bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of moisturizers on prevention of hand-foot syndrome associated with capecitabine plus oxaliplatin.
Authors: Kawakami Kazuyoshi , Suenaga Mitsukuni , Yokokawa Takashi , Sugita Kazuo , Mae Yutaro , Nakamoto Eri , Imada Hiroshi , Mizunuma Nobuyuki , Yamaguchi Toshiharu , Hama Toshihiro 
Published: February 2017

681 Background: Capecitabine plus oxaliplatin (XELOX) has been established as first-line treatment for patients with metastatic colorectal cancer. Hand-foot syndrome (HFS) is the most common toxicity associated with capecitabine, and the mechanism of which remains to be clarified. Appropriate management of HFS for continuing treatment is needed to ensure improved survival. In this study, we evaluated the efficacy of our candidate moisturizers for HFS, considering its compliance in each patient at a single institute. Methods: Patients who received XELOX for metastatic colorectal cancer at the Japanese Foundation for Cancer Research, Cancer Institute Hospital, between Apr 1 2010 and Apr 30 2011 were included in this study. Pharmacists conducted the skin care for HFS using moisturizers: heparinoid ointment, a mixture of vitamin A oil and white petrolatums (1:1). All HFS events were graded according to NCI–CTC, version 4.0. The relationship between accumulated dose of capecitabine and incidence of HFS events stratified by frequency of daily moisturizers application was analyzed by using the Kaplan-Meier method. P value of <0.05 was considered significant. Results: Moisturizers were applied two or more times a day in 45 patients (Good compliance group) and once a daily in 28 patients (Poor compliance group). In terms of incidence of grade ≥1 HFS, no significant differences were observed between good compliance group and poor compliance group (p = 0.764). Incidence of grade ≥2 HFS was observed slightly higher in the poor compliance group than in the good compliance group, though the differences were not statistically significant (p = 0.286). Conclusions: The onset of capecitabine-associated HFS is independent of frequency of using moisturizers. However, more frequent application of moisturizers appeared to have a possibility to prevent severe HFS. Assessment for compliance with the moisturizers is important as well as patient-compliance-instruction by pharmacist.
Sentinel lymph node mapping for T1 esophageal cancer.
Authors: Takeuchi Hiroya , Kawakubo Hirofumi , Saikawa Yoshiro , Nakahara Tadaki , Omori Tai , Mukai Makio , Kitagawa Yuko 
Published: February 2017

7 Background: Extended radical esophagectomy with three-field lymph node dissection has been recognized as the standard procedure for thoracic esophageal cancer in Japan, even for clinically T1N0 cases. However, to eliminate the uniform application of the highly invasive surgery, we hypothesized that sentinel lymph node (SLN) mapping would play a key role to obtain individual information and allows modification of the surgical procedure for early esophageal cancer. Methods: We have established radio-guided method to detect SLNs in patient with early esophageal cancer using endoscopic injection of technetium-99m tin colloid. Preoperative lymphoscintigraphy and intra-operative use of hand held gamma probe were reliable to locate the radioactive SLNs. Intra-operative gamma probing was also feasible in thoracoscopic or laparoscopic surgery using a special gamma detector which is introducible from trocar ports. Results: SLN mapping has been performed for 70 patients with clinically N0 and early (pT1) esophageal cancer in our institute since 1999. Detection rate of hot node using our procedure was 94% (66/70). The mean number of sentinel nodes per case was 4.6. Twenty-one of 23 cases (91%) with lymph node metastasis showed positive SLNs. Accuracy of metastatic status based on SLN was 97% (64/66). SLNs widely spread from cervical to abdominal areas. In more than 80% of the cases, at least one SLN was located in the 2nd or 3rd compartment of regional lymph nodes. However, 56 (85%) of 66 patients had no lymph node metastasis or metastasis (+) only in SLNs. Conclusions: Our results suggest that SLN concept for clinically N0 and T1 esophageal cancer could be validated. Theoretically more than 80% of patients with pT1b esophageal cancer may be controlled by local treatments such as surgery and chemoradiotherapy targeting primary tumors plus their SLNs. Individualized selective and modified lymphadenectomy targeted on SLN basins for clinically N0 early esophageal cancer should become feasible and clinically useful as less invasive surgical procedures.
Interim results of a phase II study of the mTOR inhibitor everolimus in patients with pretreated metastatic gastric and esophageal adenocarcinoma.
Authors: Wainberg Zev A. , Patel Ravi , DiCarlo Brian , Park David J , Kass Frederic C. , Liem Andre K. D. , Wang He-jing , Martinez Diego , Hecht J. Randolph 
Published: February 2017

