bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival after Yttrium-90 radioembolization in elderly and nonelderly patients with hepatocellular carcinoma or colorectal cancer liver metastases.
Authors: Redman Rebecca Ann , Coldwell Douglas , Sharma Vivek R. 
Published: February 2017

449 Background: Systemic treatment of unresectable hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (CLM) in the elderly can be complicated by increased toxicity. In addition, the increasing incidence of comorbidities with age may preclude surgical resection with curative intent. Hepatic arterial therapy is increasingly utilized in patients with HCC or CLM not amenable to surgical resection. Studies of transarterial chemoembolization in the elderly have generally shown similar safety and efficacy as compared to younger patients, although some studies suggest worse outcomes. The selective nature of radioembolization has the potential for improved tolerability in this patient population. Methods: We report the results of a retrospective review of patients with unresectable HCC or metastatic disease to the liver treated with Yttrium-90 radioembolization at a single institution. Results: Patients were referred for treatment after multidisciplinary evaluation, but were not treated as part of a clinical trial. A total of 94 patients treated were evaluable for follow up. There were approximately twice as many males as females (64% vs 36%). Elderly was defined as 70 years of age or older, representing 20 of the 94 patients. Average age of the elderly cohort was 76 (range 70-90), compared to 56 years of age (range 23-69) for the younger patients. Survival was measured from date of first radioembolization. Median survival was similar for elderly and younger patients when considering all tumor types (337 days vs 288 days). There was no difference in median survival between elderly and non-elderly patients with CLM (377 days vs 365 days) or with HCC (370 days vs 363 days). Conclusions: In our experience, survival after Yttrium-90 radioembolization in elderly and younger patients with primary HCC or CLM is similar. Age alone should not preclude consideration for liver-directed therapy.
FOLFIRINOX for the treatment of advanced pancreatic cancer: U.K. West Midlands experience.
Authors: Jain Ankit , Scott-Brown Martin , Correa Peter Denzil , Sothi Sharmila , Davies Amy , Candish Charles , Peake David , Tsalic Medy , Punia Pankaj , Ma Yuk Ting 
Published: February 2017

450 Background: The PRODIGE 4/ACCORD 11 trial demonstrated that FOLFIRINOX significantly improved response rates and survival in patients with metastatic pancreatic cancer, compared to gemcitabine. However this regimen is associated with significant toxicity. We have thus analysed the safety, tolerability and efficacy of FOLFIRINOX given outside a clinical trial setting. Methods: A retrospective analysis was conducted on all patients treated with FOLFIRINOX for advanced pancreatic cancer between July 2012 and July 2014, within the West Midlands region in the UK. Data was collected on baseline demographics, disease stage, toxicity and response to chemotherapy. Results: A total of 60 patients were identified (28 locally advanced, 32 metastatic). The median age was 59 (range 34-74) and 12% of patients were aged 70 or over. The primary tumour was located in the head of the pancreas in 68% of patients and 38% of patients had a biliary stent. All patients had an ECOG performance status of 0 or 1 (45% and 55% respectively), and had received no prior chemotherapy for advanced pancreatic cancer. FOLFIRINOX was commenced at reduced doses in 79% of patients, and subsequent dose reductions were required in 81% of patients. The median number of FOLFIRINOX cycles administered was 6 (range 1-14) but 33% of patients currently remain on treatment. Hospital admissions were required in 58% of patients but only 22% of hospital admissions were for neutropenic sepsis. FOLFIRINOX was discontinued in 30% of patients due to toxicity. There were no treatment related deaths. Of 40 patients who were eligible for assessment of response, 38% achieved a partial response and a further 45% achieved stable disease. Four patients with LA pancreatic cancer became suitable for curative surgical resection following chemotherapy; 2 of these also received chemoradiotherapy. The median overall survival for patients with metastatic disease was 12 months and the median overall survival for patients with locally advanced disease has not been reached. Conclusions: Our data shows that FOLFIRINOX can be safely delivered in a real world setting. Even with reduced doses, the response rates and survival outcomes are comparable with the results from the PRODIGE 4/ACCORD 11 trial.
Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios at the time of chemoradiation to predict survival in resected pancreatic cancer patients.
Authors: Xu Vanessa , Choi Enid , Hanlon Alexandra , Regine William , Chuong Michael David 
Published: February 2017

