Common Primary Site Research Articles

Immune-related adverse events in cancer patients referred to the palliative care team of a tertiary care center: a retrospective observational study.

The application of immune checkpoint inhibitors (ICIs) can cause multi-organ adverse events, namely immune-related adverse events (irAEs) in patients with cancer. This study aimed to characterize the epidemiological information on irAEs in patients with cancer referred to the palliative care team (PCT). The medical records of cancer patients with a history of ICI therapy referred to the PCT at a tertiary care center between January 2017 and July 2022 were retrospectively reviewed in this single-center, observational study. The median age of the 140 patients was 68years, and lung (39.3%) being the most common primary site. We observed irAEs in 46 patients (32.9%), and hypothyroidism was the most common irAE. For irAEs graded ≥ 3 in 21 patients, pneumonitis was the most common adverse event. As for strategies for management with irAEs, seventeen patients were treated with systemic steroids. irAEs ( +) had a significantly lower Performance Status at the start of ICI, a higher total number of ICI doses, and longer duration from start of ICI to date of death than irAEs (-). Among 140 cancer patients with a history of ICIs therapy consulted to the PCT, the prevalence of irAEs was 32.9%, and 21 patients (15.0%) developed irAEs with grade ≥ 3. As the use of ICI is expected to increase in the future, it is important for palliative care physicians to increase their awareness of the management of irAEs and collaborate with oncologists from an early stage.

EPID-27. THE INCIDENCE OF BRAIN METASTASIS IN GASTROINTESTINAL CANCER ACCORDING TO PRIMARY SITE AND STAGE: A 15-YEAR SINGLE INSTITUTIONAL ANALYSIS

Abstract Gastrointestinal (GI) cancers are a diverse group of cancers including pancreatic, gastric/gastroesophageal junction/esophageal (G/GEJ/E), colorectal (CRC), hepatocellular (HCC), biliary tract (BT), and anal origin cancers. The risk of developing brain metastasis (BrM) is not well characterized. The aim was to determine the incidence of BrM among all GI cancer patients at Princess Margaret Hospital (PM). We included patients diagnosed with GI cancer presenting from 2005-2020, captured prospectively in our institutional registry. These patients were cross-referenced with our radiotherapy database, where radiotherapy for brain metastases (BrM) was used as a proxy for the brain metastases development. Cumulative incidences (CI) of BrM diagnoses were calculated using death as a competing risk. Overall survival (OS) was estimated using the Kaplan Meier method. The registry accounted for 22,188 patients. The median age of the cohort was 64. Most common primary sites are CRC adenocarcinoma, pancreatic adenocarcinoma, G/GEJ/E adenocarcinoma were 31.52%/11.71%/10.25%. The 15-year CI for BrM for the entire cohort was 1.65%, and for CRC, small bowel, anal, pancreatic, G/GEJ/E, HCC, and BT cancers were 2.69%/2.49%/1.30%/0.5%/3.52%/ 0.05% /0.4% (p < 0.001) and Stage I-IV disease were 0.39%/0.81%/1.2%/3.1%, respectively (p < 0.001). 5 year CI for HER2 positive G/GEJ/E patients was 19.5%. Median OS from initial presentation for those with BrM was 25.13 months. On univariable analysis, chemotherapy receipt [HR 1.916, p < 0.001], Stage IV at presentation [HR 3.991, p < 0.001], and G/GEJ/E primary [HR 1.357, p < 0.001] predicted for higher risk of BrM. Multivariable analysis confirmed that receipt of chemotherapy and Stage IV disease predicted a higher risk for BrM and pancreatic, HCC, and BT cancers predicted for lower BrM. We observed that among patients diagnosed with GI cancers, Stage IV disease predicted higher risk for developing BrM and were more likely to receive chemotherapy.

RADT-50. CLINICAL OUTCOME OF DAILY 5-FRACTIONATED GAMMA KNIFE RADIOSURGERY FOR LARGE BRAIN METASTASES

Abstract INTRODUCTION With the introduction of the Gamma Knife Icon, hypo-fractionated Gamma Knife radiosurgery (GKRS) for large brain metastases (LBMs) is beginning to be performed. This study aimed to assess the clinical outcome and risk of the daily 5-fractionated GKRS for LBMs. METHODS A total of 100 patients who underwent 5-fractionated GKRS for LBMs (> 14cm3) were enrolled. Forty-six were male patients, and the median age was 60 years. Most common primary cancer sites were lung (41 non-small cell cancers), breast (24), and kidney (14). The median tumor volume was 22cm3 (14 – 69cm3) and marginal dose was 35Gy (50% isodose line) in 5 fractions. Median follow-up duration was 18 months (3 – 72 months). RESULTS The last follow-up showed local tumor control in 74 cases. The cumulative 1, 2, and 3-year local tumor control rates were 73, 65, and 60%, respectively. Eighty-six tumors showed best MRI response in a year, and median tumor volume decrease rate was 80% (22 – 100%). Thirty patients experienced dramatically tumor volume decrease (> 95%). Median progression free and overall survival were 7 and 16 months, respectively. Radiation necrosis occurred in 24 patients, of which only 9 had neurological symptoms and treated with steroid and bevacizumab. CONCLUSIONS The daily 5-fractionated GKRS for very LBMs showed favorable local tumor control and acceptable radiation necrosis, but questionable survival benefit. In the future, prospective multi-center study is needed.

