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The significance of molecular analysis of peritoneal fluid in staging laparoscopy of oesophagogastric junction (EGJ) and gastric cancer is still controversial. METHODS: A retrospective analysis of prospective data collection of all patients diagnosed with locally advanced gastric neoplasia or Siewert II-III EGJ cancer from July 2009 to October 2019 who underwent staging peritoneal lavage prior to neoadjuvant treatment was performed. Cytology studies and molecular analysis of peritoneal lavage were performed by real-time reverse transcriptase polymerase chain reaction (RT_PCR) of carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) as tumor makers. RESULTS: 168 patients were operated. Citology and molecular analysis were performed in 138 patients. Macroscopic carcinomatosis (P+) was evidenced in 12.3% (17 patients). Of the remaining 87.7% (121 patients), 9.9% (12 patients) had positive cytology. In 21% (29 patients) disseminated macroscopic or microscopic disease (P + or Cyt+) was identified. 11.6% (16 patients) were P0Cyt- but RT-PCR+. Of these, 9 responded to chemotherapy before salvage surgery. The sensitivity of cytology and molecular analysis was 0.70 and 0.76, respectively (p = 0.67). The survival of Cyt-RT_PCR + vs. Cyt + RT_PCR + patients was similar (p = 0.1). However, there were no differences in the survival curves between Cyt-RT_PCR- patients vs Cyt-RT_PCR + patients who underwent salvage surgery (p = 0.69). CONCLUSION: Molecular analysis showed a sensitivity of 76%. In our study, the survival of P0 Cyt-RT_PCR + patients responding to chemotherapy and undergoing surgery was similar to that of P0 Cyt-RT_PCR- patients but less disease free survival.

ObjectivesPatients with cancer are at higher risk for severe COVID-19 infection. COVID-19 surveillance of workers in oncological centres is crucial to assess infection burden and prevent transmission. We estimate the SARS-CoV-2 seroprevalence among healthcare workers (HCWs) of a comprehensive cancer centre in Catalonia, Spain, and analyse its association with sociodemographic characteristics, exposure factors and behaviours.DesignCross-sectional study (21 May 2020–26 June 2020).SettingA comprehensive cancer centre (Institut Català d’Oncologia) in Catalonia, Spain.ParticipantsAll HCWs (N=1969) were invited to complete an online self-administered epidemiological survey and provide a blood sample for SARS-CoV-2 antibodies detection.Primary outcome measurePrevalence (%) and 95% CIs of seropositivity together with adjusted prevalence ratios (aPR) and 95% CI were estimated.ResultsA total of 1266 HCWs filled the survey (participation rate: 64.0%) and 1238 underwent serological testing (97.8%). The median age was 43.7 years (p25–p75: 34.8–51.0 years), 76.0% were female, 52.0% were nursing or medical staff and 79.0% worked on-site during the pandemic period. SARS-CoV-2 seroprevalence was 8.9% (95% CI 7.44% to 10.63%), with no differences by age and sex. No significant differences in terms of seroprevalence were observed between onsite workers and teleworkers. Seropositivity was associated with living with a person with COVID-19 (aPR 3.86, 95% CI 2.49 to 5.98). Among on-site workers, seropositive participants were twofold more likely to be nursing or medical staff. Nursing and medical staff working in a COVID-19 area showed a higher seroprevalence than other staff (aPR 2.45, 95% CI 1.08 to 5.52).ConclusionsAt the end of the first wave of the pandemic in Spain, SARS-CoV-2 seroprevalence among Institut Català d’Oncologia HCW was lower than the reported in other Spanish hospitals. The main risk factors were sharing household with infected people and contact with COVID-19 patients and colleagues. Strengthening preventive measures and health education among HCW is fundamental.

Subepithelial tumors; Carcinophobia; Multicenter cohort study Tumores subepiteliales; Carcinofobia; Estudio de cohorte multicéntrico Tumors subepitelials; Carcinofòbia; Estudi de cohorts multicèntric Background and aims: Minor nonspecific gastrointestinal subepithelial lesions (usually defined by the term 'tumor') are usually associated with a malignant illness and cancer. The aim of this study was to assess anxiety-distress and carcinophobia in patients referred to specialized monographic outpatient clinics for evaluation and treatment of this type of lesion. Methods: Prospective, multicenter, cohort study. Specific self-reported questionnaires were used to report threatening life-experiences and to assess levels of distress (The Hospital Anxiety and Depression Scale) and cancer-related worries (The Cancer Worry Scale). Results: Forty participants were included and analyzed at baseline. Pathologic and borderline anxiety were detected in 13% (5/40, 95%CI: 4-27%) and 35% (14/40, 95%CI: 21-52%) of participants, respectively, whereas, cancer-related worries (moderate to very high) were observed in 48% (19/40, 95%CI: 32-64%) of participants. Pathologic global distress was identified in 25% (10/40, 95%CI: 13-42%) of subjects. Higher educational level (university studies), a lack of lifetime psychiatric comorbidity and a lack of family history of cancer were associated with less anxiety, global distress and carcinophobia. Conclusions: Almost half of the patients diagnosed with a minor nonspecific gastrointestinal subepithelial lesion presented anxiety-distress and/or carcinophobia. Specific associations with anxiety-distress reaction and fears were detected.

