed by triple negative. HER2+ tumours accounted for <10%. All PR+ tumours were also ER+. Within the ER+ group there was excellent short-term efficacy to primary endocrine therapy, regardless of PR/HER2 status. N % ER+ / PR+ / HER2– 70 72.2 ER– / PR– / HER2– 13 13.4 ER+ / PR– / HER2– 6 6.2 ER+ / PR+ / HER2+ 3 3.1 ER– / PR– / HER2+ 3 3.1 ER+ / PR– / HER2+ 2 2.0 ER– / PR+ / HER2+ 0 0 ER– / PR+ / HER2– 0 0
Risk of treatment failure after first-line tyrosine kinase inhibitors (TKI) therapy in patients with metastatic renal cell carcinoma.
Authors: G. P. Hess, C. Chen, Z. Liu, D. H. Gesme, S. S. Agarwala, J. W. Hill
Journal: Journal of Clinical Oncology (2011)

e15114 Background: Treatment for metastatic renal cell carcinoma (mRCC) includes surgery, immunotherapy, and/or targeted therapy: kinase inhibitors (including mTOR) and anti-VEGF agents. This analysis utilizes recent data to provide insight on comparative treatment effectiveness among common therapies after 1st line sunitinib or sorafenib (TKI). Methods: A retrospective observational study using claims data was conducted. Qualifying subjects were mRCC patients receiving targeted therapies from 4/1/2008 to 2/28/2010 following 1st line sunitinib or sorafenib (TKI) treatment. Following TKI treatments, 2nd line post mRCC observed therapies of interest included sunitinib, sorafenib, temsirolimus, everolimus, bevacizumab, and pazopanib. Patients were followed from the start of 2nd-line until treatment failure or last observation in the database. Treatment failure was defined as advancement to a 3rd line of post mRCC therapy, or mortality. Results were analyzed using Cox proportional hazards model controlling for baseline clinical and demographic factors. Results: The study sample consisted of 283 mRCC patients post 1st line TKI therapy. Second line treatment included: everolimus (n=81), temsirolimus (n=46), sunitinib (n=83), sorafenib (n=50), and All Others (n=23 miscellaneous regimens, generally including bevacizumab or pazopanib). Patients had a median age of 65 years, and 71% were male. The mean observation period from the start of 2nd line treatment post mRCC, was ~4.5 months. Overall treatment failure rate was 32.9% (16.6% advanced line and 16.3% died) and 67.1% of patients were censored at last observation without any treatment failure event. Compared to everolimus: temsirolimus was associated with a statistically significant, higher, adjusted risk of treatment failure (HR=2.51 p=0.008); Sorafenib trended toward a higher adjusted risk (HR=1.91, p=0.069); and sunitinib’s adjusted risk of treatment failure was statistically equivalent. Conclusions: Following treatment post mRCC with 1st line sunitinib or sorafenib (TKI), patients on 2nd line therapies were observed with differential risks of treatment failure, as defined by line advancement or death.
Clinical trial experience with uridine triacetate for 5-fluorouracil toxicity.
Authors: Wen Wee Ma, Wasif M. Saif, Bassel F. El-Rayes, Marwan Fakih, Thomas H. Cartwright, James Posey, Reid von Borstel, Michael K. Bamat
Journal: Journal of Clinical Oncology (2016)

655 Background: Life-threatening or lethal 5-FU toxicity occurs due to infusion pump/reservoir errors and 5-FU dosage miscalculations. Additionally, DPD-deficient patients often experience serious or lethal toxicity. Regardless of DPD status, some patients demonstrate severe, early-onset toxicities (as early as during 5-FU infusion) such as encephalopathy or cardiotoxicity. Uridine triacetate is an orally bioavailable prodrug of uridine, a direct antagonist of 5-FU, that competitively inhibits 5-FU incorporation in normal tissues and can counter 5-FU toxicity, reducing morbidity and mortality due to toxicity. Methods: 135 patients at excess risk of 5-FU toxicity due to overdose or accidental capecitabine ingestion (n = 111); or DPD deficiency and/or who showed rapid onset of severe toxicities (n = 24) have been treated with uridine triacetate under emergency IND or expanded access protocols. Patients were to receive uridine triacetate granules (10g q6h for 20 doses) up to 96h after the termination of 5-FU therapy. Clinical endpoints included survival compared with historical controls, time to resumption of chemotherapy, and safety. Results: A total of 130/135 (96%) patients treated with uridine triacetate recovered fully (within 30 days after receiving uridine triacetate), including rapid reversal of cardiotoxicity (EKG abnormalities, chest pain, etc) and neurotoxicity (altered mental status, ataxia, etc). Of the 111 overdose patients, 24 had a pump malfunction; 49 dose error; 5 had accidental capecitabine ingestion (2 adults/3 peds); 33 unknown. No patient who received uridine triacetate within 96 h after stopping 5-FU died. Comparatively, 38 of the 47 historical controls (81%) with 5-FU overexposure died. Of the 106 overdose patients with a diagnosis of cancer, 40 (37.7%) resumed chemotherapy within 30 days (median 20.0 days post-5-FU), highly indicative of rapid recovery from toxicity. Overall compliance was 92.5% (mean 18.3/20 doses). Mild, infrequent adverse events (diarrhea/nausea/vomiting) were attributed to uridine triacetate. Conclusions: In this study, uridine triacetate was a safe and effective life-saving antidote for 5-FU overexposure, and facilitated rapid resumption of chemotherapy. Clinical trial information: NCT01432301.
Evaluating data-driven breast surgery treatment path visualizations from registry and administrative data.
Authors: Ravi V Atreya, Alexander S Taylor, Mia Alyce Levy
Journal: Journal of Clinical Oncology (2016)

