bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single fraction high-dose-rate brachytherapy and hypofractionated external beam radiation therapy in the treatment of intermediate-risk prostate cancer: Long-term results.
Authors: Cury F. L. , Duclos M. , Aprikian A. G. , Patrocinio H. , Kassouf W. , Shenouda G. , Faria S. , David M. , Souhami L. 
Published: February 2017

83 Background: We present the long-term results of a cohort of patients with intermediate-risk prostate cancer (PC) treated with single fraction high-dose-rate brachytherapy (HDRB) combined with hypofractionated external beam radiation therapy (HRT). Methods: Patients with intermediate-risk PC were treated exclusively with HDRB and HRT. HDRB delivered a dose of 10 Gy to the prostate gland and HRT consisted of 50 Gy delivered in 20 daily fractions. The planning target volume was the prostate gland with a 1 cm margin all around. The first 121 consecutive patients with a minimum of 2 years post-treatment follow-up were assessed for acute and chronic toxicity and disease control. Results: The median follow-up was 62.8 months. No acute grade III or higher toxicities were seen. Grade II late GI toxicity was seen in 9 patients (7.4%) and grade III in 2 (1.6%). Grade 3 GU toxicity was seen in 2 patients (1.6%), both with urinary obstructive symptoms requiring catheterization. A repeat biopsy was offered to the first 58 consecutively treated patients, and 44 patients agreed with the procedure. A negative biopsy was found in 40 patients (91%). The biochemical relapse-free survival rate at 5 and 8 years were 90.7% and 81.4%, with 13 patients presenting biochemical failure. Among them, nine were diagnosed with distant metastasis. Prostate cancer-specific and overall survival rates at 8 years were 100% and 95.5%, respectively. Conclusions: Our program of HDRB and HRT is well tolerated, with acceptable toxicity rates. Furthermore, results from re-biopsies revealed an elevated rate of local control. These results are encouraging and confirm that the use of conformal RT techniques, adapted to specific biological features, have the potential to improve the therapeutic ratio in intermediate risk PC patients. No significant financial relationships to disclose.
Bowel morbidity after prostate brachytherapy with Cesium-131 assessed by longitudinal EPIC survey.
Authors: Beriwal S. , Smith R. , Vargo J. , Benoit R. M. 
Published: February 2017

84 Background: Cesium-131 is a relatively new radioisotope for prostate brachytherapy (PB), with limited long- term data for toxicity profiles. Here we report our 1-year follow up for severity and time to resolution of bowel toxicity using Expanded Prostatic Cancer Index Composite (EPIC) scoring. Methods: Longitudinal prospective study of 186 patients with prostate cancer treated with Cesium-131 PB at our institution were followed by EPIC recordings. The mean prostatic volume was 41.3 cm3 and the mean prostate D90 and V100 were 105.7% and 92.4%, respectively. Patients completed surveys preoperative and at 2 weeks, 4 weeks, 3, 6, 9, and 12 months post-operatively. Outcomes were analyzed using student t-tests, with an EPIC score drop of > 10 points considered clinically significant. Results: For all patients (n=186), the mean EPIC bowel summary score at baseline was 90.1 ± 11.7 compared to 72.0 ± 21.8 [mean difference 19.0 ± 1.7, p<0.0001], 69.7 ± 21.4 (21.1 ± 2.0, p<0.0001), 87.0 ± 13.7 (3.4 ± 1.0, p = 0.001), 90.2 ± 10.1 (0.6 ± 1.0, p = 0.508), 89.8 ± 12.8 (1.4 ± 1.1, p = .216), and 88.5 ± 13.5 (2.6 ± 1.2, p = .031) at 2 weeks, 4 weeks, 3, 6, 9, and 12 months, respectively. For patients treated with PB alone (n=128), the mean EPIC bowel summary score at baseline was 91.6 ± 10.3 compared to 70.7 ± 23.2 (20.9 ± 2.1, p<0.0001), 66.1 ± 22.1 (25.3 ± 2.6, p<0.0001), 86.7 ± 13.8 (4.9 ± 1.2, p<0.0001), 91.4 ± 8.3 (0.8 ± 0.9, p = 0.396), 91.9 ± 10.8 (0.8 ± 1.3, p = 0.545), and 91.6 ± 10.5 (1.4 ± 1.3, p = 0.266), at 2 weeks, 4 weeks, 3, 6,9, and 12 months, respectively. For patients treated with external beam radiation therapy (EBRT) + PB (n=58), the mean EPIC bowel summary score at baseline was 89.6 ± 14.2 compared to 74.7 ± 18.6 (14.9 ± 2.6, p<0.0001), 77.2 ± 17.8 (12.3 ± 2.5, p<0.0001), 87.5 ± 13.7 (0.4 ± 1.8, p = 0.823), 87.9 ± 12.9 (0.3 ± 2.2, p = 0.884), 85.8 ± 15.3 (2.6 ± 2.2, p = 0.243), and 82.9 ± 16.1 (4.8 ± 2.5, p = 0.060) at 2 weeks, 4 weeks, 3, 6, 9, 12 months, respectively. Conclusions: For men undergoing PB with Cesium-131 both as monotherapy and in conjunction with EBRT, bowel symptoms returned to clinical baseline within 3 months and statistical baseline within 6 months. These results remained non-significant relative to pre-operative values up to 1-year post-PB. No significant financial relationships to disclose.
Signet ring cell cancer: Harbinger of doom?
Authors: Taghavi Sharven , Jayarajan Senthil N. , Davey Adam , Willis Alliric Isaac 
Published: February 2017

