tbuckley/cabot-search huggingface dataset:
A restrospective study of treatments and outcome in gastric cancer patients: A report from a single institution.
Authors: Anna Koumarianou, Sylvia Krivan, Pavlos Patapis, Evangelos Missiakos, George Martikos, Anastasios Charalabopoulos, Dimitrios Schizas, Konstantinos Petropoulos, Aris Bakopoulos, Panagiotis Katsaounis, Nikolaos Xiros, Vassilios Kouloulias, George Peros, Gabriel Karatzas, Anastasios Macheras, Theodoros Liakakos
Journal: Journal of Clinical Oncology (2014)

e15089 Background: Regardless advances in surgical dissections, molecular targeted therapies and chemoradiation gastric cancer (GC) remains the second most common cause of death worldwide. Methods: In this retrospective comparative study, we sought to analyze clinical data and prognosis of patients with GC who were under the care of a multidisciplinary team in our centre, over the last decade. Pathology reports were updated according to the 7th TNM staging. Clinicopathologic characteristics and outcomes were statistically analyzed by Poisson modelling χ2 tests, Kaplan-Meier survival curves, univariable and multivariable Cox proportional hazards models and logrank tests. Results: Preoperative assessment of 164 GC patients (male:female ratio 1.87, median age 65) allowed for 132 (80.5%) to undergo total (56; 42.4%) or subtotal (76; 57.6%) gastrectomy. Surgical margins were not infiltrated (R0) in 100 (75.8%), microscopically infiltrated (R1) in 25 (18.9%) and macroscopically infiltrated (R2) in 7 (5.3%) patients. Nodal plane dissection was suboptimal in 34 (25.8), D1 in 62 (47.0) and D2 in 36 (27.3). Early gastric cancer was diagnosed in 19 patients (14.4%). 5FU-based chemotherapy was delivered in 69.7% and chemoradiation in 18.2% of patients. Chemotherapy was offered to patients with T4, TxN1 if less than D2 type of resection and >TxN2 staging. Chemoradiation was offered to patients with R1 surgical margins. The 5-year survival rate of patients according to surgical margins was 62% for R0, 38% for R1 and 0% for R2. The 5-year survival rate of patients according to nodal plane dissection was 50% for D2 and 45% for D1. On multivariate analysis, T4, N2/ N3 and R1 remained independent negative prognostic factors for overall survival. Conclusions: Our results compare with those from other centers of excellence and indicate the urgent need to optimize the therapeutic strategies and improve the outcome of patients with GC. Future efforts should also focus on predictive markers to individualize adjuvant therapy.
Sex Differences in Efficacy and Toxicity of Systemic Cancer Treatments: Role of the Microbiome
Authors: Laura Pala, Luigi Nezi, Tommaso De Pas, Elisabetta Pennacchioli, Emilia Cocorocchio, Pierfrancesco Ferrucci, Fabio Conforti, Aron Goldhirsch
Journal: Journal of Clinical Oncology (2018)
Role for surgical resection in the multidisciplinary treatment of stage IIIB non-small cell lung cancer (NSCLC).
Authors: Matthew Bott, Aalok Patel, Traves Crabtree, Daniel Morgensztern, Cliff Grant Robinson, Graham A. Colditz, Saiama Naheed Waqar, Daniel Kreisel, Alexander Sasha Krupnick, G Alexander Patterson, Stephen R. Broderick, Bryan F Meyers, Varun Puri
Journal: Journal of Clinical Oncology (2014)

