bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparative analysis of locoregional therapy (hyperthermic intraperitoneal chemotherapy [HIPEC]) and systemic chemotherapy (CT) following cytoreductive surgery in patients (pts) with disseminated mucinous appendiceal cancers (MACA).
Authors: Bekaii-Saab Tanios S. , Martin Ludmila Katherine , Vallabhaneni Geetha D. , Park Wungki , Staley Charles A. , Maithel Shishir Kumar , Wang Zhibo , Chen Zhengjia , El-Rayes Bassel F. 
Published: March 2020

e14169 Background: MACA are rare neoplasms with variable prognosis depending on tumor histology. Peritoneal dissemination is frequent and cytoreductive surgery is the mainstay of treatment (tx). HIPEC and CT may provide additional benefit, but their role is not well understood. We evaluated the role of HIPEC and CT in pts with MACA following cytoreduction. Methods: Pertinent data including demographics, tx and clinical outcome were retrospectively obtained from pts treated at The Ohio State University and Emory University. Tumors were histologically classified as disseminated peritoneal adenomucinosis (DPAM) or peritoneal mucinous carcinomatosis (PMCA) and by TNM stage. Clinical outcome was evaluated according to tx, stage, and histology. Results: 124 pts (41M, 83F) with a median age of 58 years (range 21-82) were included. All pts had stage IV disease, 43 had DPAM and 71 had PMCA (10 unavailable). Following debulking surgery, 27% of pts had HIPEC, 21% had CT, 30% had both and 22% had no additional therapy. For stage IV pts, there was a significant benefit for additional tx after surgery (Table). Pts with DPAM had significantly improved mOS versus PMCA. For pts with PMCA but not DPAM a significant survival advantage was seen for any tx (CT, HIPEC, or both) versus no therapy following surgery. Conclusions: For pts with MACA, additional tx may improve survival following cytoreductive surgery. HIPEC appears to improve outcomes, while systemic CT may not provide added benefit. Prognosis for DPAM histology appears to be superior to PMCA. Pts with PMCA may benefit most from additional tx following cytoreduction. These interesting findings are limited by their retrospective nature and prospective validation is needed. [Table: see text]
Clinicopathologic feature and outcome of appendiceal goblet cell carcinoid and neuroendocrine tumor.
Authors: Park Wungki , Vallabhaneni Geetha D. , Martin Ludmila Katherine , Adsay Volkan , Staley Charles A. , Maithel Shishir Kumar , Wang Zhibo , Chen Zhengjia , El-Rayes Bassel F , Bekaii-Saab Tanios S. 
Published: March 2020

e14170 Background: Goblet cell carcinoid (GCC) of the appendix is a rare tumor comprising 5% of primary appendiceal tumors. GCC shares histological features of both neuroendocrine tumor (NET) and adenocarcinoma. Clinically, GCC also has an intermediate behavior between them. The management of GCC is mostly based on small retrospective series. We report the clinicopathological features, treatments, and outcomes of patients with appendiceal GCCs and NETs from a merged database between Emory University and the Ohio State University. Methods: We identified patients with appendiceal GCCs and NETs treated at these institutions over the period of 12 years from 1999 to 2011. Chart reviews for age, gender, date of diagnosis, TNM stage, chemotherapy, intraperitoneal hyperthermic perfusion (IPHP), surgery, and survival were performed. Results: See table. In the GCC patients with stage I, II, and III, 30 received surgery alone and 1 received surgery plus IPHP. 29 out of 31 (94%) patients are alive without disease recurrence. Out of 6 GCC patients with stage IV, 5 received chemotherapy, 1 received chemotherapy plus IPHP, and 2 (33%) are alive. In the NET patients with stage I,II, and III, all 29 were treated with surgery alone. 29 out of 31 patients are alive and there was no disease-related mortality. Out of 2 NET patients with stage IV, one received chemotherapy and both are alive. Conclusions: Our data confirms the excellent prognosis of appendiceal NET regardless of stage. The outcomes of surgery for patients with stage I, II, and III in both GCCs and NETs were excellent. Patients with stage IV GCCs have higher possibility of aggressive clinical courses. Chemotherapy or IPHP should be considered in the management of stage IV GCCs. [Table: see text]
Trimodality therapy for stage II-III carcinoma of the esophagus: A dose-ranging study of concurrent capecitabine, docetaxel, and thoracic radiotherapy.
Authors: Wood Matthew D. , Zaki Bassem I. , Gordon Stuart R. , Sutton John E. , Lisovsky Mikhail , Gui Jiang , Dragnev Konstantin H. , Bubis Jeffrey Alan , Rigas James R. 
Published: March 2020

