bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stereotactic body radiotherapy (SBRT) in combination with surgery for primary and metastatic liver tumors.
Authors: Lappinen Erik , Thai Ngoc , Tom Kusum , Khan Akhtar , Day Ellen , Green William Ross , Christensen James , Kirichenko Alexander V. 
Published: February 2017

347 Background: Evaluate the feasibility, safety, and efficacy of SBRT in combination with surgery for primary and metastatic liver tumors. Methods: 12 patients completed hepatectomy and SBRT for either hepatocellular carcinoma (HCC) (3) or metastases from colorectal (4), neuroendocrine (2), uterine (2), or sarcoma (1) primary. All patients with metastases completed chemotherapy. Most patients (7) had resection of their operable metastases, total of 19, and gold fiducials placed in the unresectable lesions, total of 9, to facilitate definitive adjuvant SBRT. One patient with an unresectable metastasis received preoperative SBRT. Two patients with HCC had SBRT as a bridge to liver transplant. Two patients had salvage SBRT for recurrence after surgery. All patients completed 4D-CT for ITV definition and SPECT/CT to define functional normal liver parenchyma volume (NLV). MV-fluoro was performed to confirm tumor/fiducial respiratory motion within the PTV. Results: All patients successfully completed a combination of hepatectomy and SBRT. Seventeen hepatic lesions (≤ 2/patient) were treated with SBRT with a mean PTV 186.0 cc (15.1-803.5). The mean dose was 49.3 Gy (39-60) prescribed to the PTV in 5-6 fractions. With median follow-up of 9.2 months (2.8-15.3) there was no RILD > Grade 1 observed. The most common toxicity was Grade ≤ 2 fatigue. Nine patients had reduced SPECT-NLV vs. calculated NLV by a mean of 487.5 cc (p = 0.0004). In 6 of these, the SPECT-NLV vs. the CT-NLV was reduced by a mean of 253.9 cc (44.6 - 1076.2) reflecting the importance of SPECT functional imaging for SBRT planning. Postoperative morbidity was ≤ Grade 1. All surgical margins were negative. Three patients developed intrahepatic failures post SBRT. However, on follow-up imaging no in-field failures have occurred. Conclusions: The combination of liver SBRT with hepatic resection is safe and effective. It can be used preoperatively to increase resectability or to salvage surgical failures. We also report on the combination of limited hepatectomy for peripheral (including bilobar) hepatic metastases with planned SBRT to unresectable metastatic lesion(s). SBRT planning with SPECT/CT allows identification and preservation of the NLV.
Does 18-fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT) predict survival in advanced pancreatic cancer? A single-institution experience.
Authors: Ashraf Noman , Razzaque Saqib , Weber Jill M. , Malafa Mokenge Peter , Kim Richard D. 
Published: February 2017

351 Background: Pancreatic cancer is associated with a poor prognosis. Histological grade, stage and serum tumor markers are well established prognostic factors for survival. Some studies suggest that 18-fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT) correlates with survival in pancreatic cancer. In this study, we aimed to determine whether standardized uptake value (SUV), a measure of FDG uptake by fusion PET/CT, had prognostic significance in patients with advanced pancreatic cancer. Methods: Using a comprehensive pancreatic cancer database at H. Lee Moffitt Cancer Center, we identified patients who underwent PET/CT scan as initial workup for resection but were found to have advanced disease (stages III and IV) when surgery was attempted. Data from January 2006 to December 2010 was retrospectively analyzed and correlated with the maximum SUV determined by PET/CT. Other prognostic factors including stage, age, gender, serum tumor marker CA 19-9 levels and the use of chemotherapy were also evaluated using multivariate analysis. Results: We identified 41 consecutive patients who were deemed resectable by virtue of staging workup with CT, PET/CT and endoscopic ultrasound (EUS), but found to have locally advanced/metastatic disease intra-operatively. At the time of analysis, there were a total of 30 deaths. Twelve patients had metastatic disease and 29 had stage III pancreatic cancer. SUV uptake ranged from 2.9 to 16.2 with a mean of 6.4. Median overall survival for the 28 patients with SUV less than or equal to the mean (≤ 6.4) was 14 months (95% confidence interval 10 – 25 months) vs. 9.1 months for the 13 patients with SUV > 6.4 (95% confidence interval 4-17 months). This difference was not statistically significant (p=0.178). On multivariate analysis, use of chemotherapy was the only independent predictor of survival. Conclusions: Glucose uptake by PET/CT, reflected by SUV, was not found to be a predictor of survival in patients with advanced pancreatic cancer. The retrospective nature and limited sample size are limitations of our study, however further research is warranted.
Vitamin D deficiency in patients with pancreatic cancer.
Authors: Wang-Gillam Andrea , Ding Kevin , Cho May , Lockhart Albert C. , Chen Ling , Zubal Beth , Tan Benjamin 
Published: February 2017

