P71 NUTRITIONAL JEJUNOSTOMY IN ESOPHAGECTOMY FOR CANCER, A NATIONAL REGISTER-BASED COHORT STUDY OF ASSOCIATIONS WITH POSTOPERATIVE OUTCOMES AND SURVIVAL

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Holmén Anders ◽  
Hayami Masaru ◽  
Szabo Eva ◽  
Rouvelas Ioannis ◽  
Ágústsson Thorhallur ◽  
...  
Keyword(s):  
Cohort Study ◽  
Performance Status ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Length Of Hospital Stay ◽  
Tumor Location ◽  
Population Based ◽  
Invasive Technique ◽  
National Register

Abstract Aim The aim was to increase the knowledge about nutritional jejunostomies in curative intended treatment of esophageal and gastroesophageal junction cancer. Background and Methods The insertion of a jejunostomy in conjunction with esophagectomy is performed to decrease the risk for malnutrition and improve recovery. These possible benefits have, however, not been scientifically proven. All patients in Sweden, treated with esophagectomy due to cancer 2006-2017 in the Swedish National Register for Esophageal and Gastric Cancer, were included in this retrospective population-based cohort study. The indication for jejunostomy was not defined in the register. The patients were stratified into two groups: esophagectomy with jejunostomy, and esophagectomy alone. Results A total of 1024 patients (54.73%) had a jejunostomy inserted in conjunction with esophagectomy, while 847 patients (45.27%) were treated without jejunostomy. The median age was 66 years, and 79% of the patients were male. The groups were similar in regard to age, performance status, baseline dysphagia and weight, ASA-score, tumor location, neoadjuvant treatment, and use of minimally invasive technique. The patients in the jejunostomy group had more squamous cell carcinoma (20.3% vs. 17.8%, P=0.005), and more locally advanced tumors. There were no significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate. The risk of pneumonia was increased in the jejunostomy group (11.8% vs. 7.2%, P=0.001). For patients with postoperative anastomotic leaks the risk for postoperative Clavien-Dindo score of IIIb or more was reduced (79.7% vs. 94.7%, P=0.037, adjusted odds ratio 0.20, 95% CI 0.04-0.97). Conclusions Jejunostomy is a safe method to ensure postoperative nutrition after esophagectomy, and might reduce the risk for severe outcomes in patients who suffer an anastomotic leak.

FA08.01: MORTALITY AND REFRAINMENT FROM ESOPHAGECTOMY IN ESOPHAGEAL CANCER PATIENTS THAT STARTED NEOADJUVANT CHEMORADIOTHERAPY: A POPULATION-BASED COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 15-15
Author(s):  
Alicia Borggreve ◽  
Peter Van Rossum ◽  
Stella Mook ◽  
Nadia Haj Mohammad ◽  
Richard Hillegersberg ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cohort Study ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Population Based ◽  
Advanced Esophageal Cancer ◽  
Population Based Study ◽  
Locally Advanced Esophageal Cancer

Abstract Background Esophagectomy functions as the cornerstone of the curative treatment for locally advanced esophageal cancer. The addition of neoadjuvant chemoradiotherapy (nCRT) to surgery improves survival, but can be accompanied by substantial toxicity on the other hand. This cohort study describes the consequences of nCRT for esophageal cancer in terms of mortality (during or after the course of nCRT) in real-world clinical practice, as well as the proportion of patients that do not proceed to planned esophagectomy after finishing nCRT. Methods All patients that started nCRT (carboplatin/paclitaxel with 41.4 Gy) for primary, locally advanced, esophageal cancer in 2015 were included from the nationwide population-based cancer registry. Outcome measurements were mortality during or within 90 days after neoadjuvant therapy (and before planned esophagectomy), as well as refrainment from planned esophagectomy after starting nCRT and the reasons for cancelled esophagectomy. Results Some 740 patients that started nCRT for esophageal cancer were included (Table 1). A total of 13 (1.8%) patients died during or within 90 days after nCRT (before planned esophagectomy). A total of 79 (10.7%) patients that started nCRT did not proceed to esophagectomy. The most frequently reported reasons for not proceeding to esophagectomy were tumor progression (4.6%, n = 34), performance status (2.7%, n = 20), and patients’ request (1.8%, n = 13). Conclusion In this population-based study, 1 in 10 (10.7%) patients that started nCRT for locally advanced esophageal cancer did not undergo esophagectomy. Further research should aim to investigate whether this patient group can be selected prior to treatment, and if interventions and counseling will result in a larger proportion of patients who will undergo surgery. Disclosure All authors have declared no conflicts of interest.

