Neoadjuvant Therapy Group Research Articles

The Implications of the Introduction of Neoadjuvant Chemoradiotherapy for Oesophageal Cancer in a Low Volume Centre

Background: Oesophagectomy is the standard treatment for oesophageal cancer in medically fit patients, but is associated with significant morbidity and mortality. Neoadjuvant chemoradiotherapy has been included in the management of this disease with the aim to improve prognosis, and has been shown to improve survival without an associated increase in operative complications. This study included patients who underwent oesophagectomy at the Canberra Hospital, to determine if neoadjuvant therapy was associated with an increase in perioperative morbidity and mortality. Methods: Patients who underwent oesophagectomy at Canberra Hospital between January 2001 and December 2012 were reviewed retrospectively. Statistical analysis was performed using Chi-Squared tests, time to disease recurrence was estimated using Kaplan-Meier methods. Results: Of 98 patients (73 men, 25 women; median age 63 years) who underwent oesophagectomy, 39 (40%) received neoadjuvant therapy. Perioperative complications of grades III (67%) and IV (100%), occurred in the surgery alone group. Perioperative mortality rate was 3.8%, with all deaths occurring in the surgery alone group (P=0.05). Complete resection was possible in 87 patients (89%), 100% in the neoadjuvant therapy group, 82% in the surgery alone group (P=0.10). Median disease free survival was 49.2 months (CI 25.2, 73.2), with no significant difference between patient groups (P=0.53). Neoadjuvant therapy was associated with lower perioperative morbidity, with no statistically significant increase in perioperative mortality. It was also associated with improved rates of complete resection; however this did not appear to have translated into improved disease free survival.

Recent treatment patterns and survival outcomes in pancreatic cancer according to clinical stage based on single-center large-cohort data.

Backgrounds/AimsWe performed a retrospective, single-center cohort study to evaluate the impact of various treatment modalities and recent changes in treatment modalities, including the increased application of chemotherapy, on survival in patients with pancreatic cancer.MethodsAll patients with pancreatic cancer who were diagnosed and treated at Seoul National University Hospital between January 2007 and December 2014 were registered in a prospective clinical database and included in this retrospective study. All patients' radiologic imaging diagnoses were re-reviewed according to the National Cancer Center Network guidelines. The patients were divided into four groups according to their clinical stage, and each clinical stage group was further divided into four groups according to treatment modality.ResultsOverall, 475 (28.9%) patients had resectable pancreatic cancer, 129 (7.8%) patients borderline resectable pancreatic cancer, 384 (23.3%) patients locally advanced pancreatic cancer, and 658 (40.0%) patients metastatic pancreatic cancer. Among the patients with borderline resectable pancreatic cancer, the median survival was significantly longer in the neoadjuvant therapy (NAT)+surgery groups (24 months) than the surgery without NAT (16 months) group (p=0.049). A multivariate survival analysis revealed that compared with the surgery group, the 5-year mortality risk was decreased by 35% in the NAT+surgery group (24 vs. 20 months, p=0.045).ConclusionsThis retrospective cohort study showed that the rates of resectable and surgically treatable pancreatic cancer were 29.1% and 32.2%, which are higher than those reported previously, and aggressive NAT for select advanced-stage patients could lead to better survival outcomes.

Neoadjuvant Therapy Versus Upfront Resection for Pancreatic Cancer: The Actual Spectrum and Clinical Burden of Postoperative Complications.

Neoadjuvant therapy (NAT) is used for borderline-resectable or locally advanced pancreatic cancer (PDAC) and exhibits promising results in terms of pathological outcomes. However, little is known about its effect on surgical complications. We analyzed 445 pancreatic resections for PDAC from 2014 to 2016 at The Pancreas Institute, Verona University Hospital. The Modified Accordion Severity Grading System and average complication burden (ACB) were used to compare patients treated with NAT with patients who underwent upfront surgery (UFS). Of 305 pancreaticoduodenectomies (PD), patients treated with NAT (n=99) had less pancreatic fistula (POPF, 9.1% vs. 15.6%, p=0.05) without grade C cases, but grade B ACB was increased (0.28 for NAT vs. 0.24 for UFS, p=0.05). The postpancreatectomy hemorrhage (PPH) rate was lower in the NAT group (9.1% vs. 14.6%, p=0.02), but ACB grades B (0.37 for NAT vs. 0.26 for UFS, p=0.03) and C (0.43 for NAT vs. 0.29 for UFS, p=0.05) were increased. Delayed gastric emptying (DGE) was increased in NAT cases (15.2% vs. 8.3%, p=0.04), with higher grade C ACB (0.43 for NAT vs. 0.29 for UFS, p=0.03). Of 94 distal pancreatectomies (DP), NAT patients (n=26) developed more grade C POPF (11.5% vs. 1.5%, p=0.04) and DGE (11.5% vs. 2.9%, p=0.01) without differences in ACB. Patients undergoing PD for PDAC after NAT exhibited reduced incidence of POPF and PPH but increased incidence of DGE compared with patients treated with UFS. Among patients developing postoperative complications after PD, those receiving NAT were associated with increased clinical burden.

