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Wagner P, Levine EA, Kim AC, Shen P, Fleming ND, Westin SN, Berry LK, Karakousis GC, Tanyi JL, Olson MT, Madajewski B, Ostrander B, Krishnan K, Balch CM, Bartlett DL. Detection of Residual Peritoneal Metastases Following Cytoreductive Surgery Using Pegsitacianine, a pH-Sensitive Imaging Agent: Final Results from a Phase II Study. Ann Surg Oncol 2024:10.1245/s10434-024-15165-4. [PMID: 38622456 DOI: 10.1245/s10434-024-15165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/25/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND For patients with peritoneal carcinomatosis, extent of disease and completeness of cytoreductive surgery (CRS) are major prognostic factors for long-term survival. Assessment of these factors could be improved using imaging agents. Pegsitacianine is a pH-sensitive polymeric micelle conjugated to the fluorophore indocyanine green. The micelle disassembles in acidic microenvironments, such as tumors, resulting in localized fluorescence unmasking. We assessed the utility of pegsitacianine in detecting residual disease following CRS. PATIENTS AND METHODS NCT04950166 was a phase II, non-randomized, open-label, multicenter US study. Patients eligible for CRS were administered an intravenous dose of pegsitacianine at 1 mg/kg 24-72 h before surgery. Following CRS, the peritoneal cavity was reexamined under near-infrared (NIR) illumination to evaluate for fluorescent tissue. Fluorescent tissue identified was excised and evaluated by histopathology. The primary outcome was the rate of clinically significant events (CSE), defined as detection of histologically confirmed residual disease excised with pegsitacianine or a revision in the assessment of completeness of CRS. Secondary outcomes included acceptable safety and pegsitacianine performance. RESULTS A total of 53 patients were screened, 50 enrolled, and 40 were evaluable for CSE across six primary tumor types. Residual disease was detected with pegsitacianine in 20 of 40 (50%) patients. Pegsitacianine showed high sensitivity and was well tolerated with no serious adverse events (SAEs). Transient treatment-related, non-anaphylactic infusion reactions occurred in 28% of patients. CONCLUSIONS Pegsitacianine was well tolerated and facilitated the recognition of occult residual disease following CRS. The high rate of residual disease detected suggests that the use of pegsitacianine augmented surgeon assessment and performance during CRS.
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Affiliation(s)
- Patrick Wagner
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Edward A Levine
- Department of Surgical Oncology, Atrium Health Wake Forest Baptist, Wake Forest University, Winston-Salem, NC, USA
| | - Alex C Kim
- Division of Surgical Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Perry Shen
- Department of Surgical Oncology, Atrium Health Wake Forest Baptist, Wake Forest University, Winston-Salem, NC, USA
| | - Nicole D Fleming
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Laurel K Berry
- Department of Gynecologic Oncology, Atrium Health Wake Forest Baptist, Wake Forest University, Winston-Salem, NC, USA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Janos L Tanyi
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Charles M Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David L Bartlett
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
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Levine EA. Reconnaissance for Intraperitoneal Immunotherapy. Ann Surg Oncol 2024; 31:2194-2195. [PMID: 38261129 DOI: 10.1245/s10434-023-14858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Edward A Levine
- Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA.
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Pestana C, Cairns A, Fang-Chi H, Lombana G, Howard-McNatt M, Levine EA, Chiba A. Rates of high-risk screening prior to a breast cancer diagnosis in patients under age 40. Am J Surg 2024; 228:218-221. [PMID: 37863802 DOI: 10.1016/j.amjsurg.2023.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND NCCN Guidelines recommend screening young women with an increased breast cancer risk (>20 % lifetime risk). We sought to evaluate our institutional rates of high-risk screening in young breast cancer patients prior to their diagnoses." METHODS A single-institution retrospective review (2013-2018) was performed investigating risk scores (Tyrer-Cuzick model) and characteristics of breast cancer patients (age <40 y) prior to diagnosis. RESULTS 92 breast cancer patients age <40 y were identified (average age 34.5). Only 3.3 % (n = 3) underwent appropriate screening, despite 35.8 % meeting high-risk criteria. Nearly all patients underwent genetic testing (98.9 %) with pathogenic mutations identified in 36.5 %, including 15.3 % with BRCA1/2 mutations. CONCLUSIONS This analysis highlights a significant discrepancy between those meeting criteria for high-risk screening and those who underwent appropriate screening. We identified that this cohort carries significant genetic burden. Future analysis should investigate these findings on a broader scale and strategies to improve screening.
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Affiliation(s)
- Christine Pestana
- Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Ashley Cairns
- Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Hsu Fang-Chi
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | | | - Marissa Howard-McNatt
- Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Edward A Levine
- Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Akiko Chiba
- Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Solsky I, Patel A, Leonard G, Russell G, Perry K, Votanopoulos KI, Shen P, Levine EA. Distance Traveled and Disparities in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2024; 31:1035-1048. [PMID: 37980711 DOI: 10.1245/s10434-023-14469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/05/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The impact of distance traveled on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) outcomes needs further investigation. METHODS This retrospective study reviewed a prospectively managed single-center CRS/HIPEC 1992-2022 database. Zip codes were used to calculate distance traveled and to obtain data on income and education via census data. Patients were separated into three groups based on distance traveled in miles (local: ≤50 miles, regional: 51-99 miles, distant: ≥100 miles). Descriptive statistics, Kaplan-Meier method, and Cox regression were performed. RESULTS The 1614 patients in the study traveled a median distance of 109.5 miles (interquartile range [IQR], 53.36-202.29 miles), with 23% traveling locally, 23.9% traveling regionally, and 53% traveling distantly. Those traveling distantly or regionally tended to be more white (distant: 87.8%, regional: 87.2%, local: 83.2%), affluent (distant: $61,944, regional: $65,014, local: $54,390), educated (% without high school diploma: distant: 10.6%, regional: 11.5%, local: 13.0%), less often uninsured (distant: 2.3%, regional: 4.6%, local: 5.2%) or with Medicaid (distant: 3.3%, regional: 1.3%, local: 9.7%). They more often had higher Peritoneal Carcinomatosis Index (PCI) scores (distant: 15.4, regional: 15.8, local: 12.7) and R2 resections (distant: 50.3%, regional: 52.2%, local: 40.5%). Median survival did not differ between the groups, and distance traveled was not a predictor of survival. CONCLUSION More than 50% of the patients traveled farther than 100 miles for treatment. Although regionalization of CRS/HIPEC may be appropriate given the lack of survival difference based on distance traveled, those who traveled further had fewer health care disparities but higher PCI scores and more R2 resections, which raises concerns about access to care for the underserved, time to treatment, and surgical quality.
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Affiliation(s)
- Ian Solsky
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Ana Patel
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Grey Leonard
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Gregory Russell
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathleen Perry
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | - Perry Shen
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Edward A Levine
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
- Division of Surgical Oncology, Department of General Surgery, Medical Center Boulevard, Winston-Salem, NC, USA.
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Solsky I, Patel A, Leonard G, Russell G, Perry K, Votanopoulos KI, Shen P, Levine EA. ASO Visual Abstract: Distance Traveled and Disparities in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2024; 31:1071-1072. [PMID: 37996634 DOI: 10.1245/s10434-023-14545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Affiliation(s)
- Ian Solsky
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Ana Patel
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Grey Leonard
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Gregory Russell
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathleen Perry
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | - Perry Shen
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Edward A Levine
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
- Division of Surgical Oncology, Department of General Surgery, Medical Center Boulevard, Winston-Salem, NC, USA.
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Solsky I, Patel A, Valenzuela CD, Russell G, Perry K, Duckworth K, Votanopoulos KI, Shen P, Levine EA. Quality-of-Life Outcomes for Patients Taking Opioids and Psychotropic Medications Before Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2024; 31:577-593. [PMID: 37891454 DOI: 10.1245/s10434-023-14215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/09/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) on quality of life (QoL) for patients taking opioids and psychotropic medications preoperatively is unclear. METHODS This study retrospectively reviewed a CRS-HIPEC single-center prospectively maintained database for 2012-2016. Demographics and clinical data on opioids/psychotropic medication use were collected via chart review. The study collected QoL outcomes at baseline, then 3, 6, and 12 months postoperatively via the Center for Epidemiologic Studies Depression Scale (CES-D), Brief Pain Inventory, Functional Assessment of Cancer Therapy, and 36-Item Short-Form Health Survey. Differences in QoL between the groups were calculated using repeated measures analysis of variance regression. Descriptive statistics and Kaplan-Meier analyses were performed. RESULTS Of 388 patients, 44.8% were taking opioids/psychotropic medications preoperatively. At baseline, those taking opioids/psychotropic medications preoperatively versus those not taking these medications had significantly worse QoL. By 1 year postoperatively, the QoL measures did not differ significantly except for emotional functioning (e.g., no medications vs. opioids/psychotropic medications: CES-D, 5.6 vs. 10.1). Median survival did not differ significantly (opioids/psychotropic medications vs. no medications: 52.3 vs. 60.6 months; p = 0.66). At 1 year after surgery, a greater percentage of patients were taking opioids, psychotropic medications, or both than at baseline (63.2% vs. 44.8%; p < 0.001). CONCLUSION Despite worse baseline QoL, patients who took opioids/psychotropic medications had QoL scores 1 year postoperatively similar to the scores of those who did not except in the emotional domains. These data point to the potential utility of a timed psychosocial intervention to enhance emotional adaptation and further support the role of CRS-HIPEC in improving QoL.
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Affiliation(s)
- Ian Solsky
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | - Ana Patel
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | | | - Gregory Russell
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | - Kathleen Perry
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | - Katie Duckworth
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | | | - Perry Shen
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA.
