PS01.184: ESOPHAGEAL CANCER SURGICAL TREATMENT IN BRAZILIAN NATIONAL CANCER INSTITUTE: 25 YEARS EXPERIENCE

Abstract Background Esophageal cancer is the 8th most common cancer in the world. It is an lethal disease, responsible for almost 400.000 deaths by year. Surgical resection is considered the gold standard in esophageal cancer treatment, with a global 15–40% cure rate. In this study, the results of esophageal cancer surgical treatment at Brazilian National Cancer Institute, Abdominal-pelvic Surgical Section, is analyzed. Methods The medical records of 215 patients with esophageal cancer, treated with surgical resection (esophagectomy), between January 1999 and December 2015, were retrospectively studied. The endpoints analyzed in the study were: hospitalization time, operative complications and mortality, and overall survival. Results Esophageal cancer was predominant in male patients; median age was 58 years (27–78). Primary tumor location varied between 7,5 - 41 cm (median 32cm) and tumor extension 1 - 16cm (median 5cm). Median surgical time was 330 minutes (120–720); transhiatal esophagectomy with gastric tube reconstruction was the most used surgical approach. Tumors histopathological types were equaly distributed. ICU (Intensive Care Unit) stay median time was 5 days (1–87) and median hospitalization time was 15 days (5–166). Most common surgical complications were anastomotic leakage (25,5%) and pneumonia (20%), with a surgical morbidity rate of 61,8%. Surgical mortality rate was 12%, with 61% of these cases occuring in the 30 days after surgery. Median 2-year overall survival was 44,3 months. Conclusion Besides the high surgical morbidity, esophagectomy for esophageal cancer remains the standard treatment for patients with ressectable tumors and without clinical contraindications for surgery. Reduction of surgical mortality depends on rigorous patients selection, surgical team expertise and adequate perioperative and postoperative care. Disclosure All authors have declared no conflicts of interest.

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PS02.138: SALVAGE ESOPHAGECTOMY: SINGLE ONCOLOGICAL CENTER EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.138 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 159-160

Author(s):

Flávio Sabino ◽

Marco Guimaraes ◽

Carlos Eduardo Pinto ◽

Daniel Fernandes ◽

Luis Felipe Pinto ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Conflicts Of Interest ◽

High Volume ◽

Published Data ◽

Surgical Morbidity ◽

Salvage Esophagectomy ◽

Thoracic Approach ◽

Clinical Conditions ◽

Local Advanced

Abstract Background Surgical resection is considering the gold standard in esophageal cancer treatment, with 15–40% cure global rates. Radical exclusive chemoradiotherapy (CRT) is used in patients with local advanced esophageal cancer or without clinical conditions for esophagectomy, with a 5-year overall survival up to 30%. However, locoregional control is poor with a 40–60% recurrence rate and salvage esophagectomy maybe an option for these patients. Methods Our objective is to report the experience of a single high volume oncological institution with salvage esophagectomy. Retrospective analysis of 28 patients medical records, with esophageal cancer, submitted to Salvage Esophagectomy in Brazilian NCI after radical exclusive CRT or RT between January 1990 and December 2015. Results Median age was 56 years and most are male (78,5%). Esophageal middle third was the tumor principal location (50%) and histological type was squamous cell carcinoma (82%). Thoracic approach for esophagectomy was the principal surgical technique, and gastric tube the most used conduit for reconstruction (78,5%). Surgery was R0 in 83% of the cases, with a surgical morbidity of 64%. Median hospital time was 15 days (8–58) and surgical mortality 14% (4 patients), with 7% in the first 30 days. Median overall survival was 22,3 months. Conclusion Our results are in line with published data in the literature. Besides surgical morbidity and mortality, Salvage Esophagectomy remains de only chance of cure for patients with locoregional recurrence after radical exclusive CRT. Disclosure All authors have declared no conflicts of interest.

