Steven Seyedin, Pin-Chieh Wang, Quan Zhang, Percy Lee
Background: Despite results of the Intergroup 0116 (INT-0116) study showing an overall survival benefit of adjuvant chemoradiotherapy in gastric adenocarcinoma, its use in the United States remains controversial. The Surveillance Epidemiology of End Results (SEER) database was used to compare cause-specific survival outcomes in resected gastric adenocarcinoma with various adjuvant therapies and patterns of care.
Methods: Individual data from 1988 to 2008 were selected for patients with resected, nonmetastatic gastric adenocarcinoma. These patients were stratified by stage (American Joint Committee on Cancer [AJCC], 6th edition), as well as treatment modalities (surgery alone, S; surgery followed by radiotherapy, SR; surgery with chemotherapy, SC; surgery followed by radiotherapy with chemotherapy, SRC; and radiotherapy followed by surgery with chemotherapy, RSC). Overall 21,472 patients (8335 stages IA and 1B; 5944 stage II, 4594 stage III, and 2599 stage IV) were included in this study.
Results: The median age of the cohort was 66 years, with 63.0% male and 66.4% white. The median number of lymph nodes examined was 17.6. Median survival by stage was 96 months for stage I, 30 months for stage II, 20 months for stage III, and 14 months for stage IV. Using the SRC group as the reference group, for stage I patients, S had the most favorable cause-specific survival (hazard ratio [HR], 0.67; confidence interval, [CI] 0.60-0.76). For patients with stage II, III, or IV, those treated with SRC had the best outcome compared with the other treatment modalities. After 1999, the number of patients treated with surgery alone decreased by at least 14%, whereas the number treated with SRC increased by approximately 12%.
Conclusions: This large SEER database analysis showed that stage I patients benefited most from surgery alone, whereas those at more advanced stages benefited most from adjuvant radiotherapy with chemotherapy. This result is consistent with INT-0116 for gastric adenocarcinoma in support of trimodality therapy and is reflected by the increased fraction of patients receiving chemotherapy and adjuvant radiation.
{"title":"Benefit of Adjuvant Chemoradiotherapy for Gastric Adenocarcinoma: A SEER Population Analysis.","authors":"Steven Seyedin, Pin-Chieh Wang, Quan Zhang, Percy Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite results of the Intergroup 0116 (INT-0116) study showing an overall survival benefit of adjuvant chemoradiotherapy in gastric adenocarcinoma, its use in the United States remains controversial. The Surveillance Epidemiology of End Results (SEER) database was used to compare cause-specific survival outcomes in resected gastric adenocarcinoma with various adjuvant therapies and patterns of care.</p><p><strong>Methods: </strong>Individual data from 1988 to 2008 were selected for patients with resected, nonmetastatic gastric adenocarcinoma. These patients were stratified by stage (American Joint Committee on Cancer [AJCC], 6th edition), as well as treatment modalities (surgery alone, S; surgery followed by radiotherapy, SR; surgery with chemotherapy, SC; surgery followed by radiotherapy with chemotherapy, SRC; and radiotherapy followed by surgery with chemotherapy, RSC). Overall 21,472 patients (8335 stages IA and 1B; 5944 stage II, 4594 stage III, and 2599 stage IV) were included in this study.</p><p><strong>Results: </strong>The median age of the cohort was 66 years, with 63.0% male and 66.4% white. The median number of lymph nodes examined was 17.6. Median survival by stage was 96 months for stage I, 30 months for stage II, 20 months for stage III, and 14 months for stage IV. Using the SRC group as the reference group, for stage I patients, S had the most favorable cause-specific survival (hazard ratio [HR], 0.67; confidence interval, [CI] 0.60-0.76). For patients with stage II, III, or IV, those treated with SRC had the best outcome compared with the other treatment modalities. After 1999, the number of patients treated with surgery alone decreased by at least 14%, whereas the number treated with SRC increased by approximately 12%.</p><p><strong>Conclusions: </strong>This large SEER database analysis showed that stage I patients benefited most from surgery alone, whereas those at more advanced stages benefited most from adjuvant radiotherapy with chemotherapy. This result is consistent with INT-0116 for gastric adenocarcinoma in support of trimodality therapy and is reflected by the increased fraction of patients receiving chemotherapy and adjuvant radiation.</p>","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"82-90"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171970/pdf/gcr82.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32714288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Santhosh Sadashiv, Georgios Deftereos, Eli Pakravan, Jan F Silverman, Shifeng Mao
{"title":"Benign schwannoma masquerading as a malignant metastatic lesion in a patient with renal cell carcinoma.","authors":"Santhosh Sadashiv, Georgios Deftereos, Eli Pakravan, Jan F Silverman, Shifeng Mao","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"123-5"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171972/pdf/gcr123.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32713678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyunki Kim, Kimberly S Keene, David B Sarver, S Kyle Lee, T Mark Beasley, Desiree E Morgan, James A Posey
Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) are often used to detect the early response of solid tumors to an effective therapy. The early changes in intratumoral physiological parameters measured by DCE-MRI/DWI have been evaluated as surrogate biomarkers allowing a tailored treatment for the individual patient.
