Treatment Of Gastrointestinal Malignancies Research Articles

Experiences in endoscopic ultrasonography at a tertiary center general surgery endoscopy unit

Aim: Endoscopic ultrasonography (EUS) is used for diagnosing pathologies in the gastrointestinal system and surrounding organs. This study aims to share the experiences and results of EUS and biopsy at a tertiary center general surgery endoscopy unit, in the context of the literature.
 Methods: Patients who underwent EUS imaging at the general surgery endoscopy unit between January 2021 and January 2022 were retrospectively reviewed. Demographic characteristics, EUS biopsy indications, clinical pre-diagnoses, preoperative imaging methods, biopsy counts, and results, as well as complications, were analyzed.
 Results: The mean age of the 292 patients was 56.5 years, with 53.8% being male. The most common EUS indication was a mass in the pancreas, accounting for 62%. Endoscopic fine-needle aspiration biopsy was performed on 127 (43.4%) patients, and the mean diameter of biopsied masses was 35.1 mm. Malignancy was detected in 58.2% of the biopsied patients. Based on biopsy and lesion characteristics, 49.3% of patients were followed up, 27.4% underwent surgery, 15.4% received oncological treatment, and 7.9% were given endoscopic retrograde cholangiopancreatography.
 Conclusion: The role of EUS in the diagnosis and treatment of gastrointestinal malignancies, pancreatic diseases, and biliary diseases continues to evolve. We believe that EUS plays a key role in the multidisciplinary management of complex surgical and oncology patients and those with pancreatobiliary disorders.

Current status and progress in laparoscopic surgery for gallbladder carcinoma.

Gallbladder carcinoma (GBC) is the most common biliary tract malignancy associated with a concealed onset, high invasiveness and poor prognosis. Radical surgery remains the only curative treatment for GBC, and the optimal extent of surgery depends on the tumor stage. Radical resection can be achieved by simple cholecystectomy for Tis and T1a GBC. However, whether simple cholecystectomy or extended cholecystectomy, including regional lymph node dissection and hepatectomy, is the standard surgical extent for T1b GBC remains controversial. Extended cholecystectomy should be performed for T2 and some T3 GBC without distant metastasis. Secondary radical surgery is essential for incidental gall-bladder cancer diagnosed after cholecystectomy. For locally advanced GBC, hepatopancreatoduodenectomy may achieve R0 resection and improve long-term survival outcomes, but the extremely high risk of the surgery limits its implementation. Laparoscopic surgery has been widely used in the treatment of gastrointestinal malignancies. GBC was once regarded as a contraindication of laparoscopic surgery. However, with improvements in surgical instruments and skills, studies have shown that laparoscopic surgery will not result in a poorer prognosis for selected patients with GBC compared with open surgery. Moreover, laparoscopic surgery is associated with enhanced recovery after surgery since it is minimally invasive.

Is it feasible and ethical to randomize patients between surgery and non-surgical treatments for gastrointestinal cancers?

In several settings in the treatment of gastrointestinal cancers, it is unclear if the addition of surgery to a multimodal treatment strategy, or in some circumstances its omission, lead to a better outcome for patients. In such situations of clinical equipoise, high-quality evidence from randomised-controlled trials is needed to decide which treatment approach is preferable. In this article, we outline the importance of randomised trials comparing surgery with non-surgical therapies for specific scenarios in the treatment of gastrointestinal cancers. We explain the difficulties and solutions of designing these trials and recruiting patients in this context. We performed a selective review based on a not systematic literature search in core databases, supplemented by browsing health information journals and citation searching. Only articles in English were selected. Based on this search, we discuss the results and methodological characteristics of several trials which randomised patients with gastrointestinal cancers between surgery and non-surgical treatments, highlighting their differences, advantages, and limitations. Innovative and effective cancer treatment requires randomised trials, also comparing surgery and non-surgical treatments for defined scenarios in the treatment of gastrointestinal malignancies. Nevertheless, potential obstacles to designing and carrying out these trials must be recognised ahead of time to avoid problems before or during the trial.