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RA02.08: SALVAGE LYMPHADENECTOMY FOR 14 PATIENTS OF ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHRAPY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra02.08 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 22-22

Author(s):

Kazuki Odagiri ◽

Makoto Yamasaki ◽

Koji Tanaka ◽

Yasuhiro Miyazaki ◽

Tomoki Makino ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Lymph Nodes ◽

Conflicts Of Interest ◽

Treatment Guideline ◽

Hospital Death ◽

Curative Surgery ◽

Term Outcome ◽

Long Term Outcome ◽

Salvage Lymphadenectomy

Abstract Background Salvage Lymphadenectomy is regarded as the only curative surgery to residual or recurrence lymph nodes of esophageal cancer after definitive chemoradiotherapy (dCRT). However, salvage lymphadenectomy is not described in the Japanese esophageal cancer treatment guideline because of little evidences for the safety and efficacy. Methods From January 2011 to December 2015, we performed 14 salvage lymphadenectomies to residual or recurrence LN of esophageal squamous cell carcinoma(ESCC) in Osaka University. We assessed postoperative complications and long-term outcome. Results Average age was 64 year-olds (SD: 5.2). Male: Female = 11: 3. cStage I: II-IV = 7: 7. Surgery to cervical LN were 11 patients and abdominal LN were 3 patients. Surgery to residual LN (res-LN) were 9 patients and recurrence LN (rec-LN) were 5 patients. rec-LN patient's median time to recurrence after dCRT was 14.3 months (10.2–29.3). 4 patients were performed lymphadenectomy resecting with adjacent organs, 3 patients were bronchus (trachea? ) and 1 patient was right subclavian artery. 4 patients had postoperative complication, two were pneumonia, one was pulmonary thrombosis and one was lymphorrhea, but there was no serious case (Clavien-Dindo Grade II or less). We didn’t have hospital death. Six of 14 patients had recurrence and died after salvage lymphadenectomy. Recurrence sites were 2 mediastinal lymph nodes and liver, lung, loco-regional and peritoneal. But no patients had recurrence of main tumor. 5-year overall survival rate was 51.1%. Median survival time in 9 patients, surgery to res-LN, was 18.9 months (10.4–132 months) and 5 patients, surgery to rec-LN, was 4.9 months (1.4–26.6 months). Surgery to res-LN patients were longer than rec-LN patients in overall survival after salvage lymphadenectomy (P = 0.395). There was no difference due to the difference in recurrence site of the cancer in overall survival after salvage lymphadenectomy. Conclusion Our data show salvage lymphadenectomy safety and effectiveness after dCRT. Salvage lymphadenectomy may extend the prognosis of patients with esophageal cancer after dCRT. Thus, salvage lymphadenectomy may be one of the treatment options for the patients with residual or recurrent, especially the former, lymph node after definitive CRT, although it is necessary to evaluate in many cases. Disclosure All authors have declared no conflicts of interest.

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PS02.080: CLINICAL SIGNIFICANCE OF THE NUMBER OF PERITUMORAL LYMPHATIC VESSELS AFTER CHEMOTHERAPY IN ESOPHAGEAL CANCER PATIENTS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.080 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 143-143

Author(s):

Takeo Hara ◽

Tomoki Makino ◽

Makoto Yamasaki ◽

Koji Tanaka ◽

Yasuyuki Miyazaki ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Primary Tumor ◽

