bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes for patients ≥75 years with localized gastroesophageal cancer: Experience from the Princess Margaret Cancer Centre.
Authors: Natori Akina , Chan Bryan , Sim Hao-Wen , Chen Eric Xueyu , Liu Geoffrey , Darling Gail Elizabeth , Swallow Carol Jane , Brar Savtaj Singh , Brierley James D. , Ringash Jolie , Wong Rebecca , Kim Joon-Hyung J. , Rogalla Patrik , Hafezi-Bakhtiari Sara , Conner James , Knox Jennifer J. , Elimova Elena , Jang Raymond Woo-Jun 
Published: March 2017

189 Background: The optimal treatment and outcome for elderly patients (pts) with localized gastroesophageal (GE) cancer remains unclear as they are underrepresented in clinical trials. We aimed to assess survival in pts ≥ 75 years according to treatment received. Methods: A retrospective analysis was performed for all pts aged ≥ 75 years with GE cancer treated in 2012 and 2013. Frailty was measured using the Charlson comorbidity index (CCI) and ECOG performance status (PS). Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors impacting treatment choices. Results: Of 70 pts, median age was 82 years (range: 75-98), primary sites were esophageal (40%, with 61% squamous histology), GE junction (24%) and gastric (36%). Baseline characteristics included: PS: 0 (40%), 1 (39%), 2 (14%), 3 (7%); and CCI: 0 (36%), 1 (20%), 2 (21%), ≥ 3 (23%). Treatment received included surgery (33%), radiotherapy (RT) (31%); surgery plus adjuvant chemotherapy (chemo) and/or RT (9%); chemoradiation alone (7%) and 20% had no active treatment. In univariable analysis; age < 85 (p = 0.007) and surgery (p = 0.022) were associated with improved OS. Chemo and RT, either alone or in combination, did not significantly improve OS. In multivariable analysis; age < 85 (HR 0.46, 95% CI: 0.23-0.94, p = 0.034), surgery (HR 0.32, 95% CI: 0.14-0.74, p = 0.008) and CCI < 2 (HR 0.52, 95% CI: 0.27-0.99, p = 0.048) were identified as independent predictors for improved OS. Age ≥ 85 was significantly associated with omission of surgery (OR 3.61, 95% CI: 1.13-14.01, p = 0.041) but in contrast, PS ≥ 2 (p = 0.475) and CCI ≥ 2 (p = 0.939) were not predictive. Conclusions: At our institution, very few pts ≥ 75 years received multimodality therapy for localized GE cancers. Surgery was the only treatment modality associated with a significant survival advantage, and additional chemo and/or RT did not further improve OS. The only predictor for having surgery was age. Consequently, future studies should consider comprehensive assessment for surgery so that eligible elderly pts can benefit.
Outcomes of ERCC1 high locally advanced esophageal cancer patients treated with non-platinum vs platinum based CRT.
Authors: Yogarajah Meera , Stroud Chipman Robert Geoffrey , Hegde Aparna Madhukeshwar , Walker Paul R. 
Published: March 2017

192 Background: ERCC1 is a DNA excision repair enzyme which repairs the DNA adduct damage caused by platinum and hence high levels of ERCC1 has been associated with platinum resistance. Thus utility of platinum as a first line chemotherapy in esophageal cancers with high ERCC1 levels is controversial. SWOG S0356 trial noted a significantly low 2 year overall survival of 37% for platinum based CRT in ERCC1 high esophageal carcinomas, yet no studies have identified the alternative first line chemotherapy. Our Program utilized combined irinotecan 65mg/m2 on D1 and D8 and nab-paclitaxel 100mg/m2with concurrent radiation therapy of 50.4Gy for ERCC1 high esophageal cancers at the treating physician’s discretion. We compared the differences in survival with non-platinum versus platinum CRT. Methods: Retrospective analysis from 2011 to 2016 identified 25 locally advanced esophageal cancer patients in whom ERCC1 levels were checked. Out of this 25 patients 23 had high ERCC1 levels and 2 had low ERCC1 levels. Patients with low ERCC1 were excluded. Patients with high ERCC1 levels received either non-platinum or platinum CRT as neo-adjuvant, adjuvant or definitive chemotherapy. Results: Patient characteristics: Male 69.5%, female 30.5%, squamous 43.4%, adenocarcinoma 52.1%, other 4.5%, operable 39%, non-operable 61%. Non-platinum therapy was utilized for 69.5% and platinum based therapy for 30.5% of the patients. Kaplan-Meier analysis for survival showed clear separation of the curves around 2 years. Median overall survival of non-platinum doublet was not reached during a median follow up of 22 months. Overall survival at 2 years was 57%. The median overall survival for the platinum doublet was 22 months and the 2 year overall survival was 42%. (p = 0.22). Hazard ratio (HR) 0.48(95% CI 0.14-1.58 p = 0.23) .This statistical non significance was due to small sample size. Conclusions: Abraxane and irinotecan showed improved overall survival in the ERCC1 high group when compared with platinum based therapy demonstrated both in our population and the SWOG 0356 trial. [Table: see text]
Impact of race on gastric adenocarcinoma outcomes in a multiracial population.
Authors: Acoba Jared David , Simon Nicholas E 
Published: March 2017