10 Background: Signet ring cell cancer (SRC) is associated with worse prognosis. However, studies in Asia have questioned this idea. Our aim is to determine differences in presentation and outcomes between SRC and gastric adenocarcinoma (AC) to establish if SRC conveys worse prognosis in the U.S. Methods: NCI SEER was used to analyze differences in presentation and outcomes of SRC and AC from 2004−2007. Results: 10,886 gastric cancers included 2,872 SRC and 8,014 AC. SRC presented younger (62.0 vs 68.9 years, p<0.001) and less in males (53.7 vs 68.0%, p<0.001). SRC were more likely Asian (16.5 vs 13.5%) or Hispanic (23.3 vs 14.9%) and less Black (10.7 vs 11.5%) or White (71.8 vs 74.1%); p<0.001. SRC was more likely to be T-3 or T-4 (46.0 vs 33.8%), have nodal spread (72.5 vs 62.0%), and metastases (29.0 vs 24.1%); p<0.001. SRC was more likely lower stomach (30.6 vs 24.6%) or body (30.8 vs 21.6%) and less upper stomach (24.7 vs 46.9%); p<0.001. SRC more often overlapped regions (13.9 vs 6.9%, p<0.001). SRC was associated with mortality (HR 1.07, CI 1.01−1.14, p=0.017) and decreased median survival (12.0 vs. 13.0 months, p=0.034). Multivariate analysis stratified by AJCC stage and radiation found SRC was not independently associated with mortality (HR 1.04, CI 0.98−1.11, p=0.195). Mortality was associated with age (HR 1.01, CI 1.01−1.01, p=0.001), Black race (HR 1.11, CI 1.02−1.21, p=0.013), and tumor grade ( table ). Survival was associated with Asian race (HR 0.88, CI 0.81−0.95, p=0.001) and surgery (HR 0.21, CI 0.19−0.22, p=0.001). Conclusions: In the U.S., SRC differs from AC in presentation with younger age, less male predominance, greater tumor extent, metastases, and Asian or Hispanic ethnicity. Survival for SRC is associated with Asian race and surgical resection. Overall, SRC survival is less than AC. However, adjusted for stage at presentation, SRC does not portend a worse prognosis. [Table: see text]
Gastric leiomyosarcomas: A SEER analysis.
Authors: Moody John Scott , Kozak Kevin Robert 
Published: February 2017

106 Background: Gastric sarcoma is an uncommon malignancy that represents approximately 1% of gastric malignancies. The presentation and outcomes of these patients remains poorly defined, and a dearth of information is available regarding the management of such patients. Methods: Patients with primary gastric leiomyosarcoma, diagnosed between 1988 and 2008, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Clinical characteristics and outcomes of these patients were defined and compared with the characteristics of gastric adenocarcinoma patients. Results: A total of 49,258 patients were identified for analysis, 574 with leiomyosarcoma. Gastric leiomyosarcomas were more likely to occur in younger patients, female patients, and were less likely to present with advanced disease. These tumors were more likely to occur in the gastric fundus or along the greater curvature of the stomach. The incidence of gastric leiomyosarcoma has dramatically decreased over the last decade, consistent with the likelihood that many of these tumors are now considered to represent GIST tumors with current pathologic techniques. Median overall survival for gastric leiomyosarcoma patients was 36 months whereas that for gastric adenocarcinomas was significantly shorter at 10 months (P < 0.001 on Kaplan-Meier analysis). For non-metastatic patients, the median survival of leiomyosarcoma patients was 72 months versus 22 months for gastric adenocarcinoma patients. Cox proportional hazards modeling similarly demonstrated a decreased mortality risk associated with leiomyosarcoma (HR 0.52, 95% CI 0.47-0.57). A multivariable Cox analysis that examined tumor, patient and treatment characteristics demonstrated that leiomyosarcoma was independently associated with improved survival (HR 0.64, 95% CI 0.54-0.76). A Cox analysis for leiomyosarcoma patients alone showed that surgery was associated with improved survival (HR 0.14, 95% CI 0.06 – 0.34). Conclusions: Gastric leiomyosarcomas have been a distinct subset of gastric tumors with a superior prognosis than adenocarcinomas. Surgery has historically been a key component of successful management and is associated with improved survival.
Endoscopic resection as salvage treatment for patients with local failure after definitive chemoradiotherapy for stage II or III esophageal squamous cell cancer.
Authors: Makazu Makomo , Kato Ken , Takisawa Hajime , Yoshinaga Shigetaka , Oda Ichiro , Saito Yutaka , Mayahara Hiroshi , Ito Yoshinori , Itami Jun , Hamaguchi Tetsuya , Shimada Yasuhiro 
Published: February 2017