Conflicts Of Interest ◽

Locally Advanced ◽

Lymphatic Vessels ◽

Tumor Location ◽

Resected Specimen ◽

Long Term Outcome ◽

Cutoff Value

Abstract Background Neoadjuvant chemotherapy (NAC), a standard treatment for locally-advanced esophageal cancer, often achieves significant antitumor effect as clinically or microscopically confirmed. However, how chemotherapy histologically impacts upon normal tissues, in particular lymphatic vessels, adjacent to a tumor remains unclear. Methods A total of 137 patients who underwent curative esophagectomy with (NAC group n = 62)/without (nonNAC group n = 75) NAC for thoracic esophageal cancer in our department from 2004 to 2012 were analyzed. The number of lymphatic vessels (NLV) adjacent to primary tumor (within 1000μm from the edge of tumor) in lamina propria mucosae layer was assessed by immunostaining of D2–40 and its association with clinico-pathological parameters was analyzed. Results The NLV was significantly lower in the NAC group as compared with the nonNAC group (NAC vs nonNAC; 19.1 ± 9.0 vs 22.8 ± 8.6, P = 0.014). In the nonNAC group, when classified into two (high vs low NLV) groups by using the cutoff value of the median NLV in nonNAC group, NLV did not correlated with any clinico-pathological factors including age, gender, tumor location, pT, pN, pM, ly, v, and overall survival. On the other hand, in the NAC group, high NLV (classified by the same cutoff value as noted above) was significantly associated with good histological response (grade1b-2) (high vs low NLV; 52 vs 26%, P = 0.026) and less development of lymph node recurrence (16 vs 40%, P = 0.029) but not with other parameters including age, gender, tumor location, pT, pN, pM, ly, and v. Notably, the high NLV group showed the more favorable 5-year overall survival compared to the low NLV group (61 vs 49%, P = 0.0041). Multivariate analysis of overall survival further identified low NLV (HR = 3.68, 95%CI 1.54–10.83, P = 0.0005) to be one of independent prognostic factors along with pT(HR = 2.87, 95%CI 1.37–6.35, P = 0.0050) and pN(HR = 4.04, 95%CI 1.53–13.89, P = 0.0034) in the NAC group. Conclusion NAC might decrease the number of lymphatic vessels adjacent to primary tumor in resected specimen, and this number was associated with tumor response to NAC and long-term outcome in patients who underwent NAC plus surgery. Disclosure All authors have declared no conflicts of interest.

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PS02.184: PROFILING RETURN TO INTENDED ONCOLOGIC THERAPY (RIOT) IN LOCALLY ADVANCED ESOPHAGEAL CANCER PATIENTS RECEIVING ESOPHAGECTOMIES FOLLOWED BY POSTOPERATIVE CHEMOTHERAPY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.184 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 174-174

Author(s):

Wei Dai ◽

Qiuling Shi ◽

Yongtao Han ◽

Lin Peng

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Cox Regression ◽

Conflicts Of Interest ◽

Locally Advanced ◽

Minimal Invasive ◽

Postoperative Chemotherapy ◽

Risk Of Death ◽

Oncologic Therapy

Abstract Background As a novel metric to evaluate the quality of oncosurgical therapy, such as minimal invasive surgery, Return to Intended Oncologic Therapy (RIOT) has not been applied in patients with esophageal cancer (EC). This study aims to profile RIOT in locally advanced EC patients and to quantify its relationship with overall survival. Methods We conducted a retrospective study on consecutive locally advanced EC (T3–4 and/or N1–3) patients who received esophagectomies followed by postoperative chemotherapy (PC) from April 2015 to August 2017. RIOT included whether the patient did or did not undergo intended PC and the time between surgery and the start of PC. Overall survival at each RIOT group was compared via log-rank test. Cox regression models were used to estimate the prognostic value of RIOT. Results Among 658 locally advanced EC patients (547 males and 111 females) with complete PC data, 433 received minimal invasive esophagectomies (MIE) and 225 received open esophagectomies (OE). The RIOT rates were 58.0% for MIE and 54.2% for OE (P = 0.358). The 1-year overall survival rate of patients receiving PC was higher than that of patients not receiving PC (88.2% vs 76.4%; P = 0.005). After adjustment of age, gender, surgery type and postoperative length of stay, patients with PC showed significantly better OS than those without PC (HR 0.60, 95% CI 0.41–0.87; P = 0.007). Total 253 patients (MIE 168, OE 85) presented verified dates of starting PC. Median RIOT time was 42 days (min-max, 13–162) for MIE and 43 days (16–169) for OE (P = 0.855). Among those 253 patients, 179 (70.8%) started RIOT within 8 weeks. After 8 weeks, every one week delay of RIOT related to a 17% increase on the risk of death (P = 0.014). Conclusion Using a real world data, our study provided baseline profiles of RIOT in locally advanced EC patients who received esophagectomies and PC. Compared to OE, MIE did not show a significant advantage in RIOT rates and RIOT time. In spite of the short follow-up, successful RIOT is related to better OS. Prospective studies with longer follow-up are required for further application of RIOT in the evaluation of oncosurgical therapy. Disclosure All authors have declared no conflicts of interest.

