Undergo Neoadjuvant Therapy Research Articles

Perioperative outcomes in patients who undergo neoadjuvant chemoradiotherapy versus chemotherapy versus up-front surgery in patients with oesophageal cancer.

Oesophagectomy is the mainstay of curative treatment for oesophageal cancer. The role of neoadjuvant therapy has evolved over time as evidence for its survival benefit comes to hand. Clinician reluctance to offer patients neoadjuvant therapy may be based on the perception that patients receiving treatment before surgery may be exposed to a greater risk of perioperative complications. The aim of this study was to examine short-term outcomes in patients who undergo neoadjuvant therapy versus up-front surgery in patients with oesophageal cancer. This was a retrospective cohort study of prospectively collated data from 2001 to 2020 of patients undergoing resection for oesophageal cancer. Patients who had neoadjuvant chemoradiotherapy, chemotherapy and up-front surgery were compared for perioperative morbidity (via the Clavien-Dindo classification), length of stay, unplanned readmission, and 30- and 90-day mortality. Logistic regression was performed to predict perioperative morbidity following surgery. In total, 284 patients underwent an oesophagectomy. Most patients received neoadjuvant treatment (41% received chemoradiotherapy (117/284), 33% received chemotherapy (93/284)), and 26% of patients received up-front surgery (74/284). Patients who received neoadjuvant chemoradiotherapy or up-front surgery were more likely to have a complication (57%, 67/117 and 57%, 43/74) than patients who received neoadjuvant chemotherapy only (38%, 35/93, P = 0.009). The 30- and 90-day mortality rates were 1.4% (n = 4) and 2.8% (n = 8), respectively, with no difference between the use of neoadjuvant therapy. In this series, we found that patients who received neoadjuvant treatment could undergo oesophagectomy with curative intent with acceptable postoperative morbidity and mortality.

Operative trends for pancreatic and hepatic malignancies during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic disrupted routine health care, including many elective and non-cancer operations in the United States. Most hepato-pancreato-biliary malignancy patients require outpatient imaging, tissue sampling, and staging, and many undergo neoadjuvant therapy before operative intervention. The aims of this study were to evaluate the effect of the COVID-19 pandemic on hepato-pancreato-biliary oncologic operations and to determine whether trends in neoadjuvant therapy were altered by the pandemic. MethodsAdult patients in the United States undergoing oncologic operations for pancreatic, primary and secondary hepatic malignancies, with or without neoadjuvant therapy, were extracted from the Vizient Clinical Data Base. Control chart analysis was used to plot trends over time and to determine whether changes were statistically significant. Wilcoxon rank-sum tests also compared monthly operative volume from pre-pandemic (12 month) and pandemic (28 months) periods. ResultsA total of 36,553 patients were identified over 40 months. Mean monthly pancreatic oncologic operations were unaffected by the pandemic (P = .257). Operations for pancreatic oncologic operations with prior neoadjuvant therapy increased throughout the pandemic (P = .002). Oncologic operations for primary and secondary hepatic malignancies were significantly reduced for 4 and 2 months, respectively, at the beginning of the pandemic but returned to their pre-pandemic baseline within 4 months (P = .169 and P = .598). ConclusionPancreatic operation volumes for cancer did not change, but pancreatic operations after neoadjuvant therapy continued to increase during the pandemic. Operations for hepatic malignancy were transiently disrupted but quickly normalized. These observations suggest that surgery for hepato-pancreato-biliary malignancies was prioritized during the pandemic.

The Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy: A Cross-Sectional Study

