Surgical Oncology Insight最新文献

{"title":"Enhancing the National Cancer Database content using natural language processing and electronic health record data","authors":"Christina M. Stuart ,&nbsp;Yizhou Fei ,&nbsp;Richard D. Schulick ,&nbsp;Kathryn L. Colborn ,&nbsp;Robert A. Meguid","doi":"10.1016/j.soi.2024.100058","DOIUrl":"10.1016/j.soi.2024.100058","url":null,"abstract":"<div><h3>Background</h3><p>The prevalence of missing data in the National Cancer Database (NCDB) has marked implications on clinical care and research. The objective of this study was to enhance the NCDB by decreasing rates of missingness and adding new variables using automated statistical methodology.</p></div><div><h3>Methods</h3><p>One health system’s NCDB data from 2011–2021 was linked to electronic health record (EHR). Variables with frequent missingness and new clinically significant variables not yet included in the NCDB including patient Eastern Cooperative Oncology Group (ECOG) score, specific chemotherapy regimen, American Society of Anesthesiologists Physical Status Classification (ASA class), and discrete surgical procedure were identified in structured and unstructured EHR data. After automated incorporation of structured data from EHR, a natural language processing tool incorporating rule-based algorithms was designed to further extract variables from unstructured notes. Rates of missingness were compared between the original NCDB and the enhanced dataset, and example multivariable models were run to assess for altered model performance with reduced missingness and the addition of new clinically significant variables (chemotherapy regimen).</p></div><div><h3>Results</h3><p>A total of 6050 patients with NCDB records were linked to their EHR data. Prior to enhancement, rates of missingness for key variables ranged from 2.0% to 5.3%. Following dataset enhancement, missingness was significantly reduced, with relative missingness being reduced between 31.9% to 68.0%. Of the new variables added, 1367 (22.6%) of 6050 patients gained ECOG score, and 1099 (57.8%) of 1901 who received chemotherapy gained their chemotherapy regimen. Of 2989 who underwent surgery, 979 (32.8%) gained their procedure name and 621 (20.8%) gained ASA class. Comparison of the multivariable models demonstrated significant differences between the original NCDB and the enhanced dataset. Specifically, when replacing the binary predictor for chemotherapy in the original NCDB data with discrete regimens, the effect of ethnicity diminished, and the effect of radiation became significant.</p></div><div><h3>Discussion</h3><p>We applied statistical methodology to reduce rates of missingness in existing variables and add new variables to enrich the NCDB. While further refinement is needed to decrease missingness in new variables, this automated methodology can replace or augment manual chart review and improve the ability of to use the NCDB to study unanswered questions leading to clinical advancements in oncology.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000677/pdfft?md5=74493abf41e836a1b6d21845aba61887&pid=1-s2.0-S2950247024000677-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141143897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neoadjuvant approach to treatment of breast cancer: Multidisciplinary management to improve outcomes","authors":"Alison S. Baskin ,&nbsp;Laura A. Huppert ,&nbsp;Tatiana Kelil ,&nbsp;Lisa Singer ,&nbsp;Rita A. Mukhtar","doi":"10.1016/j.soi.2024.100059","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100059","url":null,"abstract":"<div><p>Over the last several decades, the treatment of breast cancer has evolved from a reliance on radical surgery to less invasive treatments incorporating systemic therapy (e.g., chemotherapy and endocrine therapy) and radiotherapy, which has allowed for breast conservation surgery and improved survival. Accordingly, the management of breast cancer today is perhaps the best example of multidisciplinary cancer care. Surgeons work closely with radiologists, medical oncologists, radiation oncologists, and other specialists to design the optimal treatment plan for their patients. This cross-disciplinary collaboration and communication is especially well-illustrated in the neoadjuvant approach to breast cancer management. Neoadjuvant therapy provides several advantages to patients with newly diagnosed early-stage breast cancer. Current neoadjuvant