S2813 Compacted Periampullary Diverticulum Masquerading as Pancreatic Head Mass on Endoscopic Ultrasound

Introduction: Endoscopic ultrasound (EUS) has become an increasingly important modality in the diagnosis and treatment of gastrointestinal malignancy as well as both pancreatic and biliary disease. It provides high-resolution, real-time imaging of the GI tract and surrounding structures. EUS is classically operator dependent and can often display suboptimal sensitivity and specificity. Numerous techniques such as Endoscopic guided fine-needle aspiration (EUS-FNA), EUS fine needle biopsy (EUS-FNB), rapid on-site cytological evaluation (ROSE) and contrast harmonic-enhanced EUS (CH-EUS) help to increase the sensitivity and specificity of this diagnostic modality. The following case describes a patient with initial EUS findings concerning for pancreatic head malignancy which was ultimately identified as a periampullary diverticulum compacted with sludge. Case Description/Methods: A 70-year-old patient with a past medical history of prostate cancer and cholelithiasis status post recent cholecystectomy presented with CT imaging findings concerning for pancreatic head mass. The patient underwent initial EGD with EUS which illustrated a well circumscribed, heterogeneously echoic 26.8 x 24 mm uncinate process mass concerning for neuroendocrine tumor (NET). FNB was performed and cytology ultimately showed no evidence of malignancy. Due to continued concern for pancreatic NET, patient underwent repeat EGD and EUS. EUS redemonstrated the large heterogeneously echoic pancreatic head lesion concerning for mass. Attempts were made to visualize the ampulla with linear EUS scope, however there was significant debris in the second portion of the duodenum. Duodenoscope was then passed and a large caliber but narrow opening periampullary diverticulum was visualized and appeared to be filled with compacted sludge. A combination of biopsy forceps and water lavage was used to clean out the compacted sludge. The EUS scope was then re-advanced into the second part of the duodenum and the suspected mass which was previously visualized was no longer visible. (Figure) Discussion: EUS is a an important, minimally invasive diagnostic procedure that has both high clinical success rate with relatively few adverse events. EUS, like many other diagnostic modalities, has limitations when identifying and ruling out malignancy. This case highlights one such limitation showing that although initial findings were concerning for malignancy, further investigation revealed a duodenal diverticulum with compacted debris masquerading as an uncinate mass.Figure 1.: A. EUS showing heterogeneously echoic 26.8 x 24 mm uncinate process mass B. Duodenoscope showing periampullary diverticulum compacted with sludge, removed with lavage and biopsy forceps C. Repeat EUS showing absence of previously visualized uncinate mass.

Circulating tumor DNA for diagnosis, prognosis and treatment of gastrointestinal malignancies.

Minimally invasive detection of circulating tumor DNA (ctDNA) in peripheral blood or other body fluids of patients with gastrointestinal malignancies via liquid biopsy has emerged as a promising biomarker. This is urgently needed, as conventional imaging and plasma protein-derived biomarkers lack sensitivity and specificity in prognosis, early detection of relapse or treatment monitoring. This review summarizes the potential role of liquid biopsy in diagnosis, prognosis and treatment monitoring of gastrointestinal malignancies, including upper gastrointestinal, liver, bile duct, pancreatic and colorectal cancer. CtDNA can now be part of the clinical routine as a promising, highly sensitive and specific biomarker with a broad range of applicability. Liquid-biopsy based postoperative relapse prediction could lead to improved survival by intensification of adjuvant treatment in patients identified to be at risk of early recurrence. Moreover, ctDNA allows monitoring of antineoplastic treatment success, with identification of potentially developed resistance or therapeutic targets during the course of treatment. It may also assist in early change of chemotherapy in metastatic gastrointestinal malignancies prior to imaging findings of relapse. Nevertheless, clinical utility is dependent on the tumor’s entity and burden.

Vaccines in Gastrointestinal Malignancies: From Prevention to Treatment.

