Beodeul Kang

Prognostic Significance of Volume-Based FDG PET/CT Parameters in Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiation Therapy

Purpose We investigated the prognostic role of volume-based parameters measured on 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) scans in patients with locally advanced pancreatic cancer (LAPC) treated with chemoradiation therapy (CRT). Materials and Methods We enrolled 60 patients with LAPC who underwent FDG PET/CT before CRT. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary pancreatic cancers were measured on FDG PET/CT scans. Treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors. Survival analysis was performed using the Kaplan-Meier method, and Cox proportional hazard models were used to determine independent prognostic factors. Results The progression-free survival (PFS), locoregional progression-free survival (LRFPS), and overall survival (OS) for this population were 6.2, 10.9, and 13.2 months, respectively. The overall treatment response rate was 16.7% at 4 weeks after CRT, and the disease control rate (DCR) was 80.0%. DCR was significantly higher in patients with low SUVmax, MTV, or TLG, and showed strong correlation with longer survival times. On univariate analysis, MTV and TLG were significant prognostic factors for PFS, LRPFS, and OS, together with pre-CRT and post-CRT CA19-9 levels. Multivariate analyses demonstrated that MTV together with the pre-CRT CA19-9 level were independent prognostic factors for PFS, LRPFS, and OS, as was TLG for LRPFS and OS. Conclusion MTV and the pre-CRT CA19-9 level provided independent prognostic information in patients with LAPC treated with CRT. Volume-based PET/CT parameters may be useful in identifying which subgroup of patients would benefit from radiation therapy as a part of CRT.

Changing treatment patterns in elderly patients with resectable colon cancer

To evaluate changing treatment patterns and survival outcomes of elderly patients (age 70 years or older) with resectable colon cancer over the past 15 years.

Palliative prognostic tools for the terminally ill patients with gastric cancer.

120 Background: Terminally ill patients with gastric cancer have specific gastrointestional symptoms and signs related with cancer progression. To estimate accurate survival expectancy of gastric cancer patients is important for timely decision making of their end of life issues. METHODS We reviewed the 276 patients with terminally ill gastric cancer who were treated at Yonsei Cancer Center between January 2007 and December 2011 and eventually were died. Retrospectively, we conducted the data of clinical signs, symptoms, and laboratory results at the time of cessation of the active treatment. Then, we established the palliative survival estimation model by stratification of risk group. RESULTS Median palliative survival time from the decision to stop further treatment to death was 42days. In the multivariate Cox regression analysis, 5 parameters were identified as prognostically significant factors: anorexia, dyspnea, hypoalbuminemia, elevated blood urea nitrogen, and elevated serum alkaline phosphatase. We scored each variables as 1-3 for symptom(1:asymptomatic, 2:symptomatic, 3:symptomatic requiring intervention) and 1-2 for lab results(1:normal, 2:abnormal) and summed up each scores. Using the total score, patients were divided into 3 risk groups: low-risk(5-7points), intermediate-risk(8-11points), and poor-risk patients(12point). As a result, median palliative survival for low-risk group(n=110) was 87.0±7.4days, intermediate-risk group(n=158) and poor-risk group(n=8) were 31.0±2.1days and 6.0±2.1days, respectively (p<0.0001). CONCLUSIONS Using multivariate analysis and summation of each prognostic factor score, 3 risk groups were determined. After validation by prospective multicenter trial, this palliative survival time estimation tool will be helpful to inform the accurate survival for terminally ill gastric cancer patients.

Delirium and its consequences in the specialized palliative care unit: Validation of the Korean version of Memorial Delirium Assessment Scale

Delirium is highly prevalent in patients with advanced cancer. This study aimed to investigate delirium rates and potential associated factors such as mortality in patients admitted to an acute palliative care unit (APCU). Our second aim was to validate the Korean version of the Memorial Delirium Assessment Scale (K‐MDAS).

Differences in the symptom distress between young adult and adult patients with advanced cancer admitted to acute palliative care unit.

