Impact Of Perioperative Chemotherapy Research Articles

The impact of peri-operative chemotherapy on the outcomes of patients with non-metastatic cholangiocarcinoma.

563 Background: Cholangiocarcinoma is a rare malignancy with poor prognosis and outcome despite therapy. It accounts for 2.2% of all new cancer cases and 5% of all cancer deaths. Surgical resection is still the main therapeutic approach, whereas the role of peri-operative chemotherapy is debatable. Methods: The National Cancer Database (NCDB) was queried for patients diagnosed with non-metastatic biliary adenocarcinoma at age 18 or older between 2004 and 2019. After excluding patients with unknown timing of surgery and chemotherapy, patients who died within 90 days of the most definitive primary site surgery and patients lost to follow-up, we split the cohort into three groups according to the clinical stage (stage I-III). Then, we evaluated the overall survival (OS) between the different treatment modalities (surgery only, adjuvant chemotherapy and neoadjuvant chemotherapy) in each group. We studied the OS using Kaplan-Meier estimates and multivariate cox regression analyses to evaluate factors associated with OS. Results: A total of 35,260 patients with non-metastatic cholangiocarcinoma were included in the analysis, of which 50.4% were females, 83% Caucasians, 9.5% African Americans. The median age at diagnosis was 70 (range 18-90). 14,757 (41.9%) were stage I, 12,472 (35.4%) stage II and 8,031 (22.8%) stage III. 7,286 (20.7%) had surgical resection only, 8,144 (23.1%) had chemotherapy only, 6,964 (19.7%) had surgical resection with perioperative chemotherapy and 12,866 (36.5%) did not receive any treatment. We compared survival between different treatment modalities based on clinical stage. In stage I, we found patient who were treated with surgery only had better median OS (mOS) compared to adjuvant chemotherapy (65.7 vs 50.4 months, P<0.001) and no statistically significant difference between neoadjuvant chemotherapy and surgery only (mOS 79.8 vs 65.7 months, P=0.63). Whereas in stage II, patients who were treated with adjuvant and neoadjuvant chemotherapy had better mOS compared to those treated with surgery only (33.9 and 40.3 vs 29.9 months with P<0.001 and P=0.005, respectively). Same trend was seen in stage III, patients who were treated with adjuvant and neoadjuvant chemotherapy had better mOS compared to surgery only (22.6 and 41.5 vs 19.5 months, respectively with P<0.001 for all). In multivariate analysis, adjuvant and neoadjuvant chemotherapy did not affect the OS in all stages, except in stage III where neoadjuvant chemotherapy was associated with better OS (HR 0.646 95% CI 0.530-0.786; P<0.001). Conclusions: Adjuvant and neoadjuvant chemotherapy do not seem to have survival benefit in early stage (stage I and II) cholangiocarcinoma. Whereas neoadjuvant chemotherapy tends to improve OS in stage III.

Impact of perioperative chemotherapy in the treatment of patients with gastric cancer.

Perioperative chemotherapy (PeriCh) is the current standard of care for stage II/III gastric cancer tumors in Europe. However, when it concerns patients who endure complications during PeriCh it is unclear if it increases the risk of postoperative complications and other poorer surgical outcomes. We aim to demonstrate if there is an association between having complications during PeriCh and postoperative complications and histopathological response. We conducted a retrospective, transversal, and observational study, including all patients with diagnosed gastric cancer who underwent PeriCh followed by surgical resection during the period of eight years. We included 80 patients with a median age of 64.0years (min 24, max 78). Eighty-eight-point eight percent ended the chemotherapy regime proposed, with a median duration of 42 days, and were also submitted to gastric resection: 58.8% total gastrectomy and 41.2% distal gastrectomy. Twelve-point five percent of the patients had no complications during the PeriCh period and 16.3% had >2 complications. Twenty-five percent of patients had a histological response of <10% of tumor burden, but in 41.3% only regression of <50% could be obtained. No significant association was found between complications during PeriCh and adverse surgical outcomes (P = .497). Patients with complications during PeriCh had slightly higher median time difference from end of PeriCh until surgery, but with no statistical significance (P = .575). In our sample, the existence of association between complications during PeriCh and postoperative complications or histological response was not demonstrated.

Impact of perioperative chemotherapy on survival outcomes among patients with metastatic colorectal cancer to the liver.

