bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of adjuvant chemoradiation to peri-operative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma.
Authors: Kim Haerin , Kollmannsberger Christian K. , Schellenberg Devin , Cheung Winson Y. , Lim Howard John 
Published: February 2017

103 Background: Currently there are several accepted peri-operative treatment modalities for the resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In the 2008, peri-operative chemotherapy (CRT) using the MAGIC was adopted as the preferred approach to adjuvant chemoradiation with the MacDonald protocol (cXRT) in the British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from the pharmacy records of patients (pts) referred to 1 of 5 cancer treatment in BC were analyzed from 2001- July 2010. Pts that underwent curative resection for GC or GEJ were only included. cXRT cohort was defined from Jan 2001-Dec 2007, prior to the CRT era. CRT cohort started from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: The Table summarizes the patient characteristics. In the CRT arm, there were more males, less pts with a LN ratio >0.2 and shorter median follow-up. 92.1% completed the pre-op chemotherapy and 44.7% completed post-op chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). 1 yr survival was similar between the 2 cohorts. Median overall survival was not reached in the CRT arm and was 64.1 months in the cXRT arm. Conclusions: Delivery of CRT was similar to that in the MAGIC trial. Outcomes of CRT compared to cXRT appears to be similar in this cohort to cohort study with similar 1 yr survival. Pre-operative CRT results in less pts with a LN ratio > 0.2. Further follow-up is needed with respect to relapse and overall survival. Either modality can be considered for peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]
Processes of care in curative therapy for gastric cancer: A RAND/UCLA appropriateness study.
Authors: Brar Savtaj Singh , Law Calvin , McLeod Robin S. , Paszat Lawrence Frank , Helyer Lucy K. , Seevaratnam Rajini , Cardoso Roberta , Mahar Alyson L. , Yohanathan Lavanya , Bocicariu Alina , Coburn Natalie G. ,   Gastric Cancer Processes of Care Expert Panel
Published: February 2017

104 Background: Processes of care in curative therapy for gastric cancer are ill-defined, have significant variations and may impact patient outcomes. Methods: A multi-disciplinary expert panel (16 physicians, 6 countries) scored 595 scenarios using the RAND/UCLA Appropriateness Methodology. Appropriateness was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores from 1-3 were considered inappropriate, 4-6 uncertain, and 7-9 appropriate. Agreement was reached when 11 of 16 panelists scored the statement similarly. If a statement was agreed to be appropriate, it was given a necessity score in the same manner. Results: Open gastrectomy was considered appropriate for all patients and necessary for patients with N2-3 disease, while laparoscopic gastrectomy was appropriate for patients with T1-2 N0 disease. D1 lymph node dissection (LND) was considered appropriate for T1 N0 disease. For all others, D2 LND was considered appropriate and necessary. It was appropriate to assess at least 15 LN. Intraoperative pathologic assessment of the proximal margin was considered appropriate for gross margins <5 cm or T3/T4 lesions. If the margin was positive on frozen section, re-resection of the stomach or abdominal esophagus was considered appropriate for N1-3 disease and necessary for N0 disease. Curative resection was appropriate if a patient presented with perforation. Neoadjuvant chemotherapy was considered appropriate for patients who presented with T1-2 N2-3 or T3-4 N0-3 disease with minor symptoms but not with major symptoms. Adjuvant chemoradiotherapy was considered appropriate and necessary for patients with T1-2 N1-3 or T3-4 N0-3 disease. No adjuvant therapy was considered appropriate for patients with T1N0 disease. Conclusions: The above criteria have been found to be appropriate and necessary for the curative treatment of patients with gastric cancer and may be used to improve processes and quality of care.
Role of repeat staging laparoscopy in locoregionally advanced gastric cancer after completion of neoadjuvant therapy.
Authors: Cardona Kenneth , Zhou Qin , Gönen Mithat , Strong Vivian E. , Brennan Murray F. , Coit Daniel G. 
Published: February 2017

