bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nipple-sparing mastectomy and immediate breast reconstruction: Critical appraisal of five-year, single-center outcomes.
Authors: Westbroek D. , Mann K. , Ho M. , Gukas I. , Karat I. , Daoud R. , Laidlaw I. J. 
Published: February 2017

99 Background: Approximately 5,000 patients undergo breast reconstruction annually in the United Kingdom (2:1 ratio of immediate versus delayed respectively). Preservation of the breast envelope, i.e., skin and nipple areola complex (NAC) improves cosmesis. While skin-sparing mastectomy is an accepted modality for local control in appropriately selected patients, nipple-sparing mastectomy (NSM) remains controversial. In over 1,800 published NSM cases, the local event rate attributable to NAC preservation following NSM (therapeutic and prophylactic) is 0.16% with no evidence of deleterious impact on disease-free survival. In our cohort, patient selection criteria included: preoperative lesion characterisation; 5-mm margin acceptance; submission of separate nipple core specimens for paraffin block histological assessment and re-excision of all involved margins. This study is intended to evaluate the efficacy of loco-regional control in a consecutive cohort of patients, under uniform conditions undergoing nipple-sparing mastectomy and immediate breast reconstruction. We highlight the surgical technique used and propose in/exclusion criteria for appropriate patient selection. Methods: 84 consecutive patients underwent NSM and IBR at Frimley Park Hospital, Surrey, UK (IJL, RD) between January 2004 and December 2008. Data was accrued retrospectively from the institution’s clinical coding, electronic records, and WinPath database. Endpoints recorded include: the incidence of (occult) malignancy at the nipple margins; NAC subcutaneous tissue loss; local (NAC) recurrence rates and disease free survival. Results: The mean age was 51.1 years and follow-up 4.9 years. There was one case of local recurrence in a patient who declined re-excision of close/involved margins. The immediate peri-operative complication rate was within the national mastectomy breast reconstruction audit outcome guidelines. Conclusions: In appropriately selected patients, our findings support nipple preservation at the time of mastectomy and immediate reconstruction as this enhances the cosmetic outcome without compromising oncologic safety.
Availability of sentinel node as predictive index of lymph node metastases to early-stage gastric cancer surgery.
Authors: Kamiya S. , Takeuchi H. , Niihara M. , Kaburagi T. , Nakamura R. , Oyama T. , Takahashi T. , Wada N. , Saikawa Y. , Kitagawa Y. 
Published: February 2017

10 Background: Recently, the less invasive surgery for the early gastric cancer attract considerable attention, in particular, sentinel node navigation surgery (SNNS) is expected to be a new strategy. We analyzed the feasibility of sentinel node (SN) biopsy and its accuracy in predicting the lymph node status in patients with early gastric cancer. Methods: Between 1999 and 2009, we have performed the gastrectomy with SN biopsy during an operation in over 500 cases. We focused attention on 115 patients with cT1N0, less or equal 40 mm in size, and isolated gastric cancer and they had undergone the individualized minimizing gastrectomy. Proximal, pylorus-preserving gastrectomy and wedge resections were performed in 51, 54 and 10 patients, respectively. We used a dual procedure with dye- and gamma probe-guided techniques for SN mapping and resected SN and non-SN as was conventionally done for the safety. Results: Subjects were 85 males and 30 females with a mean age of 63.4 years. 53 patients had undergone laparoscopy-assisted gastrectomy. The mean number of SNs was 4.3/case. Of the four patients were SN positive and false-negative was found in one case. The sensitivity of detecting metastases was 80.0% (4/5) and the accuracy was 99.1% (114/115). One case had a recurrence in the liver and no cases without SN metastasis were confirmed any recurrences and metastases. Conclusions: This study showed the diagnostic accuracy of metastasis based on SN was very high, and the minimized resection and lymphadenectomy could be performed safely. No significant financial relationships to disclose.
Prognostic significance of positive lymph node ratio in resected esophageal cancer.
Authors: Thota R. , Tashi T. , Gonsalves W. , Sama A. R. , Silberstein P. T. , Townley P. , Subbiah S. 
Published: February 2017

