bluuebunny/crossref_metadata_2025 huggingface dataset:
PS02.069: CERVICAL GASTROPLASTY ANASTOMOSIS AFTER ESOPHAGECTOMY: INDOCYANINE GREEN FLUORESCENCE IMAGING EVALUATION AND TECHNICAL SURGICAL ASPECTS
Authors: Takeda Flavio , Ribeiro Jr Ulysses , Sallum Rubens , Mariano Rocha Julio , Duarte Andre , Zaidan Evelise , Cecconello Ivan
Published: September 2018

Description

One of the most frequent complication after esophagectomy is the anastomotic leakage, which is a determiming factor of morbidity and mortality after surgical treatment. The best location for the esophagogastric anastomosis (cervical or intra-thoracic) has been topic of discussion for many years, and surgical aspects as resected margins, recurrent nerve trauma and mainly the vascularization of the anastomosis. In this video we performed a cervical gastroplasty anastomosis (McKeown), side-to-side, stapled (linear stapler) with a thin gastric tube conduit, and after that we aimed to determine the feasibility and usefulness of indocyanine green (ICG) fluorescence imaging to evaluate the gastric conduit perfusion during an esophagectomy. After pulling up the gastric conduit trhought the mediastinum and after performing the cervical anastomosis, 5 mg of ICG was in jected as a bolus and visual assessment of the blood supply of the gastric conduit was seen. This patient was a 63 years old, male, with adenocarcinoma of esophago-gastric junction (Siewert II) underwent to neoadjuvant quimiotherapy (FOLFOX regimen) and submitted after 3 cycles to esophagectomy (thoracoscopy and laparoscopy). No fistula was found in post operative follow-up, and either complications.

Disclosure

All authors have declared no conflicts of interest.
PS02.070: DEEP NEURAL NETWORK TO PREDICT POOR PROGNOSTIC FACTORS IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Hsu Po-Kuei , Yeh Joe
Published: September 2018

Background

Both lymphovascular invasion, which is characterized by penetration of tumor cells into the peritumoural vascular or lymphatic network, and perineural invasion, which is characterized by involvement of tumor cells surrounding nerve fibers, are considered as an important step for tumor spreading, and are known poor prognostic factors in esophageal cancer. However, the information of these histological features is unavailable until pathological examination of surgical resected specimens. We aim to predict the presence or absence of these factors by positron emission tomography images during staging workup.

Methods

The positron emission tomography images before treatment and pathological reports of 278 patients who underwent esophagectomy for squamous cell carcinoma were collected. Stepwise convolutional neural network was constructed to distinguish patient with either lymphovascular invasion or perineural invasion from those without.

Results

Randomly selected 248 patients were included in the testing set. Stepwise approach was used in training our custom neural network. The performance of fine-tuned neural network was tested in another independent 30 patients. The accuracy rate of predicting the presence or absence of either lymphovascular invasion or perineural invasion was 66.7% (20 of 30 were accurate).

Conclusion

Using pre-treatment positron emission tomography images alone to predict the presence of absence of poor prognostic histological factors, i.e. lymphovascular invasion or perineural invasion, with deep convolutional neural network is possible. The technique of deep learning may identify patients with poor prognosis and enable personalized medicine in esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.071: EVALUATION OF CIRCULATING TUMOR CELLS IN ESOPHAGEAL CANCER PATIENTS
Authors: Ujiie Daisuke , Ohki Shinji , Okayama Hirokazu , Yamada Leo , Tada Takeshi , Hanayama Hiroyuki , Hayase Suguru , Gonda Kenji , Saze Zenichiro , Momma Tomoyuki , Kono Koji
Published: September 2018

Background

Circulating tumor cells (CTCs) in patients with malignant tumors can be used as a prognostic marker. Recently the existence of mesenchymal CTCs have been detected by new methods. However, it has been not yet clarified how CTCs are associated with the treatment effects in esophageal cancer patients. We assessed CTCs in esophageal cancer patients and investigated the relationship between CTCs and treatment effect.

Methods

Seven patients who had potential of curative resection have been enrolled and peripheral blood samples (10ml) were collected before and after treatment. All patients received chemotherapy (5-FU and cisplatin) and four patients of them received as neoadjuvant therapy. Other patients received only chemotherapy and radiation therapy without operation. CTCs were analyzed using a Microfluidic Chip devise provide with the Nihon Gene Research Laboratories. This system can isolates CTCs from blood samples, based on their size and deformability differences from blood cells. Phenotypes of CTCs are determined by staining and scanning systems. A previous report revealed that this method had higher sensitivity for CTCs than conventional methods (the Cell Search system) in 61 metastatic breast cancer.

Results

Treatments effects were stable disease or better in all cases. Multiple CTCs were detected in all cases before treatment. Five patients had epithelial CTCs and others had only mesenchymal CTCs. Total number of CTCs after treatment whose data can be available decreased except for two cases. One patient had no CTC after treatment. Two cases have been currently analyzing.

Conclusion

CTCs may exist almost all patients of Stage II or more esophageal cancer. Decreasing the number of CTCs after treatment suggests some relationship between CTCs and treatment effect, and the accumulation of more cases is necessary.

Disclosure

All authors have declared no conflicts of interest.
PS02.073: THE APPLICATION OF ARTIFICIAL INTELLIGENCE IN ESOPHAGEAL CANCER SCREENING AND PREDICTION OF LYMPH NODE METASTASIS
Authors: Yu Zhang
Published: September 2018

Background

Artificial intelligence become the latest hot spot in medical applications, especially in diagnostics and radiology and pathology in do a preliminary exploration, prediction of esophageal cancer screening and early esophageal cancer staging has a revolutionary significance.