Gastrointestinal (GI) malignancies are some of the most common and devastating malignancies and include colorectal, gastric, esophageal, hepatocellular, and pancreatic carcinomas, among others. Five-year survival rates for many of these malignancies remain low. The majority presents at an advanced stage with limited treatment options and poor overall survival. Treatment is advancing but not at the same speed as other malignancies. Chemotherapy and radiation treatments are still only partially effective in GI malignancies and cause significant side effects. Thus, there is an urgent need for novel strategies in the treatment of GI malignancies. Recently, immunotherapy and checkpoint inhibitors have entered as potential new therapeutic options for patients, and thus, cancer vaccines may play a major role in the future of treatment for these malignancies. Further advances in understanding the interaction between the tumor and immune system have led to the development of novel agents, such as cancer vaccines.

Trajectories of functional status among older adults receiving treatment for gastrointestinal (GI) malignancies: A report from the CARE study.

12045 Background: Preservation of functional independence while undergoing treatment is of utmost importance to older adults with cancer, in addition to being associated with healthcare utilization and survival. Yet, such data are not readily available from published clinical trials. We sought to examine functional status trajectories and risk factors associated with functional decline among older adults receiving treatment for GI malignancies. Methods: This study included older adults (≥60y) treated at the UAB GI oncology clinic and enrolled in a prospective Cancer and Aging Resilience Evaluation (CARE) registry. All patients completed a geriatric assessment (GA) that included an assessment of activities of daily living (ADL) and instrumental activities of daily living (IADL). Participants were approached for a repeat assessment three months after baseline GA. Change in functional status was classified as one or more points decline or improvement in IADL and/or ADL from baseline to follow up. We measured the proportion with functional decline or improvement and constructed 95% confidence interval (95%CI) using binomial exact methods. We built multivariable logistic regression models to study the impact of baseline predictors on functional decline. Putative risk factors included age, sex, race/ethnicity, cancer type & stage, baseline CARE frailty index, fatigue, pain, malnutrition and CT-based muscle mass indices (Skeletal Muscle Index [SMI] and Skeletal Muscle Density [SMD]) at the time of diagnosis. Results: This study included 184 patients. The median age at first visit was 68y (IQR 64-74); 55% were males, 71% white. Primary cancer diagnoses included colorectal cancer (29%), pancreatic cancer (28%) and other GI cancers (43%); 73% presented with advanced stage disease (III/IV). Most patients were receiving first line therapy (91%), with systemic chemotherapy (95%). The median duration between the baseline and follow up assessment was 109 days (IQR 84-154 days). Overall, 38% (95%CI, 30-45%) experienced a functional decline, whereas functional improvement was seen in 22% (95%CI, 16-29%). In a multivariable analysis, baseline frailty (odds ratio [OR] = 2.37; 95%CI, 1.05-5.38; p =0.03) was associated with significantly increased odds of functional decline; a trend towards increased odds was seen for pancreatic cancer (OR = 2.23; 95%CI, 0.90-5.53; p= 0.08; reference group: colorectal cancer). Conclusions: One in three older adults with GI malignancies experienced functional decline while a quarter experienced functional improvement in the first 3 months following treatment. Baseline frailty was associated with higher odds of functional decline. Early identification of such patients may allow targeted interventions to preserve functional independence and optimize quality of life of older adults with cancer.

Sarcopenia, sarcopenic obesity, myosteatosis as factors of poor prognosis in gastrointestinal tract tumors: review

Over the past decade, there has been a noticeable increase in the number of publications devoted to the analysis of body composition in the treatment of gastrointestinal malignancies. Sarcopenia (skeletal muscle depletion), sarcopenic obesity and myosteatosis are shown to have a negative impact on the results of surgical and chemotherapeutic treatment of patients with gastrointestinal tumors. The review presents in detail data on clinical value of sarcopenia, sarcopenic obesity and myosteatosis along with methodological aspects of body composition analysis. Different cut-offs and diagnostic criteria exist between Western and Eastern patient populations which makes any comparison or meta-analysis not possible right now. The review presents data from Russian and foreign studies on the influence of body composition on postoperative outcomes and survival in patients with gastrointestinal tumors. The article also discusses the influence of body composition on dose-limiting toxicity of chemotherapy. We aimed at raising awareness of clinicians regarding the high prevalence of cancer cachexia and, precisely, sarcopenia, sarcopenic obesity and myosteatosis in patients with GI tract tumors. Deeper understanding of these syndromes is the key to developing measures for prevention as well as correcting the treatment of patients with gastrointestinal tumors.

