Cholangiocarcinoma is an infrequent neoplasm barely studied with 18F-FDG–PET/CT. We evaluated the metabolic behavior of cholangiocarcinoma in PET/CT according to its location (intra or extrahepatic) and analyzed the relationship between metabolic parameters of the primary tumor and tumor markers (CA19-9 and CEA), determining their prognostic significance.

Introduction: Patients (pts) with locally advanced esophageal carcinoma (LAEC) benefit from preoperative chemo-radiotherapy (NA CRT) followed by surgery. However, half of them will relapse within the first 2 years, having limited treatment options. Moreover, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) are thought to represent two different diseases which might differ in terms of recurrence. Our aim is to analyze the characteristics and outcome of pts who relapse. Methods: We retrospectively reviewed pts with LAEC treated at the Gastroesophageal Tumors Functional Unit of Catalan Institute of Oncology, Bellvitge University Hospital and integrated centers who underwent NA CRT followed by surgery from 2000 to 2014. We analyzed recurrence rate (RR), median time to relapse (mTTR) and pattern of recurrence (PR): locoregional recurrence (LRR), distant recurrence (DR) or synchronic LR and DR (SR); results were stratified by histology. Clinical data and salvage therapy (ST) were also collected, including surgery, radiotherapy and palliative chemotherapy (PCT). Kaplan Meier for median overall survival (mOS) and median time to progression (mTTP) were performed. Results: 83/100(83%) pts receiving NA CRT underwent surgery: ADC 33(40%), SCC 44(53%), undifferentiated 6(7%). 88% R0, pathologic complete response (ypT0N0): 20 (24%): ADC 18,2 %, SCC 33,3%, p0,22. After a median follow-up of 26 months (m) (1-126) 1-year and 3-year RR were 36 (ADC 40,9%, SCC 27,3%) and 43% (ADC 47,7%, SCC 36,4%) respectively. mTTR 6 m (4,1-7,8), PR (%) of the 36 (43%) pts who relapse: LRR 31% (ADC 18%,SCC 55%, 37% ND) DR 50 % (ADC 72, SCC 28) SR 19 % (ADC 86, SCC 14), logRank for histology 0,032.median OS was 32 m (IC 95% 14,1-49,3): 26,8m ADC vs 45,4m SCC (p < 0,001). Median number of metastatic sites at relapse: 2. Data of 26/36 pts who relapse was available: 13/26 (50%) received ST: radical radiotherapy1 (7%), salvage surgery 1(7%). 11 (86%) receivedPCT. 90% had performance status ≤1, 100% had albumin serum levels ≥34g/l and Hemoglobin > 12g/L. PCT schedule: Docetaxel (46%), Cisplatin plus 5-fluoracyl (23%), Carboplatin plus 5-fluoracyl (15%). Median time on treatment was 10.7m (1-22). 5/13 (38%) pts received subsequent lines of PCT. Median OS was 11m (6,3-16,5): 26m (12,2-41,5) for patients who received ST versus 6,5m (1,3-11,4) for those who received best supportive care (p < 0,026). Conclusion: ADC and SCC differ significantly in their pattern of recurrence, being ADC more frequent in distant recurrence which confers a poor prognosis. A lower rate of pathologic complete response and a higher RR was observed for the group of ADC compared to SCC, although those differences were not statistical significant. Pts who relapse and maintain favorable prognostic clinical factors clearly benefit from salvage therapy if feasible and PCT.