7573 Background: The role of multi-modality therapy in stage IIIB NSCLC remains inadequately studied. Although chemoradiation is currently the mainstay of treatment, randomized trials evaluating the efficacy of surgical resection are lacking and surgery is offered selectively. Methods: Data of clinical stage IIIB NSCLC patients undergoing multimodality therapy were obtained from the National Cancer Database (NCDB). Information on patient- and tumor-related variables, therapy modalities, and outcomes was abstracted. Multivariable Cox regression models were fitted to evaluate variables influencing overall survival (OS). Results: From 1998-2010, 7,662 clinical stage IIIB NSCLC patients were treated with chemoradiation (≤ 60 Gy radiation dose) (CR group), while 1,715 patients were treated with chemotherapy, radiation, and surgery in any order (CRS group). CRS patients were more likely to be younger, Caucasian, receive treatment at academic centers, and have slightly smaller tumors (all p < 0.01). There was no difference in Charlson Comorbidity Index (CCI) between the groups (p = 0.5). In the CRS group, 55% of patients received preoperative chemoradiation, 5% preoperative chemotherapy, and 3% preoperative radiation. The remaining CRS patients received adjuvant therapy (chemoradiation 30%, radiation 7%). Thirty-day surgical mortality was 3%. Factors associated with improved OS in multivariate analysis included younger age, female gender, decreased CCI, smaller tumor size and surgical resection (HR 0.57, 95% CI 0.52-0.63). Among patients treated with surgery, incomplete resection was associated with decreased OS (HR 1.52, 95% CI 1.20-1.92). Median OS was longer in CRS patients (25.9 months vs. 16.3 months, p<0.001). In a subset analysis of patients with N3 disease, median OS was longer in CRS patients (48.2 months vs. 26.5 months p<0.001) with 5-year OS of 26.3% after surgery. Conclusions: Surgical resection as a part of multimodality therapy is associated with improved overall survival in carefully selected patients with stage IIIB NSCLC. Multidisciplinary evaluation of these patients is critical.
Patterns of chemotherapy near the end of life for patients receiving palliative bone radiotherapy.
Authors: Powell Perng, Sarah Saleemi, Sara R. Alcorn, Susannah G. Ellsworth, Todd R. McNutt, Russell K. Hales, Theodore L. DeWeese, Thomas J. Smith
Journal: Journal of Clinical Oncology (2014)

9544 Background: Appropriate timing of chemotherapy (CT) cessation is important for optimizing quality of life, with consensus guidelines recommending termination of CT within the last 2-4 weeks of life. Yet CT near the end of life is used in 10-30% of patients, often with little realistic chance of benefit (Kelly R, Smith TJ. Lancet Oncology 2014). We review patterns of CT at the end of life among patients receiving palliative bone radiation (RT) at a high-volume academic institution. Methods: Electronic medical records were used to identify patients treated with palliative bone RT at 2 centers from 9/1/2007-7/15/2012. Patient demographics and last recorded systemic (hormonal, non-hormonal oral, and non-hormonal IV) therapy characteristics were collected, and rates of CT in the last 2 and 4 weeks of life were calculated. Factors were compared using χ2and ANOVA analyses. Results: Complete records were found for 210 patients, and 92% were deceased at the time of analysis. Among decedents, median age at death was 64 years (22-94), and primary was 36% lung, 15% breast, 13% prostate, 5% hematologic, and 31% other sites. 12% never received CT, and 30% and 13% received CT <4 weeks and <2 weeks from death. Primary site of disease for patients receiving CT <4 weeks from death were 25% lung, 17 % breast, 19% prostate, 8% hematological, and 31% other cancers; there was no significant difference in site between patients receiving CT <4 vs. ≥4 weeks or <2 or ≥2 weeks from death. Type of CT did not significantly vary relative to time until death; CT <4 and <2 weeks from death was 53% and 52% IV, 31% and 36% oral, and 17% and 12% hormonal, respectively. 16% and 7% of all patients received IV CT <4 weeks and <2 weeks from death, respectively. Patients referred to hospice were less likely to receive CT <4 and <2 weeks from death (χ2 p=0.003 and p=0.001, respectively). There was no difference in time-to-death from date of last CT based on cancer primary or CT type. Conclusions: Of patients receiving palliative bone RT, rates of CT at the end of life are relatively low, using the Quality Oncology Practice Initiative benchmarks. Chemotherapy use at the end of life is lowest among patients referred to hospice, supporting engagement of hospice in terminally ill patients.
SP0079 Major achievements and future challenges in physical activity
Authors: M.D. Iversen
Journal: Annals of the Rheumatic Diseases (2018)

<h3></h3> Research demonstrates that physical activity and exercise yield numerous health benefits for individuals with arthritis without adversely impacting joint health. Despite these data, individuals with arthritis remain less physically active than their healthy counterparts. Over the past decade, professional organisations and researchers have synthesised these data and incorporated information on the role of physical activity in management guidelines for clinicians and patients, and developed public health campaigns to motivate individuals to become more physically active. Corporations and researchers have also created and launched new software applications to measure, monitor, and promote physical activity for persons with arthritis that are easy to use and readily accessible. This presentation will highlight the major accomplishments related to the measurement of physical activity, promotion of knowledge and self-management skills to promote physical activity at the individual and population level and discuss future challenges regarding the development of effective population-based and individualised interventions to improve physical activity engagement among individuals with arthritis. <h3>Disclosure of Interest</h3> None declared
Feasibility of lymphocyte harvesting and reinfusion in patients with newly diagnosed high-grade gliomas.
Authors: Jian Li Campian, Xiaobu Ye, Douglas Edward Gladstone, Prakash Ambady, Ivan Borrello, Marc Golightly, Karen E. King Karen E. King, Matthias Holdhoff, Judith E. Karp, Stuart A. Grossman
Journal: Journal of Clinical Oncology (2014)

