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Introduction Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastases (CLM). Patient selection is key, but there is wide variation in practice. Pre-operative chemotherapy can improve oncological outcomes, however chemotherapy-associated liver injury (CALI) may hinder liver regenerative capacity. Standard pre-operative assessments fail to accurately capture factors such as CALI and future liver remnant (FLR) function. The CLiFF and CoNoR studies utilise two novel assessment techniques, aiming to improve patient outcomes. Method The CLiFF study prospectively assesses two primary outcomes in 35 patients undergoing pre-operative chemotherapy for CLM: 1) change in liver function (via LiMAx test: direct assessment of hepatic functional capacity), and 2) change in liver fat (via advanced MR imaging (in-house spectroscopy and modified Dixon technique, scaled up via Perspectum LiverMultiScan)). The CoNoR study assesses potential added benefit of these novel tools in CLM resectability decision-making via sequential workstreams: a systematic review and international hepatobiliary expert interviews inform the online survey, assessing added benefit via online MDT scenarios. Result Preliminary CLiFF analysis suggests that CALI changes in liver fat and function are unrelated. Liver fat analysis techniques are compared and correlated with digital histological analysis. The CoNoR systematic review identifies key factors influencing CLM resectability decision-making and informs the international expert interviews, scheduled to occur during a February 2020 international hepatobiliary conference. Conclusion These studies are the first to assess where these novel tools might be utilised to maximal patient benefit within the Hepatobiliary MDT, and the first systematic review in CLM resectability decision-making. Take-home message These two linked studies evaluate the use of two novel assessment tools in the treatment of colorectal liver metastases, with the potential to improve patient selection for curative resection and patient outcomes. PATEY PRIZE SESSION

Introduction The CREATE-X study, conducted in Japan and South Korea, established capecitabine as an adjuvant treatment option for patients with triple negative breast cancer (TNBC) who have residual disease (RD) following neoadjuvant anthracycline or taxane-based chemotherapy. However, there are no reports on the tolerability and outcomes of adjuvant capecitabine in the US setting following publication of the CREATE-X data. Methods We retrospectively collected treatment and tolerability data from the medical records of the first 23 TNBC patients who received adjuvant capecitabine for RD post neoadjuvant chemotherapy at our institution. Disease-free survival was assessed using the Kaplan-Meier method. Results The median starting dosage of capecitabine was 1871 mg/m2/day, most commonly divided into two daily doses on days 1-14 of each 21 day cycle. 34.8% of patients completed the treatment as prescribed. Side effects associated with treatment were common with 69.6% of patients experiencing hand-foot syndrome, 39.1% of patients experiencing diarrhea, and 13.0% of patients requiring hospitalization for side effects. Of 23 patients treated with adjuvant capecitabine, 34.8% completed the planned dose, 30.4% completed with dose reduction, and 34.8% discontinued early. At a median follow-up time of 14 months, the median disease-free survival was 22 months, with 30.4% of patients experiencing recurrence. Conclusion Tolerability was poor overall compared to the CREATE-X cohort. Administering adjuvant capecitabine for TNBC patients with residual disease in the United States is challenging given differences in tolerability. More research is needed to understand how poor tolerability will affect the efficacy of this approach in the US population.

The method used to evaluate the response of osteosarcoma to preoperative chemotherapy before specimen resection is still unclear. The purpose of this study was to identify factors that contribute to overall survival (OS) and to discuss their roles in making a decision regarding Enneking surgical margins. Patients (109) with pathologically confirmed Enneking stage IIB osteosarcoma were retrospectively analyzed. Univariate and multivariate survival analyses were performed. Patient characteristics and chemotherapy-induced contrast-enhanced MRI changes were considered as potential factors. Changes in the tumor volume and the relative necrosis ratio measured by MRI were independent risk factors predicting the OS of patients who underwent limb-salvage surgery. For those in whom the tumor volume had decreased (VolRatio

Objective To compare surgical aspects of Wilms' tumor in patients with or without pre-operative chemotherapy. Method The records of all diagnosed cases of Wilms' tumor treated between January 2011 and December 2015 were retrospectively analysed. They were divided in two groups. Group I included patients treated with pre-operative chemotherapy and group II comprised of those who didn't receive chemotherapy before surgery. They were compared with respect to size of tumour at time of surgery, duration of surgery, tumor rupture, blood loss, extent of excision, adherence and damage to surrounding structures and peri-operative complications. Result Both groups had 10 patients each. Mean size of tumor at the time of presentation in group I was 859.9 cc and average volume reduction of tumor was 22% after chemotherapy. In group II the mean size of tumor was 890.4 cc. Average duration of surgery in group I was 3.3 hours and in group II 2.8 hours.Adherence to adjacent organs were seen in 5 cases (50%) in group I whereas in only one case in group II. Rupture of tumour was not reported in group I whereas in group II it occurred in three cases (30%). Conclusion Although primary surgery is feasible, yet the incidence of tumour rupture and intra operative complication tends to be higher in patients undergoing primary surgery.

