RPCI investigators assess new approaches for diagnosis, treatment and follow-up of cancer patients
BUFFALO, N.Y. — Fifteen Roswell Park Comprehensive Cancer Center (Roswell Park) teams were invited to present research findings at the 67th annual Cancer Symposium of the Society of Surgical Oncology. The symposium, a major annual meeting for surgeon-researchers in oncology, was held March 12-15 in Phoenix, Ariz.
“This strong showing from Roswell Park surgeons and fellows is a testament to the ingenuity of our investigators,” says Steven Hochwald, MD, FACS, Vice Chair of the Department of Surgical Oncology and Chief of Gastrointestinal Surgery at the comprehensive cancer center. “Our teams have proposed novel approaches for diagnosing, stratifying, treating and following our patients, and we expect these findings to make a significant impact on clinical practice and outcomes.”
Two researchers from the Roswell Park Department of Surgical Oncology were invited to give talks on their research. Moshim Kukar, MD, a clinical fellow in the department, was first author and presenter on three oral presentations:
- In “Development of an Index to Predict Single Gland Parathyroid Disease and Selectively Eliminate Intraoperative Parathyroid Hormone Testing” (abstract 37), Dr. Kukar and colleagues set out to create an index that would help clinicians accurately predict single gland parathyroid disease preoperatively. This approach would eliminate the need for routine intraoperative parathyroid hormone testing in a substantial proportion of patients, significantly reducing operating room time, costs and a patient’s time under anesthesia. The researchers developed and validated a predictive model based on specific four-dimensional computerized tomography (4DCT) characteristics along with high preoperative calcium levels to achieve those goals. William Cance, MD, FACS, Department Chair, was senior author on the study.
- The study “Relative Delta SUV of Less than 45% on F 18- FDG Positron Emission Tomography (PET) Predicts Residual Disease in Patients with Locally Advanced Esophageal Adenocarcinoma Undergoing Neoadjuvant Chemoradiotherapy” (abstract 80) found Dr. Kukar and colleagues looking for correlation between metabolic response and pathological response in patients undergoing neoadjuvant chemoradiation therapy. In what they believe is the largest-scale examination of the role of PET characteristics in this patient population, the researchers demonstrated that relative Delta SUV, or change in maximal standardized uptake value, of less than 45% reliably predicts those patients who have residual disease. This is a key finding, since this patient population has worse overall and disease-free survival, and therefore should be evaluated for alternate forms of neoadjuvant therapy in addition to surgical therapy. Dr. Hochwald was senior author on the study.
- In “Conditional Survival Based ‘Abbreviated’ Cancer Surveillance for Sentinel Node-Negative Stage IB Melanoma” (abstract 68), Kukar and colleagues studied the long-term follow-up of patients with stage 1B melanoma undergoing “abbreviated” cancer surveillance, which was instituted in 2006 at Roswell Park, based on conditional survival. Melanoma cancer surveillance recommendations are vague, the authors note, and the high prognostic value of sentinel lymph-node biopsy (SLNB) suggests that node-negative patients have excellent overall and disease-specific survival. In their follow-up, they found an extremely low risk of recurrence and that, based on the pattern of recurrence, none of these patients would have benefited from more intense surveillance. They concluded that SLNB-negative stage IB melanoma has a survival rate similar to clinical stage IA, and that “abbreviated” cancer surveillance based on conditional survival is a cost-effective and evidence-based strategy for managing these patients. John M. Kane III, MD, FACS, Associate Professor in the Department and Chief of the Melanoma/Sarcoma Service at Roswell Park, was senior author on that study.
Pragatheeshwar Thirunavukarasu, MD, a clinical fellow, gave an oral presentation on the study “Five-Year Survival after Incorporation of Pre-Treatment CEA Levels into AJCC Staging for Colon Cancer” (abstract 22). The American Joint Committee for Cancer (AJCC) has advocated incorporating pretreatment carcinoembryonic antigen (CEA) level in blood, also known as “C-stage,” into the conventional TNM (tumor, nodes, metastasis) staging system, but implementation of such a model has been hindered by lack of outcomes data. In a large study involving 16,619 patients with colon cancer, Thirunavukarasu and colleagues compared the staging of patients using the TNM model with and without pretreatment C-stage. Incorporating CEA level into staging was an effective method of identifying patients with relatively poor prognosis, and might help clinicians to stratify those who could potentially benefit from systemic therapy. Valerie Francescutti, MD, an Assistant Professor in the department, was principal investigator and senior author on the study.
Additionally, Dr. Kukar presented “Minimally Invasive Esophagectomy with Cervical Anastomosis,” a video demonstration of an innovative surgical technique, at the Top Rated Videos session. Dr. Hochwald was the senior author on this video, which outlines a minimally invasive technique used in multimodality treatment of esophageal cancer. The technique was also the subject of one of three courses taught by Dr. Hochwald and his team during a workshop at the meeting. The Minimally Invasive Esophagectomy course was well attended by many national and international surgeons participating in the conference, and was particularly well received.
Eight Roswell Park Department of Surgical Oncology investigators were invited to share their findings in poster presentations:
- Dr. Kukar was first author and presenter for “Significance of Anatomic Site on Prognosis in Gastrointestinal Stromal Tumors (GIST)” (abstract P381)
- Tolutope Oyasiji, MD, a clinical fellow, was first author and presenter for “Malignant Adnexal Tumors of the Skin: A Single-Institution Experience" (abstract P233)
- Melanie Ruszczyk, PhD, a post-doctoral research affiliate, was first author and presenter for “Invasive breast cancer with and without ductal carcinoma in situ: Do outcomes differ?” (abstract P22)
- Rebecca Tuttle, MD, a clinical fellow, was first author and presenter for “Melanoma and Sarcoidosis: An Unusual and/or Confounding Relationship?” (abstract P224)
- Dr. Thirunavukarasu was first author and presenter for two studies: “Using Mobile App Technology for Point of Care Cancer Surgery Risk Assessment” (abstract P280) and “Pretreatment Serum CEA Level may Predict Molecular Profiling of Colorectal Cancer” (abstract P116)
- Smit Singla, MD, a clinical fellow, was first author and presenter for three studies: “Weight loss and Postoperative Outcomes in Patients with Advanced Cancer" (abstract P265); “Preoperative modified 4D-CT reduces unnecessary opposite side exploration in patients with primary hyperparathyroidism” (abstract P141); and “Bowel obstruction as a predictor of poor survival in patients undergoing cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC)” (abstract P311)
- Jacqueline Oxenberg, MD, a clinical fellow, was first author and presenter for “Multidisciplinary Cancer Conferences for Gastrointestinal Malignancies Result in Measureable Treatment Changes” (abstract P261)
- Wesley Papenfuss, MD, a clinical fellow, was first author and presenter for “Morbidity and mortality associated with gastrectomy for cancer” (abstract P378)
Dr. Singla also participated as a presenter in the “Case Presentations with Professor and Fellows” session.
The mission of Roswell Park Comprehensive Cancer Center is to understand, prevent and cure cancer. Founded in 1898, Roswell Park is one of the first cancer centers in the country to be named a National Cancer Institute-designated comprehensive cancer center and remains the only facility with this designation in Upstate New York. The Institute is a member of the prestigious National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers; maintains affiliate sites; and is a partner in national and international collaborative programs. For more information, visit www.roswellpark.org, call 1-800-ROSWELL (1-800-767-9355) or email AskRoswell@Roswellpark.org. Follow Roswell Park on Facebook and Twitter.
Annie Deck-Miller, Senior Media Relations Manager