tbuckley/cabot-search huggingface dataset:
Impact of 18F-fluorodeoxyglucose position emission tomography/computed tomography on radiotherapy treatment planning and outcomes in esophageal cancer.
Authors: Sweet Ping Ng, Jennifer Tan, Glen Osbourne, Luke Williams, Mathias Bressel, Rodney J Hicks, Eddie Lau, Julie Chu, Sam Ngan, Trevor Leong
Journal: Journal of Clinical Oncology (2016)

67 Background: Currently there is no universally accepted method to accurately delineate the gross tumor volume (GTV) of primary esophageal cancer in patients undergoing radiotherapy. This prospective study aims to determine the impact of PET/CT on radiotherapy planning and outcomes in patients with localized esophageal cancer. Methods: 54 patients were recruited between June 2003 - May 2008. All underwent PET/CT scanning in the radiotherapy treatment position and received treatment planned using the PET/CT dataset. Of these, 13 (24.1%) had metastatic disease detected on PET and 3 patients had no radical radiotherapy, while another 3 patients had missing planning PET/CT data (excluded from planning component analysis). GTV was defined separately on PET/CT (GTV-PET) and CT (GTV-CT) data sets. A corresponding planning target volume (PTV) was generated for each patient. Volumetric and spatial analysis quantified the proportion of FDG-avid disease not included in CT-based volumes. Clinical data was collected for 38 patients treated radically to determine locoregional control and overall survival rates. Results: Mean age was 67 years (range:32 - 88). Median follow up was 4 years (range:2.7 – 6.8). FDG-avid disease would have been excluded from GTV-CT in 29 patients (79%) with a mean volume of 17% (range:1-100%). In 5 patients, FDG-avid disease would have been completely excluded from the PTV-CT (median volume missed = 6%, range:2-92%). For 8 patients, less than 95% of PTV-PET would have received at least 95% of prescription dose based on the CT-based plan. GTV-CT underestimated the cranial and caudal extent of FDG-avid tumor in 14 (36%) and 10 (26%) patients respectively. There were no significant differences in radiation doses to the lungs and liver. 5-year overall survival and locoregional failure free survival were 24%, and 42% respectively. Conclusions: PET/CT prevented futile radiotherapy for 1 in 4 patients and avoided geographic misses without significant impact on normal tissues in apparently localized esophageal cancer. However, survival remains suboptimal and indicates the need for further improvement in planning and therapeutic paradigms.
Outcomes following implementation of guidelines for selecting patients who require a gastrostomy tube insertion prior to start of concurrent chemoradiotherapy (CRT) for head and neck cancer (H&amp;NCa): A tertiary institution study.
Authors: V. K. Jain, B. G. M. Hughes, T. Brown, A. Spurgin, G. F. Hartnett, J. Keller, L. Tripcony, R. A. Hodge
Journal: Journal of Clinical Oncology (2011)

e19586 Background: There is a current lack of consensus regarding the optimal method (nasogastric versus gastrostomy) and timing of enteral feeding for maintaining nutrition during curative intent CRT for H&NCa. In 2006, we developed nutritional and swallowing guidelines (H&N-GL) for patients (Pts) receiving treatment for H&NCa at our institution. Pts with planned treatment of either oral/oropharyngeal + bilateral CRT; hypo/naso pharyngeal + CRT; or with dysphagia/severe malnutrition at presentation were identified as high risk, and a gastrostomy tube insertion prior to start of CRT (PGT) was recommended. We evaluated the effect of this institutional policy change on unplanned hospitalization and duration of hospital stay during treatment. Methods: A retrospective review was undertaken on two cohorts of consecutive Pts with H&NCa who were treated with curative intent CRT in the year before (2005, 78 patients) and after (2007, 88 patients) implementation of the H&N-GL. Results: PGT insertion was overall well tolerated and no serious life threatening complications or those requiring interruption of treatment were seen. Pts treated in the 2007 cohort had significantly fewer total (p<0.001), unplanned (p< 0.001) and prolonged (stay > 7days) hospitalisations (p<0.001) when compared with the 2005 cohort. Male gender (HR 3.6, 95% CI 1.3-10, p=0.01) and intervention gastrostomy insertion during treatment (HR 9.3, 95% CI 1.8-48.9, p=0.008) were also independently associated with increased likelihood of stay in the hospital. Health cost analysis estimated a saving of 390 bed days (estimated net savings of approximately $550,000) in a single year (2007) post implementation of the H&N-GL at our institution. Conclusions: Implementation of local guidelines which recommended PGT insertion before start of CRT for H&NCa in Pts at high-risk of developing nutritional and swallowing problems, resulted in a significant decrease in all-cause hospitalizations and increased bed availability at our institution. This approach should be considered for further evaluation in clinical trials.
Mutations of the catalytic subunit a of PI3K (PIK3CA) in erlotinib-treated non-small cell lung cancer (NSCLC) patients (p) with epidermal growth factor receptor (EGFR) mutations.
Authors: E. Carcereny, M. A. Molina, J. J. Sanchez, J. Bertran-Alamillo, C. Mayo, E. Aldeguer, A. Gimenez Capitan, Z. Yeste, C. Costa, S. Benlloch, A. Martinez, C. Buges, J. Bosch, D. Isla, M. Domine, M. Provencio, J. M. Sanchez, C. Camps, M. Taron, R. Rosell
Journal: Journal of Clinical Oncology (2011)