Methods

Several large esophageal cancer treatment center of esophageal pathology as a result, the imaging results (including CT, PET, CT, ultrasound, EUS, etc.), gastroscopy, follow-up medical records and other data import to the artificial intelligence software, through artificial intelligence under the big data automatically after the learning process, susceptible to test results and the clinic has confirmed into the software, after analysis results with the postoperative pathology, endoscopy results, PET—CT results such as comparison, analysis of accuracy and sensitivity.

Results

Through automatic learning of artificial intelligence, early cancer screening was performed for susceptible people, and the patients who had been diagnosed had esophageal cancer staging and lymph node metastasis. Artificial intelligence will continuously improve the accuracy and sensitivity of the diagnosis in the learning process, and it is revolutionary.

Conclusion

In the past, the early cancer screening and staging of esophageal cancer was found, and the search for lymph node metastasis was not based on a large number of data, high sensitivity and small trauma. Through artificial intelligence, we can solve many diagnostics problems and establish a large database of esophageal cancer, which will bring great significance to the diagnosis and research of esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.075: USEFULNESS OF FDG-PET TO DECIDE THE INDICATION FOR ENDOSCOPIC RESECTION FOR SUPERFICIAL ESOPHAGEAL CANCER
Authors: Nakajima Masanobu , Muroi Hiroto , Kikuchi Maiko , Tani Yukiko , Yamaguchi Satoru , Sasaki Kinro
Published: September 2018

Background

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a useful imaging modality to reflect the tumor activity. However, FDG-PET is mainly used for advanced cancer rather than superficial cancer. In this study, we investigate the relationship between the superficial tumor depth of esophageal cancer and FDG uptake, and discuss the possibility of using FDG-PET in making the decision for performing endoscopic resection.

Methods

From 2009 to 2017, 444 esophageal cancer patients underwent esophagectomy or Endoscopic submucosal dissection (ESD), and 195 were diagnosed with pathological superficial cancer. Among them, 146 patients were examined by FDG-PET before esophagectomy or ESD. For these 146 patients, the relationship between pathological tumor depth and FDG uptake was analyzed.

Results

Mean maximun standardized uptake value (SUV Max) in pT1a-EP/LPM was 1.362 ± 0.890, pT1a-MM/pT1b-SM1 was 2.453 ± 1.872, and pT1b-SM2/SM3 was 4.265 ± 3.233 (P < 0.0001). Among 51 pT1a-EP/LPM tumors, 10 (19.6%) showed positive detection of FDG. For pT1a-MM/pT1b-SM1 and pT1b-SM2/SM3, the detection rates were 52.9% (18/34) and 82.0% (50/61), respectively. The detection rate for pT1a-EP/LPM was significantly lower than for the other two groups (P < 0.0001). Among 10 FDG-PET positive patients, the reason for one lesionbeing PET positive could not be determined; however, nine of ten lesions had suitable reasons for the lesions being detected by PET and thus not being ER indication. PET diagnosis tends to be more accurate than endoscopic diagnosis (P = 0.0574)

Conclusion

Negative detection of superficial esophageal sqamous cell carcinoma by FGD-PET is useful for deciding the indication for ER. Furthermore, when FDG uptake is recognized, a therapeutic modality other than ER should be considered.

Disclosure

All authors have declared no conflicts of interest.
PS02.076: VISUALIZATION OF BLOOD SUPPLY ROUTE TO THE RECONSTRUCTED STOMACH BY INDOCYANINE GREEN FLUORESCENCE IMAGING DURING ESOPHAGECTOMY, 2ND REPORT
Authors: Rino Yasushi , Oshima Takashi , Sato Tsutomu , Aoyama Toru , Yukawa Norio , Yamada Takanobu , Hayashi Tsutomu , Ogata Takashi , Yoshikawa Takaki , Masuda Munetaka
Published: September 2018

Background

Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We have reported the three blood supply routes to the reconstructed stomach using ICG fluorescence imaging for reconstruction during esophagectomy. Blood flow routes in the 33 patients with esophageal cancer were classified into categories on the basis of ICG imaging findings: the gastric wall route, the greater curvature route, and the omentum and splenic hiatal route. The gastric wall route was found in 13 patients and characterized by large blood vessels in the gastric wall. The greater curvature route was present in 11 patients and characterized by blood vessels in the greater omentum. The omentum and beside splenic hilum route was found in 22 patients. Blood vessels ran in the greater omentum beside the splenic hilum. a photodynamic eye (PDE) showed blood flow from right gastroepiploic artery, omentum vessels, left gastroepiploic artery, splenic hiatal vessels, short gastric artery, and gastric wall vessels to the top of the reconstructed stomach. The ‘splenic hiatal route’ was present in 66.7% of the patients and was formed by large vessels or networks of small vessels. We rechecked the ‘splenic hiatal route’ cases and recognize that the branch parted from the right gastroepiploic artery. We tried preservation of the ‘splenic hiatal route’.

Methods

Since January 2017, we have preserved the ‘splenic hiatal route’ and performed ICG fluorescence imaging in 5 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded.

Results

ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was visualized the ‘splenic hiatal route’ in all patients.

Conclusion

On ICG fluorescence imaging, the splenic hiatal vessels would be the major blood supply for the anastomosis in most patients.

Disclosure

All authors have declared no conflicts of interest.
PS02.079: ESOPHAGEAL ADENOCARCINOMA: CT, PET, EUS SENSITIVITY/SPECIFICITY FOR THE PREOPERATIVE ASSESSMENT OF LYMPH NODE METASTASES IN SINGLE THORACIC AND ABDOMINAL NODAL STATIONS
Authors: Kauppi Juha , Lugaresi Marialuisa , Lopci Egesta , Daddi Niccolò , Räsänen Jari , Mattioli Sandro
Published: September 2018

Background

In esophageal adenocarcinoma clinical staging (cStaging), interest for N-descriptor according to single lymph nodal station has emerged, but no specific data are available. CT, PET, EUS sensitivity/specificity for N-descriptor in single stations were investigated.