100 Background: Nodal involvement in esophageal cancer is associated with poor survival. We aim to determine whether the ratio of metastatic to examined lymph nodes (the lymph node ratio [LNR]) is a better predictor of survival as compared to the number of positive lymph nodes in resected esophageal cancer. Methods: 1,149 patients with resected esophageal cancer from 1995 to 2009 were identified from the VA Central Cancer Registry (VACCR) database. The patients were further characterized to 3 lymph node quartiles based on LNR and their median survivals were calculated using the Kaplan-Meier method. Results: Out of 1149 patients 26.4% patients (303) had squamous cell carcinoma and 73.6% (846) were of adenocarcinoma histology. Median age of diagnosis is 63 years. 353 (31%) are stage 1, 384 (33%) are stage 2, and 412 (36%) are stage 3. Majority of them 71% arise in lower third of esophagus followed by 13% in middle third, 4% in upper third and 12 % had unknown site of origin. The group was subdivided into 3 quartiles with 62.7% in LNR1 (0.0-0.1), 25.6% in LNR2 (0.1-0.5) and 11.7% in LNR3 (0.5-1.0). 13.7% had less than 2 nodes removed, 29.3% had 3-6 nodes and 57% had >7 nodes examined. 28% of them had tumor invading sub mucosa, 23.5% had tumor invading muscularis mucosa, 43.2% had involvement of adventitia and 5.3% had penetrating tumor at the time of diagnosis The 5 year survivals based on number of lymph nodes examined, number of positive lymph nodes and positive lymph node ratio are listed in the table. The median overall survival for resected esophageal cancer based on LNR quartiles was 37 vs 14 vs 11.5 months (p<0.0001). Conclusions: Number of positive lymph nodes and positive lymph node ratio correlated with survival outcomes but number of lymph nodes retrieved did not predict any survival differences. However LNR was a better predictor of survival when compared to number of positive nodes. Further validation of this observation needs to done in large multicenter studies. [Table: see text] No significant financial relationships to disclose.
Phase II study of docetaxel (DTX) and S-1 as neoadjuvant chemotherapy for potentially R0 advanced gastric cancer.
Authors: Watanabe M. , Emi Y. , Kakeji Y. , Oki E. , Sakaguchi Y. , Yoshida K. , Hirabayashi N. , Yamanaka T. , Baba H. , Maehara Y. 
Published: February 2017

106 Background: This trial sought to evaluate the efficacy and safety of preoperative chemotherapy with DTX plus S-1 for advanced gastric cancer with poor prognosis even after R0 curative resection. Methods: Preoperative staging was confirmed by laparoscopy. Eligibility criteria included 1) negative peritoneal cytology, H0, P0 and M0, 2) possible curative resection, and 3) ECOG PS 0-1. Patients received DTX (35 mg/m2) on days 1 and 15, and daily oral administration of S-1 (80 mg/m2/day) for days 1–14 every 4 weeks of 2 courses, followed by gastrectomy with D2 lymphadenectomy. The primary endpoint was pathological response rate (pRR), which was defined as degeneration occupying more than one-third of the cross-sectional surface area of the tumor. A sample size of 45 was planned for the expected pRR of 40% and threshold value of 20%, with one-sided alpha of 0.05 and beta of approximately 0.1. This study was registered in the UMIN clinical trial registry (UMIN000000875). Results: A total of 47 patients were centrally registered between November 2007 and November 2009 from 14 centers. All patients were eligible for analysis. The median age was 63 (range 37–79); male/female: 36/11; PS0/1:41/6; and clinical stage IIIA/IIIB: 31/16. The target pRR was 47% (90% CI, 34–60%; p < 0.0001). Forty six patients (98%) underwent surgery, in whom curative resection was performed in 44 patients, and 37 patients completed the protocol treatment. The response to preoperative chemotherapy was PR/SD/PD/NE in 16/24/2/5 with a response rate of 34%. The most common toxicities of neoadjuvant chemotherapy were grade 3/4 neutropenia (42%), febrile neutropenia (4%), grade 2 anorexia (21%), and fatigue (15%). Seven did not complete the neoadjuvant therapy due to 2 allergic reaction, 1 grade 3 anorexia, 2 grade 2 nausea and anorexia, 2 PD (all 7 had gastrectomy). Major operative morbidity included pancreatic fistula (9%), abdominal abscess (11%), pneumonia (2%), and anastomotic leakage (0%). No patients died due to surgical complications. Conclusions: The combination of DTX and S-1 was well tolerated and promising as a preoperative chemotherapy regimen for patients with potentially resectable advanced gastric cancer. [Table: see text]
Surgical lymph node clearance and pathologic evaluation in gastric cancer.
Authors: Khattak A. G. , Sachdev J. C. , Evangelist M. C. , Denbo J. , Orr W. S. , Ul-Haq M. , Farooq A. , Thompson A. C. , Dilawari R. A. , Osarogiagbon R. U. 
Published: February 2017