Comparison of transanal endoscopic microsurgery with or without neoadjuvant therapy and standard total mesorectal excision in the treatment of clinical T2 low rectal cancer: a meta-analysis.

Some clinical trials demonstrated local resection for clinical T1 rectal cancer was safe and effective. But for clinical T2 rectal cancer, the results were controversial. Neoadjuvant therapy (NT) is proven to reduce the opportunity of advanced rectal cancer recurrence in various researches. The objective of this Meta-Analysis was to evaluate the oncological outcomes of transanal endoscopic microsurgery (TEM) with or without NT comparing with conventional total mesorectal excision (TME) for the treatment of clinical T2 rectal cancer.To search for the relevant studies, an electronic search was done from the databases of Pubmed, Embase, and the Cochrane Library in this meta-analysis. We compared the effectiveness of transanal endoscopic microsurgery with or without NT and standard total mesorectal excision in the treatment of T2 Rectal Cancer. 1RCT and 3nRCTs including 121 TEM patients (TEM + NT: 59, TEM: 62) and 174 TME patients with T2 rectal cancer were retrieved. Compared with TME, there were no significant differences in the outcomes of local recurrence, overall recurrence, overall survival between TEM + NT group. However in compassion with TME, TEM without NT was associated with an increased local recurrence, overall recurrence, and a shorter overall survival, with individual ORs being 3.04 (95% Cl: 1.17–7.90; I2 = 0%), 5.67 (95% Cl: 1.58–20.38; I2 = 0%) and 0.12 (95% Cl: 0.02–0.65; I2 = 0%), respectively. Compared with TME, TEM after NT may be a feasible and safe organ preservative approach for patients with clinical T2 low rectal cancer. But for those without NT, TEM always seem be associated with worse oncological outcomes.

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis.

Anastomotic leak is one of most significant causes of mortality after esophagectomy. Therefore, it is clinically valuable to detect anastomotic leak early after esophagectomy in esophageal cancer. The purpose of this study is to investigate the associations between routine postoperative laboratory findings and anastomotic leak and to analyze the laboratory findings to find out an independent predictive marker for anastomotic leak. In addition, this study compares cases treated with neoadjuvant therapy (NT) and those without (non-NT). We retrospectively assessed the medical records of 201 consecutive cases that met this study's criteria from January 2009 to December 2016. All patients underwent curative and complete esophagectomy for intra-thoracic esophageal cancer. We compiled and analyzed routine laboratory findings from the day before surgery to the eighth postoperative day on a daily basis. Routine laboratory tests consisted of 26 separate tests, including complete blood cell counts, blood chemistries, as well as erythrocyte sedimentation rate and C-reactive protein (CRP). Barium esophagogram with chest computed tomography (CT) was performed on the seventh postoperative day to evaluate the presence of an anastomotic leak. A total of 45 of 201 patients underwent NT. Anastomotic leaks were found in 23 (11.4%) of 201 patients (8 patients in NT and 15 patients in non-NT). White blood cell (WBC) from the second postoperative day (P=0.031, P=0.006, P=0.007, P=0.007, P=0.041, and P=0.003, respectively) and CRP from the third postoperative day (P=0.012, P<0.001, P=0.014, P<0.001, P=0.001, and P=0.006, respectively) were associated with anastomotic leak in non-NT; however, only CRP on the third, fifth, sixth, and seventh postoperative days (P=0.041, P=0.037, P=0.002, and P=0.003, respectively) was associated with anastomotic leak in NT. The CRP level on the third postoperative day was a significant independent predictive marker of anastomotic leak (P=0.041, odd ratio (OR) 1.056, 95% confidential interval (CI): 1.002-1.113) and had a significant diagnostic cutoff value for the development of anastomotic leak (non-NT: cutoff value 17.12 mg/dL, sensitivity 69.2%, specificity 78.1%, P<0.001, area 0.822; NT: cutoff value 16.42 mg/dL, sensitivity 80.0%, specificity 70.0%, P=0.042, area 0.7104). There were divergent laboratory findings reflective of anastomotic leak between patients who underwent NT and those who did not. The CRP level on the third postoperative day had a significant cutoff value for early detection of anastomotic leak after esophagectomy in both NT and non-NT groups.