Methods

In 101 esophageal adenocarcinoma cases (60/41 Siewert I/II) preoperative staging and primary radical surgical resection (prospective protocols) were performed. Resected lymphatic nodes (LNY) and lymphatic metastases (LNM) were reported for the following stations: A) right paratracheal/sub carinal/pulmonary ligament; B) paraesophageal thoracic; C) pericardial; D) left gastric artery, lesser curvature; E) celiac trunk, hepatic/splenic artery. Pathological N data were compared with clinical N-descriptors.

Results

LN stations: A) LNY 137 LNM 6, Sensitivity CT 58.3%, PET 7.1%, EUS 87.5%—Specificity CT 94.3%, PET 98.8%, EUS 88.6%; B) LNY 79 LNM 18, Sensitivity CT 33.3%, PET 20%, EUS 80%—Specificity CT 92.1%, PET 96.6%, EUS 87.2%; C) LNY189 LNM 36, Sensitivity CT 46.6%, PET 23.5%, EUS 28.5%—Specificity CT 95.3%, PET 97.5%, EUS 97.7%; D) LNY 383 LNM 66, Sensitivity CT 24.1%, PET 21.4%, EUS 33.3%—Specificity CT 97.2%, PET 97.2%, EUS 100%; E) LNY 148 LNM 17, Sensitivity CT 13.3%, PET 5.5%, EUS 33.3%—Specificity CT 93%, PET 98.7%, EUS 95.2%. Figure Staging in adenocarcinoma of the esophageal-gastric junction; CT (A), PET (B) and fused PET/CT sessions (C) at the level of the primary tumor (red arrows) and para-esophageal lymph nodes including one PET-positive (red arrowheads), and one PET-negative detectable on CT only (yellow arrowheads). Panel D the box-plot for median SUVmax according to pathologic lymph node status. In the true positive lymph nodes, SUVmax was significantly higher than in true negative (median, 13.6 vs 5.0, P = 0.001) and false negative lymph nodes (median, 13.6 vs 6.9; P = 0.026). Abbreviations: FN = false negative; TP = true positive; TN = true negative.

Conclusion

For esophageal adenocarcinoma cStaging, CT, PET, EUS N-descriptor is not reliable, particularly PET data for N stations close to primary T. To tailor therapy, new biological descriptors are necessary.

Disclosure

All authors have declared no conflicts of interest.
PS02.081: ADVANCED PRETREATMENT STAGE IN OESOPHAGEAL CANCER NOT ASSOCIATED WITH POOR OUTCOMES
Authors: Newton Nick , Phillips Alex , Jaretzke Helen , Immanuel Arul , Hayes Nick , Michael Griffin S
Published: September 2018

Background

Following a diagnosis of oesophageal cancer UICC TNM staging guides treatment and informs prognosis. There is recognised variance between clinical staging (cTNM) and post-operative pathological staging (pTNM). T3N3 oesophageal cancers have a 5-year survival of less than 25% in most studies; given the morbidity associated with radical treatment these cancers may not be considered curable.

Methods

A database of patients treated in a high volume UK tertiary referral centre was interrogated for all cT3N3M0 patients. Demographics, pathological stage and outcomes were recorded.

Results

From 2011 to 2016 34 patients met the inclusion criteria of cT3N3M0 oesophageal cancer. 11 patients had squamous cell carcinoma, the remainder adenocarcinoma. Median age was 65. Predicted overall survival at two years was 71% with a median overall survival of 54 months. 29 patients had neoadjuvant chemotherapy. All patients had an R0 resection. In 15% of patients clinical stage equated to pathological stage, 9% were ’understaged’, 76% had a better prognostic pathological stage.

Conclusion

Staging is considered important to allow treatment to be tailored to the individual patient. Identifying an unfavourable clinical stage may prevent inappropriate treatment, but may disadvantage patients who are erroneously ‘overstaged’. This study highlights variance between pre-treatment clinical staging and post-operative pathological staging. Care should be taken when making treatment decisions and counselling patients who have a poor prognostic clinical stage.

Disclosure

All authors have declared no conflicts of interest.
PS02.083: CIRCULATING CELL FREE TUMOR DNA FOR DISEASE MONITORING AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: PROOF-OF-PRINCIPLE
Authors: Eyck B , Noordman B , Van Der Wilk Berend , Jansen M , Atmodimedjo P , Martens J , Lagarde Sjoerd M , Wijnhoven Bas P L , Van Lanschot J J B , Dinjens W
Published: September 2018

Background

An active surveillance approach has been proposed for patients with a clinically complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer (SANO trial). To justify renouncing surgical resection, patients with residual disease after nCRT should be accurately identified. However, substantial residual disease (TRG3–4) cannot be detected in 10% of patients with current diagnostic tests (preSANO trial). Circulating cell free tumor DNA (ctDNA) potentially improves detection of residual malignancy after nCRT and could be used for disease monitoring. The objective of this study was to investigate the feasibility of using ctDNA as biomarker for disease status after nCRT in esophageal cancer.

Methods

Twelve typical patients from the preSANO trial with variable pathological responses to nCRT were included. Blood was drawn and processed pretreatment. The feasibility of detecting TP53 mutations in baseline tumor biopsies was investigated using a next generation sequencing (NGS) panel. Subsequently, baseline blood samples of patients in whom specific TP53 mutations could be identified in baseline tumor biopsies or the surgical resection specimen were analyzed for ctDNA using cell free DNA NGS kits with single molecule barcoding (Oncomine Thermo Fisher).