Relationship between PET response and pathologic response in distal esophageal/gastroesophageal junction cancers: A provincial population-based analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15506-e15506
Author(s):  
Irene S. Yu ◽  
Shiru Lucy Liu ◽  
Yizhou Zhao ◽  
Sally CM Lau ◽  
Devin Schellenberg ◽  
...  
Keyword(s):  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Pathologic Response ◽  
High Morbidity ◽  
Curative Intent ◽  
Treatment Regimens

e15506 Background: The utility of PET scans (PETs) to predict outcomes after neoadjuvant treatment of DE/GEJ cancers is unclear. We aimed to explore the relationship between PET response and pathologic/clinical outcomes in a real-world setting. Methods: Patients (pts) with DE/GEJ cancer treated with curative intent perioperative chemotherapy or neoadjuvant chemoradiation followed by surgery in British Columbia from 2009-2018 were included. Retrospective chart review was conducted; pts were stratified into PET responders (R, ≥ 35% decrease in max SUV) or PET non-responders (NR, < 35%) groups. Chi-square and Kaplan Meier were used to test for associations between variables and outcomes. Results: Of 576 pts with locally advanced DE/GEJ cancers, 232 pts were eligible for analysis. Treatment regimens comprised of CROSS (72%), MAGIC (24%) and FLOT (4%). Median age was 66 (IQR 57-72), 85% male, 91% ECOG 0/1, 62% GEJ involvement, and 81% adenocarcinoma histology. Characteristics and treatment regimens were balanced between the PET-R and PET-NR groups (all p>0.05). Median time from end of treatment to PETs was 30 days (IQR 22-36); 67% were PET-R. Pathologic complete response rates (14% vs 13%, p=0.079) were similar for PET-R vs PET-NR, respectively. Discordance rate was 34% between PET vs pathologic response (Table). Aborted surgery rate was higher in the PET-NR group (8% vs 3%, p=0.03); 70% of aborted cases were due to peritoneal involvement. Median overall survival was similar between the groups (PET-R 31.5 mo vs PET-NR 36.1 mo, p=0.616). Conclusions: In our population-based cohort, PET response did not demonstrate prognostic utility. PET-NR were more likely to have their surgeries aborted. The predictive ability of PET in determining surgical resectability should be further investigated to avoid unnecessary high morbidity surgeries.[Table: see text]

511b: Natural History of Intestinal Metaplasia of the Gastroesophageal Junction in Olmsted County, MN: A Population Based Cohort Study

2010 ◽  
Vol 71 (5) ◽  
pp. AB121 ◽  
Author(s):  
Kee Wook Jung ◽  
Kelly T. Dunagan ◽  
Mary Fredericksen ◽  
Debra M. Geno ◽  
Yvonne Romero ◽  
...  
Keyword(s):  
Cohort Study ◽  
Natural History ◽  
Intestinal Metaplasia ◽  
Gastroesophageal Junction ◽  
Population Based ◽  
Olmsted County ◽  
History Of

Phase II study of perioperative toripalimab in combination with FLOT in patients with locally advanced resectable gastric/gastroesophageal junction (GEJ) adenocarcinoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4050-4050
Author(s):  
Hongli Li ◽  
Jingyu Deng ◽  
Shaohua Ge ◽  
Fenglin Zang ◽  
Le Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Phase Ii ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Death Receptor ◽  
Disease Free Survival ◽  
Complete Response ◽  
R0 Resection ◽  
Combination Regimen

