bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathological complete response rates after neoadjuvant chemoradiation (CRT) for rectal cancer: Do novel agents have a role?
Authors: Beg Muhammad Shaalan , Meyer Jeffrey John , Xie Xian-Jin , Balch Glen C. , Singal Amit G 
Published: March 2020

e14165 Background: Preoperative concurrent radiation with either 5-fluorouracil (5FU) or capecitabine (CAP) is considered standard of care for T3-T4 and/or node positive rectal cancers with historical pathological complete response (pCR) rates ranging from 7-29%. There is lack of randomized data on the incorporation of bevacizumab (B) and cetuximab (C) with neoadjuvant chemoradiation (CRT). The aim of our study was to quantify pCR and adverse event rates for B-CRT and C-CRT in patients with rectal cancer. Methods: A systematic literature review using the Medline database and national meeting abstracts identified trials incorporating bevacizumab and cetuximab for neoadjuvant chemoradiation between 2000 and 2011. Pooled rates of pCR and frequency of grade 3-4 adverse events per patient with 95% confidence intervals (CI) using the adjusted Wald method, were calculated. Results: Out of 24 trials identified, 15 trials with a total of 457 (range 8-61) patients incorporated B-CRT. Five studies used 5FU, ten used CAP. A third chemotherapeutic agent was also included in 7 trials of B-CRT. There were 9 trials incorporating C-CRT with a total of 332 (range 20-50) patients. Two studies used 5FU, 7 used CAP, while four studies also included a third therapeutic agent. The pooled pCR rate for B-CRT of 20.8% (95% CI 17.3-24.8), was significantly higher than the 9.6% (95%CI 6.92-13.2) pCR rate for C-CRT (p<0.001). The rate of grade 3-4 adverse events was significantly lower for B-CRT at 0.38 per patient studied (95% CI 0.34-0.43) compared to C-CRT at 0.55 per patient (95%CI 0.49-0.60) (p<0.001). Surgery was performed in 92% of B-CRT and 94% of C-CRT patients. Conclusions: The addition of either B or C to conventional neoadjuvant CRT does not appear to yield higher pCR rates than those reported with conventional CRT alone. There is insufficient evidence to support routine use of novel agents in this treatment strategy for rectal cancer. Interestingly, although surgical rates are high in both groups, C-CRT has significantly lower rates of pathologic complete response and significantly higher rates of toxicity than B-CRT.
Resectability and indication for chemotherapy in patients with colorectal liver metastases as assessed by medical oncologists and surgeons.
Authors: Homayounfar Kia , Bleckmann Annalen , Helms Hans-Joachim , Lordick Florian , Rüschoff Josef , Conradi Lena-Christin , Sprenger Thilo , Lorf Thomas , Becker Heinz , Ghadimi B. Michael , Liersch Torsten 
Published: March 2020

e14167 Background: Multidisciplinary treatment in patients with colorectal liver metastases (CRLM) is standard in modern oncology. However, for interdisciplinary discussion assessing complimentary disciplines' potential and changes in personal views is crucial. We evaluated experienced medical oncologists' (MO) and surgeons' (SG) assessment of resectability and indication for chemotherapy (CTx) in patients with CRLM. Methods: Thirty patients who underwent R0-resection of CRLM between 2001 and 2011 at our department were selected. Medical history and staging data were presented to MO (n=10) and SG (n=11) in a virtual tumor board (TB1). Standardized blinded TED-voting answers (9 options) included assessment of resectability and the indication for pre- and/or postoperative CTx. The virtual tumor board was followed by training in terms of state-of-the-art lectures on potential of CTx and surgery. Assessment was then repeated in a second virtual tumor board (TB2). Results: 630 (21x30) answers were obtained per tumor board. In TB1 resectability, borderline resectability and definite unresectability were expected in 433, 161 and 36 answers, respectively. Resectability was significantly more often expected by SG (p<0.001). In TB2 57% of answers were different from TB1 (p<0.001). Assessment shifted from borderline resectable to resectable CRLM in 81 of 161 and from unresectable to (borderline) resectable CRLM in 29 of 36 answers (p<0.001). The shift was significant in MO (p=0.012) and SG (p<0.001). Preoperative CTx was significantly more often indicated by MO (p=0.041) and included in 255 answers (44%) in TB1 compared to only 157 answers (27%) in TB2 (p<0.001). With 55% of answers voting for postoperative CTx remained stable in TB1 and TB2 without a significant difference between MO and SG in either TB1 (p=0.099) or TB2 (p=0.353). Conclusions: Resectability and indication for pre- but not postoperative CTx were discrepantly assessed by MO and SG. Training had a strong influence on decision making in MO and SG resulting in a higher rate of patients deemed (borderline) resectable. Furthermore, following training MO and SG opted less often for preoperative CTx.
Clinical and pathological characteristics of elderly colorectal cancer patients over 70 years old and comparison with patients under 50 years old.
Authors: Erismis Betul , Kucukoztas Nadire , Rahatli Samed , Yalcin Selim , Dizdar Omer , Altundag Ozden , Ozyilkan Ozgur 
Published: March 2020