80 Background: There is increased evidence that cancers of the upper GI tract are comprised of distinct epidemiological and molecular entities that may respond differently to anti-cancer therapy in Asian patients compared to North American patients. Everolimus, an oral inhibitor of the mammalian target of rapamycin (mTOR) showed clinical promise in a phase II study in Japanese patients with pre-treated metastatic gastric cancer with a disease control rate of 56% (Doi et al, JCO, 2010). This study evaluates the efficacy and safety of everolimus in patients with pre-treated metastatic gastric and esophagus cancers in a US population. Methods: Patients with advanced upper GI adenocarcinomas who experienced disease progression despite 1-2 prior regimens were treated with everolimus 10 mg PO daily. The primary endpoint was disease control rate (DCR; CR+PR+SD). Secondary end points included progression free survival (PFS), toxicity, overall survival (OS) and translational correlatives of the mTOR pathway. Results: Of the 40 patients enrolled to date, 19 have gastric, 7 have esophagus and 14 have tumors from the GEJ. 32 patients are evaluable to date: median age of 59 (range 36-79), all patients had an ECOG of 0 or 1; 11 (34%) received 1 prior regimen and 21 (64%) received 2 prior regimens. We observed 0 responses with 44% of evaluable patients having stable disease. Median overall survival was 5.6 months (95% CI: 3.2-7.6) and PFS was 1.8 months (95% CI: 1.6-2.2). 89% of all adverse events were grade 1-2, and 11% were grade 3-4. Grade 3-4 related adverse events include: fatigue (24%), thrombocytopenia (22%), anemia (9%). Updated results of translational correlatives with the mTOR pathway will be presented. Conclusions: We did not achieve the same degree of overall survival or disease control as in the Japanese study which may reflect differences in the locations of the primary tumor or underlying geographic variation. However, OS is significantly better than best supportive care reported in a recent randomized European trial (Thuss-Patience PC et al, Eur J Cancer 2011). Results of the randomized Phase III trial of everolimus vs best supportive care in this patient population are pending.
Changing national trends and survival in stage IV gastric cancer.
Authors: Leung Anna M. , Chiu Connie G. , Hari Danielle M. , Sim Myung-Shin , Bilchik Anton J. 
Published: February 2017

81 Background: With more effective systemic chemotherapy, the role for palliative gastrectomy in patients with Stage IV gastric cancer has been questioned. Methods: Using the National Cancer Data Base we identified 29,655 patients with Stage IV gastric cancer over a 14 year period (1994-2008). Patient demographics, tumor related features, and treatments were analyzed. Overall survival rates were examined using log-rank test power analysis. Results: There was a decrease in surgical resection from 31.2% in 2000 to 22% in 2008 (p<0.0001), a decrease in radiation from 20% in 2000 to 18.5% in 2008 (p= 0.0009), and an increase in systemic therapy from 45.5% in 2000 to 55.1% in 2008 (p<0.001). There were no differences in gender, age, or histology, but there was a decreasing trend of Caucasians diagnosed (p<0.0001). Survival rates decreased significantly over time p<0.05 (see table below). Conclusions: Over the past 14 years there has been an increase in the use of systemic chemotherapy and a reduction in palliative gastrectomy for stage IV gastric cancer. The negative impact on survival suggests that treatment pathways be re-evaluated. [Table: see text]
Nomograms for prognostication of patients with esophageal and gastroesophageal carcinoma undergoing definitive chemoradiotherapy.
Authors: Suzuki Akihiro , Xiao Lianchun , Hayashi Yuki , Blum Mariela Anabel , Welsh James , Lin Steven H. , Lee Jeffrey H , Bhutani Manoop S. , Weston Brian , Maru Dipen , Rice David C. , Hofstetter Wayne Lewis , Erasmus Jeremy J. , Swisher Stephen , Ajani Jaffer A. 
Published: February 2017