OBJECTIVES This study aimed to assess the Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy in Combined Military Hospital, Rawalpindi METHODOLOGY This prospective cross-sectional study was conducted at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi from January to June 2023. The sampling technique was non-probability sampling. A total of 56 female patients between the ages of 20-70 years with a histological diagnosis of carcinoma breast and undergoing mastectomy as part of their breast cancer therapy were included in the study. Patients who had metastatic cancer or connective tissue disorder were excluded from the study. After getting informed written consent, data was collected from patients. A semi-structured questionnaire was used as a study tool. Data was presented in the form of tables. RESULTSThe surgical preference of 56 patients was studied. Only 11(19.6%) patients opted for breast reconstruction. A total of 45(80.4%) patients refused to undergo BR. Several factors affecting the decision not to have BR were identified. They included fear of recurrence in 07 (15.5%) patients, long surgical procedures in 06 (13.3%), lack of concern regarding body image in 11(24.4%), financial issues in 13 (28.8%) patients, unsatisfactory results of breast reconstruction in 8 (17.7%) patients who had lack of trust in plastic surgeon regarding their post reconstruction breast shape. CONCLUSION This study laid the conceptual groundwork that factors like fear of recurrence, long surgical procedures, disregard for body image, poverty, and plastic surgeon distrust negatively influence the likelihood of having post-mastectomy breast reconstruction (PMBR). Methods: From January 2023 to June 2023, this cross-sectional study, carried out at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi, sought to explore surgical preferences for breast reconstruction (BR) among breast carcinoma patients undergoing mastectomy and to identify factors influencing these decisions. 42 patients in all were enrolled, 8 of them selected breast reconstruction while 34 did not. The decision-making process was influenced by a number of issues, such as worry about recurrence, worries about time-consuming surgical procedures, and disregard for body image, financial limitations, and previous unsuccessful reconstructive results. Results: 28 patients had right-sided disease, 13 had left-sided cancer, and 1 had bilateral involvement, according to disease features. Furthermore, 25 individuals had N0 disease, while 17 had N1 disease, according to nodal staging. Six patients had sentinel lymph node biopsy (SLNB), two underwent axillary lymph node dissection (ALND), five chose upfront surgery, and three underwent neoadjuvant therapy before surgery, demonstrating the range of the surgical methods used. Conclusion: This study provides insightful information about the complex decision-making process involving breast reconstruction in individuals with breast cancer. The identified characteristics give healthcare professionals a framework on which to build strategies that guarantee patients receive educated and individualized care, thereby improving patient happiness and quality of life in general. Key words: breast, tumor, surgery, lymph node, reconstruction, aesthetic

Comparative Effectiveness of Adjuvant Therapy on Survival in Patients With Metastatic Colorectal Cancer.

Postoperative survival outcomes are crucial in treatment decision making. This study aimed to compare the efficacy of adjuvant chemotherapy (AC)-alone with that of chemotherapy + targeted agents (CTA) in patients with metastatic colorectal cancer (mCRC) and to investigate the association between neoadjuvant therapy and survival. Patients who underwent primary tumor excision and metastasectomy were identified in the Taiwan Cancer Registry from 2010 to 2019. The analysis assessed the influence of adjuvant therapy on survival and examined the interactions between adjuvant therapy types (AC-alone and CTA) and patient characteristics with respect to overall survival. Overall, 1,728 and 757 patients received AC alone and CTA, respectively. Compared to AC alone, adjuvant CTA yielded similar mortality after surgery [hazard ratio (HR)=1.03; 95% confidence interval (CI)=0.91-1.17] but resulted in marginally reduced mortality among patients treated with neoadjuvant therapy with targeted agents (HR=0.6; 95%CI=0.34-1.05) after propensity score matching. In patients with mCRC, those who received targeted agents preoperatively and postoperatively in combination with AC had the highest mortality rate (HR=1.75; 95%CI=1.33-2.32). Overall survival is comparable between adjuvant CTA and AC alone, but adjuvant CTA may be more beneficial in patients with mCRC who undergo neoadjuvant therapy with targeted agents.

Different response of two primary neoplastic lesions to neoadjuvant therapy: a case report

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, which is mostly solitary in the pancreas. Surgery-based comprehensive treatment with adjuvant chemotherapy is the currently advanced treatment modality, neoadjuvant chemotherapy has achieved satisfactory results, however, due to the high heterogeneity of PDAC, its sensitivity to chemotherapy is also different. A 66-year-old man presented with discomfort in the upper abdomen and Computed Tomography (CT) scans revealed two tumor lesions in the head and tail of the pancreas, respectively. Endoscopic ultrasonoraphy guided fine needle aspiration (EUS-FNA) was performed to clarify the pathology and the patient was recommended to undergo neoadjuvant therapy. Through five courses of neoadjuvant chemotherapy, the two tumors showed different treatment effects, and after evaluation, total pancreatectomy and splenectomy were provided to patients.We report a case of the one patient presenting with two pancreatic cancer lesions, who demonstrated different therapeutic responses after receiving neoadjuvant chemotherapy due to the heterogeneity of PDAC.

