bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiological markers of treatment responsiveness in patients (pts) with metastatic pancreatic ductal adenocarcinomas (mPDAC) receiving systemic chemotherapy.
Authors: Park Peter Yong Soo , McAferty Kenyon Verner , Ahmadi Michael , Chen Kewei , Chang John , Dragovich Tomislav , Kundranda Madappa N. 
Published: February 2017

403 Background: mPDAC is a deadly disease with dismal survival. Newer systemic therapies including gemcitabine/nab-paclitaxel (GA) and FOLFIRINOX (FF) have resulted in modest increases in median overall survival(mOS). Currently, no good predictors exist to prioritize the use of one regimen over the other. We investigated imaging patterns in patients receiving these two regimens. Methods: A single institution retrospective analysis of pts with mPDAC receiving either GA or FF as the front-line therapy between Jan 2012 - Dec 2014 was conducted. Data included demographics and systemic therapy.Baseline CT evaluated six imaging features; lung metastases, liver metastases, peripancreatic adenopathy, retroperitoneal adenopathy, mesentery/omentum infiltration and ascites. Statistical analysis included Kaplan Meier survival analysis with Chi-square test to compare imaging features that predict mOS or median response duration (mRD). Results: N = 27 pts; median age:GA-66 years( range: 52-76), FF-55 years (range: 40-67); 13 pts (48 %) were women and 24 pts had an ECOG performance status of ≤ 1. 18 pts received GA and 9 received FF. mOS with GA = 6.1 months(m) ( range: 1.9-15.7) and FF = 9.9 m (range: 2.5-24.1). 5/18 (28%) of the GA group and 7/9(78%) of the FF group received subsequent therapies. The presence of peripancreatic adenopathy in GA pts correlated with prolonged mRD (2.2 vs. 0.6 m; p < 0.001) without statistical difference in mOS (8.5 vs. 2.9 m; p = 0.4). In pts receiving FF the absence of hepatic metastasis resulted in a significant mRD (2.3 vs. 0.9 m; p = 0.01) and mOS (7.9 vs. 1.9 m; p = 0.04). The remainder of the radiological features did not show any statistically significant difference. Conclusions: In patients with mPDAC receiving GA or FF in front-line therapy; we observed that metastasis to the liver predicts worse outcome with FF than GA. Interestingly, peripancreatic lymphadenopathy was predictive of longer mRD for GA pts, without difference in mOS. Our pilot data demonstrates the potential of using CT imaging features to predict likelihood of response to different chemotherapy regimens. A larger study is needed to confirm these findings.
FOLFIRINOX for patients with borderline and never-resectable locally advanced pancreatic cancer, with the addition of chemoradiotherapy for potentially resectable patients: A phase II study.
Authors: Bjerregaard Jon Kroll , Ladekarl Morten , Fromm Anna-Lene , Pfeiffer Per 
Published: February 2017

408 Background: Locally advanced pancreatic cancer (LAPC) is often a mix of borderline and never-resectable tumors. Multimodality treatment might downstage these tumors to allow a potential radical resection, especially the borderline group. In this ongoing phase II study we examined the feasibility of FOLFIRINOX with or without CRT followed by surgery for both borderline and never-resectable tumors (NCT-01397019). Methods: Patients in performance status 0-1, with initially non-resectable stage II/III pancreatic cancer were offered FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, 5FU 400 mg/m2+ 2400 mg/m2) every 14 days. Every 4th series the patients were evaluated and offered CRT (50.4 Gy/27F & capecitabine) if deemed potentially resectable. Resections were performed if deemed possible by the MDT. Results: Between August 2012 and present, 58 patients have been recruited with a median observation time of 14.5 months. Median age was 65(range 38-75) years, with 47%/53% stage II/III distribution. Median CA19-9 was 299(range 2-13,432). Two-hundred-seventy-four courses of FOLFIRINOX have been given, with a median of 6.5 per patient, with a median of 2 without dose modifications. Presently twenty-one patients have been treated with CRT. Twelve patients have been resected, of which 7 received prior CRT. Median survival for all patients was 15.6 months (11-NR) with a 1-year survival of 70% (49-84). For patients not resected the median survival was 12.8 months (9-16) for resected the median survival has not yet been reached. The FOLFIRINOX was associated with adverse events similar to what is expected in metastatic patients. Conclusions: FOLFIRINOX with or without CRT in patients with LAPC shows promising efficacy in patients with both borderline and never-resectable tumors. Unmodified FOLFIRINOX had acceptable toxicity, however dose reductions are often needed. CRT following initial FOLFIRINOX was feasible and without unexpected toxicity. Clinical trial information: NCT-01397019.