e14174 Background: Incidence of colon cancer increases with age and generally is diagnosed at the age of between 60-75. Because of comorbidities in elderly patients who are older 70 years of age, lower doses of adjuvant or metastatic therapy is given them or the other option can be the chemotherapeutics which had less side effects. Methods: We aim to identify clinical and pathological characteristics of elderly colorectal cancer patients over 70 years of age who were followed at Baskent University Hospital and compare with CRC patients under the 50 years of age. Results: 182 CRC patients were assigned to the study who were followed between 1998-2011. We classified the patients into two categories according to the age. 91 participants were over 70 years of age and 91 participants were under 50 years of age. There were no significant differences between two groups for gender and percentage of patients having surgery (p=0.65/0.732). History of having systemic disease was significantly higher in the elderly group (p<0.001). Adjvuvant chemotherapy was given to the 38 (53.5%) patients aged over 70 and 66 (91.7%) patients aged under 50 (p<0.001). We compared the both groups for progression free and overall survival time for all stages. However, there were no statistically significant differences between two groups. Conclusions: Our study confirms that elderly CRC patients get benefit from the adjuvant chemotherapy treatment as the same as patients under 50 years of age. Therefore, physcians should consider about performance status and systemic disease in elderly patients and give an individual treatment to them.
Extended intersphincteric resection with quadrant resection of external sphincter after neoadjuvant mid-course chemoradiotherapy in the very low rectal cancer.
Authors: Oh Nahmgun , Ko Sanghwa , Kim Hyunsung 
Published: March 2020

e14181 Background: To evaluate the results of extended intersphincteric resection of T3 rectal cancer situated below 4cm from the anal verge, comparing the results of simple intersphincteric resection of T2 rectal cancer after mid-course chemoradiotherapy. Methods: Between 2000 Between 2000 and 2006, 67 patients with rectal cancer below 4cm from anal verge, underwent abdomino-intersphincteric resection reconstructed by inversion proctoplasty with a colonic J-pouch and diverting ileostomy. All patients received a total irradiation dose of 30 Gy with conventional fractions for 3 weeks. Capecitabine was administered 1000mg/m2 twice a day on 21 days during radiotherapy, followed curative surgery in a week without resting period. After preoperative radio-chemotherapy, patients with overt T2 lesion were 27 cases (40.3%) and received intersphincteric resection (Group I: simple intersphincteric resection), and patients with borderline cases or T3 lesion were 40 cases (59.7%) and received intersphincteric resection with quadrant resection of upper external sphincter and primary repair of the external sphincter as inversion proctoplasty (Group II: extended intersphincteric resection). Results: The mean patients age was 61.2 years. The mean location of cancer was at 3.2cm from anal verge (2-4cm). Anastomotic leakage was confirmed in 11 patients (16.4%). There was no postoperative mortality. The grade I, II of continence by Kirwan classification was 81.5%, 80.0% in Group I and II. Under 3 times stool frequency per day was 51.9%, 62.5% in Group I and II. Two patients (3.0%) experienced locoregional recurrence of pelvic cavity. 5-year overall survival rate was 83.6%. Conclusions: Simple and extended intersphincteric resection is seemed to be a safe and functionally acceptable procedure. And, neoadjuvant mid-course chemoradiotherapy using oral capecitabine 2,000 mg/m2/day on 21 days during 2 Gy radiation of each 15 weekdays is seemed to be a tolerable and effective modality, in patients with very low rectal cancer.
Influence of blood neutrophil to lymphocyte ratio on oncologic outcomes in peritoneal carcinomatosis of appendiceal origin.
Authors: Idrees Kamran , Luciano Jason , Austin Frances , Sathaiah Magesh , Ramalingam Lekshmi , Jones Heather L , Pingpank James F. , Ahrendt Steven Arthur , Zureikat Amer H , Holtzman Matthew Peter , Zeh Herbert , Bartlett David L. , Choudry Haroon 
Published: March 2020