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PS02.173: SURGICAL MANAGEMENT OF TRACHEOESOPHAGEAL FISTULAS IN PATIENTS WITH ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.173 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 171-171

Author(s):

Annelijn Slaman ◽

Wietse Eshuis ◽

Wim Van Boven ◽

Suzanne Gisbertz ◽

Mark I Van Berge Henegouwen

Keyword(s):

Esophageal Cancer ◽

Surgical Treatment ◽

Tracheoesophageal Fistula ◽

Conflicts Of Interest ◽

Muscle Flap ◽

Severe Complication ◽

Tertiary Referral ◽

Muscle Flaps ◽

Tracheal Defect ◽

History Of

Abstract Background Tracheoesophageal fistula is a severe complication that can occur in patients who are treated for esophageal cancer. There is currently no consensus about the best surgical treatment. The aim of this study was to evaluate the results after surgical treatment of tracheoesophageal fistulas in patients with a history of esophageal cancer in a tertiary referral center. Methods Consecutive patients with a history of esophageal cancer who were surgically treated for tracheoesophageal fistulas between January 2010 and December 2017 were included. Primary outcome was success rate after surgical treatment. Surgical treatment was defined as successful if no combined (30-day or in-hospital) mortality and no recurrences occurred. Results Twenty patients underwent 26 surgical treatments for tracheoesophageal fistulas. Median age was 64 years (IQR 59–68). One patient developed a tracheoesophageal fistula elsewhere and was referred to our center. The incidence of tracheoesophageal fistulas following esophagectomy in our center was 1.9% (n = 13). Other tracheoesophageal fistulas were caused by traumatic intubation (n = 3) or definitive chemoradiation (n = 3). Surgery consisted of covering the tracheal defect with a muscle flap (n = 15), and/or pericardial patch (n = 11) or primary sutures (n = 5) possibly with resection of the reconstruction (n = 6). The median follow-up was 7.8 months (IQR 1.5–38.2). Treatment was successful in 60.0% of the patients (n = 12). Overall morbidity and combined (in-hospital and 30-day) mortality rates were 65.0% and 35.0%, respectively. In the last 5 patients the muscle flap was fixated to the tracheal defect and reinforced by bovine or autogenic pericardium in whom there was no mortality. Recurrences occurred in 7 patients (35.0%), but only 5 were physically eligible for secondary surgical treatment. The other patients died due to the recurrence. Patients with infectious cause of their tracheoesophageal fistula (n = 11) had more complications (7 versus 6 patients), higher mortality (5 versus 2 patients) and more recurrences (5 versus 2) than non-infectious tracheoesophageal fistulas. Conclusion Tracheoesophageal fistula is a severe complication and is associated with high mortality and recurrence rates. Surgical treatment should only be performed in tertiary referral centers. Using muscle flaps with reinforcement of pericardium might reduce the morbidity and mortality, but larger patient groups should be investigated. Disclosure All authors have declared no conflicts of interest.

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Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

PLoS ONE ◽

10.1371/journal.pone.0244325 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0244325

Author(s):

Jaejoon Lim ◽

YoungJoon Park ◽

Ju Won Ahn ◽

So Jung Hwang ◽

Hyouksang Kwon ◽

...