Synergetic effects of Docetaxel and ionizing radiation reduced cell viability on MCF-7 breast cancer cell

BackgroundIn recent decades neoadjuvant therapies such as combined chemotherapy and radiotherapy have been introduced for cancer management. Compared with monotherapy modalities, neoadjuvant therapy is associated with greater effectiveness while having minor side effects. Docetaxel is a chemotherapy agent for breast cancer treatment which can blocks the cell cycle at the G2/M phase which has shown special sensitivity to the ionizing radiation and hence causes cell death. To the best of our knowledge, there are currently no reports that explore the synergistic effects of Docetaxel and ionizing radiation on MCF-7 cancer cell death.MethodsWe divided cells into four different groups; control, cells which got in touch with Docetaxel, cells that with exposure to radiotherapy and cells which were influenced with combination of Docetaxel and radiotherapy. In vitro cell viability tests were done at different concentration of Docetaxel and different dose of radiation for 24, 48 and 72 h after the experiment.ResultsResults showed that the cytotoxicity was depending on the doses of radiation and Docetaxel. Radiation at 2 Gy dose was unable to produce significant effects neither in the radiation-only nor in the neoadjuvant therapy groups. However, the synergistic effects of neoadjuvant therapy were apparent at 4 and 6 Gy doses of radiation which could exert more significant cytotoxic effects on MCF-7 cells.ConclusionsStudy findings suggest that neoadjuvant therapy by using Docetaxel and 4 and 6 Gy ionizing radiation has synergistic effects on MCF-7 cell death and produces more significant results compared with monotherapy modalities.

Pancreatic adenocarcinoma: effects of neoadjuvant therapy on post-pancreatectomy outcomes – an American College of Surgeons National Surgical Quality Improvement Program targeted variable review

BackgroundAs the incidence of pancreatic adenocarcinoma increases, so has the utilization of neoadjuvant therapy. The objective of this study was to evaluate outcomes in patients undergoing neoadjuvant therapy or surgery first for pancreatic adenocarcinoma. MethodsThe ACS-NSQIP 2014–2015 targeted pancreatectomy variables were queried for patients with pancreatic adenocarcinoma who underwent resection. Outcomes of those receiving neoadjuvant therapy were compared to surgery first using a multivariate, logistic regression model. Results3408 patients underwent pancreatectomy; 2596 proximal pancreatectomies, 741 distal pancreatectomies, 64 total pancreatectomies and 7 other pancreatic procedures were performed. Of the 3408 patients identified, 934 (27.5%) received neoadjuvant therapy: 496 chemotherapy alone, 28 radiation alone, and 410 combined chemotherapy/radiation therapy. Overall morbidity and mortality were similar between patients receiving neoadjuvant therapy versus those who underwent surgery first. Neoadjuvant treatment was associated with lower rates of pancreatic fistulas (10.2% vs. 13.2%, P = 0.017), but higher intra/postoperative transfusion rates (27.4% vs. 20.3%, P < 0.0001). ConclusionsNeoadjuvant therapy appeared to be safe prior to operative intervention as no difference in overall postoperative morbidity or mortality rates were identified. There were increased intra/postoperative transfusions in the neoadjuvant therapy group, but neoadjuvant therapy was associated with lower rates of pancreatic fistulas.

Clinical efficacy of ladder neoadjuvant therapy in treatment of advanced mid-low rectal cancer

Objective: To explore the clinical efficacy of ladder neoadjuvant therapy in treatment of advanced mid-low rectal cancer. Methods: We performed a retrospective study of one hundred and eighty mid and low rectal cancer patients who underwent ladder neoadjuvant therapy(neoadjuvant chemotherapy followed by surgery if neoadjuvant chemotherapy was effective; neoadjuvant chemotherapy followed by neoadjuvant chemoradiotherapy if neoadjuvant chemotherapy was ineffective)(n=90) or neoadjuvant chemoradiotherapy (n=90). Results: In the ladder neoadjuvant therapy group, the descent stage rate was 85.6% (77/90), the anastomosis rate was 50.0% (45/90), the pre-sacral infection rate was 4.4% (4/90), the pathological complete remission (pCR) was 13.3%(12/90), R0 resection rate was 85.6% (77/90), the 2-year disease control rate was 76.7% (69/90), and the 2-year survival rate was 90.0% (81/90). In the control group, the descent stage rate was 88.9% (80/90), The anastomosis rate was 45.6% (41/90), the rate of pre-sacral infection was 11.1% (10/90), pCR was 16.7% 15/90), R0 resection rate was 88.9% (80/90), the 2-year disease control rate was 78.9% (71/90), and the 2-year survival rate was 87.8% (79/90). The difference was not statistically significant (P>0.05). The ladder neoadjuvant therapy group had lower prophylactic transverse colostomyrate(10.0% vs 34.4%), lower radiation injury rate (6.7% vs 27.8%), and lower sexual dysfunction rate (38.9% vs 87.8)compared to the control group. Conclusions: The ladder neoadjuvant therapy might reduce side injury caused by radiotherapy, improve compliance of patients, and reduce treatment costs. Moreover, the RO resection rate, 2-year local control rate and 2-year survival rate of ladder neoadjuvant therapy group was comparable with neoadjuvant chemoradiotherapy.