Prediction of metastatic pancreatic cancer patients’ survival using both host immunity and tumor metabolic activity.
Authors: Choi Younak , Oh Do-Youn , Park Hyunkyung , Kim Tae Yong , Lee Kyung-Hun , Han Sae-Won , Im Seock-Ah , Kim Tae-You , Bang Yung-Jue 
Published: February 2017

411 Background: Host antitumor immunity measured by neutrophil-lymphocyte ratio (NLR) is reported to be associated with prognosis of cancer patients. Standard uptake value (SUV)by18F-FDG PET represents the metabolic activity of tumor itself. The correlation of host immunity and tumor metabolic activity has not been studied. We investigate the association of these two factors and evaluate their roles in prediction of overall survival (OS) in metastatic pancreatic cancer (MPC) patients who receive palliative chemotherapy. Methods: We reviewed 396 MPC patients receivingpalliative chemotherapy. NLR was obtained before initiation of chemotherapy and after 1st cycle of chemotherapy. In 118 patients who were evaluated with 18F-FDG PET before initiation of chemotherapy (PET cohort), maximum SUV (SUVmax) was collected. Cut-offs for each variable were determined by ROC curve. Results: In multivariate analysis, higher NLR was associated with worse OS ( < 2.5, 9.0 m; 2.5-4.4, 7.2 m; ≥ 4.5, 3.9 m; p< 0.001). Reduction of NLR after 1st cycle of chemotherapywas associated with betterOS (8.0 m vs 6.1 m; HR 0.653; p< 0.001). We made the risk scoring model considering both NLR (score 0, NLR < 2.5; score 1, 2.5 ≤ NLR < 4.5; score 2, NLR ≥ 4.5) and ΔNLR(score 0:ΔNLR < 0; score 1: ΔNLR ≥ 0), which identified 4 risk groups with different prognosis (group with risk score 0 vs 1 vs 2 vs 3: OS 9.7 vs 7.9 vs 5.7 vs 2.6 months; HR 1 vs 1.329 vs 2.137 vs 7.915, respectively; P < 0.001). In PET cohort (118 patients), NLR and SUVmax were independent prognostic factors for OS. The risk model considering both NLR (score 0, NLR < 2.5; score 1, 2.5 ≤ NLR < 4.5; score 2, NLR ≥ 4.5) and SUVmax (score 0:SUVmax < 4.5; score 1: SUVmax ≥ 4.5), which define 4 risk groups with different OS. (group with risk score 0 vs 1 vs 2 vs 3: OS 11.8 vs 9.8 vs 7.2 vs 4.6 months; HR 1 vs 1.536 vs 2.958 vs 5.336, respectively; P < 0.001). Conclusions: NLR and SUVmax as simple parameters of host antitumor immunity and tumor metabolic activity, respectively, have significant impacts on the survival of metastatic pancreatic cancer patients independently. Consideration of both aspects allows more precise prediction of patients’ prognosis.
Perioperative outcomes following composite resections for colorectal cancer with liver metastases: Can we do better?
Authors: Hui Jane Yuet Ching , Li Tianyu , Ross Eric A. , Esnaola Nestor F. 