Tanning industry treats hides and the skin of animals for their use in products such as clothes, furniture and car's interiors. The worth of leather is highly affected by defects that may appear prior or during the tanning process. Break, which refers to the wrinkling of the grain surface of leather, is one of the main issues because it affects not only the visual appearance of leather, but also its mechanical properties. The standardized method to classify the break pattern is done by bending the leather with the hand and comparing visually the resulting wrinkles that appear with a reference pattern, which makes the classification subjective and limits the evaluation to small areas. Laser vibrometry is an optical technique that has been applied in vibrational and modal analysis, which are methodologies used to obtain the mechanical properties of materials. This work demonstrates the use of a single-point vibrometer as a noncontact and nondestructive optical method to discriminate among five break levels, which could increase the effectiveness of leather classification for quality control in the tanning industry.

Resumen Introduccion La reconstruccion esofagica mediante gastroplastia con anastomosis cervical es una tecnica una mayor dehiscencia anastomotica remarcable.. El objetivo de este estudio es analizar la incidencia de dehiscencia anastomotica en pacientes sometidos a gastroplastia con anastomosis cervical tras acondicionamiento isquemico angiografico del tubo gastrico. Metodos Analisis prospectivo de pacientes que se sometieron a acondicionamiento gastrico 2 semanas antes de la reconstruccion esofagica, desde enero de 2001 hasta enero de 2014. El acondicionamiento se realizo mediante embolizacion angiografica de las arterias gastricas izquierda y derecha, y la arteria esplenica. La variable principal analizada fue la incidencia de dehiscencia anastomotica en pacientes sometidos a gastroplastia con anastomosis cervical. Las variables secundarias analizadas fueron el exito del acondicionamiento, las complicaciones tras este procedimiento y postoperatorias, y la duracion media de la estancia hospitalaria postacondicionamiento. Resultados El acondicionamiento gastrico se indico en 97 pacientes, siendo la neoplasia la etiologia mas frecuente que motivo la reconstruccion esofagica (76%). Se realizaron 96 procedimientos con exito, la embolizacion arterial fue completa en 80 (83%). La morbilidad fue del 13%, sin mortalidad. La morbilidad postoperatoria fue del 45%; las complicaciones mas frecuentes asociadas a la cirugia fueron los respiratorios. Seis (7%) pacientes presentaron fistula cervical y todos tratados de forma conservadora. La mortalidad postoperatoria fue del 7%. Conclusiones En nuestra serie, la incidencia de dehiscencia anastomotica en pacientes sometidos a gastroplastia con anastomosis cervical tras acondicionamiento isquemico angiografico es del 7%. El acondicionamiento isquemico angiografico es un procedimiento con una morbilidad aceptable.

Introduction Oesophageal reconstruction by gastroplasty with cervical anastomosis has a higher incidence of dehiscence. The aim of the study is to analyze the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischemic conditioning of the gastric conduit. Methods Prospective analysis of patients who underwent gastric conditioning two weeks prior to oesophageal reconstruction, from January 2001 to January 2014. The conditioning was performed by angiographic embolization of the left and right gastric artery, and splenic artery. The main variable analyzed was the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis. Secondary variables analyzed were the result of the conditioning, complications arising from that procedure and in the postoperative period, and mean length of postconditioning and postoperative hospital stay. Results Gastric conditioning was indicated in 97 patients, with neoplasia being the most frequent etiology motivating the oesophageal reconstruction (76%). 96 procedures were successfully carried out, arterial embolization was complete in 80 (83%). The morbidity rate was 13%, with no mortality. Postoperative morbidity was 45%; the most frequent complications associated with the surgery were respiratory problems. Six (7%) patients experienced cervical fistula, and all received conservative treatment. The rate of postoperative mortality was 7%. Conclusions In our series the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischemic conditioning is 7%. Angiographic ischemic conditioning is a procedure with acceptable morbidity.

Pre-operative chemoradiotherapy using a 5-fluorouracil (5-FU)/cisplatin backbone is widely used to improve surgical outcomes in locoregional oesophageal cancer patients, despite a non-negligible failure rate. We evaluated intensification of this approach to improve patient outcomes by adding cetuximab to induction 5-FU/cisplatin/docetaxel (TPF) and to chemoradiotherapy in a phase II study. Between November 2006 and April 2009, 50 patients with stage II–IVa squamous cell carcinoma (SCC) or adenocarcinoma of the oesophagus or gastro-oesophageal junction initiated three TPF/cetuximab cycles. Six weeks later, patients with response or stabilisation initiated 6 weeks of cisplatin/cetuximab/radiotherapy, followed by surgery. The primary objective was the clinical complete response (cCR) rate after induction therapy plus chemoradiotherapy in intent-to-treat patients. Thirty-eight patients were evaluable after chemoradiotherapy, 84% of whom showed disease control. Six patients (12%) achieved a cCR, with a 54% overall response rate. Twenty-seven patients underwent surgery, 11 of whom (22%; nine SCC, two adenocarcinoma) had a pathological CR (41%). Fifteen patients were alive after a median follow-up of 23.2 months. Median progression-free survival was 12.2 months (95% confidence interval [CI] 1.7–22.8). Median overall survival was 23.4 months (95% CI 12.2–36.6) and was significantly longer among the 22 patients with complete resection than in the five patients without (42.1 vs. 24.9 months; p = 0.02, hazard ratio: 3.6, 95% CI 1.1–11.6). The toxicity profile was acceptable. Neoadjuvant cetuximab/TPF followed by chemoradiotherapy in locoregional oesophageal carcinoma patients is feasible and offers a modest response rate in this trial. The results of combining trimodality neoadjuvant treatment with cetuximab are consistent with the literature. Registration: The study is registered at ClinicalTrials.gov (NCT00733889).

