bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.039: SERUM CRP LEVEL IS A PROGNOSTIC FACTOR OF ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY
Authors: Ishioka Daisuke , Saito Masaaki , Takahashi Jun , Obitsu Tamotsu , Kiyozaki Hirokazu , Rikiyama Toshiki 
Published: September 2018

Abstract

Background
In advanced esophageal cancer, definitive combined chemoradiotherapy (d-CRT) is considered to be one of standard therapy in Japan. However, there have been few studies of the correlation of clinical factors and response to chemoradiotherapy. The aim of this study is to clarify the correlation of serum CRP level and response to definitive chemoradiotherapy for advanced esophageal cancer.

Methods
A total of 78 patients with clinical stage II/III esophageal cancer who were treated with d-CRT at our institute from 2002 to 2014 were retrospectively reviewed. 57 patients received chemotherapy using low-dose 5-FU and cisplatin, and remaining 19 patients received chemotherapy using standard-dose 5-FU and cisplatin according to the protocol described in the RTOG trial combined with radiation therapy. The patients were stratified by response to chemoradiotherapy by two groups. 60 patients (54 patients had a complete response and 6 had a partial response) were in Responder group, and 18 patients (7 patients had a stable disease and 11 had a progressive disease) were in Non- responder group. The correlation of survival rate and serum CRP level before d-CRT was evaluated.

Results
At the time of analysis, the median follow-up period was 32 months (range 3–124 months). The overall survival of the Responder group was significantly better than that of Non- responder group (P < 0.001). Univariate analysis showed that white blood cell > 8000/m3 (P = 0.036), CRP > 1.0mg/dl (P = 0.002), adventitia invasion (P = 0.04) and history of the smoking (P = 0.037) were predictive for response of d-CRT. Multivariate analyses identified serum CRP level (P = 0.002) as independent prognostic factors for response of d-CRT.

Conclusion
Our findings suggest that serum CRP level may be a useful marker to predict a response to definitive chemoradiotherapy. However, further examinations in the future will be necessary to determine its efficacy.

Disclosure
All authors have declared no conflicts of interest.
PS02.056: TIMELY LIGATION OF THORACIC DUCT IN POST ESOPHAGECTOMY CHYLE LEAK: KEY TO SUCCESSFUL MANAGEMENT
Authors: Parshad Sanjeev , Sandu Parvinder , Gogna Shekar , Beniwal Abhijeet , Karwasra Rajendra 
Published: September 2018

Abstract

Background
Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus.

Methods
From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct.

Results
Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct.

Conclusion

Disclosure
All authors have declared no conflicts of interest.
PS02.072: ESTIMATION OF DOWN STAGING AFTER CHEMORADIOTHERAPY FOR T4 ESOPHAGEAL CANCER BY QUALITATIVE RESPONSE EVALUATION USING RENDERED MD-CT AND THE OUTCOME OF CURATIVE RESECTION
Authors: Okazumi Shinichi , Shimada Hideaki , Matsubara Hisahiro 
Published: September 2018

Abstract

Background
A new qualitative diagnostic image which represented the histological responses was developed using 3D-volume rendered MD-CT, and which was applied for the estimation of down staging after chemoradiotherapy (CRT) followed curative resection for T4 advanced esophageal cancer.

Methods
95 cases of T4 advanced esophageal cancer which underwent CRT were enrolled CRT protocol: 40–60Gy dose of irradiation were done and concurrently CDDP 15(mg/mm2) and 5-FU 500(mg/mm2) were administered in day 1–5 i.v.. Down staging estimation by MD-CT rendering: Contrast media (300mg iodine/ml, 3ml/kg) was administrated intravenously (3ml/sec). CT (GE: Light Speed 16) scans were performed (slice thickness: 1.3 mm) at 50 seconds delay before and after CRT. A workstation Virtual Place(AZE) was used for rendering the diagnostic image which represented histological response with specially selected colors and opacities. Down staging was diagnosed by the fibrotic change(CT value < 50HU) of the cancer tissue in the border area to the adjacent organs. The first estimation were done at 40Gy and the down staging cases were examined for resection and no down staging cases were continued to 60Gy.

