Perioperative blood transfusion has been linked to poorer long-term survival in patients undergoing esophagectomy, presumably due to its potential immunomodulatory effects. This review aims to summarize existing evidence relating to the influence of blood transfusion on long-term survival following esophagectomy for esophageal cancer. A systematic literature search (up to February 2017) was conducted for studies reporting the effects of perioperative blood transfusion on survival following esophagectomy for esophageal cancer. Meta-analysis was used to summate survival outcomes. Twenty observational studies met the criteria for inclusion. Eighteen of these studies compared the outcomes of patients who received allogenic blood transfusion to patients who did not receive this intervention. Meta-analysis of outcomes revealed that allogenic blood transfusion significantly reduced long-term survival (HR = 1.49; 95% CI 1.26 to 1.76; P < 0.001). There appeared to be a dose-related response with patients who received ≥3 units of blood having lower long-term survival compared to patient who received between 0 and 2 units (HR = 1.59; 95% CI 1.31 to 1.93; P < 0.001). Two studies comparing patients who received allogenic versus autologous blood transfusion showed superior survival in the latter group. Factors associated with the requirement for perioperative blood transfusion included: intraoperative blood loss; preoperative hemoglobin; operative approach; operative time, and; presences of advanced disease. These findings indicate that perioperative blood transfusion is associated with significantly worse long-term survival in patients undergoing esophagectomy for esophageal cancer. Autologous donation of blood, meticulous intraoperative hemostasis, and avoidance of unnecessary transfusions may prevent additional deaths attributed to this intervention.

Good communication of diagnosis can affect treatment planning, compliance and patient outcomes, especially in the case of conditions such as schizophrenia, which has the potential to cause serious life disruption for both people with schizophrenia and their carers. Currently, there is no evidence based on findings from RCTs assessing the effects of communication strategies for disclosing the diagnosis of schizophrenia and related disorders. Research is required.

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PurposeThe 5 year overall survival (OS) for Glioblastoma multiforme (GBM) remains low.Our cohort had a lower percentage completing adjuvant treatment than those reported in trials. We assess those not completing planned 6 cycles of adjuvant treatment.We assess survival data for those who had Gliadel wafer insertion at the time of primary surgery. We go on to assess the combination of these factors on survival.MethodsCohort of 110 patients who had undergone neurosurgery followed by chemo-radiotherapy (CRT) 60 Gray in 30 fractions and adjuvant Temazolomide (TMZ) from 2007 to 2016. ResultsOS was 16 months and progression free survival (PFS) 11.9 months.57% of patients completed 4-6 cycles of adjuvant TMZ 43% received 3 or less cycles of TMZ. Those unable to complete planned adjuvant TMZ had a poorer OS (10 vs 20 months, Cox analysis P-value 0.0003).Those who had maximal safe debulking plus Gliadel wafer insertion, median OS was improved, 19.5 months P=0.06. The group with the combination of significant factors, median OS was 2 months greater than those that did not receive Gliadel wafers and could not complete 4 cycles of adjuvant TMZ.ConclusionsSurvival outcomes were improved with Gliadel wafer insertion, completing 4-6 cycles of TMZ. Consequently the combination of these factors led to improved outcomes. Second-line chemotherapy improved OS at relapse regardless of second line surgery.

e14028 Background: Glioblastoma Multiforme (GBM) is the most common primary intracranial tumour of the brain. The standard of care first line management is maximum safe debulking followed by concurrent chemo radiation (Stupp et al, 2005). In spite of further recent advances, median survival still remains poor and ranges between 14 to 21 months, especially in the MGMT unmethylated group. There are no randomised trials investigating less than 6 cycles of adjuvant temozolomide (TMZ). In our study we retrospectively analyse the impact on overall survival (OS) and progression free survival (PFS) in cases where adjuvant treatment has been discontinued due to toxicity or patient’s fitness Methods: We collected data from 2007 to 2016 for a cohort of patients who underwent adjuvant treatment for GBM following histological diagnosis. The final analyses included patient’s who completed concurrent chemoradiotherapy to a dose of 60 Gray in 30 fractions and had at least one cycle of adjuvant TMZ chemotherapy Results: Of 110 patient cohorts, 57% of patients completed adjuvant chemo radiotherapy followed by 4-6 cycles of adjuvant TMZ, 43% received 3 or less cycles of TMZ. Overall PFS was 11.9 months. Those that completed 4 or more cycles of adjuvant TMZ had an improved PFS (Log rank test P-value 0.001) versus those that completed 3 or less cycles. On cox analysis the number of adjuvant cycles of TMZ significantly affects OS, P-value 0.0003. Median overall survival was 16 months for the whole group, but was 10 vs. 20 months for the two groups. On cox analysis we also identified second line chemotherapy had a significant impact on OS (cox model P-value 0.002) Conclusions: We identified patients receiving three or fewer cycles of adjuvant TMZ had poorer outcomes. Second-line chemotherapy improved outcomes at relapse regardless of redo surgery.