82 Background: Level-1 evidence for definitive chemoradiotherapy (bimodality therapy or BM therapy) has been established for patients with esophageal and gastroesophageal junction cancers (EGEJC) who otherwise do not qualify for surgery; however, tools to estimate individual patient’s prognosis are unavailable. We used a number of clinical pre-treatment and post-treatment parameters to establish two nomograms (for overall survival [OS] and relapse-free survival [RFS]). Methods: From 2002 through 2010, 257 consecutive patients with EGJEC who received BM therapy and had pre- and post-treatment positron emission tomography (PET) and post-treatment endoscopic biopsies among other assessments were analyzed from a prospectively maintained database. Standard statistical methods were used to generate the nomograms. Results: The median follow -up time was 39.2 months (95% confidence interval [CI], 35.7 – 50.1). None of 257 patients underwent surgery. Persistent or recurrent cancer was documented in 187 (72.8%) patients. The estimated median survival duration for all 257 patients was 21.1 months (95% CI, 18.9-27.1) and median RFS duration was 11.6 months (95% CI, 9.43-15.0). The estimated OS and RFS rates at 3 years were 37.3% (95% CI, 31.2%-44.7%) and 25.1% (95% CI, 19.9%-31.6%), respectively. After BM therapy, 155 (60.3%) patients achieved a clinical complete response (cCR). In the multivariate analyses, initial standardized uptake value maximum and cCR were independent prognostic variables for OS (P=0.038, P<0.001). Nomogram concordance indices of 0.70 for OS and 0.77 for RFS were established by 200 bootstrap resampling for each of the two outcomes. Conclusions: Our data suggest that in patients with EGEJC, pre- and post-treatment clinical parameters contribute to the establishment of OS and RFS prognostic nomograms. Upon validated, these nomograms could prove useful in the clinic to individualize therapy.
Prognostic significance of lymphadenectomy in patients with esophageal cancer receiving neoadjuvant chemoradiation.
Authors: Vijapura Charmi , Shridhar Ravi , Weber Jill M. , Hoffe Sarah E. , Deneve Jeremiah Lee , Barthel James S. , Karl Richard C. , Meredith Ken , Almhanna Khaldoun 
Published: February 2017

87 Background: The optimal number of lymph nodes that should be harvested in esophageal cancer patients remains to be defined, particularly in patients that receive neoadjuvant therapies. We investigated the impact of nodal resection and survival in esophageal cancer patients treated with neoadjuvant chemoradiation (NT). Methods: Using our comprehensive esophageal cancer database we identified patients treated with NT followed by esophagectomy between 2000-2011. Clinical and pathologic data were compared using Fisher’s exact and chi-square while, Kaplan Meier estimates were used for survival analysis. Overall (OS) and disease-free survival (DFS) were compared with varying numbers of lymph nodes resected <10 and ≥10 (ST-1), <12 and ≥12 (ST-2), and <15 and ≥15 (ST-3). Multivariate analysis was analyzed by the Cox proportional hazard model. Results: We identified 358 patients treated with NT and esophagectomy with a median follow-up of 18.5 months (range, 0-116 months). There was no survival benefit demonstrated for patients with increased lymph nodes removed during their surgery (ST-1 OS p=0.400, DFS p=0.8727; ST-2 OS p=0.6833, DFS p=0.6092; ST-3 OS p=0.1798, DFS p=0.4028). Patients were further stratified by pathologic response to NT and nodal harvest. There were no differences in OS or DFS in patients with increased nodal harvest when analyzed by complete (pCR) (ST-1 OS p=0.7278, DFS p=0.3602; ST-2 OS p=0.6182, DFS p=0.3592; ST-3 OS p=0.4489, DFS p=0.6976), partial (pPR) (ST-1 OS p=0.3762, DFS p=0.5061; ST-2 OS p=0.8036, DFS p=0.6497; ST-3 OS p=0.0890, DFS p=0.3364), or non response (pNR) (ST-1 OS p=0.6825, DFS p=0.7161; ST-2 OS p=0.7084, DFS p=0.8351; ST-3 OS p=0.5002, DFS p=0.7314) to NT. Multivariate analysis demonstrated that age (p=0.028), t-stage (p=0.006), pPR (p=0.025), and pNR (p<0.0005) to NT were all independent predictors of mortality. Conclusions: In our experience, the number of lymph nodes resected was not predictive for overall or disease free survival in esophageal cancer patients treated with NT. In addition, extended lymph node resection did not improve survival for those with residual disease.
Adenocarcinomas of the esophagogastric junction: How does surgeon’s assessment influence the fate of patients?
Authors: Bogoevski Dean , Mina Sormeh , Kutup Asad , Bockhorn Maximilian , Reeh Matthias , Rösch Thomas , Izbicki Jakob Robert 
Published: February 2017