CT Imaging Assessment of Pancreatic Adenocarcinoma Resectability after Neoadjuvant Therapy: Current Status and Perspective on the Use of Radiomics.

Pancreatic adenocarcinoma (PDAC) is the most common pancreatic cancer and is associated with poor prognosis, a high mortality rate, and a substantial number of healthy life years lost. Surgical resection is the primary treatment option for patients with resectable disease; however, only 10-20% of all patients with PDAC are eligible for resection at the time of diagnosis. In this context, neoadjuvant therapy has the potential to increase the number of patients who are eligible for resection, thereby improving the overall survival rate. For patients who undergo neoadjuvant therapy, computed tomography (CT) remains the primary imaging tool for assessing treatment response. Nevertheless, the interpretation of imaging findings in this context remains challenging, given the similarity between viable tumor and treatment-related changes following neoadjuvant therapy. In this review, following an overview of the various treatment options for PDAC according to its resectability status, we will describe the key challenges regarding CT-based evaluation of PDAC treatment response following neoadjuvant therapy, as well as summarize the literature on CT-based evaluation of PDAC treatment response, including the use of radiomics. Finally, we will outline key recommendations for the management of PDAC after neoadjuvant therapy, taking into consideration CT-based findings.

Tumor characteristics, therapy, and prognosis in young breast cancer patients ≤ 35years.

Young breast cancer patients aged 35years and younger are a small group of women who tend to present at high-risk form of the disease. More analysis of the data on tumor characteristics, treatment, and survival is necessary to help improving treatment and outcome. In this retrospective study, we compared the clinical and tumor characteristics, the treatments, and the survival of 257 women aged ≤ 35years, with 6566 women aged 50-69years. We used a registry-based data of patients with invasive, non-metastatic breast cancer diagnosed between 2000 and 2015. Young women showed lower rate of hormone receptor (HR) positivity. Their tumors were more often HER2-positive, which showed lower rate of differentiation and higher rate of Ki-67 expression compared to their older counterparts. Women aged 35years and younger were more likely to undergo neoadjuvant therapy and mastectomy. Endocrine therapy was underrepresented in young patients. 5-Year disease-free survival (DFS) was significantly lower in the younger patient group (81.7% vs. 91.3%, p < 0.001), while 5-year overall survival (OS) was not impaired (91.4% vs. 91.1%, p = 0.847). The unfavorable disease-free survival in the group of younger patients might be explained by their unfavorable tumor characteristics. The surgical treatment appears to be more aggressive in young breast cancer patients and is more frequently combined with chemotherapy and immunotherapy, either in a neoadjuvant or in an adjuvant setting.

Effectiveness of Adjuvant Therapy in Patients with Pancreatic Cancer Who Underwent Neoadjuvant Therapy.

Neoadjuvant therapy (NAT) is used to treat not only advanced pancreatic cancer but also resectable lesions. The present study investigated the effectiveness of postoperative adjuvant chemotherapy for patients with pancreatic cancer who underwent surgical resection after NAT. Patients who underwent macroscopically curative resection after NAT for pancreatic cancer were enrolled. Adjuvant chemotherapy was defined as at least 1 cycle of planned chemotherapy within 3 months after the date of surgery and included S-1, gemcitabine, or both. We retrospectively examined the effect of adjuvant chemotherapy on overall survival (OS) and recurrence-free survival (RFS) as a function of patients' clinicopathological factors. Ninety-seven patients were included in the study, of which 68 (70.1%) underwent adjuvant chemotherapy. Administration of adjuvant chemotherapy was significantly associated with prolonged OS and RFS in patients whose elevated levels of carbohydrate antigen 19-9 or duke pancreatic monoclonal antigen type-2 did not normalize after NAT. In patients with pathological lymph node metastasis, the administration of adjuvant chemotherapy was significantly associated with longer OS but did not improve PFS. Postoperative adjuvant chemotherapy was associated with prolonged postoperative survival in patients with pancreatic cancer who did not sufficiently respond to NAT as judged by tumor marker expression.