2094 Background: Standard radiation (RT), temozolomide (TMZ), and dexamethasone cause severe treatment-related lymphopenia (TRL) (total lymphocyte counts (TLC) <500 cells/mm3) two months after initiating therapy in patients with newly diagnosed high grade gliomas (HGG). Published studies suggest that severe TRL is related to radiation of circulating lymphocytes and is associated with shorter survival due to tumor progression. This study was designed to evaluate the feasibility of harvesting lymphocytes before radiation and reinfusing them after radiation is completed. Methods: Ten patients with newly diagnosed HGGs and baseline TLC >1000 cells/mm3 were enrolled. Lymphocytes were harvested with a single 120 minute apheresis procedure via peripheral veins, cryopreserved, and reinfused immediately after RT was complete. Weekly blood counts were followed for 20 weeks. A post-reinfusion TLC rise of >300 cells/mm3was desired. Results: 10 patients were harvested and 8 received lymphocyte reinfusion. Median age was 55.5 years (range 40-67); median dexamethasone dose was 3 mg/day (range 0-4mg/day), and 70% was glioblastoma multiforme. Their baseline median TLC was 1980 cells/mm3 (range: 1060-2290) and a median of 8.9x107 lymphocytes/Kg (range 3.4-11.1x107) were harvested. After 6 weeks of therapy, the TLC fell 63% (median 605 cells/mm3, p<0.0001). A median of 7.0x107 lymphocytes/Kg (range: 2.7–9.5x107) were reinfused. Four weeks after reinfusion the average increase in TLC was 274 cells/mm3 (STD: ± 298, p=0.045). Overall, 7 of 8 patients (88%; 90%CI: 53-99%) had an absolute increase in TLC >300 cell/mm3in the 14 weeks following reinfusion and this persisted in 4 of 7 (57%) patients. No adverse events occurred related to harvest or reinfusion. Conclusions: Lymphocyte harvest and reinfusion is feasible in HGG patients on dexamethasone and no toxicities were noted. An increase in TLC >300 cells/mm3 was seen in 88% of reinfused patients during the 14-week observation period post reinfusion. Future studies are being designed to document the role of lymphocyte reinfusion in the increase in TLC. Clinical trial information: NCT01653834.
Prediction parameters for radiation pneumonitis in patients with stage III NSCLC.
Authors: Estefania Garcia Perez, Maria Guadalupe Bermudo Peloche, Christian Fernando Arias Quiroz, Yolanda Garcia, Elsa Dalmau Portulas, Josep Maria Sole Monne, Arnaldo Alvarado Astudillo, Manuel Lujan Torne
Journal: Journal of Clinical Oncology (2014)

e18538 Background: Assess the predictability of clinical and dosimetric parameters for radiation pneumonitis (RP) and its impact on survival in a cohort of patients with non small cell lung cancer (NSCLC) stage IIIA and IIIB. Methods: Design: Retrospective observational study with 88 patients Inclusion criteria: NSCLC stage IIIA and IIIB treated with chemotherapy and radiotherapy Data collection: demographics, toxic habits and comorbidities.Respiratory functional status pretreatment.Diagnosis and classification of radiation pneumonitis in 6 degrees of severity (0-5,CTV v.4). CFRT was used and standardized dose (66-70Gy). Study period: 2004-2011 Statistical analysis: multivariate logistic regression analysis including variables with p< 0.1 in the univariate analysis. For the impact on survival by Kaplan-Meier and log- rank test was used as a comparator. Results: 88 patients (13% women) were included, with a median age of 63 years (IQR 55-69). Respiratory functional status: Table 1. Tumor histologies: adenocarcinoma (33%), poorly differentiated (33%), squamous cell carcinoma (28%), large cell (3%) and undifferentiated carcinoma (1%). The initial chemotherapy regimen was cisplatin+gemcitabine (26%), subsequently replaced by cisplatin+vinorelbine (59%). All patients received radiotherapy (81%concurrent). The prevalence of pneumonitis was 81.7% for the entire cohort, 17% presenting severe pneumonitis grade 3 (6.8 %), grade 4 (1.1 %) and grade 5 (4.1%). Median survival was 22.97 ± 17.75 months. In the univariate analysis , factors associated with pneumonitis were the V20 than 30 (OR = 6.75, 95 % CI = 1.7-26.7) and FEV1 in the lowest quartile in the borderline significance (OR = 8, 95% CI = 0.9-73.6). In the multivariate model, both parameters associated with RP, the V20 (aOR = 17.53, 95% CI 1.87-164) and FEV1 <1.75L (aOR = 17.8, 95% CI 1.01-315)-quartile lowest-goodness of fit Hosmer-Lemeshow 0.759). Patients with severe RP (>grade 2) showed significant increase in mortality (log rank test 0.371), Figure 1. Conclusions: The V20 above 30 is a predictor of severe RP. The respiratory functional status is a prognostic factor for the occurrence of RP for patients with FEV1<1.75L, which should be considered an adjustment of dose radiotherapy.
Average length of stay in hospice for five cancers
Authors: B. Kinzbrunner, D. Tanis
Journal: Journal of Clinical Oncology (2009)