131 Background: Lymph node (LN) metastasis is common in gastric cancer, with survival implications. The number of LN with metastasis determines pathologic nodal stage; optimal staging requires examination of >14 LN. This requires adequate surgical LN clearance and careful pathology evaluation. Sub-optimal LN examination may be due to surgical or pathology laboratory quality problems, affecting the rational implementation of corrective measures. We evaluated LN examination practice in our community. Methods: Review of all gastric resections at two hospital systems in Memphis, TN from 1999 to 2008, excluding patients with pre-operative chemo/radiation therapy. Two surgeons separately reviewed all operation reports for details of LN station clearance. We tested concordance between surgeons by the kappa statistic (k) and correlated surgeon reports of LN clearance to the number of examined LN in the pathology report. Results: 51% of 116 operative reports did not state LN stations resected. The concordance rate between the two surgeons was high (k score per station ranging from 0.66 [very good] to 1.0 [perfect]). The median number of LN stations cleared was similar after proximal (PG) and distal gastrectomy (DG), but significantly more after total gastrectomy (TG) (p<0.0001). Only 39% of patients had >14 LN examined, 6% had none. The number of LN examined was lowest for PG, intermediate for DG and highest for TG patients (Table). There was no correlation between number of surgically cleared LN stations and number of examined LNs (Spearman correlation coefficient 0.23). Conclusions: Operating surgeons frequently did not identify a LN dissection procedure. Fewer LN were retrieved by pathologists during examination of PG specimens although the surgeon-reported LN clearance was similar between PG and DG. The lack of correlation between LN stations cleared and number of LN examined suggests inadequate pathological examination of LNs submitted in surgical specimens. [Table: see text] No significant financial relationships to disclose.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal carcinomatosis arising from gastric cancer.
Authors: Piso P. , Glockzin G. , Schlitt H. J. 
Published: February 2017

132 Background: Peritoneal carcinomatosis is a common sign of advanced tumor stage or disease recurrence in patients with gastric cancer. The prognosis of these patients is poor. There is some evidence that CRS and HIPEC may improve the oncological outcome of a highly selected part of patients with peritoneal carcinomatosis arising from gastric cancer. Nevertheless, the use of CRS and HIPEC as an additional therapeutic option is still controversial. Methods: Between 01/2005 and 09/2009 16 out of 256 patients underwent CRS and HIPEC for peritoneal carcinomatosis arising from gastric cancer at the University of Regensburg Medical Center. The mean age of patients at the time of surgery was 52 years (range 32-69). Four patients were female (25%). The mean follow-up time was 16.3 months. Results: Thirteen patients (81.25%) underwent complete macroscopic cytoreduction (CC-0/1). HIPEC was performed in all patients. The median hospital stay was 19.5 days (range 8-44) and the median stay on ICU 1 day (range 0-14), respectively. The median operating time was 342 minutes (range 49- 510). The perioperative grade 3/4 morbidity rate was 37.5%. Postoperative complications were pneumonia (2), pancreatitis (2), pneumothorax (2), intraabdominal abscess (2), renal insufficiency (1), urine bladder dysfunction (1) and wound infection (1). There was no operative mortality in our series. The 1-year survival rate was 68.7%. The mean survival of the ten patients that died during follow-up was 14.1 months (range 3.4-44.8). Conclusions: In highly selected patients with gastric cancer and peritoneal carcinomatosis CRS and HIPEC may lead to prolonged survival rates. However, the therapy should be integrated in an interdisciplinary multimodality treatment concept. Further prospective randomized trials are required to determine the role of CRS and HIPEC in the treatment of patients with gastric cancer. No significant financial relationships to disclose.
Phase II multicenter study of erlotinib with radiation therapy (RT) for elderly patients (pts) with esophageal carcinoma (EC): Final report.
Authors: Iyer R. V. , Yang G. , Schefter T. E. , Tan W. , Nava H. R. , Levea C. , Litwin A. , Robins M. , Khushalani N. I. 
Published: February 2017