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
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Erali RA, Pu T, Vu TM, Mangieri CW, Jee Y, Wise JS, Perry KC, Hsu FC, Levine EA, McNatt MH, Chiba A. Pivotal Role of Genetic Counselors in the Uptake of Germline Genetic Testing in Non-Metastatic Breast Cancer and the Impact of Testing on Surgical Decision Making. Am Surg 2023; 89:5842-5849. [PMID: 37183417 DOI: 10.1177/00031348231175097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Genetic testing is increasingly utilized in breast cancer patients; however, testing rates remain low. We aimed to evaluate the rate of genetic testing at a tertiary academic medical center utilizing a multidisciplinary clinic model including genetic counselor. METHODS A single-center retrospective chart review was performed on a cohort of newly diagnosed breast cancer patients from January 2018 through February 2019. Patients were reviewed for genetic screening eligibility, consultation with a genetic counselor, and test results. RESULTS Final analysis included 426 patients. 261 (61.3%) were found to meet National Comprehensive Cancer Network guidelines for genetic testing, of which 178 patient (68.2%) underwent testing and 32 patients (12.3%) declined testing. Of the 165 not eligible for testing, 5 patients were tested. A total of 183 patients underwent testing and 116 (63.4%) had a negative result, 17 (9.3%) were positive for at least one gene mutation and 50 (27.3%) were identified to have a variant of unknown significance (VUS). There was a positive association between those patients who met with a genetic counselor and eligibility for testing (OR 31.1, 95% CI 16.0-60.5). CONCLUSIONS Genetic testing result has become an increasingly important factor when defining optimal surgical treatment for breast cancer patients. Increasing the availability of genetic consultation for breast cancer patients can improve testing rates and patient selection.
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Affiliation(s)
- Richard A Erali
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Tracey Pu
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Thuy M Vu
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yoonsun Jee
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jordan S Wise
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Marissa H McNatt
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Cairns A, Chagpar AB, Dupont E, Levine EA, Gass JS, Chiba A, Ollila DW, Howard-McNatt M. Does Preoperative MRI Reduce Positive Margins after Breast-Conserving Surgery? Ann Surg Oncol 2023; 30:6053-6058. [PMID: 37505353 DOI: 10.1245/s10434-023-13884-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) is a mainstay for breast cancer management, and obtaining negative margins is critical. Some have advocated for the use of preoperative magnetic resonance imaging (MRI) in reducing positive margins after BCS. We sought to determine whether preoperative MRI was associated with reduced positive margins. PATIENTS AND METHODS The SHAVE/SHAVE2 trials were multicenter trials in ten US centers with patients with stage 0-3 breast cancer undergoing BCS. Use of preoperative MRI was at the discretion of the surgeon. We evaluated whether or not preoperative MRI was associated with margin status prior to randomization regarding resection of cavity with shave margins. RESULTS A total of 631 patients participated. Median age was 64 (range 29-94) years, with a median tumor size of 1.3 cm (range 0.1-9.3 cm). Patient factors included 26.1% of patients (165) had palpable tumors, and 6.5% (41) received neoadjuvant chemotherapy. Tumor factors were notable for invasive lobular histology in 7.0% (44) and extensive intraductal component (EIC) in 32.8% (207). A preoperative MRI was performed in 193 (30.6%) patients. Those who underwent preoperative MRI were less likely to have a positive margin (31.1% versus 38.8%), although this difference was not statistically significant (p = 0.073). On multivariate analysis, controlling for patient and tumor factors, utilization of preoperative MRI was not a significant factor in predicting margin status (p = 0.110). Rather, age (p = 0.032) and tumor size (p = 0.040) were the only factors associated with margin status. CONCLUSION These data suggest that preoperative MRI is not associated margin status; rather, patient age and tumor size are the associated factors.
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Affiliation(s)
- Ashley Cairns
- Division of Surgical Oncology Service, Department of Surgery Wake Forest School of Medicine, Medical Center BLVD, Winston-Salem, NC, USA
| | | | | | - Edward A Levine
- Division of Surgical Oncology Service, Department of Surgery Wake Forest School of Medicine, Medical Center BLVD, Winston-Salem, NC, USA
| | | | - Akiko Chiba
- Duke University Medical Center, Durham, NC, USA
| | | | - Marissa Howard-McNatt
- Division of Surgical Oncology Service, Department of Surgery Wake Forest School of Medicine, Medical Center BLVD, Winston-Salem, NC, USA.
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Cairns A, Chagpar AB, Dupont E, Levine EA, Gass JS, Chiba A, Ollila DW, Howard-McNatt M. ASO Visual Abstract: Does Preoperative MRI Reduce Positive Margins After Breast Conserving Surgery? Ann Surg Oncol 2023; 30:6059-6060. [PMID: 37537480 DOI: 10.1245/s10434-023-14002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Ashley Cairns
- Division of Surgical Oncology Service, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Edward A Levine
- Division of Surgical Oncology Service, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Akiko Chiba
- Duke University Medical Center, Durham, NC, USA
| | | | - Marissa Howard-McNatt
- Division of Surgical Oncology Service, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Forsythe SD, Erali RA, Edenhoffer N, Meeker W, Wajih N, Schaaf CR, Laney P, Vanezuela CD, Li W, Levine EA, Soker S, Votanopoulos KI. Cisplatin exhibits superiority over MMC as a perfusion agent in a peritoneal mesothelioma patient specific organoid HIPEC platform. Sci Rep 2023; 13:11640. [PMID: 37468581 PMCID: PMC10356916 DOI: 10.1038/s41598-023-38545-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
Peritoneal mesothelioma (PM) is a rare malignancy with poor prognosis, representing about 10-15% of all mesothelioma cases. Herein we apply PM patient-derived tumor organoids (PTOs) in elucidating personalized HIPEC responses to bypass rarity of disease in generating preclinical data. Specimens were obtained from PM patients undergoing cytoreductive surgery with HIPEC. PTOs were fabricated with tumor cells suspended in ECM-hydrogel and treated with HIPEC regimen parameters. Viability and characterization analyses were performed post-treatment. Treatment efficacy was defined as ≥ 50% viability reduction and p < 0.05 compared to controls. From October 2020 to November 2022, 17 tumors from 7 patients were biofabricated into organoids, with 16/17 (94.1%) sites undergoing comparative 37° and 42° treatments with cisplatin and mitomycin C (MMC). Hyperthermic cisplatin and MMC enhanced cytotoxicity which reduced treatment viability by 25% and 22%, respectively, compared to normothermia. Heated cisplatin displayed the greatest cytotoxicity, with efficacy in 12/16 (75%) tumors and an average viability of 38% (5-68%). Heated MMC demonstrated efficacy in 7/16 (43.8%) tumors with an average treatment viability of 51% (17-92.3%). PTOs fabricated from distinct anatomic sites exhibited site-specific variability in treatment responses. PM PTOs exhibit patient and anatomic location treatment responses suggestive of underlying disease clonality. In PM organoids cisplatin is superior to MMC in HIPEC.
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Affiliation(s)
- Steven D Forsythe
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA
- Wake Forest Organoid Research Center, Winston-Salem, USA
| | - Richard A Erali
- Wake Forest Organoid Research Center, Winston-Salem, USA
- Division of Surgical Oncology, Department of Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Wake Forest University, Winston-Salem, NC, 27157, USA
| | - Nicholas Edenhoffer
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA
- Wake Forest Organoid Research Center, Winston-Salem, USA
| | - William Meeker
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA
- Wake Forest Organoid Research Center, Winston-Salem, USA
| | - Nadeem Wajih
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA
- Wake Forest Organoid Research Center, Winston-Salem, USA
| | - Cecilia R Schaaf
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA
- Wake Forest Organoid Research Center, Winston-Salem, USA
| | - Preston Laney
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA
- Wake Forest Organoid Research Center, Winston-Salem, USA
| | - Cristian D Vanezuela
- Division of Surgical Oncology, Department of Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Wake Forest University, Winston-Salem, NC, 27157, USA
| | - Wencheng Li
- Department of Pathology, Wake Forest Baptist Health, Winston-Salem, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Wake Forest University, Winston-Salem, NC, 27157, USA
| | - Shay Soker
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA
- Wake Forest Organoid Research Center, Winston-Salem, USA
| | - Konstantinos I Votanopoulos
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA.
- Wake Forest Organoid Research Center, Winston-Salem, USA.
- Division of Surgical Oncology, Department of Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Wake Forest University, Winston-Salem, NC, 27157, USA.
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Thompson JF, Hyngstrom J, Caracò C, Zager JS, Jahkola T, Bowles TL, Pennacchioli E, Hoekstra HJ, Moncrieff M, Ingvar C, van Akkooi A, Sabel MS, Levine EA, Henderson M, Dummer R, Rossi CR, Kane JM, Trocha S, Wright F, Byrd DR, Matter M, MacKenzie-Ross A, Kelley MC, Terheyden P, Huston TL, Wayne JD, Neuman H, Smithers BM, Desai D, Gershenwald JE, Schneebaum S, Gesierich A, Jacobs LK, Lewis JM, O'Donoghue C, Sardi A, McKinnon JG, Slingluff CL, Farma JM, Schultz E, Scheri RP, Vidal-Sicart S, Testori AAE, Scolyer RA, Elashoff DE, Cochran AJ, Faries MB. Regarding: Predicting Regional Lymph Node Recurrence in The Modern Age of Tumor-Positive Sentinel Node Melanoma. Ann Surg Oncol 2023; 30:4359-4360. [PMID: 37149545 DOI: 10.1245/s10434-023-13570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 05/08/2023]
Affiliation(s)
- John F Thompson
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | | | | | | | | | | | | | | | | | - Christian Ingvar
- Swedish Melanoma Study Group-University Hospital Lund, Lund, Sweden
| | | | | | | | | | | | | | - John M Kane
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Steven Trocha
- Greenville Hospital System Cancer Center, Greenville, SC, USA
| | | | | | - Maurice Matter
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - Patrick Terheyden
- University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany
| | - Tara L Huston
- SUNY at Stony Brook Hospital Medical Center, Stony Brook, NY, USA
| | - Jeffrey D Wayne
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Darius Desai
- St. Luke's University Health, Bethlehem, PA, USA
| | | | | | | | - Lisa K Jacobs
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James M Lewis
- University of Tennessee Medical Center, Knoxville, TN, USA
| | | | | | | | | | | | | | | | | | | | - Richard A Scolyer
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | | | | | - Mark B Faries
- Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA.
