bluuebunny/crossref_metadata_2025_split huggingface dataset:
562 THE EFFECT OF IONISING-RADIATION AND THE TUMOUR MICRO-ENVIRONMENT (TME) ON TREATMENT NAIVE ESOPHAGEAL ADENOCARCINOMA PATIENT T CELL FUNCTION AND ACTIVITY.
Authors: Donlon N , Sheppard A , Davern M , Donohoe C , Ravi N , Reynolds J , Lysaght J 
Published: September 2020

Abstract

There is extensive literature demonstrating CD8+ T cells are essential for initial tumour control following radiation, however, effects are reduced after time due to T cell exhaustion and a lack of release Damage Associated Molecular Patterns (DAMPS) which are essential for anti-tumour immune responses. In vivo, activated T-cells migrate to the tumour site within the field of irradiation, however translational studies on the effects of radiotherapy on T-cell activation, function and activity are lacking.

Methods
EAC patient (n = 6) PBMCs were isolated by density centrifugation in Ficoll Paque. T cells were activated and were irradiated at 1.8Gy, 3.6Gy bolus dosing and fractionation for 72 hrs. A panel of immune checkpoints, DAMPS, activation markers, and cytokines were assessed by flow cytometry. To determine the effect of the TME on T cells, PBMCs were cultured under conditions of nutrient deprivation (No Glucose & No Glutamine) under conditions of normoxia and hypoxia. We then ran the aforementioned panel by flow cytometry. We also activated PBMCs with immune checkpoint blockers to determine its effects on T cell expansion and survival.

Results
3.6Gy induced a significantly higher expression of DAPMS (Fig 1 p &lt; 0.001); Calreticulin and HMGB1, most notably under conditions of nutrient deprivation (p &lt; 0.001). Ionising radiation also resulted in an increase in the expression of cytokines and importantly in the context of targeted therapy, IR at both the conventional 1.8Gy and 3.6Gy induced a higher expression of checkpoints PD-1, PD-L1, TIGIT, and TIM-3 (p &lt; 0.001). Interestingly, when T cells are activated in the presence of ICB (Atezolizumab, Pembrolizumab, Nivolumab), it increases the rate of T cell expansion, and enhances their survival compared to T cell activated only. (p &lt; 0.001).

Conclusion
This work demonstrates the impact of clinically utilised fractions of radiation, and conditions of the TME on T cell function and activity, with improved T cell expansion and survival in the presence of ICB’s suggesting it may be a feasible combination therapy as an adjunct to radiotherapy.
82 POSSIBLE NOVEL BIOMARKER OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Saito R , Maruyama S , Shoda K , Kawaguchi Y , Akaike H , Yamamoto A , Takiguchi K , Furuya S , Hosomura N , Amemiya H , Sudo M , Kawaida H , Kono H , Ichikawa D 
Published: September 2020

Abstract

Recently, patients with esophageal squamous cell carcinoma (ESCC) have been treated with combination therapy, including surgical resection, chemotherapy, and/or radiation therapy. Therefore, the development of novel and useful biomarkers is expected because the malignant behavior of tumors and the treatment effect vary in each case. In this study, we examined the clinical significance of microRNA-X (miR-X) as a biomarker because it has been reported in studies that examined ESCC cell-lines in vitro.

Methods
In all, 81 consecutive patients who underwent radical esophagectomy without preoperative treatment for ESCC were examined. Total RNA was extracted from formalin-fixed paraffin-embedded samples and miR-X expression levels were evaluated. In this process, the miR-X levels were standardized against the RNU6B expression levels and were analyzed using the ΔΔCq method. Clinicopathological features between high and low expression groups of miR-X were compared using the median expression level as the cutoff value. Prognostic analyses were performed using several factors, including miR-X expression levels, to gage the cancer-specific (CSS) and recurrence-free survival (RFS) of these patients.

Results
High miR-X expression was found to be significantly related to deep invasion (p &lt; 0.001) and high vascular invasion (p &lt; 0.001). Prognostic analyses demonstrated the suitability of miR-X expression as a significant adverse prognostic factor both in cancer-specific and recurrence-free survival (p = 0.006 & p = 0.004, respectively) of patients. Multivariate analysis using factors such as T- and N-factors, tumor size and miR-X expression levels indicated that the miR-X level was an independent prognostic factor as well as T- factor (CSS, hazard ratio: 2.263, p = 0.034), and T- and N-factors (RFS, hazard ratio: 2.22, p = 0.033).