Published: February 2017

412 Background: Curative resection for synchronous colorectal cancer and liver metastases (CRC/LM) can be performed simultaneously as composite resections or in isolation as staged resections. Composite resections expedite care and may be more cost-effective, but there is persistent controversy regarding their safety. This study aimed to identify potentially modifiable differences in adverse perioperative outcomes after composite versus (vs) isolated resection for CRC/LM. Methods: All patients (pts) with CRC/LM in the American College of Surgeons-National Surgical Quality Improvement Program Participant Use File who underwent elective colon, rectal, and/or liver resections from 2005 to 2013 were identified. Patient/procedure characteristics and perioperative outcomes were compared in pts who had isolated colon or rectal resection (CR or RR), isolated liver resection (LR), or composite colon/liver or rectal/liver resection (CLR or RLR) using chi square or Wilcoxon tests. Multiple logistic regression models were used to determine the independent effect of resection type on outcomes. Results: 13,523 pts underwent CR (3,601; 26.6%), RR (2,018; 14.9%), LR (7,002; 51.8%), CLR (513; 3.8%), or RLR (389; 2.9%). In colon cancer pts, the 30-day (30-d) rate of death/serious complication (DSC) was significantly higher after CLR (33.7%) than after CR (22.0%; adjusted odds ratio [aOR] 0.41, 95% confidence interval [95% CI], 0.33 to 0.52) or LR (13.9%; aOR 0.33; 95% CI, 0.27 to 0.41). Similarly, in rectal cancer pts, the 30-d rate of DSC was significantly higher after RLR (24.7%) than after RR (21.5%; aOR 0.66; 95% CI, 0.50 to 0.88) or LR (13.9%; aOR 0.47; 95% CI, 0.36 to 0.62). Differences in adverse outcomes following composite resections were not due to mortality, but to higher rates of pulmonary/infectious complications and returns to the operating room. Conclusions: Composite resections for CRC/LM are associated with higher rates of DSC, particularly in colon cancer pts. Aggressive targeted strategies to prevent pulmonary and infectious complications could significantly improve outcomes in pts undergoing composite resections for synchronous CRC/LM.
Impact of stereotactic body radiation therapy on patient-reported quality of life in patients with unresectable or recurrent pancreatic cancer.
Authors: Rosati Lauren M. , Cheng Zhi , Robertson Scott P. , Kummerlowe Megan N. , Hacker-Prietz Amy , Wolfgang Christopher Lee , Pawlik Timothy M. , Le Dung T , Zheng Lei , Laheru Dan , Herman Joseph M. 
Published: February 2017

413 Background: The impact of fractionated stereotactic body radiation therapy (SBRT) on patient-reported quality of life (QOL) and physician-reported toxicity in patients with recurrent or locally advanced pancreatic cancer (PCA) was prospectively evaluated. Methods: Forty-two PCA patients were treated with 25-33 Gy using SBRT in 5 fractions on a single-institution study. Both patient- and physician-reported outcomes were evaluated prior to SBRT and 4-6 weeks post-SBRT. Eight outcomes were consistently evaluated among both groups—performance status, fatigue, pain, anorexia, nausea, vomiting, constipation, and diarrhea. Patient-reported QOL metrics were assessed using a 4-point Likert scale on the EORTC QLQ-C30 and QLQ-PAN26, while physician-reported toxicities were graded using the NCI CTCAE version 4.0. Comparisons between those with paired patient- and physician-reported outcomes collected prior to and 4-6 weeks after SBRT were made using the Wilcoxon signed-rank test. Results: Of the 42 patients currently enrolled onto the study, 29 had both patient- and physician-reported outcomes collected prior to and 4-6 weeks after SBRT. Fifty-five percent were female and 83% were Caucasian. The median age at diagnosis was 65.6 years (range, 40.8-86.6). There was no significant impairment of any of the 8 physician-reported toxicities, nor were significant changes observed in patient-reported overall health (p = 0.66) or QOL (p = 0.18) scores following SBRT. Patients felt less worried about their future health (mean change [mD] = -0.45, p = 0.02), and an improvement in feeling less attractive as a result of disease and treatment reached borderline significance (mD= 0.31, p = 0.09). However, patients felt limited in planning activities in advance (mD= 0.45, p = 0.02) and were more constipated (mD= 0.38, p = 0.01) 4-6 weeks post-SBRT. Conclusions: Although the numbers are small, patients with unresectable or locally recurrent PCA do not appear to suffer any detriment of overall health or QOL after receiving a five-day course of SBRT. Moreover, this regimen may lead to a more optimistic point of view on future health and/or level of physical attraction. Clinical trial information: NCT01781728.