Results
Down staging ratio were 48% in T4 aorta, 17% in trachea,35.7% in bronchus, and 44.4% in pulmonary vein. In the irradiation dose of 41.3 ± 2.5Gy, 24cases (25.3%) (Group A) and in 61.8 ± 3.15Gy,12 cases (12.6%) obtained down staging. 30 days after CRT, 13 cases of Group A and 10 of Group B underwent curative esophagectomy. In the pathological examination, response rate were 60.8% in group A and 80% in group B. The outcome after resection was 40% in the five year survival (n = 23).

Conclusion
The qualitative diagnostic image rendered by 3D-enhanced MD-CT was useful for the down staging evaluation after CRT to estimate curability of followed resection for T4 advanced esophageal cancer. Early estimation of the down staging at the dose of 40Gy seemed to be necessary to plan the followed resection safely and survival benefit were obtained in the curatively resected case with histological response.

Disclosure
All authors have declared no conflicts of interest.
PS02.094: EVALUATION OF ADDITIONAL TREATMENT AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL RESECTION FOR ESOPHAGEAL CANCER
Authors: Ohki Shinji , Hikichi Takuto , Yamada Leo , Ujiie Daisuke , Nirei Azuma , Tada Takeshi , Watanabe Youhei , Hanayama Hiroyuki , Hayase Suguru , Gonda Kenji , Kikuchi Hitomi , Watanabe Koh , Nakamura Jun , Saze Zenichiro , Momma Tomoyuki , Kono Koji 
Published: September 2018

Abstract

Background
Recently, endoscopic submucosal dissection (ESD) has been used as a less invasive treatment for superficial esophageal cancer. Additional treatment is often required after non-curative resection to prevent local recurrence and lymph node metastasis. Here, we present the outcomes of various additional treatments for patients with superficial esophageal cancer who underwent ESD.

Methods
Between 2006 and 2017, we performed ESD in 179 patients (210 lesions) with superficial esophageal cancer and 44 cases resulted in the non-curative resection diagnosed by the pathological examination. Among them, 29 patients received additional treatment, whereas 15 patients with no additional treatment were followed up. Additional treatment included esophagectomy (8 patients), chemoradiotherapy (15 patients), ablation using argon plasma coagulation (4 patients), and chemotherapy alone (2 patients). We examined the clinicopathological characteristics and prognosis of patients in the additional esophagectomy group (S group) and chemoradiotherapy group (CRT group).

Results
Twenty-three patients with pT1a-MM, pT1b, lymphatic invasion, venous invasion, and positive resection margins (both horizontal and vertical) were divided into two treatment groups. Clinicopathological characteristics of patients in the S and CRT groups were not significantly different. Pathological findings after additional esophagectomy showed one residual tumor and one lymph node metastasis. There were no recurrences in the two groups. There was no statistically significant difference in the 5-year overall survival rate between the S group (87.5%) and the CRT group (93.3%). One patient from the S group died due to respiratory pneumonia, and one patient died due to radiation pneumonia. However, five out of the 15 (33.3%) patients who were followed up with no additional treatment developed recurrence. The 5-year overall survival rate was 40.4%, which was not significantly different from that in the additional treatment group. However, the 5-year relapse-free survival rate (30%) was significantly different from that in the additional treatment group (P > 0.05).

Conclusion
Additional treatment is essential after non-curative endoscopic submucosal resection for esophageal cancer. Additional esophagectomy and chemoradiotherapy were both safe and effective in this cohort.