regimens include chemo-immunotherapy for patients with triple negative disease, chemotherapy with human epidermal growth factor-2 (HER2) targeted therapy for patients with HER2+ disease, and chemotherapy or endocrine therapy for patients with hormone receptor positive/HER2- cases. As many studies have shown, tumor biology impacts the response to neoadjuvant therapy, including rates of pathologic complete response. Neoadjuvant approaches continue to grow in complexity, calling for increased cross-specialty understanding of its indications and treatment algorithms. Therefore, in this review we discuss contemporary neoadjuvant therapy approaches, with a focus on the interplay between imaging, systemic therapy, radiotherapy, and surgical management.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000689/pdfft?md5=44a633f5f2e183b95c7918ad8f282402&pid=1-s2.0-S2950247024000689-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and margin positivity rates of surgeon-performed intraoperative ultrasound-guided wire localization for breast cancer","authors":"Tess Huy,&nbsp;Danielle S. Graham,&nbsp;Jennifer L. Baker,&nbsp;Carlie K. Thompson,&nbsp;Courtney Smith,&nbsp;Anouchka Coste Holt,&nbsp;Nimmi S. Kapoor","doi":"10.1016/j.soi.2024.100057","DOIUrl":"10.1016/j.soi.2024.100057","url":null,"abstract":"<div><h3>Background</h3><p>Surgeon-performed intraoperative ultrasound-guided wire localization (IOL) offers an improved patient experience and decreased cost compared to preoperative localization by radiology, yet literature on this technique is sparse. Here we evaluate the safety and margin positivity rate after surgeon-performed IOL for breast cancer.</p></div><div><h3>Methods</h3><p>Patients with biopsy-proven breast malignancy and planned breast conservation who underwent IOL by a single breast surgeon between 2017–2023 and had follow-up at our institution were retrospectively identified. Patient and tumor characteristics, method of diagnosis, imaging findings, use of oncoplastic surgery, and follow-up data were analyzed.</p></div><div><h3>Results</h3><p>A total of 137 IOLs were performed for biopsy-proven ductal carcinoma in situ (DCIS) or invasive cancer. The median patient age was 69 years. Most patients had a non-palpable tumor (n = 104, 76.5%). 84.6% of patients underwent pre-operative biopsy by ultrasound guidance, 12.5% by stereotactic guidance, and 2.9% by MRI. In total, 7.3% of patients (n = 10) had positive margins, including 2 with invasive disease at the margin and 8 with DCIS at the margin. Nine patients underwent re-excision for positive or close margins, of which 8 had successful margin-negative breast conservation and 1 patient underwent mastectomy. Thirty-day postoperative complications occurred in 21 patients (15.3%). Of these, most (n = 19, 90.4%) had minor complications including seroma (n = 14), cellulitis (n = 3), and skin allergy (n = 2). At median follow-up of 20.4 months, no patients experienced recurrence.</p></div><div><h3>Conclusions</h3><p>In our single-surgeon series, IOL is a safe technique for localization of invasive carcinoma and DCIS with margin positivity, re-excision, and postoperative complication rates within previously published ranges.</p></div><div><h3>Synopsis</h3><p>This study evaluates the safety of and re-excision rates after intraoperative surgeon-performed ultrasound-guided wire localization (IOL) for breast cancer. Results demonstrate margin positivity and re-excision rates equivalent to or lower than rates reported in literature utilizing preoperative localization techniques.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000665/pdfft?md5=410eec1a825577583e3a8e9c7c2f0985&pid=1-s2.0-S2950247024000665-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141039527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in incidence of oral cavity squamous cell carcinoma in the United States 2001-2019","authors":"Salma Ramadan ,&nbsp;Tara E. Mokhtari ,&nbsp;Zaid Al-Qurayshi ,&nbsp;Jason T. Rich ,&nbsp;R. Alex Harbison ,&nbsp;Paul Zolkind ,&nbsp;Ryan S. Jackson ,&nbsp;Patrik Pipkorn ,&nbsp;Stephen Y. Kang ,&nbsp;Angela L. Mazul ,&nbsp;Sidharth V. Puram","doi":"10.1016/j.soi.2024.100055","DOIUrl":"10.1016/j.soi.2024.100055","url":null,"abstract":"","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000641/pdfft?md5=4f3faa4d5f0fd515267a929ed0e939ba&pid=1-s2.0-S2950247024000641-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141024552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The