Association of decreased peak SUV on PET after neoadjvuant therapy in patients with borderline resectable pancreatic carcinoma with pathologic response.
Authors: Glazer Evan Scott , Rashid Omar Maen , Hodul Pamela Joy , Pimiento Jose Mario , Malafa Mokenge Peter 
Published: February 2017

423 Background: Despite the use of PET scan in metastatic staging, its utility as a biomarker for borderline resectable pancreatic carcinoma (BRPC) is unclear. The peak standardized uptake value (SUVpeak) is the average SUV around the most avid portion of the tumor. We hypothesized that tumor pathologic response (PR) to neoadjuvant therapy will correlate with SUVpeak changes after therapy. Methods: We reviewed our database of patients with BRPC who completed neoadjuvant chemotherapy (GTX) followed by radiation and had pre- and post- neoadjuvant PET scans. Changes in the SUVpeak were calculated by subtracting the post-neoadjuvant/pre-resection PET scan from the pre-neoadjuvant PET scan. PET responders were defined as those patients whose SUVpeak decreased by 4 units (the overall average decrease in SUVpeak) or more. Results: We identified 74 patients- 32 patients developed progressive disease and 42 patients underwent surgery. The average age was 66 ± 9 years; 61% of patients were male. On the final pathologic specimens, 5 patients had a complete PR to therapy while 23 patients had a moderate PR (1-49% viable tumor) and 14 patients had a minimal PR (≥ 50% viable tumor). PR is associated with a decrease in SUVpeak (p = 0.02; Table). The area under the receiver operator characteristic curve for changes in SUVpeakand complete PR was 0.83 ± 0.08. Of the PET responders who underwent surgery, 29% had a complete PR while none of the PET non-responders had a complete PR (p = 0.004). Of the unresected patients, PET responders had a longer overall survival compared to non-responders (18 ± 7 vs. 12 ± 7 months, p < 0.05). Nodal disease was not associated with PR (p > 0.3). Conclusions: PR was significantly associated with a decrease in SUVpeak post-neoadjuvant therapy in patients with BRPC. Even in patients with unresectable disease, SUVpeak provides useful prognostic data. We believe that pre- and post-neoadjuvant therapy PET scans may be used as a prognostic biomarker in patients with BRPC. [Table: see text]
Can the sequence of chemotherapy regimens influence outcome in patients with metastatic pancreatic adenocarcinoma (MPAC)?