11 Background: Staging laparoscopy (SL) can identify occult, subradiographic metastatic disease, either visible or cytologic, defining patients with stage IV gastric cancer who are unlikely to benefit from gastrectomy. The purpose of this study was to characterize the yield of repeat SL performed immediately prior to gastrectomy following administration of neoadjuvant therapy for locoregionally advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma. Methods: Retrospective review of a prospective database identified patients with locoregionally advanced G/GEJ adenocarcinoma (T3−4Nany or TanyN+) that underwent pretreatment SL with negative peritoneal cytology followed by neoadjuvant chemotherapy or chemoradiation. After neoadjuvant therapy, patients underwent repeat SL. The yield of repeat SL to identify metastatic disease (M1) was determined and outcome data were analyzed. Results: From 1994−2010, 164 patients with locoregionally advanced G/GEJ adenocarcinoma were identified who underwent repeat SL immediately prior to gastrectomy. Occult M1 disease was identified in 12 patients (7.3%). Of these 12 patients, M1 disease was identified at laparoscopy in 9 patients (5.5%)—8 patients had visible disease and 1 patient had peritoneal cytology−only M1 disease. M1 disease not identified by SL was discovered at laparotomy in the other 3 patients (1.8%). There were no complications associated with patients who only underwent SL. Median follow-up was 30 months with a median survival of 18 months for patients with M1 disease and 47 months for patients resected with curative intent without M1 disease (p<0.001). Conclusions: Repeat staging laparoscopy following neoadjuvant therapy for locoregionally advanced G/GEJ adenocarcinoma identifies 5−6% of patients with clinically occult, subradiographic M1 disease. The majority of M1 disease is identified at repeat SL rather than at laparotomy and the majority is visible as opposed to cytology−only M1. These patients with occult M1 disease have a poor prognosis, are unlikely to benefit from gastrectomy, and repeat SL can avert the morbidity of a non−therapeutic laparotomy in this patient population.
Multicenter phase II study of triplet combination chemotherapy with paclitaxel, cisplatin, and S-1 for advanced gastric cancer (OGSG 0703).
Authors: Fujitani Kazumasa , Kimura Yutaka , Imamura Hiroshi , Gotoh Masahiro , Iijima Shohei , Ueda Shugo , Imano Motohiro , Oshita Masahide , Kurokawa Yukinori , Shimokawa Toshio , Takiuchi Hiroya , Tsujinaka Toshimasa , Furukawa Hiroshi ,   Osaka Gastrointestinal Cancer Study Group
Published: February 2017

124 Background: Docetaxel combined with cisplatin and 5-fluorouracil is active in advanced gastric cancer, but not generally accepted because of its substantial toxicities. We conducted a multicenter phase II study of triplet combination using paclitaxel, cisplatin and S-1 (PCS) as first-line treatment for advanced gastric cancer. Methods: Patients with previously untreated, locally advanced or metastatic measurable gastric cancer, a performance status < 2, age of 20-75 years, and adequate organ functions were given intravenous paclitaxel at 70 mg/m2 and cisplatin at 30 mg/m2 on days 1 and 15, plus oral S-1 at 40 mg/m2 b.i.d. on days 1 to 21, followed by 2-week rest, repeated every 5 weeks. Treatment was continued until disease progression or unacceptable toxicity occurred, or the patient refused the therapy. Study endpoints included overall response rate (ORR) as primary, progression free survival (PFS), overall survival (OS), and toxicity. Sample size of 40 patients was determined to reject the ORR of 55% under the expectation of 75% with a power of 80% and a one-sided α of 5%. Results: A total of 52 patients were enrolled in this study, among whom 49 were assessable for efficacy and 51 assessable for toxicity. ORR was 46.9% (95% CI: 32.5-61.7%). The median PFS and median OS were 5.4 months (95% CI: 4.1-7.0) and 11.5 months (95% CI: 7.3-16.1), respectively. Frequent grade 3/4 toxicities were neutropenia (51%), leucopenia (25%), anemia (20%), hyponatremia (16%), anorexia (14%), diarrhea (8%) and fatigue (8%). There was no treatment-related death. Conclusions: Triplet combination chemotherapy with PCS demonstrated superior feasibility with promising antitumor activity, though which did not meet the statistical hypothesis, for advanced gastric cancer.
Body weight loss after surgery as an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer.
Authors: Yoshikawa Takaki , Aoyama Toru , Kuwabara Hiroshi , Mikayama Yo , Ogata Takashi , Cho Haruhiko , Tsuburaya Akira 
Published: February 2017