Background Recently a procedure termed 'Associating Liver Partition and Portal vein ligation for Staged hepatectomy' (ALPPS) was developed to increase the resectability of marginally resectable or locally unresectable liver tumours. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases (CRLM) and pre-operative chemotherapy, with the aim to investigate whether the latter still allows for sufficient hypertrophy of the future liver remnant (FLR) following the first step of ALPPS. Methods Retrospective analysis was performed on six patients suffering from advanced CRLM. Analyses comprised demographical and basic clinical data, the perioperative courses as well as short- and long-term outcomes. Results All patients presented with bilobular CRLM and pre-operative chemotherapy of at least 6 months. Extended right hemihepatectomy was performed in all cases, four patients additionally received atypical resections in segments II/III. Mean FLR prior to step 1 of ALPPS was 397.9 cm3 (121-753 cm3 ), on average representing 20.9% of the total liver volume (13.2-27.1%). A mean hypertrophy of the FLR of 67.9% (32.5-94.1%) was achieved. Overall, severe morbidity (Dindo Clavien >3a) occurred in two patients. Following completion of ALPPS, mean post-operative disease-free survival was 5.7 months (2.6-8.9 months). Conclusion Despite pre-operative chemotherapy, ALPPS seems to result in adequate liver hypertrophy, preventing post-operative small-for-size syndrome. However, there might be a high risk of tumour recurrence in patients with an aggressive tumour biology.

Background and Objectives Study objectives, included determination of: (i) associations between radiologic and pathologic responses of colorectal cancer liver metastases (CRCLM) to chemotherapy; and (ii) whether CRCLM histopathology is associated with recurrence free survival (RFS) after resection among patients not treated with pre-operative chemotherapy (untreated). Methods Demographics, clinicopathologic characteristics, and outcomes among patients who underwent CRCLM resection from 2007 to 2014 were reviewed. Tumor regression grade (TRG) of 1–2 and 4–5 depict low and high proportions of viable tumor relative to fibrosis, respectively. Results Of 138 patients, 84 (60.9%) were treated with pre-operative chemotherapy. In these patients, there was no difference in proportions with TRG 1–2 among those with verses without radiologic response (26.9% vs. 18.8%, P = 0.393). TRG 1–2 was associated with superior RFS on univariable (median 15 vs. 6 months, P

Currently, surgery remains the only approach to cure gastric cancer. However, improvement of prognosis by surgical resection alone is limited, and peri-operative chemotherapy is necessary (1). In recent years, several large clinical trials have shown the effectiveness of adjuvant post-operative chemotherapy for gastric cancer (2-4). In contrast, the usefulness of adjuvant pre-operative chemotherapy has not been fully demonstrated.

Background: The prognosis of gastric cancer with para-aortic lymph node (PAN) metastasis is poor. We applied triple combination chemotherapy with docetaxel, cisplatin, and S-1 (DCS therapy) as pre-operative chemotherapy and investigated the outcome of the combination of this therapy and gastrectomy with para-aortic lymph node dissection (PAND). Methods: We retrospectively identified 44 patients with pathologically positive PAN who underwent curative surgery at Kanazawa University Hospital between 1990 and 2008. Among the 44 patients, 16 received pre-operative DCS therapy and subsequent surgical resection after two courses of the therapy. Results: Pre-operative DCS therapy showed high clinical response ratio (68.8%) and disease control ratio (100%). The pathological response ratio of resected specimen was 87.5%. At 2 years after surgery, the overall survival ratio was 93.8% and relapse-free survival was 75.0%. Pre-operative DCS therapy was only independent prognostic factor in multivariate analysis. Grade 3/4 toxicity was observed only in 25.0% of patients who underwent DCS therapy. Surgical complication was observed in 31.3% of patients, and this ratio was equal to that of patients who did not receive DCS therapy. Conclusion: Multimodal therapy comprising combined pre-operative DCS therapy and gastrectomy with PAND was extremely effective and feasible for advanced gastric cancer with PAN metastasis. J. Surg. Oncol © 2011 Wiley Periodicals, Inc.

