bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.090: WHY BARRETT’S ESOPHAGEAL ADENOCARCINOMAS WERE FOUND AS WIDE LESIONS
Authors: Yamasaki Akira , Fujisaki Junko , Yamamoto Yasunori , Ishiyama Akiyoshi , Yoshio Toshiyuki , Tsuchida Tomohiro , Sasaki Yutaka 
Published: September 2018

Abstract

Background
Barrett's esohageal adenocarcinoma(BEA) originated from Long-segment Barrett's esophagus(LSBE) were found to be larger lesions than BEA from Short-segment Barrett's esophagus(SSBE). In Japan, superficial BEA were found and treated by ESD. However, most of superficial BEA in Japan are originated from SSBE. We investigated about the differences between BEA from SSBE and LSBE.

Methods
We examined macroscopic appearance and histology for superficial BEA. And we compared with BEA between SSBE and LSBE.And then we examined imminohistochemical study using p53 for operated specimens of superficial BEA.

Results
The multiple lesions were presented only LSBE cases. Operations were the far more common treatment for LSBE. The ratio of lesions involving more than one-half of the lumen was significantly larger in LSBE cases. The percentage of type 0-IIb was only 3.2%(3/95) for SSBE, whereas 32.6%(15/46) for LSBE (P < 0.05). When we placed each macroscopic type into one of two groups (Elevated and Flat or depressed type), we found that elevated types accounted for 63.2%(60/95) in SSBE cases. In LSBE cases, 50.0%(23/46) were of the flat or depressed type. In SSBE, simple macroscopic types accounted for 69.5%(66/95). Whereas, in LSBE cases, 50.0%(23/46) were of complex macroscopic types (P < 0.05). The lesions with accompanied type 0- IIb accounted for 2.1%(2/95) of SSBE and 21.7%(10/46) of LSBE(P < 0.05). The more common macroscopic type of T1b invasion was type 0- IIa + IIc. p53 immunohistochemical study was done for an operated specimen. This case was operated for superficial BEA. p53 was strongly positive on adenocarcinoma. However, we could find p53 strongly positive part on other part of the specimens. There were three part of p53 positive are in this operated specimens. These parts were not defined adenocarcinoma by HE stained.

Conclusion
Most superficial BEA originated from SSBE could be distinguished by the elevated lesions. Whereas, in cases of LSBE, flat type lesions including the accompanied type 0- IIb and multiple lesions, operation cases, the ratios of lesions involving a large range and the complex macroscopic types were significantly higher. When we diagnose and treat superficial BEA, it is necessary to consider the differences between SSBE and LSBE, such as macroscopic types.

Disclosure
All authors have declared no conflicts of interest.
PS02.095: THE FIRST SERIES OF ESOPHAGEAL ESD FOR SUPERFICIAL SQUAMOUS CELL CARCINOMA IN THAILAND
Authors: Swangsri Jirawat 
Published: September 2018

Abstract

Background
Esophageal cancer is 11th common in Thailand and incidence of new case is around 2500 cases per year. Because of screening protocol is unavailable then most of patient come to hospital with advanced stage cancer which relate with poor quality of life and survival out come. We are pioneer of early esophageal screening and treatment and begin screening endoscopy since 2015 and first case ESD was success on 30 Sep 2015. Until now our unit accomplished esophageal ESD for 8 cases and report in this case series.

Methods
During 2015 - 2017 esophageal cancer parient visit out patient clinic at Siriraj hospital around 260 cases and 7 cases of superficial esophageal squamous cell carcinoma were detected. Clinical staging was evaluated by magnified power endoscopy to detect IPCL and EUS was underwent. ESD was decided for both therapeutic and diagnostic procedure. All of 7 cases were accomplished ESD in 8 procedure (1 case present of metachronous lesion and performed 2nd ESD).

Results
All of 7 patients were success 8 ESD. Average lesion size is 2.68 cm in diameter. Average operative time is 182.25 min. Pathological report of HGD for 3 cases, m2 for 1 case, Sm1 for 2 cases and Sm2 for 1 case. 1 patient present of metachronous after 1st ESD 11mo and success 2nd ESD. Local recurrent found in 2 case post 1st ESD 11 mo and 14 mo respectively, treatment by APC. Post ESD perforation found in 2 cases, both of them were full recovery by non operative treatment by fully cover SEMS. No major bleeding or severe pulmonary complications were found. No evidence of 30 - day mortality. Longest follow up period is 29 mo. Average recurrent time is 12 mo (3 cases). No evidence of distance or lymphatic metastasis in all patients.