196 Background: Gastric adenocarcinoma continues to be a major health issue, with a high prevalence among Asian and Pacific Islander populations. We performed a comprehensive analysis to evaluate outcomes and prognostic factors in a multiracial population with a focus on Whites, Asians (Chinese, Japanese, Koreans, Filipinos), and Pacific Islanders (Native Hawaiians, Samoans). Methods: We collected data from 615 consecutive patients with gastric or gastroesophageal adenocarcinoma diagnosed between 2000 and 2015. Multivariable Cox proportional hazards regression models for survival were built adjusting for race, age at diagnosis, stage, number of lymph nodes resected, histologic grade, HER2 status, systemic treatment, and insurance status for the entire study population and for those with resectable cancer. Results: Pacific Islanders presented at a younger age, higher stage, and more often were underinsured. White patients were more often diagnosed with proximal tumors. Analysis of the entire population demonstrated that older age, underinsured status, higher tumor grade, and advanced stage but not race were poor prognostic factors. Among patients with resectable cancers, the Filipino and Samoan racial sub-groups were adversely associated with survival even after adjusting for other prognostic factors. Furthermore, among Asians, Filipinos had worse outcomes compared with other Asian sub-groups. Overall, 9.5% of the 118 tumors tested for HER2 were deemed HER2(+), however the rate varied by race being as high as 43% among Samoans. Conclusions: No racial survival disparity was detected for gastric and gastroesophageal adenocarcinoma, however among resectable and potentially curable patients, Filipinos and Samoans fared worse. This could be in part due to differences in tumor biology such as HER2 expression. Further study in this area should be pursued. Within the Asian race, Filipinos demonstrated poorer survival than other sub-groups. Given the differences in survival within the Asian race, studies exploring the relationship between race and cancer should consider analysis by sub-group.
Long-term survival in 101 metastatic gastroesophageal cancer (mGEAC) patients eventually treated with consolidative local therapy.
Authors: Mizrak Kaya Dilsa , Wang Xuemei , Harada Kazuto , Blum Murphy Mariela A. , Das Prajnan , Minsky Bruce D. , Estrella Jeannelyn , Lin Quan , Ghazanfari Amlashi Fatemeh , Lee Jeffrey H , Weston Brian , Bhutani Manoop S. , Matamoros Aurelio , Sagebiel Tara L. , Skinner Heath Devin , Wu Carol C , Hofstetter Wayne Lewis , Badgwell Brian D. , Ajani Jaffer A. 
Published: March 2017

197 Background: Through a multidisciplinary decision-making process, we developed a strategy of systemic therapy followed by local consolidative therapy (chemoradiation and/or surgery) for selected mGEAC patients. We present results in a large cohort. Methods: From our database, we identified a 101 such patients. We analyzed the association of various clinical variables (location of primary, location of metastases, duration of initial chemotherapy, histologic grade, and radiation dose {≥50.4 Gy vs. <50.4 Gy}) with overall survival (OS). Results: There were 71 patients with proximal primary (esophageal, Siewert types I/II) and 30 patients with distal primary (Siewert type III and gastric). The median OS was 25.7 months (95% CI: 22.3-32.8 months). The OS rates at 2-years and 5-years from diagnosis were 53.8% (95% CI: 44.7%-64.8%) and 20.7% (95% CI: 13.4%-31.9%), respectively. The median OS was highly associated with the location of primary (22.8 months for proximal GEACs vs. 41.5 months for distal GEACs, p=0.03). Duration of initial chemotherapy was highly associated with OS (21.8 months for <3 months vs. 32.5 months for ≥3 months, p=0.004). Association between OS and tumor/treatment characteristics. Conclusions: Selected patients with mGEAC (who have favorable clinical course) can have up to 20% 5-year survival with this strategy. Patients with distal GEAC and those who receive initial chemotherapy for longer time are the maximum beneficiaries. [Table: see text]
Comparison of neoadjuvant chemoradiation versus peri-operative chemotherapy for adenocarcinoma of the distal esophagus and gastroesophageal junction.
Authors: Bertke Matthew , Gurka Marie Kate , Sharma Vivek R. , Redman Rebecca A. , Scoggins Charles Raben , Martin Robert C. G. 
Published: March 2017

