Impact of the extent of resection on primary breast angiosarcoma survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 521-521
Author(s):  
Timur Mitin ◽  
Shearwood McClelland ◽  
Jess Hatfield ◽  
Catherine Degnin ◽  
Yiyi Chen
Keyword(s):  
United States ◽  
Surgical Resection ◽  
Tumor Size ◽  
Extent Of Resection ◽  
The United States ◽  
Adjuvant Radiation ◽  
Cancer Data ◽  
Surgical Modality ◽  
The Impact ◽  
Related Mortality

521 Background: The widely accepted standard of care in treating primary breast angiosarcoma involves surgical resection, often followed by adjuvant therapy (radiation and/or chemotherapy). The rarity of this disease has precluded large-scale analyses. The question regarding the impact of resection extent on survival has yet to be examined on a nationwide scale. Methods: The National Cancer Data Base (NCDB) from 2004-2014 identified primary breast angiosarcoma patients throughout the United States having undergone surgical resection. The extent of resection (mastectomy versus lumpectomy) was adjusted for several variables (including patient age, race, income, primary payer for care, tumor size, adjuvant therapies, and medical comorbidities) to assess its impact on breast angiosarcoma-related mortality. Results: Over this eleven-year span, 826 resected primary breast angiosarcoma patients were identified in the United States. Mastectomy was by far the most common surgical modality for primary breast angiosarcoma (86% of patients). Increasing tumor size was predictive for mastectomy over lumpectomy (p < 0.0001), and for involvement of adjuvant radiation therapy (p = 0.001). The extent of surgical resection was inversely predictive of radiation usage (p = 0.017). However, surgical modality was not significantly predictive of breast angiosarcoma-related mortality. Conclusions: Despite the frequent preference of mastectomy for primary breast angiosarcoma treatment (more than 6 of every 7 patients), there is no survival benefit of mastectomy versus lumpectomy. This lack of benefit should be discussed with patients, given the reduced operative morbidity of lumpectomy versus mastectomy. The Class IIB evidence provided from this analysis represents the highest level of evidence to-date governing management of this disease.

scholarly journals Racial Differences in Disease Presentation and Management of Intracranial Meningioma

2018 ◽  
Vol 80 (06) ◽  
pp. 555-561
Author(s):  
C. Lane Anzalone ◽  
Amy E. Glasgow ◽  
Jamie J. Van Gompel ◽  
Matthew L. Carlson
Keyword(s):  
United States ◽  
Overall Survival ◽  
Racial Differences ◽  
Tumor Size ◽  
The United States ◽  
Intracranial Meningioma ◽  
Multivariable Model ◽  
Asian Populations ◽  
Hispanic Patients ◽  
The Impact

Objective/Hypothesis The aim of the study was to determine the impact of race on disease presentation and treatment of intracranial meningioma in the United States. Study Design This study comprised of the analysis of a national population-based tumor registry. Methods Analysis of the surveillance, epidemiology, and end results (SEER) database was performed, including all patients identified with a diagnosis of intracranial meningioma. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model. Results A total of 65,973 patients with intracranial meningiomas were identified. Of these, 45,251 (68.6%) claimed white, 7,796 (12%) black, 7,154 (11%) Hispanic, 4,902 (7%) Asian, and 870 (1%) patients reported “other-unspecified” or “other-unknown.” The median annual incidence of disease was lowest among black (3.43 per 100,000 persons) and highest among white (9.52 per 100,000 persons) populations (p < 0.001). Overall, Hispanic patients were diagnosed at the youngest age and white patients were diagnosed at the oldest age (mean of 59 vs. 66 years, respectively; p < 0.001). Compared with white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors (p < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely to undergo surgery than white, black, and Asian populations. Black populations had the poorest disease specific and overall survival rates at 5 years following surgery compared with other groups. Conclusion Racial differences among patients with intracranial meningioma exist within the United States. Understanding these differences are of vital importance toward identifying potential differences in the biological basis of disease or alternatively inequalities in healthcare delivery or access Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.

Room for improvement? The adoption of multimodal esophageal cancer care in the United States.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 78-78
Author(s):  
R. P. Merkow ◽  
K. Y. Bilimoria ◽  
M. McCarter ◽  
A. Stewart ◽  
W. B. Chow ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Surgical Resection ◽  
Tumor Size ◽  
Locally Advanced ◽  
The United States ◽  
Stage I ◽  
Stage Ii ◽  
Cancer Data ◽  
Factors Associated

