Search

524 Background: Gallbladder and other biliary tract tumors account for 0.6 % of all cancers. There is scarce data of Ampullary cancers, but it is known as an extremely rare neoplasia accounting just for 0.2% of gastrointestinal cancers and 7% of periampullary tumors. Most frequent histology is adenocarcinoma being intestinal and pancreatobiliary subtypes conditioning prognosis and treatment. Current approaches include, but not limited to: neo/adyuvant, radiation and palliative therapy. Methods: We conducted a retrospective study in a referral specialized center in Mexico city. We included patients with histologically confirmed ampullary cancer treated between 2008 and 2022, stages I-IV. We evaluated the frequency of surgery, radiation therapy and chemotherapy. Also, we registered, first line, subsequent and maintenance therapy and as for radiation and chemoradiation. Chi square and student T test were used for between group comparisons. Overall survival was performed using the Kaplan Meier method. Results: We included 220 patients with a median age of 60.3 years (range 28-84), female 51.8%. The clinical stage distribution was I 10%, II 16.4%, III 41.3%, IV 32.3%. Performance status 0 (26.5%), 1 (44.5%), 2 (15.6%), 3 (10.4%), 4 (2.8%). Histologic Subtype Adenocarcinoma not otherwise specified 45.7%, Intestinal Adenocarcinoma 27.1%, Pancreatobiliary Adenocarcinoma 16.7%, Mix Intestinal-Pancreatobiliary 6.2%, Signet Ring Cell Adenocarcinoma 2.4%, Neuroendocrine 1.9%. Curative intend surgery in 169 patients was possible in 90%. Initial treatment received was Adjuvant 40.9%, Palliative 27.7%, Neoadjuvant 2.3% and Never Received any kind of treatment in 29.1%. Adjuvant Treatment was given to 94 patients. Among them Gemcitabine and Capecitabine was the election of treatment in 34% and 23.4 respectively. First line Treatment. Patients receiving first line treatment (110 patients) were candidates to Gemcitabine, XELOX, and Gemcitabine-Cisplatin in 30%, 13.6% and 12.7% according to physicians and 56% other line of treatment. Patients who progressed to first line received a second line in 19%. Most frequent second line of treatment was Capecitabine 61.9% and Gemcitabine 23.8%. Of the whole population Median Overall Survival was 30.68 months, Disease Free survival: 30.71 months and 8.0 months for progression free survival in first line. Conclusions: To our knowledge first real world based large volume study reporting treatment patterns and oncologic outcomes of a rare entity.

Background: Stromal tumors of the digestive tract are uncommon malignant diseases, are subclassified as leiomyosarcomas and Gastrointestinal Stromal Tumors (GIST) depending on the molecular expression of tyrosine kinase receptor KIT (CD117). GISTs represent 1% of malignant tumors affecting this anatomical site. Localized tumours diseases are reasonably well controlled by surgical resection and several criteria define the need for adjuvant therapy. In the case of metastatic disease a poor prognosis has been reported with systemic treatment based on chemotherapy. Recently, significant advances have been shown since tyrosine kinase inhibitors (TKIs) were introduced, with median overall survival close to 5 years. Unfortunately in Mexico, even though the therapy has been long used there are no published data of the experience in the treatment of these tumors. Methods: We used an electronic data base to obtain clinical, radiological and histological data of patients diagnosed with GIST and treated in the oncological center of the Mexican Institute of Social Security, patients were subclassified by stage, symptoms at diagnosis as well as the initial and subsequent systemic treatment. Finally we made an analysis for progression free survival and overall survival identifying prognostic factors. Results: We obtained information of 71 patients with metastatic, non-resectable or recurrent GIST, treated with a TKI, we observed a predominant relation for women (60.4%) with median age of 58 years. Stage at diagnosis was predominantly metastatic (46.5%), most frequently affected sites were lung, liver and retroperitoneum. Median progression free survival was 30.6 months and overall survival was 81.3 months. All patients were initially treated with imatinib at a dose of 400 mg per day. Treatment was well-tolerated in most cases. Conclusions: Metastatic GIST evaluated in our center shows a different affection in gender and age, and our population shows a different response to TKIs, compared to those reported in other series with superior overall survival. Poor prognosis is associated with lung affection. Biological studies will be started for the molecular evaluation of these tumors.

514 Background: Gastroenteropancreatic neuroendocrine tumors (GEP NET´s) are infrequent tumors, with a variety of symptoms depending of the kind of peptide they secrete as well as the affected organs. Long acting somatostatin analogues have shown an adequate rate of symptom control in functional tumors, they also have demonstrated antiproliferative effect, which is translated in a significant improvement of progression free and overall survival Methods: In this retrospective analysis of patients with metastatic GEP NET treated with long acting somatostatin analogues as first line, treated between 2005 and 2015, we evaluated clinical and pathological features, symptoms, disease control and survival adjusted with OMS classification Results: Our cohort included 95 patients with a mean age of 53 years. Primary affected sites were midgut (29.4%), followed by pNET (17.%), stomach (14.7%), and primary unknown in 14%. 20% of cases were functional tumors with diarrhea as the most common symptom in 70% and flushing in 50%. Considering the whole cohort the most prevalent symptom was abdominal pain in the 50% of cases. The OMS classification showed low grade tumors in 65% and 35% intermediate grade. Most common metastatic organ sites were; liver only 35%, liver and other 30%, peritoneum 10% and lymph nodes in 6%, non-specified sites in 19%. Somatostatine analogues used in first line were octreotide in 80% and lanreotide in 20%. Survival results demonstrated a progression free survival for the whole cohort of 84months. No differences between lanreotide and octreotide were observed. Conclusions: This study represents the first Mexican cohort of patients with GEP NET’s treated with somatostatin analogues with a long follow up.