198 Background: Both neoadjuvant chemoradiation (NACRT) and peri-operative chemotherapy (PCTX) are viable treatment options when combined with surgical resection for locally advanced distal esophageal and gastroesophageal junction (GEJ) cancers. There is a paucity of data comparing these treatment regimens; therefore, the goal of this study was to compare the outcome of these two approaches at our institution. Methods: This is a retrospective review of a prospectively managed database, in which 66 patients with adenocarcinoma of the distal esophagus or GEJ who received either NACRT or PCTX from 2006 to 2015 were identified. Groups were balanced in regards to age, sex, subsite, T stage, and N stage. Patients treated with NACRT received either carboplatin/taxol or 5FU-based chemotherapy. PCTX regimens included ECF, EOX, DCF, or 5-FU based chemotherapy. Survival was calculated by the Kaplan–Meier method with a log‐rank test used for comparison between groups. Differences between subgroups were compared with Fisher’s Exact test. Results: A total of 47 patients were treated with NACRT and 19 with PCTX with a median follow-up of 14 months. All but three patients underwent definitive resection. No patients died within 90 days of surgery and the rate of operative complications was similar between the two groups (p = 0.77). The pathological complete response rate was 12.1% overall, with 14.9% in NACRT and 5.3% in PCTX. Median overall survival was 16.6 months and was not different between treatment subgroups (p = 0.77). Fewer treatment failures were seen with NACRT compared to PCTX (29.8% vs. 57.9%, p = 0.050), probably driven by improved local control in the NACRT arm (95.7% vs. 73.6%, p = 0.017). Distant failure was not significantly different between NACRT and PCTX (27.7% vs. 42.1%, p = 0.38). Conclusions: Pre-operative chemoradiation provided better overall disease control compared to peri-operative chemotherapy. However, improved survival could not be demonstrated, possibly due to the similar rates of distant failure and the study being underpowered due to small number of patients.
Neoadjuvant chemoradiotherapy (NCRT) compared with chemotherapy (NCT) in locally advanced squamous-cell cancer of the esophagus.
Authors: Li Xue , Hao Daxuan , Yang Yuanyuan , Cheng Xinyu , Zhang Yougai , Wu Xiaoyuan , He Chunyu , Liu Jinsong , Wang Jianhua 
Published: March 2017

202 Background: Neoadjuvant chemotherapy with or without radiotherapy are the common treatments for locally advanced squamous-cell esophageal cancer(ESCC). There is no sufficient data to choose between these two effective therapies. The aim of our retrospective study was to compare the clinical efficacy between these two strategies of complete pathological response (pCR), postoperative morbidity, mortality, and overall and disease-free survival in patients with locally advanced ESCC. Methods: Patients with stage T2-4N0-1M0 squamous-cell esophageal cancer at our institution were recruited, including patients who underwent NCRT (1 cycle of cisplatin and 5-fluorouracil with concurrent radiotherapy) or NCT (2 cycles of cisplatin and 5-fluorouracil only ) before esophagectomy. Results: From January 2009 to October 2015, a total of 177 patients were analyzed, with 72 received NCRT and the remaining 105 received NCT. The pathological complete response (pCR) rate was 22.2% (n = 16) in NCRT group and 9.5% (n = 10) in NCT group ( P= 0.019). The postoperative mortality was 1.4% in NCRT group, versus 4.8% in NCT group. The postoperative morbidity was 20.8% in NCRT group, versus 27.6% in NCT group. There was no significant difference in recurrence between the two groups ( P= 0.397). 1-,2-,3-year overall survival rates in NCRT and NCT group were 87%, 74%, 51% and 81%, 64%, 51%, respectively ( P= 0.527), and 1-,2-,3-year DFS rates were 77%, 54%, 50% and 65%, 54%, 46%, respectively( P= 0.379). Conclusions: For patients with locally advanced squamous-cell esophageal cancer, the addition of radiotherapy to neoadjuvant chemotherapy may result in higher complete pathological response with acceptable postoperative mortality and morbidity, while the long-term survival benefit is not significant.
Clinicopathologic differences and survival of Hispanics (H) versus Non-Hispanic Whites (NHW) with gastric cancer (GC) at a Majority Minority Cancer Center in South Texas.
Authors: Barron Cesar Ivan , Hernandez Brian , Mahalingam Devalingam , Michalek Joel , Patel Sukeshi R. 
Published: March 2017