Adjuvant therapy following induction therapy and surgery improves survival in N2-positive non-small cell lung cancer.

The purpose of this study was to evaluate treatment strategies and factors influencing overall survival (OS) and disease-free survival (DFS) in resectable, non-small cell lung cancer (NSCLC) with mediastinal (N2) lymph node metastasis. All patients undergoing surgery for NSCLC with N2 disease between 2006 and 2016 were included. Treatment approaches included surgery only, neoadjuvant therapy followed by surgery, surgery followed by adjuvant therapy, and neoadjuvant therapy followed by surgery and adjuvant therapy (triple therapy). Patient clinical and pathologic data were retrospectively collected. A total of 281 patients were included in the study. In total, 209 patients had neoadjuvant therapy, 47.4% of which went on to received additional adjuvant therapy. The pathologic complete response rate was 12.9%. The treatment strategy which included triple therapy was isolated as a significant contributor to improved OS and DFS. Nodal downstaging (N0) after induction therapy conferred an OS benefit (38.3% vs. 15.6%, p = .03). Patients with single-station N2 disease experienced higher DFS. Video-assisted thoracic surgery (VATS) lobectomy completion rates were higher at the end of the study period compared to the beginning (p < .001). Patients who undergo neoadjuvant therapy for N2-positive NSCLC may benefit from additional adjuvant therapy. Single-station N2 disease confers higher DFS. VATS completion rates for lobectomy increase as experience increases.

Preoperative Scoring System to Predict Prognosis in Patients Who Undergo Neoadjuvant Therapy for Pancreatic Cancer.

This study investigated the feasibility of an integrated scoring system of preoperative prognostic parameters using data from before/after neoadjuvant therapy in patients with borderline resectable pancreatic cancer (BRPC). We constructed and analyzed a prognostic scoring system using factors that were previously reported to be significant prognostic indicators or predictors of histological response. We analyzed 28 consecutive patients with BRPC who underwent neoadjuvant therapy and subsequent surgical resection. Overall survival (OS) and recurrence free survival (RFS) were greater in patients with high scores (n=11) than in patients with low scores (n=17; log-rank test p=0.03/0.028). Pathological N0 status (p<0.05) and tumor cell destruction rate >50% (p<0.05) were found at a higher incidence among patients with high scores. OS and RFS can be predicted with an integrated scoring system that uses prognostic indices before/after neoadjuvant therapy for BRPC.

The intraprostatic immune balance after prostate SBRT in patients.

339 Background: Stereotactic Body Radiotherapy (SBRT) delivers high dose per fraction radiotherapy to targets with high precision. Such hypofractionated RT appears to act as an immune adjuvant, altering the tumor infiltrating immune landscape and enriching it for lymphocytes as numerous preclinical investigations would suggest. Based on this hypothesis, hundreds of ongoing trials listed in clinicaltrials.gov currently test the combination of RT (largely SBRT) with various immunotherapies. However, studies directly measuring the representation of infiltrating immune cells after SBRT in patients are few and far between and none exist in the context of prostate cancer. We therefore sought to interrogate the tumor-immune interface after prostate SBRT using fresh tissue in patients. Methods: Fresh prostate tissue from patients (N=10) enrolled in a clinical trial of prostate SBRT (three fractions of 8 Gy directed to the prostate and seminal vesicles) in the neoadjuvant setting two weeks prior to radical prostatectomy was subjected to multicolor flow cytometry and compared to that of Gleason Grade and T stage matched controls who did not undergo neoadjuvant therapy. Results: With a threshold of significance level of 0.05 for unadjusted p-values, using two-sided two-sample t-test, myeloid cells and particularly CD14+/hiCD16+DR+ intermediate monocytes/macrophages were enriched, while lymphocytes, including T cells and CD56+16− NK cells were decreased in SBRT-treated prostates as compared to unirradiated controls. Conclusions: The immune infiltrates in prostates two weeks after SBRT demonstrates a significant lymphoid to myeloid shift consistent with a tumor microenvironment after SBRT that is likely immunosuppressive beyond what can be targeted through the PD-1/L1 or CTLA-4 axis alone. This may have implications for the design of immunotherapy trials, especially in prostate cancer, that test SBRT in combination with immunotherapies.