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12
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Solsky I, Moaven O, Valenzuela CD, Lundy M, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha C, Zarandi NP, Dourado J, Russell G, Levine EA, Votanopoulos KI, Shen P. ASO Visual Abstract: Survival Outcomes of Optimally Treated Colorectal Metastases-The Importance of R0 Status in Surgical Treatment of Hepatic and Peritoneal Surface Disease. Ann Surg Oncol 2023; 30:4274-4275. [PMID: 37020096 DOI: 10.1245/s10434-023-13392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Ian Solsky
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Cristian D Valenzuela
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Megan Lundy
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | - Tanto Cheung
- Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | | | | | - Nima Pourhabibi Zarandi
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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13
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Vallejos PA, Gonda A, Yu J, Sullivan BG, Ostowari A, Kwong ML, Choi A, Selleck MJ, Kabagwira J, Fuller RN, Gironda DJ, Levine EA, Hughes CCW, Wall NR, Miller LD, Senthil M. ASO Visual Abstract: Plasma Exosome Gene Signature Differentiates Colon Cancer from Healthy Controls. Ann Surg Oncol 2023; 30:3847-3848. [PMID: 36929140 DOI: 10.1245/s10434-023-13303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Paul A Vallejos
- Division of Biochemistry, Department of Basic Science, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Amber Gonda
- Division of Surgical Oncology, Department of Surgery, Irvine Medical Center, University of California, Orange, CA, USA
| | - Jingjing Yu
- Division of Surgical Oncology, Department of Surgery, Irvine Medical Center, University of California, Orange, CA, USA
| | - Brittany G Sullivan
- Division of Surgical Oncology, Department of Surgery, Irvine Medical Center, University of California, Orange, CA, USA
| | - Arsha Ostowari
- Division of Surgical Oncology, Department of Surgery, Irvine Medical Center, University of California, Orange, CA, USA
| | - Mei Li Kwong
- Division of Surgical Oncology, Loma Linda University Health, Loma Linda, CA, USA
| | - Audrey Choi
- Division of Surgical Oncology, Loma Linda University Health, Loma Linda, CA, USA
| | - Matthew J Selleck
- Division of Surgical Oncology, Loma Linda University Health, Loma Linda, CA, USA
| | - Janviere Kabagwira
- Division of Biochemistry, Department of Basic Science, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ryan N Fuller
- Division of Biochemistry, Department of Basic Science, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Daniel J Gironda
- Department of Cancer Biology, Wake Forest Health, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of Surgery, Wake Forest Health, Winston-Salem, NC, USA
| | - Christopher C W Hughes
- Department of Molecular Biology and Biochemistry, University of California, Irvine, CA, USA
| | - Nathan R Wall
- Division of Biochemistry, Department of Basic Science, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Lance D Miller
- Department of Cancer Biology, Wake Forest Health, Winston-Salem, NC, USA
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, Irvine Medical Center, University of California, Orange, CA, USA.
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14
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Valenzuela CD, Solsky IB, Erali RA, Forsythe SD, Mangieri CW, Mainali BB, Russell G, Perry KC, Votanopoulos KI, Shen P, Levine EA. ASO Visual Abstract: Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Ann Surg Oncol 2023; 30:2676-2677. [PMID: 36823339 DOI: 10.1245/s10434-023-13168-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Steven D Forsythe
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Bigyan B Mainali
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Wajih N, Erali R, Levine EA, Votanopoulos K, Soker S. Abstract 164: Development of a living biobank of breast cancer organoids. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Introduction: Breast cancer is one of the most frequently diagnosed cancers among women, with a high mortality rate. More than 20 different subtypes of breast cancer are identified. Advancement in patient-derived organoid technology makes it possible to preserve cellular, structural, and tissue microenvironment, which mimics the tissue in vivo. The present study aims to develop a cryopreserved (living) tumor biobank from patient-derived tumor breast tissues. Eventually, biobank organoids will be used to test treatment options outside of patients, in a dish, and provide information on what treatments the patient responds to.
Method: Patient-derived organoids (PDOs) were bio-fabricated using an unsorted tumor and normal cell suspension in a collagen-based hydrogel. Immune-enhanced tumor organoids (iTOs) were also bio-fabricated using patient-matched PMBCs and tumor cells. Breast cancer living biobanks were developed by freezing organoids in cryopreservation solutions and reestablishing them in growth media compatible with breast organoids. Histological staining for hormone receptors and Her2 receptor markers was performed. Organoids were cultured for seven days, followed by treatment with chemotherapy (Paclitaxel, Doxorubicin, and Sulphonamide) and immunotherapy (Nivolumab, Pembrolizumab, and Atezolizumab), and assessed for cell viability.
Results: H&E staining showed the characteristics of the breast tissue with well-defined acini. In tumor organoids, acini were somewhat perturbed compared to normal breast organoids. Immunofluorescence staining showed the expression of breast biomarkers, including EGF receptor 2 (HER2), Progesterone receptor (PR), and Estrogen receptor (ER). Zona occludin 2 and keratin 19 expression in luminal cells and expression of Keratin 14 and P63 in basal cells, suggesting correct polarization in the organoids. Immunofluorescence staining of iTOs, with T cell markers including CD3, CD4, and CD8, indicated that immune cells remained viable in the iTOs. Drug responses to Doxorubicin, Paclitaxel, Sulphonamide and a combination of Doxorubicin-Paclitaxel showed significant inhibition of cell growth in normal and tumor organoids (p< 0.04). Treatment of breast iTOs showed moderate responses to nivolumab (n=11) and pembrolizumab (n=5), with a 63%-100% efficacy (P < 0.05) respectively. No responses were observed for Atezolizumab (n=5). Drug responses of biobank organoids showed comparable drug sensitivities to their fresh, non-frozen counterparts, suggesting that biobank organoids retain physiological relevant information and can be used for testing new drug therapies.
Conclusion: Breast cancer organoids recapitulate the histological features of breast tissue in culture and respond to chemotherapy and immunotherapy. In the future, patient-derived breast tumor organoids can be cryopreserved and serve as living biobanks to provide a platform for personalized medicine.
Citation Format: Nadeem Wajih, Richard Erali, Edward A. Levine, Konstantinos Votanopoulos, Shay Soker. Development of a living biobank of breast cancer organoids [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 164.
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Affiliation(s)
- Nadeem Wajih
- 1Wake Forest University School of Medicine, Winston salem, NC
| | - Richard Erali
- 1Wake Forest University School of Medicine, Winston salem, NC
| | | | | | - Shay Soker
- 1Wake Forest University School of Medicine, Winston salem, NC
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16
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Mangieri CW, Valenzuela CD, Solsky IB, Erali RA, Votanopoulos KI, Shen P, Levine EA. Exposure to Neoadjuvant Oxaliplatin-Containing Chemotherapy, Does it Effect Intraperitoneal Hyperthermic Chemotherapy Perfusion? Ann Surg Oncol 2023; 30:2486-2493. [PMID: 36484904 DOI: 10.1245/s10434-022-12933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are commonly exposed to oxaliplatin neoadjuvant chemotherapy (NAT) regimens. The impact of systemic exposure to oxaliplatin prior to HIPEC with oxaliplatin is unknown. METHODS We conducted a retrospective review of our institutional registry of CRS/HIPEC cases who received oxaliplatin-containing NAT, and compared patients who underwent HIPEC with oxaliplatin versus cases perfused with mitomycin C. The primary outcome was survival, defined by overall survival (OS) and disease-free survival (DFS). Subgroup analysis was performed based on primary tumor etiology and completeness of cytoreduction. RESULTS A total of 333 cases satisfied the selection criteria-159 appendiceal primaries (all high-grade disease) and 174 colorectal cases. Thirty-one cases (9.3%) underwent HIPEC with oxaliplatin, with the remaining 302 cases (90.7%) receiving mitomycin C. Both cohorts were identical in regard to baseline characteristics, and both groups were alike in regard to NAT regimens and oxaliplatin exposure. There was no difference in survival outcomes. OS times were 2.9 (± 2.8) and 2.8 ( ± 3.6) years for oxaliplatin and mitomycin C perfusions, respectively (p = 0.94), and the 5-year OS rates were also similar at 9.7 and 18.5% (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.14-1.67, p = 0.24) for oxaliplatin and mitomycin cases, respectively. Likewise, DFS findings were similar, with survival of 2.5 (± 4.5) and 1.8 (± 2.4) years for oxaliplatin and mitomycin perfusions, respectively (p = 0.21). There was no difference in 5-year DFS rates, at 10.5 and 7.8% (OR 1.39, 95% CI 0.30-6.56, p = 0.68) for oxaliplatin and mitomycin C, respectively. Subgroup analysis found minimal discordant findings from the main results. CONCLUSION This analysis found no discernable association with NAT oxaliplatin exposure in regard to survival outcomes following CRS/HIPEC stratified out by perfusion agent.
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Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Cristian D Valenzuela
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | | | - Perry Shen
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA.