6593 Background: Factors which influence average length of stay (ALOS) for terminally ill cancer patients who choose hospice include patient and family preferences, availability of services, demographics, specialty, and experience of referring physician, advances in treatment options, and especially type of cancer. In this paper, we examined differences in ALOS for the top five cancers in patients who utilized a large, national hospice provider between 2000 and 2007. Methods: We reviewed the records of 73,263 patients with prostate, colorectal, breast, lung, or pancreatic cancer who were admitted to one of 45 hospice programs and died on service between January 2000 and December 2007. The top five cancers accounted for 58% of all cancer deaths in the hospice programs. The effect of type of cancer and year on ALOS was evaluated using analysis of variance. Pair-wise differences were compared using the Bonferroni correction. Results: Overall ALOS was 40.0 days (yearly range 37.8–41.1). ALOS for prostate, colorectal, breast, lung, and pancreas was 46.8, 44.9, 44.2, 37.3, and 31.4 days, respectively. Prostate, colorectal, and breast ALOS were not significantly different from one other; lung ALOS was less than the top three but greater than pancreas ALOS (p &lt; 0.001); and pancreas ALOS was significantly lower than all others (p &lt; 0.001). The interaction between year and type of cancer was not significant (p &gt; 0.05). Conclusions: The longer ALOS for patients with prostate, colorectal and breast cancer may be related to differences in natural history and effectiveness of anti-neoplastic therapies when compared to cancers of the lung and pancreas. Given the remarkable stability of ALOS over the last eight years and the lack of a statistical interaction between year and type of cancer, ALOS differences also suggest a steeper rate of decline for patients with cancers of the lung and pancreas following admission to hospice. No significant financial relationships to disclose.
Surgical ischemia and detection of clear cell renal cell carcinoma biomarkers.
Authors: Craig Gedye, Ghada Kurban, Brenda L. Gallie, Michael John Leveridge, Mireia Musquera, Carlos Morales, Samira A Brooks, Dimitra Tsavachidou, Antonio Finelli, Andrew Evans, Eric Jonasch, Kimryn Rathmell, Michael A.S. Jewett
Journal: Journal of Clinical Oncology (2014)

e15571 Background: To discover biomarkers of progression in patients with localized clear cell renal cell carcinoma (ccRCC), we sought to screen targeted protein and mRNA biomarkers from patient tumor specimens. We first addressed pre-analytic biases of tumor heterogeneity and “cold” ischemia, by comparing biomarkers in pre-operative vs. postoperative tumor samples. Methods: Within matched patients we collected, (1) preoperative diagnostic needle core biopsies for comparison to postoperative nephrectomy ccRCC samples (1st cohort), and, (2) intra-operative pre-ischemic biopsies for comparison to postoperative samples (2ndcohort). Protein biomarkers were screened with the MD Anderson reverse phase protein array (RPPA) and RNA using a custom NanoString signature codeset previously validated to predict prognosis in ccRCC. Results: Striking differences in protein and mRNA detection were observed between diagnostic biopsies and postoperative samples in the 1st cohort but the times to surgery was variable, and only a single technical replicate was available per patient per time point. In the 2ndcohort however, there were equally profound global differences in RNA and protein detection between the pre-ischemic and postoperative samples, across triplicate and physically separate samples. Concordant with previous studies, there was little additional change in biomarker detection in postoperative samples up to 2 hours after surgical extirpation. Phosphoproteins showed greater lability than total protein levels. Even in this limited biomarker set, several pathways were identified as significantly influenced, including the MAPK, mTOR-PI3K and EGFR pathways. Conclusions: We demonstrate for the first time in human cancers that perioperative “warm” ischemia has a broad and profound influence on protein and mRNA biomarker detection, which is far greater than post-operative “cold” ischemia. Assessment of clinically relevant biomarkers may therefore be distorted by perioperative ischemia, and high-throughput analyses using post-operative ccRCC specimens should be interpreted with caution. Validation of these findings in a larger patient cohort, and in other tumor types is urgently warranted.
Patterns of proton beam therapy for prostate cancer advertising on the Internet.
Authors: Faisal Musa, Julio Hajdenberg, Danny Landau
Journal: Journal of Clinical Oncology (2014)