452 Background: Higher pre-treatment neutrophil-to-lymphocyte ratio (NLR) and lower platelet-to-lymphocyte ratio (PLR) are independent predictors for worse survival in cancer patients. The effect of chemoradiation (CRT) on NLR and PLR in pancreatic cancer patients who also undergo surgical resection has not been reported. Methods: A retrospective review was performed of pancreatic cancer patients treated at our institution with CRT either prior to or after surgery with curative intent. Overall survival was evaluated using Kaplan-Meier method. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: After excluding patients who did not have surgery, who received palliative radiation doses, or who had incomplete medical records, 81 out of 282 patients remained with median age 62 years (35-86). Of these, 24 (29.6%) were borderline resectable (BR) and received preoperative CRT while 57 (70.4%) received adjuvant CRT. Median total dose and number of fractions were 50.4 Gy (30-59.4) and 28 (5-33), respectively. Median pre-CRT and post-CRT NLR were 2.9 and 7.8, respectively. Median pre-CRT and post-CRT PLR were 211.3 and 457.5, respectively. Most patients had a decrease in NLR (85.2%) and PLR (72.8%) after CRT, with median changes of -4.95 for NLR and -178.33 for PLR. Cox proportional hazards analysis showed a trend towards significance for pre-CRT NLR (p=.08) regarding OS. A significant relationship was found between relapse free survival and both pre-CRT NLR (p=0.02) and PLR (p=0.01). The difference or percent change of neither NLR nor PLR was found to correlate with clinical outcomes. Conclusions: This is the first study to evaluate the effect of CRT on NLR and PLR in resected pancreas cancer patients. Similar to other reports, our data indicate that a significant relationship exists between NLR, PLR, and clinical outcomes. Identification of clinically meaningful NLR and PLR cut-off points for resected pancreatic cancer patients who also receive CRT is needed.
Outcome and cause of death of hepatocellular carcinoma patients with extrahepatic metastases.
Authors: Shiba Satoshi , Kondo Shunsuke , Sakamoto Yasunari , Sasaki Mitsuhito , Koga Futa , Hosoi Hiroko , Morizane Chigusa , Ueno Hideki , Okusaka Takuji 
Published: February 2017

456 Background: Sorafenib is an orally active multi-kinase inhibitor that has been approved for the treatment of advanced hepatocellular carcinoma (HCC). Advanced HCC patients often exhibit two co-existing and life-threatening factors, cancer and cirrhosis, complicating prognostic evaluations. The present study investigated the survival and causes of death of HCC patients with extrahepatic metastases in the sorafenib era. Methods: We retrospectively analyzed 72 HCC patients with extrahepatic metastases who had received sorafenib. The causes of death among the HCC patients were classified as either hepatic causes (HC) or non-hepatic causes (NHC). Each cause of death was analyzed in the two subgroups. We then compared and assessed their clinical features and outcomes using the Chi square test, the Kaplan-Meier method, and a multivariate analysis. Results: Of the 72 HCC patients (female/male, 12/60), 50 patients had died at the time of the analysis. The median age was 66 (range, 30-84) years. At the time when sorafenib was started, the number of patients with a performance status of 0, 1, or 2 was 63 (88%), 8 (11%), and 1 (1%), respectively, and the number of patients with Child-Pugh class A, and B were 67 (93%), and 5 (7%), respectively. The median survival time and the 1-year survival rate were 11.8 (95% confidence interval 5.3-18.3) months and 49.7%, respectively. The incidence of HC and NHC was 29 (58%) and 21 (42%), respectively. Differences between the HC group and the NHC group were examined according to the patient characteristics, and the following significant differences were observed: main portal vein invasion (P<.05), intrahepatic tumor stage (P<.05), alpha-fetoprotein (AFP) (P<.05), and the des-gamma-carboxy-prothrombin level (P<.05). A multivariate analysis showed that portal vein invasion (hazard ratio [HR] = 2.29, P<.05), a Child-Pugh B status (HR = 7.19, P<.01), and high serum levels of AFP (HR = 2.18, P<.05) were independent predictors of a poor outcome, respectively. Conclusions: This study revealed differences in the clinical characteristics at the time of the start of sorafenib between patients with HC and NHC death. The present results may be useful in the design and analysis of future clinical trials.
A retrospective study of FOLFOX in the treatment of patients with advanced duodenal adenocarcinoma: A Japanese single-center experience.
Authors: Yamada Ikuhiro , Ozaka Masato , Ishii Hiroshi , Sasahira Naoki , Takano Kouichi , Matsuyama Masato , Sasaki Takashi , Saito Kei , Osumi Hiroki , Suenaga Mitsukuni , Igarashi Masahiro 
Published: February 2017