Resumen Introduccion El tratamiento del cancer de esofago con pretension curativa requiere un planteamiento multidisciplinar. La terapia neoadyuvante, la radicalidad de la reseccion y la extension de la linfadenectomia pueden incrementar la morbimortalidad postoperatoria. El objetivo de este estudio es analizar los resultados del tratamiento quirurgico del cancer de esofago desde la creacion del Comite de Tumores Esofagogastricos. Metodos Estudio retrospectivo (de enero de 2005 a marzo de 2012) de todos los pacientes con cancer de esofago o de la union esofagogastrica a los que se les realizo una esofagectomia. Se analizaron el tipo de reseccion, las complicaciones postoperatorias, la mortalidad y la supervivencia. Resultados : A 100 pacientes de un total de 392 diagnosticados se les realizo una esofagectomia. En 74 casos se administro tratamiento neoadyuvante. Se realizaron 82 esofagectomias transtoracicas en 2 o 3 campos, 10 esofagectomias transhiatales y 8 coloplastias. En 98 pacientes la reseccion fue R0. Se diagnosticaron 9 dehiscencias anastomoticas intratoracicas y 6 cervicales. La morbilidad global fue del 42% y la mortalidad hospitalaria y a los 90 dias fue del 2%. La mediana de la estancia hospitalaria fue de 16 dias. La supervivencia actuarial al ano es del 82% y a los 5 anos, del 56%. Conclusiones El tratamiento quirurgico con intencion curativa de la neoplasia de esofago solo es posible en una cuarta parte de los pacientes diagnosticados. La elevada morbilidad se debe, sobre todo, a complicaciones toracicas.

Introduction Treatment of oesophageal cancer with curative intent requires a multidisciplinary approach. Neoadjuvant therapy, the radicality of resection and extension of lymphadenectomy have been associated with increased operative morbidity and mortality. The aim of this study was to assess the results of surgical treatment of oesophageal cancer since the presence of an interdisciplinary esophagogastric tumour board. Methods Patients with cancer of the oesophagus and oesophagogastric junction who underwent oesophagectomy between January 2005 and March 2012 were included in this retrospective study. Data concerning type of resection, postoperative complications, mortality and survival were analysed. Results Of the 392 patients with a diagnosis of oesophageal cancer over the study period, 100 underwent oesophagectomy. Seventy-four patients received neoadjuvant treatment. Eighty-two patients underwent transthoracic resection while a transhiatal was used in 10 patients. Colon interposition was required in 8 cases. An R0 resection was achieved in 98 patients. Anastomotic leaks developed in 15 patients, 9 were intrathoracic and 6 were cervical. Postoperative morbidity occurred in 42% of patients, and intra-hospital and 90-day mortality was 2%. Median length of hospital stay was 16 days. The respective actuarial survival at 1 and 5 years were 82% and 56%. Conclusions Surgical treatment with curative intention for oesophageal cancer is only possible in a quarter of patients diagnosed. The high morbidity rate was mainly due to intrathoracic complications.

Resumen Objetivo Definir factores pronostico de supervivencia a largo plazo tras la duodenopancreatectomia cefalica por adenocarcinoma pancreatico. Introduccion La cirugia es el tratamiento aceptado en el adenocarcinoma de pancreas cefalico, sin embargo la supervivencia a largo plazo sigue siendo baja. Material y metodos Hemos recogido la experiencia en el tratamiento del adenocarcinoma de cabeza de pancreas (ADCP) en el Hospital Universitari de Bellvitge mediante duodenopancreatectomia cefalica (DPC) desde 1991 hasta 2007. Resultados Se realizaron 204 DPC por ADCP. El estudio histologico evidencio que el tumor resecado tenia un tamano superior a 3 cm. en 70, con permeacion linfatica en un 73%, invasion perineural en 89% y afectacion linfatica en 71%. En 120 pacientes se resecaron mas de 15 adenopatias. Tras la cirugia, se administro tratamiento adyuvante a 113 pacientes (60%). Se contabilizaron 148 fallecimientos (73%), estando vivos al cierre del mismo 55 (27%). La supervivencia actual media fue de 2,54 anos (IC95% 2,02–3,07) y la supervivencia actuarial a 5 anos de 13,55% (IC95% 7,69–19,41). El estudio de factores de riesgo de mortalidad revelo que el sexo femenino (p=0,005), la ausencia de transfusion perioperatoria (p=0,003), la reseccion de mas de 15 adenopatias en la intervencion (p=0,004) y la administracion de tratamiento adyuvante (p=0,004) comportaron mejor pronostico a largo plazo. El estudio multivariante demostro que transfusion y sexo fueron las variables de interes. Conclusiones La cirugia del adenocarcinoma de cabeza de pancreas debe incluir una linfadenectomia suficiente y debe realizarse con baja morbilidad y sin necesidad de transfusion perioperatoria.