7588
Predictive tumor and demographic characteristics by 25-OH vitamin D levels in breast cancers: A comparison with matched controls.
Authors: L. J. Peppone, A. Rickles, G. R. Morrow, S. G. Mohile, L. Sprod, M. C. Janelsins, K. M. Mustian, D. G. Hicks, K. A. Skinner
Journal: Journal of Clinical Oncology (2011)

e21144 Background: Studies show that women with low vitamin D levels have an increased risk of breast cancer incidence and mortality, but there is a lack of research examining vitamin D levels and prognostic variables in breast cancer patients. The aim of this study is to examine 25-OH vitamin D levels between breast cancer cases and controls, and by tumor characteristics among breast cancer cases. Methods: 25-OH vitamin D levels were collected from 194 women who underwent breast cancer surgery and 194 cancer-free controls (matched on age and date of visit) seen at the Univ. of Rochester Medical Center between 1/2009 and 12/2010. Mean 25-OH vitamin D levels were calculated by case/control status for the overall cohort and by tumor characteristics (invasiveness, ER status, triple-negative status, Oncotype DX score, molecular phenotype) for breast cancer cases by ANCOVA. Results: Breast cancer (BC) cases had significantly lower 25-OH vitamin D levels than cancer-free (CF) controls (BC: 32.7 ng/ml vs. CF: 37.4 ng/ml; p=0.02). A significant trend toward lower 25-OH vitamin D levels was seen in women with invasive breast cancer compared to women with in situ breast cancer (invasive: 32.0 ng/ml vs. in situ: 37.4 ng/ml; p=0.08). Lower 25-OH vitamin D levels were observed in breast cancer patients with ER- negative tumors (ER-: 28.1 ng/ml vs. ER+: 33.4 ng/ml; p=0.04) and triple-negative tumors (triple-negative: 26.2 ng/ml vs. all other BC: 33.3 ng/ml; p=0.02). Women with Oncotype scores <18 had higher mean 25-OH vitamin D levels than women with Oncotype DX scores >30 (<18: 31.5 ng/ml vs. >30: 12.3 ng/ml; p=0.05). Women with basal-like phenotype had lower 25-OH vitamin D levels than women luminal-A phenotype (basal-like: 24.2 ng/ml vs. luminal-A: 32.8 ng/ml; p=0.04). Conclusions: Breast cancer patients with a more aggressive molecular phenotype (basal-like), worse prognostic markers (ER- and triple-negative), and high recurrence risk (Oncotype) had lower mean 25-OH vitamin D levels, lending support to previous research that found decreased survival among vitamin D deficient women. Further research is needed to elucidate the biological relationship between vitamin D and breast cancer progression.
Functional BRM promoter polymorphisms, pancreatic adenocarcinoma risk, and survival.
Authors: Maja Segedi, Laura N Anderson, Osvaldo Espin-Garcia, Ayelet Borgida, Teresa Bianco, Dangxiao Cheng, Zhuo Chen, Devalben Patel, M Catherine Brown, Rayjean J Hung, Michelle Cotterchio, Steven Gallinger, Wei Xu, David Reisman, Geoffrey Liu, Sean P. Cleary
Journal: Journal of Clinical Oncology (2014)