Aim: Compare overall survival (OS) between adjuvant and neoadjuvant chemotherapy and analyze the effect of chemotherapy on OS. Materials & methods: National Cancer Database was queried for patients diagnosed with metastatic colorectal adenocarcinoma with isolated liver metastases between 2004 and 2016. We evaluated the OS and chemotherapy effect using Kaplan-Meier estimates and multivariable cox regression analyses. Results: Total 6883 patients with metastatic colorectal cancerand liver metastases were included, of which 6042 patients were treated with surgery and chemotherapy and 841 patients were treated with surgery only. Patients who received neoadjuvant chemotherapy had better OS compared with patients who received adjuvant chemotherapy. Conclusion: Patients with colorectal cancer with isolated liver metastases who were treated with neoadjuvant chemotherapy had better OS compared with adjuvant chemotherapy.

Impact of perioperative chemotherapy on survival outcome of advanced colorectal cancer patients treated with cytoreduction and hyperthermic intraperitoneal chemotherapy: A retrospective study.

e15570 Background: Colorectal cancer (CRC) with peritoneal carcinomatosis (PC) is generally associated with poor prognosis. The present study aims to assess potential value of perioperative systemic chemotherapy in patients treated with cytoreductive surgery with HIPEC (CRS/HIPEC) in a single institute in Saudi Arabia. Methods: We included CRC with PC who underwent CRS/ HIPEC from January 2012 till December 2019. Different clinicopathological, treatment-related factors and dates of relapse/death, were retrospectively assessed. We checked the distribution of these factors in addition to survival outcome in those who received perioperative chemotherapy vs. none. Results: We recruited 127 eligible patients (79 patients [62.2%] received systemic chemotherapy). Patients with no perioperative chemotherapy were more likely to have grade 1 tumours (62.5% vs. 25.3%, p &lt; 0.0001), mucinous adenocarcinoma (41.7% vs. 12.7%, p = 0.002), normal CEA ≤5 ng/dl (70.2% vs. 47.4%, p = 0.016) and peritoneal-only metastasis (66.7% vs. 45.6%, p = 0.021). Median PFS and OS were 34 and 62.2 months, respectively. Patients with no perioperative systemic chemotherapy had significantly better PFS and OS (median PFS: not reached vs. 19 months, HR = 0.29, 95% CI = 0.15-0.59, p &lt; 0.0001, OS :HR = 4.3, 95% CI 1.3-14.3, p = 0.009). After adjustment of different prognostic factors, there was no significance difference in OS between the two groups (HR = 3.8, 95% CI = 0.98-14.71, p = 0.053), while PFS was still significantly better in the no chemotherapy group (HR = 2.52, 95% CI = 1.13-5.63, p = 0.024). Conclusions: CRS/HIPEC provided favourable survival outcome in our study cohort especially in patients with more favourable prognostic features. No survival benefit with perioperative chemotherapy could be demonstrated.

Outcomes of appendiceal cancer treated at a state peritonectomy service.

3629 Background: Appendiceal cancers (AC) are rare with varied prognosis. Nomenclature refined by the WHO 2019 classification is: appendiceal mucinous neoplasms (AMNs), adenocarcinomas (AA) including mucinous (MAC), not otherwise specified (ANOS), signet ring (SRC) and goblet cell (GCA), and neuroendocrine tumours (NET). Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS+HIPEC) is the definitive treatment. The role of chemotherapy remains unclear with conflicting outcomes and there is need to delineate the optimal regimen in different disease settings. The aim of this study was to evaluate AC treatment and clinical outcomes by the WHO 2019 classification and analyse the impact of perioperative chemotherapy. Methods: We reviewed prospective data from the database at an Australian state peritonectomy service, Apr 2017-Dec 2021. Variables included demographics, tumour characteristics, treatment details and survival outcomes. Analysis was by the Kaplan-Meier method using the log-rank test for statistical comparison (SPSSv27). Results: 115 patients (of 207 referred) with confirmed AC proceeded to CRS. Histopathology comprised 49 AMNs (43%), 62 (63%) AA, 3 SRCs and 1 NET. The mean age was 56y (21-78), 53% female. 94% had CRS+HIPEC (Mitomycin 85%). 70% had cytoreductive score 0. The median peritoneal cancer index was 23 (0-39). 20 (17%) had localised (M0) disease, 10 acellular mucin (M1a) and 85 (74%) metastases (M1b/c). 71% were lymph node negative (N0). 40% had chemotherapy (oxaliplatin/5-fluorouracil 57%). 8 of 15 who had molecular testing had a KRAS mutation. Median follow-up was 26m (1.9-167). The table shows univariate survival analysis. Conclusions: This is the first study evaluating outcomes of perioperative chemotherapy for AC in a cohort of patients since the WHO 2019 classification. MAC have worse survival compared to ANOS, but similar to GCAs. Peritoneal acellular mucin has a similarly improved prognosis to patients with no peritoneal disease compared to those with cellular disease. Chemotherapy demonstrated worse survival compared to no chemotherapy, also seen in the literature and likely influenced by selection of more aggressive disease. There is a need to develop biomarkers and better treatments to improve the survival of these patients. Further multivariate analysis for prognostic and predictive factors is planned.[Table: see text]

Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancer

IntroductionThe use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity. MethodsWe retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded.The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups. ResultsA total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old.The overall major surgical morbidity (Clavien-Dindo 3–5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p=0.643).There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p=0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p=0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed. ConclusionsPerioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.

Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancer

IntroductionThe use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity. MethodsWe retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded.The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups. ResultsA total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old.The overall major surgical morbidity (Clavien-Dindo 3–5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p=0.643).There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p=0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p=0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed. ConclusionsPerioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.

Use and impact of perioperative chemotherapy in patients with resectable colorectal cancer metastases.

159 Background: There is conflicting evidence regarding benefit of perioperative chemotherapy (p-chemo) for metastatic colorectal cancer (mCRC) patients (pts) undergoing resection of metastases (mets). Aims: To describe use of and outcomes from p-chemo in mCRC pts who underwent resection of isolated liver or lung mets. Methods: Pts were identified from the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) database, a multi-centre registry of mCRC pts. P-chemo was defined as chemotherapy within 12 weeks of surgery. Multivariate (MV) analysis using a Cox proportional hazards model was undertaken. Results: 371 pts were identified. Median age was 64 (27 – 90), 169 (45%) had de novo stage IV disease, 96% were ECOG 0-1. 284 (77%) had liver-only and 87 (23%) lung-only mets. 242 (65%) pts received p-chemo (58 pre-op alone, 134 post-op alone, 50 both). 62 (19%) pts also received a biologic agent (47/62 pre-op). Median age was 68 and 61 years in no p-chemo and p-chemo groups, respectively (p&lt;0.0001). 53% of no p-chemo pts and 23% of p-chemo pts had had prior adjuvant chemotherapy (p&lt;0.001). On MV analysis, p-chemo was a significant predictor of survival (HR 0.52, 95% CI 0.32-0.88, p=0.014). The other significant predictor of improved survival was ECOG PS of 0 (HR 0.58, p=0.019). Predictors of worse survival were rectal primary (HR 1.98 p=0.009), male gender (HR 1.69 p=0.03) and de-novo metastatic disease (HR 2.63, p=0.006). Prior adjuvant chemo, age, liver vs lung mets, use of perioperative biologics, BRAF and RAS status had no significant impact. In an exploratory analysis, the group considered “resectable” upfront (n=281) was analysed separately, perioperative chemotherapy was not a significant predictor of survival in this subgroup (HR 0.69, p=0.26). Conclusions: In routine care there is a variable approach to the use of p-chemo in pts with potentially resectable liver or lung mets. P-chemo is associated with improved survival in this analysis, although this was not confirmed in the separate analysis of the “resectable” subgroup. Due to the retrospective nature of the study confounding by unmeasurable factors is possible. This study supports ongoing consideration of P-chemo in pts with resectable mets.

Impact of perioperative chemotherapy and radiotherapy in patients with primary extremity soft tissue sarcoma: retrospective analysis across major histological subtypes and major reference centres