208 Background: Incidence rates for GC have shown to be increased in H vs NHW in studies. With a higher incidence of GC in South Texas compared to the rest of US, South Texas H have more than twice the incidence of GC than NHW with possibly worse survivals. However, these patients are not included in the SEER database, and the etiology of worse survival is unclear. To date, evaluation of a South Texas population with a more homogeneous H population has not been undertaken. Therefore, we chose to evaluate differences in clinical and histopathologic features in H vs NHW with GC at our South Texas NCI-designated cancer center where the homogenous H population is the majority. Methods: Retrospective analysis of GC patients from 2000-2016 at the Cancer Therapy and Research Center, San Antonio, TX. Median overall survival (mOS) was estimated from Kaplan-Meier curves and groups were statistically compared with the log rank test. Results: 168 patients with H 64% (n = 108), NHW 36% (n = 60). Median age 59 years (26-94): H 59.6 vs NHW 58.8 years. Females: H 48% vs NHW 37%. ECOG 0-1: H 48% vs NHW 53% (p = 0.46). Common Locations: H (Antrum 30%, Body 30%, GEJ 16%, Cardia 7%, Fundus 3%) vs NHW (Antrum 23%, Body 40%, GEJ 18%, Cardia 2%, Fundus 2%) (see table). Poorly differentiated: H 58.3% vs NHW 48.3% (P = 1). Stage IV at diagnosis: H 42% vs NHW 23% (P = 0.22). Diffuse-type: H 38% vs NHW 30% (P = 0.41); Intestinal-type: H 9% vs NHW 10% (P = 0.78). No significant difference in regards to Her2, H pylori, location of metastases. mOS: H 11 months (95% CI: 7-14) vs NHW 9.5 months (95% CI 6-n/a), p = 0.66. Conclusions: Despite historical worse prognosis of GC in H, at our majority minority cancer center in South Texas,H did not have a worse prognosis than NHW, and significant differences were not observed in clinicopathologic features. Prospective studies of H patients with GC should investigate differences in epidemiology, pathogenesis, and molecular signatures of GC between both groups to identify variables that correlate with survival and predict efficacy to cancer treatments. [Table: see text]
Entral feeding tube insertion after esophagectomy: Technique via transgastric conduit or transduodenal.
Authors: Ogata Takashi , Nakajima Tetsushi , Kano Kazuki , Maezawa Yukio , Ikeda Kousuke , Yamada Takanobu , Cho Haruhiko , Yoshikawa Takaki 
Published: March 2017

210 Background: We always used early enteral feeding after esophagectomy as perioperative management. The common procedure for feeding tube insertion is jejunostomy, but sometimes complication such as internal hernia was occurred. In case of retrosternal gastric tube reconstruction, we usually inserted feeding tube through gastric conduit. But in case of posterior mediastinal gastric tube reconstruction, this procedure was not available because of the distance between abdominal wall and gastric tube. So we have developed the new procedure for feeding tube insertion using the mobilized round ligament of liver. Methods: The aims of the study is to clarify the safety of these procedures. In case of retrosternal reconstruction, we usually inserted feeding tube from prepylorus of gastric conduit, and feeding tube was delivered through pyloric ring to 3rd portion of duodenum(Procedure A). Insertion point of the tube was always close to abdominal wall, and easy to be guided to extra-abdomen. On the other hand, in case of posterior reconstruction, we used the new procedure as below(Procedure B). At first, the round ligament of liver was cut at the liver edge. Next, feeding tube was inserted 15~20cm from anterior wall of 2nd portion of duodenum with Witzel suture fixation. After that, feeding tube was led to outside of the abdominal wall through in the mobilized round ligament. The cut edge of round ligament was fixed to the duodenum wall with 4-point suture at tube insertion point, and finally feeding tube completely surrounded by round ligament without direct exposure to the abdominal cavity. And to prevent internal hernia, the space between abdominal wall and mobilized round ligament was covered by omental fat. Results: From January 2012 to December 2014, 126 cases were inserted by procedure A, and from June 2015 to February 2016, 35 cases were done by procedure B. There was no trouble derived from the feeding tube insertion such as intra-operative bleeding, leakage of digestive juice, infectious complication, ileus, and there was no trouble in removal at outpatients in both procedures. Conclusions: Both procedures were safe, so we can manage the feeding tube insertion route by the reconstruction route after esophagectomy.
Phase II trial of cabozantinib in patients with carcinoid and pancreatic neuroendocrine tumors (pNET).
Authors: Chan Jennifer A. , Faris Jason Edward , Murphy Janet E. , Blaszkowsky Lawrence Scott , Kwak Eunice Lee , McCleary Nadine Jackson , Fuchs Charles S. , Meyerhardt Jeffrey A. , Ng Kimmie , Zhu Andrew X. , Abrams Thomas Adam , Wolpin Brian M. , Zhang Sui , Reardon Amanda , Fitzpatrick Bridget , Kulke Matthew H. , Ryan David P. 
Published: March 2017