BackgroundNeoadjuvant chemotherapy for colorectal liver metastases (CRLM) reduces the accuracy of liver imaging which may understage patients pre-operatively. Retrospective review of a prospective database to determine whether liver-specific magnetic resonance imaging (MRI) prior to pre-operative chemotherapy affects intra-hepatic recurrence and long-term outcome after hepatectomy.Patients and methodsBetween 2003 and 2009, 242 patients with CRLM underwent a hepatectomy after ≥3 cycles of oxaliplatin or irinotecan-based chemotherapy. All had a liver-specific MRI immediately pre-operatively. The outcome of patients who had a liver-specific MRI prior to chemotherapy (PCI group, n= 92) was compared with those who did not (non-PCI group, n= 150).ResultsA liver-specific MRI pre-chemotherapy changed the staging in 56% of patients. At a median (range) follow-up of 55 (6–94) months, there was a higher incidence of intra-hepatic recurrence at a new site in the non-PCI group (65% vs. 48% in the PCI group, P= 0.041) and an increased rate of recurrence in patients with the same number of lesions pre- and post-chemotherapy [hazard ratio (HR) 2.02, 1:10–3.37, P= 0.024]. The non-PCI group underwent more repeat hepatectomies than the PCI group (24.7% vs. 13%, P= 0.034), achieving similar long-term survival.ConclusionsA liver-specific MRI prior to chemotherapy reduces intra-hepatic recurrence and avoids a repeat hepatectomy.

Gastric cancer is highly prevalent in several countries around the world and remains an incurable disease. Treatment involves surgery, chemotherapy and radiation. Surgical resection remains the definitive treatment for early stage (T1 and T2) gastric cancer, with 5-year survival rates of 70-95%. Localized tumours that extend beyond the submucosa are, however, associated with worse outcomes and a 5-year survival rate of 20-30%. Recent advances mainly concern chemotherapy prior to surgical resection. The goal of pre-operative chemotherapy is to allow an early attack on systemic micrometastatic disease and, by downstaging the primary tumour, to increase the percentage of patients able to undergo curative resection. Pre-operative chemotherapy remains experimental, but several phase II and III studies have shown promising results. One approach involves systemic, pre-operative chemotherapy for resectable gastric cancer. This review focuses on the development of pre-operative chemotherapy as a component of the multimodal treatment of gastric cancer.

Preoperative chemotherapy (CT) and preoperative chemoradiation therapy (CRT) for resectable oesophageal cancer have both been shown to improve overall survival in meta-analyses. However there are no trials comparing these adjuvant therapies with each other. We assessed the outcomes after oesophagectomy following preoperative CT and preoperative CRT in a randomised phase II trial for resectable adenocarcinoma of the oesophagus and gastro-oesophageal junction

症例は66歳の男性で, 慢性B型肝炎のため経過観察中, 2006年2月,#12腹腔内リンパ節腫大を指摘され, 内視鏡検査で胃噴門直下に4cm大の1型腫瘍を認め乳頭状腺癌と診断された. 腫瘍マーカーはAlpha-fetoprotein (以下, AFP) が333ng/mlと高値であった. T2N3M0: stage IVの診断で化学療法を行った. TS-1(120mg/日)をday 1～14, day 1およびday8にDo-cetaxel(60mg/日), CDDP (10mg/日) をday1～5, 8～12に経静脈投与した. 画像上PRが得られ, AFP値も45ng/mlと低下し, 胃全摘を行った. 病理組織学的診断では原発巣に癌の遺残はなく, 郭清リンパ節にもGrade 2の効果が得られた. そのうち, 1個にのみ腫瘍の残存を認め, AFP染色陽性であった. TS-1による補助化学療法を3コース施行し, 術後14か月経過した現在再発はない. 化学療法が奏効したAFP産生胃癌の1例を報告する.