Disclosure
All authors have declared no conflicts of interest.
PS02.100: ASSOCIATION BETWEEN RESPONSES OF NEOADJUVANT DOCETAXEL PLUS CISPLATIN AND FLUOROURACIL (DCF) CHEMOTHERAPY AND SURVIVALS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS
Authors: Sato Yasuyoshi , Yamashita Hiroharu , Okumura Yasuhiro , Wakamatsu Kotaro , Nishida Masato , Yagi Koichi , Ogawa Masako , Aikou Susumu , Nomura Sachiyo , Seto Yasuyuki 
Published: September 2018

Abstract

Background
For patients with stage II/III esophageal squamous cell carcinoma (ESCC), neoadjuvant chemotherapy with cisplatin and 5-fluorouracil followed by surgery has been regarded as a standard treatment in Japan based on the result of Japan Clinical Oncology Group trial (JCOG9907). However, the survival outcome of this doublet chemotherapy has been still unsatisfactory especially in stage III patients. Triplet-regimen, consisting of docetaxel plus cisplatin and 5-fluorouracil (DCF), showed good responses and survivals in some previous phase II studies, and therefore neoadjuvant DCF seems promising for more advanced stage. We adopted neoadjuvant DCF chemotherapy for patients with advanced ESCC.

Methods
We retrospectively analyzed 48 patients with ESCC treated with DCF as neoadjuvant chemotherapy from January 2013 to October 2017 in our hospital. All patients were in clinical T3–4a/N1–2/M0 or T1b-2 with bulky lymph metastasis based on the TNM classification 7th edition. DCF regimen consisted of i.v. docetaxel (60–70 mg/m2) on day 1 and cisplatin (60–70 mg/m2) on day 1, and continuous infusion of fluorouracil (600–700 mg/m2) on days 1–5. This regimen was repeated every 4 weeks.

Results
Forty-six patients (96%) completed 2 cycles of DCF. According to revised RECIST guideline, response rate was 29% (CR, 2; PR, 12; SD, 14; PD, 8; Non-CR/non-PD, 12). Forty-two patients except PD underwent surgery; R0 resection was achieved in 40 patients. Among 34 patients observed for more than 1 year after initial treatment, 1 year survival rate and overall survival time were 72.7% [95%CI: 49.1–86.7] and 20.1 months [95%CI: 9.4–30.6] in SD, Non-CR/non-PD and PD patients, while no patients died at the 1 year and did not reach median survival in CR and PR group (P = 0.001).

Conclusion
Survival of advanced ESCC patients was strongly associated with the clinical response to neoadjuvant DCF. It might be an indicator to select good candidates for surgical therapy.

Disclosure
All authors have declared no conflicts of interest.
PS02.105: LONG-TERM RESULTS OF PREOPERATIVE CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN AND FLUOROURACIL IN PATIENTS WITH ADVANCED ESOPHAGEAL CARCINOMA
Authors: Ui Takashi , Fujii Hirofumi , Hosoya Yoshinori , Lefor Alan , Yamaguchi Hiroyuki , Mori Misuzu , Saito Shin , Kurashina Kentaro , Haruta Hidenori , Matsumoto Shiro , Kanamaru Rihito , Takahashi Kazuya , Sakuma Yasunaru , Horie Hisanaga , Kitayama Joji , Sata Naohiro 
Published: September 2018

Abstract

Background
Although preoperative docetaxel, cisplatin, and fluorouracil (DCF) therapy is reportedly effective in patients with advanced esophageal squamous cell cancer (ESCC), long-term results after preoperative DCF therapy are not well known. We retrospectively reviewed the long-term results after preoperative DCF therapy.

Methods
This study includes 63 patients with advanced thoracic esophageal carcinoma (excluding T4 tumors) receiving preoperative chemotherapy between February 2010 and February 2014. All patients were intended to receive two courses of treatment every four weeks, or three courses every three weeks. Patients underwent curative surgery four to five weeks after completing chemotherapy.

