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35.7 Expression of melanoma-associated antigens (MAGE) in stage I NSCLCs C. Sadowski-Cron 1 , C. Ruiz 1 , I. Zlobec 1 , I. Ackermann 1 , M. Gugger 2 , M. Naef 2 , R. A. Schmid 2 , P. Zajac 1 , G. Spagnoli 1 , L. Bubendorf 1 , D. Lardinois 1 ( 1 Basel, 2 Berne) Objective: The classical prognostic factors for operable non-small cell lung cancers (NSCLC) are pTNstage and grade. Despite of these established prognostic factors, a considerable fraction of early-stage patients do relapse. Therefore, new prognostic and predictive molecular markers are needed to identify patients who could benefit from adjuvant chemotherapy or targeted therapies. Tumor associated antigens (TAA) of the Cancer/testis (C/T) family have been used in advanced NSCLC as targets for specific immunotherapy. Nevertheless, comprehensive data of their expression and prognostic relevance in early-stage NSCLC are not yet available. Here, we analyzed the prevalence and the prognostic significance of the C/T family members MAGE-A and NY-ESO in a multi-institutional study of stage I lung cancer patients. Methods: We constructed a tissue microarray from 519 surgical specimens from stage I NSCLC cancer patients, who underwent surgery either at the University Hospital Basel or at the Inselspital Bern. Comprehensive histopathological and clinical data were collected, including follow-up on overall and tumor-specific survival. Semi-quantitative expression of the MAGE-A and of the NY-ESO proteins was determined by immunohistochemistry. We analyzed the association of these markers with standard morphological parameters and the proliferation marker Ki67 on consecutive TMA sections. Results: 44% of NSCLC stage I tumors expressed either MAGE-A or NY-ESO protein. Squamous cell carcinomas (SqCC) showed the highest prevalence of MAGE-A protein expression (58%, 131 of 223), and only in these tumors, the expression of both C/Ts correlated significantly (p
Results: SLN negative patients were found in 67.6% (277/410) of those breast cancer patients undergoing BM aspirations simultaneously. Their BMM status was negative in 75.8% (210/277), whereas in 24.2% (67/277) BM micrometastases were identified. The median follow-up was 60 months for both groups. The 5-year overall survival was 92.7% for the BMM negative and 92.5% for the BMM positive group (p=0.85). The 5-year disease-free survival reached 93.6% in the BMM negative group versus 92.2% in the BMM positive group (p=0.50). Conclusion: This is the first prospective study to examine the long-term disease-free and overall survival in SLN negative patients in correlation to their BMM status. Although BMM are identified in one of four SLN negative patients, they are not a prognostic factor regarding disease-free and overall survival in SLN negative breast cancer patients. 36.2 PET-CT improves staging in patients with adenocarcinoma of the stomach and cardia K. Lehmann, M. Schiesser, P. Bauerfeind, A. Rickenbacher, D. Schmid, A. Weber, T. Frauenfelder, T. Hany, P.-M. Schneider (Zurich) Objective: To prospectively assess the accuracy of PET-CT, EUS and CT in staging patients with adenocarcinoma of the stomach and cardia. The accuracy of preoperative staging in patients with adenocarcinoma of the stomach or esophagogastric junction (AEG) Siewert type II/III is low despite endoscopic ultrasound (EUS) and multislice CT. PET-CT is a novel imaging modality that could improve these results. Therefore, we prospectively assessed the accuracy of PET-CT, EUS and CT. Methods: Fifty-two consecutive patients with adenocarcinoma of the stomach (n=30) or AEG type II/ III (n=22) were prospectively evaluated. Systematic D2-lymphadenectomy (median: 31 nodes) was performed with individual histopathologic assessment of lymph node stations 1-12 (Japanese Gastric Cancer Association), and additionally lymph nodes of the lower mediastinum for AEG type II/III. Preoperative staging results from EUS, CT and PET-CT were correlated to histopathological results. Results: PET-CT demonstrated a high specificity with a resulting positive predictive value of 100%, but a low sensitivity for the detection of loco-regional lymph nodes (sensitivity: 37%, specificity: 100%, accuracy: 66%). Sensitivity was higher if the tumor was PET-positive (47%), and