Conclusion
Esophageal ESD was established in Japan more than 20 year ago and just beginning in Thailand from 2015. Our report of initial ESD experiences for superficial esophageal cancer. Even though learning time and more volumn practice is needed, however this procedure found low rate of severe complications and can improve survival benefit as well. This knowledge should be distributed nationwide in near future.

Disclosure
All authors have declared no conflicts of interest.
PS02.096: ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL HIGH-GRADE SQUAMOUS DYSPLASIA: A CASE REPORT
Authors: Ying Khoo Hui , Voon Kelvin , Yee Lim Shyang 
Published: September 2018

Abstract

Background
Endoscopic resection is a novel therapeutic technique for early esophageal cancer and it is indicated in well differentiated superficial M1 or M2 lesion. The selection criteria have been expanded to selected M3 and SM1 lesion with the advancement of endoscopic technology and detailed study of relation between depth of lesion and lymphatic spread.

Methods
We report a case of endoscopic submucosal dissection (ESD) for esophageal high grade dysplasia.

Results
Madam S, a 50-year-old lady with no known medical illness, presented with gradual dysphagia for 1 year. She had no prior history of corrosive ingestion or reflux disease. She was diagnosed with esophageal stricture and underwent esophageal dilatation twice, before she was referred to our center. Clinical examination revealed no abnormality and her BMI was 25. OGDS revealed a 1cm superficial ulcerative lesion at proximal esophagus (25cm from incisor) with abnormal capillary pattern on narrow band imaging. Biopsy revealed high grade intraepithelial neoplasia. PET-CT showed metabolically active esophageal lesion with no distant metastasis. She decided for ESD after given the option of endoscopic treatment versus esophagectomy. ESD was done (Figure 1) and she had an uneventful recovery. Histopathology revealed complete resection of high grade squamous dysplasia.

Conclusion
Endoscopic treatment is less invasive option for early esophageal tumour which spares patients from esophagectomy and the related morbidities. However, it carries the risk of incomplete resection, recurrence and under-staging of the disease. It also requires highly specialized center and has a steep learning curve. Careful patient selection and proper pre-operative counseling are crucial in endoscopic treatment of early esophageal cancer. Long term surveillance is needed for early detection of recurrence.

Disclosure
All authors have declared no conflicts of interest.
PS02.098: LONG-TERM OUTCOMES OF ADDITIONAL THERAPY FOLLOWING ENDOSCOPIC RESECTION FOR T1B-SM ESOPHAGEAL CANCER
Authors: Tanaka Tsuyoshi , Ueno Masaki , Iizuka Toshiro , Hoteya Shu , Haruta Shusuke , Udagawa Harushi 
Published: September 2018

Abstract

Background
Esophagectomy is the standard treatment strategy for superficial esophageal cancer diagnosed as pT1b(sm) following endoscopic resection (EMR/ESD). However, chemoradiotherapy (CRT) is expected to be an alternative treatment option. This study retrospectively compared the long-term outcomes of surgery and CRT as additional treatments for EMR/ESD pT1b esophageal cancer.

Methods
In a retrospective single-center study, the data of 83 consecutive patients who underwent EMR/ESD and were diagnosed with pT1b(sm) from January 2002 to December 2013 were collected, and additional treatment was administered to 59 of these patients (26 surgery and 33 CRT). Long-term outcomes, recurrent patterns, and risk factors for recurrence were analyzed.

Results
Median patient age was 63 (range, 43–79) years, and male/female ratio was 54:5. Tumor characteristics were as follows: location, Ce/Ut/Mt/Lt/Ae/EG = 1/6/32/13/3/4; median size, 25 (range, 5–88) mm; depth, sm1/sm2 = 18/41; vascular invasion (ly, v), + / − = 37/22; and cut end (HM, VM), + or × / − = 17/42. Sex, Charlson comorbidity index, tumor size, macroscopic type, cut end, and resection state were not different between the two groups. Meanwhile, age, tumor location, histological type, tumor depth, and vascular invasion were different between the two groups. The 5-year survival rates (relapse-free survival rate; RFS) were 92.3% (92.3%; RFS) and 80.3% (70.4%; RFS) in the surgery and CRT groups, respectively. The surgery group was significantly superior to the CRT group in terms of RFS (P = 0.042). All tumor recurrence was observed in the CRT group (P = 0.030). Recurrent patterns were as follows: hematogenous metastases (lung, bone, and adrenal gland) in three patients and lymph node metastases (four regional and an extra-regional) in four patients. In multivariate analysis, tumor size (P = 0.048) and lymphatic invasion (P = 0.032) were revealed as significant risk factors for recurrence in the CRT group.