Introduction: The standard treatment for patients (pts) with locally advanced esophageal carcinoma (LAEC) and good performance status is preoperative chemoradiotherapy followed by surgery. The two main histologic subtypes, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) present different epidemiology and might differ in prognosis. Our aim is to analyze the outcomes of a cohort of patients treated in our center and compare both histologies.Methods: We reviewed 100 patients (pts) diagnosed with primary LAEC that were treated with concurrent CRT followed by surgery at the Catalan Institute of Oncology, Bellvitge Hospital and integrated centers between 2000-2014. All pts were discussed at the multidisciplinary Gastroesophageal Tumors Functional Unit (UTEG). We described clinical characteristics, recurrence rates and survival curves using Kaplan Meier. A multivariate Cox regression was performed to identify prognostic factors.Results: 100 pts were studied: mean age 61 (34-78); 93% male; 96% PS ≤ 1; 18% Barrett esophagus; 42/43/15% Active/Former/Never smokers; Histology: 50% ADC/ 42% SCC, 2% undifferentiated. Location: 82% esophagus (7/35/40% upper, middle, lower) and 18% esophagogastric junction (Siewert I and II). Clinical stage included cT2N + , cT3-4a-b N0/+. 88% were node positive (cN+). 96% pts received a median of 2 cycles of NA CT, being the most used regimen CDDP-5FU (83%). Total RT dose received was 45 Gy (76%) and 50,4Gy (18%), depending on the centre protocol. G3/G4 toxicity occurred in 18% pts. Radiological response was assessed by PET: 19% complete response (CR), 55% partial response (PR), 16% stable disease (SD), 7% progression (PD), 3% not determined (ND). 83 pts (83%) underwent surgery: ADC 53%, SCC 40%. 83% R0. Pathologic complete response (ypT0N0-ypCR) was achieved in 20 pts (24%): 39% ADC/61% SCC. Downstaging of cN+ to ypN0 was 61% (44/72 pts). Deaths due to post-operative complications (within 30 days) occurred in 2 patients (2,8%). After a median follow-up of 26 months (m), overall recurrence rate (ORR) of pts who underwent surgery was 43% (36 pts): 58% of resected ADC, 33% of resected SCC. Median time to recurrence disease (mTRD) for ADC was 16,5m vs SCC, not reached (p < 0,24). 1 and 3 years RR was 36% and 43%, respectively. Median overall survival (OS) was 32 m (IC 95% 14,1-49,3): 26,8m ADC vs 45,4m SCC (p < 0,001). 1 and 3 years OS rate were 66% and 53%, respectively. In the multivariate Cox regression, two independent factors influenced in OS: ypCR HR 0,5 (0,19-1,25) (p< 0,016) and ypN+ HR 2,3 (1,1-4,8) (p< 0,001).Conclusion: ADC and SCC represent two different diseases with different prognosis in locally advanced esophageal carcinoma. These results might be considered when developing novel therapies and follow up strategies in this setting. Introduction: The standard treatment for patients (pts) with locally advanced esophageal carcinoma (LAEC) and good performance status is preoperative chemoradiotherapy followed by surgery. The two main histologic subtypes, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) present different epidemiology and might differ in prognosis. Our aim is to analyze the outcomes of a cohort of patients treated in our center and compare both histologies. Methods: We reviewed 100 patients (pts) diagnosed with primary LAEC that were treated with concurrent CRT followed by surgery at the Catalan Institute of Oncology, Bellvitge Hospital and integrated centers between 2000-2014. All pts were discussed at the multidisciplinary Gastroesophageal Tumors Functional Unit (UTEG). We described clinical characteristics, recurrence rates and survival curves using Kaplan Meier. A multivariate Cox regression was performed to identify prognostic factors. Results: 100 pts were studied: mean age 61 (34-78); 93% male; 96% PS ≤ 1; 18% Barrett esophagus; 42/43/15% Active/Former/Never smokers; Histology: 50% ADC/ 42% SCC, 2% undifferentiated. Location: 82% esophagus (7/35/40% upper, middle, lower) and 18% esophagogastric junction (Siewert I and II). Clinical stage included cT2N + , cT3-4a-b N0/+. 88% were node positive (cN+). 96% pts received a median of 2 cycles of NA CT, being the most used regimen CDDP-5FU (83%). Total RT dose received was 45 Gy (76%) and 50,4Gy (18%), depending on the centre protocol. G3/G4 toxicity occurred in 18% pts. Radiological response was assessed by PET: 19% complete response (CR), 55% partial response (PR), 16% stable disease (SD), 7% progression (PD), 3% not determined (ND). 83 pts (83%) underwent surgery: ADC 53%, SCC 40%. 83% R0. Pathologic complete response (ypT0N0-ypCR) was achieved in 20 pts (24%): 39% ADC/61% SCC. Downstaging of cN+ to ypN0 was 61% (44/72 pts). Deaths due to post-operative complications (within 30 days) occurred in 2 patients (2,8%). After a median follow-up of 26 months (m), overall recurrence rate (ORR) of pts who underwent surgery was 43% (36 pts): 58% of resected ADC, 33% of resected SCC. Median time to recurrence disease (mTRD) for ADC was 16,5m vs SCC, not reached (p < 0,24). 1 and 3 years RR was 36% and 43%, respectively. Median overall survival (OS) was 32 m (IC 95% 14,1-49,3): 26,8m ADC vs 45,4m SCC (p < 0,001). 1 and 3 years OS rate were 66% and 53%, respectively. In the multivariate Cox regression, two independent factors influenced in OS: ypCR HR 0,5 (0,19-1,25) (p< 0,016) and ypN+ HR 2,3 (1,1-4,8) (p< 0,001). Conclusion: ADC and SCC represent two different diseases with different prognosis in locally advanced esophageal carcinoma. These results might be considered when developing novel therapies and follow up strategies in this setting.