222 Background: Variant alleles of two promoter polymorphisms in the BRM gene (BRM-741, BRM -1321), create MEF2D transcription binding sites that lead to epigenetic silencing of BRM, the key catalytic component of the SWI/SNF chromatin remodeling complex (PMID:23524580). BRM suppression can be reversed pharmacologically (PMID: 21478905). Our group and others have reported associations with lung, head and neck, and hepatocellular cancer risk (PMIDs: 21478907, 23322154, 23359823). We have also reported associations with lung and esophageal cancer prognosis (ASCO 2013; abstr 11057 and 4077). In this analysis, we assessed risk and survival associations with pancreatic cancer. Methods: A population-based case-control study was conducted in Ontario with 623 histologically-confirmed pancreatic adenocarcinoma cases and 1192 age/gender distribution-matched controls (PMID: 23908141). Survival of cases was obtained through the Ontario Cancer Registry. Logistic and Cox proportional hazard regression models were fitted, adjusting for relevant covariates. Results: Median age was 65 years; 52% were male; 53% had received a curative resection; Stage I (8%), II (55%), III (14%), IV (23%); 79% received chemotherapy; 83% had died. In the risk analysis, the adjusted odds ratios were 1.01 (95%CI:0.1-2.0) and 0.96 (95%CI:0.7-1.3) for the homozygous variants of BRM-741 and BRM-1321, respectively, when each was compared to wildtype; adjusted odds ratio of double-homozygotes was 1.11 (95%CI:0.80-1.53) when compared to the double-wildtype. In contrast for the survival analysis, the hazard ratios (adjusted for age, stage, receipt of curative surgery, receipt of chemotherapy, and packyears) were 2.19 (95%CI: 1.9-2.5) for BRM-741 and 1.94 (95%CI: 1.7-2.2) for BRM-1321, per each unit increase in variant alleles. Compared with the double-wildtype, the adjusted hazard ratio for carrying no, one, and two homozygous (double-homozygous) variants were 2.14 (95%CI:1.6-2.8), 4.17 (95%CI:3.0-5.7), and 8.03 (95%CI: 5.7-11.4), respectively. Conclusions: Two functional promoter BRM polymorphisms were not associated with pancreatic adenocarcinoma risk, but are strongly associated with survival.
Oral metronomic administration of cyclophosphamide and vinorelbine in previously treated patients with metastatic breast cancer: Phase II trial.
Authors: M. A. Pluma Jimenez, M. Perez, Y. L. Bautista Aragon, R. Villalobos, S. Rivera, K. Ortiz, G. G. Avila, A. J. Silva
Journal: Journal of Clinical Oncology (2011)

e11017 Background: Patients with metastatic breast cancer who previously was treated with anthracyclin and taxane therapy have low clinical benefit rate with subsequent chemotherapy. Metronomic chemotherapy is an anticancer strategy which uses conventional cytotoxic drugs administered at very low dose in close interval. Oral metronomic administration of cyclophosphamide has been administrated in metastatic breast cancer at dose of 50 mg orally daily. We designed a phase II study to evaluate the safety and activity of adding vinorelbine at 60 mg per square meter to metronomic cyclophosphamide in women with measurable metastatic breast cancer. Methods: Patients received vinorelbine at dose of 60 mg per square weekly by mouth for three weeks every 28 days and oral cyclophosphamide at dose of 50 mg orally daily. The primary study end point response rate (RR) and the safety of this regimen. Results: 20 patients were enrolled at median follow up of one year. The median age was 54 years old (36-72), Histologic type was ductal (80%), lobular (15%) and mixed (5%). Sites of metastasis were nonvisceral (35%) and visceral (65%). Patients with hormone receptor positive were 65% and with Her2/neu positive (15%). 75% of patients received more than four cycles of this regimen and with a medium of 175 days (28-322). 20 patients (100%) had prior chemotherapy for MBC. Global response rate was 60%, 5 patients (20%) with partial response and eight patients (40%) with stable disease Toxicities were minimal except for grade 3 vomiting and fatigue in 1 patient (5%). Grade 3/4 hematologic toxicity was neutropenia in 1 patient (5%) and grade 2 in 5 patients (25%). In five patients had dose reduction by 10-20% in subsequent doses and one patient withdrawn from the study because of chemotherapy related toxicity. Conclusions: Oral metronomic administration of cyclophosphamide and vinorelbine is a regimen with acceptable toxicity and efficacy with similar response to other chemotherapy in metastatic breast cancer.
Safety of I-131 tositumomabin in lymphoma patients who are intolerant of rituximab.
Authors: D. L. Bixby, D. D. Shepard, K. Rogers, A. M. Avram, M. S. Kaminski
Journal: Journal of Clinical Oncology (2011)