The prognosis of patients with unresectable M0 gastric cancer remains very poor. We performed a phase II trial to explore the efficacy and toxicity of induction irinotecan-cisplatin (IC) followed by concurrent irinotecan-cisplatin and radiotherapy (IC/RT) in this setting.Patients with unresectable M0 gastric (GC) or oesophageal-gastric junction (EGJC) adenocarcinomas were treated with two courses of IC (irinotecan, 65 mg/m(2); cisplatin, 30 mg/m(2) on days 1 and 8 every 21 days) followed by IC/RT (daily radiotherapy-45 Gy-with concurrent IC: irinotecan, 65 mg/m(2), and cisplatin, 30 mg/m(2), on days 1, 8, 15, and 22). Resectability was reassessed after this treatment, and surgical resection was performed if feasible. The primary endpoint was the R0 resection rate after induction treatment.Seventeen patients were included in the study (EGJC: 6; GC: 11). An R0 resection was achieved in only 5 patients (29%), and according to the design of the trial (Simon's optimal two-stage) accrual of patients was terminated after the first stage. No patient died during IC, whereas 3 patients (24%) died during IC/RT and one of 5 resected patients (20%) died during the first 30 days after resection. The median survival was 10.5 months, and the actuarial 2-year survival rate was 27%.Induction IC followed by IC/RT showed poor efficacy and significant toxicity in patients with unresectable GC/EGJC.

Introduction Surgery is the accepted treatment in adenocarcinoma of the head of the pancreas (ADHP); however, the long-term survival continues to be low. The aim of this study is to define prognostic factors of long-term survival after cephalic duodenopancreatectomy (CDP) due to pancreatic adenocarcinoma. Material and methods We have collected data on the treatment of adenocarcinoma of the head of the pancreas by means of a cephalic duodenopancreatectomy performed at the Hospital Universitari de Bellvitge (Barcelona) from 1991 to 2007. Results A total of 204 CDP due to ADHP were performed. The histology showed that the resected tumour was larger than 3cm in 70 cases, with lymphatic infiltration in 73%, perineural invasion in 89%, and lymphatic involvement in 89%. More than 15 lymph nodes were resected in 120 patients. A total of 113 (60%) patients received adjuvant treatment after surgery. There were 148 (73%) deaths, of which 55 (27%) were alive at closure. The actual mean survival was 2.54 years (95% CI; 2.02–3.07) and an actuarial survival at 5 years of 13.55% (95% CI; 7.69–19.41). The study of mortality risk factors showed that, female gender, absence of peri-operative transfusion ( P = .003), the resection of more than 15 lymph nodes during the operation ( P = .004), and the administration of adjuvant treatment ( P = .004) had a better long-term prognosis. The multivariate analysis showed that transfusion and gender were the most significant variables. Conclusions Surgery of head of the pancreas adenocarcinoma must include an adequate lymphadenectomy, and must be performed with a low morbidity and without the need of a peri-operative transfusion.

Purpose To determine in a Phase II trial whether preoperative irinotecan–cisplatin (IC) followed by concurrent IC therapy and radiotherapy (IC/RT) improved outcome in patients with resectable, locally advanced gastric adenocarcinoma (GC) or esophagogastric junction cancer (EGJC). Patients and Methods Patients with resectable Stage II–IV, M0 GC or EGJC made up the study population. The primary endpoint was pathologic complete response (pCR). Two courses of IC (irinotecan, 65mg/m 2 ; cisplatin, 30mg/m 2 on Days 1 and 8 every 21 days) were given. Patients without progression then received IC/RT, consisting of daily radiotherapy (45Gy) with concurrent IC (irinotecan, 65mg/m 2 ; cisplatin, 30mg/m 2 on Days 1, 8, 15, and 22). Surgical resection was performed, if feasible, 5–8 weeks after the end of radiotherapy. Results Twenty-three patients were included in the study: 10 with EGJC and 13 with GC. Two patients (9%) achieved pCR. The incidences of Grade 3–4 toxicities were as follows: IC: neutropenia 35% (febrile 13%), anemia 22%, diarrhea 22%, emesis 8%; IC/RT: neutropenia 52% (febrile 5%), asthenia 19%, anemia 9%, emesis 9%, diarrhea 5%, cardiotoxicity 5%. No patients died during IC or IC/RT. R0 resection was achieved in 15 patients (65%). Median survival was 14.5 months, and the actuarial 2-year survival rate was 35%. Conclusions Preoperative IC followed by IC/RT resulted in moderate response and resection rates with mild toxicity in patients with GC and EGJC.