Retrospective cohort analysis of neoadjuvant treatment and survival in resectable and borderline resectable pancreatic ductal adenocarcinoma in a high volume referral centre

BackgroundPancreatic ductal adenocarcinoma (PDAC) is a deadly disease. Neoadjuvant therapy (NA) with chemotherapy (NAC) and radiotherapy (RT) prior to surgery provides promise. In the absence of prospective data, well annotated clinical data from high-volume units may provide pilot data for randomised trials. MethodsMedical records from a tertiary hospital in Sydney, Australia, were analysed to identify all patients with resectable or borderline resectable PDAC. Data regarding treatment, toxicity and survival were collected. ResultsBetween January 1 2010 and April 1 2016, 220 sequential patients were treated: 87 with NA and 133 with upfront operation (UO). Forty-three NA patients (52%) and 5 UO patients (4%) were borderline resectable at diagnosis. Twenty-four borderline patients received NA RT, 22 sequential to NAC. The median overall survival (OS) in the NA group was 25.9 months (mo); 95% CI (21.1–43.0 mo) compared to 26.9 mo (19.7, 32.7) in the UO; HR 0.89; log-ranked p-value = 0.58. Sixty-nine NA patients (79%) were resected, mOS was 29.2 mo (22.27, not reached (NR)). Twenty-two NA (31%) versus 22 UO (17%) were node negative at operation (N0). In those managed with NAC/RT the mOS was 29.0 mo (17.3, NR). There were no post-operative deaths with NA within 90-days and three in the UO arm. DiscussionThis is a hypothesis generating retrospective review of a selected real-world population in a high-throughput unit. Treatment with NA was well tolerated. The long observed survival in this group may be explained by lymph node sterilisation by NA, and the achievement of R0 resection in a greater proportion of patients.

Pancreatic adenocarcinoma: effects of neoadjuvant therapy on post-pancreatectomy outcomes – a national surgical quality improvement program targeted variable review

Objective: To evaluate surgical outcomes in pancreatic adenocarcinoma patients undergoing neoadjuvant therapy or surgery first approach. Methods: The ACS-NSQIP 2014 targeted pancreatectomy database was queried for patients with pancreatic adenocarcinoma who underwent resection based on appropriate CPT and ICD-9 codes. Outcomes for patients receiving neoadjuvant chemotherapy, radiation therapy, or a combined treatment first were compared to those undergoing surgery first. Results: 1833 patients underwent elective pancreatectomy for pancreatic adenocarcinoma. Of these, 1406 underwent proximal pancreatectomy, 391 underwent distal pancreatectomy, and 36 underwent total pancreatectomy. Of the 1833 patients, 497 (27.1%) received neoadjuvant therapy (251 chemotherapy, 236 chemotherapy + radiation, 10 radiation alone). Group characteristics were similar; the neoadjuvant therapy group was younger (63.3 ± 9.6 vs. 66.9 ± 10.2; P < 0.001), more likely to have insulin-dependent diabetes (19.5% vs. 15.5%; P = 0.033) and require preoperative biliary stenting (53.9% vs. 48.2%; P = 0.031). The neoadjuvant therapy group underwent more open procedures (96.4% vs. 93.6%; P = 0.021) with vascular reconstruction (35.6% vs. 17.9%; P < 0.001). The surgery first group had a higher incidence of hypertension (57.4% vs. 49.1%%; P = 0.002). There was no difference in overall morbidity or mortality. Neoadjuvant treatment of any kind was associated lower rates of pancreatic fistulas (9.7% vs. 14.0%; P = 0.014), and higher postoperative bleeding rates (28.0% vs. 22.5%, P = 0.014). Preoperative and intraoperative factors were found to independently predict postoperative morbidity (Table). Conclusion: Neoadjuvant therapy appears to be safe prior to operative intervention with no difference in overall postoperative complication rates. Although a higher rate of postoperative bleeding was identified in the neoadjuvant therapy group, neoadjuvant therapy appears to have a protective effect against pancreatic fistulas.Tabled 1Multivariate Logistic Regression model to predict postoperative morbidityOdds ratio95% CIP valueAge (per year)1.021.01–1.030.002Female sex0.830.67–1.020.070Increasing preoperative albumin (per mg/dL)0.740.61–0.890.001Increasing preoperative bilirubin (per mg/dL)0.960.92–1.000.030Body mass index category Underweight (BMI < 18.5 kg/m2) vs. normal0.830.45–1.550.564 Overweight (BMI 25–30 kg/m2) vs. normal1.281.0–1.630.050 Obese (BMI ≥ 30 kg/m2) vs. normal1.250.94–1.650.125History of COPD1.851.12–3.080.017Bleeding disorder1.650.98–2.770.059Preoperative biliary stenting1.341.05–1.700.018Open/partially open surgical approach2.271.39–3.700.001Pancreatectomy type Proximal vs distal1.270.77–2.100.360 Total vs distal3.391.49–7.710.004Vascular resection2.171.69–2.80<0.001 Open table in a new tab