Perioperative complication rates following neoadjuvant therapy in pancreatic adenocarcinoma.

688 Background: Whether upfront resection or total neoadjuvant therapy is superior for the treatment of potentially resectable pancreatic adenocarcinoma (PDAC) remains controversial. The impact of neoadjuvant treatment on major perioperative complication rates for patients (pts) undergoing resection for PDAC is commonly debated. We hypothesized that rates would be comparable among patients receiving neoadjuvant chemoradiation (neo-CRT), neoadjuvant chemotherapy alone (neo-CHT), or upfront surgery. Methods: This is a retrospective study of 208 pts with PDAC who underwent resection within a multidisciplinary pancreatico-biliary program at an academic tertiary referral center between 2011-2018. Data were abstracted from the medical record, an institutional cancer registry and NSQIP databases. Outcomes were assessed using χ2, Fisher’s exact test and two-tailed Student’s t-tests. Results: 208 pts were identified: 33 locally advanced, borderline or upfront resectable pts underwent neo-CRT, 35 borderline or resectable pts underwent neoadjuvant-CHT, and 140 resectable pts did not undergo neoadjuvant therapy. There were no statistically significant differences in major perioperative complication rates between groups. Overall rates were 36.4%, 34.3%, and 26.4% for pts who underwent neo-CRT, neo-CHT alone, or upfront resection, respectively (p = 0.38). No significant difference were observed in complication rates (35.3% v. 26.4%; p = 0.19) or median hospital length of stay (10 days v. 10 days; p = 0.87) in pts who received any neoadjuvant therapy versus upfront resection. There were two perioperative deaths in the neo-CRT group (6.1%), zero in the neo-CHT group, and four in the upfront resection group (2.9%); p = 0.22. Conclusions: There were no significant differences in major perioperative complication rates, hospital length of stay, or post-operative mortality in pts who underwent neoadjuvant therapy (neo-CRT or neo-CHT alone) versus upfront surgery. Notably, neo-CRT had comparable perioperative complication rates to neo-CHT alone, which suggests neoadjuvant radiation therapy may not pose additional surgical risk.

Clinical and pathological characteristics of patients with overexpressed her 2 breast cancer in the national cohort study – Amazona III

Introduction: HER2 overexpressed breast cancer (+) is observed at around 15-20%. The introduction of target therapies in this subtype changed the prognosis of these patients, improving mortality and reducing surgical morbidity when neoadjuvant therapy allows downstaging of breast and axillary surgery. A recent publication with 1,310 samples from Brazilian patients described 20% of HER-2 + tumors. There are few epidemiological studies evaluating patients in our population. The Amazona III study evaluated the epidemiology of breast cancer in a sample of the Brazilian population including 2,950 patients from 23 Brazilian hospitals, completed in 2018. Objective: To characterize the frequency of positive HER-2 breast cancer in patients in the Amazona III study and its clinical characteristics. Method: Prospective, multicenter cohort study. All female patients with invasive breast cancer over 18 years of age included in the Amazona III Project were considered eligible. Immunohistochemical determination was made according to the pathology laboratory of each center. Results: Of the 2,950 study participants, 643 (21%) were HER2 +, 71% from the Unified Health System (SUS) and 28.9% from the complementary system. Most had grade 2 (52.6%) or 3 (36.4%), were post-menopausal (53%), positive estrogen receptor (71.9%), and did not undergo neoadjuvant therapy (52%). As for the number of lymph nodes, 45% were positive lymph nodes, with cN1 (27%), cN2 (12%), and cN3 (5%). 49% had positive lymph nodes in SUS and 37% in the private system. The rate of conservative breast surgery was similar in both groups, being around 46%. Conclusion: The prevalence of HER-2 + in patients included in the Amazona Study III (current epidemiological study of breast cancer in Brazil) is compatible with data from the literature. The prevalence of positive lymph node at diagnosis is high, especially in SUS (49%), therefore the impact of access to therapies that increase the chance of increasing overall survival, decreasing invasive recurrence, and decreasing surgical morbidity must be evaluated.