Conclusion
The present study revealed that high miR-X expression was related to deep invasion and high vascular invasion in ESCC. It was also independent adverse prognostic factor for patients with ESCC. Detailed examination including in vitro re-verification is required because these results were inconsistent with previous reports and miR-X might play different roles in clinical settings. In any case, further detailed studies might establish the significance of miR-X as a novel and useful biomarker of ESCC.
120 LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE AFTER ESOPHAGEAL STRIPPING.
Authors: Makino H , Nomura S , Maruyama H , Yokoyama T , Hirakata A , Takata H , Kogo H , Iwai T , Yoshioka M , Yoshida H 
Published: September 2020

Abstract

The working space in the upper mediastinum is limited and lymphadenectomy along the left recurrent laryngeal nerve is difficult and anastomosis by a circular stapler in the narrow neck field is also difficult in VATS-E. We report our technique of the lymphadenectomy along the left recurrent laryngeal nerve.

Methods
(1) Patients.
One hundred forty seven patients with esophageal carcinomas underwent VATS-E.
(2) Methods.
i) VATS-E in prone position.
Esophagectomy is performed in prone position with 5 ports those are used at the intercostal space (ICS) and pneumothorax by maintaining CO2 insufflation.
ii) Lymphadenectomy around left recurrent laryngeal nerve.
Working space at the left upper mediastinal area for lymphadenectomy around the recurrent laryngeal nerve is limited in prone position. To obtain the space the residual esophagus is stripped in the reverse direction and retracted toward the neck after the stomach tube is removed through the nose.

Results
1. The rate of permanent and transient recurrent laryngeal nerve paralysis were 2.6% and 20%, respectively.
2. The rate of anastomotic leak and postoperative pneumonia was 3.9% and 2.9%.

Conclusion
Lymphadenectomy along the left recurrent laryngeal nerve after esophageal stripping is available in prone position of VATS-E.
135 ACCURACY OF ACHALSIA QUALITY OF LIFE AND ECKARDT SCORES FOR ASSESSMENT OF CLINICAL IMPROVEMENT POST TREATMENT FOR ACHALASIA
Authors: Slone S , Richter J , Kumar A , Velanovich V , Jacobs J 
Published: September 2020

Abstract

Achalasia Quality of Life (ASQ) and Eckardt scores are two patient-reported instruments used to assess symptom severity in achalasia patients. ASQ is validated and reliable. Although Eckardt is commonly used, it has not been assessed for validity or reliability. Our aims were to evaluate 1) the accuracy of both instruments for assessing improvement post-treatment (predictive validity) with pneumatic dilatation versus surgical myotomy and 2) convergent validity of both tools.

Methods
Patients with achalasia treated between 2011–2018 were eligible. Both instruments were administered by telephone. Treatment failure was determined by review of medical records by two clinicians. The predictive ability of ASQ and Eckardt instruments in identifying treatment successes and failures was determined using receiver operating characteristics analysis and summarized as Area Under the Curve (AUC).

Results
106 patients met inclusion criteria with 44 PD, 52 Heller Myotomy, and 10 per-oral endoscopic myotomy. A review of medical records and esophageal testing defined 13 failures (13%). AUC for Eckardt was 0.96 [95% CI 0.87–0.99] and ASQ 0.97 [95% CI 0.92–0.99]. The Eckardt cutoff 4, and ASQ, cutoff 15, were 94% and 87% accurate in identifying treatment successes versus failures. The correlation coefficient between the two tools was 0.84.

Conclusion
1) ASQ and Eckardt scores are valid and reliable tools to assess symptom severity in achalasia patients; 2) Both instruments accurately classify treatment successes versus failures. 3) The choice of tool should be informed by the physicians’ and patients’ values and preferences and repeat physiologic testing may be reserved for treatment failures with either instrument and patients classified as treatment successes may be spared routine physiologic testing in the long term.
147 EFFECTIVE UNDERWATER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR A SUPERFICIAL CERVICAL ESOPHAGEAL CANCER
Authors: Sasaki S , Ishigaki N , Harada T , Hanada H 
Published: September 2020

Abstract

Underwater method is now mainly used in endoscopic mucosal resection of colorectal and duodenal lesions based on the fact that mucosa and submucosa float into the lumen moving away from the muscularis propria after filling with water without submucosal injection. We performed underwater endoscopic submucosal dissection (ESD) for a cervical esophageal lesion.