135 Background: Elderly pts with comorbidities have limited Rx options for localized EC. High EGFR expression correlates with poor response to RT. We examined the safety and efficacy of erlotinib, an oral EGFR tyrosine kinase inhibitor with RT in these pts. Methods: Pts older than 65 yrs ineligible for platinum based Rx with carcinoma of the thoracic esophagus or gastroesophageal junction received erlotinib 150mg PO QD for one year starting D1 of RT [50.4 Gy D1-28 (M-F) at 1.8 Gy per fraction]. Assessments- mucosal response by EGD 4-8 wks post RT; RECIST response by CT q3mo. Endpoints: Primary- overall survival (OS), secondary- quality of life (QOL) using the FACT-E QOL tool, progression free survival (PFS) and toxicity; correlative- pre-treatment tumor EGFR and pEGFR expression by immunohistochemistry (IHC). Results: The study was closed after 17 of planned 35 pts were included due to poor accrual. Baseline characteristics: median age 78 yrs (66-91); gender M/F: 11/6; ECOG PS 0/1/2=2/12/3; stage I-1, II=5, III=7 and IVa= 4; histology: adenocarcinoma 16, squamous cell 1; dysphagia at baseline 13/17 (76%). Median OS was 7.3 months (95% CI: 4.5-22.3) with 12 pts dead (5 alive, 3 still on treatment). Reason for coming off study (n=14): disease progression (n=6), toxicity (n=5), withdrew consent, completed one year of treatment, death from unrelated cause (n=1 each). There were 2 mucosal CRs and one residual carcinoma in situ, 3 partial endoscopic responses of the 9 pts who had post RT endoscopy. Estimated PFS is 5.3 months (95% CI: 2.4-11). Sites of progression- distant 3, locoregional 6, unknown 5 and too early 3. Estimated one year survival is 26 %, 3 pts lived >12 months. Smoking status- current/past/never 3/12/2. Treatment related toxicities (any grade n=or>5) were, rash (16), fatigue (16), diarrhea (11), lymphopenia (10), anorexia (7) and dehydration (6) and 21 grade 3/4 toxicities occurred. IHC results- EGFR, neg: 1/16; pos: 15/16 and pEGFR, neg: 2/16; pos:14/16. Conclusions: For elderly pts with localized EC and no chemotherapy options, erlotinib monotherapy with RT is a tolerable therapy with modest activity. Further studies are needed to define the role of EGFR inhibition with RT in EC. No significant financial relationships to disclose.
Long-term survivorship in gastric cancer.
Authors: Kunz P. L. , Gubens M. A. , Fisher G. A. , Ford J. M. , Lichtensztajn D. , Clarke C. A. 
Published: February 2017

14 Background: Gastric cancer is the fourth most prevalent malignancy and second leading cause of cancer death worldwide. For all stages, gastric cancer is rapidly fatal with a 5-year survival rate of 25%. Of those patients who survive, very little is known about their demographic and tumor characteristics. Methods: Cases of gastric and gastroesophageal junction (GEJ) adenocarcinoma diagnosed between 1998 and 2005 were identified within the California Cancer Registry, a SEER registry. Univariate and multivariate logistic regression models were constructed predicting the outcome of survival to 3, 5 and 8 years based on demographic, disease and treatment variables. Results: Of the 47,049 patients with gastric or GEJ cancer, 38,380 (82%) died within 3 years of diagnosis, 8,669 (18%) survived at least 3 years, 5,336 (11%) survived at least 5 years, and 3,002 (6%) survived at least 8 years. The 5-year survivors had a median age at diagnosis of 67 years with a male predominance (64%). The majority were non-Hispanic whites (64%), followed by Asian/Pacific Islanders (23%), and Hispanics (18%). Most had localized (48%) or regional (41%) disease. In the multivariate model, odds of surviving to 5 years were highest with localized stage (odds datio=27), surgery (7.8), regional stage (5.9), fundus/body/antrum site (1.7), Asian/Pacific Islander race (1.5), intestinal histology (1.5), high SES (1.4), and well/moderately differentiated tumors (1.4). Kaplan-Meier curves for cause-specific death were examined by anatomic site and histology. Persons with tumors originating in the fundus/body/antrum had longer median OS compared to patients with tumors originating in the esophagus/cardia (15 vs. 12 months). Intestinal histology had longer median OS (30 months) compared to other or diffuse (both approx 12 months). Conclusions: Long-term survivors of gastric and GEJ cancer have distinct demographic patterns when compared to patients who died within three years. The multivariate analyses demonstrated that earlier stage, surgery, anatomic site (fundus/body), Asian race, intestinal histology, high SES, well/moderately differentiated tumors, and radiation were the strongest independent predictors of survival. No significant financial relationships to disclose.
S-1 and intraperitoneal and intravenous paclitaxel as neoadjuvant chemotherapy for gastric cancer with positive peritoneal cytology.
Authors: Peng Y. , Imano M. , Imamoto H. , Nishiki K. , Nakamori Y. , Shiraishi O. , Yasuda A. , Shinkai M. , Yasuda T. , Shiozaki H. 
Published: February 2017

