Oncology Referral Center Research Articles

Differences by Anatomical Site of Non-Acral Lentiginous Melanomas of the Lower Limb

Background: Acral location of melanomas is associated with poor survival. It can be due, at least in part, to the fact that acral lentiginous melanoma, a distinct melanoma subtype, has a particular biological profile and a bad clinical behavior. However, since almost 50% of acral melanomas are not of acral lentiginous melanoma subtype, the worse clinical behavior could also be attributable to the intrinsic characteristics of the location. Objective: This study aimed to investigate if melanomas of the lower limb excluding acral lentiginous melanoma differ by location. Methods: This retrospective, observational study recruited patients from an oncology referral center in Spain. We included 285 patients with superficial spreading and nodular melanomas of the lower limb. We compare melanomas by site, clinical and pathological characteristics, and the differences by location of disease-free and melanoma-specific survival by the Kaplan-Meier method and Cox proportional hazard method. Results: Patients with melanomas on the foot, compared to those on the rest of the limb, were older and reported having suffered less sunburns; the melanoma more frequently appeared in areas that had been rarely sun exposed, were more frequently of nodular type, presented thicker tumors, with more ulceration, less regression, and more advanced stage of the disease. Foot location increased the risk of relapse and decreased melanoma-specific survival. Conclusion: Melanoma development in foot is less related to sun exposure and is associated with pathological features that can account for the worse prognosis and poorer survival.

Hematologic malignancies of primary bone marrow involvement: a decade's experience in Bahrain

IntroductionThe data on the pattern of primary hematologic malignancies in Bahrain is sparse, although previously published studies suggested rising trends in their incidence. This study aimed to compare with regional and world data and identify any changing trends. MethodsA retrospective cross-sectional chart analysis study was done on all cases of primary hematologic malignancies of bone marrow origin of Bahraini nationals presenting during the 10-year period from January 2005 to December 2014 at the sole oncology referral center in Bahrain during the study period. ResultsIn a total of 272 cases, the primary hematologic malignancies in decreasing order of frequency with respective median ages at diagnosis were: acute myeloid leukemia (AML; 26.1%, 39 years), acute lymphoblastic leukemia (ALL; 22.8%, 9 years), multiple myeloma (MM, 16.2%, 57 years), chronic myeloid leukemia (CML, 14%, 39.5 years), myelodysplastic syndromes (MDS; 12.5%, 56 years) and chronic lymphocytic leukemia (CLL; 5.5%, 65 years). The overall crude annual incidence rate of these malignancies was 4.8/105 population. Age-specific incidence rates were found to increase dramatically with age, except for ALL, for which it peaked in the pediatric age group. The age-standardized incidence rates (ASIRs) per 105 per year were 1.47 (AML), 1.13 (MM), 0.93 (ALL), 0.85 (MDS), 0.81 (CML) and 0.44 (CLL). ConclusionThe pattern of primary hematologic malignancies in Bahrain shows unique features that distinguish it from trends reported in Eastern and Western world populations. Compared to previously published reports, ASIR trends decreased in CML and ALL but increased in MDS and MM.

Lateral temporal bone resections for peri-auricular cutaneous squamous cell carcinoma: prognostic indicators and radiological predictive values.

Lateral temporal bone resections are used in the management of locally advanced peri-auricular cutaneous squamous cell carcinomas, but there is still conflicting evidence regarding the staging, surgical and adjuvant treatment decisions. A retrospective analysis was performed on all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma between January 2015 and December 2019 at a dedicated tertiary oncology referral centre. Twenty-nine patients were included, with a median age of 77 years. Computed tomography, magnetic resonance imaging and positron emission tomography showed good diagnostic accuracy in identifying disease in the parotid gland, external auditory canal and mastoid bone, but had poor sensitivity in identifying cervical nodal metastasis. Six patients had recurrence at a median of 4.8 months post-operatively. Tumour differentiation (p = 0.0040) and post-operative radiotherapy (p = 0.0199) were associated with significantly better recurrence-free survival. Lateral temporal bone resection for peri-auricular cutaneous squamous cell carcinoma requires careful surgical planning using clinico-radiological correlation, particularly in patients with poorly differentiated tumours.

Psychometric evaluation of "Family Inventory of Needs" in parents of cancer children.