Neoadjuvant therapy affects margins and margins affect all: perioperative and survival outcomes in resected pancreatic adenocarcinoma

Objective: Resection margin status is an important prognostic factor in pancreatic cancer; however, previous studies suggested that neoadjuvant therapy may abrogate R1/R0 margin effect. We investigated the predictive value of neoadjuvant therapy for margin status and subsequently, its survival benefit after pancreaticoduodenectomy for pancreatic adenocarcinoma. Methods: Patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma between 2006 and 2012 were identified from the National Cancer Database (NCDB). Multivariate logic regression analysis was utilized to examine the predictive value of neoadjuvant chemotherapy (with or without radiation) for resection margin status, prolonged hospital stay and 90-day mortality. Propensity-score matching was performed for the probability of negative margins to equalize baseline characteristics after neoadjuvant therapy. Long-term outcomes were compared using the Kaplan-–Meier method. Results: 7189 patients were identified in total; 911 (12.7%) and 6278 (87.3%) patients received neoadjuvant therapy and upfront surgery, respectively. Neoadjuvant therapy was independently predictive for or R0 margin (81.2% vs. 74.9%; OR, 1.53; p<0.001); however, neoadjuvant therapy did not correlate with prolonged hospital stay (18.4% vs. 22.0%; OR, 1.15; p=0.128) or 90-day mortality (6.4% vs. 7.3%; OR, 1.149; p=0.335). R0 margin was associated with survival benefit in both upfront surgery (median survival, 19.8.0 vs. 14.3 months; p<0.001) and neoadjuvant therapy groups (median survival, 25.0 vs. 17.8 months; p<0.001). This survival advantage remained robust after matching. Conclusion: Neoadjuvant therapy is associated with increased R0-resection rates after pancreaticoduodenectomy for pancreatic adenocarcinoma. Moreover, R0 margin status was associated with increased survival in both up-front surgery and neoadjuvant cohorts.

Impact of neoadjuvant chemoradiation on perioperative outcomes in patients with rectal cancer.

Neoadjuvant chemoradiation for rectal cancer is associated with lower local recurrence rates. The objective of this study is to assess the impact of neoadjuvant therapy on perioperative complications in patients with rectal cancer. Using the ACS-NSQIP database (2005-2012), a propensity score was used to match 3592 patients with rectal cancer receiving neoadjuvant therapy to 3592 patients undergoing surgery alone. The association between neoadjuvant chemoradiation and perioperative outcomes was evaluated. Among all patients, overall morbidity was significantly higher in the neoadjuvant therapy group (n = 1170, 29.9%) compared to the surgery alone (n = 2350, 26.4%; P < 0.0001), but 30-day mortality was lower in the neoadjuvant group (n = 27, 0.7%) compared to the surgery alone group (n = 112, 1.3%; P = 0.0043). However, in propensity-matched patients, there was no difference in overall morbidity (OR 0.912, 95% CI 0.825-1.008) or 30-day mortality (OR 0.639, 95% CI 0.38-1.05). Overall morbidity and 30-day mortality were 29.3% (n = 1054) and 0.7% (n = 25) in the neoadjuvant group, respectively, compared to 31.3% (n = 1124) and 1.1% (n = 39) in the surgery alone group, respectively. Patients with newly diagnosed rectal cancer could be evaluated for neoadjuvant therapy prior to surgical resection without the fear of upfront therapy causing a significant increase in perioperative complications.

Neoadjuvant Therapy Followed by Resection Versus Upfront Resection for Resectable Pancreatic Cancer: A Propensity Score Matched Analysis.