109 Background: Local failure after definitive chemotherapy and/or radiotherapy for stage II or III esophageal cancer is one of the causes of poor outcome. Endoscopic resection (ER) is an effective treatment for superficial esophageal cancer. However, its curative potential and safety remain unclear for local recurrent or residual tumor. Methods: Two hundred and sixty patients (pts.) who received definitive chemotherapy and/or radiotherapy for stage II or III esophageal squamous cell cancer between January 2000 and July 2007 were retrospectively reviewed. Results: Characteristics of all patients were as follows: median age of 65 (range 35-86); male/female: 226/34; performance status 0/1/2:117/141/2; clinical stage IIA/IIB/III: 64/70/126; regimen of chemoradiotherapy/radiotherapy: 235/15; and radiation dose 50.4/60/>66 Gy: 31/218/10. Of 260pts, 170 (65%) achieved complete response after chemoradiotherapy. Median survival time was 38.5 months and 5-year survival rate was 43.5%. While 81 of them had recurrent disease, 39 had locoregional recurrence without distant metastasis. While 86 of 260 pts (33%) had residual disease after chemoradiotherapy, 68 had only locoregional disease. Of the 107 pts who had only locoregional recurrent or residual tumor, 15 (14%) underwent salvage ER (17 lesions in total). Tumor depth was limited in mucosal layer in 10 lesions and submucosal in 7 lesions. En bloc resection was performed in 9 lesions (52.9%). The vertical margin was free from cancer cells in 15 lesions (88.2%). No major complications, such as hemorrhage requiring blood transfusion and perforation, were experienced. Only one pt experienced minor hemorrhage 16 days after EMR, and was treated by endoscopic treatment. At a median follow-up period of 40.0 months (range, 0.7-94 months) after salvage ER, no recurrence was detected in 9 pts. (60%). Local recurrence was detected in 4 pts. (27%). The clinical courses of the remaining 2 pts were unknown. Three-year survival rate after salvage ER was 58%. Conclusions: Salvage ER is feasible and one of the promising treatments for local recurrent or residual esophageal cancer after chemoradiotherapy or radiotherapy.
A phase I study of salvage photodynamic therapy (PDT) using talaporfin sodium and a diode laser for local failure of esophageal carcinoma (EC) after chemoradiotheapy (CRT).
Authors: Nagai Kengo , Muto Manabu , Ezoe Yasumasa , Yamamoto Takashi , Niimi Miyuki , Yoshimura Kenichi , Yoda Yusuke , Yano Tomonori , Higashino Koji , Iishi Hiroyasu , Yamamoto Yoshinobu , Nishizaki Hogara 
Published: February 2017

