- Email: [email protected]
P14 Retrospective series of 22 cases with small bowel adenocarcinoma and review of the literature
Other Cancers
European Journal of Cancer 50, suppl. 1 (2014) S9–S15
were included. Their medical charts were retrospectively reviewed. The median radiation dose was 5040 cGy with concurrent chemotherapy. By logistic regression analysis, risk factors of lymph node metastasis were identified. Results: The rate of lymph node metastasis was 12.8% (90/705). In univariate analysis, the risk factors of lymph node metastasis were tumor size after treatment, perineural invasion, venous invasion, angiolymphatic invasion and ypT classification. Angiolymphatic invasion and ypT2 were independent risk factors of lymph node metastasis (Odds ratio [OR] = 4.888, 95% confidence interval [CI] = 2.512–9.511, p-value <0.0001; ypT1 vs. ypT0is: OR = 1.192, 95% CI = 0.457–3.113, p-value = 0.720; ypT2 vs. ypT0-is: OR = 2.079, 95% CI = 1.058–4.085, p-value = 0.034, respectively). Conclusion: Angiolymphatic invasion and ypT classification (ypT2) were the risk factors of lymph node metastasis in rectal cancer patients with good responses following preoperative CRT. In rectal cancer patients without these risk factors, local excision may be an alternative treatment option after preoperative CRT. Reference(s) [1] Bhangu A, Brown G, Nicholls RJ, et al. Survival outcome of local excision versus radical resection of colon or rectal carcinoma: a Surveillance, Epidemiology, and End Results (SEER) population-based study. Ann Surg 2013;258:563−9. [2] Pucciarelli S, De Paoli A, Guerrieri M, et al. Local Excision After Preoperative Chemoradiotherapy for Rectal Cancer: Results of a Multicenter Phase II Clinical Trial. Dis Colon Rectum 2013;56:1349−56. Conflict of interests: No conflict of interests
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and total cholesterol levels were significant better in SL. As a conclusion, SL method is safety for complications after PD. Strategy 2: To improve the prognosis of advanced pancreas cancer case, phase II study of pre-operative chemo (TS-1 80 mg/day)-radiation (39.6 Gy) therapy has been performed for 20 cases. Even if vessel-invasion pancreas cancer, pre-operative chemo-radiation was demonstrated to lead a satisfactory outcome for patient prognosis. Strategy 3: To develop a novel therapy, the experimental results for molecular targeting study will be shown. Extra-cellular signal-regulated kinase (ERK) is well known to represent a convergent point for the intracellular signaling pathways in whole cancer cells. In the present, by reviewing our recent studies that evaluate the usefulness of the vitamin K3 (menadione, 2-methyl-1,4naphthoquinone; VK3)-induced growth inhibitory effect through ERK pathway, this novel approach to cancer therapy and its potential in future clinical applications will be highlighted. Reference(s) [1] Osada S, et al: A modified reconstruction method to prevent critical complications after pancreatoduodenectomy. Hepatogastroenterology, 53: 296–300, 2006. [2] Osada S, et al: Extracellular signal-regulated kinase phosphorylation due to menadione-induced arylation mediates growth inhibition of pancreas cancer cells. Cancer Chemotherapy and Pharmacology, 63: 315–320, 2008. [3] Osada S, et al: The best choice to achieve zero complications after pancreatoduodenectomy. Surgical Science, 2: 45−51, 2011. Conflict of interests: No conflict of interests
P12 SCIENTIFIC POSTER ABSTRACT Colorectal cancer in Morocco: a retrospective study A. Ayoujil1 , H. Hami1 , F. Habib2 , A. Soulaymani1 , A. Mokhtari1 , A. Quyou1 . 1 Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco, 2 Al Azhar Oncology Center, Rabat, Morocco Goals: Colorectal cancer is a major cause of morbidity and mortality in Northern Africa, accounting for 5.8% of all cancers. It is the fifth most common diagnosed cancer and the fourth leading cause of cancer-related death in both men and women, with about 12 891 new cases of colorectal cancer and 8,296 cancer deaths in 2012 (GLOBOCAN 2012). The aim of this study is to determine the epidemiological profile of colorectal cancer in Morocco. Methods: This is a retrospective study of colorectal cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 1994 and 2004. Results: During 1994–2004, 433 cases were diagnosed with colorectal cancer at Al Azhar Oncology Center (51.3% of cases in the rectum and 48.7% in the colon); 54% in men and 46% in women, giving a male-female ratio of 1.17 and accounting for 