e16098 Background: Due to increased cost and unproven advantage over traditional radiation techniques, large insurance payers have declined to reimburse for proton beam therapy for prostate cancer. Yet, patients request this modality. A possible reason for this is the marketing efforts, including those on the internet. We analyzed the content of websites through common search engines. Methods: Utilizing the search phrase “proton therapy for prostate cancer”, through Google, Bing and Yahoo, webpages were judged on trends in information provided. Results: 15 centers were evaluated. All 15 centers advertised the technique as “more precise”, “more effective”, “fewer side effects” and less likely to affect the healthy organs compared with IMRT. 65% used phrases including “innovative”, “higher dose of radiation than IMRT”, “spares healthy tissues”, and “smaller radiation fields.” 30% advertised it as” the most targeted form of radiotherapy” and stated that protons can “selectively kill cancerous cells.” 15% described it as the “cutting edge technology” with “shorter and simpler recovery.” Few websites provided references to support their claims. Websites did not mention specifics on the cost difference between different modalities. Conclusions: Information available online are biased towards proton beam therapy and may lead to patients requesting this technique.
Clinicopathological characteristics of Iranian lung cancer patients: A single institute study.
Authors: Kian Khodadad, Zahra Esfahani-Monfared, Adnan Khosravi, Sharareh Seifi, Shirin Karimi, Amanda McKinnon, Habib Emami, Mohamad Reza Masjedi
Journal: Journal of Clinical Oncology (2014)

e18520 Background: There could be some disparities between lung cancer patients from different geographical regions and ethnicities in terms of etiology, genders ratio, age and stage of disease. The purpose of this study is to explore clinico-pathological characteristics of Iranian lung cancer patients, referred to “National Research Institute of Tuberculosis and Lung Disease,” a unique tertiary referral center in Tehran, Iran. Methods: Retrospectively, demographic and clinico-pathological data retrieved from charts of lung cancer patients between August 1997 and Jun 2013. Results: In a total of 1210 patients; male to female ratio was 3.2 (928/282) with mean age of 58.97±11.70 years, although women were significantly younger than men at the time of diagnosis (55.79±12.38 vs 59.93±11.32 yrs; P=0.001). The majority of patients had regionally advanced or metastatic disease (stage I+II: 5.2%, IIIA: 6.9%, IIIB: 13.2%, IV: 61.6%, NA: 13.1%). Overall, only 56.9% had history of smoking. Men were much more likely to be smoker than women (70.4% vs 29.6%; P=0.0001). The histology subtypes were: Adenocarcinoma 42.1%, squamous cell carcinoma 23.9%, undifferentiated non-small cell carcinoma 16.2%, small cell carcinoma 15.2%, large cell carcinoma 0.8%, and mixed 0.5%. In both genders adenocarcinoma was the predominant pathology (females 63.1%, males 35.2%, missing data 1.3%). Conclusions: This single institute study displays clinic-pathological characteristics of Iranian lung cancer patients and is representing the largest Iranian study sample size to date. Overall, this study demonstrates key differences in Iranian patients when compared to their Western counterparts. For instance, the smoking rates of the Iranian lung cancer patients in this study were significantly lower, especially for women, than the western population suffering from lung cancer. Also, the mean age of diagnosis was lower in the Iranian patients when compared to the western countries. This may indicate that lung cancer patterns and etiology in some developing countries may vary from industrialized countries. Further joint team working from different parts of the world is needed to elucidate these differences.