4050 Background: FLOT is the standard perioperative treatment for resectable gastric /gastroesophageal junction (GEJ) adenocarcinoma. However, patient’s outcome is still poor. Toripalimab, a humanized IgG4 monoclonal antibody against programmed cell death receptor-1 (PD-1), has shown remarkable clinical efficacy in various cancers. This trial evaluates the addition of Toripalimab to FLOT for resectable patients. Methods: This is a prospective, single-arm, investigator-initiated phase II trial. Patients with histologically confirmed, resectable, gastric and GEJ adenocarcinoma (≥cT2 or cN+) were enrolled to receive 4 pre-and post-operative cycles of toripalimab (240mg, q2w) plus FLOT (docetaxel 50 mg/m2; oxaliplatin 85 mg/m2; leucovorin 200 mg/m2; 5-FU 2600 mg/m2, q2w). The primary endpoint was pathological complete response rate (pCR). The secondary endpoints included major pathological (complete and nearly complete) response (MPR), and R0-resection rate, 3-year disease-free survival rate, overall survival, and adverse events. Results: In total, of 36 patients were enrolled from June 2019 through Dec 2020. Male, 66.7%; median age, 60y; cT3 8.3%, T4, 83.3%; cN+ 88.9%; GEJ 47%; MSI-H, 5.6%, Her-2neu-positive, 5.6%, EBER-positive, 5.6%). Two patients refused surgery, six patients have not yet completely neoadjuvant treatment. 100% of patients completed the 4 pre-cycle. Patients who had received gastrectomy after neoadjuvant treatment (n=28) were included in this analysis. 6 (21%) patients had operations involving a thoracic approach (oesophagogastrectomy with two field lymphadenectomy), 21 (75%) gastrectomy with D2 lymphadenectomy. 8 (29%) evaluable patients had Clavien-Dindo grade II post-operative complications and 2 (7%) grade IIIA complications; one patient had an anastomotic leakage that was treated endoscopically. There were no emergency re-operations. All 28 patients achieved R0-resection and were discharged home after a median of 12 days (range:7-63) in hospital. 7 （25%）patients achieved pCR (TRG1a) and 12 (42.9%) patients achieved major pathologic response (MPR, TRG1a/b). Treatment-related adverse events (TRAEs) to any drug were reported in 30 (94%) patients. Mostly TRAEs were grade 1-2, the grade 3 or 4 TRAEs included neutropenia (34%), neutropenia (25%), lymphopenia (3%), Alanine aminotransferase increased (3%), hypokalemia (3%) and anaemia (3%). Conclusions: Perioperative toripalimab in combination with FLOT showed promising efficacy with high pCR and MPR rate and well tolerated safety profile in patients with resectable gastric/GEJ adenocarcinoma. This combination regimen might present a new option for patients with locally advanced, resectable gastric/GEJ adenocarcinoma. Clinical trial information: NCT04354662.

scholarly journals Brain atlas for assessing the impact of tumor location on perioperative quality of life in patients with high-grade glioma: A prospective population-based cohort study

2019 ◽  
Vol 21 ◽  
pp. 101658 ◽  
Author(s):  
Lisa Millgård Sagberg ◽  
Daniel Høyer Iversen ◽  
Even Hovig Fyllingen ◽  
Asgeir Store Jakola ◽  
Ingerid Reinertsen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
High Grade Glioma ◽  
Tumor Location ◽  
Population Based ◽  
Brain Atlas ◽  
High Grade ◽  
The Impact

scholarly journals Association between time interval from neoadjuvant chemoradiotherapy to surgery and complete histological tumor response in esophageal and gastroesophageal junction cancer: a national cohort study