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17
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Mangieri CW, Valenzuela CD, Solsky IB, Erali RA, Votanopoulos KI, Shen P, Levine EA. ASO Visual Abstract: Exposure to Neoadjuvant Oxaliplatin-Containing Chemotherapy; Does It Affect Intraperitoneal Hyperthermic Chemotherapy Perfusion? Ann Surg Oncol 2023; 30:2496. [PMID: 36681734 DOI: 10.1245/s10434-022-13003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Christopher W Mangieri
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Cristian D Valenzuela
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ian B Solsky
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Richard A Erali
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Konstantinos I Votanopoulos
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Perry Shen
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Edward A Levine
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Mangieri CW, Levine EA. ASO Author Reflections: Neoadjuvant Oxaliplatin Therapy for Peritoneal Carcinomatosis, Any Impact on Subsequent Hyperthermic Intraperitoneal Chemotherapy Perfusion? Ann Surg Oncol 2023; 30:2494-2495. [PMID: 36602661 DOI: 10.1245/s10434-022-13009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, USA.
| | - Edward A Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, USA
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Levine EA. Is a Prognostic Nomogram for Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei Useful? JAMA Surg 2023; 158:531. [PMID: 36920379 DOI: 10.1001/jamasurg.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Edward A Levine
- Surgical Oncology Service, Wake Forest University, Winston-Salem, North Carolina
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20
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Vallejos PA, Gonda A, Yu J, Sullivan BG, Ostowari A, Kwong ML, Choi A, Selleck MJ, Kabagwira J, Fuller RN, Gironda DJ, Levine EA, Hughes CCW, Wall NR, Miller LD, Senthil M. Plasma Exosome Gene Signature Differentiates Colon Cancer from Healthy Controls. Ann Surg Oncol 2023; 30:3833-3844. [PMID: 36864326 PMCID: PMC10175396 DOI: 10.1245/s10434-023-13219-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 01/02/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Liquid biopsies have become an integral part of cancer management as minimally invasive options to detect molecular and genetic changes. However, current options show poor sensitivity in peritoneal carcinomatosis (PC). Novel exosome-based liquid biopsies may provide critical information on these challenging tumors. In this initial feasibility analysis, we identified an exosome gene signature of 445 genes (ExoSig445) from colon cancer patients, including those with PC, that is distinct from healthy controls. METHODS Plasma exosomes from 42 patients with metastatic and non-metastatic colon cancer and 10 healthy controls were isolated and verified. RNAseq analysis of exosomal RNA was performed and differentially expressed genes (DEGs) were identified by the DESeq2 algorithm. The ability of RNA transcripts to discriminate control and cancer cases was assessed by principal component analysis (PCA) and Bayesian compound covariate predictor classification. An exosomal gene signature was compared with tumor expression profiles of The Cancer Genome Atlas. RESULTS Unsupervised PCA using exosomal genes with greatest expression variance showed stark separation between controls and patient samples. Using separate training and test sets, gene classifiers were constructed capable of discriminating control and patient samples with 100% accuracy. Using a stringent statistical threshold, 445 DEGs fully delineated control from cancer samples. Furthermore, 58 of these exosomal DEGs were found to be overexpressed in colon tumors. CONCLUSIONS Plasma exosomal RNAs can robustly discriminate colon cancer patients, including patients with PC, from healthy controls. ExoSig445 can potentially be developed as a highly sensitive liquid biopsy test in colon cancer.
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Affiliation(s)
- Paul A Vallejos
- Department of Basic Science, Division of Biochemistry, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Amber Gonda
- Department of Surgery, Division of Surgical Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Jingjing Yu
- Department of Surgery, Division of Surgical Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Brittany G Sullivan
- Department of Surgery, Division of Surgical Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Arsha Ostowari
- Department of Surgery, Division of Surgical Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Mei Li Kwong
- Division of Surgical Oncology, Loma Linda University Health, Loma Linda, CA, USA
| | - Audrey Choi
- Division of Surgical Oncology, Loma Linda University Health, Loma Linda, CA, USA
| | - Matthew J Selleck
- Division of Surgical Oncology, Loma Linda University Health, Loma Linda, CA, USA
| | - Janviere Kabagwira
- Department of Basic Science, Division of Biochemistry, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ryan N Fuller
- Department of Basic Science, Division of Biochemistry, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Daniel J Gironda
- Department of Cancer Biology, Wake Forest Health, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgery, Division of Surgical Oncology, Wake Forest Health, Winston-Salem, NC, USA
| | - Christopher C W Hughes
- Department of Molecular Biology and Biochemistry, University of California, Irvine, Irvine, CA, USA
| | - Nathan R Wall
- Department of Basic Science, Division of Biochemistry, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Lance D Miller
- Department of Cancer Biology, Wake Forest Health, Winston-Salem, NC, USA
| | - Maheswari Senthil
- Department of Molecular Biology and Biochemistry, University of California, Irvine, Irvine, CA, USA.
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Mangieri CW, Valenzuela CD, Solsky IB, Erali RA, Votanopoulos KI, Shen P, Levine EA. Impact of myometrium invasion on survival outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). J Surg Oncol 2023; 127:450-456. [PMID: 36285743 PMCID: PMC10065224 DOI: 10.1002/jso.27122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/01/2022] [Accepted: 09/18/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective surgical intervention for peritoneal surface malignancy. The effect of myometrium invasion on outcomes is unknown. METHODS Retrospective review of our institutional registry with analysis of CRS-HIPEC cases involving a hysterectomy. Compared cases with myometrium invasion versus those without invasion. Primary outcome was survival as measured by overall survival (OS) and disease-free survival (DFS). Secondary outcome was the evaluation of risk factors for myometrium invasion based on multivariate analysis. RESULTS A total of 126 cases of CRS-HIPEC involving a hysterectomy were identified. Ninety-seven cases (76.9%) had no myometrium invasion and the remaining 29 cases (23.1%) had malignant invasion. The presence of myometrial invasion was a significant negative survival prognostic factor. The OS was halved with mean survival times of 2.8 (±2.3) versus 5.8 (±4.7) years for cases with and without invasion, respectively (p = 0.002). Five-year OS rates were also inferior with myometrium invasion at 17.4% versus 53.8% (odds ratio [OR] = 0.181, 95% confidence interval [CI]: 0.057-0.580, p = 0.002). A similar trend was present with DFS with mean survival times of 1.4 (±0.9) versus 3.7 (±3.9) years for noninvasion and invasion cases (p = 0.009). The 5-year DFS rates were 0% versus 34.8% (OR = 0.652, 95% CI: 0.549-0.775, p = 0.004). Secondary analysis significantly associated several risk factors with myometrium invasion to include lymph node positivity (OR = 2.539, 95% CI: 1.074-6.003, p = 0.012), colorectal primary tumors (OR = 2.248, 95% CI: 1.094-5.161, p = 0.035), and high-grade tumors (OR = 2.160, 95% CI: 1.080-4.820, p = 0.038). CONCLUSION Myometrium invasion is a significant negative prognostic factor for survival following CRS-HIPEC. Several risk factors are potentially predictive of identifying those at high-risk for myometrium invasion.
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Affiliation(s)
| | | | - Ian B. Solsky
- Wake Forest Baptist Health Medical Center, Section of Surgical Oncology
| | - Richard A. Erali
- Wake Forest Baptist Health Medical Center, Section of Surgical Oncology
| | | | - Perry Shen
- Wake Forest Baptist Health Medical Center, Section of Surgical Oncology
| | - Edward A. Levine
- Wake Forest Baptist Health Medical Center, Section of Surgical Oncology
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22
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Solsky I, Moaven O, Valenzuela CD, Lundy M, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha C, Zarandi NP, Dourado J, Russell G, Levine EA, Votanopoulos KI, Shen P. Survival Outcomes of Optimally Treated Colorectal Metastases: The Importance of R0 Status in Surgical Treatment of Hepatic and Peritoneal Surface Disease. Ann Surg Oncol 2023:10.1245/s10434-023-13174-3. [PMID: 36754944 DOI: 10.1245/s10434-023-13174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Although colorectal hepatic metastases (HM) and peritoneal surface disease (PSD) are distinct biologic diseases, they may have similar long-term survival when optimally treated with surgery. METHODS This study retrospectively reviewed prospectively managed databases. Patients undergoing R0 or R1 resections were analyzed with descriptive statistics, the Kaplan-Meier method, and Cox regression. Survival was compared over time for the following periods: 1993-2006, 2007-2012, and 2013-2020. RESULTS The study enrolled 783 HM patients undergoing liver resection and 204 PSD patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). Compared with PSD patients, HM patients more often had R0 resections (90.3% vs. 32.4%), less often had pre-procedure chemotherapy (52.4% vs. 92.1%), and less often were functionally independent (79.7% vs. 95.6%). The 5-year overall survival for HM was 40.9%, with a median survival period of 45.8 months versus 25.8% and 33.4 months, respectively, for PSD (p < 0.05). When stratified by resection status, R0 HM and R0 PSD did not differ significantly in median survival (49.0 vs. 45.4 months; p = 0.83). The median survival after R1 resection also was similar between HM and PSD (32.6 vs. 26.9 months; p = 0.59). Survival between the two groups again was similar over time when stratified by resection status. The predictors of survival for HM patients were R0 resection, number of lesions, intraoperative transfusion, age, and adjuvant chemotherapy. For the PSD patients, the predictors were peritoneal cancer index (PCI) score, estimated blood loss (EBL), and female gender. CONCLUSION The study showed that R0 resections are associated with improved outcomes and that median survival is similar between HM and PSD patients when it is achieved. Surveillance and treatment strategies that facilitate R0 resections are needed to improve results, particularly for PSD.
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Affiliation(s)
- Ian Solsky
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Cristian D Valenzuela
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Megan Lundy
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | - Tanto Cheung
- University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | | | | | | | - Nima Pourhabibi Zarandi
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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Valenzuela CD, Solsky IB, Erali RA, Forsythe SD, Mangieri CW, Mainali BB, Russell G, Perry KC, Votanopoulos KI, Shen P, Levine EA. Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Ann Surg Oncol 2023; 30:2666-2675. [PMID: 36754945 DOI: 10.1245/s10434-022-13061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/26/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare diagnosis with a dismal prognosis if untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is shown to significantly improve survival. Our institution is uniquely positioned to report long-term outcomes in MPM with CRS-HIPEC, due to our robust peritoneal surface disease program existing over the past three decades. METHODS Our prospectively maintained, single-institution database of CRS-HIPEC cases was reviewed, identifying 111 consecutive patients with MPM over 28 years (1993-2021). Prognostic, operative, and pathologic factors were reviewed. Overall survival (OS) and conditional survival (CS) analyses were performed. RESULTS The average age was 55.1 years; 58.6% of patients were male; 17 of 111 patients (15.3%) had a second CRS-HIPEC. At first CRS-HIPEC, the average PCI score was 18.7, and the perfusate drugs were platinum-based (72.1%) and mitomycin C (27.9%). The resection status at first CRS-HIPEC was R2a (46.4%), followed by R0-1 (29.1%), and R2b-c (24.5%). Median OS was 3.3 years for the entire cohort, with 75th and 25th percentiles at 10.7 months and 10.6 years. Median CS was improved if patients survived to the 1-year postoperative mark (4.9 years, p < 0.01) and trended toward further improvement with each passing year. If 3-year postoperative survival was achieved, the median CS improved to 6.1 years. CONCLUSIONS This represents one of the largest and lengthiest, single-center, longitudinal, case series of peritoneal mesothelioma treated with CRS-HIPEC. The OS suggests efficacy for CRS-HIPEC for MPM. Long-term survival improves significantly after patients achieve the 1-year, postoperative mark.