195 Background: Breast cancer patients face difficult decisions about their surgical care without a full understanding of their options. The learning health system goal is to use information from the care of prior patients to inform the care of future patients. We aim to apply this concept to generate data-driven surgical paths, develop interactive path visualizations to inform patients, and evaluate their impact. Methods: We used cancer registry and administrative CPT codes for women diagnosed with stage 0-III breast cancer between FY2010-14 at a comprehensive cancer center. We generated surgical event sequences and visualized them using interactive Sankey diagram path visualizations. We will run a prospective educational intervention this winter to evaluate their impact on the shared decision making process. A web-based application will be available to patients prior to, during, and after their surgical clinic visit; we will survey their reaction pre-visit, post-visit, and post-surgery. Results: 1556 patients had 1951 surgical events in the registry and 48% started their surgical care with a breast conserving surgery while 52% began with a mastectomy. Mastectomy paths are presented in Table 1. We have developed interactive visualizations for patients to view, will be conducting our prospective educational intervention this winter, and will be ready to present preliminary results in February. Conclusions: We have been able to develop interactive, data-driven surgical path visualizations for breast cancer patients from cancer registry and administrative data. We will be conducting a prospective educational intervention to evaluate our implementation of this learning health system concept. [Table: see text]
Intraocular Sensors: Biocompatible Multifunctional Black-Silicon for Implantable Intraocular Sensor (Adv. Healthcare Mater. 4/2017)
Authors: Jeong Oen Lee, Vinayak Narasimhan, Juan Du, Blaise Ndjamen, David Sretavan, Hyuck Choo
Journal: Advanced Healthcare Materials (2017)

In article number 1601356, Hyuck Choo and co-workers report the first demonstrated use of high-aspect-ratio black-silicon (b-Si) as a multifunctional layer on an optically probed implantable intraocular pressure (IOP) sensor, a crucial device for glaucoma management and drug delivery. The anti-reflective and anti-biofouling properties of b-Si significantly improved sensor readout performance and long-term reliability in in vivo studies, bring this IOP-sensing approach a step closer to practical use in medicine.
Results of the randomized phase IIB ADMIRE trial of FCR with or without mitoxantrone in previously untreated CLL
Authors: T Munir, D R Howard, L McParland, C Pocock, A C Rawstron, A Hockaday, A Varghese, M Hamblin, A Bloor, A Pettitt, C Fegan, J Blundell, J G Gribben, D Phillips, P Hillmen
Journal: Leukemia (2017)
Safe administration of intracerebrospinal fluid chemotherapy (ICC).
Authors: Michel Bidros, Lisa Holle, Jessie Riemer, Susan Tannenbaum, Jessica Mary Clement
Journal: Journal of Clinical Oncology (2013)