2019 ◽  
Vol 33 (5) ◽  
Author(s):  
F Klevebro ◽  
K Nilsson ◽  
M Lindblad ◽  
S Ekman ◽  
J Johansson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cohort Study ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Chemoradiotherapy ◽  
Population Based ◽  
R0 Resection ◽  
Time Interval ◽  
Histological Response ◽  
Time To Surgery ◽  
Prolonged Time

SUMMARY The optimal time interval from neoadjuvant therapy to surgery in the treatment of esophageal cancer is not known. The aim of this study was to investigate if a prolonged interval between completed neoadjuvant chemoradiotherapy and surgery was associated with improved histological response rates and survival in a population-based national register cohort. The population-based cohort study included patients treated with neoadjuvant chemoradiotherapy and esophagectomy due to cancer in the esophagus or gastroesophageal junction. Patients were divided into two groups based on the median time from completed neoadjuvant treatment to surgery. The primary outcome was complete histological response. Secondary outcomes were lymph node tumor response, postoperative complications, R0 resection rate, 90-day mortality, and overall survival. In total, 643 patients were included, 344 (54%) patients underwent surgery within 49 days, and 299 (47%) after 50 days or longer. The groups were similar concerning baseline characteristics except for a higher clinical tumor stage (P = 0.009) in the prolonged time to surgery group. There were no significant differences in complete histological response, R0 resection rate, postoperative complications, 90-day mortality, or overall survival. Adjusted odds ratio for ypT0 in the prolonged time to surgery group was 0.99 (95% confidence interval: 0.64–1.53). Complete histological response in the primary tumor (ypT0) was associated with significantly higher overall survival: adjusted hazard ratio: 0.55 (95% CI 0.41–0.76). If lymph node metastases were present in these patients, the survival was, however, significantly lower: adjusted hazard ratio for ypT0N1: 2.30 (95% CI 1.21–4.35). In this prospectively collected, nationwide cohort study of esophageal and junctional type 1 and 2 cancer patients, there were no associations between time to surgery and histological complete response, postoperative outcomes, or overall survival. The results suggest that it is safe for patients to postpone surgery at least 7 to 10 weeks after completed chemoradiotherapy, but no evidence was seen in favor of recommending a prolonged time to surgery after neoadjuvant chemoradiotherapy for esophageal cancer. A definitive answer to this question requires a randomized controlled trial of standard vs. prolonged time to surgery.

Irinotecan/capecitabine versus cisplatin/capecitabine in advanced adenocarcinoma of the stomach or gastroesophageal junction: Interim analysis of a randomized German AIO phase II study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4032-4032 ◽  
Author(s):  
M. Moehler ◽  
S. Kanzler ◽  
M. Geissler ◽  
J. Raedle ◽  
M. Ebert ◽  
...  
Keyword(s):  
Remission Rate ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Tumor Control ◽  
Hand Foot Syndrome ◽  
Tumor Distribution ◽  
Abstract Submission ◽  
Intent To Treat