BackgroundThe role of radiotherapy (RTx) and chemotherapy (CTx) in primary extremity soft tissue sarcoma (eSTS) patients is not precisely defined. MethodsAll consecutive primary eSTS patients treated within three European and one North American reference centres in a 20-year time span were included. The tendency to perform chemotherapy/radiotherapy (CTx/RTx) was explored using multivariable binary logistic models. Five and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. Multivariable analyses of OS, CCI of LR and CCI of DM were performed. The effect of CTx administration was explored with a propensity score matching analysis. ResultsOverall, 3752 patients were included. Median follow-up was 79 months (interquartile range 44–119). Ten-year OS, CCI of LR and CCI of DM were 66.3% (64.3–68.2%), 8.2% (7.2–9.2%) and 28.2% (26.6–30.0%), respectively. Centre and histology significantly influenced administration of RTx/CTx. RTx was associated with a better local outcome, especially in myxoid liposarcoma, vascular sarcoma and myxofibrosarcoma, without being associated with survival. Chemotherapy was not an independent prognostic factor for OS in all patients (p = 0.73). In a propensity score–matched analysis, patients treated with CTx had longer survival although this difference did not reach statistical significance (p = 0.054). The use of perioperative CTx in patients with primary localised eSTS was not associated with worse survival after occurrence of DM. ConclusionSome histologies gain a greater benefit from perioperative RTx in terms of LR risk reduction. The trend towards a 5% survival benefit associated with CTx administration is consistent with the published literature, but definitive conclusions are awaited from ongoing randomised controlled trials. Perioperative CTx for primary eSTS does not hamper post-DM survival.

Impact of perioperative chemotherapy and radiation for locally advanced penile squamous cell carcinoma (PSCC).

4589 Background: While neoadjuvant chemotherapy preceding radical surgery (S) for PSCC appears to provide the most optimal outcomes, there are no randomized studies. The impact of triple-modality S plus perioperative chemotherapy (C) plus radiation (XRT) for PSCC is unclear. The differential outcomes provided by perioperative XRT vs. perioperative C are also unclear. Given the absence of prospective trials, we retrospectively analyzed the U.S. National Cancer Database (NCDB) to study this issue. Methods: Data from the NCDB was obtained for pts with locally advanced PSCC from 1998-2011. Patients who underwent S for PSCC pathologic stage ≥1 with data for receipt of perioperative C and/or XRT and follow-up were eligible for analysis. The following variables were evaluated: pathologic stage, age, Charlson Comorbidity Index (CCI), race, overall survival (OS), socioeconomic status based on median income of area of residence and therapy (S+C, S+XRT, S+C+XRT). Treatment patterns were described. Multivariate analyses (MVA) were conducted to determine the impact of factors on OS with P &lt; 0.05 considered significant. Results: A total of 418 pts were evaluable including 132 in the S+XRT group, 166 in the S+C group and 120 in the S+C+XRT group. The number of pts with stages 1, 2, 3, 4 and unknown were 26, 78, 146, 137 and 31, respectively. In the MVA, stage was independently significantly prognostic (p = 0.002), while age (p = 0.056) and CCI (p = 0.057) were trending significant. S+C+XRT was not statistically better than S+XRT (HR 1.37 [95% CI: 0.935 - 2.007]) or S+C (HR 0.834 [95% CI: 0.589 - 1.180]). Additionally, S+C was not associated with significantly different OS compared to S+XRT (HR 1.142 [95% CI: 0.790 - 1.652]). Limitations of a retrospective analysis apply. Conclusions: This is the largest retrospective study of perioperative therapy for locally advanced PSCC. Triple modality therapy (S+C+XRT) did not extend OS compared to dual modality therapy (S+C or S+XRT). Additionally, the analysis did not identify whether C or XRT should be preferred in pts receiving dual modality therapy. The phase II International Penile Cancer Adjuvant Trial (InPACT) will investigate these conundrums for this orphan malignancy.

The impact of peri-operative chemotherapy for patients with lymph node-positive urothelial cancer.

388 Background: Patients with locally advanced urothelial cancer with regional lymph node involvement (LN+) have a poor prognosis. Surgical management of these patients is controversial and practice patterns vary. We evaluated the outcomes of patients with LN+ disease treated with pre-operative chemotherapy and cystectomy, cystectomy and post-operative chemotherapy, and chemotherapy alone. Methods: Patients with urothelial cancer with TxN1-3M0 disease treated with chemotherapy in Alberta from 2005 to 2015 were evaluated. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis. Cox regression analysis was performed to evaluate the impact of age, gender, T stage, and N stage on survival. Results: 184 patients with LN+ disease treated with chemotherapy were evaluable for outcomes; 42 underwent pre-operative chemotherapy (Group A), 92 underwent post-operative chemotherapy (Group B), and 50 received chemotherapy alone (Group C). The median age at diagnosis was 65 years (range 31-89) and most patients (83%) were male. The median follow-up time was 23.2 months. A higher T stage was seen in patients in Group A, while patients in Group C had a higher N stage. The median number of chemotherapy cycles delivered was equal in all arms at 4. Patients in Group A or B had significantly better PFS and OS compared with patients in Group C (Table). When adjusting for age, gender, T stage, and N stage, patients in Group C had significantly lower OS compared with those patients in Group A (HR 1.87, 95% CI 1.09 – 3.18, p=0.02). Conclusions: In this real-world analysis of patients with LN+ urothelial cancer, patient outcomes were improved with surgical resection of disease in combination with pre-operative chemotherapy. After chemotherapy in fit patients with LN+ disease, surgical management is a reasonable consideration. [Table: see text]