Background: Glioblastoma multiform is the most common malignancy and very aggressive tumor found in the central nervous system. The current standard treatment for glioblastoma includes maximal safe resection followed by adjuvant concurrent chemo-radiation and adjuvant chemotherapy. With its aggressive behavior, delayed adjuvant therapies may lead to worse survival outcome that is showed by data from other tumors such as breast cancer and lung cancer. However, the relationship between timing to initiation post-operative adjuvant chemo-radiotherapy in glioblastoma remains unclear.Methods: A literature search was conducted on 5 databases by 2 persons. Bias assessment for individual studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale by 2 independent reviewers.Results: Total of 2,804 studies were found from initial database search. Twenty studies met eligibility criteria and were reviewed. Nine studies found no statistically significant effects of time to initiation post-operative adjuvant chemo-radiotherapy on overall survival. On the other hand, eleven studies found statistically significant effects of time to initiation post-operative adjuvant chemo-radiotherapy on overall survival.Conclusions: Time to initiation adjuvant chemo-radiotherapy is a challenging issue. Most of the studies reported that slight delayed (4-6 weeks) timing to initiation of chemo-radiation seems to have a better survival outcome.

BackgroundThe 5 year overall survival (OS) for Glioblastoma (GBM) remains low. Our cohort had a lower percentage completing adjuvant treatment than those reported in trials. Therefore, we assess those not completing planned 6 cycles of adjuvant treatment and effect on survival outcomes. We also assess survival data for those who had Gliadel wafer insertion at the time of primary surgery. We go on to assess the combination of these factors on survival outcomes.MethodsWe carried out a retrospective cohort study of 110 patients who underwent neurosurgery followed by chemoradiotherapy (CRT) 60 Gray in 30 fractions and adjuvant Temazolomide (TMZ) from 2007 to 2016. We assessed OS and progression free survival (PFS) and carried out a number of subset analyses. ResultsOS was 16 months and PFS 11.9 months. 57% of patients completed 4-6 cycles of adjuvant TMZ 43% received 3 or less cycles of TMZ. Those unable to complete planned adjuvant TMZ had a poorer OS (10 vs 20 months, Cox analysis P-value 0.0003). Those who had maximal safe debulking plus Gliadel wafer insertion, median OS was improved, 19.5 months P=0.06. The group with the combination of significant factors, median OS was 2 months greater than those that did not receive Gliadel wafers and could not complete 4 cycles of adjuvant TMZ. ConclusionsSurvival outcomes were improved with Gliadel wafer insertion and completing 4-6 cycles of TMZ. Consequently the combination of these factors led to improved outcomes.

AIMS To assess the benefit of combining maximal resection, Gliadel wafer insertion, CCRT and 4 or more cycles of adjuvant TMZ. METHOD We retrospectively reviewed a cohort of 110 patients who had undergone neurosurgery followed by chemo-radiotherapy (CRT) 60 Gray in 30 fractions and had at least one cycle of adjuvant TMZ from 2007 to 2016. Minimum follow up period 5 years. RESULTS Patients who had maximal safe debulking plus Gliadel wafer insertion, median OS was 19.5 months (95% confidence interval 14-30) those without wafers median OS was 16 months (95% confidence interval 14 – 21), P=0.06; significant on cox regression modelling. (P-value 0.008). Those continuing to receive at least 4 cycles of adjuvant TMZ median OS improved by 10 months compared to those unable to complete 4 cycles (10 vs 20 months). On cox analysis the number of adjuvant cycles of TMZ significantly affects OS, P-value 0.0003. Of these significant predictors of OS when combined (n=12) median OS was 18 months. Compared to 16 months for those who did not receive Glidel wafers and could not complete 4 cycles of TMZ following CRT. OS log-rank test P-value 0.4 CONCLUSION We were not able to demonstrate a statistically significant improved OS for those undergoing wafer insertion and completing at least 4 cycles of TMZ. Data may be inconclusive due to the small numbers, we conclude standard of care should still remain maximal safe debulking followed by CCRT and TMZ.