224 Background: Stromal tumors of the digestive tract are uncommon malignant diseases, and are subclassified as leiomyosarcomas and gastrointestinal stromal tumors (GIST) depending on the molecular expression of CD117 (KIT). GISTs represent 1% of malignant tumors affecting this anatomical site. Located diseases are reasonably well controlled by surgical resection and several criteria define the need for adjuvant therapy. In the case of metastatic disease a poor prognosis has been reported with systemic treatment based on chemotherapy. Recently, significant advances have been shown since Tyrosine – kinase inhibitors were introduced, with median overall survival close to 5 years. Unfortunately in Mexico, even though the therapy has been long used there are no published data of the experience in the treatment of these tumors. Methods: We used an electronic data base to obtain clinical, radiological and histological data of patients diagnosed with GIST and treated in the oncological center of the Mexican Institute of Social Security, patients were subclassified by stage, symptoms at diagnosis as well as the initial and subsequent systemic treatment. Finally we made an analysis for progression free survival and overall survival identifying prognostic factors. Results: We obtained information of 71 patients with metastatic, nonresectable or recurrent GIST, treated with a TKI, we observed a predominant relation for women (60.4%), with median age of 58 years. Stage at diagnosis was predominantly metastatic (46.5%) most frequently affected sites were lung, liver and retroperitoneum. Median progression free survival was 23.6m and overall survival was 81.3 months. All patients were initially treated with imatinib at a dose of 400mg per day. Treatment was well tolerated in most cases. Conclusions: Metastatic GIST evaluated in our center shows a different affection in gender and age, our population shows a different response to TKI’s, than reported in other series with superior overall survival, Poor prognosis is associated with lung affection. Biological studies will be started for the molecular evaluation of these tumors.

e15567 Background: Primary debulking surgery is considered the standard of treatment in advanced ovarian cancer (AOC) while neoadjuvant chemotherapy is used in non resectable stages. Methods: We retrospectively analyzed 68 AOC cases from January 2000 to December 2011. 35 received neoadjuvant chemotherapy (NAC) while 33 were resected primarily and received adjuvant chemotherapy (AC). To compare both groups we used T standard test and 2 sided chi -squared. Non parametric variables were analyzed with U Mann – Whitney. Overall survival(OS) was analyzed using Kaplan Meier method with log rank test. We considered statistically significant p-26 months for neoadjuvant and 27+/- 35 months for primary surgery (p=0.56). In a subgroup analysis of patients who received 6 neoadjuvant cycles vs perioperatory chemotherapy (3 pre and 3 postoperatory) we observed a significant survival difference, with a median of 62 months (95% CI 12-38) vs 12 months (95% CI 54 – 178) respectively (p=0.010). Conclusions: Non inferior survival or differences in surgical outcomes were observed with neoadjuvant therapy. Significant survival increase was observed in patients who received complete chemotherapy schedule before surgery, this evidence allowed to design a prospective trial in our Institution.

ResumenLos tumores neuroendocrinos son poco frecuentes, pero su incidencia está aumentando gradualmente. En el presente estudio se evaluaron las características demográficas y tumorales, el tipo de tratamiento, las tasas de respuesta y la supervivencia de pacientes con tumores neuroendocrinos. Cuarenta y dos pacientes con diagnóstico de tumor neuroendocrino de un centro de tercer nivel fueron evaluados retrospectivamente. La supervivencia global y la supervivencia libre de progresión fueron calculadas por el método de Kaplan-Meier.No encontramos diferencias en cuanto al género; la media de edad fue de 62 años. El sitio primario más común fue el estómago (26%), seguido por pulmón (21%). Se encontró síndrome carcinoide en un 14% de los pacientes. El 43% presentaba enfermedad localizada al momento del diagnóstico y la tasa de resección quirúrgica fue del 59.5%. En el 100% de los pacientes se realizó inmunohistoquímica para cromogranina y el 50% de los pacientes tenía por patología un grado 2. Al 62% se le ofreció tratamiento con análogos de la somatostatina, en tanto que al 14% se le administró quimioterapia con un esquema basado en cisplatino/etopósido. La mediana de supervivencia global en los tumores primarios gástricos fue de 30 meses, en tanto que para los primarios de pulmón fue de 23.5 meses.AbstractNeuroendocrine tumours are rare, but their incidence is gradually increasing. In this study, the demographic and tumour characteristics, treatment modalities and response rates, and survival rates were assessed in patients with neuroendocrine tumours. Forty-two patients with neuroendocrine tumours from a tertiary care centre were retrospectively assessed. Overall survival and progression-free survival rates were estimated using the Kaplan–Meier method.No differences were found in terms of gender. The median age was 62 years. The most common primary site was the stomach (26%), followed by lung (21%). Carcinoid syndrome was found in 14% of patients. Forty-three percent had localised disease at diagnosis, and surgical resection rate was 59.5%. In 100% of the patients, immunohistochemistry for chromogranin was performed, and 50% of the patients had pathological grade 2 disease. Treatment with somatostatin analogues was offered to 62%, while chemotherapy was given to 14%, with a regimen based on cisplatin/etoposide. Median overall survival in gastric primary tumours was 30 months, whereas for lung primary tumours it was 23.5 months.