Keyword(s):

Overall Survival ◽

Surgical Technique ◽

Surgical Resection ◽

Surgical Approach ◽

Dna Methyltransferase ◽

Surgical Techniques ◽

Motor Evoked Potential ◽

High Rate ◽

Surgical Morbidity ◽

Neurophysiologic Monitoring

The importance of maximal resection in the treatment of glioblastoma (GBM) has been reported in many studies, but maximal resection of thalamic GBM is rarely attempted due to high rate of morbidity and mortality. The purpose of this study was to investigate the role of surgical resection in adult thalamic glioblastoma (GBM) treatment and to identify the surgical technique of maximal safety resection. In case of suspected thalamic GBM, surgical resection is the treatment of choice in our hospital. Biopsy was considered when there was ventricle wall enhancement or multiple enhancement lesion in a distant location. Navigation magnetic resonance imaging, diffuse tensor tractography imaging, tailed bullets, and intraoperative computed tomography and neurophysiologic monitoring (transcranial motor evoked potential and direct subcortical stimulation) were used in all surgical resection cases. The surgical approach was selected on the basis of the location of the tumor epicenter and the adjacent corticospinal tract. Among the 42 patients, 19 and 23 patients underwent surgical resection and biopsy, respectively, according to treatment strategy criteria. As a result, the surgical resection group exhibited a good response with overall survival (OS) (median: 676 days, p < 0.001) and progression-free survival (PFS) (median: 328 days, p < 0.001) compared with each biopsy groups (doctor selecting biopsy group, median OS: 240 days and median PFS: 134 days; patient selecting biopsy group, median OS: 212 days and median PFS: 118 days). The surgical resection groups displayed a better prognosis compared to that of the biopsy groups for both the O6-methylguanine-DNA methyltransferase unmethylated (log-rank p = 0.0035) or methylated groups (log-rank p = 0.021). Surgical resection was significantly associated with better prognosis (hazard ratio: 0.214, p = 0.006). In case of thalamic GBM without ventricle wall-enhancing lesion or multiple lesions, maximal surgical resection above 80% showed good clinical outcomes with prolonged the overall survival compared to biopsy. It is helpful to use adjuvant surgical techniques of checking intraoperative changes and select the appropriate surgical approach for reducing the surgical morbidity.

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Incidence and Outcome of Acute Myeloid Leukemia in Peru: An 11-Year Single Center Experience

Blood ◽

10.1182/blood-2020-143373 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 28-29

Author(s):

Ali Al-kassab-Córdova ◽

Lizbeth Lachira-Yparraguirre ◽

Gustavo Sandival-Ampuero ◽

Katia Roque ◽

Emperatriz Ortega ◽

...

Keyword(s):