Conclusion
Surgery is recommended as the additional treatment for ESD/EMR-pT1b esophageal cancer for better recurrent-free survival. Although CRT could be an acceptable treatment choice, the indication should be carefully decided, particularly in cases with large tumor size or lymphatic invasion.

Disclosure
All authors have declared no conflicts of interest.
PS02.101: PREOPERATIVE TREATMENT BASED ON THE DCF CHEMOTHERAPY AND SUPPORTIVE THERAPY FOR ESOPHAGEAL CANCER
Authors: Tanabe Shunsuke , Shirakawa Yasuhiro , Maeda Naoaki , Ninomiya Takayuki , Noma Kazuhiro , Fujiwara Toshiyoshi 
Published: September 2018

Abstract

Background
The neoadjuvant chemotherapy using CDDP and 5-FU(CF) is the standard treatment for advanced esophageal cancer, defined as clinical stage II/III in Japan. However, more powerful chemotherapy has been required for the treatment of cases of cStageIII cases. In 2011, the combination treatment of CF and Docetaxel (DCF) was introduced for the treatment of those cases in our institute. DCF therapy increased chemotherapy remarkable cases. But, adverse events occur at high rates, including high myelosuppression. Therefore, it is necessary to ensure support by early intervention of supportive therapy so as not to exacerbate adverse events. We report about treatment outcome in preoperative DCF therapy cases.

Methods
We treated 128 esophageal cancer patients who underwent surgery following preoperative DCF therapy between 2011 and July 2017, and preoperative DCF was administered to 128 patients 2 course completely. The neoadjuvant chemotherapy regimen using DCF is Docetaxel:70mg/m2 (day1) + CDDP:70mg/m2 (day1) + 5-FU:700mg/m2 (day1–5).

Results
In the preoperative DCF group, overall response rate (over PR) was 51.5%. There were 37 cases in 128 cases of pathological tissue effect judgment for Grade 2 and 3. 14 cases of them (14cases/37cases:37.8%) had lymph node metastasis. Therefore it is necessary to control lymph node metastasis by surgery even in a remarkable group. Almost all patients experienced grade 4 adverse events, particularly neutropenia is a high frequency. From the start of chemotherapy, pretreatment of intraoral infection lesion and prevention and treatment of oral mucositis are performed. Considering the degree of myelosuppression during initial chemotherapy, in the second course, we actively administer G-CSF preparation.

Conclusion
A good prognosis can be expected if preoperative DCF therapy is effective. It is necessary to perform intensive and safe preoperative chemotherapy with appropriate supportive therapy intervention.

Disclosure
All authors have declared no conflicts of interest.
PS02.102: RESULTS FROM MULTICENTER, RANDOMIZED PHASE 3 FLOT4-AIO-TRIAL
Authors: Mönig Stefan , Al-Batran Salah 
Published: September 2018

Abstract

Background
The MAGIC trial established perioperative (periop) epirubicin, cisplatin, and 5-FU (ECF) as a standard treatment for patients (pts) with operable esophagogastric cancer, but survival continues to remain poor. FLOT4 (NCT01216644) is a multicenter, randomized, investigator-initiated, phase 3 trial (AIO-trial). It compares the docetaxel-based triplet FLOT with the anthracycline-based triplet ECF/ECX as a periop treatment for pts with resectable gastric or GEJ adenocarcinoma.

Methods
Eligible pts of stage ≥ cT2 and/or cN + were randomized to either 3 preoperative and 3 post-operative 3-week cycles of ECF/ECX (epirubicin 50 mg/m2, cisplatin 60 mg/m², both d1, and 5-FU 200 mg/m² as continuous infusion or capecitabine 1250 mg/m2 orally d1–21) or 4 pre-operative and 4 post-operative 2-week cycles of FLOT (docetaxel 50 mg/m2, oxaliplatin 85 mg/m², leucovorin 200 mg/m², and 5-FU 2600 mg/m² as 24-hour infusion, all d1). The primary endpoint was overall survival (OS; 80% power; HR of 0.76; 2-sided log-rank test at 5% type I error).