e14184 Background: The Neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammatory response, is associated with prognosis in various cancers. The aim of this study is to evaluate the association of pre-operative NLR with oncologic outcomes in patients with appendiceal carcinomatosis. Methods: Clinico-pathological data were obtained from a prospectively maintained database of patients with appendiceal carcinomatosis who underwent cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemoperfusion (HIPEC) between 2001 and 2010. Pre-operative absolute neutrophil and lymphocyte counts were used to compute NLR, with elevated NLR defined a priori as >5. Logistic regression modeling and Kaplan-Meier analyses were performed on the available data. Results: 195 patients, with a median age of 54.5 years, underwent CRS and HIPEC. The median follow up time was 1.96 years. There were 41 patients (21%) who had elevated NLR preoperatively. Factors associated with overall survival (OS) were grade (p=0.01), simplified peritoneal cancer index (SPCI) (p=0.013), and age (p=0.02). In patients who did not undergo splenectomy at the time of CRS, elevated NLR, lymph node involvement, SPCI, age and pre-operative albumin were statistically significant predictors of OS on multivariable analysis. None of these factors were significant in patients who underwent splenectomy at the time of CRS. The 5-year overall survival was 57% vs. 31% in patients with NLR<5 compared to NLR>5 respectively (p<0.0001). Time to progression was 30 months compared to 14 months in patients with NLR<5 vs. >5 (p=0.001). Strikingly, the 5-year OS in patients with NLR<5 with or without splenectomy was 63% and 50% compared to patients with NLR>5 with or without splenectomy 37.5% vs. 23%, respectively (p=0.0001). Conclusions: In patients with appendiceal carcinomatosis, pre-operative NLR is a potential systemic inflammatory marker that independently predicts oncologic outcomes. The impact of NLR appears to be influenced by the performance of splenectomy at the time of CRS. Further studies will be required to prospectively validate this systemic inflammatory marker and its interaction with splenectomy.
Recursive partitioning for new classification of patients with esophageal cancer treated by chemoradiotherapy.
Authors: Nomura Motoo , Shitara Kohei , Kodaira Takeshi , Kondoh Chihiro , Takahari Daisuke , Ura Takashi , Kojima Hiroyuki , Kamata Minoru , Muro Kei , Sawada Satoshi 
Published: March 2020

e14500 Background: The 7th edition of the American Joint Committee on Cancerstaging system does not include lymph node size in the guidelines for staging patients with esophageal cancer. The objectives of this study were to determine the prognostic impact of the largest lymph node diameter (ND) on survival and to develop and validate a new staging system for patients with esophageal squamous cell cancer who were treated with definitive chemoradiotherapy (CRT). Methods: Information on 402 patients with esophageal cancer undergoing CRT at 2 institutions was reviewed. Univariate and multivariate analyses of data from 1 institution were used to assess the impact of clinical factors on survival, and recursive partitioning analysis was performed to develop the new staging classification. To assess its clinical utility, the new classification was validated using data from the second institution. Results: According to RPA, ND stages were best when classified as ND0 (the absence of lymph node metastases), ND1 (< 2.8 cm), and ND2 (≥ 2.8 cm). By multivariate analysis, gender, T, N, and ND stages were independently and significantly associated with survival (p<0.05). The resulting new staging classification showed the following: T1-2ND0 as Group I; T3-4ND0 or T1-2ND1 as Group II; T3-4ND1 as Group III; and TanyND2 as Group IV. The 4 new stages led to good separation of survival curves in both the developmental and validation datasets (p<0.05). Conclusions: Our results showed that lymph node size is a strong independent prognostic factor and that the new staging system, which incorporated lymph node size, provided good prognostic power and discriminated effectively for patients with esophageal cancer undergoing CRT.
A phase II trial of gemcitabine and S-1 therapy in patients with resected pancreatic cancer: Japanese study group of adjuvant therapy for pancreatic cancer (JSAP-03).
Authors: Ishii Hiroshi , Ueno Hideki , Kosuge Tomoo , Matsuyama Yutaka , Saiura Akio , Koga Rintaro , Sakamoto Yoshihiro , Shimada Kazuaki , Nakao Akimasa , Doi Ryuichiro , Tanaka Masao ,   Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer
Published: March 2020