Prevalence of Human Papillomavirus-Associated Head and Neck Cancer in Rwanda: A 10-Year Review.

Head and neck cancer (HNC) is a significant global health burden, with late presentation leading to complex treatment. While human papillomavirus (HPV) infection has been implicated in HNC, data from low- and middle-income countries (LMICs) are limited. In this study, we investigated the prevalence and role of HPV in head and neck cancers diagnosed in Rwanda. A retrospective cross-sectional study was conducted using Rwanda Cancer Registry from January 2011 through December 2020. p16 immunohistochemistry as a surrogate for HPV was performed on a randomly selected case. p16-positive cases were genotyped. A total of 1001 patients with HNC were identified; 82% (n = 819) had squamous cell carcinoma. The mean age at diagnosis was 51.1 years, with a majority being males (58%). Oral cavity and lip (27%) were the most common primary cancer sites. Stage was unknown in most cases (75%, n = 747). HIV status was known in 33% (n = 334) of patients with 10% (n = 33) HIV-positive; 22% of 202 randomly selected cases were p16-positive; 34% of the p16-positive cases were oropharynx. PCR analysis of p16-positive cases showed 19% HPV positivity, and HPV16 was the most common high-risk HPV strain, and 55.5% were recorded HPV-positive by PCR. HNC cases in Rwanda have been increasing from 2011 to 2020, with a significant portion being HPV-positive. Strategies to implement routine testing for p16, especially in oropharynx cancer patients, improved preservation of tissue samples, collection of comprehensive information including cancer risk factors, staging, and treatment are needed in Rwanda.

Integrating Machine Learning with Web-Based Tools for Personalized Prognosis in Oral Adenoid Cystic Carcinoma

BackgroundAdenoid cystic carcinoma (ACC) of the oral cavity is a rare head and neck cancer. This rarity contributes to the paucity of comprehensive research on this cancer thereby complicating the development of evidence-based treatment strategies. This study aims to use machine learning (ML) techniques to analyze survival outcomes and optimize treatment approaches of ACC. MethodsThe SEER database (2000-2020) was used in this study. Cox regression analysis was used to identify the prognostic variables; prognostic models using five ML algorithms were constructed to predict the 5-year survival rates. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of ML models. Also, Kaplan-Meier survival analysis was performed. ResultsThis study's sample included 645 patients. The most common primary site for ACC was the hard palate, followed by the cheek mucosa. Survival rates varied across treatment groups, with the highest rates observed in patients who underwent surgery only. ML models revealed that the most significant prognostic factors were age, metastasis, and surgery. ConclusionsThis study contributes evidence and knowledge to the limited literature on ACC and emphasizes the importance of adjuvant radiotherapy. This study highlights that metastasis and age are key prognostic factors. Furthermore, the developed ML-based web tool offers a novel approach for the personalized prognosis of these rare cancer types.

A real-world study on the clinicopathological profile, treatment outcomes and health-related quality of life, anxiety and depression among patients with desmoid tumor at two tertiary care centers in India.