123 Background: We recently reported that porfimer sodium (Photofrin)-based PDT was a less invasive, curative treatment option for carefully selected patients with locally residual EC after CRT (Endoscopy 2011:43:657-63). However, porfimer sodium-based PDT has some problems (long light shielding and skin phototoxicities). Conversely, talaporfin sodium (Laserphyrin)-based PDT using a diode laser system can overcome these problems. Therefore, we conducted a phase I study to establish the recommended dose of laser irradiation and to evaluate safety of talaporfin sodium-based PDT as a salvage treatment after CRT. (UMIN000003970). Methods: We recruited patients with residual or recurrent EC at primary site and who were treated with more than 50 Gy of (chemo)radiotherapy. To determine the dose limiting toxicity (DLT) according to the energy of the diode laser, dose escalation was set at three energy levels (50,75 and 100J/cm2). The DLT was defined as follows; 1) severe pain, 2) ≥ grade 2 CTC-AE fever, 3) esophageal fistulae or stenosis, 4) ≥ grade 3 CTC-AE hemorrhage, and 5) ≥ grade 4 CTC-AE non-hematologic toxicity. Results: Between Oct. 2010 and May 2011, a total of 9 patients (9 men, median age of 72 y-o) were recruited and were treated using up to the third energy level in groups of three individuals. The initial T stage was T1/T2/T3(4/2/3) and recurrent T stage was T1/T2(6/3). None of the patients experienced DLT at all energy levels. A complete response was achieved in 5 of 9 patients (56%). Conclusions: Based on the results of our phase I study, we concluded that irradiation at 100J/cm2 appeared to be a recommended dose for talaporfin sodium-based PDT as a salvage treatment for locally residual esophageal carcinoma after CRT. We are currently running a phase II part of the study to investigate efficacy of salvage talaporfin sodium-based PDT.
Validation of a gastric cancer nomogram using a U.S. cancer registry.
Authors: McGhan Lee Joseph , Dueck Amylou C. , Pockaj Barbara A. , Gray Richard J. , Bagaria Sanjay Prakash , Wasif Nabil 
Published: February 2017

13 Background: A Memorial Sloan Kettering Cancer Center (MSKCC) nomogram predicts disease−specific survival (DSS) following R0 resection for gastric adenocarcinoma using patient and tumor factors, with predictive ability superior to that of the current AJCC staging system. However, validation has only been performed in high−volume, specialized institutions. The goal of this study is to compare nomogram-predicted survival with actual survival by using a population database with the largest sample size reported to date. Methods: A retrospective review of all gastric cancer patients from Surveillance, Epidemiology and End Results (SEER) registry data from 1988 to 2000 was conducted. Data for patient age, tumor size, gender, primary location of tumor, Lauren histology, depth of tumor invasion, and % (+) and (-) lymph nodes was entered into the nomogram calculator for each patient. Nomogram-derived 5−year DSS was compared with actual DSS survival using Cox proportional hazards regression and Kaplan-Meier estimates. Results: 4,700 patients were identified. Mean patient age was 68.7 years (SD 12.3), and mean tumor size was 4.8 cm (SD 2.7). The commonest tumor location was the body/middle third of stomach (1519, 32%), followed by the gastro−esophageal junction (1381, 29%) and the antrum (1376, 29%). The majority of patients (76%) had intestinal histology. The estimated proportion of patients surviving 5 years was 23%, 48%, 58%, and 82% for survival groups defined by nomogram likelihoods of 5−year DSS of 0−25%, 26−50%, 51−75%, and 76−100%, respectively. Relative to patients in the 76−100% 5−year nomogram group, patients in the 0−25%, 26−50%, and 51−75% group had significantly higher likelihood of death with hazard ratios of 7.0 (95% CI 6.1−8.0), 3.3 (95% CI 2.8−4.0), and 2.6 (95% CI 2.2−3.0), respectively (all p<0.001). Median follow-up was 9.1 years (range, 0−18). The concordance index (c−index) for the 5−year nomogram score was 0.68 (95% CI 0.67−0.69). Conclusions: There is good discrimination of survival between nomogram-predicted survival groups. Our results validate the use of the MSKCC nomogram in the setting of the general population, outside of specialized institutions, for predicting DSS following resection of gastric adenocarcinoma.
Standardized pathologic evaluation of the esophagus after neoadjuvant chemoradiation.
Authors: Muijs Christina T. , Smit Justin K. , Karrenbeld Arend , Beukema Jannet C , Langendijk Johannes A. , Plukker John Theodorus 
Published: February 2017