e14514 Background: This dose escalation study was performed to determine the recommended phase II dose of capecitabine to be delivered concurrently with thoracic radiation therapy and weekly docetaxel in patients with locally advanced esophageal carcinoma. Methods: Patients with operable stage II or III esophageal carcinoma were staged by endoscopic ultrasonography and CT. Two cycles of docetaxel (80 mg/m2) and carboplatin (target AUC of 6) were delivered over 6 weeks, followed by concurrent weekly docetaxel (15 mg/m2), thoracic radiotherapy (50.4 Gy in 28 fractions), and increasing doses of capecitabine (500-3500 mg) given prior to each fraction of radiotherapy. After re-staging, responding patients continued to esophagectomy. Results: Forty-four patients were enrolled and 40 were evaluable for the dose-ranging component of chemoradiotherapy. The median age was 63 (range 47-87), 32 patients (80%) were male, and 36 (90%) had adenocarcinoma while 4 (10%) had squamous cell carcinoma. EUS stages at enrollment were T3N1 (29), T3N0 (4), T2N1 (6), and T4N0 (1). The maximum tolerated dose of capecitabine was 3500 mg. Common non-hematologic grade 3 or 4 toxicities were dysphagia (n=6, 15%) and nausea/vomiting (n=3, 8%). Common grade 3 or 4 hematologic toxicities were ANC and WBC abnormalities (n=10, 25% and n=9, 23% respectively). Overall, 58% of patients had no stage 3 or 4 toxicity. Thirty-six patients had surgery; 83% had R0 (curative) resection and 14% had complete pathological response (pCR). With a median follow-up time of 18.9 months, the median overall survival was 23.5 months, with 34% and 27% alive at three and five years, respectively. The three- and five-year relapse-free survival was 37%. In patients who had pCR or microscopically residual disease, 5-year survival was 74% (n=8). Conclusions: The recommended phase II dose of capecitabine is 3500 mg when given concurrently with 50.4 Gy in 28 fractions of thoracic radiotherapy with weekly docetaxel. This trimodality therapy for locally advanced esophageal carcinoma was well-tolerated and remarkably active. This regimen holds promise for treatment of esophageal carcinoma and warrants further investigation.
Biweekly cetuximab in combination with irinotecan as second-line treatment in patients with platinum-resistant gastroesophageal cancer (GEC).
Authors: Schønnemann Katrine Rahbek , Bjerregaard Jon Kroll , Yilmaz Mette K. N. , Jensen Helle Anita , Nielsen Kirsten Marie , Vestermark Lene Weber , Pfeiffer Per 
Published: March 2020

e14517 Background: Inspired by the promising results seen in patients (pts) with chemo-resistant metastatic colorectal cancer we evaluated a biweekly schedule of cetuximab (cet) and irinotecan (iri) - (Cetiri) (Pfeiffer et al. Ann Oncol 2008) in platinum resistant GEC. Methods: We treated and evaluated 111 consecutive pts with histological verified GEC adenocarcinoma and documented failure to first-line platinum-based treatment. Pts received cet 500 mg/m2 and iri 180 mg/m2 day 1 every 2nd week until progression or unacceptable toxicity. Toxicity was evaluated according to NCI-CTCAE v. 3.0. Response rate (RR) was evaluated according to RECIST v. 1.0 every 8th week. Clinical parameters and blood samples at baseline were analyzed in order to find prognostic and predictive values for prolonged overall survival (OS). Results: Pts were included from December 2007 to August 2010. Median age was 63 years (range 33-81). Performance status (PS) was 0-1 in 95 % of the pts. Thirty-six (46%) pts had more than two organs involved. Median number of courses were 5 (1-46). RR was 13% (13 PR) and 48 % had stable disease for at least 2 months. Median PFS and OS were 3.3 months (CI 2-4) and 5.6 months (CI: 5-7) respectively. Seventy six (68%) pts had treatment induced skin toxicity, rash. In a univariate analysis PS 0-1, normal baseline haematology and skin rash was associated with significantly increased survival. These parameters retained significance in a multivariate analysis. One patient had a curative intended resection after 28 courses and had an overall survival at 29.5 months. Two pts are still alive. Conclusions: Biweekly Cetiri is a convenient and well-tolerated second-line (SL) regimen in pts with GEC adenocarcinoma. Good PS, normal baseline haematology and development of skin rash indicate increased survival. Based on our findings biweekly Cetiri can be recommended as SL treatment to GEC pts in a good PS. Further studies into the role of rash are warranted.
Cost-effectiveness analysis of treatment modalities for hepatocellular carcinoma in the SEER-Medicare population.
Authors: Hanna Nader , Shaya Fadia T. , Breunig Ian Michael , Chirikov Viktor , Seal Brian S. , Mullins C. Daniel 
Published: March 2020