4032 Background: Irinotecan with 5-FU is highly effective in advanced gastric cancer. In addition, capecitabine seems to be as effective as 5-FU, with its advantage of oral administration. Thus, we compared efficacy and toxicity of irinotecan/capecitabine versus cisplatin/capecitabine in this prospective multicentric, open trail. Methods: Patients (pts) with previously untreated locally advanced or metastatic adenocarcinoma of stomach or gastroesophageal junction and Karnofsky Performance status (KPS) of ≥ 60%, at least one measurable lesion and adequate organ functions were eligible. Pts were randomized to 3-weekly cycles of irinotecan 250 mg/m2, day 1 (arm A) or to cisplatin 80 mg/m2, day 1 (arm B). Capecitabine was administered at a 1000 mg/m2 twice daily for 14 days followed by a 7-day rest in both arms. Primary endpoint was remission rate, treatment was continued until disease progression. Results: At time of abstract submission, 91 of 120 pts (planned sample size) were randomized to arm A (45 pts) or B (46 pts). Interim data were available on 76 patients included into intent to treat analysis (34 pts arm A, 42 pts arm B). Baseline characteristics (arm A vs. B) were median age: 60 vs. 64 years, gender (female/male) 23%/77% vs. 30%/70%, KPS (≥80%) 97% vs. 93%, tumor distribution of gastric origin and gastroesophageal junction 85%/15% vs. 63%/37%. Grade 3 toxicities in A/B (% of pts) were anemia 3/9, neutropenia 17/19, diarrhoea 17/5, nausea 14/21, vomiting 3/14, hand-foot syndrome 6/2, respectively. Grade 4 toxicity occured only for neutropenia with 3% vs.5% in A/B, respectively. In 59 evaluable pts (28/31 in A/B), overall remission rate (CR + PR) and tumor control rate (CR + PR + SD) were 39% vs. 42% and 64% vs. 74%, respectively. Despite being only very descriptive, median progression-free and overall survival (arm A vs B) were 5.2 vs. 5.0 and 8.9 vs. 9.4 months, respectively. Conclusions: In patients with locally advanced or metastatic gastric and gastroesophageal cancer, both regimen irinotecan/capecitabine or cisplatin/capecitabine are effective, well tolerated and can be administered safely on an out-patient basis. Currently, both treatment arms are comparable. Accrual continues. No significant financial relationships to disclose.

Bevacizumab in combination with first-line metastatic chemotherapy in patients with advanced nonsquamous non-small cell lung cancer (NSCLC): Results from the cohort study EOLE.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18005-e18005
Author(s):  
Christos Chouaid ◽  
Roland Schott ◽  
Lionel Falchero ◽  
Franck Bonnetain ◽  
Julien Neaume ◽  
...  
Keyword(s):  
Cohort Study ◽  
Performance Status ◽  
Locally Advanced ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Large Cell Carcinoma ◽  
First Line ◽  
Ecog Performance Status ◽  
Study Results ◽  
Chi2 Test

e18005 Background: EOLE, a large cohort of 423 patients included in 1 year (July 2010 – July 2010) with locally advanced, metastatic or recurrent non-squamous NSCLC, aimed to describe the targeted population receiving first-line bevacizumab (Bev) in addition to chemotherapy with regards to progression-free survival, overall survival, safety and quality of life in real clinical practice. Methods: Patients who received physician’s choice of 1st-line Bev-containing treatment were included in this cohort study. Results: This analysis describes the inclusion data of 417 patients consisting of adenocarcinoma (92%), large cell carcinoma (4%), undifferentiated carcinoma in predominantly non-squamous (3%), bronchoalveolar carcinoma (1%). Patient characteristics were as follow: the median age being 60 (years) [32; 84], more males than females (68%), 40% had a baseline ECOG Performance Status (PS) 0, 47% of PS 1 and 12% of PS 2, most patients had Stage IV disease (91%), 13% of patients had never smoked. Tumor location was reported as central for 17% of patents and among them 4% was in contact with the large vessels. For 3% of the lesions a cavitation was notified; and 20% of included patients had brain metastases. The main comorbidities at the inclusion were: cardiovascular (45%), arterial thromboembolic and /or venous (20%) with pulmonary embolism (3%); related to the tumor lesion - bloody sputum (4%) and hemoptysis (1%). 68% of patients have received the dose of Bev 7.5mg/kg q3w; for 49% of patients Bev was combined with cisplatin/pemetrexed, 24% with carboplatin/paclitaxel, 13% with carboplatin/pemetrexed and 7% with cisplatin/gemcitabine. The EGFR mutation analysis was carried out for about 50% of patients. Conclusions: Compared to AVAil and SAil studies, EOLE cohort included more patients classified as having: a baseline PS of 2 (p <0.0001, Fisher test), a never smoked status (p<0.0001, chi2 test) and an adenocarcinoma (92%) (p<0.0001, chi2 test). Around a half of included patients received combination Bev - cisplatin /pemetrexed.

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