Overall Survival ◽

Acute Myeloid Leukemia ◽

Incidence Rate ◽

National Cancer Institute ◽

Myeloid Leukemia ◽

Clinical Characteristics ◽

Conflicts Of Interest ◽

Survival Rates ◽

Newly Diagnosed ◽

Acute Myeloid

Background: Acute myeloid leukemia (AML) is a highly heterogeneous disease with new cases commonly diagnosed in the elderly population. Despite advances in AML therapy, disease outcomes remain poor. Between 2010 and 2016, the reported 5-year overall survival in the U.S. was 28.7% (Source: NCI SEER 13 statistics). National based registries are vital to monitor the incidence, outcome and survivorship of AML patients. Therefore, we aim to explore the incidence and outcome of AML patients managed at the National Cancer Institute in Peru over the past decade. Methods: We conducted a retrospective analysis of all newly diagnosed AML patients seen at the National Cancer Institute (INEN) in Lima-Peru between January 2008 to December 2018. The INEN is the major governmental leukemia center providing care for about 60% of newly diagnosed AML patients in Peru. Patient eligibility screening was performed using the Flow Cytometry Core Lab Registry. We excluded patients with acute promyelocytic leukemia. Demographic and clinical characteristics were obtained from medical records. Place of birth and death records were confirmed using the Peruvian National Registry of Identification and Civil Status (RENIEC). Survival analysis was performed using Kaplan Meier and Log-rank tests. The cumulative 11-year AML incidence rate was calculated and plotted using a choropleth map of Peru. Results: A total of 1,499 newly diagnosed AML cases were identified and had sufficient data for analysis. Median age at diagnosis was 44 years (range: 0-92) with a female:male ratio of 0.9:1. Clinical characteristics and outcome are presented in Table 1. Twenty-two percent (n=324) of patients were older than 65 years-old at the time of diagnosis. Most patients (n=926, 62%) came from the coastal region of Peru, followed by the mountains (30%) and the rainforest (8%). The cumulative 11-year incidence rate according to geographical location is shown in Figure 1. Overall, the Peruvian hospital-based cumulative incidence rate was 4.79 AML cases per 100,000 habitants, with the highest incidence rate observed in Piura (a coastal city in Northern Peru) with 38 AML cases per 100,000 habitants. At a median follow up of 68 months, the global 5-year overall survival (OS) rate of AML cases seen in Peru was 16%. Worse survival rates were found in patients aged 66 years and older (5-year OS 3%, median survival time [MST] 2 months, p<0.001), followed by patients aged 46 to 65 years (5-year OS 9%, MST 2 months, p<0.001) (Figure 2). Better survival rates were observed in children and adolescents (5-year OS 43%, MST 18 months, p<0.001) and in patients coming from the rainforest of Peru (5-year OS 26%, MST 9 months, p<0.001) (Figure 2). No differences on survival were found when comparing by gender and year of diagnosis (Table 1). Conclusions: This is the first study describing the incidence and outcome of AML patients in Peru. In this large contemporary cohort, we found a cumulative 11-year incidence rate of 4.79 AML cases per 100,000 habitants, with an alarming high incidence of AML cases observed in the city of Piura which needs further epidemiological evaluation. Despite improvements in supportive care in the contemporary era, our inpatient mortality for adult patients with AML remains high particularly among older patients. Further analyses are warranted to examine predictors of AML-related deaths in Peru and to develop strategies that improve patient outcomes. Disclosures No relevant conflicts of interest to declare.

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PS02.175: CLINICAL CHARACTERISTICS AND TREATMENT OF NEUROENDOCRINE CARCINOMA OF THE ESOPHAGUS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.175 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 171-172

Author(s):