Results

Baseline biopsy samples were available in 8 out of 12 patients. In 7 of these 8 patients (88%) specific TP53 mutations could be identified in their baseline biopsies. In 11 out of 12 patients (92%) specific TP53 mutations could be identified in baseline biopsies or the resection specimen. Eight of these 11 mutations were potentially detectable by the Oncomine panel. The panel detected TP53 mutational ctDNA in 4 of these 8 samples (50%).

Conclusion

Specific and clonal TP53 mutations can be identified in pretreatment biopsy samples and in surgical resection specimens of patients with esophageal cancer. These mutations can be matched to ctDNA identified in blood samples. Hence, ctDNA analyses in blood samples can potentially be used for disease monitoring during active surveillance and for disease monitoring in follow-up after surgical resection.

Disclosure

All authors have declared no conflicts of interest.
PS02.084: PROSPECTIVE EVALUATION OF 18F-FDG PET-CT AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR DETECTING LYMPH NODE METASTASES NEAR THE CELIAC TRUNK IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Groen Jasper , Gisbertz Suzanne , Van Berge Henegouwen Mark I , Slaman Annelijn E , Meijer Sybren , Hulshof Maarten , Lagarde Sjoerd M , Bergman Jacques , Van Laarhoven Hanneke , Bennink Roel J
Published: September 2018

Background

Celiac trunk metastases are an independent factor for inferior survival in patients with esophageal cancer. Detecting these metastases before esophagostomy would aid clinical decision making. The aim of our study was to evaluate the accuracy of integrated PET and CT (PET-CT) using 18F-FDG in detecting these metastases in patients with esophageal cancer after neoadjuvant chemoradiotherapy (nCRTx) followed by esophagectomy.

Methods

All patients with a carcinoma of the mid-to-distal esophagus or the gastroesophageal junction (GEJ) who underwent esophageal resection with curative intent following nCRTx between January 2011 and January 2017 were included. The PET-CT scans after nCRTx were reviewed by nuclear radiologists and lymph nodes within a margin of 2 cm around the celiac trunk were expressed in SUVmax. Lymph nodes with SUVmax > 2.0 were deemed positive. The truncal nodes were extracted during esophagectomy and reviewed by different pathologists using standard pathology protocol. To assess the accuracy of the PET-CT in detecting lymph node metastases near the celiac trunk the sensitivity, specificity and positive and negative predictive value were calculated.

Results

A total of 448 patients were included. There were 24 patients (5.4%) with positive truncal nodes on the PET-CT versus 424 patients (90.6%) with negative truncal nodes on the PET-CT. Out of these 24 patients 20 (83.3%) had truncal node metastases confirmed in the resection specimen (positive predictive value of 83.3%). In the other 424 patients 40 (9.4%) had truncal node metastases confirmed in the resection specimen (negative predictive value of 90.6%). This results in a sensitivity of 33.3% and a specificity of 99.0%.

Conclusion

The sensitivity and specificity of the PET-CT in detecting lymph node metastases near the celiac trunk in patients with esophageal cancer who underwent nCRTx were respectively 33.3% and 99.0% This shows that the PET-CT is accurate in detecting truncal lymph node metastases in this patient group.

Disclosure

All authors have declared no conflicts of interest.
PS02.087: EARLY RESPONSE EVALUATION OF NEOADJUVANT THERAPY WITH PET/MRI TO PREDICT RESECTABILITY IN PATIENTS WITH ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION
Authors: Achiam Michael , Löfgren Johan , Belmouhand Mohamed , Hjorth Johannesen Helle , Baeksgaard Lene
Published: September 2018

Background

The primary treatment for locally advanced adenocarcinoma of the esophagogastric junction remains surgery combined with neoadjuvant chemo- or chemoradiotherapy (NT). A prediction of response to NT would be valuable, as insufficient response following NT may reflect therapy resistance leading to disease progression, unnecessary delay of surgery and risk of unresectability. Determining insufficient response to NT could lead to change of therapy and reduce possible chemo(radio)therapy toxicity. Positron Emission Tomography (PET)/Magnetic Resonance Imaging (MRI) is a new modality that has showed promising results for various clinical indications. Currently, evaluation of neoadjuvant therapy (NT) among patients with adenocarcinoma of the esophagogastric junction has primary been reserved for PET/computed tomography (CT). The aim of this study was to investigate if simultaneous PET/MRI is a feasible method to evaluate early tumor response to predict resectability in patients with AEG during NT. We also examined the association between histopathological response and changes on PET/MRI during NT.

Methods

Patients with untreated adenocarcinoma of the esophagogastric junction (Siewert's I/II) and fit for NT with no contraindications for PET/MRI were considered eligible. A baseline scan was performed prior to NT induction and an evaluation scan 3 weeks later. For histopathological response evaluation the Mandard tumor regression grade score was applied. Response on PET/MRI was evaluated with Response Evaluation Criteria in Solid Tumors (RECIST 1.1), and change in ADC and SUVmax values.

Results

Twenty-eight patients were enrolled, and 22 completed both scans and proceeded to our final analyses. 17 patients were found resectable vs. five not resectable. PET/MRI response evaluation is a feasible method to predict resectability in patients with adenocarcinoma of the esophagogastric junction with sensitivity 94%, specificity 80%, and AUC = 0.95. However, no association with histopathological response (tumor regression grade) was found nor was RECIST correlated with resectability.