353 Background: Vitamin D deficiency is common in many cancer patients but little is known about the vitamin D status in patients with pancreatic cancer. Frequently, patients with pancreatic cancer have malabsorption syndrome, and since vitamin D is fat soluble, it is likely to be deficient in this population. Methods: We conducted a retrospective review on patients with pancreatic cancer who were treated at Siteman Cancer Center (SCC). Patients’ demographic information, clinical staging at the time of vitamin D assessment, vitamin D status and survival data were collected. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [(25(OH)D] <20 ng/mL; vitamin D insufficiency was defined as 25(OH)D <30 but >20. Results: Between Dec 2007 and June 2011, 184 out of 625 pancreatic cancer patients had their vitamin D level checked at least once. Median age was 64 (range 34-86); 87 patients were female and 97 were male. The majority (159) were Caucasian. Sixty-four (34.8%) patients were post resection, while 34 (18.5%) and 86 (46.7%) had local disease and metastatic disease, respectively. Out of 184, 43 (23.3%) patients had normal vitamin D levels, while 53 (28.8%) and 88 (47.85%) were found to be vitamin D insufficient and deficient, respectively. All 28 non-Caucasian patients had either vitamin D deficiency or insufficiency, and their median 25(OH)D level was 11 ng/mL, compared to 21 ng/mL for Caucasian patients. The median 25(OH)D level was 17.5 ng/mL in patients with resected cancer, 22 ng/mL in patients with local disease, and 23 ng/mL in patients with metastatic disease. After adjusting age and stage, 25(OH)D <20 ng/mL was found to be an independent prognostic factor (p= 0.071). Conclusions: Vitamin D insufficiency and deficiency is prevalent amongst our patients with all stages of pancreatic cancer. Vitamin D appears to be prognostic and should routinely be assessed in patients with pancreatic cancer.
Liver resection for multifocal hepatocellular carcinoma.
Authors: Kim Peter Tae Wan , Jang Jihyun , Fischer Sandra , Greig Paul David , Gallinger Steven , Wei Alice Chia-chi , McGilivray Ian M , Cattral Mark S , Cleary Sean P 
Published: February 2017

355 Background: Liver resection for multifocal hepatocellular carcinoma (HCC) is controversial. This study was conducted to outline our institution’s experience with liver resection for multifocal HCC. Methods: A retrospective review of patients who underwent liver resections from 1992 to 2011 for histologically confirmed hepatocellular carcinoma was performed. Multifocal disease was defined as more than 1 histologically proven HCC found in the liver resection specimens. Results: Of the 386 liver resections performed for HCC, 47 were performed for multifocal disease. Mean age was 60+11 years, and most patients (92%) had chronic liver disease. Hepatitis B was the most common etiology (60%), followed by hepatitis C (26%), and other etiologies (15%). Most patients were Child’s class A (89%). Most patients had intermediate Barcelona Clinic Liver Cancer (BCLC) stage (stage B) tumors (81%) and a minority of patients had early stage tumors (BCLC stage A, 19%). Major hepatectomy (>2 segments) was performed in 87% with an in hospital mortality of 6.4%. Major complications (Clavien-Dindo scale >3) occurred in 4 patients (9%). Median length of stay was 7 days and the rate of liver failure was 4.3%. Mean tumor number was 3+2 and the size of the largest lesion was 5+3 cm. Cirrhosis was present in 51% of patients. Majority of tumors were moderately differentiated (60%) and vascular invasion was present in 42%. The recurrence rate was 57% and the liver was the most common site of recurrence (81%). Treatment of recurrences occurred in 74% of patients: ablation (33%), chemotherapy (11%), transarterial chemoembolization (11%), resection (7.4%), sorafenib/radiation (7.4%) and transplantation (3.7%). Median disease free interval was 8 months and the overall survival was 18 months Conclusions: Liver resection for multifocal HCC can be performed safely in patients with chronic liver disease. Long term survival can be achieved in these patients and it should be considered as an option.
The influence of surgical oncology fellowship programs in training hepatopancreatobiliary surgeons.
Authors: Wiatrek Rebecca Lynn , Lee Wendy , Wray Curtis Jackson , Singh Gagandeep , Yim John H , Chen Steven L. , Garcia-Aguilar Julio , Kim Joseph 
Published: February 2017