The prognosis of liver resection for patients with four or more colorectal liver metastases has not improved in the era of modern chemotherapy.

The impact of perioperative chemotherapy on patients with multiple colorectal liver metastases (CRLM) remains unclear. We attempted to examine whether the introduction of modern chemotherapies has improved the prognosis of patients that undergo liver resection for ≥4 CRLM. Between January 1990 and December 2013, 194 patients underwent liver resection for CRLM at our institution. The outcomes of the patients with ≥4 and 1-3 CRLM were compared before and after 2005, when modern chemotherapies were introduced to Japan. There were 50 and 144 patients with ≥4 (Group 1) and 1-3 (Group 2) CRLM, respectively. The overall survival (OS) rate of Group 1 was significantly worse than that of Group 2 (P = 0.0007). The OS rate of Group 2 was significantly better after 2005 than before 2004 (P = 0.039), while no such differences were observed in Group 1. Multivariate analysis identified three prognostic factors in Group 1: a serum carcinoembryonic antigen level of ≥20 ng/ml (P = 0.018), a serum cancer antigen 19-9 level of ≥100 U/ml (P = 0.018), and a primary colorectal cancer N factor of ≥N2 (P = 0.023). The prognosis of patients with ≥4 CRLM that undergo liver resection has not improved despite the development of modern chemotherapies. J. Surg. Oncol. 2016;114:959-965. © 2016 Wiley Periodicals, Inc.

Response to neoadjuvant chemotherapy and impact on survival for resected gastric cancer.

122 Background: This study assesses the survival impact of perioperative chemotherapy, with further analysis of pathologic response to neoadjuvant chemotherapy (NAC), in patients undergoing gastrectomy for gastric cancer (GC) in a large US sample. Methods: Using the 2003-2012 ACS National Cancer Database, 16,128 patients underwent gastrectomy for cancer. Treatment groups were categorized as: NAC, adjuvant chemotherapy, and surgery only. Patients receiving NAC were further categorized as: down-staged, no response, and disease progression. Univariate and multivariate analyses were performed to estimate the impact of treatment on overall survival. Results: Of patients undergoing gastrectomy, 36.6% received NAC, 19.5% received adjuvant chemotherapy, and 43.9% underwent surgery only. Median time of survival was longer in patients with more advanced disease who underwent either NAC or adjuvant chemotherapy versus surgery alone (see Table). In multivariate analysis, patients who received NAC had 20% lower hazard of death than surgery only patients (HR = 0.80, p &lt; 0.0001). Within the NAC cohort (N = 5,909), 47.7% were down-staged, 36.5% had no response, and 15.7% demonstrated disease progression. Having a pathologic response to NAC was associated with having private insurance (OR = 1.22, p &lt; 0.0001), higher socioeconomic status (OR = 1.21, p = 0.003), treatment in the central US (p &lt; 0.0001, both), and undergoing proximal gastrectomy (OR = 1.59, p &lt; 0.0001). Among patients who received NAC, median time of survival was longer if NAC down-staged patients to stages 0 or 1, with no survival difference in advanced stage disease. Conclusions: Neoadjuvant chemotherapy elicits a survival benefit in patients with advanced GC. Pathologic response is achieved in nearly half of patients undergoing NAC and is associated with improved survival, although only when down-staging to early stage disease. [Table: see text] [Table: see text]

Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma.