e14522 Background: Multiple treatment options for HCC exist and the treatment(s) received depend on clinical characteristics, resource availability and access to specialists. Their comparative cost effectiveness is unclear. Methods: Medicare patients with a 1st diagnosis of 1ry HCC in 2000-07 were studied through end of ‘09. Data are from the SEER with linked Medicare parts A-B. We use incremental cost effectiveness ratios (ICERs) and 95% cost intervals for transarterial chemoembolization (TACE) vs no treatment, liver transplantation (OLT), surgical resection (RS), radiofrequency ablation (AB), systemic chemotherapy (CH), and radiation therapy (RD). Using HCC-related mortality, Cox proportional hazards models were used to compute mean life years survived (LY) under each modality, adjusting for clinical (cancer stage, underlying health status, liver conditions) and demographics. Multiple propensity scores were incorporated to adjust for treatment selection bias. Average HCC-related Medicare costs (US$2011) attributed to each modality are estimated using generalized least squares methods. Results: Cancer stages 1, 2, 3, and 4 represent 24%, 9%, 14%, and 17% of the 11,047 patients: 37% unstaged, 66% male, 75% Caucasian, 10% African American, and 13% Hispanic, 61% of patients untreated, 8% TACE, 2% “liver directed therapy” (LD), 4% OLT, 8% RS, 5% AB, 8% CH, and 6% RDST. Relative to no treatment, OLT was most effective in reducing HCC mortality (HR .06, p<.01), followed by RS (HR .19, p<.01), LD (HR .25, p<.01), AB (HR .33, p<.01), TACE (HR .39, p<.01), RD (HR .44, p<.01), CH (HR .49, p<.01). All ICERs were significant; OLT cost effective ($2,951/LY), followed by RS ($5,801/LY), RD ($6,322/LY), CH ($6,748/LY), AB ($8,405/LY), TACE ($9,074/LY), then LD ($10,453/LY). Conclusions: In SEER-Medicare patients, all treatments were associated with reduction in HCC-related mortality. TACE was more effective when combined with ablative therapy, yet OLT and resection were still more effective. Though, OLT patients are more likely than others to survive. TACE alone was only more effective than radiation therapy and systemic chemotherapy.
Feasibility and benefits of second-line chemotherapy in advanced biliary tract cancer: A large retrospective study.
Authors: Walter Thomas , Horgan Anne , McNamara Mairead Geraldine , McKeever Elizabeth , Min Trisha , Hedley David W , Serra Stefano , Krzyzanowska Monika K. , Chen Eric Xueyu , Mackay Helen , Feld Ronald , Moore Malcolm J. , Knox Jennifer J. 
Published: March 2020

e14524 Background: Chemotherapy is effective in advanced biliary tract cancer (ABTC). The benefits of second-line chemotherapy (CT2) are unclear. Methods: We retrospectively studied all patients starting at least one line of chemotherapy for ABTC at our institution between 1991 and 2011. We analyzed patient and chemotherapy characteristics in order to: 1) characterize patients eligible for CT2; 2) evaluate the efficacy of CT2. Results: Three hundred and ninety five, 100 (25%), and 25 (6%) patients received CT1, CT2, and CT3, respectively. Primary tumor location was the gallbladder (29%), intraphepatic (19%), perihilar (17%), distal common bile duct (19%), and ampulla of Vater (14%). Ninety-one percent had a baseline performance status (PS) of 0-1 prior to CT1. Females (p=0.005), age≤60 years (p=0.009), and patients with progression free survival (PFS) >6 months following CT1 (p=0.01) were more likely to be offered CT2. Objective response rates and stable disease with CT2 were 10% and 35%, respectively. Median PFS and median overall survival (OS) from the beginning of CT2 were 2.8 and 8.0 months, respectively. Prognostic factors impacting PFS with CT2 were the regimen type (doublet versus monotherapy, p=0.004) and PS<2 (p<0.0001). Conclusions: Among patients with ABTC, 25% received CT2, typically younger patients and those with longer PFS following CT1. Disease control occurred in 45% of patients, and more often with a doublet than single agent. However, clearly more effective therapies must be found.
A randomized study on lipiodal ethanol mixture (LEM) versus transarterial chemoembolization (TACE) for treatment of hepatocellular carcinoma (HCC): Report of a preplanned interim analysis.
Authors: Chan Stephen Lam , Hui Joyce , Yeo Winnie , Hui Edwin P. , Mo Frankie , Ma Brigette , Chan Anthony T. C. , Yu Simon 
Published: March 2020