Use of Molecular Assays and Circulating Tumor DNA in Early-Stage Colorectal Cancer: A Roundtable Discussion of the Gastrointestinal Cancer Therapy Expert Group.

The use of genomic testing is rapidly emerging as an important clinical tool both for cancer diagnosis and for guiding treatment decisions in a wide range of malignancies, including gastrointestinal (GI) cancers such as colorectal cancer (CRC). Advances in technologies such as polymerase chain reaction and next-generation sequencing methods have made it possible to noninvasively screen for CRC through, for example, the use of blood- or stool-based testing, with high specificity. Tests are also available that can provide prognostic information beyond traditional clinicopathologic factors such as tumor size, grade, and nodal status, which can enable clinicians to more accurately risk stratify patients for recurrence. Lastly, in the setting of resected CRC, tests are now available that can detect circulating tumor DNA as a means for noninvasive minimal/molecular residual disease monitoring, thereby potentially guiding the use of adjuvant chemotherapy and/or escalating or de-escalating therapy. The Gastrointestinal Cancer Therapy Expert Group (GICTEG) recently convened a virtual meeting to discuss current issues related to genomic testing in GI cancer, with the goal of providing guidance on the use of these tests for the practicing community oncologist, for whom GI cancer may be only one of many tumor types encountered. This article provides a summary of the discussion and highlights the key opinions of the GICTEG on this topic. IMPLICATIONS FOR PRACTICE: The Gastrointestinal Cancer Therapy Expert Group seeks to provide practical guidance and opinion on the treatment of gastrointestinal malignancies, including colorectal cancer (CRC), for the practicing community oncologist in situations for which guidelines from established bodies, such as the National Comprehensive Cancer Network and the American Society of Clinical Oncology, may be less clear. In the present report, clinical guidance on the use of molecular assays for a range of clinical indications in CRC is presented, including the use of circulating tumor DNA to detect minimal/molecular residual disease in patients with successfully resected early-stage CRC.

Adoptive Cell Therapy for Gastrointestinal Cancers

AbstractThe reinfusion of autologous or allogeneic immune cells that have been educated and/or engineered ex vivo to respond to tumor-specific antigens is termed “adoptive cell therapy.” While adoptive cell therapy has made tremendous strides in the treatment of hematologic malignancies, its utilization for solid tumors has lagged somewhat behind. The purpose of this article is to concisely review the clinical research that has been done to investigate adoptive cell therapy as a treatment for gastrointestinal malignancies.

Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center

BackgroundMinimally invasive techniques have gradually come to take a leading position in the surgical treatment of gastrointestinal malignancies. In order to define an effective process for the implementation of similar techniques in the treatment of gastric cancer, patient caseload represents a pivotal factor for education and training, but is a prerequisite not fulfilled in most Western countries. Additionally, as opposed to the East, a variety of additional factors such as the usually advanced stage of the disease and differences in patient characteristics are prevailing and raise further obstacles. Hereby we report a strategy for a safe and effective process for the implementation of laparoscopic gastric cancer surgery in a Western tertiary referral center.MethodsThe present study describes the stepwise implementation of laparoscopic gastrectomy for the treatment of gastric cancer at a tertiary referral center, comprising the time period 2012–2019. This process was facilitated by a close collaboration with two high-volume centers in Japan, as well as exchanging fellowships and observerships between the Karolinska University Hospital and other European centers. From the initially strict selection of cases for laparoscopic surgery, laparoscopic gastrectomy has gradually become the preferred approach also in patients with locally advanced tumors.ResultsFrom January 1st 2010 until December 31st 2019, 249 patients were operated for gastric cancer, of whom 141 (56.6%) had an open and 108 (43.4%) a laparoscopic procedure. In the latter group, total gastrectomy was performed in 33.3% of the patients. While blood loss, operation time and length of stay decreased during the first years after implementation, these variables increased slightly during the last years of the study period, probably due to the higher proportion of advanced gastric cancer cases, as well as the higher rate of laparoscopic total gastrectomy with more extended lymphadenectomy.ConclusionsLaparoscopic surgery is currently a valid therapeutic option for gastric cancer, which has expanded to also embrace total gastrectomy and locally advanced tumors. Collaboration between centers in the East and West, centralization to high-volume centers and application of enhanced recovery protocols are essential components in the implementation and further refinement of minimally invasive gastrectomy.