e18531 Background: Patients (pts) may have anaphylactic or grade 3 or higher hypersensitivity reactions to rituximab (R) at the time of infusion that are severe enough to warrant discontinuation of therapy. These pts are generally not re-challenged with R and are often not deemed appropriate for radioimmunotherapy (RIT) out of concern for cross-reactivity. R is a Type I anti-CD 20 chimeric antibody and I-131 tositumomab (I-131 T) is composed of a purely murine Type II anti-CD 20 antibody. Because of the differences in antibodies, we sought to determine the tolerance for I-131 T in pts previously intolerant of R. Methods: Records for 129 consecutive pts receiving I-131 T after previous exposure to R from 9/2003-4/2009 were reviewed. Pts with infusion reactions to R were identified and their tolerance of I-131 T infusion was recorded. Results: 7 pts (5.4% of 129) were identified who had severe enough reactions to R precluding further infusion or re-challenge (grade 3 or higher). Severe dyspnea, stridor or sensation of throat swelling were noted in 4. Two had severe rash, one of whom had an associated “anaphylactoid” reaction. The remaining pt had severe GI pain and hypotension with infusion. At time of RIT, the median age of these pts was 56 (42-70), 6 were female, all had stage III or IV disease, 6 had follicular lymphoma, one had bulky disease, and all had normal LDH. The median number of prior treatments was 2 (1-4) and the median time since last R dose was 15 months (3-31). None of these 7 pts had infusion reactions of any grade with I-131 T, even without any extra premedication. One pt went on to be re-challenged with R post RIT and had recurrent severe dyspnea/rigors and fever. Conclusions: These data indicate that RIT with I-131 T can be given safely in pts with past severe reactions to R, keeping this important salvage option open for such pts. This is potentially related to the structural differences in the antibodies, and for that reason, these data cannot be extrapolated to Y-90 ibritumomab which incorporates R in the regimen.
Claims/utilization-based intensity of end-of-life (EOL) cancer care in integrated health systems (IHS).
Authors: Elizabeth Loggers, Paul Arthur Fishman, Arvind Ramaprasan, Craig Earle
Journal: Journal of Clinical Oncology (2012)

230 Background: Little is known about the intensity of EOL cancer care for patients within IHS or those under 65 years of age. This study assessed achievement of National Quality Forum (NQF) benchmarks for EOL cancer care among IHS enrollees aged &gt;20 at death. Methods: Using methods described by Earle, we identified IHS enrollees whose cause of death was cancer (not diagnosed at death or via autopsy) per tumor registry data between 2000-2008. Using claims/utilization data we identified individuals who received chemotherapy (chemo) in the last 14 days of life (C, benchmark (B): &lt;10%) or a new chemo regimen in the last 30 days of life (NC, B&lt;2%); had &gt;1 emergency department visit (ER, B&lt;4%):) or hospitalization (H, B&lt;4%) in the last 30 days of life; died in hospital (HD, B: &lt;17%), were not admitted to hospice (NH, B: &lt;45%), or where admitted to hospice in the last 3 days of life (SH, B: &lt;8%). The percentages were then compared to previously established fee-for-service (FFS) Medicare benchmarks. Results: At death, 4,924 IHS cancer patients were &gt;65 years of age, 3,478 were &lt;65. For those &gt;65, benchmarks were achieved for chemo in the last 14 days of life (5%), death in an acute care hospital (16%), and hospice stay &lt;3 days (4%). For those aged 21-64 years of age at death, benchmarks were achieved for chemo in the last 14 days of life (7%) and hospice stay &lt;3 days (4%). Benchmarks were not achieved in either group for new chemo regimens, ER visits, or hospitalizations in the last 30 days of life or hospice admissions. Conclusions: Most NQF benchmarks for EOL cancer care were not achieved, particularly among the young. Future research should update FFS benchmarks based on current utilization and clarify benchmarks for those &lt;65. Final presentation will include results from at least 2 other IHS. [Table: see text]
Is primary surgery without preoperative chemotherapy the best treatment option for signet ring cell esophagogastric adenocarcinomas?
Authors: Katja Ott, Wilko Weichert, Susanne Blank, Dirk Jaeger, Ulrike Heger, Leila Sisic, Markus W. Büchler, Florian Lordick
Journal: Journal of Clinical Oncology (2014)