Methods
Case report.

Results
An 81-year-old man with a history of drinking and smoking underwent endoscopy, revealing a 1/3 round superficial cancer in the cervical esophagus. ESD was performed under general anesthesia and tracheal intubation. The lumen was so narrow from natural constriction that a good view could not be secured under CO2 insufflation. Therefore, we tried the underwater method. As the lumen was expanded by filling with 0.9% saline solution, it was possible to secure a visual field. Because the submucosal layer floated up underwater, a circumferential incision and submucosal dissection were completed easily and quickly.

Conclusion
Endoscopic resection for lesions within a physiologic narrow space is difficult. The underwater method is reported to be useful for treatment of rectal tumors near the dentate line and cecal tumors in the appendiceal orifice. We found that the underwater method made ESD for the cervical esophageal cancer even easier by securing a good view. To our knowledge, this is the first report of underwater ESD for a cervical esophageal cancer.
160 SURVIVAL ANALYSIS OF 18F-FDG PET/CT QUANTITATIVE PARAMETERS MEASURED IN PRIMARY TUMOR AND SUSPICIOUS LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CARCINOMA
Authors: Tustumi F , Takeda F , Duarte P , Albenda D , Sallum R , Ribeiro Junior U , Buchpiguel C , Cecconello I 
Published: September 2020

Abstract

18F-FDG PET/CT quantitative techniques have been described as prognostic indicators in esophageal cancer. Objective: To evaluate the prognostic value of the maximal Standardized Uptake Value (SUVmax), the Metabolic Tumor Value (MTV) and the Total Lesion Glycolysis (TLG) measured in the primary tumor and in the suspicious lymph node.

Methods
A cohort study was performed to assess the association of SUVmax, MTV and TLG measured prior and post to neoadjuvant therapy, as well as the variation of these values between the two studies, with overall survival (OS) in patients with esophageal cancer submitted to trimodal therapy. The quantitative techniques were applied in the primary tumor (PT) and in the suspicious nodes (LN) by a nuclear medicine physician. The OS rates were analysed. Before neoadjuvant therapy, 106 patients had PET/CT, and 39 patients had post neoadjuvant PET/CT exams.

Results
Before neoadjuvant period all the variables related to LN were able to predict OS. MTV of primary (HR: 1.89; 95%CI: 1.01–3.52) tumor were also able to predict OS. On post neoadjuvant period and the variation pre-to-post neoadjuvant periods, none of the PET/CT variables related to LN were related to prognosis. All primary tumor volumetric variables were related to OS. MTV (HR: 4.66; 95%CI: 1.54–14.08) and TLG (HR: 4.86; 95%CI: 1.66–14.26) of PT of post neoadjuvant period; and the variation of MTV (HR: 2.95; 95%CI: 1.01–3.52) and TLG (HR: 3.49; 95%CI: 1.01–3.52) of the PT pre-to-post neoadjuvant periods were prognostic variables.

Conclusion
In patients with esophageal cancer, the burden of disease in the suspicious nodes and primary tumor prior to therapy and the residual burden of disease in PT in post therapy 18F-FDG PET/CT were associated with dismal prognosis.
163 TRANSHITAL ESOPHAGECTOMY IN THE TREATMENT OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kruel C , Vieira F , Schramm R , Chedid M , Rosa A , Vieira A 
Published: September 2020

Abstract

In the state of Rio Grande do Sul, Brazil, it is encountered a very high incidence of. esophageal squamous cell carcinoma in the world.(1). Advances in surgical procedure techniques and. postoperative treatment have arisen in esophagectomy, which remains as with significant morbidity. and mortality. Compared to other esophagectomies. conducted with thoracotomy, such as Ivor-Lewis and McKeown techniques, the Transhiatal. esophagectomy has a shorter surgical time, a lower rate of mediastinitis and then lower morbidity.

Methods
Ninety-six patients undergoing transhiatal esophagectomy in the Hospital de Clínicas de Porto Alegre, between 2005 and 2017 were evaluated. Thirteen patients underwent neoadjuvant treatment with chemoradiotherapy. Ninety-day survival and 5-year survival were evaluated.