e14528 Background: Transarterial injection of LEM produces long-lasting embolization of both arteriolar feeders and peribiliary plexus of HCC leading to infarction of tumor. Our group previously reported the efficacy and safety of LEM for HCC in a phase II clinical trial (Yu et al. J Vasc Interv Radiol. 2008). We initiated a randomized study to compare LEM vs. TACE in HCC. (NCT00467974). Methods: Major eligibility criteria: histologically confirmed HCC; unresectable disease without distant metastases; size ≤15cm; absence of portal vein thrombosis. Consented patients (Pts) were randomized into LEM vs. TACE stratified by tumor size and number. Pts were prospectively followed up and assessed with computed tomography (CT) every 8 weeks. The primary endpoint is overall survival (OS) and secondary endpoints include progression free survival (PFS), RECIST response rate (RR) and toxicity. An interim analysis is planned after recruitment of 70 pts. Results: From 07 to 10, total 70 pts were enrolled. 2 pts withdrew consent and were excluded from the analysis. There were no differences in baseline characteristics between LEM and TACE. Male:Female=53:15; Mean Age=64; Tumor size≤7: >7cm=45:23; Child A:B=55:13. The median follow-up was 2.3 years. The OS of LEM was 25.32 months(m) vs. TACE 22.56m (p=0.38). PFS of LEM was 9.00m vs. TACE 7.8m (p=0.50). Partial response of LEM vs. TACE was 30% vs. 18% (p=0.52); disease control rate of LEM vs. TACE was 80% vs. 70% (p=0.39). Commonest G3 or above toxicities include ALT elevation (LEM 22.2% vs. TACE 9.4%); hyperbilirubinemia (LEM 19.4% vs. 9.4%); pain (LEM 0% vs. TACE 4%). Except pain, there were no differences of toxicities between LEM and TACE after procedure (p=0.04). Conclusions: At interim analysis, LEM showed comparable efficacy and toxicity profile to TACE. A trend of better OS, PFS and RR was observed in LEM arm but statistically insignificant. Further accrual and follow-up is ongoing.
Impact of up-to-seven criteria and neutrophil-to-lymphocyte ratio in liver transplantation for patients who received pretreatment for hepatocellular carcinoma.
Authors: Yoshizumi Tomoharu , Ikegami Toru , Yoshiya Shohei , Motomura Takashi , Mano Yohei , Muto Jun , Matono Rumi , Toshima Takeo , Ikeda Tetsuo , Soejima Yuji , Shirabe Ken , Maehara Yoshihiko 
Published: March 2020