Chemotherapy has improved the overall survival (OS) in patients (pts) with advanced gastric cancer (AGC). Docetaxel (D), oxaliplatin (O) and capecitabine (C) have shown interesting activity in this setting. We defined “suboptimal” pts as those with PS ECOG = 2, weight loss 10–25 % and/or age ≥70 years. This population is usually underrepresented in AGC clinical trials. We explored in 43 previously untreated “suboptimal” AGC pts the effect of “miniDOX” regimen (D: 40 mg/m2 iv, day 1; O: 80 mg/m2 iv, day 1; C: 625 mg/m2 po bid, day 1 to day 21, every 21 days; after six courses, only C was maintained). Primary end point was response rate (RR), and secondary end points were adverse events (AE), progression-free survival (PFS) and overall survival (OS). Patients characteristics: PS ECOG = 2: 12 pts; weight loss 10–25 %: 23 pts; median age 73.3 years (range 40–87; 28 pts were ≥70 years); 32 males; locally advanced: 8 pts/metastatic: 35 pts; primary site: gastric 32 pts/EGJ 11. Worst AE per pt (grade 3–4): neutropenia: 5 pts (febrile neutropenia: 3); pulmonary embolism (PE): 4 pts (3 of them suffered sudden death); diarrhea: 9 pts; paronychia: 2 pts; ictus: 1 pt; renal failure: 1 pt (this pt suffered infection/bacteriemia without neutropenia and died); hand-foot syndrome: 4 pts and asthenia: 5 pts. Response: CR: 1 pt, PR: 23 pts (RR: 56 %), SD: 12 pts, progression: 3 pts, no determined: 4 pts. Median and 1 year actuarial PFS and OS were 5.5 months/18 % and 13.3 months/52 %, respectively. Although miniDOX’s toxicity (mainly PE)has been important, its activity has been promising in “suboptimal” pts with AGC, and this combination should be further investigated in this setting.

Treatment of oesophageal cancer with curative intent requires a multidisciplinary approach. Neoadjuvant therapy, the radicality of resection and extension of lymphadenectomy have been associated with increased operative morbidity and mortality. The aim of this study was to assess the results of surgical treatment of oesophageal cancer since the presence of an interdisciplinary esophagogastric tumour board.Patients with cancer of the oesophagus and oesophagogastric junction who underwent oesophagectomy between January 2005 and March 2012 were included in this retrospective study. Data concerning type of resection, postoperative complications, mortality and survival were analysed.Of the 392 patients with a diagnosis of oesophageal cancer over the study period, 100 underwent oesophagectomy. Seventy-four patients received neoadjuvant treatment. Eighty-two patients underwent transthoracic resection while a transhiatal was used in 10 patients. Colon interposition was required in 8 cases. An R0 resection was achieved in 98 patients. Anastomotic leaks developed in 15 patients, 9 were intrathoracic and 6 were cervical. Postoperative morbidity occurred in 42% of patients, and intra-hospital and 90-day mortality was 2%. Median length of hospital stay was 16 days. The respective actuarial survival at 1 and 5 years were 82% and 56%.Surgical treatment with curative intention for oesophageal cancer is only possible in a quarter of patients diagnosed. The high morbidity rate was mainly due to intrathoracic complications.

Skin rash is an adverse event which might be associated with longer survival in patients treated with epidermal growth factor receptor tyrosine kinase inhibitors. The aim of this nonrandomised phase II clinical trial is to prospectively evaluate the relationship between skin rash and overall survival (OS) in advanced/metastatic pancreatic cancer treated with erlotinib plus gemcitabine.Patients were given gemcitabine (1000 mg/m2/week, 3 weeks every 4 weeks) plus erlotinib (100 mg/day orally continuously) until disease progression/unacceptable toxicity. The primary end point was OS.A total of 153 eligible patients were enrolled (grade≥2 rash, 25%; grade2 rash, 75%). OS was longer in patients with grade≥2 rash versus grade2 (11 versus 5 months; P0.001). Progression-free survival was longer in patients with grade≥2 rash versus grade2 (6 versus 3 months; P0.001) and shorter in those without rash versus grade 1 (2 versus 4 months; P=0.005) or grade≥2 (2 versus 6 months; P0.001). Patients with grade≥2 rash showed higher rates of overall response (21% versus 7%; P0.05) and disease control (84% versus 43%; P0.05) versus grade2.This study prospectively confirms the relationship between rash and longer OS in unresectable locally advanced/metastatic pancreatic cancer treated with erlotinib plus gemcitabine.

Treatment of locally advanced esophageal cancers with high-dose definitive concomitant chemoradiotherapy can lead to high-grade esophageal strictures, or, rarely, total obliteration of the lumen. Strictures can be successfully treated with various endoscopic techniques; however, complete obstruction is a technically challenging problem. Anterograde endoscopic techniques carry the risk of perforation or bleeding. A combined anterograde–retrograde dilation technique, described in a few reports, is another option but requires retrograde access through a prior ostomy [1–4]. We report a novel method for managing complete esophageal obstruction using endoscopic ultrasound (EUS)-guided puncture for access to the distal lumen, previously described only in a case of total colonic stricture using a prototype forward-view echoendoscope [5]. A 62-year-old woman had received highdose chemoradiation for a squamous cell esophageal carcinoma (stage IIIC) and her esophagus had completely occluded, with severe compromise to her quality of life (●" Fig.1). Several attempts to pass a guide wire though the stricture were unsuccessful. We decided to attempt recanalization of the lumen using an EUS-guided access. The linear echoendoscope (GF-UCT140AL5;Olympus, Tokyo, Japan)wasadvanced 24cm from the incisors and the distal esophageal lumenwas identified from the proximal endon theEUSimage (●" Fig.2a). A 19G needle (Expect Flex; Boston Scientific Corp, Natick, Massachusetts, USA) was used to puncture the obstructed lumen under EUS guidance (●" Fig.2b). Contrast filling was visualized under fluoroscopy and a 0.035-inch guide wire (Microvasive Jagwire; Boston Scientific) was advanced through the EUS needle (●" Fig.3a,b). An 8-mm biliary balloon (Hurricane RX; Boston Scientific) was used to perform a first dilation under endoscopic and fluoroscopic guidance (●" Fig.3c). The endoscopic appearance after dilation was satisfactory, with reestablishment of luminal continuity (●" Video 1). The patient underwent four additional endoscopic balloon dilations of up to 15mm (●" Fig.4). She respondedwell, gaining the ability to swallow secretions, drinks, and soft food, andwithout evidence of delayed complications. Fig.2 a,b EUS images of the esophageal total stricture. a A thickened esophageal wall (arrows) continues through the stenosis. b EUS image of the 19G needle through the stricture (arrow).