The Utility of EUS-FNA to Determine Surgical Candidacy in Patients with Pancreatic Cancer after Neoadjuvant Therapy

BackgroundIn patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who undergo neoadjuvant therapy, CT imaging is the standard of care for restaging. However, differentiating residual tumor from post-treatment inflammation with CT is unreliable. The diagnosis of periarterial soft tissue cuffing (PSTC) near major vessels is key to guiding resectability. The goal of this study was to assess the utility of EUS-FNA in determining the etiology of PSTC in BRPC or LAPC after neoadjuvant treatment. MethodsWe performed a retrospective analysis of patients referred for EUS-FNA of PSTC following downstaging therapy for LAPC or BRPC at our tertiary medical center. Negative EUS-FNA cytology results were compared with surgical pathology after resection. Patients with positive EUS-FNA cytology results were either followed clinically or results were compared to surgical pathology if surgery was attempted despite the positive cytology. ResultsFourteen patients were included in the study of whom four had positive cytology. Two of these patients had progression of disease, and two had attempted resection with positive surgical pathology (100% true positives). All ten patients with negative cytology underwent attempted surgical resection. Nine patients (90%) achieved negative margins, and one patient (10%) had a positive surgical margin. The sensitivity, specificity, and accuracy of EUS-FNA for determining resectability were 80%, 100%, and 92.9%, respectively. ConclusionsIn this series of patients with BRPC or LAPC and persistent PSTC after downstaging neoadjuvant treatment, EUS-FNA accurately determined surgical resectability and should be considered as part of the evaluation of such patients.

Frozen Sections of Sentinel Lymph Nodes From Breast Cancer Patients Who Undergo Neoadjuvant Therapy Are Accurately Diagnosed Using Telepathology

Abstract Objectives Telepathology enables histologic diagnosis to be made from a scanned slide visualized on a computer. Frozen sections (FSs) can be performed at remote locations and read by a pathologist at a central site. At our institution, qualifying breast cancer patients are enrolled in clinical trials that require FS on sentinel lymph nodes (SLNs) after neoadjuvant therapy (NAT), including chemotherapy or endocrine therapy. In this setting, histology is complicated by treatment effect and biopsy site changes. Others have reported good accuracy of FSs on SLNs after NAT. We investigated whether pathologists are accurate in diagnosing SLN FSs for such cases while using telepathology. To our knowledge, this has not been reported previously. Methods SLNs were entirely submitted and serially sectioned (2-mm thickness). At least two levels were cut. All FSs were submitted for formalin-fixed, paraffin-embedded permanent sections. A pathology assistant at the remote location prepared the FSs and scanned slides using the VisionTek M6 digital microscope ecosystem (East Dundee, IL). Cases were interpreted by board-certified pathologists who completed training on the VisionTek system. For this study, diagnoses from FSs and permanents were compared. Results Forty-five SLNs from 19 breast neoadjuvant cases were read by VisionTek from March 2017 to January 2019. Forty-three cases (96%) called negative by FSs were confirmed negative (on permanents). One hundred percent called positive by FSs were positive. Four SLN called atypical on FSs were positive. Three of these were neoadjuvant endocrine cases for invasive lobular carcinoma. Two cases called atypical were negative. One of these, called atypical/suspicious, resulted in axillary dissection. This case was reviewed by three pathologists at the time of surgery. It had abundant treatment effect, mimicking carcinoma. Conclusion While pitfalls exist, overall, the diagnostic accuracy of frozen section analysis by telepathology of SLNs from breast cases after neoadjuvant therapy is high.

MRI Evaluation of the Response of Rectal Cancer to Neoadjuvant Chemoradiation Therapy.