125 Background: S-1 adjuvant chemotherapy improves survival of stage II/III gastric cancer, however, the compliance is not high. The aim of the present study is to clarify risk factors for continuation of S-1 after gastrectomy. Methods: Patients were retrospectively selected according to the following criteria; (1) patients underwent curative D2 gastrectomy for gastric cancer during 2002 and 2010, (2) pathological stage II/III, (3) creatinine clearance more than 60 ml/min, and (4) S-1 was initiated at a dose of 80mg/m2 within 6 weeks after surgery. Clinical factors when starting S-1 chemotherapy were examined by uni- and multi-variate analyses. Results: Seventy-five patients were eligible. Median age was 62 years (range: 36-80). Performance status was 0 in 65 patients and 1 in 10. Serum albumin level was >4.0 g/dl in 34 patients and <4.0 g/dl in 39. Operative procedure was total gastrectomy (TG) in 46 patients and distal one in 29. Median percentile of body weight loss to preoperative state (%BW loss) was 9.3 (range 0-21.1). Stage was II in 22 patients and III in 53. When %BW loss was classified to two groups; LOW (<15%, n=64) and HIGH (>15%, n=11), S-1 continuation rates were 82.8% in the LOW and 54.6% in the HIGH at 3 months and 73.2% in the LOW and 45.5% in the HIGH at 6 months, which were statistically significant (p=0.025). Among age, performance status, type of gastrectomy, %BW loss, serum albumin, and stage, only %BW loss was a significant independent risk factor for S-1continuation with hazard ratio of 2.437 by multi-variate Cox proportional hazard analyses (p=0.039). Conclusions: To improve drug compliance which leads to survival, it is a key to maintain BW before starting adjuvant chemotherapy. Peri-operative nutritional therapy should be developed and be focused on chronic inflammatory phase after surgery and on starvation after gastrectomy. A randomized phase III trial is on-going to show efficacy of peri-operative nutritional support including eicosapentaenoic acid (EPA).
Quality of life following laparoscopic distal gastrectomy with modified billroth II reconstruction.
Authors: Le Maithao N. , Ellenhorn Jacob , Kim Joseph , Trisal Vijay , Ellenhorn Joshua D. I. 
Published: February 2017

140 Background: Laparoscopic gastrectomy has been proposed as a procedure to reduce the morbidity of gastric cancer surgery. Modified Billroth II (BII) reconstruction with a side to side loop gastrojejunostomy is technically straightforward to accomplish laparoscopically. To determine the long term morbidity of this reconstruction technique, we performed a quality of life (QOL) analysis of patients undergoing laparoscopic distal gastrectomy with modified BII reconstruction. Methods: Between June 2005 and May 2011, 64 patients underwent laparoscopic distal gastrectomy with modified BII reconstruction at City of Hope Medical Center (COH). Patients alive with no evidence of disease were recruited to participate in the QOL study. The study was approved by the Institutional Research Board of COH. Research subjects completed the EORTC QOL-STO22 instrument which queried patients for post gastrectomy symptoms. Comparison between groups was done using the Student-t test. Results: 33 of 64 patients met the criteria for participation in our QOL study. Of these, 23 patients consented to participate and completed the EORTC QOL-STO22 instrument. Overall, 81% categorized symptoms as occurring “not-at-all” or “a-little” while 19% reported symptoms occurring “quite-a-bit” or “very-much”. Since symptoms could be worse in patients with small gastric pouches, we divided our cohort into two groups, one having at least 70% of the stomach resected (12 patients) and the other having less than 70% of the stomach resected (11 patients). The two groups were compared with respect to symptoms. There was no difference between the groups with respect to dysphasia (p=0.80), pain (p=0.98), reflux (p=0.93), and eating restriction (p=0.33). Overall 78% of patients with a small gastric pouch and 83% of patients with a larger gastric pouch reported these symptoms as occurring “not-at-all” or “a-little”. Conclusions: Laparoscopic distal gastrectomy with modified BII reconstruction resulted in an acceptable morbidity rate with few patients experiencing severe symptoms. Gastric pouch size did not predict symptoms and most patients with a small gastric pouch report excellent QOL.
SBRT as an alternative to RFA for the treatment of primary and metastatic liver tumors.
Authors: Liu Erqi , Stenmark Matthew H. , Lee Oliver E , Schipper Matthew J , Caoili Elaine M , Ben-Josef Edgar , Lawrence Theodore Steven , Feng Mary Uan-Sian 
Published: February 2017