The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus.

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

Introduction: Neoadjuvant chemoradiotherapy (NA CRT) has shown benefit in overall survival (OS) in patients with locally advanced esophageal carcinoma. However, toxicity and postoperative morbidity are not negligible.Methods: We retrospectively reviewed patients with locally advanced esophageal carcinoma treated at Catalan Institute of Oncology and integrated centers who underwent NA CRT from 2009 to 2013. G3/4 toxicity and postoperative complications were recorded. OS and disease free survival (DFS) curves and medians were performed by using Kaplan Meier method as well as identification of prognostic factors using multivariate Cox regression.Results: 61 pts were studied: median age 61 (34-75); 90% male; 97% PS ≤ 1, 3% PS2; 20% Barrett esophagus; 51% adenocarcinoma (ADC)/ 49% squamous cell carcinoma (SCC). Location: 82% esophagus, 18% esophagogastric junction (Siewert I or II). Clinical stage included cT2N + , cT3-4a N0/+. 95% were node positive (cN+). 90% pts received 2 cycles of NA CT, being the most used regimen CDDP-5FU (87%). Total RT dose received was 45 Gy (75%) and 50,4 Gy (25%), depending on the centre protocol. G3/G4 toxicity occurred in 9% pts (5% nonhematologic, 4% hematologic). Treatment radiological response was assessed by PET: 16% complete response, 56% partial response, 20% stable disease, 8% progression. 51 pts (84%) underwent surgery, 88% R0. Pathologic complete response (ypT0N0) was achieved in 12 pts (24%): 15% of resected ADC, 30% of SCC, ypN+ 38%. Deaths due to post-operative complications (within 30 days) occurred in 2 patients (4%). Overall recurrence rate (ORR) of pts who underwent surgery was 43% (54% of resected ADC, 32% of SCC). 25% pts had distant recurrence (DR), 8% locoregional recurrence (LR), and 10% synchronic DR and LR. After a median follow-up of 18 months (m), median OS was 31,2 m (IC 95% 20,9-41,5): 22,4m ADC vs 39,7m SCC (p < .38). 1 and 2 years overall survival rate were 76,9% and 53,7%, respectively. mDFS was 17m (IC 95% 12-22): ADC 13m vs SCC 18m (p <.29). In the multivariate Cox regression, two independent factors influenced positively in OS: R0 (p< .001) and PS ≤ 1 (p< .012).Conclusion: NA CRT is a safe strategy for locally advanced esophageal carcinoma in selected pts, who have been treated with multidisciplinary approach. It improves R0 rate and tumor downstaging with similar results than previous reports. ADC and SCC represent two distinct diseases with different epidemiology and prognosis. However, no significant differences were achieved in our cohort probably due to small number of pts. Introduction: Neoadjuvant chemoradiotherapy (NA CRT) has shown benefit in overall survival (OS) in patients with locally advanced esophageal carcinoma. However, toxicity and postoperative morbidity are not negligible. Methods: We retrospectively reviewed patients with locally advanced esophageal carcinoma treated at Catalan Institute of Oncology and integrated centers who underwent NA CRT from 2009 to 2013. G3/4 toxicity and postoperative complications were recorded. OS and disease free survival (DFS) curves and medians were performed by using Kaplan Meier method as well as identification of prognostic factors using multivariate Cox regression. Results: 61 pts were studied: median age 61 (34-75); 90% male; 97% PS ≤ 1, 3% PS2; 20% Barrett esophagus; 51% adenocarcinoma (ADC)/ 49% squamous cell carcinoma (SCC). Location: 82% esophagus, 18% esophagogastric junction (Siewert I or II). Clinical stage included cT2N + , cT3-4a N0/+. 