49.6% of all new cases of gastrointestinal cancer reported during this period. The average age at diagnosis was 54.2±13.6 years. The risk of developing the disease is strongly related to age with 7.7% of cases diagnosed in patients younger than 35 years, 81.3% in those aged 35−69 years and 11% in those aged 70 years and over. Among all detected cases, 8.5% were diagnosed with metastatic disease and 17.6% died during the study period, accounting for 38.8% of all gastrointestinal cancer deaths. Conclusion: Colorectal cancer is a major public health problem. Early detection in order to improve colorectal cancer outcome and survival remains the cornerstone of colorectal cancer control in Morocco. Conflict of interests: No conflict of interests
Other Cancers P13 SCIENTIFIC POSTER ABSTRACT Novel strategies for advanced pancreas cancer S. Osada1 , H. Imai1 , Y. Sasaki1 , K. Yoshida1 . 1 Dept of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan To estimate novel and potentially less toxic forms of pancreas cancer therapy, the developed three types of strategies will be demonstrated here. Strategy 1: To reduce postoperative complications, the new and original reconstruction procedure after pancreatoduodenectomy (PD) will be described to evaluate for its usefulness. As surgical Technique, the jejunum is made for an end-to-side choledochojejunostomy, and the cut proximal jejunum for approximately 20 cm was led to the pancreatic stump for end-to-end anastomosis with telescoping. Approximately 20 cm of jejunum was created with a side-to-end anastomosis with the stomach, and end-to-side jejunojejunostomy for Roux-en-Y reconstruction. And then, as post-operative course, this separated loop method (SL, n = 38) was evaluated by comparing pancreatogastrostomy (PG, n = 31) and Imanaga method (IM, n = 26). On SL, PG and IM cases, the high amylase level in drainage fluid was noted in 2.6%, 6.5% and 19.2%, respectively. The delayed gastric emptying was seen in PG and IM, but not in SL. Serum albumin levels were similar, but cholinesterase
P14 SCIENTIFIC POSTER ABSTRACT Retrospective series of 22 cases with small bowel adenocarcinoma and review of the literature M. Sagmeister1 , J. Bridgewater2 , D. Hochhauser2 . 1 Foundation Doctor, North Central London Foundation School, London, UK , 2 Cancer Services, University College Hospital, London, UK Background: Small bowel adenocarcinoma (SBA) accounts for less than 1% of cancers of the digestive system. Its scientific exploration, previously impeded by its rarity, has made significant progress in the past decade owing to the centralisation of oncological care and novel imaging techniques for the small bowel. Goals: Describe the management and outcomes for patients with SBA at a British tertiary centre for gastrointestinal malignancies and correlate these with current scientific evidence. Methods: We analysed medical records of 22 patients with a histological diagnosis of SBA between 1999 and 2010. The study recorded treatments, their effects, progression-free and overall survival. Furthermore, we reviewed the literature regarding characteristics, outcomes and treatment efficacies for SBA. Results: 13 of 22 patients received active interventions. Palliative chemotherapy (fluoropyrimidine with/without oxaliplatin) accomplished a partial response with 1 of 3 patients. Resection was margin-free in 6 of 11 cases. Only 3 patients attained sustained remission. Progression-free survival and overall survival was 47% and 68% respectively at 6 months (follow-up for n = 19), and 12% and 41% at 24 months (follow-up for n = 17). These outcomes correlate with those quoted in the literature [1]. Recent phase II studies suggest chemotherapy response rates up to 50%. A fluoropyrimidine with oxaliplatin appears to emerge as the most efficacious regimen based on retrospective data, although evidence for improved survival relative to other regimens is still missing [2]. Conclusion: SBA is difficult to treat and carries poor outcomes. However, a scope for evidence-based management is currently emerging and demands further validation through multicentre prospective controlled trials. Reference(s) [1] O. Qubaiah, et al.: “Small intestinal cancer: a population-based study of incidence and survival patterns in the United States, 1992–2006” Cancer Epidemiol Biomarkers Prev 2010; 19(8): 1908−18. [2] T. Tsushima, et al.: “Multicenter Retrospective Study of 132 Patients with Unresectable Small Bowel Adenocarcinoma Treated with Chemotherapy” The Oncologist 2012; 17:1163–1170. Conflict of interests: No conflict of interests