Efficacy of mesenchymal stem cells in the treatment of gastrointestinal malignancies.

Mesenchymal stem cells (MSCs), which are a kind of stem cell, possess an immune privileged nature, tumour homing features, and multi-lineage differentiation ability. MSCs have been studied in many fields, such as tissue engineering, nervous system diseases, and cancer treatment. In recent years, an increasing number of researchers have focused on the effects of MSCs on various kinds of tumours. However, the concrete anticancer efficacy of MSCs is still controversial. Gastrointestinal (GI) malignancies are the major causes of cancer-related death worldwide. The interactions of MSCs and GI cancer cells in specific conditions have attracted increasing attention. In this review, we introduce the characteristics of MSCs and analyse the effects of MSCs on GI malignancies, including gastric cancer, hepatoma, pancreatic cancer, and colorectal cancer. In addition, we also provide our perspectives on why MSCs may play different roles in GI malignancies and further research directions to increase the treatment efficacy of MSCs on GI malignancies.

Skin platinum deposition in colorectal cancer patients following oxaliplatin-based therapy.

Oxaliplatin is widely used in the treatment of gastrointestinal malignancies. One of the most common and dose-limiting side effects of oxaliplatin is the chronic peripheral sensory neuropathy. The mechanism of this neurotoxicity is poorly understood and there are no effective preventive or treatment strategies, other than oxaliplatin dose interruption or reduction. Colorectal cancer patients who completed FOLFOX at least 6months prior to enrollment were eligible. EORTC QLQ-CIPN20 questionnaire was used for assessing self-reported neuropathic symptom. Blood samples and skin biopsies were obtained and analyzed for platinum. Twelve patients were enrolled. The mean cumulative dose of oxaliplatin was 818 ± 54mg/m2, and the median time from last dose of oxaliplatin was 38.7months (range: 7.2-65.6months). The QLQ-CIPN20 sensory score was 18 or less in 10 patients and 19 and 25, respectively, in 2 patients. Platinum was detectable in plasma from 4/12 patients up to 63.3months after the completion of FOLFOX. In all six patients with skin biopsies, platinum was present in the skin with imaging mass cytometry. QLQ-CIPN20 scores and plasma platinum concentrations were not related to cumulative doses of oxaliplatin or interval from the last dose of oxaliplatin. Platinum was readily detectable in skin biopsies more than 60months post-completion of FOLFOX. This is the first demonstration of platinum deposition in skin post-oxaliplatin treatment and it provides a possible mechanism for oxaliplatin-induced peripheral sensory neuropathy and its persistence.