language of palliative surgery: A scoping review","authors":"K.E. Kopecky ,&nbsp;O. Monton ,&nbsp;C. Arbaugh ,&nbsp;J. Purchla ,&nbsp;L. Rosman ,&nbsp;S. Seal ,&nbsp;F.M. Johnston","doi":"10.1016/j.soi.2024.100053","DOIUrl":"10.1016/j.soi.2024.100053","url":null,"abstract":"<div><h3>Background</h3><p>Despite an identified need for palliative surgery to have a clear definition and well-defined therapeutic goals, comprehensive assessment of utilization of the term palliative has not been performed in the surgical literature. The objective of this scoping review is to characterize use of the word palliative in reference to surgery performed for adult general surgery patients.</p></div><div><h3>Methods</h3><p>Four electronic databases were searched for peer-reviewed articles published from January 2000 to April 2023. Two independent reviewers extracted data and conducted a qualitative thematic synthesis of included studies. Representative analytic themes were generated and agreed upon by all authors.</p></div><div><h3>Results</h3><p>6906 studies were identified and 222 met inclusion criteria. 96.4% of studies were performed in oncology patient populations. Thematic synthesis revealed two domains: the language of palliative surgery and the evaluation of palliative surgery, each with associated themes. There was wide variability in the use and meaning of the term palliative. Many researchers reported survival as the sole outcome measure and very few studies utilized a validated instrument to quantify post-operative outcomes related to palliation. There was often a misalignment between the patient population, study objectives, study design, and conclusions drawn.</p></div><div><h3>Conclusions</h3><p>Disparate definitions of palliative surgery and poor study design compromise the validity of studies investigating palliative-intent surgery. Patient-reported and patient-centered outcomes are not routinely measured and lead to unwarranted conclusions. Consistent and accurate use of medical terminology, in addition to proper study design, is required to inform surgeons who counsel patients and families regarding the potential benefits of palliative-intent surgical interventions.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000628/pdfft?md5=98e1da9c898c0d49e2c45751c9db1c46&pid=1-s2.0-S2950247024000628-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141033401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility","authors":"Gregory P. Stimac ,&nbsp;Kristin Lupinacci ,&nbsp;Michael S. Cowher ,&nbsp;Hannah Hazard-Jenkins","doi":"10.1016/j.soi.2024.100054","DOIUrl":"10.1016/j.soi.2024.100054","url":null,"abstract":"<div><h3>Introduction</h3><p>The feasibility of the outpatient mastectomy in a rural setting is poorly characterized. The aim of this study is to analyze the efficacy and safety of an outpatient mastectomy program in our tertiary care facility treating rural Appalachian patients.</p></div><div><h3>Methods</h3><p>We performed a single-institution, retrospective review of all women with breast cancer older than 18 years of age treated with mastectomy with or without immediate alloplastic breast reconstruction at JW Ruby Memorial Hospital from 2019 to 2022. Our primary objective was to determine the 30, 60, and 90-day readmission rates and complications. Our secondary objective analyzed perioperative pain control variables that contribute to appropriate discharge.</p></div><div><h3>Results</h3><p>We identified thirty-two women between 2019–2022 who underwent same-day mastectomy at JW Ruby Memorial Hospital in Morgantown, West Virginia. Overall readmission rates at 30- 60- and 90-days were 3.1% (n = 1), 9.4% (n = 3) and 9.4% (n = 3), respectively. Two patients were admitted for reasons unrelated to surgery. The patient in the 30-day readmission group required washout for hematoma due to perioperative apixaban making the overall surgical readmission rate 3.1% (n = 1). Preoperatively, 90.6% (n = 29) of women received a local anesthetic block by the anesthesia provider. The mean milligram morphine equivalents received for the duration of the hospital encounter was 15.9 (STD = 10.1).</p></div><div><h3>Conclusion</h3><p>Outpatient mastectomy is a safe and effective option for eligible patients in rural settings. Careful patient selection and a multidisciplinary team should assess the individual circumstances to determine if outpatient mastectomy is appropriate.