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Affiliation(s)
- Cristian D Valenzuela
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Steven D Forsythe
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Bigyan B Mainali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Perry Shen
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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Mangieri CW, Levine EA. ASO Author Reflections: Evaluating HIPEC Switch for Repeat CRS-HIPEC, Time to End a Common Practice? Ann Surg Oncol 2023; 30:392-393. [PMID: 36066658 DOI: 10.1245/s10434-022-12483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA.
| | - Edward A Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
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Mangieri CW, Valenzuela CD, Solsky IB, Erali RA, Votanopoulos KI, Shen P, Levine EA. Switching Perfusion Agents for Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Surgical Dogma or Evidence-Based Practice? Ann Surg Oncol 2023; 30:384-391. [PMID: 35969300 DOI: 10.1245/s10434-022-12392-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND A common practice is to switch chemotherapy perfusion agents for repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). However, there is a paucity of objective benefit with this practice. METHODS A retrospective review of our institutional registry involving repeat CRS-HIPEC cases was conducted, comparing cases that underwent a perfusion agent switch versus those cases with no switch. The primary outcome of this study was survival, measured by overall survival (OS) and disease-free survival (DFS). A subgroup analysis was performed on the basis of primary etiology. RESULTS A total of 101 cases met selection criteria. Mitomycin C was used as the index perfusion agent in 84% of cases, while oxaliplatin was utilized in the remaining 16% of cases. In total, 66 cases underwent a perfusion switch, with 35 cases using the same agent. Analysis revealed no survival benefit with HIPEC perfusion switch. For OS, there were similar mean survival times of 5.2 (± 4.1) years and 5.1 (± 3.6) years for cases with perfusion switch and no perfusion switch, respectively (P = 0.985). The 5-year OS rates were also similar at 61.4% and 53.3% for switch and non-switch cases, respectively [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.54-3.56, P = 0.49]. Mean DFS was 4.0 (± 4.2) years and 3.6 (± 3.8) years for switch and non-switch cases, respectively (P = 0.74). The 5-year DFS rates had a greater difference with statistical trend, with rates of 53% versus 28% for switch and non-switch cases, respectively (OR 2.91, 95% CI 0.86-9.86, P = 0.081). Subgroup analysis had a similar trend to the main results. CONCLUSIONS The study findings revealed no survival benefit with switching perfusion agents. Analysis suggests that the practice of perfusion switch is ineffective.
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Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Wake Forest University School of Medicine Boulevard, Winston-Salem, NC, USA
| | - Cristian D Valenzuela
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Wake Forest University School of Medicine Boulevard, Winston-Salem, NC, USA
| | - Ian B Solsky
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Wake Forest University School of Medicine Boulevard, Winston-Salem, NC, USA
| | - Richard A Erali
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Wake Forest University School of Medicine Boulevard, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Wake Forest University School of Medicine Boulevard, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Wake Forest University School of Medicine Boulevard, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Wake Forest University School of Medicine Boulevard, Winston-Salem, NC, USA.
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Mangieri CW, Valenzuela CD, Solsky IB, Erali RA, Votanopoulos KI, Shen P, Levine EA. ASO Visual Abstract: Switching Perfusion Agents for Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy, Surgical Dogma or Evidence-Based Practice? Ann Surg Oncol 2023; 30:394. [PMID: 36059031 DOI: 10.1245/s10434-022-12451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA.
| | - Cristian D Valenzuela
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | | | - Perry Shen
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
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Mangieri CW, Levine EA. Management of peritoneal surface metastases from colorectal cancer: Cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, pressurized intraperitoneal chemotherapy, and beyond. Front Oncol 2022; 12:992030. [PMID: 36425565 PMCID: PMC9679779 DOI: 10.3389/fonc.2022.992030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/23/2022] [Indexed: 08/30/2023] Open
Abstract
This article provides a contemporary review of the current surgical management of peritoneal surface malignancy (PSM) of colorectal origin. A brief review of the founding history of surgical intervention for PSM is followed by a focused review of the level I evidence, current clinical questions, and evolving advancements. While not intended to address all the facets of PSM, this review aims to provide the reader with the essential knowledge and resources to effectively provide surgical care for carcinomatosis due to colorectal malignancies.
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Affiliation(s)
| | - Edward A. Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, United States
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Menzies AV, Usher EC, Hsu FC, Levine EA, Lentz SS, Kelly MG. HIPEC after neoadjuvant chemotherapy is associated with acceptable toxicity and favorable quality of life in newly diagnosed advanced ovarian cancer patients. Gynecol Oncol 2022; 167:234-238. [PMID: 36085091 DOI: 10.1016/j.ygyno.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate toxicity, quality of life and PFS in patients with advanced ovarian cancer who underwent neoadjuvant chemotherapy (NAC) followed by CRS and HIPEC with carboplatin. METHODS Patients with stage IIIC or IVA epithelial ovarian cancer, who were not candidates for primary CRS, were enrolled in this phase two trial. Patients received 3-6 cycles of NAC with an IV carboplatin doublet followed by CRS with HIPEC (carboplatin 800 mg/m2 for 90 min). They were followed for at least 12 months to assess for adverse events, quality of life (QOL) and disease progression. QOL was measured using the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaires prior to CRS and post-operatively at 6 weeks, 3 months, and 6 months after CRS. RESULTS Twenty patients were enrolled. HIPEC was completed successfully in all twenty patients, and there was no peri-operative mortality. Twelve (70.6%) patients experienced a grade 3 or 4 toxicity; most commonly anemia (59%), thrombocytopenia (29%), and hypokalemia (24%). There was no significant change between the pre-operative and postoperative 6 weeks, 3 month, and 6 month FACT-O, NTX, and AD scores. Nine (45%) patients have experienced disease recurrence to date. The median progression free survival in this cohort is 11.2 months (2.5-23.7 months). CONCLUSION The addition of HIPEC with carboplatin to interval CRS was well tolerated in patient population. Myelosuppression was the most common adverse event. CRS with HIPEC did not adversely impact these patients' QOL indices. The efficacy of this regimen should be further evaluated in a larger clinical trial.
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Affiliation(s)
- Anya V Menzies
- Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
| | - Erik C Usher
- Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Edward A Levine
- Department of Surgical Oncology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Samuel S Lentz
- Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Michael G Kelly
- Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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Forsythe SD, Sivakumar H, Erali RA, Wajih N, Li W, Shen P, Levine EA, Miller KE, Skardal A, Votanopoulos KI. ASO Visual Abstract: Patient-Specific Sarcoma Organoids for Personalized Translational Research: Unification of the Operating Room with Rare Cancer Research and Clinical Implications. Ann Surg Oncol 2022; 29:7370-7371. [PMID: 35840846 DOI: 10.1245/s10434-022-12173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Steven D Forsythe
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA
| | - Hemamylammal Sivakumar
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Richard A Erali
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA
- Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Medical Center Boulevard, Winston Salem, NC, USA
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nadeem Wajih
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA
| | - Wencheng Li
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Medical Center Boulevard, Winston Salem, NC, USA
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Medical Center Boulevard, Winston Salem, NC, USA
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine E Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Aleksander Skardal
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
- Arthur G. James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Konstantinos I Votanopoulos
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA.
- Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Medical Center Boulevard, Winston Salem, NC, USA.
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Crystal JS, Thompson JF, Hyngstrom J, Caracò C, Zager JS, Jahkola T, Bowles TL, Pennacchioli E, Beitsch PD, Hoekstra HJ, Moncrieff M, Ingvar C, van Akkooi A, Sabel MS, Levine EA, Agnese D, Henderson M, Dummer R, Neves RI, Rossi CR, Kane JM, Trocha S, Wright F, Byrd DR, Matter M, Hsueh EC, MacKenzie-Ross A, Kelley M, Terheyden P, Huston TL, Wayne JD, Neuman H, Smithers BM, Ariyan CE, Desai D, Gershenwald JE, Schneebaum S, Gesierich A, Jacobs LK, Lewis JM, McMasters KM, O'Donoghue C, van der Westhuizen A, Sardi A, Barth R, Barone R, McKinnon JG, Slingluff CL, Farma JM, Schultz E, Scheri RP, Vidal-Sicart S, Molina M, Testori AAE, Foshag LJ, Van Kreuningen L, Wang HJ, Sim MS, Scolyer RA, Elashoff DE, Cochran AJ, Faries MB. Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial. JAMA Surg 2022; 157:835-842. [PMID: 35921122 PMCID: PMC9475390 DOI: 10.1001/jamasurg.2022.2055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/19/2022] [Indexed: 12/12/2022]
Abstract
Importance Sentinel lymph node (SLN) biopsy is a standard staging procedure for cutaneous melanoma. Regional disease control is a clinically important therapeutic goal of surgical intervention, including nodal surgery. Objective To determine how frequently SLN biopsy without completion lymph node dissection (CLND) results in long-term regional nodal disease control in patients with SLN metastases. Design, Setting, and Participants The second Multicenter Selective Lymphadenectomy Trial (MSLT-II), a prospective multicenter randomized clinical trial, randomized participants with SLN metastases to either CLND or nodal observation. The current analysis examines observation patients with regard to regional nodal recurrence. Trial patients were aged 18 to 75 years with melanoma metastatic to SLN(s). Data were collected from December 2004 to April 2019, and data were analyzed from July 2020 to January 2022. Interventions Nodal observation with ultrasonography rather than CLND. Main Outcomes and Measures In-basin nodal recurrence. Results Of 823 included patients, 479 (58.2%) were male, and the mean (SD) age was 52.8 (13.8) years. Among 855 observed basins, at 10 years, 80.2% (actuarial; 95% CI, 77-83) of basins were free of nodal recurrence. By univariable analysis, freedom from regional nodal recurrence was associated with age younger than 50 years (hazard ratio [HR], 0.49; 95% CI, 0.34-0.70; P < .001), nonulcerated melanoma (HR, 0.36; 95% CI, 0.36-0.49; P < .001), thinner primary melanoma (less than 1.5 mm; HR, 0.46; 95% CI, 0.27-0.78; P = .004), axillary basin (HR, 0.61; 95% CI, 0.44-0.86; P = .005), fewer positive SLNs (1 vs 3 or more; HR, 0.32; 95% CI, 0.14-0.75; P = .008), and SLN tumor burden (measured by diameter less than 1 mm [HR, 0.39; 95% CI, 0.26-0.60; P = .001] or less than 5% area [HR, 0.36; 95% CI, 0.24-0.54; P < .001]). By multivariable analysis, younger age (HR, 0.57; 95% CI, 0.39-0.84; P = .004), thinner primary melanoma (HR, 0.40; 95% CI, 0.22-0.70; P = .002), axillary basin (HR, 0.55; 95% CI, 0.31-0.96; P = .03), SLN metastasis diameter less than 1 mm (HR, 0.52; 95% CI, 0.33-0.81; P = .007), and area less than 5% (HR, 0.58; 95% CI, 0.38-0.88; P = .01) were associated with basin control. When looking at the identified risk factors of age (50 years or older), ulceration, Breslow thickness greater than 3.5 mm, nonaxillary basin, and tumor burden of maximum diameter of 1 mm or greater and/or metastasis area of 5% or greater and excluding missing value cases, basin disease-free rates at 5 years were 96% (95% CI, 88-100) for patients with 0 risk factors, 89% (95% CI, 82-96) for 1 risk factor, 86% (95% CI, 80-93) for 2 risk factors, 80% (95% CI, 71-89) for 3 risk factors, 61% (95% CI, 48-74) for 4 risk factors, and 54% (95% CI, 36-72) for 5 or 6 risk factors. Conclusions and Relevance This randomized clinical trial was the largest prospective evaluation of long-term regional basin control in patients with melanoma who had nodal observation after removal of a positive SLN. SLN biopsy without CLND cleared disease in the affected nodal basin in most patients, even those with multiple risk factors for in-basin recurrence. In addition to its well-validated value in staging, SLN biopsy may also be regarded as therapeutic in some patients. Trial Registration ClinicalTrials.gov Identifier: NCT00297895.