158 Background: Radiofrequency ablation (RFA) is a widely used local therapy for small, unresectable liver tumors (LT). Stereotactic body radiotherapy (SBRT) has been used for similar patients, and has the advantage that it can be used when lesions are adjacent to blood vessels, are difficult to reach and cannot be imaged on ultrasound. We examined RFA and SBRT outcomes for treating primary and metastatic LT at our institution and identified predictive factors for local control. Methods: This study included 62 patients (pts) with 106 LT (69 metastatic, 37 primary) treated with SBRT and 127 pts with 206 LT (80 metastatic, 126 primary) treated with RFA from 2000 to 2010. 42 lesions were ablated intra-operatively while 164 were ablated percutaneously. Mean tumor size by maximum diameter was 2.2 cm (0.4-11) and 2.3 cm (0.6-6.2) for RFA- and SBRT-treated LT, respectively. Freedom from local progression (FFLP) for SBRT was defined as absence of progressive LT within or at the PTV margin while FFLP for RFA was defined as recurrence within or immediately adjacent to the ablation zone. Results: With a median follow-up of 29.4 months (0.46 to 120.8), 1- and 2-yr FFLP rates for all SBRT- vs RFA-treated LT were 93% and 84% vs 86% and 83%. There were 14 cases of residual LT after RFA, 6 of which were re-ablated; these were not counted as RFA failures. Significantly more pts in the SBRT group had received prior systemic therapy (54% vs 31%, p=0.0001) and had active extrahepatic disease at treatment start (36% vs 23%, p=0.01). For SBRT, neither LT size nor dose predicted for FFLP. For RFA, tumor size ≥3 cm had worse FFLP (HR: 5.3, p<0.0001) but an intraoperative approach had better FFLP (HR: −2.2, p=0.01). For tumors >3cm, SBRT had significantly better FFLP than percutaneous RFA (HR: 0.32, p=0.018). In the RFA group, there were 9 complications, including pneumothorax, hemothorax, and small bowel injury, 2 of which resulted in death. In the SBRT group, there was 1 case of radiation-induced liver disease in a Child-Pugh Class B pt but no other significant toxicities. Conclusions: SBRT is a safe alternative to RFA, can be used in a wider variety of patients, and may be more effective than percutaneous RFA at locally controlling larger liver tumors.
Diagnostic microRNA serum profile in pancreatic cancer.
Authors: Schultz Nicolai Aagaard , Dehlendorff Christian , Werner Jens , Nielsen Thor Schutt Svane , Calatayud Dan , Giese Nathalia , Vittrup Benny , Nielsen Kaspar , Johansen Julia S. , Andersen Klaus Kaae 
Published: February 2017

160 Background: MicroRNAs (miRs) regulate genes with important roles in oncogenesis, angiogenesis and tissue differentiation. MiRs have high tissue-specific expression patterns and are interesting new biomarkers with a potential for earlier diagnosis of pancreatic cancer (PC). The aim was: 1) to identify a panel of diagnostic miRs in serum that can separate patients with PC from patients with chronic pancreatitis (CP) and healthy subjects (HS); and 2) to use statistical methods that make the analysis of the miR panel less sensitive to known methodological day-to-day variation. Methods: RNA was purified from serum according to SOP in pretreatment samples stored at −80°C from two prospective studies of 139 patients with PC (101 were operated and 38 had locally or metastatic PC), 17 patients with CP and 50 healthy subjects from 4 University Hospitals. MiR expression was measured using TaqMan Array Human MicroRNA A and B cards (v3.0 Applied Biosystems) profiling 768 miR. Raw miR expression values were checked for outliers. In a univariate selection method the rank of each miR (miRs were ranked for each subject) was related to PC using logistic regression. MiRs with p-values below 0.000001 were tested in a multivariate analysis. Results: Serum samples from 206 patients had acceptable miR. After exclusion of miRs that was undetermined in ≥20% of samples 85 miRs were considered in the univariate analysis and 12 of these subsequently included in the multivariate model. Seven miRs were significantly associated with PC. For all miRs in the diagnostic panel decreased expression is associated with PC. Conclusions: We present a diagnostic panel of 7 miRs in serum that discriminates samples from patients with PC from patients with CP and HS. The 7 miRs were selected with a rank-based method, which is a novel non-parametric method for data processing in miRNA array studies. [Table: see text]
Endoscopic ultrasound-guided fine needle core biopsy versus aspiration for gastrointestinal mass lesions: A randomized trial.
Authors: Nguyen Nam Q. 
Published: February 2017