Purpose To compare overall survival between patients who received neoadjuvant therapy (NAT) followed by resection and those who received upfront resection (UR)-as well as a subgroup of UR patients who also received adjuvant therapy-for early-stage resectable pancreatic adenocarcinoma. Patients and Methods Adult patients with resected, clinical stage I or II adenocarcinoma of the head of the pancreas were identified in the National Cancer Database from 2006 to 2012. Patients who underwent NAT followed by curative-intent resection were matched by propensity score with patients whose tumors were resected upfront. Overall survival was compared by using a Cox proportional hazards regression model. Early postoperative and oncologic outcomes were evaluated. Results We identified 15,237 patients with clinical stage I or II resected pancreatic head adenocarcinoma. From the NAT group, 2,005 patients (95%) were matched with 6,015 patients who underwent UR. The NAT group was associated with improved survival compared with UR (median survival, 26 months v 21 months, respectively; stratified log-rank P < .01; hazard ratio, 0.72; 95% CI, 0.68 to 0.78). Patients in the UR group had higher pathologic T stage (pT3 and T4: 86% v 73%; P < .01), higher positive lymph nodes (73% v 48%; P < .01), and higher positive resection margin (24% v 17%; P < .01). Compared with a subset of UR patients who received adjuvant therapy, NAT patients had a better survival (adjusted hazard ratio, 0.83; 95% CI, 0.73 to 0.89). Conclusion NAT followed by resection has a significant survival benefit compared with UR in early-stage, resected pancreatic head adenocarcinoma. These findings support the use of NAT, particularly as a patient selection tool, in the management of resectable pancreatic adenocarcinoma.

Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer.

Neoadjuvant multi-agent chemotherapy and stereotactic body radiation therapy (SBRT) are utilized to increase margin negative (R0) resection rates in borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) patients. Concerns persist that these neoadjuvant therapies may worsen perioperative morbidities and mortality. Upfront resection patients (n=241) underwent resection without neoadjuvant treatment for resectable disease. They were compared to BRPC or LAPC patients (n=61) who underwent resection after chemotherapy and 5 fraction SBRT. Group comparisons were performed by Mann-Whitney U or Fisher's exact test. Overall Survival (OS) was estimated by Kaplan-Meier and compared by log-rank methods. In the neoadjuvant therapy group, there was significantly higher T classification, N classification, and vascular resection/repair rate. Surgical positive margin rate was lower after neoadjuvant therapy (3.3% vs. 16.2%, P=0.006). Post-operative morbidities (39.3% vs. 31.1%, P=0.226) and 90-day mortality (2% vs. 4%, P=0.693) were similar between the groups. Median OS was 33.5 months in the neoadjuvant therapy group compared to 23.1 months in upfront resection patients who received adjuvant treatment (P=0.057). Patients with BRPC or LAPC and sufficient response to neoadjuvant multi-agent chemotherapy and SBRT have similar or improved peri-operative and long-term survival outcomes compared to upfront resection patients.