Methods: Patients with newly diagnosed, biopsy-proven, treatment-naïve gastrointestinal stromal tumor (GIST) or hepatocellular carcinoma (HCC) were enrolled prospectively after institutional review board (IRB)-approved informed consent (5 patients per tumor type). Patients with GIST were treated with sunitinib over 6 weeks. DCE-MRI/DWI was applied before therapy (baseline imaging) and at 2 and 6 weeks after therapy initiation. Patients with HCC were treated with radiation during the first 2 weeks and then with sorafenib for the next 6 weeks. DCE-MRI/DWI was applied in all patients with HCC before and after radiation therapy and at the end of sorafenib therapy. Tumor volume, perfusion parameters (K (trans), the forward volume-transfer constant, and k ep, the reverse reflux-rate constant) and the apparent diffusion coefficient (ADC) were measured.
Results: During 2 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 32 ± 13, 45 ± 24, and 42 ± 15%, respectively, whereas ADC increased 76 ± 24%. After 6 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 56 ± 7, 70 ± 7, and 50 ± 12%, respectively, whereas ADC increased 85 ± 33%. After completion of radiation therapy, HCC volume, K (trans), and k ep decreased 34 ± 14, 35 ± 12, and 4 ± 21%, respectively, but ADC increased 21 ± 9%. During the entire 10-week therapeutic period, HCC volume, K (trans), and k ep decreased 65 ± 15, 40 ± 9, and 26 ± 2%, respectively, whereas ADC increased 28 ± 10%.
Conclusion: DCE-MRI/DWI can measure the perfusion and diffusion changes in GISTs or HCCs treated with multikinase inhibitors.
{"title":"Quantitative perfusion- and diffusion-weighted magnetic resonance imaging of gastrointestinal cancers treated with multikinase inhibitors: a pilot study.","authors":"Hyunki Kim, Kimberly S Keene, David B Sarver, S Kyle Lee, T Mark Beasley, Desiree E Morgan, James A Posey","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) are often used to detect the early response of solid tumors to an effective therapy. The early changes in intratumoral physiological parameters measured by DCE-MRI/DWI have been evaluated as surrogate biomarkers allowing a tailored treatment for the individual patient.</p><p><strong>Methods: </strong>Patients with newly diagnosed, biopsy-proven, treatment-naïve gastrointestinal stromal tumor (GIST) or hepatocellular carcinoma (HCC) were enrolled prospectively after institutional review board (IRB)-approved informed consent (5 patients per tumor type). Patients with GIST were treated with sunitinib over 6 weeks. DCE-MRI/DWI was applied before therapy (baseline imaging) and at 2 and 6 weeks after therapy initiation. Patients with HCC were treated with radiation during the first 2 weeks and then with sorafenib for the next 6 weeks. DCE-MRI/DWI was applied in all patients with HCC before and after radiation therapy and at the end of sorafenib therapy. Tumor volume, perfusion parameters (K (trans), the forward volume-transfer constant, and k ep, the reverse reflux-rate constant) and the apparent diffusion coefficient (ADC) were measured.</p><p><strong>Results: </strong>During 2 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 32 ± 13, 45 ± 24, and 42 ± 15%, respectively, whereas ADC increased 76 ± 24%. After 6 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 56 ± 7, 70 ± 7, and 50 ± 12%, respectively, whereas ADC increased 85 ± 33%. After completion of radiation therapy, HCC volume, K (trans), and k ep decreased 34 ± 14, 35 ± 12, and 4 ± 21%, respectively, but ADC increased 21 ± 9%. During the entire 10-week therapeutic period, HCC volume, K (trans), and k ep decreased 65 ± 15, 40 ± 9, and 26 ± 2%, respectively, whereas ADC increased 28 ± 10%.</p><p><strong>Conclusion: </strong>DCE-MRI/DWI can measure the perfusion and diffusion changes in GISTs or HCCs treated with multikinase inhibitors.</p>","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"75-81"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171969/pdf/gcr75.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32714287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ghaith Abu-Zeinah, Dwight Owen, Carlos Prieto-Granada, Natasha Rekhtman, David Klimstra, Dipti Gupta, James Harding, Ghassan K Abou-Alfa
{"title":"From the liver to the foot: a case of systemic embolism and acrometastasis in hepatocellular carcinoma.","authors":"Ghaith Abu-Zeinah, Dwight Owen, Carlos Prieto-Granada, Natasha Rekhtman, David Klimstra, Dipti Gupta, James Harding, Ghassan K Abou-Alfa","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"103-7"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171976/pdf/gcr103.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32713673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Metastatic breast cancer masquerading as primary gastric cancer: case report and review of the literature.","authors":"Alexander C Black, Danielle Lu, Susan Murakami","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"117-8"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171973/pdf/gcr117.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32713676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renée M Marchioni Beery, Thomas J Devers, Jessica M Clement