The medical management of DT comprises tyrosine kinase inhibitors (TKIs), hormonal agents, anti-inflammatory drugs with the recently approved gamma secretase inhibitor nirogacestat being the current standard of care. Real-world data on evolving treatment landscapes of DT remains scarce. This is a retrospective study of patients with DT registered between 1995 and 2020 at All India Institute of Medical Sciences, New Delhi and Tata Medical Center, Kolkata. Baseline characteristics were analyzed in form of median values and interquartile range. Categorical and continuous variables were compared by chi square and independent samples T- tests respectively. Anxiety, depression and QoL were prospectively measured among 30 patients using Hospital Anxiety and Depression (HADS) and Functional Assessment of Cancer Therapy-General (FACT-G) scales respectively between 2022 to 2023. 200 patients were included with a male-predominant (n=111, 55.5%) population and median age 26.5 (2.5-75) years. Extremity (n=100, 50%) and abdomen (n=65, 32.5%) were commonest primary sites and median of 2 (1-4) lines of treatment were received. First-line included surgery (n=116, 58%), systemic therapy (n=67, 33.5%), radiotherapy (10, n=5%) and active surveillance (n=7, 3.5%). First-line systemic agents included tamoxifen (n=55, 27.5%), imatinib (n=7, 3.5%), sorafenib (n=1, 0.5%) and chemotherapy (n=4, 2%). 2019 onward, 3% and 63% underwent active surveillance and surgery respectively. Best radiological response obtained with tamoxifen was stable disease (SD) (n=76, 59%) and partial response (PR) (n=31, 24.2%). Best radiological response obtained with sorafenib was PR (n=17, 60.7%) and SD (n=9, 32.1%). Thirty patients underwent HADS and FACT-G scale assessment. Mean HADS-Anxiety subscale score was 3.6 (+/-3.9 SD) and HADS-Depression sub-scale score was 2.6 (+/-3.5 SD) with clinically significant anxiety and depression in 2 (6.7%) patients each. The overall mean FACT-G score was 87.5 (+/-12.6 SD) and lower mean physical well-being (p=0.006) and emotional well-being (0.017) scores were significantly associated with higher HADS-anxiety (>/=8) scores. Assessment of anxiety, depression and QoL are paramount to gauge the psychological impact of DT. This study gives an overview of clinical and management profile of patients with DT in India, with limitations of selection bias, heterogeneous population and small sample size for QoL assessment.

Community-acquired sepsis in the medical intensive care unit: An experience from a lower-middle-income country.

To determine microbiological pathogens and in-hospital mortality in patients admitted with communityacquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country. The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019 of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with in-hospital mortality were identified. Data was analysed using SPSS 23. Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). Multi-drug-resistant organisms were isolated in 39 (28.9%) patients. In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure assessment score were significantly associated with mortality (p<0.05). Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients.

Pediatric non-nasopharyngeal head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results (SEER) program with review of the literature

BackgroundDespite its prevalence in adults, head and neck squamous cell carcinoma (HNSCC) is considered a rare entity in pediatrics where lymphomas, neural tumors, and soft tissue sarcomas predominate in the head and neck. Given the association of squamous cell carcinoma with the human papillomavirus, a risk factor that may be present from birth, and the difficulties in staging this disease for prognostication in children, it is important to revisit nationally collected data for prevalence and outcomes assessments. ObjectiveTo examine a publicly available national database to describe the incidence, pathology, treatment, and survival of pediatric HNSCC. To review the available literature regarding management, outcomes, and risk factors for this disease process. MethodsThe National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor database was queried to identify pediatric subjects ages 0 to 19 diagnosed HNSCC between 1973 and 2019. ResultsTwo-hundred ninety-two cases were identified. Subjects were 62.7 % male (n = 183) and the average age was 15.4 years (range 2–19, median 16). Subjects were 65.8 % white (n = 192), 22.9 % black (n = 67), 8.9 % Asian/Pacific Islander (n = 26), 1 % American Indian (n = 3), and 1.4 % unknown (n = 4). The most common primary sites were nasopharynx (45.9 %), oral cavity (30.5 %), larynx (8.6 %), salivary gland (4.1 %), nasal cavity & paranasal sinus (3.4 %), and lip (2.7 %). There was no statistically significant difference between primary subsite and age, race, histologic grade, or extent of disease. The 5-year overall survival was 83.6 %. DiscussionHead and neck squamous cell carcinoma is more likely to present in older children and is more prevalent in White populations. The nasopharynx is the most common subsite involved, which differs from adult populations in which non-nasopharyngeal subsites including the larynx, oral cavity, and oropharynx are most frequently affected. ConclusionHead and neck squamous cell carcinoma is rare in pediatric patients but should not be overlooked by physicians in the differential diagnosis, particularly in teenagers. Further study is needed to determine whether this represents a unique entity or can be staged and treated according to adult guidelines.