Early childhood cancer creates various challenges in parents' lives and influences new needs, the identification of which requires a valid and reliable tool. The aim of this study was to translate and validate the Family Inventory of Needs (FIN) with the parents of children with cancer. In this methodological research, 210 parents of children with cancer visiting pediatric oncology referral centers in Iran were selected through convenience sampling, based on the study inclusion criteria. The Farsi version of FIN was developed through translation and back-translation. Face validity as well as construct validity using the confirmatory factor analysis (CFA) were performed. The correlation between the score of FIN and the score of Caring Ability of Family Caregivers of Patients with Cancer-mothers' version (CAFCPC-mother's version) was also calculated in order to evaluate the convergent validity. Furthermore, the stability and internal consistency reliability were investigated using software packages LISREL and SPSS. The results of CFA showed that the single-factor structure of the tool with 20 items has an appropriate fit with the data and is therefore approved. Pearson coefficient (r) of the correlation between the mean scores of the NFI and the CAFCPC-mothers' version was calculated to be 0.17 (p<0.01). The Cronbach's alpha of the tool was calculated as 0.90, and the test-retest correlation coefficient as ICC=0.91. The Farsi version of the FIN has appropriate psychometric properties among the population of Iranian parents of children with cancer. It may therefore be a suitable tool for measuring the emotional, physical, and psychological support provided for the parents of children with cancer.

Swallowing and communication outcomes following primary transoral robotic surgery for advanced or recurrent oropharyngeal cancer: Case series

Purpose: Transoral robotic surgery (TORS) is most commonly undertaken as a minimally invasive approach for early staged oropharyngeal cancers (OPC), with good expectations for a functional recovery. A small number of patients, however, require TORS for recurrent or advanced OPC tumours. Their prospects for longer term recovery of communication and swallowing are both unreported and hypothesised to be poorer than the majority of TORS cases. This case-series describes the recovery of swallowing and communication function post-TORS for this unique group of patients. Method: Consecutive recruitment was carried out prospectively at a quaternity oncology referral centre. Participants were aged 18 years and older, with reconstruction involving a free-flap and tracheostomy. Patients were assessed using Fibreoptic Endoscopic Evaluation of Swallowing, and clinician and patient-reported outcomes 12-months post-TORS. Their pre-operative baseline and three-month post-TORS FOIS scores were collated retrospectively. Result: Six participants were recruited over an 18-month period of which three patients underwent TORS for recurrent, and three for advanced OPC. Those with recurrent-OPC did not return to their baseline diet and demonstrated post-swallow silent aspiration of pharyngeal residue. Three of the six were rehabilitated back to their baseline intelligibility (100%). Conclusion: TORS in the recurrent OPC setting appears congruent with high rates of silent aspiration and prolonged reliance on a feeding tube due to oropharyngeal dysphagia, as well as compromised intelligibility. This is the first study that evaluates this instrumentally and provides clinically relevant evidence to inform practice.

P25. Preoperative embolization in surgical treatment of spinal metastases originating from primary non-thyroid and non-renal cell tumors

<h3>BACKGROUND CONTEXT</h3> Preoperative embolization (PE) reduces intraoperative blood loss during surgery for spinal metastases of primary thyroid and renal cell tumors. However, most spine metastases originate from primary breast, prostate, and lung tumors and it remains unclear whether these and other spine metastases benefit from PE. <h3>PURPOSE</h3> To assess whether PE reduces the amount of intraoperative blood loss in patients with spine metastases originating from primary non-thyroid and non-renal cell tumors. <h3>STUDY DESIGN/SETTING</h3> A retrospective study from two affiliated tertiary care orthopedic oncology referral centers. <h3>PATIENT SAMPLE</h3> This study contained a total of 387 patients who underwent surgery for spine metastases between June 2001 and June 2014; 56 with PE and 331 without PE. <h3>OUTCOME MEASURES</h3> The estimated amount of intraoperative blood loss. <h3>METHODS</h3> Operative notes were used to determine the estimated amount of intraoperative blood loss. Multivariable analysis was used to assess whether PE was independently associated with the estimated amount of intraoperative blood loss. <h3>RESULTS</h3> PE was not independently associated with the estimated amount of intraoperative blood loss (95% Confidence Interval [CI] -0.02 – 0.58; p=0.07). Factors independently associated with the estimated amount of intraoperative blood loss included the cervical region of the spine (<0.001), the duration of surgery (<0.001), two levels of the spine operated upon (0.035) and adenocarcinoma as opposed to other primary tumors as the primary tumor of origin (p=0.045). <h3>CONCLUSIONS</h3> Preoperative embolization before surgery on non-thyroid and non-renal cell spine metastases does not significantly influence the estimated amount of intraoperative blood loss. Our data suggest that patients with these types of spine metastases might not benefit from PE. Larger studies could aid in finding a subset of spine metastases that may benefit from PE. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Thyroid dysfunction induced by immune checkpoint inhibitors is associated with a better progression-free survival and overall survival in non-small cell lung cancer: an original cohort study.

