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Locally Advanced Colon Cancer: Evaluation of Current Clinical Practice and Treatment Outcomes at the Population Level

Charlotte E.L. Klaver, Lieke Gietelink, Willem A. Bemelman, Michel W.J.M. Wouters, Theo Wiggers, Rob A.E.M. Tollenaar, Pieter J. Tanis, and on behalf of the Dutch Surgical Colorectal Audit Group

Background: The goal of this study was to evaluate current clinical practice and treatment outcomes regarding locally advanced colon cancer (LACC) at the population level. Methods: Data were used from the Dutch Surgical Colorectal Audit from 2009 to 2014. A total of 34,527 patients underwent resection for non-LACC and 6,918 for LACC, which was defined as cT4 and/or pT4 stage. LACC was divided into those with multivisceral resection (LACC-MV; n=3,385) and without (LACC-noMV; n=1,595). Guideline adherence, treatment strategy, and short-term outcomes were evaluated. Results: Guideline adherence was >90% regarding preoperative imaging and ≥80% regarding preoperative multidisciplinary team (MDT) discussion. In the elective setting, neoadjuvant chemoradiotherapy (chemoRT) was applied in 6.2% of the cT4 cases, and neoadjuvant chemotherapy in 4.0%. R0 resection rates were 99%, 91%, and 87% in patients with non-LACC, LACC-noMV, and LACC-MV, respectively (P<.001). A postoperative complicated course occurred in 17%, 25%, and 29% of patients (P<.001), and the 30-day/in-hospital mortality rate was 3.6%, 6.0%, and 5.4% (P<.001) in the non-LACC, LACC-noMV, and LACC-MV groups, respectively. Discussion/Conclusions: This population-based study suggests that there is room for improvement in the treatment of LACC, with regard to short-term surgical outcomes and oncologic outcomes (ie, radicality of resection). Improvement might be expected from optimized preoperative imaging, routine MDT discussions, and further specialization and centralization of care. Optimized use of neoadjuvant treatment strategies based on already available and upcoming evidence is likely to result in a better margin status and thereby a better long-term prognosis. Furthermore, lower R0 resection rates in an emergency setting suggest a potential role for bridging strategies in order to enable optimal staging, neoadjuvant treatment, and elective surgery by a surgical team most optimally qualified for the procedure.

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Quality of Life Is Associated With Survival in Patients With Gastric Cancer: Results From the Randomized CRITICS Trial

Romy M. van Amelsfoort, Iris Walraven, Jacobien Kieffer, Edwin P.M. Jansen, Annemieke Cats, Nicole C.T. van Grieken, Elma Meershoek-Klein Kranenbarg, Hein Putter, Johanna W. van Sandick, Karolina Sikorska, Cornelis J.H. van de Velde, Neil K. Aaronson, Marcel Verheij, and on behalf of the CRITICS Investigators

Background: The evaluation of health-related quality of life (HRQoL) in clinical trials has become increasingly important because it addresses the impact of treatment from the patient’s perspective. The primary aim of this study was to investigate the effect of postoperative chemotherapy and chemoradiotherapy (CRT) after neoadjuvant chemotherapy and surgery with extended (D2) lymphadenectomy on HRQoL in the CRITICS trial. Second, we investigated the potential prognostic value of pretreatment HRQoL on event-free survival (EFS) and overall survival (OS). Patients and Methods: Patients in the CRITICS trial were asked to complete HRQoL questionnaires (EORTC Quality-of-Life Questionnaire-Core 30 and Quality-of-Life Questionnaire gastric cancer–specific module) at baseline, after preoperative chemotherapy, after surgery, after postoperative chemotherapy or CRT, and at 12 months follow-up. Patients with at least 1 evaluable questionnaire (645 of 788 randomized patients) were included in the HRQoL analyses. The predefined endpoints included dysphagia, pain, physical functioning, fatigue, and Quality-of-Life Questionnaire-Core 30 summary score. Linear mixed modeling was used to assess differences over time and at each time point. Associations of baseline HRQoL with EFS and OS were investigated using multivariate Cox proportional hazards analyses. Results: At completion of postoperative chemo(radio)therapy, the chemotherapy group had significantly better physical functioning (P=.02; Cohen’s effect size = 0.42) and less dysphagia (P=.01; Cohen’s effect size = 0.38) compared with the CRT group. At baseline, worse social functioning (hazard ratio [HR], 2.20; 95% CI, 1.36–3.55; P=.001), nausea (HR, 1.89; 95% CI, 1.39–2.56; P<.001), worse WHO performance status (HR, 1.55; 95% CI, 1.13–2.13; P=.007), and histologic subtype (diffuse vs intestinal: HR, 1.94; 95% CI, 1.42–2.67; P<.001; mixed vs intestinal: HR, 2.35; 95% CI, 1.35–4.12; P=.003) were significantly associated with worse EFS and OS. Conclusions: In the CRITICS trial, the chemotherapy group had significantly better physical functioning and less dysphagia after postoperative treatment. HRQoL scales at baseline were significantly associated with EFS and OS.