8078 TERT Positive Thyroid Nodule in the Setting of Metastatic Melanoma

Abstract Disclosure: E. Langnas: None. S. Chao: None. K.M. Gomes: None. A. Bhan: None. Metastatic disease to the thyroid gland is uncommon with a reported incidence of up to 4% in post-surgical specimens. Lung cancer is the most common primary tumor site in autopsy series. Clinically, renal cell carcinoma is the most common primary tumor site. Metastatic melanoma to the thyroid gland is clinically rare, however, in autopsy series, it has been reported with incidence of up to 39%. A 61-year-old man presented to the endocrinology clinic for an incidentally detected thyroid nodule. He had recently presented with a chronic cough, prompting a chest x-ray that revealed pulmonary nodules. Subsequent computed tomography (CT) showed numerous bilateral lung nodules measuring up to 2.5 cm and an incidental thyroid nodule. Ultrasound of the thyroid identified a 2.7 cm mixed cystic-solid right thyroid nodule. No risk factors for thyroid cancer were identified. His TSH was 3.51uIU (0.45 - 5.33 uIU/mL). The thyroid nodule was biopsied, and pathology revealed atypical spindle cells with irregular nuclear membranes and scattered histiocytes. A further review with cytopathology suggested non-thyroidal origin of the cells. Molecular testing with AFIRMA reported a telomerase reverse transcriptase (TERT) promoter mutation at C228T. The sequencing was negative for TERT C250T, BRAF, RET, PETC1, PTC3 and MTC. Due to concerns about metastatic disease, a positron-emission tomography (PET)-CT was conducted, revealing hypermetabolic lesions in numerous bilateral lung nodules, right thyroid nodule, porta hepatis lymph node, and a soft tissue nodule within the greater curvature of the gastric body. Subsequent biopsies of the right lung and gastric body confirmed the diagnosis of metastatic melanoma. On further questioning, it was found that the patient had a history of a skin lesion on his back that was excised several years ago with pathology reporting tumoral melanosis. Malignant melanoma has a poor prognosis due to high recurrence and metastatic rates. In melanoma, TERT promoter mutations are the most common mutations in noncoding regulatory regions. TERT C228T mutations and C250T mutations are seen in malignant melanoma and studies have shown that TERT promoter mutations are associated with aggressive clinical behavior. These TERT promoter mutations can also be seen in various other cancers including primary thyroid cancers with a similar association with more aggressive thyroid tumor characteristics. Our case describes a patient with a thyroid nodule and molecular testing noting a TERT promoter mutation. Both primary thyroid cancer and metastatic disease to the thyroid should be considered in these cases. This case also highlights the importance of obtaining a thorough history of prior malignancy in patients with thyroid nodules to assess the risk of metastatic disease. Presentation: 6/1/2024

6857 Adrenal Incidentaloma In A Patient With Surgically Treated Lung Adenocarcinoma A Decade After Complete Remission

Abstract Disclosure: L. Kaur: None. R. Kaur: None. F. Haider: None. A. Iqbal: None. N. Patel: None. Adrenal incidentaloma is an adrenal mass &amp;gt;1 cm in size commonly discovered incidentally in up to 5-7% of patients on imaging performed for reasons other than adrenal causes. Metastasis to the adrenal glands is common due to their rich blood supply, with lung cancer being the most common primary site, followed by the stomach, esophagus and the liver. Bilateral adrenal metastasis is common, however isolated metachronous or synchronous adrenal metastasis is rare, with an incidence of 1-6%. We present a case of incidentally discovered isolated right adrenal mass ten years after curative surgical resection of right lung adenocarcinoma. A 74 year old male with history significant for adenocarcinoma of the right upper lung lobe stage 1A , negative for metastasis status post lobectomy and no adjuvant chemotherapy or radiation 10 years ago presented to the hospital for his routine follow up evaluation. His vitals were within normal limits and physical examination was unremarkable. The follow up diagnostic CT imaging was done which showed an incidental 2.1 x 1.6 x 1.2 cm right adrenal mass without any pathological lesion or lymphadenopathy. A review of CT scan done one year ago revealed no prior adrenal mass or other suspicious findings. The patient was referred to endocrinology for evaluation of the adrenal mass. He denied abdominal or right flank pain, headaches, palpitations, elevated blood pressure, sweating, muscle weakness, weight gain/loss and was healthy appearing. Lab work up including biochemical studies for hormonal over production, including aldosterone-renin ratio, adrenocorticotropic hormone, plasma catecholamines with urine metanephrines and urine cortisol were within physiological ranges. CT scan was repeated after 2 months which revealed right adrenal mass of 3.2 x 1.8 x 1.7 cm in size with heterogeneity and high pre contrast density. Given the patient's history of lung cancer, imaging characteristics and rapid interval increase in size, there was high suspicion for metastatic disease. Other differentials considered due to fast growth rate included adrenocortical carcinoma and less likely adrenal adenoma. A decision was made to proceed with right adrenalectomy for definitive resection and histological diagnosis secondary to quickly growing adrenal mass with no lymphadenopathy. The patient underwent laparoscopic adrenalectomy and the final pathological report was consistent with metastatic lung adenocarcinoma. Postoperatively the patient recovered well. At 2 week and 3 month follow up he reported no concerns. Isolated adrenal metastasis is unusual and rare but may occur in lung cancer patients years after curative resection of the primary tumor and hence long term annual follow up imaging and monitoring is recommended for prompt diagnosis and timely treatment. Presentation: 6/2/2024