European Journal of Cancer 50, suppl. 1 (2014) S9–S15
were included. Their medical charts were retrospectively reviewed. The median radiation dose was 5040 cGy with concurrent chemotherapy. By logistic regression analysis, risk factors of lymph node metastasis were identified. Results: The rate of lymph node metastasis was 12.8% (90/705). In univariate analysis, the risk factors of lymph node metastasis were tumor size after treatment, perineural invasion, venous invasion, angiolymphatic invasion and ypT classification. Angiolymphatic invasion and ypT2 were independent risk factors of lymph node metastasis (Odds ratio [OR] = 4.888, 95% confidence interval [CI] = 2.512–9.511, p-value <0.0001; ypT1 vs. ypT0is: OR = 1.192, 95% CI = 0.457–3.113, p-value = 0.720; ypT2 vs. ypT0-is: OR = 2.079, 95% CI = 1.058–4.085, p-value = 0.034, respectively). Conclusion: Angiolymphatic invasion and ypT classification (ypT2) were the risk factors of lymph node metastasis in rectal cancer patients with good responses following preoperative CRT. In rectal cancer patients without these risk factors, local excision may be an alternative treatment option after preoperative CRT. Reference(s) [1] Bhangu A, Brown G, Nicholls RJ, et al. Survival outcome of local excision versus radical resection of colon or rectal carcinoma: a Surveillance, Epidemiology, and End Results (SEER) population-based study. Ann Surg 2013;258:563−9. [2] Pucciarelli S, De Paoli A, Guerrieri M, et al. Local Excision After Preoperative Chemoradiotherapy for Rectal Cancer: Results of a Multicenter Phase II Clinical Trial. Dis Colon Rectum 2013;56:1349−56. Conflict of interests: No conflict of interests
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and total cholesterol levels were significant better in SL. As a conclusion, SL method is safety for complications after PD. Strategy 2: To improve the prognosis of advanced pancreas cancer case, phase II study of pre-operative chemo (TS-1 80 mg/day)-radiation (39.6 Gy) therapy has been performed for 20 cases. Even if vessel-invasion pancreas cancer, pre-operative chemo-radiation was demonstrated to lead a satisfactory outcome for patient prognosis. Strategy 3: To develop a novel therapy, the experimental results for molecular targeting study will be shown. Extra-cellular signal-regulated kinase (ERK) is well known to represent a convergent point for the intracellular signaling pathways in whole cancer cells. In the present, by reviewing our recent studies that evaluate the usefulness of the vitamin K3 (menadione, 2-methyl-1,4naphthoquinone; VK3)-induced growth inhibitory effect through ERK pathway, this novel approach to cancer therapy and its potential in future clinical applications will be highlighted. Reference(s) [1] Osada S, et al: A modified reconstruction method to prevent critical complications after pancreatoduodenectomy. Hepatogastroenterology, 53: 296–300, 2006. [2] Osada S, et al: Extracellular signal-regulated kinase phosphorylation due to menadione-induced arylation mediates growth inhibition of pancreas cancer cells. Cancer Chemotherapy and Pharmacology, 63: 315–320, 2008. [3] Osada S, et al: The best choice to achieve zero complications after pancreatoduodenectomy. Surgical Science, 2: 45−51, 2011. Conflict of interests: No conflict of interests
P12 SCIENTIFIC POSTER ABSTRACT Colorectal cancer in Morocco: a retrospective study A. Ayoujil1 , H. Hami1 , F. Habib2 , A. Soulaymani1 , A. Mokhtari1 , A. Quyou1 . 1 Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco, 2 Al Azhar Oncology Center, Rabat, Morocco Goals: Colorectal cancer is a major cause of morbidity and mortality in Northern Africa, accounting for 5.8% of all cancers. It is the fifth most common diagnosed cancer and the fourth leading cause of cancer-related death in both men and women, with about 12 891 new cases of colorectal cancer and 8,296 cancer deaths in 2012 (GLOBOCAN 2012). The aim of this study is to determine the epidemiological profile of colorectal cancer in Morocco. Methods: This is a retrospective study of colorectal cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 1994 and 2004. Results: During 1994–2004, 433 cases were diagnosed with colorectal cancer at Al Azhar Oncology Center (51.3% of cases in the rectum and 48.7% in the colon); 54% in men and 46% in women, giving a male-female ratio of 1.17 and accounting for 49.6% of all new cases of gastrointestinal cancer reported during this period. The average age at diagnosis was 54.2±13.6 years. The risk of developing the disease is strongly related to age with 7.7% of cases diagnosed in patients younger than 35 years, 81.3% in those aged 35−69 years and 11% in those aged 70 years and over. Among all detected cases, 8.5% were diagnosed with metastatic disease and 17.6% died during the study period, accounting for 38.8% of all gastrointestinal cancer deaths. Conclusion: Colorectal cancer is a major public health problem. Early detection in order to improve colorectal cancer outcome and survival remains the cornerstone of colorectal cancer control in Morocco. Conflict of interests: No conflict of interests