Results
Between Aug 2010 and Feb 2015, 716 pts (360 ECF/ECX; 356 FLOT) were randomly allocated. Baseline characteristics were similar between arms (overall, male 74%; median age 62; cT3/T4 81%; cN + 80%; GEJ 56%). 91% and 37% of pts with ECF/ECX and 90% and 50% with FLOT completed planned pre-operative and post-operative cycles, respectively. Median follow-up was 43 mon. 369 pts died (203 ECF/ECX; 166 FLOT). FLOT improved OS (mOS, 35 mon with ECX/ECF vs. 50 mon with FLOT; HR 0.77 [0.63 - 0.94]; P = 0.012). 3y OS rate was 48% with ECF/ECX and 57% with FLOT. FLOT also improved PFS (mPFS, 18 mon with ECX/ECF vs. 30 mon with FLOT; HR 0.75 [0.62 - 0.91]; P = 0.004). Periop complications were 50% with ECF/ECX and 51% with FLOT. 30- and 90-day mortality was 3% and 8% with ECF/ECX and 2% and 5% with FLOT. There was more G3/4 nausea and vomiting with ECF/ECX and more G3/4 neutropenia with FLOT.

Conclusion
Periop FLOT improved outcome in patients with resectable gastric and GEJ cancer compared to periop ECF/ECX.

Disclosure
All authors have declared no conflicts of interest.
PS02.110: PREDICTION OF PROGNOSIS BY EVALUATING RELATIVE CHANGE IN FDG-UPTAKE OF THE METASTATIC LYMPH NODES AFTER NEOADJUVANT CHEMOTHERAPY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yoshino Shigefumi , Takeda Shigeru , Kanekiyo Shinsuke , Kitahara Masahiro , Nishiyama Mitsuo , Iida Michihisa , Suzuki Nobuaki , Tokuhisa Yoshihiro , Tomochika Shinobu , Tokumitsu Yukio , Ueno Tomio , Hazama Shoichi , Nagano Hiroaki 
Published: September 2018

Abstract

Background
Prognosis of patients with esophageal squamous cell carcinoma (ESCC) can be significantly improved by neoadjuvant chemotherapy (NAC). The current best clinical method to predict pathologic response of chemotherapy is the maximum standardized uptake value (SUVmax) in 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET). However, most of the FDG-PET evaluation has been focused on the primary tumors, but not on other metastatic lesions. The aim of this study was to determine the predictive value of FDG-uptake measured prior and after NAC both in the primary tumors and in the metastatic lymph modes (mLN) in ESCC.

Methods
Forty-five consecutive potentially resectable ESCC patients treated with NAC, which consisted of 2 courses of continuous infusion of 5-FU for days 1–5 and CDDP on day 1, between 2009 and 2016 were evaluated. FDG-uptake was measured at baseline and after chemotherapy in the primary tumors and in the mLN, and all patients underwent esophagectomy with R0 resection. The predictive values of FDG-PET and clinicopathological characteristics were determined with univariate and multivariate analyses.

Results
The median age was 66 years, with 35 males and 9 females. Pretreatment clinical classification of tumor depth was T1 in 9, T2 in 10, T3 in 26, respectively, and that of lymph modes metastases was N0 in 9, N1 in 12, N2 in 18, N3 in 6, respectively. The average SUVmax before and after NAC in the primary tumors was 13.9 and 7.9, respectively, and the average SUVmax reduction was 39.8% after chemotherapy. Pathological response was found to correlate well with the SUVmax reduction in the primary tumors, however, relative change in FDG uptake after chemotherapy was not associated with overall survival (OS). The average SUVmax before and after NAC in the mLN was 6.9 and 3.3, respectively, and the average SUVmax reduction was 46.2% after chemotherapy. Univariate and multivariate analyses revealed that both of the SUVmax and relative change in FDG uptake after chemotherapy in the mLN were well correlated with OS.

Conclusion
Post-NAC SUVmax and relative change in FDG uptake after chemotherapy in the mLN are valuable independent preoperative predictor of prognosis for patients with ESCC who received chemotherapy before surgery.

Disclosure
All authors have declared no conflicts of interest.
PS02.114: CLINICAL SIGNIFICANCE OF PREOPERATIVE CHEMORADIOTHERAPY FOR RESECTABLE ESOPHAGEAL CANCER PATIENTS USING PROPENSITY SCORE
Authors: Fujiwara Yoshinori , Kubota Hisako , Higashida Masaharu , Watanabe Yusaku , Okada Toshimasa , Uraoka Mio , Okamoto Yuko , Mineta Shyumei , Inoue Masatoshi , Fukuda Shuichi , Tsuruta Atsushi , Ueno Tomio 
Published: September 2018

Abstract

Background
Preoperative chemoradiotherapy(CRT) for advanced resectable esophageal cancer patients is controversial in Japan, and it is different from other countries. We examine the clinical significance of it using propensity score(PS).