Masaru Morita ◽

Masaki Kagawa ◽

Yu Nakaji ◽

Masahiko Sugiyama ◽

Daisuke Yoshida ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Resection ◽

Clinical Features ◽

Neuroendocrine Carcinoma ◽

Clinical Characteristics ◽

Systemic Chemotherapy ◽

Conflicts Of Interest ◽

Term Survival ◽

Carcinoma Of The Esophagus ◽

Node Metastasis

Abstract Background Neuroendocrine carcinoma (NEC) of the esophagus is a rare and highly aggressive disease; however, an appropriate treatment strategy remains to be established, especially for surgical resection. The objective of this study is to clarify the clinical characteristics of NEC of the esophagus and to determine the optimal surgical strategy. Methods Nineteen patients who were immunohistochemically diagnosed with NEC of the esophagus from 1998 to 2017 were included in this study. The clinical features and therapeutic outcomes were examined. Results 1. Clinical features Sixteen of 19 patients showed protruding or localized type with or without ulceration. Only five patients were negative for both lymph node and organ metastasis and eight cases were positive for metastasis to distant organs and/or distant lymph nodes. 2. Surgical treatment Five patients underwent esophagectomy. Four cases were classified as cStage I (cT1bN0M0); the other case was classified as cStage III (cT3N2M0). The preoperative diagnoses, based on the examination of biopsy specimens, were NEC (n = 2), SCC (n = 1), adenocarcinoma (n = 1), and carcinoma (n = 1). Subtotal and distal esophagostomy were performed in 3 and 2 patients, respectively. Salvage esophagectomy for recurrent disease was performed after definitive chemotherapy in one patient. Anastomotic leakage, which was conservatively healed, developed in one patient. Two patients with histologically-positive node metastasis died at 8 and 13 months, respectively, while another 3 patients (pT1bN0, n = 2; pT2N0, patient, n = 1) are currently alive without any recurrence, at 12, 45 and 72 months after esophagectomy, respectively. 3. Non-surgical treatment Systemic chemotherapy was performed as the main treatment for 13 patients with advanced NEC. The regimens included cisplatin combined with irinotecan or etoposide (n = 10), cisplatin plus 5-fluorouracil (n = 2) and UFT plus irinotecan (n = 1). The MST was 13 months (range, 6–17 months). Conclusion The possibility of NEC should be kept in mind when we encounter protruded tumors of a distinctive shape. Consistent with previous reports, the prognosis of NEC of the esophagus is dismal, irrespective of the administration of systemic chemotherapy. However, surgical resection is considered to be a treatment option for cStage I/II NEC without node metastasis, as a long-term survival after esophagectomy was achieved by some patients. Disclosure All authors have declared no conflicts of interest.

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Management of primary intracranial germinomas: diagnostic surgery or radical resection?

Journal of Neurosurgery ◽

10.3171/jns.1997.87.2.0262 ◽

1997 ◽

Vol 87 (2) ◽

pp. 262-266 ◽

Cited By ~ 101

Author(s):

Yutaka Sawamura ◽

Nicolas de Tribolet ◽

Nobuaki Ishii ◽

Hiroshi Abe

Keyword(s):

Surgical Resection ◽

Radical Resection ◽

Morbidity Rate ◽

Surgical Morbidity ◽

Female Ratio ◽

Content Type ◽

Neurological Improvement ◽

Significant Difference ◽

Male Female Ratio ◽

Fine Print

✓ Because intracranial germinomas are readily curable with radiation and chemotherapy or radiation therapy alone, the role of radical surgery has become debatable. This study assesses the optimum degree of surgical resection for intracranial germinomas. Twenty-nine patients who underwent surgery for germinoma were retrospectively analyzed (male/female ratio 27:2, median age 18 years). Among these 29 patients there were 10 solitary pineal, seven solitary neurohypophyseal/hypothalamic, and 12 multifocal or disseminated tumors. Biopsy samples were obtained in 16 patients (stereotactically in eight, transsphenoidally in four, and via frontotemporal craniotomy in four). Partial resection was attained in five patients (via a frontotemporal approach in three and occipitotranstentorially in two). Gross-total resection was achieved via an occipitotranstentorial route in eight patients with pineal masses. After surgery, 10 patients were treated with radiotherapy alone, and 19 received radiation and chemotherapy; complete remission was achieved in all 29 patients. The overall tumor-free survival rate was 100% at a median follow-up period of 42 months. There was no significant difference in outcome related to the extent of surgical resection. Postoperative neurological improvement was seen in only two patients, whereas transient postoperative complications, mainly upgaze palsy, were observed in six. One patient experienced a slight hemiparesis, bringing the surgical morbidity rate to 3% (one of 29). It is concluded that radical resection of intracranial germinomas offers no benefit over biopsy. The primary goal of surgery should be to obtain a sufficient volume of tumor tissue for histological examination. If there is strong evidence of germinoma on radiological studies, biopsy samples should be obtained. When a perioperative histological diagnosis of pure germinoma is made during craniotomy, no risk should be taken in continuing the resection.