Other Cancers P13 SCIENTIFIC POSTER ABSTRACT Novel strategies for advanced pancreas cancer S. Osada1 , H. Imai1 , Y. Sasaki1 , K. Yoshida1 . 1 Dept of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan To estimate novel and potentially less toxic forms of pancreas cancer therapy, the developed three types of strategies will be demonstrated here. Strategy 1: To reduce postoperative complications, the new and original reconstruction procedure after pancreatoduodenectomy (PD) will be described to evaluate for its usefulness. As surgical Technique, the jejunum is made for an end-to-side choledochojejunostomy, and the cut proximal jejunum for approximately 20 cm was led to the pancreatic stump for end-to-end anastomosis with telescoping. Approximately 20 cm of jejunum was created with a side-to-end anastomosis with the stomach, and end-to-side jejunojejunostomy for Roux-en-Y reconstruction. And then, as post-operative course, this separated loop method (SL, n = 38) was evaluated by comparing pancreatogastrostomy (PG, n = 31) and Imanaga method (IM, n = 26). On SL, PG and IM cases, the high amylase level in drainage fluid was noted in 2.6%, 6.5% and 19.2%, respectively. The delayed gastric emptying was seen in PG and IM, but not in SL. Serum albumin levels were similar, but cholinesterase
P14 SCIENTIFIC POSTER ABSTRACT Retrospective series of 22 cases with small bowel adenocarcinoma and review of the literature M. Sagmeister1 , J. Bridgewater2 , D. Hochhauser2 . 1 Foundation Doctor, North Central London Foundation School, London, UK , 2 Cancer Services, University College Hospital, London, UK Background: Small bowel adenocarcinoma (SBA) accounts for less than 1% of cancers of the digestive system. Its scientific exploration, previously impeded by its rarity, has made significant progress in the past decade owing to the centralisation of oncological care and novel imaging techniques for the small bowel. Goals: Describe the management and outcomes for patients with SBA at a British tertiary centre for gastrointestinal malignancies and correlate these with current scientific evidence. Methods: We analysed medical records of 22 patients with a histological diagnosis of SBA between 1999 and 2010. The study recorded treatments, their effects, progression-free and overall survival. Furthermore, we reviewed the literature regarding characteristics, outcomes and treatment efficacies for SBA. Results: 13 of 22 patients received active interventions. Palliative chemotherapy (fluoropyrimidine with/without oxaliplatin) accomplished a partial response with 1 of 3 patients. Resection was margin-free in 6 of 11 cases. Only 3 patients attained sustained remission. Progression-free survival and overall survival was 47% and 68% respectively at 6 months (follow-up for n = 19), and 12% and 41% at 24 months (follow-up for n = 17). These outcomes correlate with those quoted in the literature [1]. Recent phase II studies suggest chemotherapy response rates up to 50%. A fluoropyrimidine with oxaliplatin appears to emerge as the most efficacious regimen based on retrospective data, although evidence for improved survival relative to other regimens is still missing [2]. Conclusion: SBA is difficult to treat and carries poor outcomes. However, a scope for evidence-based management is currently emerging and demands further validation through multicentre prospective controlled trials. Reference(s) [1] O. Qubaiah, et al.: “Small intestinal cancer: a population-based study of incidence and survival patterns in the United States, 1992–2006” Cancer Epidemiol Biomarkers Prev 2010; 19(8): 1908−18. [2] T. Tsushima, et al.: “Multicenter Retrospective Study of 132 Patients with Unresectable Small Bowel Adenocarcinoma Treated with Chemotherapy” The Oncologist 2012; 17:1163–1170. Conflict of interests: No conflict of interests