136 Background: The main objective of this study was to develop and validate a method to reconstruct the gross and clinical tumor volume (GTV and CTV) on the esophageal specimen in order to facilitate a good pathologic examination of the original tumor area after neo-adjuvant chemoradiation (CRT). Methods: The GTV and CTV borders of 25 patients were defined by a radiation oncologist on the planning CT in relation to 5 anatomical reference points. After CRT, the GTV and CTV borders were marked in vivo on the esophagus during surgical resection. Finally, the pathologist evaluated the presence of macroscopic and microscopic tumor in- and outside the GTV and CTV. The radiation tumor response was scored according to the standardized 5-tier Mandard classification. Radiation induced side effects were scored as well. Results: The Mandard classification could be scored on basis of the GTV alone in 68% of the cases (N=17). For the other patients (N=8), the GTV and the CTV should both be incorporated for correct evaluation of the tumor response. Five patients (20%) showed complete tumor response (Mandard 1), 68% (N=17) showed partial response (Mandard 2-3) and 12% (N=3) showed hardly any response (Mandard 4-5). In the partial responders, macroscopic tumor was found within the delineated GTV and microscopic tumor remained within the CTV both in 100% of the cases. In two patients (40%) with hardly any response, microscopic tumor was also found outside the CTV. This might be caused by tumor growth during the neo-adjuvant treatment or by geographical miss. Nine patients turned out to have positive lymph nodes. On average 18 (range 8-30) lymph nodes were evaluated per patients. Giant cell reactions, lymphocyte infiltration, and fibrosis, which indicate tumor regression were seen in the CTV and GTV, and were most pronounced in the GTV. Conclusions: This study suggested that demarcation of the GTV and CTV on the esophagus in vivo is important for standardized pathologic evaluation of the esophagus after neo-adjuvant chemoradiation. Furthermore using this method we determined microscopic tumor outside the CTV in 40% of the cases (N=2) of the bad responders (Mandard 4-5), illustrating the importance of our method in this patient category.
Clinical significance of obesity index (VFA versus BMI) as a risk factor for gastric cancer surgery.
Authors: Song Kyo Young , Shim Jung Ho 
Published: February 2017

139 Background: Obesity is considered as a major perioperative risk factor in various cancer surgeries. We aimed to elucidate the effect of two different obesity index, such as VFA (visceral fat area) and BMI (body mass index), on gastrectomy. Methods: From Mar 2009 to July 2010, 632 patients with diagnosed gastric carcinoma underwent curative gastrecomy at Seoul St. Mary’s hospital. We reviewed patients’ clinicopatholic data and collected 187 patients who had data including BMI, VFA and SFA. Patients with body mass index (BMI) ≥ 25 kg/m 2 were defined as obese and visceral fat area (VFA) ≥ 100 were defined as centrally obese. Results: Out of a total 187 patients, eighty patients were in the high BMI group and 107 patients were in the low BMI group. We selected patients with high VFA and low BMI (group A) and compared to the patients with low VFA and low BMI (group B). Out of a total 107 patients in low BMI, seventy three patients were censored as high VFA, and age older than 60 and male patients were prevalent in this group (p=0.045 and 0.046). The operation time (OT) and estimated blood loss (EBL) were significantly higher in group A than group B (p=0.043 and p=0.05). Conclusions: VFA and BMI are correlated each other and successfully represent patients’ obesity. However in selected patients, such as male patients with age older than sixty, VFA more practically represent their obesity.
HER2 status and histopathologic findings related to tumor regression in gastric carcinomas treated with preoperative chemotherapy.
Authors: Begnami Maria D. , Silva Milton Jose B , Costa Wilson L. , Coimbra Felipe José Fernandez , Chaves Marcos , Ribeiro Heber Salvador de Castro , Peresi Patricia , Mello Celso 
Published: February 2017

145 Background: Neoadjuvant chemotherapy is now the standard of care of patients with resectable gastric carcinomas (GC). Predictive molecular markers and histopathological evidence of tumour response to chemotherapy are not widely available. In this study we evaluated HER2 status and histopathological features associated with tumor regression in 36 GC treated with neoadjuvant chemotherapy followed by surgery. Methods: 36 patients had received ECF, DCF or ECX chemotherapy prior the surgery. The entire tumor beds of the specimens were histologically evaluated. HER2 expression by immunohistochemistry was detected in the biopsy and gastrectomy specimens. Results: 46% of the cases were intestinal type, 40% were diffuse and 14% were unclassified. Nine patients had major clinical and radiological response (CRR) characterized by presence of viable tumor cells less than 50% of the tumor with increased fibrosis (>50%). Three cases had complete CRR showing tumor beds totally replaced by fibrosis. The remaining cases had minimal CRR characterized by viable tumor cells in more than 50% and minimal fibrosis. Necrosis was not found; mucinous metaplasia was observed in three cases of the major CRR. Inflammatory infiltrated was found in all cases. The downstaging of T-stage seems to be greater in the intestinal type than diffuse type (80% vs 44%). HER2+ (score 3) was detected in 16,6% of the biopsy specimen. Only 1 case was HER2+ in the biopsy and in the gastrectomy tissue. All the HER2+ GC showed minimal CRR. Conclusions: The ratio of viable tumor cells and fibrosis is directly associated with tumor response to preoperative chemotherapy. The chemotherapy regimens seem to collaborate to downstaging rates; however the treatment of HER2+ GC group could be improved by the use of Ttrastuzumab.