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Unicentric Castleman Disease with High Inflammatory State: Surgical Treatment Is a Potential Cure

Blood ◽

10.1182/blood-2020-134350 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 14-15

Author(s):

Miaoyan Zhang ◽

Xinxin Cao ◽

Dao-Bin Zhou ◽

Lu Zhang ◽

Jian Li

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Surgical Treatment ◽

Disease Progression ◽

Conflicts Of Interest ◽

Statistical Significance ◽

Castleman Disease ◽

Biological Behavior ◽

First Line ◽

Inflammatory State

Objective: Castleman disease (CD) is a group of rare lymphoproliferative disorders which are divided into unicentric CD (UCD) and multicentric CD (MCD) according to the number of lymph node regions involved. In the case of UCD, no or only local compressive symptoms are present with normal biochemistry, and prognosis is great after complete surgical resection. However, we have noticed that a small portion of UCD patients presenting with severe constitutional symptoms accompanied by high inflammatory state might resemble MCD in clinical presentations and biochemical features. Since our current understanding of this group of patients is far from enough, we are here to summarize the characteristics, treatments and outcomes of these high inflammatory patients and compare them with other UCD patients to see whether surgery still serves well as first-line treatment, so as to illuminate the biological behavior of these hyper-inflammatory UCD patients. Method: We retrospectively analyzed 123 cases of UCD diagnosed between Jan 2000 and Dec 2019 in Peking Union Medical College Hospital. The patients with high inflammatory state who met the laboratory and clinical criteria for idiopathic MCD (Blood, 2017) were included in the hyper-inflammatory group (Figure 1). We summarized their clinical characteristics, treatments and outcomes. Response criteria of iMCD defined by Castleman Disease Collaborative Network (CDCN) were cited to evaluate treatment response in symptoms and biochemistry. Kaplan-Meier analysis were used to analyze the progress-free survival (PFS) and overall survival (OS), and comparison was made with other UCD patients through Log-rank test. Result: Among 24 UCD patients with high inflammatory state (19.5%), when compared to others without, constitutional symptoms, organomegaly, fluid retention and complication of paraneoplastic pemphigus (PNP) or bronchiolitis obliterans (BO) were more common. ESR or CRP elevation, anemia, abnormal platelet count, albumin decrease, renal function impairment and IgG increase were also more usually discovered (Table 1). Meanwhile, plasmacytic (PC) histopathology was more frequently seen (45.8% vs 14.1%, P=0.001) (Table 2), but no statistical significance was shown on the lymph node region involved. As for first-line treatments (Figure 1), 18 UCD patients with high inflammatory state (75.0%) underwent complete surgical excision alone; there was no recurrence of lymphadenopathy after surgery, and the inflammation resolved completely except 2 cases of disease progression (both complicated by PNP), achieving a response rate of 88.9%. 2 patients (8.3%) received chemotherapy together with surgery, and all disease completely resolved. Among the 3 patients (12.5%) treated only with chemotherapy, 1 experienced symptomatic and biochemical progression of disease. Finally, there was one patient (4.17%), after a watch-and-wait period, experienced progression in symptoms. In contrast, disease progression was not seen in UCD without high inflammatory state. There was no statistical difference between median follow-up time of the two groups. UCD patients without high inflammatory state have a better PFS curve [P<0.001, HR=0.005 (95%CI: 0.001-0.043)], but median PFS was not reached in either group of patients (Figure 2). The overall survival was not significantly different between the two groups [P=0.225, HR=4.722 (95%CI: 0.123-181)]. Conclusion: UCD patients with high inflammatory state are not uncommon. Although they resemble MCD with more PC histopathology, more severe symptoms and abnormal lab results, the good response to surgical treatment suggested that patients with high inflammatory state still shared common biological behavior with other UCD. However, recurrence of symptoms and progression of inflammation might still happen in patients with PNP or unresectable disease, so treatment options other than surgery should be considered in these patients. Figure Disclosures No relevant conflicts of interest to declare.

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