{"title":"A case of primary colonic small-cell carcinoma arising in a patient with long-standing ulcerative colitis.","authors":"Renée M Marchioni Beery, Thomas J Devers, Jessica M Clement","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"119-22"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171971/pdf/gcr119.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32713677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renata D'Alpino Peixoto, Sheridan Wilson, David F Schaeffer, Howard J Lim
{"title":"Pseudomyxoma peritonei metastatic to the bone: case report and review of systemic management.","authors":"Renata D'Alpino Peixoto, Sheridan Wilson, David F Schaeffer, Howard J Lim","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"108-10"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171977/pdf/gcr108.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32713674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maen W H Kamal, Maham Farshidpour, Andrew W Long, Saleem Farooqui, Steven C Cunningham
{"title":"Hepatocellular Carcinoma With Intra-atrial Extension Responding to Transarterial Chemoembolization via the Right Hepatic and Right Inferior Phrenic Arteries.","authors":"Maen W H Kamal, Maham Farshidpour, Andrew W Long, Saleem Farooqui, Steven C Cunningham","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"111-6"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171979/pdf/gcr111.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32713675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali A Haydar, Deborah Mukherji, Walid Faraj, Mohammad Khalifeh, Bedros Taslakian, Zeinab Abou Yehia, Sally Temraz, Karen T Brown, Ghassan K Abou-Alfa, Ali Shamseddine
Background: The combination of systemic antiangiogenic therapy and transarterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) is the subject of several ongoing clinical trials. We present a series of patients treated with sorafenib and TACE at our institution, highlighting the technical challenges of combining these two modalities of treatment.
Methods: We retrospectively identified patients with HCC treated with TACE and sorafenib at our institution.
Results: Five patients were treated with the combination of TACE and sorafenib given off-protocol based on preliminary reports in the literature. The first four patients started sorafenib 7 days prior to TACE resulting in intratumoral vascular pruning and poor visualization of lesions on angiography. This was managed by either superselective angiography or lobar TACE. The fifth patient stopped sorafenib 7 days prior to TACE with full visualization of multiple hypervascular lesions on angiography prior to embolization.
Conclusions: Our observations suggest that the biologically preferable strategy of continuous antiangiogenic therapy should be weighed against the possibility of suboptimal TACE due to poor visualization of lesions on angiography and safety.
{"title":"Challenges in combining antiangiogenic therapy with transarterial chemoembolization for hepatocellular carcinoma.","authors":"Ali A Haydar, Deborah Mukherji, Walid Faraj, Mohammad Khalifeh, Bedros Taslakian, Zeinab Abou Yehia, Sally Temraz, Karen T Brown, Ghassan K Abou-Alfa, Ali Shamseddine","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The combination of systemic antiangiogenic therapy and transarterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) is the subject of several ongoing clinical trials. We present a series of patients treated with sorafenib and TACE at our institution, highlighting the technical challenges of combining these two modalities of treatment.</p><p><strong>Methods: </strong>We retrospectively identified patients with HCC treated with TACE and sorafenib at our institution.</p><p><strong>Results: </strong>Five patients were treated with the combination of TACE and sorafenib given off-protocol based on preliminary reports in the literature. The first four patients started sorafenib 7 days prior to TACE resulting in intratumoral vascular pruning and poor visualization of lesions on angiography. This was managed by either superselective angiography or lobar TACE. The fifth patient stopped sorafenib 7 days prior to TACE with full visualization of multiple hypervascular lesions on angiography prior to embolization.</p><p><strong>Conclusions: </strong>Our observations suggest that the biologically preferable strategy of continuous antiangiogenic therapy should be weighed against the possibility of suboptimal TACE due to poor visualization of lesions on angiography and safety.</p>","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"98-102"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171975/pdf/gcr98.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32714290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evelyn Brosnan, Kabir Mody, Richard A Zuckerman, Kathryn L Ruoff, J Marc Pipas
{"title":"Multiorgan Streptococcus milleri Abscesses During FOLFIRINOX Chemotherapy in a Patient With Metastatic Pancreatic Cancer.","authors":"Evelyn Brosnan, Kabir Mody, Richard A Zuckerman, Kathryn L Ruoff, J Marc Pipas","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":"7 3-4","pages":"126-8"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171978/pdf/gcr126.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32713679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}