106 Background: Recent retrospective multicentric data favor a primary resection without neoadjuvant chemotherapy for signet ring cell (SRC) gastric cancer. Aim of this retrospective exploratory study is the comparison of primary resected with neoadjuvantly treated locally advanced SRC esophagogastric adenocarcinomas (EGA) in respect of outcome. Methods: From 2002-2012 200/646 resected EGA were classified as SRC by WHO classification (more than 50% signet ring cells) and staged cT3/4 Nany M0/x. Clinical response evaluation was based on endoscopy and CT-scan and histopathological regression was based on the Becker score (&lt;10% residual tumor cells: responder). UICC 7 th was used. Analysis was retrospectively from a prospective data base. Results: 103 were treated by preoperative chemotherapy (CTx), 97 were primary resected. 73 (37%) had AEG, 127 (63%) gastric cancer. Postoperative CTx was delivered in 62/103 (60%) of the patients with preoperative CTx and in 51/97 (53%) of the primary resected patients (p=0.28). In-hospital mortality was 4.5% (9/200). 20 (20%) were classified as clinical, 15 (8%) as histopathological responders. Preoperative CTx was significantly associated with worse pretherapeutic cT- (p=0.005) and cN- (p=0.008) categories, but subsequent lower (y)pN-category (p=0,001) and improved lymphnode ratio (p=0.001). Overall survival was significantly improved after preoperative CTx compared to primary resection (median survival 30.2 versus 17.6 months, p=0.001). Median survival of responding patients is not reached, median survival of nonresponder was 24.4 months (identical for clinical and histopathological responders) compared to 17.6 months in primary resected patients (p=0.002). The positive prognostic effect of preoperative CTx was significantly higher in AEG (p=0.004) compared to gastric cancer (p=0.067). In the 119 completely resected patients the survival was significantly improved by preoperative CTx (p=0.005), but it was no independent prognostic factor. Conclusions: A pre/periopative CTx seems also to be justified in SRC EGA. Relevant limitations are the retrospective and non-randomized design.
Cognitive difficulties among patients with cancer receiving chemotherapy affects quality of life: A University of Rochester Clinical Community Oncology Program study of 439 patients.
Authors: M. C. Janelsins, K. Devine, K. M. Mustian, S. G. Mohile, L. J. Peppone, L. Sprod, M. Weiss, V. Vinciguerra, A. Jacobs, G. R. Morrow
Journal: Journal of Clinical Oncology (2011)

9119 Background: Cognitive difficulties affect up to 75% of cancer patients receiving chemotherapy, and these difficulties linger in up to 35% of survivors years after treatment. The extent to which cognitive difficulties affect quality of life (QOL) in patients receiving chemotherapy is not well-understood. Methods: We examined levels of memory and concentration difficulty in 439 patients undergoing chemotherapy who were enrolled in a randomized trial assessing effects of modafinil on cancer-related fatigue conducted through the University of Rochester Clinical Community Oncology Program (CCOP). Memory and concentration were assessed via the Fatigue Symptom Checklist (FSCL) from those that completed the measure at cycles 2, 3, and 4 of chemotherapy. QOL (i.e., general activity, mood, normal work, and enjoyment of life) items were assessed by the Brief Fatigue Inventory (BFI). Spearman’s rho correlations were used to determine the strength of the relationship between cognitive function and QOL. Logistic regression was used to predict associations between memory and concentration at cycle 2 and 3 with cycle 4 and was also used to predict associations between memory and concentration difficulty at cycle 2 with interference in QOL at cycle 4. Results: Concentration and memory difficulty at cycles 2 and 3 were both significant predictors of concentration and memory difficulty at cycle 4 (OR range=1.94 to 9.08; all p <0.05). At cycles 2, 3, and 4, problems with memory and concentration were significantly correlated with interference in all QOL items assessed (r values range=0.160 to 0.365, all p <0.05). Concentration difficulty at cycle 2 was significantly predictive of interference in all QOLs items at cycle 4 (OR range=2.23 to 3.34; all p <0.05). Memory difficulty at cycle 2 was only significantly predictive of interference in mood at cycle 4 (OR=2.05, p <0.05) and not other items (OR range=1.33 to 2.13; p >0.05). Conclusions: Our results suggest that cognitive difficulties in cancer patients receiving chemotherapy are associated with reductions in QOL. Further research on the long-term effects of cognitive difficulties on QOL are needed.