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Affiliation(s)
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - John Hyngstrom
- Department of Surgery, University of Utah, Salt Lake City
| | - Corrado Caracò
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale," Napoli, Italy
| | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Tiina Jahkola
- Department of Plastic and Reconstructive Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tawnya L Bowles
- Department of Surgical Oncology, Intermountain Medical Center, Salt Lake City, Utah
| | - Elisabetta Pennacchioli
- Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, European Institute of Oncology, Milano, Italy
| | | | - Harald J Hoekstra
- Department of Surgery, University Hospital Groningen, Groningen, the Netherlands
| | - Marc Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Alexander van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Edward A Levine
- Department of Surgical Oncology, Wake Forest University, Winston-Salem, North Carolina
| | - Doreen Agnese
- Department of Surgery, Ohio State University, Columbus
| | - Michael Henderson
- Department of Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Rogerio I Neves
- Department of Surgery, Pennsylvania State University Milton S. Hershey Medical Center, Hershey
- Now at Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - John M Kane
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Steven Trocha
- Department of Surgical Oncology, Prisma Health, Columbia, South Carolina
| | - Frances Wright
- Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David R Byrd
- Department of Surgery, University of Washington, Seattle
| | - Maurice Matter
- Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Eddy C Hsueh
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Alastair MacKenzie-Ross
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark Kelley
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Tara L Huston
- Department of Surgery, Stony Brook University, Stony Brook, New York
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Heather Neuman
- Department of Surgery, University of Wisconsin at Madison
| | - B Mark Smithers
- Department of Surgery, University of Queensland, Brisbane, Australia
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Darius Desai
- Department of Surgery, Saint Luke's University Hospital, Bethlehem, Pennsylvania
| | | | - Shlomo Schneebaum
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anja Gesierich
- Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - James M Lewis
- Department of Surgery, University of Tennessee Medical Center, Knoxville
| | - Kelly M McMasters
- Department of Surgery, University of Louisville, Louisville, Tennessee
| | | | | | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, Maryland
| | - Richard Barth
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
| | - Robert Barone
- Surgical Oncology, Sharp Hospital, San Diego, California
| | - J Greg McKinnon
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Erwin Schultz
- Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical Center, Nuremberg, Germany
| | | | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Manuel Molina
- Department of Surgery, Lakeland Regional Health, Lakeland, Florida
| | | | - Leland J Foshag
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Lisa Van Kreuningen
- Manager of Research Operations, Saint John's Cancer Institute, Santa Monica, California
| | - He-Jing Wang
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Myung-Shin Sim
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Richard A Scolyer
- Melanoma Institute Australia, Department of Medicine, University of Sydney, Sydney, Australia
| | - David E Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Alistair J Cochran
- Department of Anatomic Pathology, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Page LL, Ehlers DK, Russell G, Levine EA, Howard-McNatt MM, Mihalko SL. Does Physical Activity Differentially Influence Physical Function In Younger Versus Older Women With Breast Cancer? Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000880492.08094.9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hong MJ, Lum SS, Dupont E, Howard-McNatt M, Chiba A, Levine EA, Gass JS, Gallagher K, Fenton A, Murray M, Solomon NL, Ollila DW, Lazar M, Namm JP, Walters LL, Chagpar AB. Omission of Radiation in Conservative Treatment for Breast Cancer: Opportunity for De-escalation of Care. J Surg Res 2022; 279:393-397. [PMID: 35835032 DOI: 10.1016/j.jss.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/02/2022] [Accepted: 06/11/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION De-escalation of breast cancer treatment aims to reduce patient and financial toxicity without compromising outcomes. Level I evidence and National Comprehensive Cancer Network guidelines support omission of adjuvant radiation in patients aged >70 y with hormone-sensitive, pT1N0M0 invasive breast cancer treated with endocrine therapy. We evaluated radiation use in patients eligible for guideline concordant omission of radiation. METHODS Subgroup analysis of patients eligible for radiation omission from two pooled randomized controlled trials, which included stage 0-III breast cancer patients undergoing breast conserving surgery, was performed to evaluate factors associated with radiation use. RESULTS Of 631 patients, 47 (7.4%) met radiation omission criteria and were treated by 14 surgeons at eight institutions. The mean age was 75.3 (standard deviation + 4.4) y. Majority of patients identified as White (n = 46; 97.9%) and non-Hispanic (n = 44; 93.6%). The mean tumor size was 1.0 cm; 37 patients (88.1%) had ductal, 4 patients (9.5%) had lobular, and 17 patients (40.5%) had low-grade disease. Among patients eligible for radiation omission, 34 (72.3%) patients received adjuvant radiation. Those who received radiation were significantly younger than those who did not (74 y, interquartile range = 4 y, versus 78 y, interquartile range = 11 y, P = 0.03). There was no difference in radiation use based on size (P = 0.4), histology (P = 0.5), grade (P = 0.7), race (P = 1), ethnicity (P = 0.6), institution (P = 0.1), gender of the surgeon (P = 0.7), or surgeon (P = 0.1). CONCLUSIONS Fewer than 10% of patients undergoing breast conservation met criteria for radiation omission. Nearly three-quarters received radiation therapy with younger age being a driver of radiation use, suggesting ample opportunity for de-escalation, particularly among younger eligible patients.
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Affiliation(s)
| | - Sharon S Lum
- Loma Linda University, Loma Lindaaffn, California.
| | | | | | - Akiko Chiba
- Wake Forest University, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Edward A Levine
- Wake Forest University, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | | | | | | | | | | | - David W Ollila
- University of North Carolina, Chapel Hill, North Carolina
| | - Melissa Lazar
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jukes P Namm
- Loma Linda University, Loma Lindaaffn, California
| | | | - Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Forsythe SD, Sivakumar H, Erali RA, Wajih N, Li W, Shen P, Levine EA, Miller KE, Skardal A, Votanopoulos KI. Patient-Specific Sarcoma Organoids for Personalized Translational Research: Unification of the Operating Room with Rare Cancer Research and Clinical Implications. Ann Surg Oncol 2022; 29:7354-7367. [PMID: 35780216 DOI: 10.1245/s10434-022-12086-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/10/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Sarcoma clinical outcomes have been stagnant for decades due to heterogeneity of primaries, lack of comprehensive preclinical models, and rarity of disease. We hypothesized that engineering hydrogel-based sarcoma organoids directly from the patient without xenogeneic extracellular matrices (ECMs) or growth factors is routinely feasible and allows rare tumors to remain viable as avatars for personalized research. METHODS Surgically resected sarcomas (angiosarcomas, leiomyosarcoma, gastrointestinal stromal tumor, liposarcoma, myxofibrosarcoma, dermatofibrosarcoma protuberans [DFSP], and pleiomorphic abdominal sarcoma) were dissociated and incorporated into a hyaluronic acid and collagen-based ECM hydrogel and screened for chemotherapy efficacy. A subset of organoids was enriched with a patient-matched immune system for screening of immunotherapy efficacy (iPTOs). Response to treatment was assessed using LIVE/DEAD staining and metabolic assays. RESULTS Sixteen sarcomas were biofabricated into three-dimensional (3D) patient-specific sarcoma organoids with a 100% success rate. Average time from organoid development to initiation of drug testing was 7 days. Enrichment of organoids with immune system components derived from either peripheral blood mononuclear cells or lymph node cells was performed in 10/16 (62.5%) patients; 4/12 (33%) organoids did not respond to chemotherapy, while response to immunotherapy was observed in 2/10 (20%) iPTOs. CONCLUSIONS A large subset of sarcoma organoids does not exhibit response to chemotherapy or immunotherapy, as currently seen in clinical practice. Routine development of sarcoma hydrogel-based organoids directly from the operating room is a feasible platform, allowing for such rare tumors to remain viable for personalized translational research.