92 Background: Due to controversial staging systems, classifying tumors of the esophagogastric junction (EGJ) and the choice of the following surgical therapy remains a delicate affair. Methods: In this study the impact of the preoperative surgical-clinical assessment concerning assorting tumors of the EGJ was evaluated in correlation to the patient’s outcome. We analyzed clinicopathological data from 92 patients who were pre- and intraoperatively classified as distal esophageal cancer (Type I) and thus underwent esophagectomy with gastric tube reconstruction and who afterwards (final histology) in part turned out to be cardia/gastric cancers (Type II). Results: Patients with Type II cancers showed significantly more frequent lymphonodal metastasis (p=0.022) and higher recurrence rates (p=0.01), especially distant metastatic recurrence (p=0.03). Cancer-related death was also significantly higher (p=0.002) and recurrence-free survival was significantly shorter (median: 22 vs. 57 months, p=0.027). Also the thoracoabdominal approach (TA) had a favourable influence on patients’ outcome compared to the transhiatal approach (TH). Conclusions: The correct preoperative assessment of tumors of the EGJ and the appropriate surgical therapy are crucial for the outcome of the patient. Those patients with Type II cancers might experience a survival benefit by undergoing radical combined esophago (-hemi)gastrectomy with colon interposition.
Safety and oncologic outcomes of robotic-assisted esophagogastrectomy.
Authors: De La Fuente Sebastian G. , Weber Jill M. , Hoffe Sarah E. , Shridhar Ravi , Almhanna Khaldoun , Karl Richard C. , Meredith Kenneth 
Published: February 2017

93 Background: The introduction of robotic systems to surgical oncology has allowed improved visualization with more precise manipulation of tissues. In esophageal cancer patients, this is crucial since most patients undergo neoadjuvant therapy (NT) prior to surgical resection. We report our initial experience in patients undergoing robotic-assisted Ivor-Lewis esophagogastrectomy (RAIL) for oncologic purposes at a large-referral center. Methods: A retrospective review of all consecutive patients undergoing RAIL from 2010-2011 was performed. Basic demographics such as age, gender, and body mass index (BMI) were recorded. Oncologic outcomes include tumor type, location, NT, post-operative tumor margins, and nodal harvest. Immediate 30-day postoperative complications were also recorded. Results: We identified 50 patients who under went RAIL with median age of 66 (42-82 years). The mean BMI was 28.6 ± 0.7, 67% of patients received NT and 54% had an ASA classification of 3. The mean and median number of lymph nodes retrieved during surgery was 20 ± 1.4 and 18.5 (8-63) respectively. R0 resections were achieved in all patients. The mean estimated blood loss was 146 ± 15 ml and there were no conversions to an open procedure. Postoperative complications occurred in 13 (26 %) of patients. Complications included atrial fibrillation 5 (10%), pneumonia 5 (10%), anastamotic leak 1 (2%), conduit staple line leak 1(2%), and chylous thorax 2 (4%). There were no wound infections documented. The median ICU stay and length of hospitalization (LOH) were 2 and 9 days respectively. Total mean operating time calculated from time of skin incision to wound closure was 453 ± 13 minutes. The mean operative time significantly decreased over time (first 23 cases 479 min vs. second 23 cases 428 min, p<0.05). Similarly the frequency of complications decreased significantly after 28 cases: 10 (35%) vs. 3 (13%) p=0.04. There were no in hospital mortalities. Conclusions: We demonstrated that RAIL for esophageal cancer can be performed safely with acceptable oncologic outcomes. RAIL may be associated with fewer complications after a learning curve, and shorter ICU stay and LOH.
Perioperative chemotherapy for upper gastrointestinal cancer: Correlation between response to treatment and outcome.
Authors: Alcindor Thierry , Ferri Lorenzo , Ades Steven , Andalib Amin , Al-Baimani Khalid , Hickeson Marc , Artho Giovanni , Chasen Martin Robert , Marcus Victoria , Thirlwell Michael P. 
Published: February 2017