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HSR22-143: Outcome Differences Amongst Stage-Matched Inflammatory vs Non-Inflammatory Breast Cancer Patients

Michael Grimm, Kai Johnson, Patrick Schnell, Ashley Pariser, Margaret Gatti-Mays, Jeffrey VanDeusen, Nicole Williams, Daniel Stover, Sagar Sardesai, Robert Wesolowski, Preeti Sudheendra, Bhuvaneswari Ramaswamy, Ko Un Park, Sachin R Jhawar, Amy Kerger, and Mathew A Cherian

patients diagnosed with IBC: neoadjuvant chemotherapy, modified radical mastectomy, and chest wall and regional nodal radiation therapy. This multidisciplinary approach has improved survival rates for patients with IBC. In spite of aggressive therapies

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CLO23-058: Targeted Axillary Dissection Post Primary Chemotherapy: Data Analysis From a Single Multidisciplinary Unit in South Africa

Carol-Ann Benn, Bernado Rapoport, and Dominic van Loggerenberg

receive primary/neoadjuvant chemotherapy as their initial treatment for breast cancer. Standard of care post-NAC has traditionally required an axillary dissection. Recently, targeted axillary dissection has been postulated and studied in many academic

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CLO23-045: A Prospective Interventional Study to Assess the Response of Systemic Chemotherapy in Aggressive, Recurrent Giant Cell Tumor

Mohit Dhingra, Saroj Sah, Amit Sehrawat, and Sonal Saran

was conducted from January 2021 to July 2022. A total of 25 patients with histologically proven giant cell tumors were included. Of them 8 patients took interferons and 17 denosumab as neoadjuvant chemotherapy. The clinical outcome was evaluated by

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Chemotherapy in the Management of Osteosarcoma and Ewing's Sarcoma

Scott M. Schuetze

for patients aged under 40 years with bone sarcoma in Britain, 1980–1994 . Br J Cancer 2006 ; 94 : 22 – 29 . 4. Bacci G Mercuri M Longhi A . Neoadjuvant chemotherapy for the treatment of osteosarcoma of the extremities: a comparison of

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Authors’ Reply to Letter to the Editor by Chen et al

Fei Gao, Nan Li, YongMei Xu, and GuoWang Yang

recommended for patients with resected stage IIIA disease, including those with resected stage IIIA-N2 disease who can tolerate chemotherapy. 2 It is undeniable that preoperative neoadjuvant chemotherapy is applied to patients with IIIA-N2 disease, but in the

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Oncology Research Program

With Residual Disease Post Standard Neoadjuvant Chemotherapy Principal investigator: Kimberly Blackwell, MD Sub-investigators: Sarah Sammons, MD; Paul Kelly Marcom, MD; Kelly Westbrook, MD; and Gretchen Kimmick, MD Condition: Breast cancer

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NCCN Guidelines Insights: Bladder Cancer, Version 2.2016

Peter E. Clark, Philippe E. Spiess, Neeraj Agarwal, Rick Bangs, Stephen A. Boorjian, Mark K. Buyyounouski, Jason A. Efstathiou, Thomas W. Flaig, Terence Friedlander, Richard E. Greenberg, Khurshid A. Guru, Noah Hahn, Harry W. Herr, Christopher Hoimes, Brant A. Inman, A. Karim Kader, Adam S. Kibel, Timothy M. Kuzel, Subodh M. Lele, Joshua J. Meeks, Jeff Michalski, Jeffrey S. Montgomery, Lance C. Pagliaro, Sumanta K. Pal, Anthony Patterson, Daniel Petrylak, Elizabeth R. Plimack, Kamal S. Pohar, Michael P. Porter, Wade J. Sexton, Arlene O. Siefker-Radtke, Guru Sonpavde, Jonathan Tward, Geoffrey Wile, Mary A. Dwyer, and Courtney Smith

Perioperative Chemotherapy One of the most noteworthy issues in the treatment of bladder cancer is the optimal use of perioperative chemotherapy for muscle-invasive disease. Data support the role of neoadjuvant chemotherapy before cystectomy for T2, T3, and T4

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CLO23-040: Electrocardiographic Findings in Cancer Patients Receiving Chemotherapy From the Colombian Coffee Triangle Region

Andres Garcia, David Medina, Alejandra Palacio, Andrés Vallejo, Luz Adriana Díaz, Juan Darío Franco, Tatiana Taborda, and María José Rojas

Background: Some antineoplastic agents are known for their cardiotoxicity, especially anthracyclines, used for breast cancer neoadjuvant chemotherapy and induction treatment for some hematological malignancies. Nevertheless, there is scarce