7476 Clinical, Pathological and Biochemical Characteristics of patients with Neuroendocrine Neoplasms (NENs) at a University Hospital in Belo Horizonte, Brazil

Abstract Disclosure: R.D. Romanowski: None. F.P. Ribeiro: None. T.T. Mello: None. B.S. Soares: None. J.B. Drummond: None. Neuroendocrine neoplasms (NENs) are a group of rare, heterogeneous, and potentially aggressive neoplasms, whose incidence is on the rise, largely due to advances in diagnostic methods that allow for more precise and early identification. A recent comprehensive review focusing on the epidemiology, incidence and prevalence of NENs described global findings, however, it did not include any data from Latin America, particularly after WHO 2019 digestive system tumours classification. Methods: We carried a retrospective analysis in a single center aiming to evaluate different clinical, pathological and biochemical characteristics of a cohort of patients with NENs followed at the Neuroendocrinology Outpatient Clinic of the Federal University of Minas Gerais, Brazil, who were diagnosed between the years of 2004 and 2023. Results: The study sample (n=30) included 13 female patients (43%). The median (range) age at diagnosis was 42 (19-73) years old. The most common primary sites observed in the studied population were the pancreas (38%) and the stomach (24%). Twenty three percent of the patients had MEN1 associated NENs. Fourteen tumors (45%) were classified as G1 NENs, 7 tumors (23%) were classified as G2 NENs and two tumors (6,7%) were classified as neuroendocrine carcinomas, while tumor grade classification was not feasible in 7 patients (23%). One third of the patients had functional tumors and metastatic disease was present in 60% of the cases at the time of diagnosis. Conclusion: In general, the epidemiological characteristics here described for our patients align with the global trend. Concerning gender, we observed a higher prevalence of these tumors in men (57%), consistent with the male predominance of up to 3 times over females described around the world. Our patient population seems to be younger than the mean age reported in different case series. Tumoral grade classification was not feasible in a high proportion of patients and despite the high prevalence of well differentiated and low-grade NENs, metastases were commonly seen at diagnosis, in accordance with the literature. Presentation: 6/2/2024

Predictors of brain metastases in patients with oligometastatic solid tumours treated with stereotactic body radiation therapy.

In patients with oligometastatic disease (OMD) treated with stereotactic body radiation therapy (SBRT), those who develop brain metastases (BrM) may have poor outcomes. We aimed to investigate variables associated with BrM development in this population. Patients with ≤ 5 extracranial metastases from solid tumors treated with SBRT from 2008 to 2016 at Sunnybrook Odette Cancer Centre were included. We investigated the association between covariates and CIBrM (cumulative incidence of BrM) using Fine-Gray analysis, and progression-free survival (PFS) and overall survival (OS) using Cox regression. We investigated the association between extracranial progression and CIBrM using time-based conditional analysis. Among 404 patients, the most common primary sites were lung, colorectal, prostate, breast and kidney. Median follow-up was 49 months. Median PFS was 25 months. Median OS was 70 months. 58 patients developed BrM, and 5-year CIBrM was 16%. On multivariable analysis, number of extracranial metastases, location of metastases, total planning target volume (PTV), and time from primary diagnosis to OMD were not associated with CIBrM, although several of these variables were associated with extracranial PFS and OS. Primary site was associated with CIBrM, with colorectal and prostate cancer associated with lower CIBrM compared to lung cancer. Widespread extracranial progression (≥ 5 sites) within 24, 36, 48 and 60 months of OMD diagnosis was independently associated with higher CIBrM. In patients with OMD treated with SBRT, baseline variables related to extracranial disease burden and distribution were not associated with BrM development, while primary site and widespread extracranial progression were associated with BrM development.

Krukenberg tumours: which patients should be considered for surgery?-a narrative literature review.