Results
Radical resection was performed in 58 patients (92%). R0 resection was completed in 48 patients (83%). The 5-year overall survival and progression free survival were 55% [95% confidential interval, 0.41–0.66] and 0.46% [0.34–0.58], respectively. Recurrences occurred in 34 patients (54%). Distant metastases developed in 13/48 (27%) after R0 resection. Chemotherapy-related adverse events included G4 hematotoxicity (n = 50, 79%, neutrophil < 500), febrile neutropenia (n = 16, 25%), and G3 non-hematotoxicity (n = 15, 24%).

Conclusion
These results suggest that preoperative DCF therapy may be effective and improve the long-term outcomes in patients with advanced esophageal carcinoma.

Disclosure
All authors have declared no conflicts of interest.
PS02.108: EFFECTS OF PREOPERATIVE CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kamio Yukinori , Hachiya Osamu , Fujimoto Hiroto , Takasu Naoki , Toda Makoto , Suzuki Takefumi , Sato Tamie , Nakano Ryo , Nozu Shintaro , Kimura Wataru 
Published: September 2018

Abstract

Background
In Japan, preoperative chemotherapy followed by surgery is the standard treatment for clinical stage II or III, excluding T4 thoracic esophageal squamous cell carcinoma (SCC). Here, we investigated the efficacy of preoperative chemotherapy in our hospital.

Methods
From January 2010 through December 2017, 33 patients with clinical stage II/III esophageal SCC underwent esophagectomy after preoperative chemotherapy with two cycles of cisplatin and 5-fluorouracil. Overall survival (OS) and clinical and pathological tumor responses were retrospectively evaluated. In addition, fluorodeoxyglucose (FDG) uptake was assessed by FDG-positron emission tomography/computed tomography (PET/CT).

Results
There were 9 patients with stage II and 24 with stage III esophageal SCC, and two cycles of chemotherapy were completed by 27 patients (81.8%). Three-year OS rates were 100% in patients with stage II and 66.7% in patients with stage III esophageal SCC, whose observation period exceeded beyond 3 years. Of the 33 patients who showed a clinical response at the primary site, 22 (66.7%) had a partial response (PR), and a 3-year OS of 85.7%, while 4 (12.1%) had a complete response (CR), and a 3-year OS of 100%. In regards to pathological response, as evaluated using The Japan Esophageal Society histological evaluation criteria, 3 patients (9.1%) were classified as grade 0, 18 (54.5%) as grade 1a, 4 (12.1%) as grade 1b, 6 (18.2%) as grade 2, and 2 (6.1%) as grade 3. Of the 22 patients who achieved PR, 14 (63.6%) were classified as either grade 0 or 1a. On the other hand, when we compared the maximum standardized uptake value (SUVmax) of FDG − PET/CT at the primary site before and after preoperative chemotherapy, the patients with high decreasing rates mostly belonged to the grade 1b-3 group. The OS rate tended to be higher in the grade 1b-3 group than in the grade 0–1a group.

Conclusion
Our present results suggest that, although pathological responses do not necessarily correspond to clinical tumor reduction, a good pathological response is potentially related to a better prognosis. Furthermore, the FDG uptake value may reflect pathological effects that occur owing to preoperative chemotherapy.

Disclosure
All authors have declared no conflicts of interest.
PS02.111: A 5-YEAR EXPERIENCE IN ANASTOMOTIC LEAK AFTER NEODJUVANT FOLLOWED ESOPHAGECTOMY IN A BRAZILIAN UNIVERSITY HOSPITAL
Authors: Vieira Felipe , Schramm Ricardo , Chedid Marcio , Ricardo Da Rosa André , Dario Kruel Cleber 
Published: September 2018

Abstract

Background
Neoadjuvant treatment of esophageal cancer is world accepted since 2012 (1), showing benefits in long-term survival. However, there is still controversy relating to potential complications with the use of antineoplastic drugs and radiotherapy, notably because of the higher incidence of cervical esophageal leak. Our study describes a five-year experience in anastomotic leaks in esophagectomies after neoadjuvant therapy in a southern Brazilian referral center.