To investigate the impact of perioperative chemo(radio)therapy in advanced primary urethral carcinoma (PUC). A series of 124 patients (86 men, 38 women) were diagnosed with and underwent surgery for PUC in 10 referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank testing was used to investigate the impact of perioperative chemo(radio)therapy on overall survival (OS). The median follow-up was 21 months (mean: 32 months; interquartile range: 5-48). Neoadjuvant chemotherapy (NAC), neoadjuvant chemoradiotherapy (N-CRT) plus adjuvant chemotherapy (ACH), and ACH was delivered in 12 (31%), 6 (15%) and 21 (54%) of these patients, respectively. Receipt of NAC/N-CRT was associated with clinically node-positive disease (cN+; P = 0.033) and lower utilization of cystectomy at surgery (P = 0.015). The objective response rate to NAC and N-CRT was 25% and 33%, respectively. The 3-year OS for patients with objective response to neoadjuvant treatment (complete/partial response) was 100% and 58.3% for those with stable or progressive disease (P = 0.30). Of the 26 patients staged ≥cT3 and/or cN+ disease, 16 (62%) received perioperative chemo(radio)therapy and 10 upfront surgery without perioperative chemotherapy (38%). The 3-year OS for this locally advanced subset of patients (≥cT3 and/or cN+) who received NAC (N = 5), N-CRT (N = 3), surgery-only (N = 10) and surgery plus ACH (N = 8) was 100%, 100%, 50% and 20%, respectively (P = 0.016). Among these 26 patients, receipt of neoadjuvant treatment was significantly associated with improved 3-year relapse-free survival (RFS) (P = 0.022) and OS (P = 0.022). Proximal tumor location correlated with inferior 3-year RFS and OS (P = 0.056/0.005). In this series, patients who received NAC/N-CRT for cT3 and/or cN+ PUC appeared to demonstrate improved survival compared with those who underwent upfront surgery with or without ACH.

The effect of neoadjuvant chemotherapy (NACT) on lymph node retrieval in gastroesophageal carcinoma: A comparison of two cohorts treated at a single institution.

182 Background: Surgery for gastric cancer (GC) has evolved over time. D2-lymphademectomy with a minimum of 16 nodes is the current approach in many countries. In locally advanced GC, surgery alone has high rates of recurrence. Hence, adjuvant therapies are needed. Adjuvant chemoradiotherapy (CRT) and perioperative chemotherapy (PCT) are standard. The effect of PCT causing histological changes and tumor regression is clear. However it is unknown if PCT could change the number of dissected nodes due to tumor response and histological modification. Our aim is to evaluate patients treated with gastrectomy followed by CRT or PCT and surgery and define the impact of PCT in the number of nodes dissected. Methods: We retrospectively analyzed two historical cohorts treated at our institution. Cohort 1 (C1) underwent upfront gastrectomy and CRT. Cohort 2 (C2) underwent PCT and gastrectomy. Results: C1 had 51 patients. Median age was 54y. 60.8% male and 39.2% female. There were 88% primary gastric and 12% esophagastric junction (EGJ). Pathologic stages II or III were described in 92.2%. Median follow-up was 65 m. C2 had 66 patients. Median age was 58y. 70.1% male and 29.9% female. There were 71.6% primary gastric and 28.4% EGJ. cT3 was described in 82% and cN+ in 77.4%. Main chemotherapy regimens were DCF in 35.8%, EOX in 23.9% and CF in 13.4%. At surgery, 67.1% had stages II or III. Six patients had pathologic complete response. Three patients died due to toxicity. Median follow-up time was 34 m. Median number of dissected nodes was 35 in C1 and 31 in C2 (p=0.08). 90.2% in C1 and 91% in C2 had more then 16 nodes dissected. Median number of positive nodes was four in C1 and one in C2 (p=0.01). Regarding chemotherapy, DCF or a non-taxane regimen had the same median of 31 nodes dissected. 3-year recurrence free survival was 78.3% for C1 and 66% for C2 (p=0.21). 28.3% of patients recurred in C1 and 35% in C2, mainly in distant sites. Only two patients in each group had local failure. Conclusions: Although NACT induces histological changes, it does not reduce the number of retrieved lymph nodes at surgery. Moreover, PCT is associated with a lower median number of positive nodes, related to tumor downstaging.

Impact of perioperative chemotherapy on oncological outcomes after gastric cancer surgery.

