bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intensive up-front treatment versus a sequential approach in advanced gastric cancer patients: Does first line matter?
Authors: Bittoni Alessandro , Scartozzi Mario , Pistelli Mirco , Galizia Eva , Del Prete Michela , Giampieri Riccardo , Faloppi Luca , Bianconi Maristella , Maccaroni Elena , Cascinu Stefano 
Published: February 2017

131 Background: The definition of the standard chemotherapy regimen for advanced gastric cancer is still a matter of debate. A recent meta-analysis suggested that the addition of a third drug to a doublet regimen should be considered the state-of-the-art strategy to improve overall survival. Aim of our analysis was to retrospectively assess whether an intensive, three-drugs, front line approach could be comparable to a sequential (two-drugs front line then second line) in terms of RR (response rate), PFS (progression free survival), and OS (overall survival) in advanced gastric cancer patients. Methods: Patients with metastatic gastric cancer who have received a first-line combination chemotherapy with a two or three-drugs regimen were included in our analysis. We divided our patients into two groups, A and B, based on the first line chemotherapy administered (group A=three drugs; group B= two drugs). Results: A total of 390 patients were eligible for our analysis. 211 patients (54%) received three chemotherapeutic agents (group A) and 179 patients (46%) received a two drugs regimen as first-line combination chemotherapy (group B). The 2 groups of patients resulted comparable for all known prognostic factors of clinical relevance. RR for group A and B was 46,5% and 28%, respectively (p=0,0007), median PFS was 7,12 months in group A and 3,96 months in group B (p<0,0001). No significantly difference resulted for the median OS of patients in the two groups (13 months for group A and 11,8 months for group B; p= 0,962). Conclusions: The addition of a third drug to a doublet chemotherapy regimen appeared more active in terms of response rate and PFS. However median OS resulted comparable. On this basis, a triplet regimen may represent an optimal choice, particularly when response and PFS are relevant treatment endpoints. Nevertheless the use of a sequential approach may also represent a reasonable strategy for patients unwilling or unable to undergo a more intensive treatment without compromising OS.
Preventive effect of rikkunshito, traditional Japanese medicine, for chemotherapy-induced nausea and vomiting.
Authors: Kajiura Shinya , Hosokawa Ayumu , Yoshita Hiroki , Nakada Naokatsu , Itaya Yuko , Ueda Akira , Ando Takayuki , Fujinami Haruka , Ogawa Kohei , Sugiyama Toshiro 
Published: February 2017

135 Background: Supportive therapies are being developed for chemotherapy-induced nausea and vomiting (CINV). Rikkunshito is a Kanpo medicine, which is a part of traditionally practiced Japanese-based ancient Chinese medicine. It has been reported to be effective against cisplatin-induced anorexia in rats. In the present study, we evaluated the preventive effect of rikkunshito for CINV in patients receiving high-dose cisplatin. Methods: We selected subjects who received chemotherapy including cisplatin (≥60mg/m2) for gastric or esophageal cancer between April 2008 and July 2011 at our institution. We targeted 26 cases treated without a reduction in the anti-cancer medication in the second course and added 7.5g/day of rikkunshito, orally administered for seven days, to their second course treatment regimen. All cases were treated with 5-HT3 receptor antagonist and steroid, and 12 cases were treated with palonosetron for the prevention of CINV in their first and second courses. We evaluated the complete response (CR, defined as no emesis and no rescue medication) rate and other toxicity, according to CTCAE v4.0, of the first and second courses. Results: The median age of the patients was 67 years (range, 49–77 years). There were nine cases of gastric cancer and 17 cases of esophageal cancer. The chemotherapy regimens were cisplatin + irinotecan in two cases, cisplatin + 5-FU in 15 cases, cisplatin + S-1 in seven cases and cisplatin + 5-FU + docetaxel in two cases. Six cases received concomitant radiation therapy. Anorexia in the first course was grade 0/1/2 = 4/12/10, but had been mitigated in the second course to grade 0/1/2 = 11/11/4 (P = 0.020). CR rate was 69.3% in the first course (95% CI, 51.6%–87.0%) and by the second course had improved to 88.5% (95% CI, 76.2%–100%) (P = 0.089). And about the other major toxicity, there was no significant difference between first and second courses. Conclusions: These results suggest that rikkunshito has the potential to improve CINV in patients receiving high-dose cisplatin.
A pilot study of WCA (a Chinese Jianpi Herbal Formula) integrated to systemic chemotherapy (CT) in the first-line treatment for advanced gastric cancer (AGC).
Authors: Zhao Aiguang , Li Zhaoyan , Zhao Gang , Cai Yong , Xu Yan , Zhu Xiaohong , Cao Nida , Yang Jinkun 
Published: February 2017