e14536 Background: There is currently no consensus on how to manage patients with hepatocellular carcinoma (HCC) while awaiting liver transplantation (LT). The guideline published in UK states that locoregional therapy should be considered for all listed patients with HCC. Living donor LT (LDLT) is a choice for treating HCC patients in organ shortage era. The aim of the present study is to clarify the risk factors of tumor recurrence after LDLT in patients who had received pre-transplant treatments (pre-Tx) for HCC. Methods: One hundred two adult patients (39 females and 63 males) who had undergone LDLT due to end-stage liver disease with recurrent HCC after pre-Tx were enrolled. The primary end-point of this study was HCC recurrence after LDLT. Recurrence-free survival rates after LDLT were calculated. Risk factors of tumor recurrence were identified using univariate and multivariate analysis. Results: The 1-, 3-, and 5-year recurrence-free survival rates were 89.4%, 80.7%, and 78.8%, respectively. Seventy-four of 102 patients underwent pre-Tx more than twice. Moreover, the times of pre-Tx, the interval between the first treatment and LDLT, and the interval between the last treatment and LDLT did not affect the outcome of LDLT. On univariate analysis, the factors affecting recurrence-free survival were exceeding the up-to-seven criteria (p<0.0001), exceeding the Kyushu University criteria (p<0.0001), neutrophil-to-lymphocyte ratio (NLR) > 4 (p=0.0001), Alpha-fetoprotein > 400 ng/ml (p<0.0001), and bilobar tumor distribution (p=0.047). A multivariate analysis identified independent risk factors for post-LDLT tumor recurrence were exceeding the up-to-seven criteria (p=0.001) and NLR > 4 (p=0.002). The 1- and 3-year recurrence-free survival rates in the recipients with exceeding the up-to-seven criteria and NLR > 4 were 30.0% and 15.0%, respectively. Conclusions: The kind or duration of pre-Tx did not affect the outcome of LDLT, but LDLT should not be performed for the patients with exceeding the up-to-seven criteria and NLR more than 4 after pre-Tx for HCC to prevent tumor recurrence.
Comparison of adjuvant chemoradiation to peri-operative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma.
Authors: Kim Hae Rin , Kollmannsberger Christian K. , Schellenberg Devin , Cheung Winson , Lim Howard John 
Published: March 2020

e14537 Background: Currently there are several accepted peri-operative treatment modalities for the resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In the 2008, peri-operative chemotherapy (CRT) using the MAGIC was adopted as the preferred approach to adjuvant chemoradiation with the MacDonald protocol (cXRT) in the British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from the pharmacy records of patients (pts) referred to 1 of 5 cancer treatment in BC were analyzed from 2001- July 2010. Pts that underwent curative resection for GC or GEJ were only included. cXRT cohort was defined from Jan 2001-Dec 2007, prior to the CRT era. CRT cohort started from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: Table 1 summarizes the patient characteristics. In the CRT arm, there were more males, less pts with a LN ratio >0.2 and shorter median follow-up. 92.1% completed the pre-op chemotherapy and 44.7% completed post-op chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). 1 yr survival was similar between the 2 cohorts. Median overall survival was not reached in the CRT arm and was 64.1 months in the cXRT arm. Conclusions: Delivery of CRT was similar to that in the MAGIC trial. Outcomes of CRT compared to cXRT appears to be similar in this cohort to cohort study with similar 1 yr survival. Pre-operative CRT results in less pts with a LN ratio > 0.2. Further follow-up is needed with respect to relapse and overall survival. Either modality can be considered for peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]
Prognosis significance of HER2/neu overexpression and amplification in patients with curatively resected gastric cancer.
Authors: Zhou Fei , Li Ning , Hua Zhaolai , Xia Lin , Wang Liwei 
Published: March 2020

e14539 Background: HER-2/neu targeted therapy has been successfully used in advanced gastric cancer, but the role of HER-2/neu inprognosis of gastric cancer is not yet clear. To investigate the correlation between HER-2/neu expression and amplification and their associations with clinicopathologic outcomes and prognosis in patients with curatively resected gastric cancer. Methods: We constructed tissue microarray blocks containing >70% of gastric cancer tissue and matched adjacent normal gastric tissue for 229 patients. Expression of the HER-2/neu protein in these specimens was analyzed using immunohistochemical (IHC) staining. Amplification of HER-2/neu was also analyzed for the same samples using fluorescence in situ hybridization (FISH). Kaplan Myers curve and Cox proportional hazards model were used to assess the survival. Results: Of the 229 gastric cancer samples, 14.85% were positive for HER-2/neu protein expression that was closely correlated to the Lauren type, degree of differentiation, tumor size, lymph node metastasis and overall survival. Overall, 11.79% of the 229 gastric cancers were positive for amplification of HER-2/neu, which was also closely correlated to the Lauren type, degree of differentiation, tumor size and overall survival. Moreover, Cox proportional hazards model showed that positive expression of HER-2/neu, Lauren type, tumor size, vessel invasion, TNM stage were independent prognostic factor. Both IHC and FISH assays provide an important prognostic factor for gastric cancer with a concordance rate of 96.9%, but IHC was a stronger independent prognostic factor. Conclusions: Expression of the HER-2/neu protein, compared with its gene amplification, was an independent and more sensitive prognostic factor for curatively resected gastric cancer patients.