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Affiliation(s)
- Steven D Forsythe
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA
| | - Hemamylammal Sivakumar
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Richard A Erali
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA.,Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Winston-Salem, NC, USA.,Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nadeem Wajih
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA
| | - Wencheng Li
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Winston-Salem, NC, USA.,Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Winston-Salem, NC, USA.,Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine E Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Aleksander Skardal
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA. .,The Ohio State University and Arthur G. James Comprehensive Cancer Center, Columbus, OH, USA.
| | - Konstantinos I Votanopoulos
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Wake Forest Organoid Research Center (WFORCE), Winston-Salem, NC, USA. .,Department of Surgery, Division of Surgical Oncology, Wake Forest Baptist Health, Wake Forest University, Winston-Salem, NC, USA. .,Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Forsythe SD, Erali RA, Laney P, Johansen AM, Sasikumar S, Shen P, Levine EA, Soker S, Votanopoulos KI. Abstract 3076: Low PTIP expression is linked to HIPEC resistance in appendiceal cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Peritoneal carcinomatosis is a late-stage complication of appendiceal cancer, leading to decreased life expectancy and poor quality of life. Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has improved overall survival. Despite this advancement, there remain challenges in determining which patients may benefit from the procedure. Hyperthermia has been shown to potentiate chemotherapy toxicity through interfering with DNA repair, suggesting DNA repair proteins could serve as a predictive marker of clinical outcomes. Herein we applied patient derived tumor organoids (PTOs) to examine the personalized impact of DNA repair mechanisms in efficacy of HIPEC.
Methods: Tumor specimens were obtained from patients undergoing CRS under IRB protocols. Specimens were dissociated and incorporated into a collagen-hyaluronic acid organoid model and treated with clinical HIPEC regimens using mitomycin C (MMC) and oxaliplatin under normothermic (37°C) and heated conditions (42°C) for two hours. The post-treatment viability average responses were aggregated and used for statistical analysis. Treated organoids and tissues were processed histologically and qPCR was performed on patient tumor cells to determine expression of DNA damage markers and DNA damage response.
Results: From June 2019-October 2021, 59 appendiceal tumor tissues from 35 patients with peritoneal carcinomatosis were acquired. 53 PTO groups, from 17 high grade and 36 low grade tumors, were successfully fabricated and tested for HIPEC sensitivity. Hyperthermia potentiated the cytotoxic effect for both MMC (35% vs 57%, p<0.0001, 3/17 HGA and 6/36 LGA PTO sets) and oxaliplatin (41% vs 66%, p<0.0001, 5/17 HGA and 13/37 LGA PTOs). Within the thermosensitive cohort, MMC and oxaliplatin based HIPEC, resulted in similar post perfusion viabilities (35% vs 41%, p=0.25). Furthermore, low and high grade primaries exhibited similar post perfusion viabilities for both MMC (32% vs 40%, p=0.25) and oxaliplatin (36% vs 49%, p=0.08)To test if resistance to HIPEC was associated with increased expression of DNA damage repair proteins in treated organoids, we examined Pax2-Interacting-Protein (PTIP), an important DNA repair protein for both chromatin remodeling and interactions with other DNA repair proteins. Lower PTIP expression in appendiceal tissue sections is correlated with HIPEC treatment sensitivity for both oxaliplatin when compared to high expression (32% vs 49%, p=0.02) and MMC (29% vs 38%, p=0.05). qPCR results confirmed these observations in PTOs, stratifying them into responding and non-responding groups.
Conclusions: Decreased expression of PTIP offers resistance in appendiceal cancer patients treated with HIPEC. PTOs can serve to determine personalized efficacy of HIPEC regimens both at the level of selection of perfusion chemotherapy agent or application of hyperthermia.
Citation Format: Steven D. Forsythe, Richard A. Erali, Preston Laney, Allan M. Johansen, Shyama Sasikumar, Perry Shen, Edward A. Levine, Shay Soker, Konstantinos I. Votanopoulos. Low PTIP expression is linked to HIPEC resistance in appendiceal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3076.
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Affiliation(s)
| | | | | | | | - Shyama Sasikumar
- 3Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC
| | - Perry Shen
- 2Wake Forest Baptist Health, Winston-Salem, NC
| | | | - Shay Soker
- 4Wake Forest Institute of Regenerative Medicine, Winston-Salem, NC
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Valenzuela CD, Levine EA, Mangieri CW, Gawdi R, Moaven O, Russell G, Lundy ME, Perry KC, Votanopoulos KI, Shen P. Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis: A 30-year Institutional Experience. Ann Surg Oncol 2022; 29:3436-3445. [PMID: 35286531 PMCID: PMC10088912 DOI: 10.1245/s10434-022-11441-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/26/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) improves survival in abdominal cancer patients with metastatic disease limited to the peritoneal cavity. Patients are increasingly being offered repeat CRS-HIPECs for peritoneal recurrence. However, in this rare clinical scenario, the survival benefit of performing repeat CRS-HIPEC operations remains unclear. METHODS A retrospective review of the CRS-HIPEC database at Wake Forest Baptist Medical Center was performed over a 30-year timespan. From 1547 patients with appendix cancers, colorectal cancers, mesotheliomas, and other miscellaneous cancers, 156 received more than one CRS-HIPEC. Kaplan-Meier survival analysis was performed using overall survival (OS) from the time of surgery as the primary endpoint. Multi-variable Cox proportional hazards regression modelling was performed on pertinent clinical variables. RESULTS Patients who received multiple CRS-HIPECs had significantly better median OS (10.7 years) versus those who received one CRS-HIPEC (2.5 years), with appendix cancers faring best (12.9 years). Resection status R2a or better was achieved in 76.4% of repeat CRS-HIPECs. There were no significant changes in complication rates after repeat CRS-HIPEC. On multivariate analysis of repeat CRS-HIPEC, patients with appendix and colorectal cancers, heart disease, and poor functional status were independently associated with poor OS. Factors not independently associated with OS were age, sex, body mass index, race, diabetes, lung disease, smoking history, and systemic chemotherapy between CRS-HIPECs. CONCLUSIONS Performing multiple CRS-HIPEC operations on appropriate surgical candidates may significantly prolong survival. Appendix cancers derived the greatest benefit. Satisfactory resection margins and complication rates are comparable to first cases and achievable in repeat CRS-HIPEC procedures.
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Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Megan E Lundy
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Mercier F, Passot G, Bonnot PE, Cashin P, Ceelen W, Decullier E, Villeneuve L, Walter T, Levine EA, Glehen O, Baik SH, Baratti D, Bhatt A, De Hingh I, De Simone M, Dubé P, Edwards RP, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman MP, Hsieh MC, Kecmanovic D, Lee KW, Lehmann K, Liu Y, Mehta S, Morris DL, O’Dwyer S, Orsenigo E, Pande PK, Park EJ, Pingpank JF, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Tentes AAK, Teo M, Yarema R, Younan R, Zaveri SS, Zeh HJ, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Ferron G, Kianmanesh R, Dico RL, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F. An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World J Surg 2022; 46:1336-1343. [PMID: 35286418 DOI: 10.1007/s00268-022-06498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry. METHODS A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed. RESULTS The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications. CONCLUSION CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.
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Affiliation(s)
- Frederic Mercier
- Department of Surgical Oncology, CHU Montreal, University of Montreal, 1000 St-Denis, Montreal, QC, H2X 0C1, Canada. .,The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.
| | - Guillaume Passot
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | | | - Peter Cashin
- Department of Surgery, Akademiska Sjukhuset, Uppsala University Hospital, Uppasala, Sweden
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Gent University Hospital, Ghent, Belgium
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Laurent Villeneuve
- EMR 37-38, Lyon 1 University, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Thomas Walter
- Department of Gastroenterology and Oncology, Hospices Civils de Lyon, Edouard Herriot Hospital University of Lyon, Lyon, France
| | - Edward A Levine
- Section of Surgical Oncology, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Olivier Glehen
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
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Valenzuela CD, Levine EA, Votanopoulos KI, Shen P. ASO Author Reflections: Thirty Years of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) at Wake Forest University. Ann Surg Oncol 2022; 29:3446-3447. [PMID: 35275327 DOI: 10.1245/s10434-022-11514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Levine EA, Mangieri CW, Gawdi R, Moaven O, Russell G, Lundy ME, Perry KC, Votanopoulos KI, Shen P. ASO Visual Abstract: Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis-A 30-year Institutional Experience. Ann Surg Oncol 2022. [PMID: 35254574 DOI: 10.1245/s10434-022-11488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Megan E Lundy
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Votanopoulos KI, Levine EA, Shen P. ASO Author Reflections: When is the Best Time to Perform Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for a Recurrent Low-Grade Appendiceal Mucinous Neoplasm? Ann Surg Oncol 2022; 29:3432-3433. [PMID: 35257253 DOI: 10.1245/s10434-022-11515-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Mangieri CW, Garland-Kledzik M, Gawdi R, Russell G, Perry KC, Votanopoulos KI, Levine EA, Shen P. Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms. Ann Surg Oncol 2022; 29:3422-3431. [PMID: 35254575 PMCID: PMC10085001 DOI: 10.1245/s10434-022-11440-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Low-grade appendiceal mucinous neoplasm (LAMN) with peritoneal involvement is a common indication for cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC). With peritoneal recurrence, patients are increasingly being offered repeat CRS/HIPECs, however optimal timing for a second CRS/HIPEC remains unknown. METHODS A prospectively maintained 30-year database at our high-volume HIPEC center was analyzed retrospectively for patients with LAMNs and peritoneal recurrence receiving one or two CRS/HIPECs. Kaplan-Meier survival analysis, linear regression modeling, and Cox proportional hazards regression analyses were performed. RESULTS Overall, 143 patients with LAMNs who underwent CRS/HIPECs had confirmed postoperative peritoneal recurrence. Of these patients, 85 underwent one CRS/HIPEC and 58 underwent two CRS/HIPECs. The groups had significant differences in age, with younger patients more likely to undergo a second CRS/HIPEC (48.5 vs. 58.0 years; p < 0.001). The median overall survival (OS) for the group undergoing two CRS/HIPECs was approximately four times longer compared with the group undergoing one CRS/HIPEC (227.1 vs. 54.5 months; p < 0.0001). The time from recurrence to the second CRS/HIPEC was not significantly associated with OS from the time of the first operation. Instead, a shorter time between the first CRS/HIPEC and recurrence was significantly associated with shorter OS from the time of the first operation (p = 0.037). CONCLUSION In peritoneal LAMNs with recurrence, receiving two CRS/HIPECs was associated with better OS compared with receiving one CRS/HIPEC. Longer time to recurrence was a good prognostic factor. Delay between recurrence and second CRS/HIPEC had no apparent impact on OS from the first CRS/HIPEC; thus, immediate or delayed reoperative intervention are both reasonable approaches.