Authors: Schmidt Shannon Leah , Durkal Vipal , Pattali Jayavalsan Shinoj , Ritch Paul S. , Thomas James P. , Erickson Beth , Christians Kathleen K. , Tsai Susan , Evans Douglas B. , George Ben 
Published: February 2017

428 Background: FOLFIRINOX(FFX)/FOLFOX(FX) and Nab-paclitaxel plus Gemcitabine (NabG) represent standard first line (FL) treatment options for MPAC, but there is no prospective data to ascertain the ideal sequence of these regimens when used off protocol for patients with MPAC. We reviewed our single institution experience to evaluate whether the sequence of these regimens influenced clinical outcome. Methods: All MPAC patients treated with FFX/FX or NabG, in either sequence, from 1/1/11 to 12/31/14 at the Froedtert and Medical College of Wisconsin (MCW) Clinical Cancer Center were identified and their charts reviewed. This study was approved by the Froedtert & MCW Institutional Review Board. Results: Among 64 patients reviewed, the median age at diagnosis was 62. 64.1% were male and 95.3% were Caucasian. Median Ca19-9 and CEA at diagnosis were 855 and 10.4 respectively. 37/64 (57.8%) patients received SL therapy. Details of treatment and disease control rate (DCR) are summarized in the Table. Of patients who were refractory to FL FFX/FX, 4/7 (57.1%) demonstrated disease control (DCR) with SL NabG; numbers were too small for reverse analysis. Median overall survival (OS) of patients who received 2 lines of therapy was 12.1 months, while median OS of patients who received one line was 4.1 months. Median OS associated with sequential therapy is summarized in the Table. Conclusions: Both FFX/FX and NabG are active in the SL setting. Outcomes appear to be fairly similar regardless of sequence. The numerically superior median OS associated with FL NabG followed by SL FFX should be interpreted with caution in the context of small number of patients in this subset. A substantial minority of patients do not receive second line chemotherapy due to deteriorating clinical status and/or patient preference suggesting unfavorable tumor biology. [Table: see text]
EUS combined with CT in predicting SMV/PV resection in patients with borderline resectable pancreatic carcinoma.
Authors: Glazer Evan Scott , Rashid Omar Maen , Klapman Jason , Harris Cynthia L. , Hodul Pamela Joy , Pimiento Jose Mario , Malafa Mokenge Peter 
Published: February 2017

432 Background: Guidelines recommend pancreatic protocol CT scan (CT) for staging vascular involvement in patients with pancreatic cancer (PC). While endoscopic ultrasound (EUS) has been demonstrated to be effective in venous staging of PC, its role when combined with CT is poorly defined. We evaluated the utility of EUS in addition to CT in staging PC. We hypothesized that EUS complements CT in identifying SMV/PV tumor involvement as measured by the requirement for vein resection. Methods: We reviewed our database of patients with borderline resectable PC who went to surgery with curative intent. Inclusion criteria were pre-operative staging with CT scan, EUS, PET scan, and CA 19-9 levels, as well as completion of neoadjuvant chemotherapy and radiation. Results: We identified 62 patients with 74% of tumors in the pancreatic head. 97% of resections were R0. The average age was 65 ± 9 years; 60% were male. Patients were classified as borderline resectable by EUS alone in 29%, CT alone in 23%, and both modalities in 48% of patients, respectively. 34 patients required vein resection; EUS identified 88% of these patients pre-operatively while CT identified 68%. EUS identified 11 patients who required vein resection that CT did not identify while CT identified 4 patients that EUS did not identify. EUS had higher sensitivity and specificity than CT in identifying patients requiring venous resection (Table). On multivariate logistic regression analysis, EUS was predictive of vein resection (P < 0.02) but CT scan findings, PET scan findings, tumor size, and CA19-9 values were not predictive (each P > 0.1). In margin negative resected patients, median survival was longer when both CT and EUS identified borderline status compared to only 1 modality (43 vs 23 months, P < 0.05). Conclusions: EUS complemented CT in identifying patients with borderline resectable PC requiring vein resection- 29% of patients were identified with EUS alone. This observation supports the use of EUS in addition to CT scan for the vascular staging of patients with PC. [Table: see text]
Tumor response in the CLARINET study of lanreotide depot vs. placebo in patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Authors: Phan Alexandria T. , Dasari Arvind , Liyanage Nilani , Cox David , Lowenthal Susan Pitman , Wolin Edward M. 