Perioperative chemotherapy has become standard care for resectable gastric cancer. However, available evidence is based on a limited number of trials, and the outcomes in routine clinical practice and in unselected patients are scarcely reported. The study included a consecutive series of patients with resectable gastric cancer treated between 2001 and 2011 in Central Norway. Before 2007, patients with resectable gastric cancer did not receive perioperative chemotherapy. Since 2007, medically fit patients with resectable gastric cancer and aged 75 years or less have been offered this. Response rates were evaluated by CT, and tolerability was assessed by the frequency of hospital admission, need for dose reduction or treatment discontinuation. The two time intervals were compared on an intention-to-treat basis for patients aged no more than 75 years for any impact on resection rates, surgical morbidity, postoperative mortality and long-term survival. About two-thirds (259) of the 419 patients registered were aged 75 years or less at diagnosis. Ninety-five of 136 patients in the later interval were eligible for chemotherapy, of whom 90 actually received the specified regimen, and 78 (87 per cent) were able to complete the preoperative course. Only 40 (44 per cent) completed all scheduled preoperative and postoperative cycles. Thirty-eight (43 per cent) of 89 evaluable patients showed a definite response on CT. Chemotherapy had no impact on postoperative morbidity or mortality. The 5-year survival rate on an intention-to-treat basis was 40·7 (95 per cent c.i. 30·7 to 50·7) per cent in the first interval, compared with 41·7 (31·5 to 51·9) per cent after the introduction of perioperative chemotherapy (P = 0·765). After adjustment for other risk factors, based on comparisons of the two time intervals, there were no differences in oncological outcomes with the use of perioperative chemotherapy. Perioperative chemotherapy was completed in less than half of the patients with resectable gastric cancer. An observed tumour response to chemotherapy did not translate into any long-term survival benefit compared with surgery alone.

The impact of perioperative chemotherapy on tumor recurrence after resection of colorectal liver metastasis

The impact of perioperative chemotherapy on tumor recurrence after resection of colorectal liver metastasis

Impact of perioperative chemotherapy on Nigerian patients with locally advanced and metastatic gastric cancer.

e15180 Background: The overall 5-year survival of patients with gastric cancer is only 14% in Nigeria as compared to 23% in the United States of America and 60% in Japan [1-3]. The possible reasons...

Effect of chemotherapy, radiation, or immunosuppression on the integrity of the intestinal anastomosis

Despite significant advances in surgical technique and perioperative care, anastomotic leak remains an uncommon yet dreaded surgical complication with potential catastrophic consequences for the patient. Other articles in this issue focus on the impact of technical factors including anastomotic technique, bowel preparation, and fecal diversion. This article delves into the effects of chemotherapy, radiation, and immunosuppression on the integrity of the intestinal anastomosis. Although large studies are conflicting regarding the overall impact of perioperative chemotherapy on the risk of anastomotic leak, the antiangiogenesis class of chemotherapy drugs, including bevacizumab, has emerged as a known risk factor. The literature is also somewhat conflicting as to whether neoadjuvant radiation is a risk factor for anastomotic leak in patients with rectal cancer. It is clear, however, that this patient population is at overall high risk for leak, and therefore the recommendation of fecal diversion is well-supported by the literature. The effects of immunosuppression on anastomotic leak have been extensively studied in the IBD and solid-organ transplant populations. Corticosteroids have been shown to increase risk of anastomotic leak in both IBD and non-IBD populations, although a clear dose- or duration-effect has not been determined. For solid-organ transplant patients, the mTOR inhibitors, including sirolimus and everolimus, have been demonstrated to significantly impair wound healing, including anastomoses in animal models, and are thus recommended to be replaced with tacrolimus for 6 weeks preoperatively.

Effect of peri-operative chemotherapy on the quality of life of patients with early breast cancer

Since chemotherapy is assumed to have a negative impact on quality of life, the impact of peri-operative chemotherapy on physical, psychological and social well-being and on the activity level of patients with early stage breast cancer was investigated. 24 women received peri-operative chemotherapy and 29 did not. They were interviewed 2 months and at a mean of 12 months post-surgery. Although the treated group reported more fatigue and considered hair loss a severe side-effect, no differences were found in overall physical and psychological well-being, perceived social interaction and activity level at 2 months. 1 year after surgery no differences were found between the two groups. Although no substantial effects of peri-operative chemotherapy on quality of life were demonstrated, patients almost unanimously considered peri-operative chemotherapy the most burdensome aspect of the treatment because of alopecia.