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Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Mangieri CW, Garland-Kledzik M, Gawdi R, Russell G, Perry KC, Votanopoulos KI, Levine EA, Shen P. ASO Visual Abstract: Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hajjar R, Mercier F, Passot G, Pasquer A, Gelli M, Levine EA, Villeneuve L, Poncet G, Walter T, Glehen O. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for small bowel neuroendocrine tumors with peritoneal metastasis. European Journal of Surgical Oncology 2022; 48:1626-1630. [DOI: 10.1016/j.ejso.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/07/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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Mangieri CW, Moaven O, Valenzuela CD, Erali RA, Votanopoulos KI, Shen P, Levine EA. Utility of Neoadjuvant Chemotherapy for Peritoneal Carcinomatosis Secondary to High-Grade Appendiceal Neoplasms for Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2022; 29:2641-2648. [DOI: 10.1245/s10434-021-11153-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/13/2021] [Indexed: 12/23/2022]
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Mangieri CW, Levine EA. ASO Author Reflections: Neoadjuvant Chemotherapy for High-Grade Appendiceal Neoplasms Before Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy, Closer to Evidence-Based Practice? Ann Surg Oncol 2022; 29:2649-2650. [PMID: 35001235 DOI: 10.1245/s10434-021-11165-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, USA.
| | - Edward A Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, USA
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Mangieri CW, Moaven O, Valenzuela CD, Erali RA, Votanopoulos KI, Shen P, Levine EA. ASO Visual Abstract: Utility of Neoadjuvant Chemotherapy for Peritoneal Carcinomatosis Secondary to High-Grade Appendiceal Neoplasms for Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-021-11239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Moaven O, Clark CJ, Russell GB, Votanopoulos KI, Howerton R, Levine EA, Shen P. Optimal Adjuvant Treatment Approach After Upfront Resection of Pancreatic Cancer: Revisiting the Role of Radiation Based on Pathologic Features. Ann Surg 2021; 274:1058-1066. [PMID: 31913868 PMCID: PMC7335684 DOI: 10.1097/sla.0000000000003770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify the survival benefit of different adjuvant approaches and factors influencing their efficacy after upfront resection of pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA The optimal adjuvant approach for PDAC remains controversial. METHODS Patients from the National Cancer Database who underwent upfront PDAC resection from 2010 to 2014 were analyzed to determine clinical outcomes of different adjuvant treatment approaches, stratified according to pathologic characteristics. Factors associated with overall survival were identified with multivariable logistic regression and Cox proportional hazards were used to compare overall survival of different treatment approaches in the whole cohort, and propensity score matched groups. RESULTS We included 16,709 patients who underwent upfront resection of PDAC. On multivariable analysis, tumor size, grade, positive margin, nodal involvement, lymphovascular invasion (LVI), stage, lymph node ratio, not receiving chemotherapy, and/or radiation were predictors for worse survival. In the presence of at least 1 high-risk pathologic feature (nodal or margin involvement or LVI) chemotherapy with subsequent radiation provided the most significant survival benefit (median survivals: 24.8 vs 21.0 mo for adjuvant chemotherapy; HR = 0.81; 95% CI: 0.77-0.86; P < 0.001 in propensity score matching). The addition of radiation to adjuvant chemotherapy did not significantly improve overall survival in those with no high-risk pathologic features (median survivals: 54.6 vs 42.7 mo for adjuvant chemotherapy; HR=0.90; 95% CI: 0.75-1.08; P = 0.25 in propensity score matching). CONCLUSIONS In the presence of any high-risk pathologic features (nodal or margin involvement or LVI), adjuvant chemotherapy followed by radiation provides a better survival advantage over chemotherapy alone after upfront resection of PDAC.
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Affiliation(s)
- Omeed Moaven
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston Salem, NC
| | - Clancy J. Clark
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston Salem, NC
| | - Gregory B. Russell
- Department of Biostatistics and Data Science, Wake Forest University, Winston Salem, NC
| | | | - Russell Howerton
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston Salem, NC
| | - Edward A. Levine
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston Salem, NC
| | - Perry Shen
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston Salem, NC
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Mangieri CW, Moaven O, Valenzuela CD, Erali RA, Votanopoulos KI, Shen P, Levine EA. Utility of hyperthermic intraperitoneal chemotherapy in cases of incomplete cytoreductive surgery. J Surg Oncol 2021; 125:703-711. [PMID: 34841542 DOI: 10.1002/jso.26759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Hyperthermic intraperitoneal chemotherapy (HIPEC) during cytoreductive surgery (CRS) is typically reserved for a complete or optimal cytoreduction. There is the potential for therapeutic effect of HIPEC with an incomplete cytoreduction, particularly for near optimal cytoreductions. METHODS Retrospective review of incomplete cytoreductions (R2b, R2c) for appendiceal and colorectal primaries. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Subgroup analysis for primary etiology and specific cytoreductive score. RESULTS A total of 121 cases of incomplete CRS, 74 CRS alone, and 47 CRS-HIPEC. For the entire study group there was a survival benefit with HIPEC. OS and PFS were 2.3 versus 1.4 (p = 0.001) and 1.6 versus 0.7 (p < 0.0001) respectively for cases with and without HIPEC. Subgroup analysis of appendiceal neoplasms, 43 CRS-HIPEC and 50 CRS alone, found HIPEC benefit persisted; OS and PFS were 2.4 versus 1.5 (p = 0.016) and 1.7 versus 0.8 (p < 0.0001), respectively for cases with and without HIPEC. Benefit most pronounced in low-grade cases with doubling of the OS and PFS (p = 0.004). With colorectal primary cases, 10 CRS-HIPEC and 18 CRS alone, no difference in OS and PFS. When stratifying out by cytoreduction scores, R2b and R2c, HIPEC only provided a benefit for R2b cases; OS and PFS for R2b cases were 2.28 versus 1.01 (p = 0.011) and 1.67 versus 0.75 (p = 0.001), respectively for cases with and without HIPEC. CONCLUSION HIPEC has utility for incomplete cytoreductions with appendiceal neoplasms, greatest effect with low-grade appendiceal neoplasms. HIPEC is only beneficial for near optimal cytoreductions (R2b).
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Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Surgical Oncology Section, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA
| | - Omeed Moaven
- Department of Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Cristian D Valenzuela
- Division of Surgical Oncology, Surgical Oncology Section, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA
| | - Richard A Erali
- Division of Surgical Oncology, Surgical Oncology Section, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA
| | - Konstantinos I Votanopoulos
- Division of Surgical Oncology, Surgical Oncology Section, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA
| | - Perry Shen
- Division of Surgical Oncology, Surgical Oncology Section, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA
| | - Edward A Levine
- Division of Surgical Oncology, Surgical Oncology Section, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA
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Chagpar AB, Howard-McNatt M, Chiba A, Levine EA, Gass JS, Gallagher K, Lum S, Martinez R, Willis AI, Fenton A, Solomon NL, Senthil M, Edmonson D, Namm JP, Walters L, Brown E, Murray M, Ollila D, Dupont E, Garcia-Cantu C. Factors Affecting Time to Surgery in Breast Cancer Patients. Am Surg 2021; 88:648-652. [PMID: 34732082 DOI: 10.1177/00031348211054714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care. METHODS Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded. RESULTS The median TTS among the 583 patients in this cohort was 34 days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30 days. Hispanic patients less likely to have a TTS ≤30 days (P = .001). There was significant variation in TTS by surgeon (P < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, P < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30 days 41.9% vs 51.9%, respectively, P = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30 days 25.0% vs 50.9%, P < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 (P = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, P < .001) and community practice type (OR: .324; 95% CI: .194-.541, P < .001) remained independent predictors of lower likelihood of TTS ≤30 days. CONCLUSIONS Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.
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Affiliation(s)
| | | | - Akiko Chiba
- 12279Wake Forest University, Winston-Salem, North Carolina
| | | | | | | | - Sharon Lum
- 4608Loma Linda University, Loma Linda, CA
| | | | | | | | | | | | | | | | | | - Eric Brown
- 6559Thomas Jefferson University, Philadelphia, PA
| | - Mary Murray
- 205980Doctors Hospital at Renaissance, Edinburg, TX
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Pearce JB, Hsu FC, Howard-McNatt MM, Levine EA, Chiba A. Evaluation of the Axillary Surgery Performed in Clinically Node-Positive Breast Cancer Patients Following Neoadjuvant Chemotherapy. Am Surg 2021; 88:623-627. [PMID: 34730447 DOI: 10.1177/00031348211050803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The American College of Surgeons Oncology Group Z1071 trial in 2013 demonstrated the fesability of sentinel lymph node biopsy in clinically node-positive patients following neoadjuvant chemotherapy. The goal of this study was to determine the continued impact of this study on our practice pattern. MATERIALS AND METHODS This is a retrospective review of institutional changes in the management of axillary nodal disease following the publication of Z1071. Patients with clinically node-positive disease that completed neoadjuvant chemotherapy between 2014 and 2020 were included. The Cocoran-Armitage trend test was used to analyze change in categorical variables over time, and the Spearman's rank coefficient was used to analyze two-ranked variables. RESULTS A cohort of 102 patients were included in the study and demonstrated that the number of sentinel lymph node biopsies to evaluate axillary disease increased over time. Additionally, the number of biopsies of suspicious nodes, and the use of marker clips on the biopsied nodes increased over time. CONCLUSION Our institution has continued to incorporate the result from Z1071 in our practice patterns.
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Affiliation(s)
- Jane B Pearce
- 12279Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Fang-Chi Hsu
- 12279Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Marissa M Howard-McNatt
- 12279Department of Surgical Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Edward A Levine
- 12279Department of Surgical Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Akiko Chiba
- 12279Department of Surgical Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
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Chouliaras K, Ethun CG, Poultsides GA, Howard HJ, Clarke CN, Roggin KK, Fields RC, Levine EA, Cardona K, Votanopoulos KI. Predictors of Desmoid Recurrence after Surgical Management from the US Sarcoma Collaborative. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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