142 Background: The prognosis of gastric cancer with positive peritoneal cytology is dismal. Standard treatments for these patients have not been established. The purpose of this study was to evaluate the safety and response of the regimen. Methods: Patients who were diagnosed with advanced gastric cancer between 2007 and 2010 underwent staging laparoscopy and received intraperitoneal paclitaxel when peritoneal cytology were positive and sequential systemic chemotherapy, S-1 combined with intravenous paclitaxel within 14 days after staging laparoscopy. Paclitaxel was administered intraperitoneally at 80 mg/m2. S-1 was administered at 80 mg/m2/day for 14 consecutive days, followed by 7 days rest. Paclitaxel was administered intravenously at 50 mg/m2 on day 1 and day 8. After 2 courses of S-1 combined with paclitaxel were administered, clinical response was assessed by gastroendoscopy and computed tomography. Additional 2 or 3 courses were administered unless progression of disease was proved. Patients who achieved complete response (CR) or partial response (PR) and patients with stable disease (SD) underwent second-look laparoscopy following gastrectomy when peritoneal cytology turned negative. Results: 8 (7 male, 1 female) patients were enrolled: median age was 64 years (range 40-75). Of 8 patients, 1 patient achieved CR, and 5 PR. 2 patients showed progressive disease (PD). Grade 3 neutropenia occurred in 1 patient. 6 patients underwent second-look laparoscopy and peritoneal cytology turned negative in all 6 patients. Total or distal gastrectomy with lymphnode dissection was performed consecutively in 3 or 3 patients, respectively. Median follow-up duration was 775 days (range 187-1,028). No recurrence has not been observed, while the 1-year and 2-year survival rates of 14 patients with peritoneal cytology positive gastric cancer who have not received neoadjuvant chemotherapy were 58.3% and 33.3%, respectively. Conclusions: S-1, intraperitoneal and intravenous paclitaxel as neoadjuvant chemotherapy seems to be a effective strategy against gastric cancer with positive peritoneal cytology. No significant financial relationships to disclose.
A comparison of IMRT and 3DCRT in the treatment planning of patients with distal esophageal cancer.
Authors: Patil S. 
Published: February 2017

143 Background: There is limited data comparing intensity modulated radiation therapy (IMRT) and 3D conformal radiation therapy (3DCRT) in node-negative patients with cancer of the distal esophagus. Methods: Eight patients with node-negative cancer of the distal esophagus measuring 1-5 cm tumors were selected for this study. Target volumes were generated for all patients based on standard current practice; 3DCRT and IMRT plans optimized to obtain minimum dose to the heart were then created using the using the Eclipse Treatment Planning. Conformality index (CI, the amount of target volume covered by the prescription dose) and conformation number (CN, the amount of normal tissue receiving prescription dose) were calculated. Dose volume histograms also were generated and clinically relevant parameters were extracted and compared for each planning modality using paired T-tests. Each patient served as his or her own control. Results: The difference in CI ranged from 0-0.01, indicating equivalent target coverage for each patient. IMRT produced superior CN (mean CN = 0.74) vs. the 3DCRT plans (mean CN = 0.45). Heart V40 and the maximum dose to spinal cord were lower for IMRT (mean difference in heart V40 = 34.5%, p=0.0006 and mean difference in the maximum dose to the spinal cord = 18.1 Gy, p=0.0005) but lung V5 and V20 were lower for 3DCRT (mean difference in lung V5 = -21.3%, p=0.0026 and mean difference in lung V20 = -5.2%, p=0.0014). Conclusions: When optimized to minimize dose to the heart, IMRT plans were substantially more conformal to the target structures with less dose to the heart as compared to 3DCRT plans; however this occurred at the expense of increased dose delivered to the lung. No significant financial relationships to disclose.