143 Background: To improve survival of AGC, practitioners of traditional Chinese medicine (TCM) prescribe a combination of plant species/minerals, called formulae, based on their clinical experiences. WCA, a Chinese “Jianpi” herbal formula, could inhibit gastric cancer cells MKN-45, SGC-7901 growth in vivo on our previous studies. All the herbs formed the formula have been used for thousands of years in Chinese clinical practices. Methods: A nonrandomized concurrent control trial was performed to investigate the role of WCA for AGC. Patients (pts) with gastric adenocarcinoma (locally advanced, recurrent, or metastatic) were prospectively enrolled. All pts were assigned to receive WCA+CT q3w for 3 or more than 3 cycles or CT alone. WCA was formulated as following: Radix pseudoxtellariae 12g, Stir-fried Rhizoma atractylodis macrocephalae 12g, Poria cocos 30g, Sargentodoxa cuneata 30g, Concha ostreae 30g, Prunellae vulgaris 9g. It was given orally every day until disease progression. The primary end point was overall survival (OS). The baseline comparison was analyzed by using chi-squared test. Results: 270 eligible pts had been histologically confirmed adenocarcinoma. At the time of last follow-up, 197 pts (73.0%) had died of disease, and 67 pts (26.7%) had censored, 1 patient (0.3%) had died of unrelated cause. The median follow-up of pts was 39.9 months. Baseline characteristics (gender; age of onset; primary tumor site; histological type; initial CT scheme; cycle of CT) were well balanced across arms. Median OS was significantly improved in WCA+CT arm (n=127) compared to that in CT (n=143) alone: 19.3 vs. 13.1 months, respectively (HR 0.550; 95% CI 0.412, 0.734; p=0.000). The treatment was generally well tolerated. There were no WCA-related adverse events observed. No patient died related to WCA treatment. Conclusions: This prospectively concurrent control trial investigating Chinese herbal therapy in advanced GC showed that WCA+CT be a promising candidate treatment for GC superior to CT alone. A randomized controlled trial is needed to further evaluate the value of WCA in improving the OS of AGC.
Neutropenic fever and neoadjuvant intraperitoneal and systemic chemotherapy (DCF-like) in gastric cancer with peritoneal dissemination.
Authors: Muñoz Martin Andrés Jesús , Garcia Alfonso Pilar , Gonzalez Bayon Luis , Vasquez Jimenez Wenceslao , Ruperez Blanco Ana Belen , Lopez Marti Maria Pilar , Tapia Rico Gonzalo , Blanco-Codesido Montserrat , Alvarez Suarez Sonsoles , Martin Miguel 
Published: February 2017

144 Background: Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) is a new treatment modality in gastric cancer with peritoneal seeding. Several phase I-II clinical trials with NIPS and cytoreductive surgery have shown an increase in overall survival in Japanese patients (pts) with acceptable toxicity. We report the toxicity related to neutropenia and granulocyte colony stimulating factor (G-CSF) use of the first experience in Spain with NIPS (DCF-like) in gastric cancer with peritoneal carcinomatosis. Methods: Ten consecutive pts have been enrolled in this protocol in a compassionate use program in our center from 2009 to 2011. Chemotherapy (DCF-like) was delivered through an implantable peritoneal catheter. Primary prophylaxis with GCS-F was not used as described in the phase II studies, except in one pt. Clinical characteristics (Table). Results: The incidence of grade 3–4 neutropenia was 70% and any grade neutropenia 80%. Febrile neutropenia was described in 50% of the pts. All pts received secondary prophylaxis according to ASCO guidelines. No treatment-related deaths were observed. One pt discontinued chemotherapy due to febrile neutropenia and diarrhoea. There were no complications due to the infection of peritoneal catheter. Late or unexpected toxicities have not been observed. Conclusions: The first results suggest febrile neutropenia rate of this treatment modality exceeds the 20% ASCO threshold. Primary prophylaxis with G-CSF should be considered in this setting. [Table: see text]
S-1 plus oxaliplatin compared with fluorouracil/leucovorin/oxaliplatin as neoadjuvant chemotherapy for locally advanced gastric carcinoma.
Authors: Yu Jiren , Wu Yijun , Gao Yuan , Shen Qianyun , Zhang Qing , Liu Xiaosun , Zhu Kankai 
Published: February 2017

147 Background: Perioperative chemotherapy could improve the prognosis compared with surgery alone. This study is to compare the efficacy and safety of S-1 and oxaliplatin (SOX) with fluorouracil, leucovorin and oxaliplatin (FOLFOX) as neoadjuvant chemotherapy for locally advanced gastric carcinoma. Methods: Patients with histologically confirmed locally advanced gastric carcinoma were enrolled and divided into two groups. Preoperative staging and response evaluation was achieved mainly by gastroscopy and abdominal computer tomography. Neoajuvant chemotherapy consisted of 2-6 cycles of S-1 80mg/m2 (2-week administration and 1-week rest) plus oxaliplatin 130mg/m2 on Day1 in SOX group, or 2 h infusion of 130mg/m2 oxaliplatin plus 2h infusion of 400 mg/m2 leucovorin, followed by infusion of 400 mg/m2 5-fluorouracil on Day 1 and 46 h 2.4 g/m2 bolus in FOLFOX group. The clinical response was evaluated after 2 cycles of chemotherapy, and surgery was attempted. Results: From 2009.9 to 2011.5, 88 patients were enrolled in this study(56 in SOX and 32 in FOLFOX). The clinical response rate was significant higher in the SOX compared with FOLFOX (54.7% vs. 31.2%, p=0.03). 68 patients received surgery(45 in SOX and 23 in FOLFOX), R0 resection rate was similar in both group (SOX: 93.3% vs. FOLFOX: 82.6%, p=0.22). Pathological complete response was observed in 3 patients in SOX group. All enrolled patients were evaluated for the adverse events (AE). The most common non-hematological AE was nausea (57.1% in SOX and 50% in FOLFOX) and vomiting (41.1% in SOX and 40.6% in FOLFOX). The major hematological AE included thrombocytopenia (37.5% in SOX and 21.9% in FOLFOX), neutropenia (33.9% in SOX and 53.1% in FOLFOX) and leukocytopenia (32.1% in SOX and 40.6% in FOLFOX). Conclusions: SOX had higher response rate and acceptable toxicity compared with FOLFOX as neoadjuvant chemotherapy.
Patient-reported toxicities and comorbidities after treatment for cancers of the upper gastrointestinal tract.
Authors: Metz James M. , Hampshire Margaret K. , Vachani Carolyn , Di Lullo Gloria A. , Hill-Kayser Christine E. 
Published: February 2017

148 Background: Patients may be at risk for significant late effects after multimodality therapy for gastric and esophageal (GE) cancers, the impact of which may be difficult to evaluate using conventional methods. This Internet-based study evaluates patient perceptions of toxicity after treatment for GE cancer. Methods: Patient-reported data was gathered via a convenience sample frame from GE cancer survivors voluntarily utilizing a publically available, free, Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and through the OncoLink website, the tool allows survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, GE cancer survivors are queried regarding late effects associated with specific treatments. All data have been maintained with IRB approval. Results: Sixty-six GE cancer survivors answered queries regarding late effects; 62% were female and 93% Caucasian. Median diagnosis age was 55 yrs (19–74 yrs), median current age 59 yrs (19–77 yrs), and average time since diagnosis 3.8 yrs. Most reported having had multimodality therapy—88% surgery, 80% chemotherapy, and 48% radiation. When queried regarding persistent health problems after cancer treatment, 35% reported cardiovascular disease (21% hypertension, 13% hyperlipidemia, 3% angina), 28% sexual dysfunction, 36% tinnitus, 24% peripheral neuropathy, 42% cognitive changes, 100% difficulty swallowing, 60% dry mouth or taste changes, 40% dental changes, and 14% chronic lung disease. Conclusions: Survivors using this tool anonymously and voluntarily report significant health problems after treatment for GE cancers. The data reported here may be of significant impact in future study of quality of life, as well as patient counseling and survivor care.
What are the limiting factors related to discontinuance of chemotherapy after failure of first-line S-1 plus CDDP in Japanese patients with advanced gastric cancer?
Authors: Ohhara Yoshihito , Chin Keisho , Ogura Mariko , Suenaga Mitsukuni , Shinozaki Eiji , Matsusaka Satoshi , Mizunuma Nobuyuki , Yamaguchi Toshiharu , Hatake Kiyohiko 
Published: February 2017

149 Background: Recently, it is suggested that second-line chemotherapy improved survival in advanced gastric cancer (AGC) and it is commonly performed in Japanese daily practice in these several years. We investigated the limiting factor not to be able to receive second-line chemotherapy in Japanese patients with AGC. Methods: Between 2007 and 2009, 155 patients received S-1 plus cisplatin (SP) treatment as first-line chemotherapy in Cancer Institute Hospital of JFCR, Japan. Among them, 148 patients could not continue SP treatment because of disease progression or unacceptable toxicity. 109 patients could receive second-line chemotherapy (Group A), while 39 patients could not (Group B). We evaluated the clinicopathologic factors that affected not to receive second-line chemotherapy, retrospectively. Univariate and multivariate analyses were performed on the baseline factors before starting first-line chemotherapy. Results: Characteristics of patients were below (Group A vs B): median age, 60 vs 66 (years); gender (male), 71.6 % vs 66.7 %. Median progression-free survival were not different in both Group statistically (6.5 vs 7.2 months; log-rank, p=0.861). Median overall survival were 16.5 vs 10.3 months (log-rank, p<0.001), respectively. Univariate analyses found 4 limiting factors not to initiate second-line chemotherapy: age over 65 years old (p=0.025), performance status>1 (p=0.017), alkaline phosphatase (ALP) >400 IU/l (p<0.001), C-reactive protein (CRP) >1.0 mg/dl (p=0.004). Multivariate analyses showed ALP elevation was a limiting factor (HR 4.122, p=0.003). Conclusions: Alkaline phosphatase can be an uncomplicated and potent limiting factor of discontinuance of chemotherapy after failure of the first line S-1 plus CDDP in Japanese patients with AGC.
The effect of vascular reconstruction on early postoperative outcomes after pancreaticoduodenectomy: An analysis of the American College of Surgeons National Surgical Quality Improvement Program database.
Authors: Castleberry Anthony W. , White Rebekah Ruth , De La Fuente Sebastian G. , Tyler Douglas S. , Pappas Theodore N. , Scarborough John E. 
Published: February 2017

153 Background: Several single-center reports have been published suggesting that vascular reconstruction (VR) during pancreaticoduodenectomy (PD) allows an acceptable oncologic outcome in patients with pancreatic adenocarcinoma without affecting early postoperative mortality or morbidity. The objective of our study was to review the outcomes associated with VR during PD using a large multicenter data source. Methods: A retrospective cohort analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjusting for patient demographics and comorbidities. Results: 3582 patients were included for analysis, 281 (7.8%) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality (5.7% with VR vs. 2.9% without VR, Adjusted Odds Ratio (AOR) 2.1, 95% CI 1.22-3.73, p = 0.008) and overall morbidity (39.9% with VR vs. 33.3% without VR, AOR 1.36, 95% CI 1.05-1.75, p = 0.02). Patients undergoing VR required significantly longer operative times, and were more likely to require intraoperative transfusion or early reoperation, than patients not undergoing VR during PD. There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team. Conclusions: Contrary to the findings of several previously published single-center analyses, data from ACS-NSQIP suggests that VR significantly increases the risk of 30-day postoperative death or complications after PD. Patients who may require VR during PD will likely benefit from referral to centers with sufficient experience with this procedure.
Neoadjuvant chemoradiation versus surgery first for resectable pancreatic head adenocarcinoma: An economic and outcome analysis.
Authors: Abbott Daniel Erik , Tzeng Ching-Wei David , Merkow Ryan P. , Cantor Scott B. , Katz Matthew H.G. , Bentrem David J. , Bilimoria Karl Y. , Crane Christopher H. , Varadhachary Gauri R. , Fleming Jason B. 
Published: February 2017