Results
Overall 90-day survival was 91.7%. The overall 5-year survival was 41.2%. Patients undergoing neoadjuvant therapy had a 90-day survival of 100% and a 5-year survival of 74.1%. Patients undergoing frontline esophagectomy had a 90-day survival of 90.3% and 5-year survival rate of 36%. Non-neoadjuvant patients with negative lymph nodes had a 5-year survival of 50.2%. The average surgical time was 253 minutes. Thirty-seven patients (38.5%) had positive lymph nodes in the surgical specimen. Multivariate analysis showed that surgical time and presence of positive lymph nodes are associated with a worse outcome.

Conclusion
Patients submitted to transhiatal esophagectomy present considerable long-term survival, which can be amplified in the absence of lymph node involvement. Operated patients who have undergone neoadjuvant therapy prior to surgery demonstrate increased survival times compared with those without treatment.

References
1) Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol. 2001 Dec;30(6):1415–25.
179 FEASIBILITY AND ONCOLOGICAL OUTCOME OF CHEMORADIATION WITH INTENSIFIED IMRT IN LOCALLY ADVANCED ESOPHAGEAL CANCER
Authors: Innocente R , Navarria F , Petri R , Palazzari E , Gigante M , Vecchiato M , Ziccarelli A , Martino A , Foltran L , Buonadonna A , Lo Re G , Spina M , Ubiali P , Tonin D , Lauretta A , Polesel J , Franchin G , De Paoli A 
Published: September 2020

Abstract

To assess safety, feasibility and efficacy of an intensified preoperative 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
a retrospective analysis of toxicity (CTCAE 4.03), progression free survival (PFS) and overall survival (OS) of pts affected by LAEC, treated with preoperative intensified radiotherapy (IMRT) and weekly concurrent carboplatin and paclitaxel-based chemotherapy (CT) according to the CROSS trial, between February 2016 and October 2019, at the Centro di Riferimento Oncologico, Aviano (CRO).

Results
Sixty-nine consecutive pts, 57(82.6%) males, were treated. The median age was 69 yrs (38–85), the ECOG PS 0–2. All pts underwent concurrent chemoradiotherapy, IMRT technique, 45 Gy/25 to PTV1 (primary tumor volume + regional nodes), a simultaneous boost from 52.5Gy to 54Gy to PTV2 (gross tumor volume) and weekly concurrent carboplatin (AUC2) and paclitaxel (50 mg/m2). Induction CT was administered to 17 pts. All pts completed RT with median 4 (1–5) CT cycles. Median follow-up was 8 months (4–17); 2-yr PFS and OS were 49.0% and 80.3%, respectively. At 2 yrs, local recurrence rate was 8.4% (CI 95%: 2.6%–18.8%).

Conclusion
Preoperative intensified IMRT with concomitant Carbo/Tax CT in pts with LAEC appears safe and feasible with promising oncological outcome and needs to be confirmed in a larger series of pts.
184 WHICH ROUTE FOR ESOPHAGEAL RECONSTRUCTION WHEN NONE IS FEASIBLE?
Authors: De Malleray H , Hubaud V , Bottet B , Brioude G , Trousse D , Thomas P , D'journo X 
Published: September 2020

Abstract

Which route for esophageal reconstruction when none is feasible?

Methods
What is in the video: this 3-minute video describes a challenging case of a complex esophageal reconstruction for a giant trachea-esophageal fistula in a patient with severe comorbidities and a radiation-induced mediastinal fibrosis. We depict the technical aspect of a presternal gastric by-pass covering with a pediculized myocutaneous latissimus dorsi flap.

Results
Why this video is important for the congress: this video exposes the surgical dilemma of the route of reconstruction for digestive continuity when none of traditional routes are allowed: 1) posterior mediastinum route forbidden because of post-radiation mediastinal fibrosis; 2) retrosternal route prohibited by a previous coronary artery by-pass; 3) subcutaneous route not feasible because of severe sternal radiodermatis.

Conclusion
In conclusion, our case shows that covering the presternal digestive interposition with a locoregional pediculized myocutaneous flap is a valid alternative when others routes have been eliminated.

Video
https://drive.google.com/open?id=1SXueOktZU15N8GgG324KJJb1SF-XqPym
203 RISK AND PROTECTIVE FACTORS OF GASTROESOPHAGEAL REFLUX DISEASE AFTER PERORAL ENDOSCOPIC MYOTOMY
Authors: Fukushima N , Masuda T , Yano F , Tsuboi K , Hoshino M , Yamamoto S , Akimoto S , Sakashita Y , Omura N , Mitsumori N , Kashiwagi H 
Published: September 2020

Abstract

Peroral endoscopic myotomy(POEM)has been reported as safe and effective treatment for achalasia. This procedure is proposed to be a less invasive alternative to conventional laparoscopic Heller-myotomy with Dor-fundoplicatin(LHD), previous studies have shown that POEM may result in a higher incidence of gastroesophageal reflux disease(GERD)compared with LHD. However, certain predictors of GERD after POEM remain unstudied limiting current treatment strategy of achalasia. The aim of this study is to clarify the protective factors of GERD post-POEM.