161 Background: Endoscopic ultrasound (EUS) guided biopsy allows cytologic and/or histologic diagnosis of lesions within or adjacent to the gastrointestinal tract (GIT). However, the amount of tissue obtained with a regular aspirating needle is not always satisfactory. A newly developed Coo Pro-Core 22G needle has been proposed to obtain core tissue and may improve diagnostic yield. This study aimed to compare the performance of two EUS guided biopsy systems, Coo 22G fine needle aspiration (FNA) versus Coo 22G Pro-Core (PC) needle, in the evaluation of mass lesions within or adjacent to the GIT. Methods: 61 consecutive patients, who were referred for EUS guided biopsy of mass lesions within or adjacent to the upper GIT, were randomized to either the use of 22G FNA or 22G PC needle. The procedures were performed by a single experienced EUS-endoscopist. Four needle passes were taken from each lesion and all specimens were prepared as cell-block for histo-cytological analysis. Measured outcomes were diagnostic yield and complication. Results: EUS guided biopsy was performed with 22G FNA needle in 31patients and with 22G PC needle in 30 patients. There were no differences in age, gender, site or size of biopsied lesion between the groups. Diagnostic yield from the PC group was significantly higher than that of the FNA groups (27/30 vs. 22/31, P=0.04). The ability to obtain core-like tissue and provide “histological” detail were also higher in the PC group (16/30 vs. 0/31, P<0.001). Although no patients with FNA biopsy had complications, the first 4 cases of PC needle biopsy had abdominal pain (with 1 proven pancreatitis), requiring overnight admission. No further complications occurred after the number of PC passes was reduced to 2 per lesion. Conclusions: EUS guided biopsy with Pro-Core needles had a substantially higher diagnostic yield than that with FNA needles, with the ability to provide "histological" information in the majority of cases. Initial use of the Pro-Core needle, however, is associated with an increased risk of abdominal pain, which is reduced with fewer passes and more experience.
Use of endoscopic ultrasound to reduce the need for SpyGlass cholangioscopy and improve its diagnostic yield.
Authors: Nguyen Nam Q. 
Published: February 2017

169 Background: The accuracy of SpyGlass cholangioscopy (SGC) guided biopsy is only modest (60%) due to extrinsic lesion causing ductal stricture. Endoscopic ultrasound (EUS) can visualise the biliary tree and acquire tissue via fine needle aspiration (FNA). The aim is to evaluate the utility of EUS-FNA in patients who were referred for SGC for biliary strictures. Methods: The clinical impact of EUS-FNA was prospectively examined in 17 patients (10M; 56.2±1.9 yrs) who were referred for SGC to investigate difficult biliary strictures over 15 months. All patients had endoscopic retrograde cholangiography and biliary stenting with negative ductal brushing. Any mass lesion(s) or pathological node(s) found on EUS were biopsied. SGC and ductal biopsy were only performed if EUS-FNA could not provide a diagnosis. The results were compared to the surgical specimens or the positive histo-cytological findings from biopsies. Results: EUS examination was able to identify all ductal or peri-ductal abnormalities responsible for the biliary strictures, with sonographic diagnoses of cholangiocarcinoma (n=10), autoimmune pancreatitis (n=2), choledochocyst related stricture (1); pancreatic cancer (n=1), gallbladder cancer (n=1), Mirrizi’s syndrome (n=1) and colorectal metastasis (n=1). EUS-FNA was possible in 13 (76%) cases and provided tissue diagnosis in 9 (59%) patients, which can potentially avoid the need for SGC and cost saving of ~$ 48,000. SGC examination was successful in 7/8 patients, with 100% correct tissue diagnosis from Spybite biopsy (4 cholangio-carcinomas, 1 autoimmune pancreatitis, 1 biliary villous adenoma, 1 hepatoma, 1 high grade dysplastic choledochocyst). SpyScope intubation was not possible in a patient with long-standing primiary sclerosing cholangitis who had tight stricturing of the entire extra-hepatic duct. Overall, tissue diagnosis was established in 94% (16/17) patients. Conclusions: EUS able to detect 100% ductal or peri-ductal abnormalities responsible for biliary strictures referred for SGC. Together with FNA, EUS provides correct diagnosis and avoids the need for SGC in 59% of cases, resulting in significant cost saving but also improving the yield of SpyGlass guided biopsy.