To assess if surgical manipulation increases peripheral blood cancer cells dissemination in early stage (I and II) breast cancer patients.We analyzed 64 patients using RT-PCR for cytokeratin-19 as a marker for peripheral blood breast cancer cell dissemination. Peripheral blood was obtained at 4 different time-points (24 hours before and after surgery, one week and one month later).RT-PCR was positive in 14 (24%) out of 59 evaluable patients. Circulating cells were detected in 4 out of 14 patients before surgery (7%) while in the remaining 10, the positivity was observed after surgery (17%). The percentage of patients with occult breast cancer cells increased significantly after surgery (p = 0.01).1) 7% of early breast cancer patients had circulating tumor cells before surgery. 2) After surgery tumor cells were detected in 17% of patients. 3) Surgery significantly increased the presence of occult breast cancer cells. 4) The clinical significance of occult breast cancer cells should be tested within a larger clinical trial trying to assess their role as an independent prognostic factor.

4098 Background: Perioperative chemotherapy has demonstrated better OS and DFS than surgery alone in resectable stomach or EGJ adenocarcinoma. Trastuzumab has improved OS when added to chemotherapy in pts with HER-2 + metastatic gastric cancer and is interesting to explore its role in the perioperative setting. Methods: A Spanish, multicenter, open-label phase II study evaluated the efficacy and toxicity profile of perioperative XELOX-T (capecitabine 1000 mg/m2/12h po days 1-14, oxaliplatin 130 mg/m2 day 1, trastuzumab 8 mg/kg→ mg/kg day 1, q3w ; 3 preoperative cycles and 3 postsurgery cycles followed by 12 cycles of trastuzumab monotherapy) in patients with T1-2N+M0 or T3-4NxM0 resectable stomach or EGJ adenocarcinoma, HER-2+ ( IHQ3+ or IHQ2+/FISH+). The primary endpoint was 18 months DFS, secondary endpoint included pCR, R0 resection rate, ORR and toxicity of preoperative treatment (NCI CTC v3.0 criteria). Results: From June 2010 to March 2012, 36 pts were included: median age 65 (39-85); ECOG 0/1/2: 16/19/1 pts; localization: stomach 21 pts, EGJ 15 pts; histologic type: intestinal: 23 pts, diffuse: 4 pts, mixed: 1pt, not specified 8 pts; TNM: T 4: 7 pts; N+: 31 pts. Preoperative XELOX-T: Response: PR: 14 pts (39%), SD: 18 pts, PD: 0 pts, NE: 4 pts. G-3-4 toxicity (≥ 5% of pts): diarrhea 22% and asthenia 5%. Surgery was performed in 31 pts: R0: 28 pts (78%, 95% CI: 61-90%), R1: 1 pt, R2: 2 pts (1 had peritoneal carcinomatosis); pCR was observed in 7 pts (19 %; 95% CI: 8-36%) and 22 pts (61%) were pN0. Two pts died due to surgical complications,. We do not have mature data about postoperative XELOX-T yet. Follow-up is still too short for DFS and OS. Conclusions: This preliminary analysis suggests that perioperative XELOX+T in HER-2 positive resectable stomach or esophagogastric junction adenocarcinoma is feasible and has interesting activity. Clinical trial information: NCT01130337.

e15111 Background: Modern management of Oesophageal and oesophagogastric junction (OGJ) cancers requires a multidisciplinary approach, which was implemented at our health centre in 2005. This study aimed to assess the impact of this change on clinical outcomes. Methods: A retrospective cohort study was conducted, covering all patients treated for oesophageal and OGJ cancer at the cancer centre established by the Bellvitge University Hospital and Catalonian Institute of Oncology, over two time periods, i.e., 2000-2004 and 2005-2008. Descriptive and multivariate analyses were performed using survival at 1 and 3 years as dependent variables. Results: Between 1 January 2000 and 31 December 2008, 586 patients were included. Number of patients with unknown stage at diagnosis was significantly reduced. Neoadjuvant strategies at the oesophageal location clearly increased in the recent period. A multidisciplinary approach resulted in a significant reduction in surgical mortality (11.8% vs. 2%) in the period 2005-2008. Analysis restricted to patients undergoing surgery with curative intent indicated a significant increase in 1- and 3-year survival in the latter period (68.4% vs. 89.8% and 38.2% vs. 57.1% respectively). Multivariate analysis showed that variables associated with improved survival were: age; tumour stage; radical intent of treatment (surgery and radical combined chemoradiotherapy); and therapeutic strategy. Conclusions: Better selection of patients for therapy together with improved staging resulted in a significant improvement in 1- and 3-year survival in cases undergoing surgery with curative intent. These changes would support the adoption of a multidisciplinary approach to clinical decision-making in cases of oesophageal and OGJ cancer.