228 Background: Activation of VEGFR2 and c-MET has been implicated in driving growth of neuroendocrine tumors (NET); additionally, expression of c-MET has been associated with shorter survival. Cabozantinib inhibits VEGFR2 and c-MET. We performed a two-cohort phase II study to evaluate the efficacy of cabozantinib in patients (pts) with advanced carcinoid or pNET (NCT01466036). Methods: Pts with progressive, well differentiated, grade 1-2 carcinoid or pNET were enrolled in parallel cohorts and treated with cabozantinib 60 mg po qd . There was no limit to prior therapy. Pts were restaged every 2 mos for the first 6 mos, then every 3 mos. The primary endpoint was objective response rate as measured by RECIST 1.1. Enrollment of approximately 35 patients of each tumor type was planned. Results: 41 pts with carcinoid (median age 63 yrs, 44% male, % ECOG PS 0/1 = 51/49) were accrued. Accrual to the pNET cohort was halted due to investigator/sponsor decision after 20 pts (median age 55 yrs, 60% male, % ECOG PS 0/1 = 40/60). Carcinoid pts completed a median of 8 (range 0-44) 28-day treatment cycles; pNET pts completed a median of 10 (0-35) cycles. 14 pts remain on treatment. Reasons for discontinuation were progression or death (51%), withdrawal of consent or investigator decision (28%), adverse events (AE, 21%). 3/20 pts with pNET achieved PR (ORR 15%, 95% CI 5-36%); 15/20 had SD. 6/41 pts with carcinoid achieved PR (ORR 15%, 95% CI 7-28%); 26/41 had SD . Median PFS was 21.8 mo (95% CI, 8.5-32.0 mo) in pts with pNET and 31.4 mo (95% CI, 8.5 mo-NR) in pts with carcinoid. Gr 3/4 toxicity in ≥ 1 pt included hypertension (13%), hypophosphatemia (11%), diarrhea (10%), lymphopenia (7%), thrombocytopenia (5%), fatigue (5%), increased lipase or amylase (8%). Unexpected Gr 3/4 AEs included heart failure and autoimmune hemolytic anemia, each in 1 pt. 81% of 53 pts completing more than 1 cycle of treatment required dose reduction from the initial 60 mg dose. Conclusions: Treatment with cabozantinib was associated with objective tumor responses and encouraging PFS durations in patients with advanced carcinoid and advanced pNET. While dose reduction was common, treatment was tolerable. Further evaluation of cabozantinib is warranted in both NET subgroups. Clinical trial information: NCT01466036.
Oesophageal cancer: Commonly familial, possibly heritable.
Authors: Peters Niamh , King Sinead , O'Donovan Emily , Gallagher David James , Reynolds John V 
Published: March 2017

23 Background: Oesophageal cancer (OC) accounts for 400 deaths in Ireland per year. Prognosis remains poor, and improved prevention is needed. Familial clustering has been described however, The Nordic Twin Study of Cancer does not support a strong hereditability. We investigated familial OC over a decade in Ireland. Methods: The independent records of two national referral services were reviewed: an oesophageal surgery database and a hereditary cancer genetics database. Demographic Factors including family history of OC were recorded from the surgical database. Families containing a single OC diagnosis were identified in the genetics database. Age at diagnosis and additional cancer diagnoses in the family were recorded. Results: 1238 patients with OC were seen at St. James’s Hospital from 2005 to 2015. Demographic characteristics are shown in Table. 641 patients (51%) had a family history of malignancy. Seventy eight (6.3%) reported a family history of OC, 6 (7.6%) of whom had two or more first degree relatives with OC and 10 (13%) had both a first degree and second degree relative with OC. More male relatives were diagnosed with OC than female (59% vs 41%).The majority (24%) with a family history were diagnosed at Stage III, the majority (29%) without a family history were diagnosed at Stage II. 1840 pedigrees from the genetic database were reviewed. No pedigree contained a Proband with OC.4.5%(n = 84) included at least one family member with OC. The median age at diagnosis was 64. Breast, colorectal and gastric were the most commonly associated cancers with median ages of 50,59 and 64 respectively. Conclusions: More than half of patients presenting with OC report a family history of cancer, with likely hereditary and environmental components. OC patients are rarely referred for genetic assessment, possibly due to treatment related morbidity and poor clinical outcome. [Table: see text]