Krukenberg tumours (KTs) are metastatic signet ring cell (SRC) adenocarcinomas of the ovary, arising from the stomach in most cases (70%). Other common primary sites are the colon, appendix and breast. The use of the term "Krukenberg tumour" is inconsistent in the literature which makes data interpretation difficult. Prognosis of KTs is dismal and, in the absence of randomised controlled trials, the best treatment strategies remain controversial. Evidence from retrospective studies suggests that metastectomy is associated with improved survival. Our narrative literature review set out to determine which patients gain maximal survival benefit from surgical management. A comprehensive literature search was performed using PubMed and Google Scholar databases, from 1 January 2000 to 15 July 2024, with the terms 'Krukenberg', 'metastatic mucinous adenocarcinoma of ovary'. This search identified 20 full-text manuscripts, including data on 1,815 patients. We found that the overall prognosis of these patients remains poor, with a median overall survival (mOS) ranging between 9 and 50 months. Metastectomy is associated with survival benefit only when all visible disease is removed (R0): mOS in patients with microscopic residual disease (R1) or gross residual disease (R2) is similar to mOS in unresected patients (11 vs. 10 months). The following other factors have been identified as independent prognostic factors for survival in multivariate analyses: heated intraperitoneal chemotherapy (HIPEC), adjuvant chemotherapy, curative surgery for the primary tumour, i.e., gastrectomy, no ascites, non-gastric origin, a good performance status, less extensive metastatic disease, i.e., no extra-ovarian disease or no extra-pelvic disease, no peritoneal carcinomatosis or a low Peritoneal Cancer Index (PCI), smaller size of lesion, no SRC features, expression of oestrogen receptor-β (ER-β) and progesterone receptors (PR), metachronous tumours, linitis plastica, tumour grade. Multiple retrospective analyses have demonstrated that metastectomy is associated with a survival benefit in patients with metastatic mucinous ovarian adenocarcinomas. However, patients with poor prognostic factors are less likely to benefit from surgery and should be counselled accordingly. Diagnostic laparoscopy could be considered before debulking surgery, to assess resectability of disease and to avoid a futile exploratory laparotomy. HIPEC after cytoreductive surgery (CRS) remains controversial, with possible survival benefit for KTs of gastric origin, particularly when peritoneal dissemination is present but the PCI is low.

Cancer as an Independent Mortality Risk in Chronic Thromboembolic Pulmonary Hypertension

BackgroundThe management of chronic thromboembolic pulmonary hypertension (CTEPH) has advanced significantly in recent years, thereby improving patient prognosis. However, the impact of cancer on the outcomes of patients with CTEPH under current treatment remains unclear. This study aimed to investigate the prevalence of cancer in patients with CTEPH and determine how comorbid cancer affects their prognosis and clinical course. MethodsData from an ongoing Japanese prospective cohort study were analyzed. Prevalence and primary cancer sites were evaluated. The association of a history of cancer with a composite endpoint, including all-cause death, lung transplantation, and worsening of CTEPH, as well as venous thromboembolism and bleeding events, was assessed. ResultsOf the 1,270 patients in the cohort, 134 (10.6%) had a history of cancer, with the most common primary sites being the breast in women and the prostate in men. The incidence of composite outcome and all-cause death was higher in those with a history of cancer (p<0.001, log-rank test). In the Cox proportional hazard model, age- and sex-adjusted hazard ratios for the composite outcome and all-cause death were 2.69 (95% confidence interval, 1.48–4.89, p=0.001) and 4.25 (95% confidence interval, 1.98–9.10, p<0.001), respectively, for patients with a history of cancer. No significant differences in venous thromboembolism and bleeding events were observed between patients with and those without a history of cancer. ConclusionsA history of cancer, with a prevalence of 10.6%, is an independent risk factor for mortality in patients with CTEPH undergoing the currently recommended treatment.

Pediatric sporadic Burkitt lymphoma of the head and neck: A case series and analysis of national trends

ObjectiveBurkitt lymphoma (BL) is an aggressive form of non-Hodgkin lymphoma with the sporadic subtype being predominant in North America. The clinical presentations and outcomes of pediatric BL within the head and neck were assessed using both an institutional case series and the Surveillance, Epidemiology, and End Results (SEER) Cancer database. MethodsThe electronic medical record at our quaternary children's hospital was queried over a 22-year period (2000–2022) for BL patients with head and neck manifestations. Demographics, clinical presentation, staging, treatment, and outcomes data were collected and analyzed. A corresponding review of the SEER database from 1975 to 2022 was also performed. ResultsOur institutional case series identified 48 sporadic BL patients with a mean age of 8.7 years, the majority of whom were male (79 %) and white (74 %). The most common primary sites were the cervical lymph nodes (38 %) and (or) palatine tonsils (23 %). Thirty-five patients (73 %) were treated initially for a presumed inflammatory or infectious process before undergoing malignancy work-up, which did not significantly delay time to diagnosis (31.5 vs. 38.8 days, p = 0.27). The SEER database analysis identified 78 cases, 43.5 % of whom were 5–9 years of age, with a similar male (66 %) and Caucasian (76.9 %) predominance. Cervical lymph nodes were also the most common subsite (67 %), followed by the palatine tonsils (13 %). Remission rates were similar, 93.7 % and 94.8 %, respectively, in both the institutional and SEER database cohorts. ConclusionUnilateral cervical lymphadenopathy and asymmetric tonsillar hypertrophy are the most common presentations in sporadic BL in the head and neck. Clinical presentation in patients with BL is often similar to common, insidious pediatric otolaryngology symptoms and a majority of patients initially undergo treatment for presumed infectious or inflammatory disease. Although overall BL disease-free survival is high even for disseminated BL, the prognosis is better for local/regional disease, and minimizing time to diagnosis and treatment should remain a priority.