Methods
We have analyzed all patients submitted to the combined treatment of neoadjuvant therapy plus esophagectomy between 2012–2016, including patients with squamous cell carcinoma and adenocarcinoma. We describe the number of patients that experienced anastomotic leak after surgery. The diagnosis of an anastomotic leak is based in any quantity of digestive secretion in the neck wound, seen on the post-operative period. It did not secrete bacteriological analysis. McKeown and transhiatal esophagectomy were used, and esophagogastric anastomosis were conducted in the cervical region.

Results
Between the years of 2012–2016, thirty-six patients were submitted to a combined treatment of neoadjuvant therapy plus esophagectomy. Of these patients, 20 (55%) evolved with anastomotic leaks. All of these leaks occurred in the cervical region, and were treated in a conservative way.

Conclusion
The incidence of anastomotic leaks was exceptionally high, regardless of the usual care. Possible causes of this high number of leaks could be related to diagnostic criterion, the patient's own characteristics, local alterations associated to the neoadjuvant treatment, the surgical technique, or even microbiological factors. New studies are necessary with the goal to determine which of these factors contributes in the most significant way, with the means to improve the results of this unpleasant esofagectomy complication. 1) VAN HAGEN, P. et al. Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer. New England Journal Of Medicine,[s.l.], v. 366, n. 22, p.2074–2084, 31 maio 2012. New England Journal of Medicine (NEJM/MMS). http://dx.doi.org/10.1056/nejmoa1112088.

Disclosure
All authors have declared no conflicts of interest.
PS02.113: NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY ESOPHAGECTOMY FOR LOCALLY BORDERLINE RESECTABLE THORACIC ESOPHAGEAL CANCER
Authors: Miyata Kazushi , Fukaya Masahide , Nagino Masato 
Published: September 2018

Abstract

Background
Nowadays, it has emerged that conventional neoadjuvant chemotherapy for locally borderline resectable esophageal cancer is not effective. However, it still remains controversial which treatment is best. We aimed to evaluate neoadjuvant chemoradiotherapy for locally borderline resectable esophageal cancer.

Methods
Twenty six patients (23 men, 3 women) who underwent esophagectomy after neoadjuvant chemoradiotherapy between January 2011 and December 2016 were subjected. Radiotherapy was administered at 40 Gy with concurrent chemotherapy which consisted of 5-fluorouracil and cisplatin for all 26 patients. The therapeutic effect of neoadjuvant chemoradiotherapy and surgical outcomes including rates of curative resection and pathological complete response, and postoperative complications were retrospectively reviewed. Postoperative complications were defined as any event requiring specific medical or surgical treatment, which were assessed by the Clavien-Dindo classification. The evaluation criteria of neoadjuvant chemoradiotherapy were assessed by the RECIST guideline (ver.1.1).

Results
For primary tumor, 24 patients showed partial response and 2 showed stable disease. Therefore, the response rate to the primary tumor was 92.3%. For metastatic lymph nodes, on the other hand, 11 patients showed partial response and 8 showed stable disease and 1 showed progressive disease, and the response rate was 55%. Two patients were unresectable, three patients had R2 resection, and the remaining 21 patients (81%) had curative resection (R0). In the R0 resected group, the 5-year survival rate was 57%. The median operative time, bleed loss, and postoperative hospital stays were 546 minutes (178–963), 720ml (262–5170) and 34days (17–99), respectively. Postoperative complications were observed in 22 patients. The incidences of more than grade2 postoperative pneumonia, vocal cord palsy, and anastomosis leakage were 8/26 (31%), 8/26 (31%) and 3/26 (12%). There were treatment-related mortality in 2 patients. Seven patients (27%) achieved histologically complete response.

Conclusion
Neoadjuvant chemoradiotherapy for locally borderline resectable esophageal cancer is effective in increasing curative resection rate. In addition, patients who underwent curative resection can expect long-term survival.

Disclosure
All authors have declared no conflicts of interest.