Therapeutic regimens using monoclonal antibodies in gastroenterology

Therapeutic regimens using monoclonal antibodies have been implemented in clinical daily practice for various gastroenterological diseases, for therapeutic strategies in gastrointestinal (GI) oncology, and infectious diseases of the gastrointestinal tract. The main indications remain the therapy of chronic inflammatory bowel disease and in GI oncology. Anew field has opened for targeted therapy with monoclonal antibodies of recurrent Clostridium difficile infection. In the nomenclature of monoclonal antibodies, the endings of the substances indicate the production or degree of "humanization" of the respective antibodies ("umab": fully human, recombinant antibody; "ximab": chimeric antibody with variable murine domain). For chronic inflammatory bowel disease, monoclonal antibodies has been developed to interfere with molecular targets of the inflammatory cascade in the underlying pathogenesis (tumor necrosis factor‑α, interleukin-12 and -23; α4β7-integrins). The development of targeted therapies in the treatment of GI malignancies, monoclonal antibodies has been developed to interfere with substantial pathways of proliferation and apoptosis as well as neoplastic vascularization and neovascularization (e.g., vascular endothelial growth factor [VEGF] and VEGF receptor antibodies, epidermal growth factor receptor antibodies, HER2/neu antibodies). In the current review, we provide asummary of the current applications of monoclonal antibodies in the therapeutic treatment of gastroenterological diseases.

Imaging biomarkers in upper gastrointestinal cancers.

In parallel with the increasingly widespread availability of high performance imaging platforms and recent progresses in pathobiological characterisation and treatment of gastrointestinal malignancies, imaging biomarkers have become a major research topic due to their potential to provide additional quantitative information to conventional imaging modalities that can improve accuracy at staging and follow-up, predict outcome, and guide treatment planning in an individualised manner. The aim of this review is to briefly examine the status of current knowledge about imaging biomarkers in the field of upper gastrointestinal cancers, highlighting their potential applications and future perspectives in patient management from diagnosis onwards.

F-box/WD-40 repeat-containing protein 7: A potential target in the progression and treatment of gastrointestinal malignancy.

Cancer is a principal cause of human morbidity and mortality, with gastrointestinal malignancies, in particular, resulting in a marked number of tumor-associated mortalities. The progression of gastrointestinal malignancy is regulated by a variety of aberrantly expressed proteins, a number of which facilitate tumor progression, whereas, others function as tumor suppressors. The detection of such proteins not only contributes to the early diagnosis of cancer, they may additionally serve as potential therapeutic targets. In normal tissues, numerous proteins encoded by proto-oncoproteins are degraded by ubiquitylation enzymes, consisting of F-box/WD-40 repeat-containing protein 7 (Fbw7) and other proteins, thus avoiding tumorigenesis and maintaining homeostasis. In tumor tissues, the downregulation of Fbw7, caused by various factors, leads to disorders in ubiquitinase synthesis, which may induce tumor progression and chemoresistance, particularly in gastrointestinal malignancy. Therefore, an in-depth study of the regulatory mechanisms involved in disorders of Fbw7 expression and the role of Fbw7 in chemoresistance of gastrointestinal tumors may suggest improvements for early diagnostic screening and targeted therapy.

The efficiency of electronic list-based multidisciplinary team meetings in management of gastrointestinal malignancy: a single-center experience in Southern China

BackgroundThe multidisciplinary team (MDT) discussion has earned increasing popularity for the delivery of cancer care. However, MDT meeting (MDTM) is time and resource intensive, and some efforts to optimize discussion processes are required. This study aims to investigate the efficiency of electronic list-based MDTM in treatment of gastrointestinal (GI) malignancy.MethodsBetween January 2015 and December 2016, patients with GI cancers were retrospectively reviewed. Patients permitting an MDTM with our novel technique (eMDT group) were compared with those undergoing a traditional discussion (cMDT group). The efficiency of MDT working, including time cost per meeting or case and overall number of reviewed cases, was checked, with accuracy of clinical staging and other outcomes explored meanwhile.ResultsThree thousand six hundred seventy-four patients were included, with 2156 (58.7%) and 1518 (41.3%) cases for eMDT and cMDT groups, respectively. Comparisons in age (P = 0.529), gender (P = 0.844), cancer type (P = 0.218), treatment plan (P = 0.737), and pathological stage (P = 0.098) were not significant between groups. However, the average time cost in both each meeting (149.4 vs. 205.1 min; P < 0.001) and each case (3.1 vs. 6.2 min; P < 0.001) was markedly reduced. Besides, this novel technique was associated with improved accuracy of clinical staging (P = 0.070) and reduced hospital stay (P < 0.001) compared with the traditional approach, with similar incidence of complications observed (P = 0.243).ConclusionsThe MDT working based on an intelligent checklist could save considerable time while not affecting treatment of GI malignancies. The improved efficiency also earns an increased capacity of hospital admission and in-patient care.