Abstract A070: Real world treatment patterns and patient outcomes of neuroendocrine tumors: A single institution study

Abstract Neuroendocrine tumors (NETs) are rare and diverse, with increasing incidence but poorly understood prognostic variables. While African American or Black patients typically have poorer outcomes across various tumor types, this is not well documented for NETs. Our study aimed to investigate racial disparities in NET outcomes. Patients who had a diagnosis of neuroendocrine tumor between 2014 and 2022 were identified and analyzed in this retrospective chart analysis, with race determined as Caucasian (CA) or Black African American (BAA). Histology was stratified as high grade or those without high grade histology. Grade of tumor was identified as well differentiated, moderately or poorly differentiated, and other/unknown. Log-rank test was conducted to compare the survival curves between CA and AA groups. Cox proportional hazards model was built to adjust for potential confounders, including age at diagnosis and gender (if applicable) while comparing racial disparities. The CA vs. AA hazard ratio (HR) and p-values were calculated. Among the 655 patients analyzed, 63.4% were Caucasian (CA) and 36.6% were Black African American (BAA). The average age at diagnosis across the cohort was 61.5 years. The gender distribution was approximately equal, with 50.2% females and 49.8 % males. High-grade histology was identified in 114 patients, of whom 28.1% were BAA and 71.9% were CA. Within this subgroup, males were more prevalent than females (61.4% vs. 38.6%). Overall survival (OS) for CA patients with high-grade histology was 57.4 months, compared to 67.5 months for BAA patients (p=0.7). Additionally, no statistically significant difference in OS was observed between males and females with high-grade histology (60.8 months vs. 68.1 months, respectively; p=0.3). Analysis of tumor grade revealed that well- differentiated tumors were present in 122 patients (18.63%). Among these patients, there was no statistically significant difference in survival between BAA and CA. The primary tumor site was the colon in 89 patients (13.6%), with 77.5% being CA and 22.5% BAA. Pancreatic tumors were present in 119 patients (18.2%), with 72% being CA and 28% BAA. The next most common primary sites were the small intestine (24.9%), rectum (17.6%), and stomach (9.9%). In comparing survival outcomes between racial groups, CA patients had a significantly worse OS (76.9 months) compared to BAA patients (84.6 months) (p=0.05). Regardless of race, females demonstrated better survival (84.2 months) compared to males (75.7 months) (p=0.04). In our retrospective analysis, Caucasian (CA) patients had worse overall survival (OS) than Black African American (BAA) patients, likely due to a higher proportion of CA patients with high- grade histology and primary tumors in the colon. Females showed better OS than males across all subtypes. The reasons for the higher incidence of worse histology in CA patients are unclear. Larger studies are needed to confirm these findings, understand racial disparities, and develop strategies to mitigate them. Citation Format: Radhika Gutta, Wan-Ting su, Ruicond She, Muhammad Shahid, Gazala Khan. Real world treatment patterns and patient outcomes of neuroendocrine tumors: A single institution study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A070.

Colorectal Cancer in Patients Younger than 40 years -Analysis of Clinicopathological Profile and Treatment Pattern

Background: The incidence of colorectal cancer (CRC) is increasing among young adults. Cancer diagnosis in young adults leads to many challenges due to the impact of the disease on their fertility, career, and life expectancy. In the present study, we investigated the clinicopathological profile of colorectal cancer patients younger than 40 years. Materials and Methods: Retrospective analysis of all the biopsy proven CRC patients were collected over the period of 5 years, from January 2012 to December 2018. Clinicopathological data of patients under the age of 40 years were collected from their medical and pathological reports and analysed. Results: Out of 729 CRC, a total of 154 (21%) patients of colorectal cancer were younger than 40 years were registered during the study period. Among them, with 94 (61%) being male and 60 females (39%). Most of the patients were 30-35 years (37%) and less than 30 years (36%) age group. Adenocarcinoma was present in 97% patients and signet ring cell carcinoma in 3% patients The most common primary site was rectum (57 %), followed by ascending colon (17 %). Most of the patients presented with stage III (64 %) disease. The liver was the most common site of distant metastasis. Conclusion: The incidence of colorectal cancer is increasing among young adults. Most patients present in a locally advanced and non-metastatic stage and have the potential for curative treatment. Therefore, early detection by screening at a younger age may improve the survival of younger patients. Long term follow-up of these patients will provide insights on Treatment Outcomes.