99 Background: Understanding about young adults with advanced cancer in palliative care was still insufficient. The purpose of this study was to identify the differences in symptom distress between young (20-39 years) and older (≥ 40 years) adults with advanced cancer who were admitted to acute palliative care unit. METHODS We retrospectively analyzed 502 consecutive patients admitted to acute palliative care unit between April 2015 and March 2016 in two tertiary cancer centers. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS), and Symptom Distress Scale (SDS) were performed. RESULTS Among 502 patients, 33 (7%) were aged 20-39 years, and 469 (93%) were aged ≥ 40 years. The most common malignancies among the young adult patients were stomach and colorectal cancers. SDS was similar between young adult (38.7 ± 15.1) and old adult (41.5 ± 13.7) patients. However, pain, nausea, poor feeling of well-being sense, sleep disturbance, and financial distress were numerically higher in young adult group than older adult group. Especially, sleep disturbance (5.72 vs. 4.56, p = 0.030) and financial distress (4.44 vs. 2.87, p = 0.008) showed statistically significant difference. CONCLUSIONS Young adult advanced cancer patients appear to show different symptom profiles. Further research is needed to identify determinants and to provide timely integration of palliative care services for this unique patient cohort.

PTEN Methylation Dependent Sinonasal Mucosal Melanoma

Sinonasal mucosal melanoma (SMM) is an aggressive and rare type of melanoma. Although the classic RAS-RAF-MEK pathway is thought to be the main pathway involved in melanoma pathogenesis, genetic alterations in the phosphatidylinositol 3-kinase–AKT pathway, including PTEN-regulated signaling, are also thought to contribute. So far, data regarding altered PTEN expression and epigenetic mechanism of PTEN silencing in development of SMM is extremely limited. Herein we report on a case of SMM with liver and bone metastases with an epigenetic alteration of PTEN. Results of mutation analysis for BRAF, NRAS, HRAS, KRAS, PIK3CA, c-Kit, and PTEN were negative; however, methylation of PTEN CpG islands was observed. Our case not only supports PTEN as a major tumor suppressor involved in melanoma tumorigenesis, but also a potential epigenetic mechanism of PTEN silencing in development of SMM.

Abstract 4662: Prognostic value of total lesion glycolysis from 18F-fluorodeoxyglucose positron emission tomography patients with gastric neuroendocrine carcinoma

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA Background: Gastric neuroendocrine carcinomas (NET) are very rare, aggressive tumors of the stomach. The objective of this study was to examine the predictive role of pretreatment fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET)-assessed metabolic parameter of the whole-body and primary tumors in patients with gastric NET Method: We conducted a retrospective review of the 25 patients with histopathologically confirmed poorly differentiated NETs of the stomach at our hospital between January 2005 and December 2012. All of the patients underwent 18F-FDG-PET examination at diagnosis. Metabolic parameters [SUVmax, SUVmean, and total lesion glycolysis (TLG)] on pretreatment 18F-FDG-PET were analyzed for survival. Results: Median follow up duration was 39.4 months (95% CI, 20.0-58.1 months) and median overall survival (OS) was 25.7 months (95% CI, 14.1-37.2 months). When subjects were divided into two groups according to TLG with a cutoff value of 500, the high TLG group showed significantly shorter OS compared to the low TLG group (p=0.006). However, SUVmean and SUVmax had no significant association OS (p = 0.258, and p = 0.52, respectively). Conclusions: Our findings suggest that TLG may be more useful than SUVmean and SUVmax for predicting OS in patient with NET. The TLG measurement on 18F-FDG-PET imaging could be routinely recommended to advanced gastric cancer with neuroendocrine carcinoma Citation Format: Minkyu Jung, Beodeul Kang, Ji Soo Park, Sun Min Lim, Hyo Song Kim, Sun Young Rha, Joong Bae Ahn, Hyun Cheol Chung, Mijin Yun, Arthur Cho. Prognostic value of total lesion glycolysis from 18F-fluorodeoxyglucose positron emission tomography patients with gastric neuroendocrine carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4662. doi:10.1158/1538-7445.AM2014-4662