No abstract

Materials/Methods: Forty-two EC patients were enrolled in this ongoing prospective imaging study. For this report, we report on the 20 patients who had surgery after neoadjuvant CRT. Outcome was assessed pathologically based on tumor regression grade (TRG, 1 Z pathologic complete response, 2 Z near complete response, and 3 Z more than minimal residual). FDG PET imaging was acquired before treatment (baseline, BL), approximately 2 weeks after starting chemoradiation (interim, IM), and at first follow-up (FU) 4-6 weeks after completing CRT. The 3D tumor was contoured on the PET images using gradient edge technique using MIM software (MIM Software Inc. Cleveland, OH). Summary statistics for SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were determined from the contoured volume at each time point. Relative changes in each tumor PET parameter from BL to IM and FU scan were calculated and compared by outcome status defined as TRG1 vs. TRG2/TRG3 using Wilcoxon rank-sum test. Multiple logistic regression was used to evaluate receiver operating curve (ROC) characteristics for predicting pathologic response status based on analysis of DSUVmax, DSUVmean, DMTV, and DTLG values. Results: TRG 1, 2, and 3 after CRT and surgery were seen in 5 (29%), 9 (43%), and 6 pts (29%), respectively. Tumors that had a complete pathologic response exhibited significantly greater change in TLG (P Z 0.0117) from the baseline to interim scan, with a threshold of 59% decrease. Change in SUVmax (P Z 0.232, P Z 0.832), SUVmean (P Z 0.086, P Z 0.550), and MTV from BL to IM or BL to FU scans were not predictive of pathologic CR, respectively. Predicting outcome status based on change in TLG at the IM scan yielded AUROC of 0.888 (95% CI: 0.742-1.000). Youden's optimal sensitivity (specificity) were 1.000 (0.813) for DTLG at the IM scan. Conclusion: Our results indicate that DTLG on PET imaging after 2 weeks of CRT may predict pathologic complete response in esophageal cancer. Early response assessment with FDG-PET is potentially useful for stratification of EC pts to treatment intensification or non-surgical management.

Local excision alone is an acceptable option for well-differentiated, T1 carcinomas, < or = 3 cm. Adjuvant radiation is recommended for T2 lesions. The high local recurrence rate in patients after local excision of T3 lesions with or without adjuvant radiotherapy would mandate a radical resection.

No abstract

Goal To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. Methods A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. Results Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). “Worst burden” respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year. Conclusions In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.