Conclusion

Our work has identified response evaluation with PET/MRI as a feasible method to predict resectability in patients with adenocarcinoma of the esophagogastric junction, however, larger studies are warranted to justify the use of this modality for this indication.

Disclosure

All authors have declared no conflicts of interest.
PS02.089: METABOLIC RESPONSE FOR CHEMORADIOTHERAPY PREDICTS PROGNOSIS OF PATIENTS TREATED WITH NEOADJUVANT THERAPY PLUS ESOPHAGECTOMY FOR ADVANCED ESOPHAGEAL CANCER
Authors: Motoyama Satoru , Sato Yusuke , Wakita Akiyuki , Kawakita Yuta , Nagaki Yushi , Minamiya Yoshihiro
Published: September 2018

Background

We evaluated that metabolic response using [18F]-Fluorodeoxyglucose positron-emission tomography/computed tomography (PET/CT) predicts survival outcome in patients treated with neoadjuvant chemoradiotherapy (NACRT) plus esophagectomy for thoracic esophageal squamous cell carcinoma (TESCC).

Methods

Fifty consecutive Japanese patients with cStage IIB-IV TESCC, treated at our hospital between April 2009 and January 2014, were enrolled. We analyzed the metabolic response (fractional decrease in tumor maximum standardized uptake value) to NACRT. Independent prognostic factors predictive of 3-year survival were investigated using univariate and multivariate analysis.

Results

The study participants included 41 (82%) males and 9 (18%) females, with an age of 62.5 (rage 43–74) years. All 42 patients examined were found to be positive for tumors on FDG-PET/CT before treatment. After NACRT, 28% (10/36) of patients had changed from positive to negative for tumor on FDG-PET/CT. Seventy-one percent (30/42) of patients were positive for lymph node involvement on FDG-PET/CT before treatment. After NACRT, 81% (22/27) of patients previously positive for lymph node involvement were negative on FDG-PET/CT. The median fractional decrease in tumor SUVmax was 75% (range = 19–90%). We found that there was a significant correlation between a decrease in FDG-PET/CT and recurrence. Consistent with those findings, univariate and multivariate analysis taking into consideration age, gender, cT, cN, cM, adverse events, interval between NACRT and surgery, number of dissected LNs, pT, pN, pCR, pathological response, and fractional decrease in tumor SUVmax showed that fractional decrease in tumor SUVmax of < 75% to be significant prognostic factors associated with poorer survival.

Conclusion

Metabolic response as a decrease in SUVmax of ≥ 75% was an independent prognostic factor for 3-year overall survival in multivariate analysis and associated with recurrence. On the other hand, cT, cN, pT, pN, pCR were not associated with survival outcome or recurrence.

Disclosure

All authors have declared no conflicts of interest.
PS02.093: LYMPH NODE METASTASES IN T1 OESOPHAGEAL ADENOCARCINOMA: WHAT IS THE REAL RISK IN EARLY OESOPHAGEAL CANCER?
Authors: Mitchell David , Falk Gregory , Yeluri Sashi
Published: September 2018

Background

Lymph node status is regarded as the most important factor for prognosis for oesophageal cancer. T1 oesophageal adenocarcinoma management has shifted from oesophagectomy only to include endoscopic management as part of the algorithm, with some bodies (National Comprehensive Cancer Network (NCCN) 2016) recommending it for management of T1a disease and selected T1b disease. We reviewed the literature to assess the true risk of lymph node metastasis in patients with T1 oesophageal adenocarcinoma.

Methods

Medline, Embase, Pubmed and Cochrane where searched for manuscripts in english reviewing the lymph node metastasis in superficial (T1) oesophageal adenocarcinoma. The main outcome was reviewing the risk of lymph node metastasis in T1a and T1b oesophageal adenocarcinoma. Secondary outcomes looked at the rate of lymph node metastasis for T1b cancers based on degree of submucosal involvement (SM1, SM2 and SM3). Studies were excluded if neo-adjuvant chemotherapy or radiotherapy were received and if the surgical lymph node yield was < 15 lymph nodes.

Results

38 Studies were identified. 22 studies were excluded due to low lymph node yield (< 15) or insufficient statistical analysis. For the 16 studies, a total of 1422 cases were included. 533 patients had T1a adenocarcinoma with 11 patients demonstrating positive lymph nodes (2%). 849 had T1b adenocarcinoma with 189 patients demonstrating positive lymph nodes (22%). Eight Studies did subgroup analysis of T1b lesions with a total of 365 patients identified. The rate of lymph node positivity for SM1, SM2 and SM3 was 17.9%, 16.6% and 29.6% respectively.

Conclusion

Early oesophageal adenocarcinoma (T1) is increasing in prevalence due to surveillance of pre-malignant conditions (Barrett's Oesophagus).

Recently some bodies recommend the use of endoscopic mucosal resection as first line therapy for T1a disease. It is important to inform our patients the risk of lymph node metastasis is low but significant (2%). Given in specialised units, oesophagectomy can be performed with low mortality (< 1%) and morbidity with good quality of life it is justifiable to recommend oesophagectomy or endoscopic management in patients who are fit enough for surgery. For T1b disease an oesophagectomy is the gold standard of treatment given the significant risk of lymph node positivity (22%).

Disclosure

All authors have declared no conflicts of interest.
PS02.104: CLINICAL STUDY OF PROSPECTIVE RANDOMIZED CONTROLLED TRIALS ON ADJUVANT THERAPIES IN TREATMENT OF RESECTABLE PIB-III (PT2–4AN0–1M0) ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Zheng Bin , Chen Maohui , Wu Canxing , Zeng Taidui , Zhang Shuliang , Zheng Wei , Chen Chun
Published: September 2018

Background

Esophageal squamous cell carcinoma (ESCC) patients have relatively poor prognosis after operation. The study was designed to analyse the effect of surgery alone, surgery with adjuvant chemotherapy and surgery with chemoradiotherapy on prognosis in the patients with pathologic stage pIB-III (pT2–4aN0–1M0) who received radical esophagectomy.