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S295024702400063X/pdfft?md5=d9025e027cdb6edd6786ec513f8f4f22&pid=1-s2.0-S295024702400063X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between preoperative cardiopulmonary exercise testing and six-minute walk test, five-times sit to stand test and Short Form-36 physical component score in patients undergoing cytoreductive surgery","authors":"Preet G S Makker ,&nbsp;Neil Pillinger ,&nbsp;Nabila Ansari ,&nbsp;Cherry E Koh ,&nbsp;Michael Solomon ,&nbsp;Daniel Steffens","doi":"10.1016/j.soi.2024.100052","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100052","url":null,"abstract":"<div><h3>Introduction</h3><p>Assessment of preoperative function is important for determining fitness for surgery, preoperative optimisation and predicting postoperative morbidity in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). This study explored correlations between preoperative cardiopulmonary exercise testing (CPET) variables, and six-minute walk test (6MWT), five-times sit to stand test (5STS) and Short Form-36 (SF-36) physical component score in patients scheduled for elective CRS-HIPEC.</p></div><div><h3>Methods</h3><p>This study included patients who underwent preoperative CPET, 6MWT, 5STS and responded to the SF-36 survey prior to elective CRS-HIPEC at Royal Prince Alfred Hospital in Sydney. CPET was performed using a cycle ergometer and measured peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). The associations between preoperative CPET variables and preoperative 6MWT, 5STS and SF-36 were assessed using correlation test.</p></div><div><h3>Results</h3><p>A total of 133 patients scheduled for elective CRS-HIPEC were included in this study. The median VO₂, AT and VE/VCO₂ were 20.3 [6.5] ml/kg/min, 13.1 [4.9] ml/kg/min and 29 [4.5], respectively. The median 6MWT, 5STS and SF-36 physical component score were 525 m, 9.2 s and 50.2, respectively. CPET variables were significantly correlated with 6MWT (VO₂ r = 0.51; AT r = 0.35; VE/VCO₂ r = −0.25; p &lt; 0.01), 5STS (VO₂ r = −0.32; AT r = −0.27; VE/VCO₂ r = 0.24; p &lt; 0.01) and SF-36 (VO₂ r = 0.42; AT r = 0.38; VE/VCO₂ r = −0.23; p &lt; 0.01).</p></div><div><h3>Conclusions</h3><p>6MWT, 5STS and SF-36 are at best moderately correlated with CPET variables, which suggests that these tests may serve as adjuncts rather than a replacement to CPET in the clinical setting.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000616/pdfft?md5=6b15723ed75bccaaa9c578efb117eeda&pid=1-s2.0-S2950247024000616-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140901215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in socioeconomic inequalities in pancreatic cancer mortality in Canada: Evidence from the Canadian Vital Statistics Death Database","authors":"Madeline Kubiseski ,&nbsp;Min Hu ,&nbsp;Mohammad Hajizadeh","doi":"10.1016/j.soi.2024.100051","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100051","url":null,"abstract":"<div><h3>Background</h3><p>Pancreatic cancer is one of the leading causes of death in Canada and is projected to be the second leading cause of cancer death by 2030. This study sought to evaluate education and income inequalities in pancreatic cancer mortality in Canada between 1990 and 2019.</p></div><div><h3>Methods</h3><p>Using a unique census division level dataset (n = 280) constructed from the Canadian Vital Statistics Death Database, Canadian Census of Population (1991, 1996, 2001, 2006, 2016), and National Household Survey (2011) we assess socioeconomic inequalities in pancreatic cancer in Canada. Age-standardized Concentration index was used to quantify income and education inequalities in pancreatic cancer mortality. Trends analyses were conducted to assess changes in income and education inequalities in pancreatic cancer mortality over time.</p></div><div><h3>Results</h3><p>Our results show that crude pancreatic cancer mortality in Canada increased significantly from 10.23 for males and 9.65 for females in 1990, to 15.99 for males and 14.28 for females in 2019, per 100,000 people. The statistically significant negative values of age-standardized Concentration indices suggest persistent income and education inequalities in pancreatic cancer mortality in Canada. Trend analyses indicates reductions in income and education inequalities in pancreatic cancer mortality over time, particularly among females.