95 Background: Perioperative chemotherapy improves outcomes of surgery for upper GI cancer. Some patients have rapid recurrence. We hypothesized that any type of response to chemotherapy would predict better disease-free survival (DFS). Methods: From May 2007 to Sep 2009, 43 patients with operable adenocarcinoma of the esophagus, stomach or gastroesophageal junction went on a multicenter phase II trial. 3 cycles of docetaxel/cisplatin/5FU were given pre and post surgery. We compared DFS between responders and nonresponders after 3 cycles. Clinical response was defined as improvement of ≥ 2 points on a dysphagia score (0: normal swallowing, to 4: total obstruction), metabolic response as ≥ 35% reduction of maximum SUV by PET scan. Lack of nodal involvement or significant histologic regression (less than 50% viable tumor) was considered pathologic response. Log-rank test was used for univariate analysis, Cox regression model for multivariate analysis. All p values are double sided, median follow-up from surgery is 808 days. Results: Clinical response data for 29/40 patients: 26 responses (90%). Median DFS was 405 days for clinical responders vs. 210 days for nonresponders (p= 0.018). Metabolic response data for 28/40 patients : 22 responses (70%). Median DFS was 276 days in metabolic nonresponders, and has not been reached in responders (p = 0.009). 14 patients had no nodal involvement at resection (N0) and had longer DFS (median not reached) than the 26 with N+, who had median DFS of 562 days (p = 0.045). A nonsignificant trend (p = 0.192) was seen in favor of the 20 with significant tumor regression (DFS 565 days) compared to the 20se without it (median DFS not reached). All results were supported by multivariate analysis. Conclusions: These preliminary results indicate that clinical, metabolic and pathologic responses may be individually predictive of longer DFS in patients receiving perioperative chemotherapy for upper GI adenocarcinoma. This requires confirmation in larger datasets. The optimal management of nonresponders is unclear at present. Acknowledgements: Biostatistics Unit (McGill University Health Centre) and Cedars Cancer Institute (Henry R Shibata Fellowship to Dr Alcindor).
Validation of a panel of cell-cycle progression genes for improved risk stratification in a contemporary radical prostatectomy cohort.
Authors: Cooperberg Matthew R. , Simko Jeffrey , Cowan Janet E. , Reid Julia E. , Bhatnagar Satish , Gutin Alexander , Lanchbury Jerry S. , Stone Steven , Carroll Peter 
Published: February 2017

10 Background: Using clinical parameters, prostate cancers can be risk-stratified to aid treatment decisions. However, novel biomarkers are needed to predict tumor behavior more accurately. We aimed to validate the ability of a previously described 46-gene expression panel consisting of 31 cell-cycle progression (CCP) genes and 15 “housekeeping” genes to predict recurrence in a contemporary cohort of men undergoing radical prostatectomy (RP). Methods: Patients undergoing RP at UCSF since 1994 with ≥5 years of follow-up were included. RNA was extracted from archival RP tissue, and CCP score was calculated as average expression of the 31 CCP genes. Recurrence was defined as 2 PSAs ≥0.2 ng/ml or any salvage treatment at least 6 months after surgery. CCP score association with recurrence was assessed in univariate survival analysis and adjusted for PSA at diagnosis, pathologic Gleason score, margin status, extracapsular extension, seminal vesicle invasion, lymph node invasion. These variables were considered as separate covariates and as measured by the validated CAPRA-S score. Results: 413 men were included, 82 recurred. Most had low- to intermediate-risk pathology (mean CAPRA-S 2.1 ± 1.8). CCP scores ranged from -1.62 to 2.16; the mean was -0.28 ± 0.63. CCP score was associated with recurrence, HR 2.1 per CCP score unit (95% CI 1.6-2.9), p<0.0001. With adjustment for pathologic variables, patient age, and year of surgery, HR was 2.0 per CCP score unit (1.4-2.9), p<0.0001; and with adjustment for CAPRA-S score, the HR was 1.7 per CCP score unit (1.3-2.3), p<0.001. By likelihood ratio testing, adding the CCP score to the CAPRA-S improved accuracy significantly (LR χ2 11.4, p<0.0001). Based on Kaplan-Meier analysis, CCP score adds useful discrimination to both the overall cohort and for patients with clinically low-risk disease (CAPRA-S score 0-2). Conclusions: In a contemporary post-RP cohort, the CCP score was validated to have significant prognostic accuracy even when controlling for clinical and pathologic data. The score has potential to substantially improve accuracy of risk-stratification, and lead to better decision-making with respect to timing and intensity of treatment.