e14506 Background: Gemcitabine plus S-1 (GS) for metastatic pancreatic cancer (PC) resulted in a high response rate of 44.4%. We have previously conducted a phase I trial of adjuvant GS in patients (pts) with resected PC, and determined a recommended dose of this regimen for the current trial. Methods: Eligibility criteria included macroscopically curative resection of invasive ductal PC and no earlier chemotherapy. The pts received gemcitabine (800 mg/m2/week) intravenously over 30 min on day 1 and S-1 (60 mg/m2/day) orally twice daily from days 1 to 7 every 14 days for 12 cycles. The primary endpoint was overall survival (OS). A total of 55 pts were required based on the assumption of an expected 2-year OS rate of 60% and the threshold rate of 40%, with an α-error of 5% (two-sided) and a β-error of 10%. Results: A total of 55 pts were enrolled between April 2008 and September 2009. The efficacy and toxicity of the treatment were analyzed in 54 pts who had received at least one course of GS therapy. Of the 54, 40 (74%) completed the scheduled 12 cycles, 9 discontinued adjuvant GS within 6 cycles, and the remaining 5 discontinued between 6 and 12 cycles. The reasons for discontinuation were disease progression in 6 and adverse events in the remaining 8. The most common adverse reaction was neutropenia (G3/4: 59.2%, G4: 25.9%). There were no G4 adverse events except neutropenia (1.9%) and hyperkalemia (1.9%). At the time of analysis (median follow-up: 25.4 months), 22 pts were alive without disease, 15 were alive with disease, and the remaining 17 pts were dead. Median OS was not yet reached. The estimated 1-year and 2-year OS rates were 88.9% and 72.1%, respectively. The estimated 1-year and 2-year disease-free survival rates were 57.4% and 44.4%, respectively. Among potential prognostic factors, male gender, head tumor of the pancreas, and the primary tumor smaller than 3 cm were associated with favorable prognosis in a proportional hazard model. Conclusions: Adjuvant GS therapy produced a good disease-free survival (DFS) and OS rates with an acceptable toxicity profile in pts with resected PC. A randomized phase III trial to confirm the efficacy of this regimen is ongoing (JSAP-04).
Nimotuzumab combined with radiotherapy on esophageal cancer: Preliminary study of a phase II clinical trial.
Authors: Liang Jun , Wang Luhua , E Mingyan , Gang Wu , Zhao Lujun , Li Xia , Xiu Xia , Li Ning , Chen Bo , Hui Zhouguang , Lv Jima , Fang Hui , Tang Yu , Bi Nan , Wang Wenqing , Zhai Yirui , Li Tao , Chen Dongfu , Zou Shuangmei , Lu Ning 
Published: March 2020

e14511 Background: To evaluate the safety and therapeutic effect of Nimotuzumab (h-R3) in combination with radiotherapy on esophageal cancer. Methods: 42 patients with stage II (Inoperable or refused surgery) to IV (Supraclavicular lymph node metastasis only)were assigned to the phase II clinical trial during Nov. 2008 to Jul. 2010. Histopathological classification of all patients was squamous cell carcinoma. All patients received 50-70 Gy of three-dimensional conformal radiotherapy. 200mg of Nimotuzumab was administered once a week during radiotherapy. Results: There were 9, 25 and 8 patients with stage II, III and IV esophageal cancer, respectively. All patients received 50-70 Gy of radiation therapy except two. 37 patients (88.1%) received Nimotuzumab for more than 5 times. The recorded grade III toxicities (21.4% of all adverse events) included gastrointestinal toxicity, esophagitis, dermatology toxicity and hematological toxicity. Complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) were observed in 0, 22 (52.4%), 17 (40.5%) and 3 (7.1%) patients in one month after treatment. EGFR over-expression rate was 95.2%. Median survival time (MST) was 14 months. One-year and 2-year overall survival (OS) and progression-free survival (PFS) were 54.8%, 36.8% and 39.4, 33.3%, respectively. After a median follow-up time of 17 months, the local recurrence and distant metastases were observed in 18 (42.9%) and 14 (33.3%) patients, respectively. Conclusions: Nimotuzumab combined with radiotherapy were well-tolerated in patients with esophageal cancer. The incidence of grade III toxicity was 21.4%, no grade IV toxicity was observed. EGFR over-expression was found higher than in previous studies. One-year and 2-year OS and PFS were 54.8%, 36.8% and 39.4, 33.3%, respectively. Further study is needed to confirm the therapeutic efficacy of Nimotuzumab in esophageal cancer.
Retrospective analysis of the difference of prognosis between unresectable and recurrent biliary tract cancer: Kansai Hepatobiliary Oncology Group (KHBO) 1001.
Authors: Kanai Masashi , Ikezawa Kenji , Ajiki Tetsuo , Tsukamoto Tadashi , Toyokawa Hideyoshi , Terajima Hiroaki , Furuyama Hiroaki , Nagano Hiroaki , Ikai Iwao , Kuroda Nobukazu , Awane Hiroaki , Ochiai Toshiya , Takemura Shigekazu , Miyamoto Atsushi , Kume Makoto , Ogawa Masao , Takeda Yutaka , Taira Kaoru , Ioka Tatsuya ,   Kansai Hepatobiliary Oncology Group
Published: March 2020