Methods
Fifty-one patients who underwent POEM at our institution between January 2016 and December 2019 were included. We performed esophagogram and high-resolution esophageal manometry (HRM) as a part of preoperative evaluation. Upper gastrointestinal endoscopy has been assessed 3 months, 1 year, and then yearly after POEM. Patients were divided into two groups based on post-POEM endoscopic findings: GERD group (patients who had esophagitis [n = 28; median age 53 years with 18 male]) and non-GERD group (patients who did not have GERD [n = 23; median age 50 years with 14 male]). We compared preoperative foregut tests between the two groups.

Results
Twenty-eight out of 51 patients (54.9%) developed esophagitis. There were no differences in age, sex, BMI, and findings of esophagogram between the groups. Based on HRM test, greater overall lower esophageal sphincter (LES) length was noted in the non-GERD group compared with the GERD group (3.0 vs. 2.6 cm, p = 0.034). Length of gastric myotomy was comparable between the GERD and non-GERD groups (2.0 vs. 3.0 cm, p = 0.477). Similar incidence of esophagitis was evident in patients who had a history of prior LHD and those who underwent POEM as a primary intervention (60% [9/15 patients] vs. 52.8% [19/36 patients], p = 0.437).

Conclusion
Shorter overall LES length appears to be associated with esophagitis post-POEM. Length of gastric myotomy did not correlate to GERD in the study cohort. Prior Dor fundoplication may not avert development of GERD after POEM. Further study is warranted.
257 CHEMORADIOTHERAPY FOLLOWED BY ACTIVE SURVEILLANCE VERSUS SURGERY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND INDIVIDUAL PATIENT DATA META-ANALYSIS
Authors: Van Der Wilk B , Eyck B , Hofstetter W , Ajani J , Piessen G , Castoro C , Alfieri R , Kim J , Kim S , Furlong H , Walsh T , Nieboer D , Wijnhoven B , Lagarde S , Lanschot J 
Published: September 2020

Abstract

Up to 50% of patients with esophageal cancer have a pathologically complete response after neoadjuvant chemoradiotherapy (nCRT) plus surgery. An active surveillance strategy may be feasible in patients with a complete clinical response (cCR) after nCRT. The aim of this study was to perform a meta-analysis using data of individual patients that underwent active surveillance with surgery for recurrent disease versus standard surgery after nCRT.

Methods
A systematic search was performed in Embase, Medline, Web of Science, Scopus and Cochrane from inception to February 2020. Studies were sought that reported on overall survival and recurrence rates in patients with cCR after nCRT that underwent active surveillance versus standard surgery. Authors were contacted to supply individual patient data. Pooled hazard ratio (HR) comparing survival outcomes and distant dissemination rates (DDR) between patients with cCR undergoing active surveillance or standard surgery were estimated using a random-effect meta-analysis. Cumulative incidence of locoregional recurrences in active surveillance were assessed using a Cox Frailty model.

Results
Seven studies including 788 patients (256 active surveillance and 532 surgery) were identified. All authors provided anonymized patient data. Pooled two- and five-year overall-survival was 75% and 58% for active surveillance and 76% and 60% for standard surgery with a pooled HR of 1.04 (95%CI:0.73–1.49) (Figure 1). Two-years DDR was 18% and 19% for active surveillance and standard surgery, respectively (HR 1.10,95%CI:0.75–1.63). Locoregional recurrence rate necessitating esophagectomy in patients undergoing active surveillance was 24% at one year, 33% at two years and 38% at five years. Active surveillance patients undergoing postponed surgery had R0 in 91% of cases.

Conclusion
Overall survival is comparable in patients undergoing active surveillance with postponed surgery compared to standard surgery after neoadjuvant chemoradiation. Distant dissemination rate is also comparable between both groups. During active surveillance, local regrowths developing after two years are rare. Although these data support an active surveillance strategy, randomized trials have to be completed before an active surveillance strategy can be actively proposed to patients with esophageal cancer.