Methods

We carried out the prospective randomized study. In this study, we analyzed 104 patients who had undergone minimally invasive esophagectomy for thoracic ESCC and been assessed as pathological stage pIB-III (pT2–4aN0–1M0) from January 2013 to October 2015 in our institute. 48 patients are treated with surgery alone (S group),33 patients received surgery and adjuvant chemotherapy (CT group), and 23 patients received surgery and adjuvant chemoradiotherapy (CRT group). We do the follow up for all the patients, collect the clilnical, patholigical data of them, and analyze the overal survival (OS) and disease-free survival (DFS) of them.

Results

The basic clinical characteristics of three groups were comparable. The average age was (52.1 ± 9.7) years old. The median follow‐up period was 39 months. The 3-year OS of the patients in the S group, CT group, and CRT group were 37.5%,18.8%, 65.2%, respectively. According to the follow-up data, both the 3-year OS and the 3-year DFS of the patients in the CRT group were better than those of the patients in the S group and CT group group (P < 0.05). However, the incidence rates of side effects and complications in CRT group were higher than those in S group and CT group, without signicant differences. One patient died in S group in perioperative period, because of postoperaive pulmonary embolism, and no patients died in CT group and CRT group in peri-treatment period.

Conclusion

Our prospective, randomized controlled trial showed that surgery with adjuvant chemoradiotherapy could improve 3-year OS and DFS compared with treatment of surgery alone or surgery with adjuvant chemotherapy.The side effects and complications of surgery with adjuvant chemoradiotherapy were acceptable. However, because our study enrolled limited patients, and the follow-up time was not long enough, we need to collect more patients and longer follow-up to further comfirm our conclusion.

Disclosure

All authors have declared no conflicts of interest.
PS02.107: OUTCOMES FOLLOWING DIFFERENT NEOADJUVANT CHEMORADIATION REGIMENS FOR LOCALLY ADVANCED ESOPHAGEAL CANCER
Authors: Shen Robert , Collins William , Yahn Colten , Allen Mark , Blackmon Shanda , Cassivi Stephen , Nichols Iii Francis , Wigle Dennis
Published: September 2018

Background

The objective of this study was to analyze the induction therapy regimens employed since publication of CROSS Trial in patients treated with locally advanced EGJ cancer in terms of toxicity, complications, survival and recurrence.

Methods

Retrospective chart review all patients in single institution prospective database who had neoadjuvant CRT→Surgery 2012–2015. Complications during CRT and after surgery graded using National Cancer Institute CTCAE. Cox-proportion hazard ratios were used to compare the primary outcomes of overall survival (OS) and disease-free survival (DFS).

Results

288 patients, 237 men and 51 women were identified. 246 were adenocarcinoma, 38 squamous cell carcinoma, and 4 had other histologic types. 4 distinct neoadjuvant regimens were observed: 50.4 Gy radiation with 5-fluorouracil and cisplatin (N = 22), CROSS regimen (41.4 Gy with carboplatin & paclitaxel) (N = 44), 50.4 Gy with carboplatin and paclitaxel (N = 152), and ‘Other’ which include 27 distinct regimens (N = 70). There were no differences in treatment related complications or postoperative complications between regimens. There was no difference in pathologic complete response rate, OS, or DFS between regimens.

Conclusion

Since the publication of the CROSS Trial, there is a significant heterogenity in the neoadjuvant chemoradiation treatment regimen employed for patients with locally advanced EGJ tumors. Does not appear to be any differences in treatment related complications or postoperative complications between regimens. There was also no difference in pCR, overall survival or disease-free survival.

Disclosure

All authors have declared no conflicts of interest.
PS02.112: A RETROSPECTIVE STUDY OF NEOADJUVANT 5-FU, DOCETAXEL, AND NEDAPLATIN (UDON) COMBINATION CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL CANCER
Authors: Kimura Yutaka , Shiraishi Osamu , Kawakami Hisato , Ueda Hiroto , Iwama Mitsuru , Kato Hiroaki , Okuno Tatsuya , Hiraki Yoko , Yasuda Atsushi , Shinkai Masayuki , Imano Motohiro , Imamoto Haruhiko , Nakagawa Kazuhiko , Yasuda Takkushi
Published: September 2018

Background

In Japan, pre-operative5-FU and cisplatin (CDDP) (FP) combination therapy has been the standard neoadjuvant chemotherapy (NAC) for advanced resectable esophageal cancer (EC), whereas the efficacy of docetaxel (DTX)-containing triplet regimen, FP plus DTX has been reported (Yamasaki M, et al, Ann Oncol 2017). However, for frail patients, such as patients with old age, chronic renal failure, poor performance status, severe commodities or malnutrition, high dose CDDP is not generally recommended in terms of toxicity. We have been developing non-CDDP-containing triplet regimen, 5-FU, DTX, and nedaplatin (NED) (UDON) on a phase I/II trial basis. This retrospective study aimed to investigate the safety and efficacy of NAC with UDON combination for advanced EC.

Methods

Eleven patients with advanced resectable EC who were unsuitable for the administration of high dose CDDP were enrolled in this study. Patients received two cycles of NAC with UDON (5-FU, 640 or 800 mg/m2, day1–5, DTX, 28 or 35 mg/m2, day1 and 15 and NED, 72 or 90 mg/m2, day1, q28) followed by esophagectomy. Primary endpoint was response rate and secondary endpoint was adverse event (AE).