457 Background: Duodenal adenocarcinoma is a rare tumor with poor prognosis. There is little data on the efficacy of chemotherapy for this disease. Methods: The current study included data from all consecutive patients who were diagnosed as having duodenal adenocarcinoma at our hospital between October 2008 and December 2013. Selection criteria were as follows: patients who 1) had histologically confirmed duodenal adenocarcinoma, 2) were diagnosed as having unresectable or recurrent disease, and 3) received first-line chemotherapy with infusional 5-FU, leucovorin and oxaliplatin (FOLFOX). We examined efficacy and toxicity of FOLFOX therapy from the case cards and analyzed their survival data. Results: There were 20 patients who met the selection criteria. The median age was 67.5 years (range, 35-76). Of the 20, 11 (45%) were male, 17 (85%) had a good performance status, 15 (75%) had received resection of the primary tumor, and 13 (65%) had a liver metastasis. They received median of 8 (range, 1-32) chemotherapy cycles. There was no complete response. Of the 20, 4 (20%) achieved partial response, 9 (45%) remained stable disease, 6 (30%) showed progressive disease and the remaining one did not have a CT evaluation. The median progression free survival and overall survival months from the initiation of FOLFOX therapy were 5.0 and 11.7, respectively. Grade 3/4 toxicities were observed in 9 (45%). Although there was no febrile neutropenia, grade 3/4 neutropenia was observed in 7 (35%). Treatment-related death due to pneumonitis was documented in one. Whereas prognostic factor was not found in multivariate analysis, a peritoneum metastasis tended to be associated with poor progression free survival (p=0.06). Conclusions: The FOLFOX therapy shows moderately activity with acceptable toxicities for the treatment of advanced duodenal adenocarcinoma.
Effect of renin-angiotensin system (RAS) inhibition on survival in advanced ductal adenocarcinoma (PDAC).
Authors: Winston Rachel , Weiss Glen J. , Baldwin Ashley , Frank Samuel , Tims Lucas , Brooks Nakia Lashawn , Kundranda Madappa N. 
Published: February 2017

464 Background: Advanced PDAC portends a poor survival due to several factors including development of resistance to therapies via tumor-stromal interactions. In preclinical studies, RAS inhibition has been implicated in PDAC development due to its anti-inflammatory effect by reducing pancreatic inflammation and fibrosis via suppressed activation of pancreatic stellate cells. Methods: A retrospective analysis was conducted at two institutions in North America of patients (pts) with advanced PDAC receiving palliative chemotherapy. Data collection included age, gender, ECOG, prescription for an angiotensin I-converting enzyme inhibitors (ACEIs) and/or angiotensin II type-1 receptor blockers (ARBs), and overall survival (OS). Statistical analysis included Kaplan Meier survival analysis along with the log-rank test to compare treatment strata. Additionally, multivariate analyses were performed using a Cox proportional hazard model. Results: The 403 pts included had a median age of 61 years (range: 25-86 yrs); 176(43%) were women and 329 (>80%) had an ECOG performance status of 0 or 1. A majority of patients received combination therapy that was either gemcitabine or 5-flurouracil based. 57 (14%) received ACEIs and 25(6.2%) received ARBs. There was no statistically significant difference in median OS between those prescribed ACEI or ARB and those who were not (13.7 vs. 14.2 months; p=0.432). Subgroup analysis of ACEI vs. no ACEI or ARBs vs. no ARBs was similar (ACEI =13.8 vs. 14.2 months (p=0.741) and ARB=13.7 vs. 14.2 months (p=0.405). In addition, ACEI vs. ARB showed similar results 13.8 months (ACEIs) vs. 13.7 months (ARBs) (p=0.687). Conclusions: Our study did not demonstrate a statistically significant difference in OS between advanced PDAC patients in North America that were prescribed ACEI, ARB, or to those who were not. Compliance with taking prescribed ACEI or ARB medications could not be determined. A prospective phase 2 study in a Japanese population using the combination of gemcitabine and candesartan (an ARB) did not demonstrate a survival benefit with the combination. Based on these clinical evaluations, use of ACEI or ARB to take advantage of blocking RAS in advanced PDAC cannot be supported.
Comparative efficacy of S-1 versus best supportive care in advanced hepatocellular carcinoma.
Authors: Yu Pengfei 
Published: February 2017