e14518 Background: The difference of prognosis between patients (pts) with unresectable and recurrent biliary tract cancer (BTC) receiving chemotherapy has not been clarified although some studies reported prognostic factors of BTC. In this study, we aimed to compare the prognosis of unresectable BTC with that of recurrent BTC. We also evaluated other prognostic factors of BTC. Methods: This study retrospectively reviewed the data of 403 consecutive pts with pathologically proven unresectable or recurrent BTC who received palliative chemotherapy from 18 hospitals in Japan between April 2006 and March 2009. The 1-year survival rate and overall survival (OS) and patient characteristics were compared between unresectable and recurrent cases. Univariate and multivariate analyses were performed to identify prognostic factors. Results: 380 pts (94.3%) received chemotherapy using gemcitabine and/or S-1. The 1-year survival rate and OS were significantly better in 192 pts with recurrent BTC than 211 pts with unresectable BTC (1-year survival 57.3% vs. 43.1%, p=0.005; OS 398 days [95% confidence interval (CI) 365-430] vs. 323 days [95% CI 282-364], p=0.004). In baseline characteristics, the proportion of pts who had distant metastasis was significantly greater in recurrent BTC than unresectable BTC (77.1% vs. 66.8%, p<0.001). In contrast, lymph node involvement, biliary intervention and elevated tumor marker levels (CEA and CA19-9) were more common in pts with unresectable BTC (p<0.001). After the multivariate analysis, unresectable BTC group still demonstrated a significantly worse survival than recurrent BTC group (hazard ratio [HR] 1.44, 95% CI 1.15-1.80, p=0.002). Other statistically significant prognostic factors were ECOG PS (HR 1.49, 95% CI 1.18-1.87, p<0.001), metastatic disease (HR 1.53, 95% CI 1.20-1.97, p<0.001) and higher CEA (≥5 ng/ml) (HR 1.71, 95% CI 1.36-2.15, p<0.001). Conclusions: The status of unresectable/recurrent disease is identified as one of the prognostic factors for pts with BTC receiving chemotherapy and recommended to be used as a stratification factor in the clinical trials.
Arterial infusion of recombinant human adenoviral p53 gene in treatment of advanced pancreatic cancer.
Authors: Mo Jinggang , He Bing , Tan Kai , Yang Xiaopin , Zhuang Xusheng , Ruan Libin 
Published: March 2020

e14523 Background: There are few treatment options for unresectable advanced pancreatic cancer. Here we report beneficial effects of arterial infusion of recombinant human adenoviral p53 gene (rAdp53) in treatment of the late-stage pancreatic cancer. Methods: Sixteen patients having an average age of 56.8 years old, 11 males and 5 females, with unresectable advanced pancreatic cancer were treated using arterial infusion of rAdp53 at dose of 2-4×1012 viral particles (VP) per 3 days for 4 times. The rAdp53diluted into 10 ml ofsaline solution were slowly injected into arterial branches supplying the tumor. Results: Among 16 patients, 56.3% (9/16) achieved a partial response. Overall one year survival rate was 62.5%. Jaundice of 7 in 10 patients was reduced. The ascites of 8 in11 cases was absorbed. General symptoms associated with the late-stage pancreatic cancer were relieved in 81.3% (13/16) of cases. There were no significant side effects or complications observed except for transient fever. Conclusions: The treatment of arterial infusion of rAdp53 showed the beneficiary effects of both safety and efficacy and is a treatment option for unresectable advanced pancreatic cancer.