78 Background: Consensus guidelines recommend neoadjuvant chemo- or chemoradiation therapy as the preferred treatment for locally advanced esophageal adenocarcinoma; however, it is unknown if this recommendation has been widely adopted in the U.S. Our objective was to examine esophageal cancer multimodal therapy and identify factors associated with the use of neoadjuvant therapy. Methods: From the National Cancer Data Base, patients with middle third, lower third and GE junction (GEJ) adenocarcinomas were identified. Patients who were clinical stage I-III and underwent surgical resection were included. Separate logistic regression models were developed to identify predictors of neoadjuvant therapy utilization and outcomes. Results: From 1998 to 2007, 8,051 patients underwent surgical resection for esophageal cancer: 16.3% stage I, 45.0% stage II and 38.7% stage III. For stage II/III tumors, neoadjuvant use increased (49.0% to 77.8%, p<0.001). After adjustment, factors associated with underuse of neoadjuvant therapy in stage II/III patients were older age, Black or Hispanic ethnicity, more severe comorbidities, tumor location (GEJ and middle vs. lower third), tumor size ≥ 2cm, stage II (vs. III) and geographic region. Stage II/III patients not receiving neoadjuvant had an over two fold increased risk of positive lymph nodes (OR 2.14. 95% CI 1.79 – 2.55, p<0.001). In addition, the positive surgical margin rate increased almost three fold (OR 2.80 95% CI 2.17-3.62, p<0.001) but 30-day postoperative mortality risk was not significantly affected (OR 1.50 95% CI 0.94-2.39; p=0.090). For stage I patients, neoadjuvant therapy decreased over time (38.0% to 11.4%, p<0.001). The overuse of neoadjuvant therapy was associated with higher tumor grade, larger tumor size, and low surgical case volume (all p<0.05). Conclusions: The adoption of neoadjuvant therapy has increased in the past decade; however, opportunity exists to improve guideline treatment for locally advanced esophageal cancer. Registry-based feedback to individual hospitals, such as benchmark comparison tools, could help institutions provide care in concordance with national guidelines. No significant financial relationships to disclose.

Facility Size and Its Influence on the Presentation and Treatment of in Situ Breast Carcinoma in the United States

2012 ◽  
Vol 78 (7) ◽  
pp. 766-769 ◽  
Author(s):  
Jennifer Salotto ◽  
Jack Sariego
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Breast Carcinoma ◽  
Breast Conservation ◽  
The United States ◽  
Breast Cancer Patients ◽  
Cancer Centers ◽  
Cancer Data ◽  
The Impact

Studies have suggested that outcomes from breast cancer are improved when treatment is rendered at high-volume teaching centers. The current study was undertaken to examine the impact of facility type on the presentation and treatment of “early” breast carcinoma across the United States. Breast cancer data were available from the American College of Surgeons National Cancer Database. The cohort consisted of 305,358 patients presenting with in situ cancers and no prior treatment from 2000 to 2008. Data were stratified by type of treatment facility, “invasive” versus “noninvasive” nature of the tumor, and treatment performed. Only 15 per cent of patients presented to community cancer centers (CCCs). Despite this, a greater percentage presented with invasive disease at CCCs (82.1%) compared with comprehensive community cancer centers (CCCCs; 80%) or teaching/research facilities (T/Rs; 70.2%). In examining the in situ cohort, a higher percentage of patients at CCCs were treated with breast conservation than at CCCCs or T/Rs. Although small, these differences were statistically significant. These data do not support the contention that only “early” cases of breast cancer present and are treated at community centers. In early breast cancer, patients are as likely to receive state-of-the-art treatment at a CCC as they are at a T/R.

The Impact of Adjuvant Radiation Therapy for High-Grade Gliomas by Histology in the United States Population

2014 ◽  
Vol 90 (4) ◽  
pp. 894-902 ◽  
Author(s):  
Chad G. Rusthoven ◽  
Julie A. Carlson ◽  
Timothy V. Waxweiler ◽  
Miranda J. Dally ◽  
Anna E. Barón ◽  
...  
Keyword(s):  
United States ◽  
Radiation Therapy ◽  
The United States ◽  
Adjuvant Radiation ◽  
High Grade ◽  
Adjuvant Radiation Therapy ◽  
United States Population ◽  
High Grade Gliomas ◽  
The Impact

scholarly journals Geographical Differences in Intracranial Meningioma Management: Examining 65,973 Patients across the United States

2018 ◽  
Vol 80 (06) ◽  
pp. 547-554
Author(s):  
Charles Lane Anzalone ◽  
Amy Glasgow ◽  
Elizabeth Habermann ◽  
Brandon R. Grossard ◽  
Jamie J. Van Gompel ◽  
...  
Keyword(s):  
United States ◽  
New Mexico ◽  
Tumor Size ◽  
Multivariable Analysis ◽  
The United States ◽  
Patient Treatment ◽  
Treatment Preferences ◽  
Intracranial Meningioma ◽  
Geographical Differences ◽  
The Impact

Background Age, tumor size and location, overall health, and patient preference are primary considerations driving treatment decision-making for intracranial meningiomas. However, even for the same individual patient, treatment recommendations may vary between centers and providers. Objective To study associations between geography, disease presentation, and management of intracranial meningioma in the United States. Methods The population-based Surveillance, Epidemiology, and End Results(SEER) data were queried between 2004 and 2014 for cases of intracranial meningioma. Results A total of 65,808 patients with intracranial meningioma were identified. Univariate analyses demonstrated strong associations between geographic location, age, and size of tumor at presentation. The mean age for all registries was 64.2 years, with a range from 62.0 (Utah registry) to 66.6 (Detroit registry). The greatest proportion of small tumors (<1 cm) were identified in the Utah registry (13.9% of tumors), while the greatest proportion of large tumors (> 4cm) were noted in the Hawaii registry (30.7% of tumors). Multivariable analysis demonstrated that the impact of geography on treatment selection was just as important as other established variables. For example, the distribution in tumor size between New Mexico and Greater California registries is nearly identical; however, the odds ratio for surgery was 1.5 times greater for the New Mexico population. Conclusion These data suggest that disease presentation and treatment are significantly influenced by regional referral patterns, provider or institutional treatment preferences, and regional availability of subspecialty expertise. Understanding such biases is important for patients, referring physicians, and treatment providers in an effort to provide balanced counseling and treatment.

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