358 Background: It is unclear how the physician shortage in the US will affect cancer care for our aging population and specifically how it will affect the care of hepatopancreatobiliary (HPB) malignancies. Our objective was to assess the clinical practices of recent surgical oncology fellowship graduates to determine their contribution in caring for this patient population. Methods: Practice data was gathered for surgeons who completed Society of Surgical Oncology (SSO)-approved surgical oncology fellowship programs between 2003-2008. Types of practice were defined as: (1) University Hospital or NCI-designated Cancer Center (NCICC); (2) University-affiliated hospital with resident training; (3) Private/community hospital with residency training program; (4) Private practice; (5) Military; and (6) International. Results: Of 253 surgeons who matched into SSO approved programs during our study period, 10 did not complete training, 11 entered military positions, and 17 are practicing internationally. Of the remaining 215 surgeons, 75% (n=161) obtained teaching positions and 25% (n=54) entered private practice. Of those in teaching positions, the majority were at University Hospitals/NCICC (n=133); followed by University-affiliated hospitals (n=16) and private/community hospitals with resident training (n=12). Overall, the practice focus was most commonly general surgical oncology (60%, n=130) followed by primary HPB (20%, n=43), breast/endocrine or melanoma/sarcoma (17%, n=36), and breast alone (3%, n=6). Conclusions: Our investigation shows that the majority of trainees from surgical oncology fellowship training programs obtain teaching positions with at least a portion of their practice covering HPB malignancies. Thus, recent surgical oncology fellowship graduates are positively contributing to the workforce treating HPB malignancies.
The urinary metabolomic signature of Barrett's esophagus.
Authors: Davis Vanessa Wylie , Schiller Dan E. , Sawyer Michael B. 
Published: February 2017

36 Background: Current screening and surveillance strategies for Barrett’s esophagus are inadequate. More reliable tools are needed. A unique urinary metabolomic signature could fill this niche. We applied metabolomic techniques to identify urinary metabolites capable of facilitating in the diagnosis of Barrett’s esophagus. Methods: Urine samples from patients with histologically confirmed Barrett’s esophagus (n=32) and normal, healthy volunteers (n=25) were collected and examined using 1H-NMR spectroscopy. Targeted profiling of spectra using Chenomx NMR Suite 7.0 software permitted the detection and quantification of 66 distinct metabolites. Unsupervised (principal component analysis, PCA) and supervised (partial-least squares discriminant analysis, PLS-DA) multivariate pattern recognition techniques were applied to discriminate between sample spectra of patients with Barrett’s esophagus and healthy volunteers using SIMCA-P (version 11, Umetrics, Umeå, Sweden). Results: Significant differences were found when comparing the concentrations of 59 metabolites in the urine of healthy volunteers and patients with Barrett’s esophagus. Those metabolites contributing the most class discriminating information included 3-hydoxybutyrate, adipate and choline. Clear distinction between patients with Barrett’s esophagus and healthy controls was noted when PLS-DA was applied to the data set. Model parameters for both the goodness of fit R2, and the predictive capability Q2, were high (R2 = 0.96; Q2 = 0.90). Model validity was tested using response permutation and results were suggestive of excellent predictive power. Conclusions: Urinary metabolomics identified a discrete signature associated with Barrett’s esophagus compared to healthy controls. This profile has the potential to aid in diagnosis and the development of new therapeutic targets.
Definitive radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer: A retrospective analysis.
Authors: Nakamura Akira , Shibuya Keiko , Takaori Kyoichi , Kawaguchi Yoshiya , Yoshimura Michio , Matsuo Yukinori , Itasaka Satoshi , Hiraoka Masahiro 
Published: February 2017