Introduction Since 2006, the results of MAGIC trial demonstrated that a perioperative regimen of Epirrubicin-cisplatin-5FU (ECF) decreases tumour size and stage, with significantly improvement in overall survival (OS) and progression-free survival (PFS). However, the survival rate of patients (pts) with locally advanced resectable gastric cancer (LARGC) remains poor. Our aim was to identify prognostic factors and their correlation with a more aggressive disease in our area. Methods We retrospectively reviewed 65 pts with LARGC who were planned to receive perioperative chemotherapy followed by surgery at our institution, between May 2008 and February 2012. We analysed the correlation between mOS and recurrence free survival (RFS) with patient characteristics, sex and age, and some tumour characteristics, as histology, tumour localization, both clinical and pathological stage, and tumour regression rate (TRR). OS and RFS was analysed using Kaplan-Meier curves and the differences with Log-Rank test. Results 16 women and 49 men were analysed, with a median age of 63 years (range 38-78). 41% pts had a diffuse type, 49% an intestinal type and 10% a mixt type adenocarcinoma. 30% of tumours were proximal and 70% were distal. There were clinically 1.6% stage I, 49.2% stage II and 49.2% stage III pts. 58 pts (98%) completed 3 cycles of neoadjuvant chemotherapy. 42 pts received ECF, whereas 23 pts received other schemes (13 pts carboplatin+5FU, 8 pts cisplatin+5FU, 2 pts other combinations). Radiological downstaging was observed in 59% pts. 40 total gastrectomy, 14 partial gastrectomy and 9 Ivor-Lewis were conducted. There was 1 pt who underwent a palliative derivation. We found 1 surgery-related death. Adjuvant chemotherapy was delivered in 45 pts. There were pathologically 22% stage I, 47% stage II, 22% stage III and 9% stage IV pts. Pathological downstaging in terms of TRR (RG1+RG2+RG3) was obtained in 42% pts, achieving 3 complete responses (RG1). 4 pts had marked regression (RG2) and 19 pts had 10-50% viable tumour remaining (RG3), meanwhile 36 pts did not respond (RG4). The median follow-up of the whole group was 24 months. We did not reach nor the mOS neither the mRFS, given that 70% pts were alive after 2 years. 2 year OS was 72% (95 CI, 60.3%-83.6%) and 2 year RFS was 52.5% (95 CI, 39.8%-65.3%). Age Conclusion Preoperative chemotherapy contributes to pathological downstaging and histologic tumour regression in less than 50% pts. Age>60 years, minor pathological downstaging and tumour regression rate have been objectively correlated to poor outcomes. New patient and tumour characteristics must be identified as prognostic and predictive factors. The development of targeted therapies should provide new possibilities in the treatment of LARGC.

Introduction The long term survival of patients with resectable pancreatic cancer (PC) is appalling, so data regarding what factors may influence outcome, following attempted curative resection is essential in order to optimize the treatment options for patients. Our aims were to analyze prognostic factors influencing survival in patients with resected PC in our institution. Methods Eligible participants included all persons diagnosed with pancreatic cancer from June 2004 to August 2008 that underwent pancreaticoduodenectomy for adenocarcinoma of only pancreatic head at the Surgical Department in Bellvitge Hospital. Risk factors associated with overall survival (OS) and Progression Free Survival (PFS) were assessed with the Kaplan-Meier survival method and the log-rank test. Demographic, tumour, and clinical variables were assessed using the Cox proportional hazards model. We also examined plasmatic VEGF (pVEGF) levels in these patients to evaluate the prognostic significance of these levels and correlate the results with the clinic- pathological features, microvascular density and K-RAS gene status. Results The median follow-up was 17.8 months for all patients. The median follow-up for living patients was 40 months (range 3-83 months). The median survival time for all patients was 21.26 months (95% confidence interval 13.29-29.24 months).The median Progression Free Survival for all patients was 15.76 months (95% confidence interval 4.99-26.54 months). Pathological stage was unfavorable prognostic factor in our pancreas cancer patients by univariate and multivariate analysis for OS and PFS. Perineural and vascular invasion as well as R1 resection were also negative prognostic factors for PFS. There was no survival correlation between high levels of p-VEGF and the remaining clinico-pathological features (including the number of resected nodes, microvascular density or K-RAS gene status). Conclusion Our results are consistent with the most important published studies and tumor characteristics remain the best significant features influencing survival after pancreatic cancer surgery.