466 Background: S-1, an oral fluoropyrimidine derivative, has been shown to be clinically effective against hepatocellular carcinoma (HCC). We carried out a retrospective study to evaluate the efficacy of S-1, compared to best supportive care (BSC) in patients with advanced hepatocellular carcinoma. Methods: From 2009.12 to 2013.12, 32 cases of advanced hepatocellular carcinoma (the presence of extrahepatic metastasis or locally advanced disease not amenable to surgical resection or other locoregional therapies) were retrospectively analysed. 18 patients received S-1 (80 mg/m2/day, administered during days 1~14 and repeated every 21 days) and 14 patients received best supportive care (BSC). The time to progression (TTP), overall survival (OS) and safety were assessed. Results: 17 of 32 (53.1%) patients had metastatic disease, including the retroperitoneal lymph nodes (7 cases), lung (4 cases), supraclavicular lymph nodes (3 cases), abdominal wall (3 cases), brain (2 cases) and adrenal glands (2 cases). 12 patients (37.5%) had portal vein tumor thrombus. The two groups were well matched at baseline. In S-1 group,a total of 63 cycles were administered with median of 3.5 cycles (range, 2~7).The most common grade 3/4 toxicities were thrombocytopenia (28.1%), neutropenia (21.8%), elevated serum aspartate aminotransferase levels (15.6%) and rash (9.4%). A patient (5.6%) had a partial response,11 (61.1%) had stable disease, and 6 (33.3%) had progressive disease. Median TTP was 4.7 months in the S-1 group compared with 2.3 months in the BSC group (P=0.013). Overall survival was 15.1 months in patients treated with S-1, compared with 8.3 months in those who received BSC (P=0.027). Conclusions: S-1 showed an acceptable safety profile and benefit in survival in patients with advanced HCC.The conclusion needs further evaluation in randomized clinical trials.
Changing epidemiology of gastric sarcomas in the United States.
Authors: Lin Albert Y. , Ravdin Peter 
Published: February 2017

47 Background: The introduction of imatinib as targeted therapy for the treatment of gastrointestinal stromal tumors (GIST) has supplied a strong impetus for the reclassification of gastric sarcomas (GS). We examined the changes in the incidence and mortality over the last 20 years for GS subtypes using the Surveillance, Epidemiology, and End Results (SEER) database over the last 20 years. Methods: Based on information from SEER, GS cases were identified by primary cancer site and ICD-O-3 codes. SEER*stat was used to make estimates of incidence and cause specific survival. Joinpoint software was used to test for trends. Results: The overall incidence of GS increased of from 1991 and to 2011 from 2.9 (standard error [SE] 0.4) to 6.6 (SE 0.6) cases per million per year. The histologic subtypes of changed over this time interval with the leiomyosarcoma being initially the leading GS subtype with an incidence from 2.3 (SE 0.4) decreasing to 0.1 (SE 0.1). The incidence of gastric GIST increased from 0.1 (SE 0.1) to 6.3 (SE 0.6) representing 95% of all GS cases in 2011. For GS test for trend with Joinpoint model did not detect a discontinuity in the trend (occurring at a rate of 4.7% [p < 0.001]) relative increase per year. Much of the total GS increase in incidence was for localized disease with the incidence rates which increased from 1.2 to 4.5 cases per 10^6/year a relative increase of 6.8% (p < 0.01) per year. During this period the 3-year cause specific mortality improved for localized GS from 9.4% to 0.9%. Improvements were also seen for mortality outcomes for regional and distant disease. Conclusions: Between 1991 and 2011, more than a doubling of incidence of GS was observed with a concurrent rapid change in GIST - most in localized disease and a dramatic improvement in its outcome. It seems unlikely that this is due to changes in the underlying biology of the disease, or to imatinib alone, but may be, in part, due to changes in diagnostic techniques or pathologic evaluation
Evaluation of dynamic tumor-tracking IMRT for patients with pancreatic cancer using gimbaled linac of vero system.
Authors: Nakamura Akira , Nakamura Mitsuhiro , Itasaka Satoshi , Kishi Takahiro , Ishihara Yoshitomo , Mukumoto Nobutaka , Akimoto Mami , Mizowaki Takashi , Kokubo Masaki , Hiraoka Masahiro 
Published: February 2017