MP57-18 EXPRESSION OF STEROID HORMONE RECEPTORS IN RESIDUAL CANCER AND STROMAL CELLS AFTER NEOADJUVANT CHEMOHORMONAL THERAPY WITH DOCETAXAL FOR HIGH-RISK LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2016MP57-18 EXPRESSION OF STEROID HORMONE RECEPTORS IN RESIDUAL CANCER AND STROMAL CELLS AFTER NEOADJUVANT CHEMOHORMONAL THERAPY WITH DOCETAXAL FOR HIGH-RISK LOCALIZED PROSTATE CANCER Shintaro Narita, Taketoshi Nara, Mingguo Huang, Koichiro Takayama, Kazuyuki Numakura, Hiroshi Tsuruta, Atsushi Maeno, Mitsuru Saito, Takamitsu Inoue, Norihiko Tsuchiya, Hiroshi Nanjo, Shigeru Satoh, and Tomonori Habuchi Shintaro NaritaShintaro Narita More articles by this author , Taketoshi NaraTaketoshi Nara More articles by this author , Mingguo HuangMingguo Huang More articles by this author , Koichiro TakayamaKoichiro Takayama More articles by this author , Kazuyuki NumakuraKazuyuki Numakura More articles by this author , Hiroshi TsurutaHiroshi Tsuruta More articles by this author , Atsushi MaenoAtsushi Maeno More articles by this author , Mitsuru SaitoMitsuru Saito More articles by this author , Takamitsu InoueTakamitsu Inoue More articles by this author , Norihiko TsuchiyaNorihiko Tsuchiya More articles by this author , Hiroshi NanjoHiroshi Nanjo More articles by this author , Shigeru SatohShigeru Satoh More articles by this author , and Tomonori HabuchiTomonori Habuchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.672AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies suggest that activation of steroid hormone receptors (SHRs) is associated with PCa progression and resistance to chemohormonal therapy. In this study, we investigated SHR expressions in human PCa tissues in patients who underwent radical prostatectomy (RP) with and without neoadjuvant chemohormonal therapy. METHODS A tissue microarray with 210 cores from 70 high-risk localized PCa patients who underwent RP without neoadjuvant therapy (NNA), with neoadjuvant hormonal therapy (NHT), or with neoadjuvant chemohormonal therapy with docetaxel (CHT) was used to assess the epithelial and stromal expressions of four SHRs including androgen receptor (AR), glucocorticoid receptor (GR), estrogen receptor (ER) alpha, and progesterone receptor (PR). Expression levels of SHRs between the three groups were statistically assessed. Multivariate analyses were performed to investigate the prognostic factors of BCR in patients who underwent surgery with CHT. RESULTS AR and GR were expressed in both residual cancer and stromal cells, whereas ER alpha and PR were mainly expressed in stromal cells. The mean nuclear AR immunoreactivity score in residual cancer cells was significantly higher in the NNA group than in the NHT and CHT groups. The mean nuclear GR immunoreactivity score in residual cancer cells and mean nuclear ER alpha and PR in stromal cells were significantly higher in the CHT group than in the NNA and NHT groups. The patients with a low PR immunoreactivity score in stromal cells had a significantly higher BCR rate than those with a high nuclear immunoreactivity score (p = 0.011). In multivariate analysis, the number of risk factors constituting the classification of high-risk, a preoperative PSA level, pathological chemotherapy effect, and low nuclear PR immunoreactivity score in stromal cells were independent prognostic factors for BCR. CONCLUSIONS Stromal PR expression may be a potential prognostic marker for BCR in high-risk PCa patients who underwent radical prostatectomy after neoadjuvant chemohormonal therapy. The expression of SHRs in both residual cancer and stromal cells may play an important role in PCa resistance to chemohormonal therapy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e759-e760 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shintaro Narita More articles by this author Taketoshi Nara More articles by this author Mingguo Huang More articles by this author Koichiro Takayama More articles by this author Kazuyuki Numakura More articles by this author Hiroshi Tsuruta More articles by this author Atsushi Maeno More articles by this author Mitsuru Saito More articles by this author Takamitsu Inoue More articles by this author Norihiko Tsuchiya More articles by this author Hiroshi Nanjo More articles by this author Shigeru Satoh More articles by this author Tomonori Habuchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A comparison of formalin and GEWF in fixation of colorectal carcinoma specimens: rates of lymph node retrieval and effect on TNM staging

AimsThe Royal College of Pathologists recommend that a median of at least 12 lymph nodes should be harvested during pathological staging of colorectal cancer. It is not always easy to...

Un adecuado número de ganglios linfáticos puede ser obtenido en la mayoría de los especímenes quirúrgicos de resección radical de recto después de tratamiento neoadyuvante

The aim of this study was to assess the possibility of obtaining an adequate number of lymph nodes (LN) from rectal cancer patients treated with neoadjuvant therapy (NAT) and to evaluate the correlation of LN with survival. 70 patients were divided into two groups: those who had received NAT and those who had not. The NAT group was further divided into those with < 12 LN and >12 LN. The non-NAT group showed more lymph vascular invasion (33.3% vs. 14.3%) and perineural invasion (19% vs. 4.1%). Average LN in NAT group was 15.7+7.1 vs. 27.28+14.9 (p=0.0238) and ≥12 LN were resected in 74% vs. 90.5% (p=0.0326). The <12 and >12 LN groups showed no difference in N stage, staging and survival. The 5-yr survival of NAT group was 82.3% v 76.9% (p=0.465).

PTU-140 Neoadjuvant therapy toxicity and efficacy in oesophago-gastric cancer

Introduction The advantages of neoadjuvant therapy (NAT) in oesophago-gastric (OG) cancer have been proven in randomised trials. Benefits are modest and likely to be restricted to patients who respond well to therapy. The risks may outweigh benefits in earlier stages of disease. This study explores the risks associated with NAT, analyses which patients benefit and investigates whether there is a need for a change in NAT treatment strategy. Method All patients planned for surgical resection of OG cancer in this unit between 01/2010 and 12/2014 were identified. Part a) patients were divided according to pre-operative stage. Within each stage, survival was compared in patients undergoing NAT and those undergoing surgery alone. Similar comparisons were made with the NAT group further divided into histological responders and non-responders. Part b) from the cohort, patients undergoing NAT were identified. Adverse effects (AE) were recorded and graded according to the Common Terminology Criteria for Adverse Events v3.0. The relationships between the presence of AE and a range of variables were investigated along with survival. Survival analyses were undertaken by plotting Kaplan-Meier curves. Groups were compared using the Log Rank (Mantel-Cox) test. Results 587 patients were identified from the database. Part a) only stage III patients had improved survival with NAT vs. surgery alone (P = 0.02). Those in stage II with a histological response to treatment showed a trend towards better survival vs. surgery alone (P = 0.058). In all patients above the threshold for offering NAT (≥stage II), survival was no different in non-responders vs. those having surgery alone. Age and performance status were lower in the NAT group vs. the surgery only group and were both associated inversely with survival. This could mean NAT effects are overestimated and true survival in non-responders to NAT may be poorer than in patients having surgery alone. Part b) 376 patients received NAT and 88 (23.4%) suffered AE. 69% of these were severe, life-threatening or fatal. NAT course completion rate was lower in patients suffering AE vs. those not (P = 0.003). 20.5% patients with AE did not proceed to resection vs. 6.4% without AE (P = 0.001). Survival was better in patients without AE vs. with AE (P = 0.02) and was better in those undergoing resection (P Conclusion Efficacy of NAT is dependent on cancer stage and histological response to NAT. AE are common, often severe and associated with a reduced resection rate and survival. Identifying a means of predicting response to NAT is of great importance and should be used to guide treatment alongside/instead of disease stage. Disclosure of interest None Declared.