Published: February 2017

434 Background: In the CLARINET study, significant improvement in progression-free survival (primary endpoint) was reported in patients (pts) treated with lanreotide depot (LAN), a long-acting somatostatin analog, for moderately- or well-differentiated, nonfunctioning, locally advanced or metastatic GEP-NETs. A favorable safety profile was also observed. This retrospective analysis presents tumor response from CLARINET. Methods: Pts were randomized to LAN 120 mg (n=101) or PBO (n=103) once every 28 days for 96 weeks. Tumor response was evaluated centrally using RECIST version 1.0. Pts’ tumors were measured by sum of the longest diameter (SLD) of target lesions (TLs). Change was calculated for each pt’s SLD from baseline to last available post-baseline assessment. Tumor response was classified as complete response (CR): disappearance of all TLs and non-target lesions (NTLs) and no new lesions; partial response (PR): ≥30% decrease in SDL and no progressive disease (PD); stable disease (SD): not meeting criteria for CR/PR or PD; PD: ≥20% increase in SLD from baseline or nadir, unequivocal progression of NTLs or appearance of new lesions. The remaining pts were not evaluable (NE) for response. Results: 101 pts treated with LAN and 103 pts treated with PBO were assessed for tumor response. Among pts receiving LAN, 64% (65/101) demonstrated SD compared to 43% (44/103) of pts receiving PBO (Table). An additional 2 pts in the LAN group achieved a PR. Similar trends were observed in pts with pancreas and midgut origin tumors. Conclusions: A clinical benefit (defined as CR+PR+SD) of 66% (67/101) was observed with single agent LAN vs 43% (44/103) with PBO in the CLARINET population, further supporting the clinical efficacy of LAN. Clinical trial information: NCT00353496. [Table: see text]
Retrospective phase II study of efficacy and safety of 177Lu-DOTATOC peptide receptor radiotherapy in patients with advanced neuroendocrine tumours.
Authors: Baum Richard P. , Kluge Andreas , Kulkarni Harshad , Sayeg Manal , Schorr-Neufing Ulrike , Niepsch Karin , Bitterlich Norman , van Echteld Cees J.A. 
Published: February 2017

436 Background: Emerging evidence, that 177Lu-DOTATOC has a particularly favorable therapeutic index compared to other PRRT agents, prompted us to further evaluate efficacy and safety of 177Lu-DOTATOC. Methods: 56 patients with metastasized and progressive neuroendocrine tumors (NET) (50% gastroenteral, 26.8% pancreatic, 23.2% other primaries) were consecutively treated with 177Lu-DOTATOC and analyzed retrospectively. Patients received on average 2.1 (range 1 – 4) cycles of 177Lu-DOTATOC as 7.0 GBq (median) doses at 3-monthly intervals. Efficacy was analyzed based on RECIST and stratified for number of treatment cycles and primary tumor origin. Results: Median progression-free (PFS) and overall survival in the total population (A) were 17.4 and 34.2 months, respectively. Patients treated with > 1 cycle had a PFS of 32.0 months for all NET (B), 34.5 months for gastroenteropancreatic NET (GEP-NET) (C), and 11.9 months for other NET (D). Objective response (OR) rates [complete (CR) or partial (PR)], were 34%, 41%, 54%, and 0% for A, B, C, and D, while disease control [CR, PR and stable disease, SD] rates (DCR) were 66%, 94%, 100%, and 75%, resp. CR was found in 16%, 19% and 25% of A, B and C, resp. In 68% of responders initial response occurred within 4 months from the 1st cycle, whereas in 32% this took 4-8 months. In 47% of all OR it took > 8 months to achieve OR. No renal toxicity was found, although 20% of patients had mild renal insufficiency at baseline. No SAE and only a single case of self-limiting grade 3 myelotoxicity was observed. Conclusions: 177Lu-DOTATOC shows unparalleled potential to induce OR and long lasting DC in progressive NET, even when administered at moderate activity doses. In GEP-NET patients CR was 25%, which is the highest value ever reported. Efficacy was highest when the agent was administered in repetitive cycles. Overall DCR was 94%, compared to 80-85% reported for 177Lu-DOTATATE. This difference in DCR is mainly accounted for by an approx. 10-fold higher rate of CR with 177Lu-DOTATOC. This high efficacy together with the observed safety profile suggests a very high therapeutic index, reflecting a uniquely low systemic uptake of 177Lu-DOTATOC.