The objective of this study was to investigate the association between the onset of TD and treatment efficacy in NSCLC patients who initiated anti-PD-1 blockade (Nivolumab®) and to assess the impact of TD severity and subtype on nivolumab efficacy. This study was performed at a referral oncology center between July 20, 2015 and June 30, 2018. Patients with histologically confirmed stage IIIB/IV NSCLC in progression after one or two lines of treatment and who initiated Nivolumab were included. Thyroid function (TSH ± fT4, fT3) was monitored and patients were classified according to TD status [TD(+) versus TD(-)], severity [moderate thyroid dysfunction: TSH level between 0.1 and 0.4 or 4.0 and 10 mIU/L and severe thyroid dysfunction: TSH ≤ 0.1 or ≥ 10mUI/L) and subtype (isolated hypothyroidism, isolated hyperthyroidism and hyperthyroidism then hypothyroidism)]. Clinical endpoints were overall survival (OS) and progression-free survival (PFS). Among 194 eligible patients, 134 patients (median age, 63 yo; 70.1% male) were included. Forty (29.9%) patients were classified in TD(+) and had a longer OS of 29.8months (95% CI 18.8-NR) versus 8.1months (95% CI 5.5-11.5) in TD(-) group (p < 0.001). PFS was also longer (8.7months (95% CI 5.3-15.1) in TD(+) versus 1.7months (95% CI 1.6-1.9) in TD(-) group (p < 0.001). In Cox proportional hazards analysis, TD remained an independent predictive factor of OS/PFS. Severity and subtype of TD were not correlated with OS/PFS. This study suggested that TD induced by Nivolumab appears to be an independent predictive factor of survival, irrespective of TD severity and subtype.

First Insights into Clinical and Resistance Features of Infections by Klebsiella pneumoniae among Oncological Patients from a Referral Center in Amazon Region, Brazil.

Klebsiella pneumoniae appears as one of the most prevalent pathogens among cancer patients. The present study investigates the clinical, epidemiological and microbiological aspects related to infections caused by K. pneumoniae in cancer patients treated at an oncology referral center in the state of Pará, Amazon region, Brazil. Between July 2017 to July 2019, an epidemiological, observational, cross-sectional study, with a descriptive and analytical approach was conducted, including patients with confirmed diagnosis of cancer who acquired infection by K. pneumoniae 72 h after hospital admission. K. pneumoniae isolates included in the study were obtained from different clinical materials (blood, urine, catheter tip and bladder catheter, orotracheal secretions, oncological and surgical wounds). Antimicrobial susceptibility testing and molecular detection of the carbapenemase-encoding genes were performed. A high prevalence of MDR K. pneumoniae isolates was observed, including two colistin-resistant isolates and seven isolates harboring blaKPC-1 gene. To conclude, our findings provide the firsts insights into the epidemiology and infection by K. pneumoniae in the state of Pará, Brazil, and may be useful on treatment guidance and establishment of strategies to control the spread of resistance strains of K. pneumoniae in the region.

Prospective Multicentric Observational Study of COVID19 in Oncohematological Patients in the Catalonia Region: The Opposite Effect of Steroids on Survival