Results

The median age was 73 years (range: 58–80) with eight patients being aged 70 or older. ECOG PS was 1/2: 7/4. The main location of the tumor was Ce/Ut/Mt/Lt/Ae: 1/1/7/1/1 and cStage was IIA/IIB/IIIA/IIIB/IIIC/IV: 2/2/4/0/2/1. The RR (CR + PR) was 82% (CR/PR/SD/PD: 1/8/2/0). The pathological response was grade 0/1a/1b/2/3: 2/3/3/2/1. Major grade 3 or 4 adverse events included neutropenia (27%), febrile neutropenia (27%), diarrhea (18%), enteritis (9%) and hyponatremia (27%). The postoperative morbidity included recurrent nerve palsy (36%), aspiration (27%), pneumonia (18%), anastomotic leakage (9%) and delirium (36%). There was no treatment-related death and no reoperation.

Conclusion

NAC with UDON for advanced resectable EC unsuitable for the administration of high dose CDDP might be feasible and effective. We are planning a phase II clinical study based on the present results.

Disclosure

All authors have declared no conflicts of interest.
PS02.117: OUTCOMES FOR SQUAMOUS CELL CARCINOMA OF THE OESOPHAGUS IN A WESTERN POPULATION
Authors: Madhavan Anantha , Phillips Alex , Wyatt Nicola , Navidi Maziar , Michael Griffin S
Published: September 2018

Background

Squamous cell carcinoma of the oesophagus comprises approximately 30% of oesophageal malignancies in the ‘west’. Different approaches in management have been advocated. In the UK patients may receive conventional neoadjuvant chemotherapy (OEO2) or neoadjuvant chemoradiotherapy (CROSS). The aim of this study was to evaluate outcomes of patients receiving potentially curative surgical treatment for squamous cell carcinoma of the oesophagus.

Methods

A retrospective review of patients who underwent treatment with curative intent for oesophageal squamous cell carcinoma between 2006 to 2016 at a single institution was performed. Patients underwent a standardised staging protocol and were assigned to the treatment modality based on the stage of the disease by a multi-disciplinary team. Outcomes were evaluated according to the treatment received.

Results

Overall 199 patients underwent curative treatment in the 10 year period. This comprised 26% of the oesophagectomies for carcinoma. Of these, 168 patients had disease which was staged T3 and above or had evidence of nodal disease. 81% of these patients received neo-adjuvant treatment, 108 receiving chemotherapy alone and 29 receiving chemoradiotherapy. The remaining 31 patients underwent surgery alone. There was no significant difference in the clinical staging between the three treatment modalities, (P = 0.25). There were 31 patients with early (T1/2 N0) cancer that underwent unimodality treatment in the form of surgery. Estimated median survival was 85 months for those that received chemotherapy and 53 months chemoradiotherapy (P = 0.45). Within the surgical group those patients with locally advanced disease (T3 + or N + ) median survival was 19 months; median survival was not reached for early cancers.

Conclusion

Both chemoradiotherapy and chemotherapy in the neoadjuvant setting combined with radical surgery enable excellent long-term outcomes to be achieved. Data from the Neo-aegis trial will hopefully inform which neoadjuvant treatment confers the greatest survival advantage.

Disclosure

All authors have declared no conflicts of interest.
PS02.121: INTENSIFIED IMRTWITH CARBOPLATIN AND PACLITAXEL IN LOCALLY ADVANCED ESOPHAGEAL CANCER: AN ANALYSIS ON EARLY OUTCOME
Authors: Innocente Roberto , Navarria Federico , Palazzari Elisa , Matrone Fabio , Farina Eleonora , Fanetti Giuseppe , Boz Giovanni , Gigante Marco , Foltran Luisa , Castoro Carlo , Ubiali Paolo , Petri Roberto , Ruol Alberto , De Paoli Antonino , Franchin Giovanni
Published: September 2018

Background

Evaluate safety, feasibility and efficacy of an intesified IMRT and concomitant carboplatin and paclitaxel-based chemotherapy (Carbo/Tax CT) in patients (pts) with locally advanced esophageal cancer (LAEC) treated at our Institution

Methods

We retrospectively analyzed acute toxicity (according to CTCAE 4.0 scale), compliance and response to treatment in a series of consecutive patients treated, between February 2016 and February 2018, with intensified radiotherapy (IMRT) and weekly concurrent carboplatin and paclitaxel-based chemotherapy (CT) according to the CROSS trial.

Results

Thirty-four consecutive pts, 30(88%) males and 4 (12%) females, were treated. The median age was 68.5 yrs (range 46–83) and the ECOG Performance status ranged from 0 to 2. The diagnosis was adenocarcinoma in 15 pts (44%), squamous-cell carcinoma in 18 pts (53%) and undifferentiated carcinoma in 1 pt (3%). Two pts (6%) had a T2, 26 pts (76.4%) a T3 and 6 pts (17.6%) a T4 disease, respectively; 5 pts (15%) were N0, 21 pts (62%) N1 and 8 pts (23%) N2, respectively. Tumor involved the cervical esophagus in 3 pts (9%), the thoracic esophagus in 24 pts (70.5%) and the gastroesophageal junction in 7(20.5%). All pts underwent concurrent chemoradiotherapy (CRT), with IMRT technique, consisting of 45 Gy/25 frs to PTV1 (the primary gross tumor volume and the regional nodes), a simultaneous integrated boost ranging from 52.5Gy to 54Gy to PTV2 (gross tumor volume) and weekly concurrent carboplatin (AUC2) and paclitaxel (50mg/m2). Induction CT was administered to 6 pts. All pts completed the RT schedule. The median number of CT cycles was 3 (range 1–5) and 11 pts (32%) received 4 to 5 cycles of CT. Two adverse reactions to paclitaxel were reported. There were no major non-hematological adverse effects, the most common were nausea and vomiting (10%), and dysphagia (7%). Leukopenia was reported in 20 pts (71%), G3 in 2 pts (10%) and G2 in 18 (90%), respectively. G2 anemia occurred in 2 pts while G2 thrombocytopenia was reported in 3 pts (10%). Among the 30 evaluable pts (restaging is ongoing in 4 pts) a clinical complete response (PET, endoscopy and biopsy) was observed in 11 pts (37%), 7 with adenocarcinom and 4 with squamous cell carcinoma. Partial response was observed in 11 pts (37%) and 8 (26%) showed progressive disease. Total esophagectomy with radical lymphadenectomy, performed in 11 pts, showed a pathologic complete response in 6 pts (54%).