MRI plays a critical role in the staging and restaging of rectal cancer. Although newly diagnosed early-stage rectal cancers may immediately be amenable to surgical resection, patients with advanced disease first undergo neoadjuvant therapy that consists of a combination of chemotherapy and radiation therapy. Evaluation of rectal cancer after neoadjuvant therapy is best performed with MRI, given its superior soft-tissue contrast and its ability to allow multiplanar imaging and functional evaluation. In this setting, MRI allows accurate evaluation of primary tumor staging, which is determined on the basis of the depth of invasion within and through the rectal wall and the involvement of adjacent organs. MRI can also be used to evaluate posttreatment morphologic components within the tumors, including fibrosis and mucinous changes that have been shown to correlate with the response to treatment. Additional features such as the circumferential resection margin and extramural vascular invasion-factors shown to affect prognosis and local recurrence-are also assessed before and after therapy. Functional assessment with diffusion-weighted MRI and perfusion MRI plays a role in predicting tumor aggressiveness and the likelihood of response to treatment, as well as the extent of residual tumor after therapy. Lymph node staging is also performed at MRI, with assessment of not only lymph node size but also the internal architecture and signal intensity characteristics. ©RSNA, 2019 See discussion on this article by Wasnik and Al-Hawary .

Neoadjuvant Sunitinib Decreases Inferior Vena Caval Thrombus Size and Is Associated With Improved Oncologic Outcomes: A Multicenter Comparative Analysis.

We analyzed outcomes of neoadjuvant sunitinib in patients with renal-cell carcinoma (RCC) and inferior vena caval (IVC) tumor and compared outcomes to patients who did not undergo neoadjuvant therapy before surgery. We performed a multicenter retrospective comparison of RCC patients with IVC tumor who underwent neoadjuvant sunitinib before surgery versus those who did not. Response to sunitinib was defined by Response Evaluation Criteria in Solid Tumors (RECIST). Primary outcome was cancer-specific survival. Secondary outcomes included overall survival. Multivariate analysis was performed to identify risk factors associated with primary and secondary outcomes. Kaplan-Meier analysis compared survival in neoadjuvant and primary surgery groups. Data of 53 patients were analyzed (19 neoadjuvant sunitinib, 34 primary surgery; median follow-up, 58 months). Eighteen (9 in each group, P= .143) had metastatic RCC. There was no difference in IVC tumor level between the 2 groups (P= .76). After neoadjuvant sunitinib, median primary tumor decreased size from 8.1 to 6.8 cm, and IVC tumor decreased by 1.3 cm. IVC tumor level decreased in 8 (42.1%) of 19 and was stable in 10 (52.6%) of 19; 5 (26.3%) of 19 experienced partial response. Similar proportions of patients underwent robot-assisted or minimally invasive approaches (P= .351), and no differences were noted in complications (P= .194). Multivariate analysis showed neoadjuvant sunitinib was associated with improved cancer-specific survival (odds ratio= 3.28; P= .021). Kaplan-Meier analysis demonstrated significantly longer median cancer-specific survival (72 vs. 38 months, P= .023) for neoadjuvant sunitinib. Neoadjuvant sunitinib was associated with a reduction in primary tumor and thrombus size as well as improved survival. Further investigation is needed to determine the utility of neoadjuvant sunitinib in RCC with IVC tumor.

Does ERCP Before Resection Worsen Survival in Patients with Pancreatic Cancer

Although a small subset of patients with potentially resectable pancreatic cancer proceed directly to surgery, most undergo neoadjuvant therapy first.

Association of Modified-FOLFIRINOX-Regimen-Based Neoadjuvant Therapy with Outcomes of Locally Advanced Pancreatic Cancer in Chinese Population.