366 Background: Only surgical resection can provide a chance of long-term survival for patients with pancreatic cancer, but loco-regional recurrence has been a major challenge which inevitably results in poor prognosis and loss of patients’ quality of life. Curative reoperation is seldom attainable but has been suggested to have benefits on overall survival. We hypothesized that definitive radiotherapy could offer a good control for the unresectable local recurrence and improve survival. The primary objective of this retrospective analysis is to evaluate the efficacy and tolerability of definitive radiotherapy for patients with isolated locally-recurrent pancreatic cancer. Methods: A total of 26 patients, who developed local recurrence of primarily resected pancreatic cancer and received radiotherapy between 2000 and 2011, were retrospectively analyzed. The isolated local recurrence was diagnosed with the radiological images (CT/MRI/PET) and tumor marker relapse. The overall survival (OS) and local control rate (LC) were calculated from the start day of radiotherapy and estimated by Kaplan-Meier method. The responses in tumor size and tumor markers were evaluated. The treatment-related toxicity was assessed according to CTC-AE (ver. 4.0). Results: The median total dose of radiotherapy was 50.4 Gy (range, 39.6–54 Gy). Concurrent chemotherapy consisted of gemcitabine (62%), S-1 (19%), and 5-fluorouracil (4%). At a median follow-up time of 13 months, the 1-year OS and median survival were 75% and 21.6 months, respectively. The 1-year local control rate was 59%. Objective radiological response was not seen. The tumor marker reduction and ≥ 50% reduction were observed in 65% and 12%. Grade≥3 hematological toxicity was seen in 62%. Grade ≥ 3 of acute gastrointestinal toxicity was not observed. At a late phase, Grade 3 ileus observed in one, and Grade 3 gastric bleeding ulcer was seen in one patient. Conclusions: Definitive radiotherapy resulted in encouraging local control and overall survival for patients with isolated locally-recurrent pancreatic cancer. This treatment strategy should be further evaluated prospectively.
Usefulness of gemcitabine combined with 5-fluorouracil and cisplatin (GFP) for patients with advanced biliary carcinoma as a postoperative adjuvant chemotherapy.
Authors: Morine Yuji , Shimada Mitsuo , Utsunomiya Toru , Imura Satoru , Ikemoto Tetsuya , Hanaoka Jun , Sugimoto Koji , Saito Yu , Yamada Shinichiro , Asanoma Michihito 
Published: February 2017

367 Background: Prognosis of patients with advanced biliary carcinoma is still poor, and chemotherapy has been shown to have little impact. The aim of the present study was to clarify the effectiveness of GEM combined with CDDP and 5FU (GFP) therapy for advanced biliary carcinoma. The usefulness as a postoperative adjuvant chemotherapy using GFP (UMIN000006924) was evaluated. Methods: 1. Identification of independent poor prognostic factors: One hundred one patients with biliary carcinoma before induction of GFP chemotherapy, including intrahepatic cholangiocarcinoma (IHC: n=33), hilar cholangiocarcinoma (HC: n=29), and gallbladder cancer (GBC: n=39) were enrolled. The prognostic factors were investigated by multivariate analysis using Cox’s proportional hazard model. 2. Clinical usefulness of adjuvant GFP chemotherapy: One hundred forty-eight patients with biliary carcinoma (IHC: n=46, HC: n=43, GBC: n=39), who were positive for poor prognostic factors, received postoperative adjuvant GFP chemotherapy. The prognosis of these patients was compared to those not having postoperative adjuvant chemotherapy. Results: 1. In multivariate analysis, non-curative resection, lymph nodes metastasis and intrahepatic metastasis were identified as the independent prognostic factors. 2. Seventy-nine patients (53.3%) had poor prognostic factors. Of these, 22 patients received postoperative adjuvant GFP chemotherapy. The prognosis of patients with poor prognostic factors, who received postoperative adjuvant GFP chemotherapy, was significantly better than those not having such adjuvant chemotherapy (p<0.01) (3y survival: 59.6% vs. 18.9%). Furthermore, in patients with non-curative resection, postoperative adjuvant GFP chemotherapy also prolonged postoperative prognosis (p<0.01) (3y survival: 62.5% vs. 9.4%) Conclusions: Postoperative GFP adjuvant chemotherapy for patients with poor prognostic factors may improve the surgical outcomes.
Incidence and prediction of venous thromboembolism (VTE) in ambulatory patients (pts) with pancreas cancer receiving chemotherapy.
Authors: Ruperez Blanco Ana Belen , Muñoz Martin Andrés Jesús , Garcia Alfonso Pilar , Alvarez Suarez Sonsoles , Cavanagh Podesta Mercedes , Custodio Cabello Sara , Mondejar Solís Rebeca , Lopez-Trabada Ataz Daniel , Blanco-Codesido Montserrat , Martin Miguel 
Published: February 2017