Conclusion

Intensified IMRT with concomitant Carbo/Tax CT in pts with LAEC seems to be safe and effective. These promising results need to be confirmed in all pts evaluated in this multimodality program

Disclosure

All authors have declared no conflicts of interest.
PS02.129: BRAIN METASTASIS FROM THORACIC ESOPHAGEAL CANCER AT A SINGLE INSTITUTE
Authors: Hirao Motohiro , Tanaka Eiichi , Okita Y , Fujinaka T , Nishikawa K , Hamakawa T , Mano M , Nakamori S , Sekimoto M
Published: September 2018

Background

Brain metastases (BM) from esophageal cancer (EC) are rare. Despite of an advance of treatments for the patients with BM from EC, life expectancy and quality of life of these patients are still poor. We present an overview of the patients with BM from EC at a single institute.

Methods

We retrospectively identified 10 patients with BM from EC treated with surgery, radiation, or a combination of multidisciplinary therapies at Osaka National Hospital between 2003 and 2017 for stages IIb through IV of primary EC (follow-up, > 157 days). Medical records were reviewed to collect demographic and clinical information.

Results

Median age at diagnosis of BM was 63.5 years (range, 53–79 years). 9 patients were male, and 7 patients had squamous cell carcinoma of EC at the primary esophageal resection. Median overall survival from the commencements of therapy for BM was 156 days (range, 17–5404 days). The interval between the primary esophagectomy and the start of therapy for BM from EC was 298 days (range, 64–860 days). The average score of Karnofsky performance status (KPS) just before a diagnosis of BM was 75 (range, 50–90). On univariate analysis, the patients with the lower score of KPS (P = 0.01) or the shorter interval between the primary esophageal surgery and the start of therapy for BM (P = 0.06) were found to have worsened survival after the therapy for BM from EC.

Conclusion

The patients who had a poor KPS just before a diagnosis of BM, or the shorter interval between the esophagectomy for the primary EC and the start of therapy for BM, had poor prognosis.

Disclosure

All authors have declared no conflicts of interest.
PS02.132: SAFETY, ANTITUMOR ACTIVITY AND BIOMARKER OF ANTI-PD-1 ANTIBODY IN PATIENTS WITH ADVANCED ESOPHAGEAL CARCINOMA
Authors: Wang Feng , Meng Xiangrui , Fan Qingxia
Published: September 2018

Background

Esophageal squamous cell carcinoma (ESCC) has a poor outcome with a 5-year survival rate of only about 15–25%.Immunotherapy targeting the checkpoint programmed cell death protein 1 (PD1) has been shown to be effective in the management of melanoma, non-small cell lung cancer, and renal cell carcinoma.To assessed the safety and activity of anti-PD-1 antibody in patients with metastatic ESCC.PD-L1expression, mutation load were also assessed in this study.

Methods

A retrospective analysis of 52 patients with advanced ESCC received anti-PD-1 antibody or chemotherapy, all patients has previously received first- or multi-line chemotherapy.26 patients in the observation group received continuous treatment of anti-PD-1 antibody: Q2W with initial dose of 200mg until disease progression or intolerable toxicity. 26 patients in the control group received irinotecan intravenously on day 1 and 8 at a dose of 80 mg·m-2.During this process, efficacy and safety of anti-PD-1 antibody and irinotecan were also evaluated.

Results

Total 52 patients were participated in the study from January 2016 to June 2017, and all of them could be evaluated for objective efficacy and safety.In observation group, ORR and DCR were 26.9% and 46.2% respectively.In control group, ORR and DCR were 23.1% and 42.3% respectively.PFS were 3.5months (95% CI, 1.3–7.9 months) and 3.1months (95% CI, 1.9–5.4 months) in observation group and in control group respectively.The differences between the 2 groups in ORR, DCR and PFS were not statistically significant(P>0.05).In observation group, treatment-related AEs occurred in 20 patients (76.92%), most commonly reactive capillary hemangiomas(76.92%), pruritus(19.23%) and hypothyroidism(11.54%).Most events were grade 1 or 2. Two(7.69%) treatment-related grade 3 events(pneumonitis) were reported, No grade 4 or grade 5 treatment-related adverse events were reported.In control group,25 patients (96.15%) experienced treatment-related adverse events,19(73.08%) treatment-related grade 3 or grade 4 events were reported.509 genes panal sequencing showed that the TMB in the group with clinical benefit (CB) was much higher than that in that without clinical benefit (NCB) (P = 0.0479).An objective response was more common in patients with PD-L1-positive tumors as defined by > 5% staining than in those with PD-L1-negative tumors.

Conclusion

In this population of ESCC patients, anti-PD-1 antibody had a manageable safety profile and promising antitumor activity.

Disclosure

All authors have declared no conflicts of interest.