IntroductionCoronavirus Disease 2019 (COVID19) has shown higher mortality in patients with comorbidities, including cancer. First reports from China, Italy, and US showed mortality comprised between 20% and 40% in this specific population. However, the number of patients in these studies was limited and the percentage of hematological patients was underrepresented. In our study, we present a prospective evaluation of patients affected by solid and liquid tumors who were affected by COVID19 from the same geographical area and time period. Survival outcomes, prognostic risk factors, and effects of oncological treatments received were analyzed.MethodsWAll consecutive oncological patients with age > 18 years old affected by COVID19 (confirmed by pharyngeal PCR test) who were hospitalized in 5 tertiary oncological referral centers in the Catalonia region were included in the study. The recruitment period started from 13/03/2020 to 24/04/2020.Two-hundred thirty-one patients were recruited. Thirty-three percent had hematological malignancies and 67% had solid tumors. The median age was 65 years (range 58-75 years). Female patients were 41%. Twenty-six percent of patients were not considered candidates to intensive care treatments (tracheal intubation) due to their advanced oncological status. Of the hematological cohort, lymphoid malignancies represented 36% of the population, multiple myeloma 20%; acute leukemias 15%; chronic lymphoproliferative diseases 12% and other malignancies 17%. At the time of infection, 11% of patients were receiving steroids (more than 0.5mg/kg/24 hours >15 days), 4% were on active immunosuppressive therapy (calcineurin inhibitors, sirolimus or mycophenolate mofetil) and 5% had grade >3 neutropenia. Most importantly, 61% were on active oncological treatment, 18% were on follow-up, 10% had been diagnosed without having received any treatment.ResultsAt COVID19 diagnosis, 75% of patients had a fraction of inspired oxygen (FiO2) < 24% and 63% had fever. Only 16% had cough,16 % had mucous secretion and 12% had dyspnea. All the other symptoms (myalgia, diarrhea, anosmia, ageusia, fatigue, headache) had an incidence < 10%. Chest X-ray was abnormal in 60% of cases. Regarding in-hospital treatments, 85% received antibiotics, 76% hydroxychloroquine, 12% tocilizumab, 30% corticoids, 70% prophylactic anticoagulation and 55% oxygen support.The median duration of hospitalization was 9.00 days (range 5-16 days).WThe overall mortality rate was 26% with a non-significant difference between hematological (32%) and oncological (23%) patients (p-value = 0.23, figure 1). A significant difference was observed between patients who were candidates to intensive care treatments (21.5%) and not candidates (42.6%)(p-value = 0.0038, figure 1).The following risk factors were associated with decreased survival on multivariate analysis: having the oncological disease in progression (HR 3.33, 95%Confidence Interval (CI)= 1.73-6-41, p<0.001); use of steroids (>0.5mg/kg/24 hours) in the last 15 days (HR 3.76; 95%CI=1.69-8.40, p<0.001); age (continuous variable, HR 1.05, 95%CI= 1.01-1-08, p=0.005); grade 4 neutropenia. When considering COVID19 in-hospital treatments, only steroids were associated with a protective effect on survival (HR 0.51, 95%CI=0.27-0.94, p=0.032) while hydroxychloroquine and tocilizumab had no significant effect.Severe respiratory insufficiency (defined as use of >50% FiO2 as oxygen support) was present or developed in 46% of patients. On multivariate analysis, the following factors were associated with a higher risk of developing severe respiratory insufficiency: use of steroids (>0.5mg/kg/24 hours) in the last 15 days (HR 2.36; 95%CI=1.12-4.97, p=0.023); age (HR 1.05, 95%CI= 1.01-1-08, p=0.009) and dyspnea at diagnosis (HR 3.95; 95%CI=1.77-8.78, p=0.001).ConclusionWCOVID19 is associated to increased mortality in patients affected by solid and liquid tumors. Being a candidate for intensive care treatments could improve survival while having progressive disease, older age and grade >3 neutropenia were considered negative factors. Interestingly, the use of steroids was associated to reduced survival if received within 15 days before COVID19 diagnosis, while it has protective effect when used as part of COVID19 therapy.DisclosuresMussetti:Novartis, Gilead: Honoraria, Research Funding. Sureda Balari:Gilead/Kite: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; BMS: Speakers Bureau; Roche: Honoraria; Sanofi: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Incyte: Consultancy.OffLabel Disclosure:Tocilizumab for COVID19

Oncoradiology Preparedness in the COVID-19 Pandemic: Perspective from a Tertiary Oncology Referral Center from Eastern India

AbstractAt the time of writing this article, more than 18 million people worldwide have been infected by the severe acute respiratory syndrome-associated coronavirus-2 and about 700,000 people have died from coronavirus disease 2019 (COVID-19). In India, about 190,000 people have been infected and nearly 39,000 people have succumbed to this infection. Infection among health-care workers has emerged as one of the key problems in facing this pandemic. The purpose of this article is to describe the measures taken by the department of oncoradiology at our institution to control the infection and minimize staff exposure during the current lockdown period with reduced patient load and in the post-lockdown period with increased demand for radiology services. The key focus of this article is the continued delivery of cancer imaging services with practical precautions and optimized resources. We have also discussed algorithms and protocols unique to the practice of oncoradiology in the time of the COVID-19 pandemic.