229 Background: ICC administration, which includes intrathecal and intraventricular routes, is a complex procedure that involves staff from different disciplines. ICC administration errors are rare, yet potentially fatal. Since 1968, more than 55 cases of ICC administration errors have been documented, but the incidence is suspected to be higher because of underreporting. Little unified action has occurred despite alerts issued by the Joint Commission on Accreditation of Healthcare Organizations and World Health Organization. We have taken a multidisciplinary approach to address this issue. Methods: We identified two problems that could potentially lead to ICC errors: the lack of a formal institutional training/certification program and a comprehensive institutional safe ICC administration policy. Our Hematology-Oncology Fellowship Program along with Pharmacy and Nursing at the University of Connecticut Health Center (UCHC), created a multidisciplinary work group whose purpose is to create a comprehensive institutional policy and training program for disciplines involved in the administration of ICC. Results: The safeICC administration policy has been finalized and presented for approval. Creation of the training program is in progress and will be a part of the educational Core Curriculum of the Fellowship Program. Fellows will be required to demonstrate competency in lumbar and Ommaya reservoir puncture using simulation training on mannequins. Computer-based training with classroom review and testing will be required for all disciplines involved with ICC and will include safe preparation, delivery, handling, verification, administration of ICC, and identification of potential complications. Annual certification will be required. Conclusions: The lack of a formal ICC administration policy and training can lead to catastrophic errors. Development of an institutional policy and training program has heightened awareness of potential sources of ICC administration errors at UCHC and will serve as a mechanism for assessing quality care in the future. We believe the establishment of such a policy and definition of training should be part of the general ASCO/ONS guidelines for safe administration of chemotherapy.
Mortality reduction of breast cancer in Canada: Beneficial impact of cancer care infrastructure
Authors: J. Ragaz, J. J. Spinelli, G. Villeneuve, L. Ellison, A. Coldman
Journal: Journal of Clinical Oncology (2005)

649 Background: Survival after breast cancer has been improving in the last two decades. This study examines breast cancer population mortality in Canada over the last 25 years, with two main objectives: 1) To determine the impact of evolving therapy and diagnostic interventions between 1979–2003; and 2) To identify differences between the provinces of Canada, and if these could be accounted for by different cancer care infrastructures (provincial guidelines and community outreach programs, funding, etc.) Methods: Annual age-standardized mortality rates per 100,000 for breast cancer in different provinces of Canada were evaluated, using Statistics Canada Data for the years 1979–2003. Relative changes in mortality between the baseline period (average values, years 1979–83), and subsequent 5 year periods were computed for all Canada and for regions with differing organizational structure of cancer care, and expressed both as Relative % change from baseline (Mortality % Change) and as an Absolute age-standardized mortality (deaths per 100,000 population), both averaged for each of the sequential 5-year periods. Results: Conclusions: These data provide evidence for a substantial population mortality reduction in Canada, seen also in other parts of the western world. These trends probably reflect the interaction of all interventions including adjuvant systemic therapy, screening mammography, education, etc. Furthermore, in BC, the first Canadian province with implementation of provincial guidelines and well-funded community outreach since mid-1970s, the mortality reductions were observed earlier, and to a larger degree, than in other Canadian provinces. Thus, these data would suggest an association between mortality reduction and organization of cancer care, such as implementation of cancer guidelines, community work, and associated funding. No significant financial relationships to disclose.
Results of an online survey of physical, emotional, and practical concerns for prostate cancer survivors in the United States.
Authors: Oussama M. Darwish, Prajakta Adsul, Sameer Siddiqui
Journal: Journal of Clinical Oncology (2015)

75 Background: Prostate cancer survivors face numerous health concerns after treatment. The type of treatment received may have a significant impact on the physical, emotional and practical concerns of the patient. Methods: We analyzed self-reported data from the 2010 LIVESTRONG survey for people affected by prostate cancer. Survey questions were divided into 3 sections including physical, emotional, and practical concerns in the survivorship period. Survey was administered online between June 20, 2010 and March 31, 2011 on the LIVESTRONG.org website. Results: Of the 12,307 respondents, 281 males were included in the analysis based on a primary diagnosis of prostate cancer and US residency status. Mean age was 60 years (range, 41-94) and the majority were white men (90%). The 3 most common physical concerns were decrease in sexual function (70%), urinary frequency (54%) and fatigue (35%). The leading emotional concerns were fear of cancer recurrence (61%), grief about death of other cancer patients (52%) and worry about cancer genes in family members (51%). Practical concerns were cost beyond insurance coverage (90%), financial debt (40%), and inability to continue previous work (6%). One way ANOVA was conducted to detect differences in number of physical, emotional and practical concerns across types of treatment received (surgery, radiation, hormonal and combination). Significant differences were seen in number of physical (p=0.02), emotional (p=0.04) and practical (p&lt;0.001) concerns for patients receiving different treatments (Table 1). Patient concerns also varied based on length of follow-up after treatment. Conclusions: Based on treatment type, hormonal patients have the greatest physical and emotional concerns compared to other treatment options, while surgery patients demonstrate the most practical concerns. The results of the survey illuminate the principal physical, emotional and practical concerns of prostate cancer survivors, and can assist in prioritizing and addressing major patient concerns after prostate cancer treatment.