The multi-disciplinary approach, including surgery, chemotherapy, endocrine therapy and radiation therapy, has become the standard treatment for primary breast cancer patients. The indication of pre-operative chemotherapy has been extended to women with potentially operable breast cancer based on the results of large randomized studies and has become an attractive option that extends the chance of breast conservation. The clinical and pathological responses to pre-operative chemotherapy correlates with long-term outcome. The anthracycline-containing regimen is now considered the standard. Sequential administration of non-cross-resistant drugs, namely taxanes, improves local tumor response but its long-term benefit has been controversial. Prediction of response to pre-operative chemotherapy still remains a challenge. Identification of useful predictive markers and development of molecular-targeted drugs is the key to individualized therapy in the future.

症例は74歳の男性で, 主訴は全身倦怠感. 内視鏡検査で, 噴門より胃体下部に及ぶ2型病変を認めた. 生検の結果, 腺癌と診断したが, 一部の検体では扁平上皮癌を認めた. 腹部CTで膵臓への直接浸潤ならびにリンパ節#12Pに転移を認めた. Downstagingを目的にTS-1/CDDPによる術前化学療法を3コース施行した. CT画像による効果判定はNCであった. 胃全摘, 脾摘, 膵体尾部切除術を施行. 膵への直接浸潤を認めたが, 腹膜播種を認めず, Stage IV, 根治度はBであった. 病理組織学的検査では, 扁平上皮癌成分のみ認め, 腺癌成分を認めず, 腺扁平上皮癌の腺癌成分が術前化学療法により消失したものと考えられた. 腺癌成分と扁平上皮癌成分では, 化学療法に対する感受性が異なる可能性が示唆された.

Resume La chimiotherapie preoperatoire des cancers bronchiques non a petites cellules avait le double but de detruire les micrometastases et d’augmenter la resecabilite des tumeurs. Les essais de Rosell et de Roth etaient positifs en faveur de l’association mais avaient de faible effectif. Dans l’essai francais, la survie globale n’etait pas differente pour l’ensemble des patients mais l’etait dans les stades precoces. Les resultats preliminaires de l’essai du SWOG objectivent une difference de 6 % a 2 ans non significative. L’essai EORTC 08941, dans les tumeurs IIIAN2 non resecables, ne montrait pas de difference dans la comparaison de la chirurgie a la radiotherapie apres chimiotherapie d’induction. L’essai INT-0139 etudiait l’apport de la chirurgie apres chimio-radiotherapie d’induction par rapport a l’association exclusive chimio-radiotherapie. Il n’y avait pas de difference entre les 2 strategies mais l’analyse par sous-groupes indique que certains groupes pourraient beneficier de la triple association. Deux essais sont en attente de publications. Le petit nombre de patients finalement inclus par essai conduira a une meta-analyse pour acquerir une opinion definitive. L’association chirurgie et chimiotherapie va devenir un standard, dans les stades II. Seul reste en discussion le meilleur moment, pre ou postoperatoire. Dans l’objectif initial, seule la destruction des micrometastases est actuellement confortee.

522 Background: PUC is characterized by E-cadherin loss, diffuse growth pattern and aggressive natural history. Management of this entity is controversial. This retrospective study aims to evaluate the impact of PUC histology on clinical outcomes with ctx compared to UC-NOS. Methods: Consecutive cases of nonmetastatic PUC were identified as either (1) localized disease (LD: cT2-3 cN0) or (2) locally-advanced (LA: fixed bladder or radiographic nodal disease). All cases were reviewed by a GU pathologist to confirm PUC histology per WHO classification (2016). A separate cohort of neoadjuvant(NAC)-treated UC-NOS (Tully et al, ASCO GU 2014) served as comparator for clinical outcomes. Kaplan-Meier estimates and logrank test were used for analysis of recurrence free (RFS) and overall survival (OS) defined from date of cystectomy (RC). Results: Between 2000 and 2017, eighty one PUC were identified, with median age of 65 years (range: 22 - 84) and 65% male. Thirty patients (pts) had up-front RC; 51 pts had ctx. In the former group, all pts had LD but upstaging was seen on post-op pathology: 63% pT3, 17% pT4 and 37% pN+. Among ctx pts, 33/51(65%) were LD and had NAC: 70% had ctx doublet and 24% triplet; 82% had 4 cycles and 18% had up to 6 cycles. Response ( < pT2 pN0) was seen in 7/33(22%), four (12%) of which had no residual disease (pCR). Six RC were aborted after NAC for pT4b disease. NAC response was not associated superior RFS (NR vs. 17.3 months; HR 0.52 95% CI 0.18 – 1.47, p = .218) or OS (41.3 vs. 25.5 months; HR 0.65 95% CI 0.23 – 1.87, p = .428). Compared to UC-NOS, PUC responders had significantly inferior outcomes (table). In LA cohort, majority had triplet chemotherapy (72%) and up to 6 cycles (89%). Response was seen in 4/18(22%) pts, with two pCR (11%). Five RC were aborted for pT4b disease. Median RFS and OS were 5.8 and 10.5 months, respectively, with 19% alive at 2-years. Most common sites of recurrence/progression for PUC were peritoneal (42%) and locoregional invasion (26%). Conclusions: Outcomes for PUC are poor with conventional NAC-RC approach. [Table: see text]