95% were node positive (cN+). 90% pts received 2 cycles of NA CT, being the most used regimen CDDP-5FU (87%). Total RT dose received was 45 Gy (75%) and 50,4 Gy (25%), depending on the centre protocol. G3/G4 toxicity occurred in 9% pts (5% nonhematologic, 4% hematologic). Treatment radiological response was assessed by PET: 16% complete response, 56% partial response, 20% stable disease, 8% progression. 51 pts (84%) underwent surgery, 88% R0. Pathologic complete response (ypT0N0) was achieved in 12 pts (24%): 15% of resected ADC, 30% of SCC, ypN+ 38%. Deaths due to post-operative complications (within 30 days) occurred in 2 patients (4%). Overall recurrence rate (ORR) of pts who underwent surgery was 43% (54% of resected ADC, 32% of SCC). 25% pts had distant recurrence (DR), 8% locoregional recurrence (LR), and 10% synchronic DR and LR. After a median follow-up of 18 months (m), median OS was 31,2 m (IC 95% 20,9-41,5): 22,4m ADC vs 39,7m SCC (p < .38). 1 and 2 years overall survival rate were 76,9% and 53,7%, respectively. mDFS was 17m (IC 95% 12-22): ADC 13m vs SCC 18m (p <.29). In the multivariate Cox regression, two independent factors influenced positively in OS: R0 (p< .001) and PS ≤ 1 (p< .012). Conclusion: NA CRT is a safe strategy for locally advanced esophageal carcinoma in selected pts, who have been treated with multidisciplinary approach. It improves R0 rate and tumor downstaging with similar results than previous reports. ADC and SCC represent two distinct diseases with different epidemiology and prognosis. However, no significant differences were achieved in our cohort probably due to small number of pts.

We sought to determine the safety and feasibility of esophagectomy after neoadjuvant immunotherapy and chemoradiotherapy in clinical trial patients with locally advanced esophageal cancer.We retrospectively identified patients who were treated with neoadjuvant immunotherapy and chemoradiotherapy (n = 25) or chemoradiotherapy alone (n = 143) at our institution between 2017 and 2020. The primary end point was risk of 30-day major complications (Clavien-Dindo classification system grade ≥ 3), which was assessed between groups using a multivariable log-binomial regression model to obtain adjusted relative risk ratios. Secondary end points were interval to surgery, 30-day readmission rate, and 30-day mortality.All included patients successfully completed neoadjuvant therapy and underwent esophagectomy with negative margins. Age, sex, performance status, clinical stage, histologic subtype, procedure type, and operative approach were similar between groups. Neoadjuvant immunotherapy was not associated with a statistically significantly increased risk of developing a major pulmonary (relative risk, 1.43; 95% confidence interval, 0.53-3.84; P = .5), anastomotic (relative risk, 1.34; 95% confidence interval, 0.45-3.94; P = .6), or other complication (relative risk, 1.29; 95% confidence interval, 0.26-6.28; P = .8). Median (interquartile range) interval to surgery was 54 days (47-61 days) in the immune checkpoint inhibitor group versus 53 days (47-66 days) in the control group (P = .6). Minimally invasive approaches were successful in 72% of cases, with only 1 conversion. Thirty-day mortality and readmission rates were 0% and 17%, respectively, in the immune checkpoint inhibitor group and 1.4% and 13%, respectively, in the control group.On the basis of our preliminary experience, esophagectomy appears to be safe and feasible following combined neoadjuvant immunotherapy and standard chemoradiotherapy for locally advanced esophageal cancer.