Surgery Versus Radiofrequency Ablation in the Management of Spinal Osteoid Osteomas: A Spine Oncology Referral Center Comparison Analysis of 138 Cases

Osteoid osteomas (OOs) are benign bone forming tumors that, usually, occur in the extremities, with about 10% of them arising in the spine more commonly in the posterior elements. The aim of this study is to evaluate the long-term results of patients suffering from spinal OO treated with surgery and radiofrequency ablation. This was a retrospective comparison analysis of data prospectively collected from 2 cohorts of consecutive patients diagnosed with OO of the spine treated at the same Institute from November 2002 to February 2019. The first cohort included patients submitted to an intralesional extracapsular excision of the lesion (surgery group); the second cohort included patients submitted to radiofrequency ablation (RFA group). The surgery group showed a local recurrence rate of 1.7% versus a recurrence rate of 12.5% in the RFA group with a statistically significant difference in the disease-free survival at longest follow-up (P= 0.012). No statistically significant differences were observed in local recurrence rate stratified for level and site of lesion. No complications were observed in both groups at the time of first procedure. Surgery and RFA are both safe and effective interventional procedures for the management of spinal OO, although RFA is associated with a greater recurrence rate. Treatment should be tailored according to the relationship of lesions with neural structures and to advantages and disadvantages of each technique.

Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital.

In Australia, the rate of immediate breast reconstruction (IBR) following breast cancer surgery is highly variable. This study aimed to identify the rate of IBR within an Australian public tertiary breast oncology referral centre and analyse the tumour and demographic factors that impact upon IBR uptake. A retrospective cohort study of 288 admissions of women requiring mastectomy between January 2012 and March 2015 was performed. Data collected included demographic data, tumour pathology, operative details and neoadjuvant therapy. Demographic data included a Socioeconomic Index for Area score, based on individual residential postcode, country of birth and need for an interpreter. Our study demonstrated an IBR rate of 41.3% and included a wide variety of reconstructions. Factors that increased the IBR rate included younger age and negative lymph node status. Our patient population was ethnically and linguistically diverse, with over 50 different countries of birth represented and with 53 patients requiring interpreters in 19 different languages. Our analysis shows that the requirement for an interpreter is negatively correlated with having an IBR. Our research demonstrates a high rate of IBR that includes a wide range of autologous and alloplastic reconstructions. Our study represents a unique opportunity to identify socioeconomic barriers that influence patient choice for reconstruction following mastectomy. This can lead to improved health care provision for our patients. This is particularly important in tertiary services with a strong multicultural and multi-linguistic population.

Setting indicators for oncological clinical pathways: a 2-round Delphi method and face-to-face meeting

Abstract Background An ongoing project, promoted by “Gruppo Italiano di Reti Oncologiche” (GIRO) network and coordinated by the “Istituto Superiore di Sanità”, aims to apply Value Based Healthcare (VBH) for evaluating the performance of oncological healthcare providers. In this framework, the aim of this study was to define a set of indicators for assessing the overall clinical pathway for patients with colorectal cancer receiving healthcare in one of the seven GIRO referral centers. Methods A 2-round Delphi study was conducted involving experts from GIRO centers. A list of preliminary indicators, identified from national and international agencies, was firstly evaluated according to four criteria (relevance, evidence-based, measurability, actionability) using a 5-point Likert scale. Indicators receiving ≥50% of judgements ≥3 in 3/4 criteria went to selection process of the second round. The second survey firstly asked whether the indicator was to be included in the final set and, if yes, it was then evaluated on a balancing criterion. Indicators receiving ≥75% of agreement for inclusion and ≥50% of judgements ≥3 for balancing were confirmed for the final set. During the face-to-face meeting, a subset of indicators was prioritized for a pilot collection. Results After 1st-round consultation, all the 34 indicators in the preliminary list passed to the 2nd-round and 32 (94%) of these were included in the final set (16 colon;16 rectum). During the face-to face meeting, critical issues highlighted during the process (e.g. events occurring outside the referral center) were discussed and 16 (50%) indicators were prioritized for the pilot collection (8 colon;8 rectum). Conclusions Evaluating the overall clinical pathway for oncological patients is very important for achieving high-quality healthcare. Enhancing collaboration and networking among oncological referral centers is a main tool for the continuous improvement of healthcare outcomes in a VBH perspective. Key messages Evaluating the overall clinical pathway for oncological patients is very important for achieving high-quality healthcare. