bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tumor size as a prognostic factor for patients with colon cancer undergoing sentinel lymph node mapping and conventional surgery.
Authors: Saha Sukamal , Kanaan Mohammed Nawaf , Shaik Mohammed , Abadeer Benjamin , Korant Alpesh , Krishnamoorthy Madhumitha , Kaushal Sunil , Singh T. Trevor , Arora Madan L. , Wiese David 
Published: February 2017

546 Background: Unlike other solid tumors, tumor size (TS) is not a part of the TNM staging for colon cancer (CC). Our goal is to correlate TS with TNM staging, nodal positivity(NP), and 5-year overall survival (OS) for patients (pts) with invasive CC undergoing sentinel lymph node mapping (SLNM) vs. conventional surgery (CS). Methods: A retrospective review of 681 pts with invasive CC were reviewed and divided into two groups of pts (SLNM and CS). The pts in these two groups were subdivided according to the TS in four groups (0-2, 2-4, 4-6 and more than 6 cm). 461 pts underwent SLNM between 1996-2010 compared to 220 pts who underwent CS between 1996-2006. The pathology reports reviewed for TS (the maximum diameter of the primary tumor), T staging, and NP. The OS was calculated from the social security database and our hospital cancer registry. Then all data was compared between both groups. Results: Pts with TS <2cm were mainly T1+T2 (72%, 70%), whereas tumors >6 cm, majority of pts wereT3+T4 (94%, 85%). T1+T2 percentage consistently decreased as TS increased, and T3+T4 percentage was increasing consistently with increased TS (Table 1A). NP according to TS for SLNM pts were (16%, 53%, 56%, 48%) NP and for CS pts were (15%, 32%, 34%, 39%). In both groups, NP increased as TS increased compared to 0-2 cm group. The overall NP in both groups was 47% and 31% (Table 1B). OS for SLNM and CS pts were calculated in each group according to TS. Overall SLNM pts had better OS when compared to CS pts (65 %, 54%). Conclusions: Increasing TS was consistent with increasing T staging for both SLNM and CS pts. NP and OS were worse with increased TS for SLNM and CS pts. SLNM pts had higher NP and better outcome in OS when compared to CS pts, hence TS should be considered as a prognostic factor in pts with adenocarcinoma of the colon. [Table: see text]
Treatment of colorectal cancers with minimally invasive surgical techniques at a dedicated cancer center.
Authors: Reddy Sanjay S. , Sigurdson Elin R. , Farma Jeffrey M. 
Published: February 2017

549 Background: Laparoscopic (LS) and robotic surgery (RS) for colorectal cancer provides a new perspective of the deep pelvis. Our goal was to identify the role of LS and RS for patients with sigmoid and rectal cancer. Methods: We retrospectively analyzed 53 patients treated from 2007-2012. Resection type, previous surgery, neoadjuvant and adjuvant therapy, timing of surgery, lymph nodes (LN) harvested, estimated blood loss (EBL), operative time (OT), complications, and pathology were reviewed. Results: Of 53 patients, 32 underwent LS, and 18 RS. There were 47 patients with adenocarcinoma, 5 with unresectable polyps and 1 with anal melanoma. 62% of patients underwent a recto-sigmoid resection, 23% rectal, and 8% sigmoid. 32% had prior surgery. Neoadjuvant treatment (NAT) was initiated in 31 patients; 3 received chemotherapy without radiation, and 1 short course radiation. An average of 12.8 and 8.4 LN were harvested in the LS and RS groups respectively, with a mean of 9.9 LN after NAT, and 13.9 without. EBL was 155ml (20-650) with LS and 178ml (25-600) with RS. 3 LS cases were converted to an open procedure. Median OT was 270 and 302 minutes for LS and RS groups. Using the Clavien grading system, 12 patients had grade 1-2 complications, 5 grade 3, and 2 grade 4’s within 30 days. Radial margins were positive in 2 patients; one received NAT for a fungating anal adenocarcinoma, and the other had chemotherapy alone. One patient had a positive proximal margin with no prior therapy. Rate of complete pathological response (pCR) was 35%, and 71% were down staged. The mean interval between completion of NAT and resection was 8 weeks (range 4-12), and surgery to adjuvant therapy was 8 weeks (range 4-22). Conclusions: LS and RS surgery for colorectal cancer can be safely performed in conjunction with neoadjuvant and/or adjuvant chemotherapy. NAT should not preclude adoption of these techniques, as we achieved a 35% pCR with minimal operative morbidity allowing patients to proceed to adjuvant chemotherapy in a timely fashion. [Table: see text]
A phase II study on third-line chemotherapy combined bevacizumab with S-1 for metastatic colorectal cancer with mutated KRAS: SAVIOR study.
Authors: Takagane Akinori , Miyake Yasuhiro , Kobayashi Kouji , Nagata Naoki , Sato Atsushi , Ogata Yutaka , Fukunaga Mutsumi , Otsuka Koki , Takahashi Takao , Matsumoto Hidetomo , Negoro Yuji , Matsubara Yoshihiro , Yoshida Motoki 
Published: February 2017

552 Background: Anti-Epidermal growth factor receptor (EGFR) antibody therapy is expected to be effective in treatment for metastatic colorectal cancer (mCRC) with wild-type KRAS, but for mCRC with mutated KRAS, no salvage treatment has been established. We performed a phase II clinical study on 3rd-line chemotherapy combined bevacizumab with S-1, an oral fluorinated pyrimidine preparation containing a dihydropyrimidine dehydrogenase inhibitor, and bevacizumab for mCRC resistant to oxaliplatin and irinotecan. Methods: Subjects were mCRC patients with mutated KRAS, who showed aggravation even after 2 regimens with oxaliplatin and irinotecan. S-1 (80-120 mg/body) was administered for 4 weeks and withdrawn for 2 weeks. The dose of S-1 was decided according to the subjects’ body surface area. Bevacizumab (5 mg/kg) was administered on Days 1, 15, and 29. This treatment was provided until progression. The primary endpoint was disease control rate (DCR), and secondary endpoints were response rate (RR), median progression free survival (mPFS), overall survival (OS), and adverse event (AE). Results: A total of 31 subjects mutated KRAS were enrolled between August 2009 and July 2011. An independent review committee evaluated antitumor effects in eligible 29 of the 31 subjects in accordance with the Response Evaluation Criteria in Solid Tumors (RECIST). Two subjects in whom antitumor effects could not be evaluated were excluded. The DCR was 69% (95% confidence interval [CI], 49.2-84.7%), RR 0% (95% CI, 0-12.3%), mPFS 3.7 months (95% CI, 2.7-6.5 months), OS 9.0 months (95% CI, 7.5-12.0 months), and the median observation period 9.0 months. In 30 subjects for safety evaluation, the incidence of Grade 3 or greater adverse events was 50%. There was no treatment-related death. Major adverse events were anorexia (Grade 3 or greater, 20%), diarrhea (Grade 3, 10%), and decreased hemoglobin (Grade 3 or greater, 16.7%). Conclusions: The results suggest that 3rd-line chemotherapy combined bevacizumab with S-1 is safe and may delay the progression of mCRC resistant to oxaliplatin and irinotecan with mutated KRAS. Clinical trial information: NCT00974389.
Algorithm for identifying various second- and third-line chemotherapy regimens in elderly U.S. Medicare patients with metastatic colon cancer.
Authors: Bikov Kaloyan A , Mullins C. Daniel , Onukwugha Ebere , Seal Brian S. , Hanna Nader 
Published: February 2017

553 Background: Patients with metastatic colon cancer (mCC) often receive multiple lines of chemotherapy treatment (TX) in response to disease progression or toxicities. A claims-based algorithm that identifies TX lines can provide information on “real world” clinical practice patterns that may not be captured by clinical trials. Methods: Our claims-based algorithm was applied to SEER-Medicare data of elderly mCC patients diagnosed in ‘03-‘07 and followed through ‘09. The algorithm included 17 clinical rules for identifying the beginning and end TX lines. The face validity of the algorithm was assessed by 1) examining the output against a TX map for a random sample of patients; 2) evaluating the overall results; and 3) conducting a sensitivity analysis, which evaluated the variability in the number of detected TX lines as a function of key algorithm parameters. Results: Of 7,951 mCC patients, 3,266 (41%) received TX; 1,440 (18% of all, 44% of TX) and 274 (3% of all, 8% of TX) received 2nd and 3rd line TX, respectively. Fewer than 1% of treated patients had a 4th TX line. The utilization patterns in terms of number and type of TX lines were robust to changes in the algorithm parameters. OX±BEV (45%), 5FU/LV±BEV (33%) and IRI±BEV (16%) were the three most common initial TXs. 2nd line TX most commonly consisted of IRI±BIOLOGIC (62%) and OX±BIOLOGIC (26%), but 6% of patients received only BIOLOGICS. CETUX (19%), PANIT (15%), IRI alone (17%) and OX alone (12%) were the most common 3rd line TXs. OX to IRI (49%), IRI to OX (14%), 5FU/LV to OX (12%), and 5FU/LV to IRI (12%) were the most frequent TX progressions for those with 2nd line TX. 5FU/LV to OX to IRI (26%), OX to IRI to BIOLOGICS alone (25%), 5FU/LV to IRI to OX (14%) and IRI to OX to BIOLOGICS alone (6%) were the most frequent TX progressions for those with 3rd line TX. Conclusions: Our claims-based algorithm suggests that during 2003-2009 relatively few elderly mCC patients received 2nd and 3rd line TX. Sensitivity analysis confirmed the robustness of the algorithm. Future observational studies should address the “real world” benefits and risks of 2nd and 3rd line TX among elderly mCC patients.
Uptake of recommendations for adequate nodal removal in colorectal cancer resection.
Authors: Becker Daniel Jacob , Hanna Mina Samir Erian , Carter Eileen , Henderson Joy , Grossbard Michael L. 
Published: February 2017

557 Background: The number of lymph nodes removed during colorectal cancer (CRC) resection is associated with overall survival. The National Cancer Institute published recommendations to remove at least 12 lymph nodes in 2001. Previous analyses noted that as of 2001 the majority of patients in the US had inadequate lymph node resection (<12); geographic location is strongly associated with adequacy of lymph node resection. In this study, we examined the association between the year of cancer diagnosis and the number of lymph nodes removed between 2000 and 2008. Methods: We used the Surveillance Epidemiology and End Results (SEER) New Jersey cancer registry to identify patients diagnosed with stage I- III colon cancer from 2000 to 2008 who underwent resection and had lymph nodes removed. We used multiple linear regression to test for the independent association of year of diagnosis and the number of lymph nodes resected. We controlled for age at diagnosis, gender, race, tumor grade, tumor stage, and tumor location. Results: Our inclusion and exclusion criteria yielded 25,407 cases. The patients were 51% male, and 49% female; 48% had right–sided colon cancer, 29% had left–sided colon cancer and 23% had rectal cancer. The majority of the patients were white (87%); 25% had stage 1 CRC, 28% had stage 2 CRC, and 37% had stage 3 CRC. The mean number of lymph nodes removed was suboptimal in the year 2000 (11.4) but gradually rose to the recommended cut-off of 12 in 2002 and was 15.6 in 2008 (p<0.0001 for comparison of 2000 and 2008). The regression confirmed the independent association of year of diagnosis and number of lymph nodes removed. For every 1 year increase in the year of diagnosis, keeping all covariates constant, there is an increase of 0.55 lymph nodes removed (p < 0.0001). Higher grade, higher stage, female gender, and right colon tumors were also associated with increased lymph node removal. Conclusions: Between 2000 and 2008 in the New Jersey, there was a steady increase in the number of lymph nodes removed with CRC resection, reflecting an increased adherence to evidence-based guidelines and an improvement of cancer care.
Survival outcomes in U.S. patients with metastatic colorectal cancer (mCRC).
Authors: Knopf Kevin , Iqbal Sheikh Usman , Thompson Stephen F , Malangone Elisabetta , Gorritz-Kindu Magdaliz , Stern Lee , Sherman Steven A , Naoshy Sarah , Wooten Michael , Andria Michael L. 
Published: February 2017

559 Background: The increase in survival seen in recent years in patients with mCRC has been attributed to improvements in treatments, including the introduction of targeted biologic agents. The objectives of this retrospective, observational study are to investigate recent treatment patterns in US mCRC patients and examine real-world survival outcomes. Methods: Data were obtained from a large U.S. database (SDI/IMS Health) of mCRC patients diagnosed from January 1, 2004 to June 30, 2011, ≥18 y at diagnosis, and who received chemotherapy and/or biologic treatment. Complete follow-up was defined as those who either died before June 2011 or who had at least 1 claim within 30 days of June 30, 2011. Kaplan-Meier curves were generated to determine overall survival (OS) from the date of mCRC diagnosis. Results: 1,066 stage IV mCRC patients with complete follow-up were identified (57.5% male; mean age, 61.6 y). Approximately 80% were diagnosed with mCRC after 2006; 51.7% had liver metastases. The most common 1L, 2L, and 3L regimens were FOLFOX plus bevacizumab (34.52%), FOLFIRI plus bevacizumab (21.83%), and irinotecan plus cetuximab (15.83%), respectively. A total of 445 patients died during the study period, yielding a mortality rate of 41.74%. Mean time from diagnosis to first treatment was 3.31 months (SD=7.13). All patients received 1L therapy; OS from diagnosis was 35.77 months (95% CI: 32.57-38.10); 5-year survival was approximately 28%. After 1L, 591/1066 (55%) patients went on to receive 2L therapy; for these patients, median survival from diagnosis was 37.13 months (95% CI: 34.07-40.43) and 5-year survival was approximately 25%. After 2L, 278/591 (47%) patients received 3L therapy; for these patients, median survival from diagnosis was 38.10 months (95% CI: 34.83-43.13); 5-year survival was approximately 25%. Conclusions: In this study, OS (35.77 months) was longer than for other mCRC observational studies that have reported survival from start of treatment, but is more comparable when the ~3 months from diagnosis to start of treatment are not included. Addition of targeted agents and novel chemotherapy has prolonged OS in mCRC patients. Because of poor 5-year survival rates, the need for additional agents in later lines of therapy still exists.
The utility of PET scanning in colorectal cancer liver metastases being considered for surgery.
Authors: Kelly Ciara Marie , McCarthy Lauragh , O'Reilly Aine , McEneaney Peter , Bennett Michael William , O'Regan Kevin N. , Mulvihill Erica , O'Sullivan Adrian , O Suilleabhain Criostoir , O'Reilly Seamus , Power Derek G. 
Published: February 2017

561 Background: Liver resection remains the only potentially curative option for a subset of patients with metastatic colorectal cancer (CRC) to liver. Preoperative imaging used to determine resectability includes contrast enhanced computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). The objective of this study was to determine the utility of PET scanning for potentially resectable metastatic CRC to liver. Methods: We retrospectively reviewed a prospectively maintained database for all patients considered for liver resection of metastatic CRC from July 2010 to July 2012 in a specialist colorectal/hepatobiliary cancer centre. We extracted and analysed data with respect to preoperative staging imaging and definitive treatment performed on completion of staging. Results: We identified 50 patients who underwent preoperative staging investigations for potentially resectable metastatic CRC to liver. The imaging techniques performed included: CT (n=50, 100%), MRI liver (n=45, 90%), PET (n= 47, 94%). In 9 (9/47, 19%) patients PET scanning added to the preoperative cross sectional staging information, identifying local recurrence (n=1, 2%), confirming liver metastases following an inconclusive CT/MRI (n=1, 2%), and identifying extrahepatic sites suspicious for disease (n=7, 15%). The extrahepatic sites included either lung (n=4) or bone (n=1) or lymph nodes (n=2). One patient with FDG-avid mediastinal lymph nodes had no cancer on endobronchial biopsy. PET scanning definitively changed the therapeutic strategy in 6 patients (6/47, 12.8%): precluding liver resection in 2 patients (2/47, 4.3%), leading to resection of extrahepatic disease in 3 patients (3/47, 6.4%) and resection of hepatic metastases in one patient (1/47, 2.1%). Conclusions: In this small retrospective cohort the addition of metabolic imaging changed the management in 12.8% of patients with potentially resectable liver confined metastatic CRC. We plan to include data from other cancer centres in Ireland to confirm our findings.
Can grade 2 neutropenia predict the risk of grade 3 neutropenia in metastatic colorectal cancer patients treated with chemotherapy?
Authors: Yoshida Yoichiro , Hoshino Seiichiro , Aisu Naoya , Naito Masayasu , Tanimura Syu , Yamashita Yuichi 
Published: February 2017

562 Background: Neutropenia is a major factor affecting the continuation of chemotherapy for colorectal cancer. In many clinical trials, a neutrophil count of more than 1500 is targeted for the continuation of chemotherapy; for a count of less than 1500, medication is commonly discontinued. However, there is no definite evidence for setting the targeted neutrophil count at 1500. In our department, chemotherapy is discontinued when the neutrophil count is less than 1000 (Grade 3); for a count of 1000 to 1500 (Grade 2), chemotherapy is continued. We examined the neutrophil count during continuation of chemotherapy in patients with a count of 1000 to 1500, and verified whether these neutrophil counts warrant discontinuation of medication. Moreover, we examined the neutrophil count during the previous course of chemotherapy when it fell below 1000. Methods: The study included 104 patients who received XELOX + bevacizumab (BV) therapy, XELOX therapy, and XELIRI + BV therapy for advanced or recurrent colorectal cancer. Results: The patients with a neutrophil count of 1000 to 1500 were 26 (23.1%) of the total. Two (7.7%) of 26 patients had a neutrophil count of less than 1000 during the following course of chemotherapy. Moreover, among the patients with a neutrophil count of less than 1000, 25% had a count of 1000 to 1500 during the previous course of chemotherapy and 75% had a count of more than 1500. Conclusions: According to these results, Grade 2 neutropenia cannot predict the risk of the Grade 3 neutropenia. Continuation of chemotherapy in patients with a neutrophil count of 1000 to 1500 may be appropriate, and discontinuation of therapy is not always required.
Colorectal carcinoma (CRC) management approach in octogenarians and over a single institute experience.
Authors: Jordan Emmet , Murphy Amy , Coyle Seamus , O Connor Miriam , Calvert Paula , Horgan Anne M 
Published: February 2017

575 Background: The incidence of CRC increases with age. Future numbers are projected to rise due to an ageing population. Little data exists on chemotherapy in those ≥80 years (yrs) with CRC, a subgroup rarely included in clinical trials. The purpose of this study was to evaluate chemotherapy use, feasibility and tolerability in patients ≥80 yrs with CRC in a single institution. Methods: CRC diagnosed in those ≥80 yrs in a single institution in Ireland , from 2004 -2009, was determined. Clinicopathological data collected included age, gender, morphology, stage, and treatment including surgery, radiation or chemotherapy. In those receiving chemotherapy tolerance was determined by dose delays, reductions and number of completed cycles. Results: 83 cases of CRC were identified; 80-89 yrs (n=78), 90-100 yrs (n=5). Median age was 84 yrs (range 80-102), 38/83 (45.8%) were female. 59 cases of colon and 24 cases of rectal cancer were seen. Stage at diagnosis included IV (n=18), III (n=21), II (n=38) and I (n=6). For stage IV disease 4/18 (22%) received chemotherapy. Median overall survival for those with stage IV disease who received chemotherapy was 317 days (range 64-487) versus 169 days (range 30-473) for supportive care. 3/21(14%) stage III patients received chemotherapy. Median survival for stage III disease who received chemotherapy was 1193 days (range 432-1640) compared to 641 days who did not (range 0-1640). All patients with stage IV disease received single agent (SA) treatment (capecitabine n=3, cetuximab n=1). Treatment of stage III disease included: XELOX n=1, 5Fluorouracil/Leucovorin n=1, capecitabine n=1). 3/6 (50%) had dose reductions (n=4) and delays (n=7) in treatment. 1 patient completed scheduled adjuvant treatment. 1 patient with metastatic disease received second and third line treatment (SA irinotecan, cetuximab). Data including performance status, co morbidity will be presented. Conclusions: The uptake of chemotherapy in this cohort is low. Although the rates of treatment modifications are high, those treated appear to benefit. Better clinical tools are needed to differentiate those older patients likely to benefit from systemic therapy and those better served by supportive measures alone.
Dose escalation using dose-painted IMRT in locally advanced rectal cancer.
Authors: Ghaly Maged , Vijeh Lili , Marrero Mihaela , Vinciguerra Vincent , Angel Luz Paulina , Nasim Mansoor , Bloom Beatrice 
Published: February 2017

582 Background: After preoperative chemo-radiation, clinical response and tumor pathologic downstaging showed a close correlation with improved outcomes. We report our initial experience in dose escalation using dose-painted intensity-modulated radiation therapy (DP-IMRT) in patients with locally advanced rectal cancer. Methods: Fifteen patients with locally advanced rectal cancer (T3-4,N0-1) were prospectively identified. Tumors were staged using the cTNM classification by PET/CT, EUS & MRI. All received preoperative 5-FU and DP-IMRT. Doses were prescribed as follows:56 Gy/2.0 Gy fractions (fxn) to the planning target volume (PTV) and 47.6Gy/1.7Gyfxn to elective nodal PTV. Surgery was performed 6-8 weeks after chemo-radiation. The surgical procedure was tailored to tumor downstaging. The choice of sphincter-preserving surgery was based on the distance between the lower tumor pole and the anorectal ring “ after” chemoradiation. All were reevaluated for tumor response, preoperatively by imaging studies (ycTNM) and by pathological staging (ypTN) following surgery. Acute and late toxicities were monitored by the treating physician. Results: All patients completed therapy. Tumors were in the lower 1/3 in 3 patients, middle 1/3 in 7, and upper 1/3 in 5. With preoperative endorectal US, PET/CT and MRI, the clinical staging of the tumors was: 13 (T3N0) and 2 (T4N0). Acute toxicity was limited to a moderate proctitis (RTOG acute toxicity scoring system, G1 ) in all patients, with two patients with tumors extending into the anal canal having G 3 dermatitis. Complete clinical response was obtained in 10 of 15 patients.All 15 underwent surgery; 6 had pathological pT0N0, 4 had residual micro foci of carcinoma (pT1N0), and 5 had residual disease limited to the muscularis propria (pT2N0). No difference in perioperative complications was seen. Conclusions: Preoperative dose-escalation using dose-painted radiation therapy (DP-IMRT) seems to be safe. Moderate local acute toxicity was seen with very low-lying tumors. This modality provides a high rate of tumor downsizing especially for patients with lesions in the lower 2/3 of the rectum with a possible potential for an increased ability to perform sphincter-preserving surgery.