95 Background: Peritoneal lavage cytology of positive and localized peritoneum metastasis of gastric cancer (GC) are defined as CY1 and P1 in the 14th edition of the Japanese Classification of GC. Patients (pts) with CY1 and/or P1 have poor prognosis after removing all macroscopically visible disease by standard gastrectomy followed by S1. The aim of this study was to investigate the efficacy of pre-operative chemotherapy (Pre-Cx) in patients with CY1 and/or P1. Methods: We retrospectively reviewed the GC pts who were diagnosed to have CY1 and/or P1 at 34 institutions participating in the Stomach Cancer Group of Japan Clinical Oncology Group between 2007 and 2012. Inclusion criteria were: no distant metastasis other than CY1 or P1, no prior treatment for GC. The subjects were divided to two groups according to treatment strategy with/without Pre-Cx before surgery. In the Pre-Cx group, status of CY and P was diagnosed by laparoscopy before and after Pre-Cx, and indication of surgical resection was decided by each physician. Results: A total of 824 pts were collected from 34 institutions. Of the 713 eligible pts, 150 pts received Pre-Cx (Pre-Cx group) and 563 pts underwent surgery followed by Cx (Post-Cx group). Proportions of P0CY1/P1CY0/P1CY1 were 69/12/19% and 69/17/14% in the Pre- and Post-Cx. Cx regimen for Pre-Cx were S1 plus cisplatin/ docetaxel and cisplatin plus S1/others (n=90/37/23). In the Pre-Cx, 57 (38%) pts who achieved P0CY0 after Pre-Cx showed better survival than the remaining 92 pts (overall survival (OS), 31.0 vs. 19.9 months (M), HR=1.99, 95% CI 1.32-2.93, p=0.001). OS was 24.8 and 24.0 M in the Pre- and Post-Cx (HR 1.07; 95% CI 0.87-1.32, p=0.502). In multivariate analysis, P1CY1, over 65 years old and clinical N3 lymph node metastasis were identified as the independent prognostic factor for OS (p

A case of a 38 year old woman who developed superior vena caval syndrome and dyspnea due to invasive thymoma was described. The pre-operative chemotherapy with CDDP, ADM. CPA and VCR resulted in partial remission. Twenty-three days after the start of chemotherapy, complete resection of the invasive thymoma was carried out with combined resection of superior vena cava, upper lobe of the right lung, right phrenic nerve and pericardium. Bilateral brachiocephalic veins were reconstructed with Gore Tex graft 8mm in diameter., 論文

A case of a 38 year old woman who developed superior vena caval syndrome and dyspnea due to invasive thymoma was described. The pre-operative chemotherapy with CDDP, ADM. CPA and VCR resulted in partial remission. Twenty-three days after the start of chemotherapy, complete resection of the invasive thymoma was carried out with combined resection of superior vena cava, upper lobe of the right lung, right phrenic nerve and pericardium. Bilateral brachiocephalic veins were reconstructed with Gore Tex graft 8mm in diameter.

14. ABSTRACT Purpose: To study possible associations between the MRI morphological patterns of the primary breast tumor and properties of the surrounding host tissue. Scope: Identification of such properties of host tissue may be useful in characterizing breast tissue for earlier stage breast cancers. Major findings: We have developed MRI algorithms necessary to measure signal enhancement ratios in non-tumor tissue using the existing database of patients who underwent neoadjuvant chemotherapy. Results: We found that change in uninvolved breast tissue volume with treatment was correlated with tumor phenotypes and was shown to be predictive of recurrence. Significance: Host tissue changes with treatment can potentially provide information about pre-cancerous tissue that may have applicability to risk assessment.