Methods
142 patients in resectable cStageII/III/IV(TNM 6th edition) esophageal cancer patients were studied. There were 55 preoperative CRT cases (Group A), 87 patients with surgery alone(Group B). The survival was analyzed between the two groups. PS was calculated by Logistic analysis and the background factor was adjusted by the PS matching and IPTW(Inverse probability of treatment weighting) method for the preoperative CRT (Group A) vs surgery alone group (GroupB), Cox model was used to analyzed the prognostic factors.

Results
1, Unmatched situation: In OS(Overall survival), no difference was found between the two groups. In DFS(Disease free survival), the prognosis of group A was better than that of group B (5 years DFS: 52.2% vs 34.55%, P < 0.05). 2, After PS matching: OS, GroupA was tended to be better(P = 0.097). DFS: the prognosis of the Group A was better (5 years DFS: 57.2 vs 28.1%, P < 0.01). With Cox analysis, the presence or absence of preoperative CRT was a significant prognostic factor. 3, After IPTW: Prognosis of group A in both OS and DFS was better (5 years OS: 77.25 vs 41.13%, P < 0.05, 5 years DFS: 76.7 vs 32.14%, P < 0.01). In Cox analysis, preoperative CRT and TNM stages were independent prognostic factors.

Conclusion
1, Preoperative CRT for resectable advanced esophageal cancer is a recommended treatment by analyzing the PS. 2, IPTW and PS matching are different methods for evaluating PS, and since there is a possibility that different results may be occurred when evaluated between two groups by PS, the evaluation of it should be done more carefully.

Disclosure
All authors have declared no conflicts of interest.
PS02.115: PERIOPERATIVE CHEMOTHERAPY VERSUS NEOADJUVANT CHEMORADIATION FOR PATIENTS WITH ADENOCARCINOMA OF THE DISTAL OESOPHAGUS IN AUSTRIA
Authors: Koch Oliver , Tschoner Andreas , Partl Richard , Perathoner Alexander , Gehwolf Philipp , Weitzendorfer Michael , Varga Martin , Kapp Karin , Függer Reinhold , Öfner-Velano Dietmar , Emmanuel Klaus 
Published: September 2018

Abstract

Background
The aim of this study is to compare the outcome of patients with adenocarcinoma of the distal oesophagus (AEG Type I) treated with perioperative chemotherapy or neoadjuvant chemoradiation.

Methods
A retrospective analysis of eligible patients from four Austrian centers was conducted. All patients with AEG type I treated between January 2007 and October 2017 with chemotherapy (EOX-protocol) or chemoradiation (CROSS-protocol, or 5-FU/Cisplatin), followed by oesophagectomy were included in the study. Primary outcomes overall survival, and disease free survival as well as secondary outcomes, achievement of pathological complete response pCR (ypT0N0M0) or downstaging of T- or N-stage were analyzed. Primary outcomes were calculated by the Kaplan-Meier-method.

Results
Data of 117 patients were analyzed, 59 received chemoradiation (50/59 CROSS and 9/59 5-FU/Cisplatin) and 58 patients received perioperative chemotherapy (EOX). Complete data at time of submission were available in 40 patients in the chemoradiation group and in 37 patients in the chemotherapy group. The median follow-up time in the chemoradiation group was 13,0 months (CI 95%: 11,0–15,0) and in the chemotherapy group 45,0 months (CI 95%: 28,8–61,3). Overall survival rate in the EOX group after ½, 1, 3 and 5 years was 92%, 83%, 63% and 34%. So far long term data are not available after chemoradiation, after ½ year overall survival was 84% and after one year 60%. Disease free survival rate in the EOX group after ½, 1, 3 and 5 years was 91%, 81%, 54% and 32%, in the chemoradiation group after ½ and one year 80% and 50%. A significant difference was found in the pathological complete response (pCR) rate, it was achieved in 19% of patients after chemoradiation and in 3% after chemotherapy (P = 0000).

Conclusion
Concerning major response of the primary tumor there are clear advantages for chemoradiation. In regards to systemic tumor control there seems a tendency in favor for chemotherapy.

Disclosure
All authors have declared no conflicts of interest.