Treatment strategies for patients over 80 years of age with oral squamous cell carcinoma

ObjectiveTo analyze the clinical characteristics of patients with oral squamous cell carcinoma aged ≥80 years, focusing on surgical treatments. Study DesignWe reviewed patients with oral squamous cell carcinoma aged ≥80 years who underwent surgery between 2005 and 2018. Basic information, comorbidities, multiple primary cancers, initial treatment, complications, and outcomes were evaluated. ResultsOf 197 patients aged ≥80 years, 119 patients underwent surgery (50 males, 69 females; mean age: 83.5 years). The gingiva was the most common primary tumor site (63 patients, 52.9%). The stage classification was stage I in 35 patients (29.4%), stage II in 44 (37%), stage III in 16 (13.4%), stage IVA in 22 (18.5%), and stage IVB in 2 (1.7%). Comorbidities were identified in 112 patients (94.1%). Surgery was the initial treatment in 111 patients (93.3%). Eight (6.7%) patients received postoperative adjuvant chemotherapy/radiotherapy; 20 patients (16.8%) underwent free tissue transplantation. Perioperative complications were observed in 36 patients (30.3%). The cumulative 5-year and 10-year overall survival rates were 82% and 68.3%, respectively; the disease-specific survival rates were 90%. ConclusionGood treatment outcomes were obtained with radical surgery. Surgery should be the first choice if quality of life is assured and there are no issues with surgical tolerance, regardless of age.

Artery Grafting for Arterial Anastomoses in Head and Neck Free Tissue Transfer Reconstruction.

Vessel grafting is an important technique in head and neck free tissue transfer (FTT) reconstruction when a tension-free anastomosis is not otherwise feasible. To our knowledge, there are limited data regarding interposition artery grafts for arterial anastomoses in head and neck reconstruction. Here, we present a multi-institutional cohort of arterial interposition grafts for FTT reconstruction for head and neck defects. A retrospective review was conducted at four tertiary care institutions for patients who underwent FTT reconstruction for head and neck defects which utilized an interposition artery graft for the arterial anastomosis. Charts were reviewed for type and length of artery grafts harvested, surgical indication, indication for artery graft, types of flaps harvested, and various preoperative characteristics (including history of radiation or previous FTT reconstruction surgery). Postoperative complications within postoperative day 30 were measured and reported. Nine patients met inclusion criteria. The lateral circumflex femoral artery (either transverse or descending branches) (n = 3) and facial artery (n = 3) were the most commonly harvested arteries. The scalp (n = 5) was the most common primary defect site. Seven grafts were harvested initially and in a planned fashion, while two were harvested as salvage techniques (either for flap salvage or vein graft failure). In planned grafts, arteries were the preferred interposition grafting method due to either size match preferences (n = 4) or similarities in wall thickness (n = 3) between graft and recipient artery. There were no reported cases of unplanned readmission, postoperative hematoma, fistula formation, wound infection, or donor site morbidities. Two patients required unplanned return to the operating room for flap compromise, both of which ultimately resulted in flap failure secondary to clot formation at both arterial and venous anastomoses. When arterial pedicle length is insufficient, interposition artery grafting is both a feasible and viable technique to achieve tension-free arterial anastomoses for select cases of highly complex head and neck free tissue reconstruction.

Radiation Dose-Induced Carotid Artery Stenosis and Brain Necrosis in Head and Neck Cancer-A Real World Cohort Study.

Objective: This study aims to examine whether radiation therapy doses are related to incidences of carotid artery stenosis and brain necrosis in a large-scale real-world database. Methods: We identified a cohort of HNC patients from the catastrophic illness patient dataset using ICD-9 or ICD-10 to compare the incidence and risks of carotid artery stenosis (CAS) and brain necrosis (RIBN) in patients who received a radiation therapy dose of ≥5400 cGy/30 fractions (group A) with those who received a radiation therapy dose of <5400 cGy/30 fractions (group B). The incidence and hazard ratios were quantified using Cox proportional hazards models. Results: A total of 19,964 patients were identified in group A and group B. Among them, 965 and 863 cases of CAS and 435 and 359 cases of RIBN were identified in group A and group B, respectively. There was no statistically significant association between the two groups for CAS risk, whereas there was a statistically significant association between the two groups for RIBN risk. The most common primary site of head and neck cancers was the nasopharynx (1144 of 19,964, 5.73%). Conclusions: Our study suggests that RT may increase the risk of carotid stenosis and brain necrosis in patients with NPC. To ensure patient safety during treatment, the optimal balance between tumor control and toxicity prevention in individual patients through minimization of the radiation dose to all relevant OARs must be properly understood.