Lessons Learned. Modification of FOLFIRINOX significantly improves safety and tolerability in Chinese patients with locally advanced pancreatic cancer.Patients with locally advanced pancreatic cancer benefit from neoadjuvant therapy and experience a much better survival than patients with upfront surgery.Background.The objective of this study was to evaluate the efficacy of modified‐FOLFIRINOX (mFOLFIRINOX) regimens in Chinese patients with locally advanced pancreatic cancer (LAPC) and to compare outcomes between patients with LAPC treated with mFOLFIRINOX‐based neoadjuvant therapy (LAPC‐N) and patients with LAPC who underwent upfront surgery (LAPC‐S).Methods.Forty‐one patients with LAPC‐N were enrolled prospectively. Imaging features, chemotherapy response, adverse events, perioperative complications, histology, and survival were analyzed. Seventy‐four patients with resectable pancreatic cancer (RPC) (from April 2012 to November 2017) and 19 patients with LAPC‐S (from April 2012 to March 2014) were set as observational cohorts, and data were collected retrospectively. LAPC‐N patients with adequate response underwent surgical treatment, whereas continuous chemotherapy was given to LAPC‐N patients who were not deemed resectable after treatment, and the response was re‐evaluated every 2 months.Results.Forty‐one patients with LAPC received mFOLFIRINOX with a response rate of 37.1%. The most common severe adverse events were neutropenia and anemia. mFOLFIRINOX‐based neoadjuvant therapy contributed to a remarkable decrease in CA19‐9 level and tumor diameter. Fourteen LAPC‐N patients underwent surgery (LAPC‐N‐S) after downstaging. Compared with LAPC‐N‐S cases, LAPC‐S patients had longer operative time, more blood loss, and a higher risk of grade 5 complications. The median overall survival (OS) and progression‐free survival (PFS) of LAPC‐N‐S patients were 27.7 months and 19.3 months, respectively, which were similar to those of patients with RPC (30.0 months and 23.0 months) and much longer than those of patients with LAPC‐S (8.9 months and 7.6 months), respectively.Conclusion.Neoadjuvant chemotherapy such as the mFOLFIRINOX regimen can be recommended for Chinese patients with LAPC after dose modification. Patients with LAPC‐N who underwent surgery obtained significantly improved survival compared with patients in the observational LAPC‐S cohort, who did not undergo neoadjuvant therapy.

PS02.189: A STUDY ON PRETREATMENT NUTRITIONAL SCORE OF ESOPHAGEAL CANCER PATIENTS WHO UNDERWENT PREOPERATIVE TREATMENT

Abstract Background Esophageal cancer tends to be malnourished due to anorexia, transit disorder, so it is important to conduct sufficient nutritional assessment and treatment. For standard treatment of neoadjuvant chemotherapy for esophageal cancer, Cisplatin + 5-fluorouracil (FP) therapy is common, but sufficient therapeutic effect has not been obtained. As a more powerful regimen, DCF therapy with Docetaxel added to FP therapy and chemoradiotherapy have been introduced. In this study, we examined pretreatment nutritional score of esophageal cancer patients who underwent neoadjuvant therapy. Methods We studied 105 patients undergoing preoperative treatment diagnosed as esophageal cancer or esophagogastric junctional carcinoma from July 2012 to August 2017. Esophagectomy with lymph node dissection after neoadjuvant therapy. Relationship between Glassgow Prognostic Score (GPS) and Controlling Nutrition Status Score (CONUT) score, sex, age, staging, main tumor location, adverse event, postoperative complication and tube feeding nutrition are examined. Results Median age was 66 years, male/female = 92/13, and cases requiring tube feeding were 29 cases. The breakdown of the clinical stage is Stage IA, B/IIA, B/IIIA, B, C/IV = 9/34/50/12. The breakdown of neoadjuvant therapy is FP/DCF/FPRT/DCFRT/other = 9/27/26/39/4. The incidences of grade 3/4 adverse events during preoperative treatment were 66 cases (63%) in 105 patients. The treatment effect is CR/PR/SD/PD = 6/41/50/8. Histopathological result is Grade 0/1a/1b/2/3 = 3/52/13/6/31. Postoperative complications were Clavien-Dindo classification Grade IIIa or more in 20 cases, in-hospital death was 1 case.CONUT score was judged to be cut-off by more than 2, there was a significant relationship between presence of tube nutrition and treatment result (P = 0.0376, 0.0231). GPS was judged to be 1 or more cutoff, there was a significant association with tube nutrition availability and histopathological result (P = 0.0019, 0.0083). There was no significant difference between occurrence of adverse events and occurrence of postoperative complications. Conclusion It was suggested that CONUTscore and GPS at hospitalization are useful as predictors of treatment result and histopathological result in esophageal cancer patients who undergo neoadjuvant therapy. Disclosure All authors have declared no conflicts of interest.