</p></div><div><h3>Conclusions</h3><p>Significant income and education inequalities in pancreatic cancer mortality in Canada warrant public policy concern and action. Further research is required to understand whether differential access to treatment across socioeconomic groups played a role in the observed socioeconomic inequalities.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000604/pdfft?md5=198019acc9a899eb7a2408c70c4ae076&pid=1-s2.0-S2950247024000604-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140647171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transhiatal esophagectomy after major thoracic surgery. Don’t give up too soon!","authors":"Maxwell Seaton ,&nbsp;Kayla Widdowson ,&nbsp;Julie Grossman ,&nbsp;Daniel J. Gross ,&nbsp;Alan S. Livingstone","doi":"10.1016/j.soi.2024.100050","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100050","url":null,"abstract":"<div><p>Transhiatal esophagectomy (THE) involves a partially blunt dissection in the posterior mediastinum with incomplete visualization. The technical feasibility and safety of THE following thoracic surgery is unclear. We retrospectively identified cases of patients(5) who underwent transhiatal esophagectomy following major thoracic procedures. All patients had successful Transhiatal resections of esophageal cancer with minimal intraoperative complications (Table 1). THE is a feasible and safe approach, in experienced hands, for patients with previous thoracic surgeries especially in patients who are not candidates for single lung ventilation.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000598/pdfft?md5=70663cdc5445b8f20c5285d8b167b3e0&pid=1-s2.0-S2950247024000598-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140621770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase I dose escalation study for In Vivo Lung Perfusion (IVLP) as an adjuvant treatment for patients with resectable pulmonary metastasis of bone or soft tissue sarcomas","authors":"Sahar A. Saddoughi ,&nbsp;Jennifer Lister ,&nbsp;Vinicius Schenk Michaelsen ,&nbsp;Aizhou Wang ,&nbsp;Runshan Will Jiang ,&nbsp;Janusz Pawliszyn ,&nbsp;Shaf Keshavjee ,&nbsp;Peter Slinger ,&nbsp;Juan Camilo Segura Salguero ,&nbsp;Abha Gupta ,&nbsp;Thomas K. Waddell ,&nbsp;Albiruni Abdul Razak ,&nbsp;Marcelo Cypel","doi":"10.1016/j.soi.2024.100048","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100048","url":null,"abstract":"<div><h3>Background</h3><p>Metastatic sarcoma is an aggressive disease with few effective treatment options. Standard of care for limited pulmonary metastasis is surgical resection, however micrometastasis are often present and go undetected. Here, we determine the maximal tolerated dose and safety of doxorubicin delivered via In Vivo Lung Perfusion (IVLP) for patients with resectable sarcoma pulmonary metastases.</p></div><div><h3>Methods</h3><p>This is a phase I dose escalation study using doxorubicin during IVLP in sarcoma patients with surgically resectable bilateral pulmonary metastases from 2017 to 2022. While the bilateral disease was surgically resected, only a single side underwent IVLP with doxorubicin at different dose levels (DL 1–3). Intraoperative serum, perfusate and lung tissue were collected and evaluated for doxorubicin levels. Patients were closely monitored intra- and post-operatively for adverse events.</p></div><div><h3>Results</h3><p>8 patients consented and six patients met the inclusion criteria, while 2 patients had progressive disease before surgery and were excluded. Initial dose of 5ucg/ml perfusate of doxorubicin (DL1) was used in 1 patient, 3 patients had a dose escalation to 7ucg/ml (DL2), 2 patients with the final dose escalation of doxorubicin to 9ucg/ml (DL3). With DL3, lung infiltrates were observed, therefore it was declared as the maximal administered dose and DL2 was deemed to be the recommended phase 2 dose (RP2D). There were no safety concerns during the IVLP procedure and no deaths within the first 90 days.</p></div><div><h3>Conclusions</h3><p>Here, we demonstrate the safety and feasibility of doxorubicin as a treatment during IVLP for resectable limited pulmonary metastases for sarcomas.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000574/pdfft?md5=1f64f9e18f14c9506feaa456994cfbe0&pid=1-s2.0-S2950247024000574-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140553973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}