481 Background: We have started dynamic tumor-tracking intensity-modulated radiotherapy (DT-IMRT) using the gimbaled linac of Vero4DRT from June 2013. This study reports the first clinical evaluation of DT-IMRT for patients with locally-advanced pancreatic cancer (LAPC). Methods: Five patients with histologically proven LAPC and written informed consent were enrolled. One Visicoil fiducial marker was percutaneously or endoscopically inserted inside the tumor. DT-IMRT was performed with the gimbaled X-ray head which can swing the intensity-modulated beam towards the moving tumor based on a correlation model of external-to-internal motion. During the beam delivery, the Visicoil was continually monitored with the kV and MV imagers mounted on the gantry of the Vero4DRT, and the correlation model was recalibrated when needed. An escalated dose of 45-51 Gy in 15 fractions was delivered to the planning target volume (PTV) with concurrent full-dose gemcitabine (1,000 mg/m2). The following factors were evaluated: the differences in PTV volume and the absolute volume receiving 39Gy or 42Gy (V39 or V42) for stomach and duodenum between DT-IMRT and a conventional technique; positional errors between the predicted tumor and irradiated positions; in-room time for the daily treatment; and radiotherapy-induced toxicities. Results: The mean reduction in PTV volume was 15%. The planned V39/V42 to stomach and duodenum were reduced approximately by 92%/96% and 83%/91%, respectively, when compared with a conventional technique, while tumor doses were comparable. The 95th percentiles of positional errors were within 2.5, 2.8, and 3.2 mm in left-right, anterior-posterior, and cranio-caudal directions, respectively. The mean in-room time was 24.5 minutes. All patients completed the planned radiotherapy and concurrent full-dose gemcitabine. There were mild hematological toxicities, but no severe gastrointestinal toxicities directly attributable to the DT-IMRT. Conclusions: A safe dose-intensification was achieved applying DT-IMRT for patients with LAPC, based on the high accuracy for tumor-tracking and the reductions in PTV volume and high-dose volume in critical organs.
Efficacy of chemotherapy after self-expanding metal stent placement for gastric outlet obstruction caused by an unresectable malignant tumor.
Authors: Yamamoto Taikan , Miyashita Kouichirou , Shimada Ken , Sekikawa Takashi , Uto Yu , Nunoue Toshikazu , Kaga Yasuhiro , Kitahara Yu , Saito Yusuke , Kobayashi Kouji , Kinugasa Eriko 
Published: February 2017

484 Background: Gastric outlet obstruction (GOO) is a late complication of advanced and metastatic malignant tumors. Self-expanding metal stent (SEMS) placement is a safe and effective palliative treatment for patients with GOO. In general, the median survival time after SEMS placement for GOO is approximately 90 days, and advanced chemotherapeutic treatment could further improve prognosis. Methods: This retrospective study aimed to analyze the efficacy of chemotherapy after SEMS placement on improvement of oral intake and survival time. Eight patients with symptomatic malignant GOO were treated by SEMS placement in our hospital. Surgical bypass could not be performed due to severe advanced malignant tumors. Patients were classified into two groups depending on whether they received chemotherapy after SEMS placement. Group A included five patients who were treated with palliative therapy alone (median age: 72 years; cases 1, 2, 3, and 4 with advanced gastric cancer, and case 5 with advanced pancreatic carcinoma). Group B included three patients who were treated with palliative therapy, followed by chemotherapy (median age: 68 years; case 6 with advanced pancreatic cancer treated with gemcitabine chemotherapy; case 7 with advanced gastric carcinoma treated with TS-1 and paclitaxel chemotherapy; and case 8 with duodenal stenosis due to advanced colonic carcinoma treated with irinotecan and cetuximab chemotherapy after SEMS placement). We estimated the gastric outlet obstruction scoring system (GOOSS ; no oral intake: 0; only liquids: 1; soft solids: 2; low-residue or full diet: 3) and survival time as the main outcomes. Results: SEMS placement using endoscopy was successful in all cases. No complications occurred after the procedure. Performance status did not change after SEMS placement. GOOSS improved from 0 to 1 in group A and from 0 to 2 in group B. Median survival time was 68 days in group A and 188 days in group B. We considered chemotherapy after SEMS contributed lifetime. Conclusions: Our study findings indicate that SEMS placement is a safe and effective method for managing malignant GOO and that chemotherapy after SEMS placement can improve diet intake and prognosis.