for nodes located in compartment D2 compared to D1 (40% vs. 21%). In comparison, EUS was more sensitive (sensitivity: 80%, specificity: 63%, accuracy: 70%), and CT alone displayed similar results (sensitivity: 53%, specificity: 69%, accuracy: 60%). PET-CT however, displayed a higher accuracy for the detection of extraregional lymph node metastases (M1LYM) and organ metastases (sensitivity: 77%, specificity: 100%, accuracy: 94%) compared to CT alone (sensitivity: 38%, specificity: 97%, accuracy: 83%). Conclusion: PET-CT enhances the specificity and positive predictive value for the staging of loco-regional lymph nodes compared to EUS and CT, and is more accurate in the detection of extra-regional lymph nodes and systemic metastases compared to CT alone. We therefore recommend the use of PET-CT for preoperative staging of adenocarcinoma of the stomach and cardia. 36.3 Management of peritoneal carcinomatosis by hyperthermic intraperitoneal chemotherapy a 13 years experience F. Ris, G. Herren, Ph. Morel, F. Volonte, A. Roth, O. Huber (Geneva) Objective: Peritoneal carcinomatosis (PC) is a common manifestation of advanced malignancies, associated to bad prognosis. There is presently increasing interest in hyperthermic intraperitoneal chemotherapy (HIPEC) combined with surgical cytoreduction (SC). We report here our 13 years experience for the management of peritoneal carcinomatosis. Methods: Retrospective study of all operative management of PC by SC-HIPEC from 1996 to 2009. Results: During this period, 53 surgical explorations for PC were performed. Complete cytoreduction was judged impossible in 7. Median age of the 46 resected patients (31 F, 15 M), was 52 (17-65). Primary cancers were 32% pseudomyxomas, 24% colorectal, 22% ovarian, 17% gastric and 4% mesotheliomas. Overall morbidity (grade I-IV) was 71%; severe morbidity (grade III-IV) 39%; reoperation was warranted in 20% (3 anastomotic leaks, 4 perforations); perioperative mortality (D60) was 2% (n=1); median hospital stay was 23 days (12-84). Median follow-up was 13.5 months (1-196), with an overall survival rate of 80%. 8 patients died of disease; 37 patients are alive, from which 86.6% (32/37) are presently without signs of recurrence. Conclusion: these results show that, in very selected patients, SC-HIPEC has a profound impact on the prognosis PC; in this context, the high observed morbidity appears easily acceptable; SC-HIPEC has a very promising future in specialized centers. 36.4 Impact of 18F-FDG-PET on re-staging and prediction of tumor response of patients with locally advanced rectal cancer B. Kern, F. Jüngling, A. Staehelin, K. Baumann, M. O. Guenin, R. Peterli, C. Ackermann, M. von Flüe (Basel) Objective: Neoadjuvant chemoradiotherapy (CRT) has become a standard practice for locally advanced rectal cancer. Complete pathologic response can be achieved in up to 20% and discussions about a “watch-and-wait” strategy in these patients are going on. Reliable methods to detect patients with a complete pathological response after CRT are not known. One possible method may be the 18F- FDG-PET. The aim of this study was to evaluate the change in tumor maximum standardized uptake value (SUVmax) before and after CRT and to correlate the change with the pathologic response. Methods: Between 7/2005 and 11/2009 104 patients (36 females, 68 males) with locally advanced rectal cancer were treated by preoperative CRT in a prospective study. A18F-FDG-PET scan was performed in 97 patients before and in 99 patients 4 weeks after CRT. For each scan SUVmax was measured in the tumor. The percentage of SUVmax decrease from starting scan to presurgical scan was correlated with pathologic response and tumor regression grade. Surgical approach was a sphincter saving total mesorectal excision or an abdominoperineal amputation 6 weeks after CRT. Results: Mean tumor uptake was 11.9 ± 0.7 before and 3.6 ± 0.4 after CRT (p
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FRAGMIN ® DER ERFAHRENE WEGGEFÄHR
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Kalbermatten Daniel, PD Dr., CHUV C
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Meyer Antoine, Dr., Hôpital canton
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Covidien Switzerland Limited multip
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