Neo-adjuvant hormone therapy for non-metastatic prostate cancer: a systematic review and meta-analysis of 5,194 patients.

BackgroundNeo-adjuvant hormone therapy (NHT) following radical prostatectomy (RP) or radiotherapy has been utilized in the multimodal approach to patients with intermediate- to high-risk prostate cancer (PCa). Herein, we performed a systematic review and meta-analysis of published randomized trials to evaluate the clinical efficacy of NHT.MethodsLiteratures were searched from PubMed, EMBASE, Web of Science, and Cochrane Library for comparing neo-adjuvant therapy group (NHT plus radiotherapy or radical prostatectomy) with traditional therapy (radiotherapy or prostatectomy) alone. Quality of the research was assessed on the basis of the Cochrane’s risk of bias of randomized controlled trial. Comparable information were obtained from eligible trials and assembled for meta-analysis up to 31 August 2014. RevMan 5.2 software was used for statistical analysis.ResultsFifteen randomized controlled trials (RCTs) (total 5,194 patients) were included in this study. Meta-analysis showed there was a significant improvement in overall survival (OS) (Odds ratio (OR) = 1.51, 95% confidence interval (CI) 1.22 to 1.87, P = 0.0002), positive surgical margin (PSM) rate (OR = 0.30, 95% CI 0.24 to 0.38, P < 0.00001), and biochemical disease-free survival (bDFS) (OR = 1.95, 95% CI 1.13 to 3.39, P = 0.02), but no significant difference in disease-free survival (OR = 1.52, 95% CI 0.90 to 2.59, P = 0.12) and clinical disease-free survival (cDFS) (OR = 0.96, 95% CI 0.22 to 4.18, P = 0.95). Heterogeneity and risk of bias were observed between different studies.ConclusionsPatients with aggressive prostate cancer would better benefit from the receipt of neo-adjuvant therapy. Physicians should make individualized treatment strategies according to adverse reactions, financial capacities, and personal wishes.

The impact of neoadjuvant therapy for gastroesophageal adenocarcinoma on postoperative morbidity and mortality.

156 Background: The effects of neoadjuvant chemotherapy (CTX) or chemoradiotherapy (CTX-RT) on postoperative complications following surgical resection of adenocarcinomas of the stomach and gastroesophageal junction (GEJ) have not been well studied. Methods: We identified 308 patients undergoing a surgery-first approach and 145 patients undergoing neoadjuvant therapy (CTX, n = 73 and CTX-RT, n = 72) followed by curative-intent surgeryfor adenocarcinomas of the stomach and GEJ from 1995-2014. We compared the baseline characteristics and the postoperative outcomes between the two groups using univariate and multivariate analyses. Results: Patients receiving neoadjuvant therapy were significantly more likely to be of younger median age (63 y vs. 71 y), have tumors of the GEJ (37% vs. 17%), to undergo esophagogastrectomy (51% vs. 26%) and D2 lymphadenectomy (39% vs. 27%), and to have more advanced stage disease than patients undergoing surgery first. There were no differences in overall 30-day morbidity or mortality rates between the neoadjuvant therapy and surgery-first groups, respectively (Table). However, patients undergoing surgery first were significantly more likely to have higher-grade complications than those undergoing neoadjuvant therapy. Conclusions: Despite having more advanced disease and undergoing higher-risk surgical procedures, patients with adenocarcinomas of the stomach or GEJ who receive neoadjuvant therapy prior to surgery are less likely to have major post-operative complications than patients treated with a surgery-first approach. Concerns about higher rates of post-operative complications should not deter the use of neoadjuvant therapy for gastroesophageal cancer. [Table: see text]