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Endoscopic ultrasound staging for early esophageal cancer: Are we denying patients neoadjuvant chemo-radiation?

World Journal of Gastroenterology 2017年第46期23卷 8193-8199页

作者： Carrie Luu Marisa Amaral Jason Klapman Cynthia Harris Khaldoun Almhanna sarah hoffe Jessica Frakes Jose M Pimiento Jacques P Fontaine Department of Thoracic Oncology H. Lee Moffitt Cancer Center and Research Institute Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Department of Radiation Oncology H. Lee Moffitt Cancer Center and Research Institute

AIM To evaluate the accuracy of endoscopic ultrasound(EUS) in early esophageal cancer(EC) performed in a highvolume tertiary cancer center. METHODS A retrospective review of patients undergoing esophagectomy was performed and patients with c T1 N0 and c T2 N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student's t test and Fisher's exact test or χ~2 test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS *** Between 2000 and 2015, 139 patients with clinical stage Ⅰ or Ⅱ?A esophageal cancer undergoing esophagectomy were identified. There were 25(18%) female and 114(82%) male patients. The tumor location included the middle third of the esophagus in 11(8%) and lower third and gastroesophageal junction in 128(92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients(21%) were under-staged by EUS; of those, 19(14%) had unrecognized nodal disease. Positron emission tomography(PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients(6%) in whom both EUS and PET were negative for nodal involvement. CONCLUSION EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.

关键词： Esophageal cancer Endoscopic ultrasound Staging Early esophageal cancer Endoscopic mucosal resection

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Management of borderline resectable pancreatic cancer

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World Journal of Gastrointestinal Oncology 2015年第10期7卷 241-249页

作者： Amit Mahipal Jessica Frakes sarah hoffe Richard Kim Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Department of Radiation Oncology H. Lee Moffitt Cancer Center and Research Institute

Pancreatic cancer is the fourth most common cause of cancer death in the United States. Surgery remains the only curative option; however only 20% of the patients have resectable disease at the time of initialpresentation. The definition of borderline resectable pancreatic cancer is not uniform but generally denotes to regional vessel involvement that makes it unlikely to have negative surgical margins. The accurate staging of pancreatic cancer requires triple phase computed tomography or magnetic resonance imaging of the pancreas. Management of patients with borderline resectable pancreatic cancer remains unclear. The data for treatment of these patients is primarily derived from retrospective single institution experience. The prospective trials have been plagued by small numbers and poor accrual. Neoadjuvant therapy is recommended and typically consists of chemotherapy and radiation therapy. The chemotherapeutic regimens continue to evolve along with type and dose of radiation therapy. Gemcitabine or 5-fluorouracil based chemotherapeutic combinations are administered. The type and dose of radiation vary among different institutions. With neoadjuvant treatment, approximately 50% of the patients are able to undergo surgical resections with negative margins obtained in greater than 80% of the patients. Newer trials are attempting to standardize the definition of borderline resectable pancreatic cancer and treatment regimens. In this review, we outline the definition, imaging requirements and management of patients with borderline resectable pancreatic cancer.

关键词： Pancreatic cancer Surgery Chemotherapy Radiation B

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Prognostic value of pre-treatment F-18-FDG PET-CT in patients with hepatocellular carcinoma undergoing radioembolization

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World Journal of Gastroenterology 2016年第47期22卷 10406-10414页

作者： Yazan Abuodeh Arash O Naghavi Kamran A Ahmed Puja S Venkat Youngchul Kim Bela Kis Junsung Choi Benjamin Biebel Jennifer Sweeney Daniel A Anaya Richard Kim Mokenge Malafa Jessica M Frakes sarah E hoffe Ghassan El-Haddad Department of Radiation Oncology H Lee Moffitt Cancer Center and Research Institute Department of Interventional Radiology H Lee Moffitt Cancer Center and Research Institute Department of Gastrointestinal Oncology H Lee Moffitt Cancer Center and Research Institute

AIM To evaluate the value of pre-treatment 18F-FDG PET/CT in patients with HCC following liver *** We identified 34 patients with HCC who underwent an FDG PET/CT scan prior to hepatic radioembolization at our institution between 2009 and 2013. Patients wereseen in clinic one month after radioembolization and then at 2-3 mo intervals. We assessed the influence of FDG tumor uptake on outcomes including local liver control(LLC), distant liver control(DLC), time to distant metastases(DM), progression free survival(PFS) and overall survival(OS).RESULTS The majority of patients were males(n = 25, 74%), and had Child Pugh Class A(n = 31, 91%), with a median age of 68 years(46-84 years). FDG-avid disease was found in 19(56%) patients with SUVmax ranging from 3 to 20. Female patients were more likely to have an FDG-avid HCC(P = 0.02). Median follow up of patients following radioembolization was 12 months(1.2-62.8 mo). FDG-avid disease was associated with a decreased 1 year LLC, DLC, DM and PFS(P < 0.05). Using multivariate analysis, FDG avidity predicted for LLC, DLC, and PFS(all P < 0.05).CONCLUSION In this retrospective study, pre-treatment HCC FDGavidity was found to be associated with worse LLC, DLC, and PFS following radioembolization. Larger studies are needed to validate our initial findings to assess the role of F-18-FDG PET/CT scans as biomarker for patients with HCC following radioembolization.

关键词： F-18 fluorodeoxyglucose PET Hepatocellular carcinoma Radioembolization Prognosis Biomarker

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