368 Background: VTE is considered a main cause of mortality and morbidity in cancer pts and is commonly underestimated by oncologists. Pancreatic cancer is associated with the highest risk of VTE and the true incidence remains uncertain. Chemotherapy has been identified as an independent risk factor for VTE. The aim of this study is to analyze the incidence of cancer-associated thrombosis in ambulatory pts with pancreatic cancer receiving chemotherapy. Methods: We performed a retrospective review to determine the incidence of VTE in the gastrointestinal cancer unit of our centre. Between 2008 and 2010, 64 consecutives pts were identified and included in the analysis. Pancreatic neuroendocrine tumors were excluded. Results: Clinical characteristics ( table 1). Twenty pts (31.2%) experienced VTE including 7 pulmonary emboli (PE), 8 deep-vein thromboses (DVT) and 8 visceral vein thromboses (VVT). PE:25%. DVT:25%. VVT:35%. PE+DVT:10%. DVT+VVT:5%. Arterial thromboembolism (ATE): 2 pts (3.1%). 56% of the events were diagnosed during the first six months after diagnosis. Khorana’s predictive model for chemotherapy-associated thrombosis (risk category): intermediate risk (IR) 17 pts (27.9%) and high risk (HR) 44 pts (72.1%). VTE in HR and IR category: 14/44 pts (31.8%) and 6/17 pts (35.3%). Conclusions: The high incidence of VTE observed in this study is consistent with prior reports. Primary antithrombotic prophylaxis should be considered in this setting. Specific predictive model for chemotherapy-associated thrombosis in pancreas cancer must be investigated. [Table: see text]
Gemcitabine (G) and nab-paclitaxel (nab-P) in patients with refractory advanced pancreatic cancer (PC).
Authors: Ernani Vinicius , Akunyili Ikechukwu Immanuel , Hosein Peter Joel , Macintyre Jessica , Rocha Lima Caio Max S. 
Published: February 2017

373 Background: There is no standard chemotherapy regimen for PC patients who have progressed on G and fluoropyrimidine-based therapy. Single agent nab-P had limited activity on a second-line phase II trial in PC. Synergistic preclinical studies with G and taxanes have been reported. Nab-P targets stromal cells and leads to improved delivery of chemotherapy to PC cells. The combination of G + nab-P might be an effective approach in pretreated PC. Methods: A retrospective analysis of advanced refractory PC patients treated from Sep 2010 to Aug 2011 with the combination of G + nab-P was performed at the Sylvester Comprehensive Cancer Center. Patients received G 1000mg/m2 and nab-P 100mg/m2 on D1, 8 and 15 of a 28 day cycle. Treatment response was assessed by review of imaging studies using the RECIST criteria, CA19-9 response and symptomatic improvement. The progression-free survival (PFS) and overall survival (OS) were calculated from time of commencement of G + nab-P until documented progression or death respectively. Results: 10 patients were treated with G + nab-P; 60%, 30% and 10% of patients had received 3, 2 and 1 prior chemotherapy regimen. 90% and 80% received prior G or fluoropyrimidine-based regimen respectively. Therapy was discontinued in one patient following only one dose of G + nab-P (Cycle 1, day 1) due to grade 2 thrombocytopenia. The remaining 9 patients received a median of 4 cycles. Two (22.2%) patients had confirmed PR, 3(33.3%) patients had confirmed stable disease while 4 (44.4%) patients progressed on therapy. The median PFS was 13.7 weeks. The median PFS was 20 weeks in patients with PR or SD and 9.9 weeks in patients with PD. Recurrent malignant ascitis resolved in a patient with peritoneal carcinomatosis. Treatment was well tolerated; grade 3-4 hematologic toxicity included anemia, thrombocytopenia and neutropenia in 2, 1 and 2 patients respectively. 70% of patients required G-CSF support. Non hematologic Grade 3-4 toxicities included fatigue, peripheral neuropathy; nausea and vomiting in 3, 2 and 1 patient respectively. Conclusions: G + nab-P resulted in clinical benefit in half of this group of advanced PC patients who had previously progressed on G and fluoropyrimidine-based regimens.