156 Background: The optimal sequence of treating pancreatic cancer (PC) with chemotherapy, radiation and surgical intervention remains elusive. Thus, cost should be considered. This study was conducted to compare the cost and outcome of a surgery first approach versus neoadjuvant chemoradiation (CRT) followed by surgery. Methods: A decision model was constructed to contrast the 2 treatment strategies. The NCDB (2003-5), ACS NSQIP (2005-9) and literature populated probabilities and outcomes in the surgery first arm, including operative outcome, complication rate, pathologic stage, adjuvant therapy and stage-specific survival based. Data from a prospectively maintained PC database (2002-8) populated the neoadjuvant arm. Costs were based on Medicare reimbursement (2011$). Survival, discounted when appropriate, was reported in quality-adjusted life months (QALM). Results: 164 pts completed neoadjuvant CRT. Of these, 36 (22%) did not proceed to surgery. Failure was due to metastases, 18(50%), prohibitive performance status (PS), 17(47%) and pt choice, 1(3%). 12 pts (7%) proceeded to laparotomy but were deemed unresectable. 116 (71%) pts underwent definitive resection. The surgery first approach cost $95,781 to yield survival of 8.7 QALM, while the neoadjuvant strategy cost $71,416 to achieve 18.8 QALM. In the neoadjuvant population, pts not undergoing surgery, those unresectable at laparotomy and those completing surgery demonstrated a cost of $12,401 to yield 7.7 QALM, $39,112 to yield 7.1 QALM and $92,887 to achieve 23.4 QALM, respectively. Conclusions: Treating pts with neoadjuvant CRT identifies those who develop early metastases or prohibitive PS and can be spared an ineffectual or prohibitively morbid operation. Our data suggest this approach is associated with improved OS at significantly lower cost. Neoadjuvant therapy for resectable PC should be employed more frequently to provide cost-effective care for this lethal disease. [Table: see text]
A RAND/UCLA appropriateness study of the management of familial gastric cancer.
Authors: Dixon Matthew , Seevaratnam Rajini , Wirtzfeld Debrah , McLeod Robin S. , Helyer Lucy K. , Law Calvin , Swallow Carol Jane , Paszat Lawrence Frank , Tinmouth Jill , Cardoso Roberta , Mahar Alyson L. , Coburn Natalie G. 
Published: February 2017

16 Background: Hereditary diffuse gastric cancer (HDGC) makes up 0.1-0.3% of all gastric cancers. Management of patients with HDGC is inconsistent and there is disagreement regarding management. Methods: A multi-disciplinary expert panel of 16 physicians from 6 countries scored 47 scenarios using the RAND/UCLA Appropriateness Methodology. Appropriateness was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores (AS) 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 (NS) in the same manner. AS and NS are reported if agreement was met. Results: Gastric cancer (GC) patients with a family history of diffuse gastric cancer (DGC), lobular breast cancer or multiple family members with GC should be referred for genetics assessment and multidisciplinary decision-making (AS 8.0). It is appropriate for patients with DGC to have CDH1 mutation testing in a family with: (1) two or more cases of GC, with at least one case of DGC diagnosed before the age of 50 (AS 8.0); (2) three or more cases of GC diagnosed at any age, one or more of which is DGC (AS 8.0); (3) a patient diagnosed with DGC and lobular breast cancer (AS 8.0); or (4) a patient diagnosed with DGC under the age of 35 (AS 7.0, NS 5.0). A prophylactic total gastrectomy should be offered to CDH1 mutation carriers 20 years or older (AS 7.0). Conclusions: The Gastric Cancer Processes of Care panelists have outlined high risk patients in whom CDH1 mutation status should be determined, and cases in which a prophylactic gastrectomy is appropriate.