Introduction Fluoropyrimidine (F) and platinum (P) combination chemotherapy has been widely used as a first-line treatment of advanced gastric cancer (AGC). Docetaxel has been considerable promise against this disease. We want to investigate the efficacy and safety of docetaxel monotherapy as salvage chemotherapy for AGC in clinical practice and determine the prognostic factors in these patients. Methods We retrospectively reviewed the medical records of patients with AGC for whom fluoropyrimidine and platinum had previously failed and who had received docetaxel salvage monotherapy between March 2005 and December 2011. Docetaxel was administered at a dose of 75 mg/m(2) intravenously every 3 weeks with dexamethasone prophylaxis. Results A total of 40 patients received 133 cycles of docetaxel with a median of three cycles per patient (range 1-6). The median age was 63 years (range 38-78 years). The objective response rate was 10%, with 4 partial responses, with response duration of 1.1, 2.2, 2.6 and 7.1 months respectively. An additional 4 patients achieved stable disease. The median time to progression (TTP) for all patients was 1.9 months [95% confidence interval (CI), 1.2-2.7] and the median overall survival (OS) from the start of docetaxel chemotherapy was 4.1 months (95% CI, 3.6-4.6). Grade 3/4 neutropenia and febrile neutropenia occurred in 15% of patients and anemia occurred in 12.5%. The incidence of non-hematologic toxicities of grade 3 or worse was asthenia 25%, anorexia 12.5%, diarrhea 2.5% and stomatitis 2.5%. Multivariate analysis showed that the Eastern Cooperative Oncology Group (ECOG) performance status (0 or 1 versus 2) was an independent prognostic factor for both TTP and OS. Number of metastatic sites was a predictor for better TTP. Conclusion Docetaxel 75 mg/m(2) is relatively active against AGC as a second-line salvage treatment after failure of fluoropyrimidine and platinum combination chemotherapy in general clinical practice. The toxicity profile is moderate. Further investigation in salvage therapy is needed, in order to improve survival and provide palliation of symptoms.

4094 Background: Skin rash is a common adverse event associated with HER1/EGFR-targeted agents. Clinical trials suggest a relationship between the development of rash and response and/or survival. ...

e14573 Background: Chemoradiotherapy is an effective treatment in esophageal cancer p; however, there are no reliable pretreatment clinical parameters to predict the efficacy of this multimodal app...

12031 Background: Human tumor xenografts in mice can be remarkably predictive of response in humans to cytotoxic chemotherapeutic drugs. Tumor endothelial cells are sensitive to the action of conventional cytotoxic drugs when they are regularly administrated at low doses. This concept, known as metronomic chemotherapy, has been demonstrated in preclinical studies using transplanted tumor models. We aim to investigate the potential anti-tumoral activity of Gemcitabine (G) when administered in a low-dose schedule in an ortothopic implantation model of human pancreatic carcinomas. Methods: Standard gemcitabine schedule: NP18 tumor orthotopically implanted nude mices were randomly distributed to experimental (n = 13, G100 mg/kg intraperitoneally on days 0, 3, 6 and 9 post-implantation) and control group (n = 13, saline). Animal were sacrificed after 4 weeks and we compared weigths (grams) and volume (cm3) of tumors betwen the two groups by the Mann-Whitney U test. Metronomic schedule: After a toxicological study an optimal metronomic dose of 1 mg G /kg per day was chosen. Thirty xenografted mices were randomly distributed to experimental group (n = 15, intraperitoneal G1 mg/kg) and control group (n = 15, saline) and treated for 30 days. Animal were analysed as described before. Results: Standard schedule: Tumor weight mean of treatment group was 0.01 grams ± 0.01 versus 0.54 grams ± 0.48 of the control group. Tumor volume mean in G group was 0.01 cm 3 ± 0.01 versus 0.51 cm 3 ± 0.67) in the control group.Treatment significantly inhibited NP18 tumour growth (p < 0.001). No differences in mice weight were observed between both groups. Metronomic schedule: Tumor weight mean in the treatment group was 0.04 grams ± 0.08 versus 0.53 grams ± 0.46 in control group. Tumor volume mean in G group was 011 cm 3 ± 0.19 versus 0.37 cm 3. Treatment with low-dose of G significantly inhibited NP18 tumour growth (p < 0.003). There were no differences in mice weight between the two groups. Conclusions: Our data show that G administered in a metronomic schedule is effective in inhibiting the growth of NP18 tumor orthotopically implanted in the nude mice. We now aim to study the angiogenic profile of tumors receiving the standard and metronomic schedule and to set up a new experiment to compare survival benefit in the animal model. No significant financial relationships to disclose.

Gemcitabine shows a marked antitumor effect as a result of its cytotoxic action toward proliferative cells. In this article, we aim to investigate the potential antitumor and antiangiogenic effect of gemcitabine following a metronomic schedule that involves the regular administration of cytotoxic drugs at doses lower than standard treatment. In vitro results showed that human endothelial cells are more sensitive to gemcitabine (IC50 3 nmol/L) than pancreatic tumor cells (IC50 20 nmol/L). For in vivo studies, we used an orthotopic implantation model of human pancreatic carcinoma in nude mice. Gemcitabine was administered i.p. following a low-dose schedule (1 mg/kg/d for a month) and compared with the conventional schedule (100 mg/kg days 0, 3, 6, and 9 postimplantation). Metronomic treatment effect on established tumor was equivalent to standard administration. The measure of CD31 endothelial marked area allowed us to show an in vivo antiangiogenic effect of this drug that was further enhanced by using metronomic administration. This effect correlated with an induction of thrombospondin-1, a natural inhibitor of angiogenesis. Our results allow us to hypothesize that, in addition to a direct antiproliferative or cytotoxic antiendothelial cell effect, a secondary effect involving thrombospondin-1 induction might provide an explanation for the specificity of the effects of metronomic gemcitabine treatment. [Mol Cancer Ther 2008;7(3):638–47]