Surveillance after Treatment of Gastrointestinal Cancer

Treatment for gastrointestinal malignancies has evolved over the past two decades. Long-term outcomes have considerably improved, however a high rate of recurrence persists. With the exception of colon cancer, clear consensus strategies with regards to post-treatment surveillance are lacking. Current surveillance practices in non-colon cancer cases are inadequately based on retrospective case analyses and expert recommendations which are not uniformly consistent.This article presents the key follow-up aspects such as recurrence frequency, timing, localization, and therapeutic efficacy for the most common gastrointestinal tumors, and summarizes current recommendations for early detection of recurrence. In particular, we compare and contrast the recommendations of the German S3 guideline, the European Society for Medical Oncology (ESMO) and the American National Comprehensive Cancer Network (NCCN).

Racial differences of iron deficiency anemia in gastric cancer.

e15564 Background: One of the six domains of health care quality identified by the Institute of Medicine in 2001 was equitable care.1 While disparities in cancer are often expressed in terms of mortality, comorbidities such as iron deficiency anemia (IDA) that can be caused by less comprehensive or less timely treatment of gastrointestinal malignancies also impact quality of life and may be considered as a metric of equitable care. Methods: Using data from the Healthcare Cost and Utilization Project (HCUP), total numbers of U.S. admissions with gastric cancer listed as primary diagnosis were recorded for each year between 1999-2014. The subset of these numbers with IDA listed as a secondary diagnosis were recorded to derive a prevalence of IDA within this gastric cancer population. The relative rate of African American and Hispanic IDA prevalence were compared to Caucasians for each year. Within each ethnic subset, cost, length of stay, and inpatient mortality were compared. Results: The relative rate of iron deficiency in gastric cancer for African Americans versus Caucasians was 1.745 and for Hispanics versus Caucasians was 1.665. Hospital cost by ethnic group: Caucasians $55,359, African Americans $62,020, Hispanics $83,914. Length of stay in days by ethnic group: Caucasians 9.13, African Americans 10.12, Hispanics 10.17. Inpatient mortality by ethnic group: Caucasians 4.51%, African Americans 4.02%, Hispanics 2.29%. All values were significant (p &lt; 0.05). Conclusions: African American and Hispanic populations are at increased risk of iron deficiency anemia in the setting of gastric cancer as compared to Caucasians. This was associated with increased cost and length of stay to a lesser degree. Surprisingly, Caucasians still demonstrated the highest mortality rate, followed by African Americans and Hispanics. This suggests that though ethnic disparities are still evident as of 2014 they may not accurately reflect mortality but still continue to impact morbidity. As this comorbidity impacts quality of life, it may be a target for future metrics or interventions.

The Continued Promise and Many Disappointments of Oncolytic Virotherapy in Gastrointestinal Malignancies.

Oncolytic virotherapy represents a novel therapeutic strategy in the treatment of gastrointestinal malignancies. Oncolytic viruses, including genetically engineered and naturally occurring viruses, can selectively replicate in and induce tumor cell apoptosis without harming normal tissues, thus offering a promising tool in the armamentarium for cancer therapy. While this approach has garnered much interest over the past several decades, there has not been significant headway across various tumor types. The recent approval of talimogene laherparepvec, a second-generation oncolytic herpes simplex virus type-1, for the treatment of metastatic melanoma, confirms the therapeutic potential of oncolytic viral therapy. Herein, we will highlight and review the role of oncolytic viral therapy in gastrointestinal malignancies while discussing its limitations and potential alternative mechanisms to improve its treatment efficacy.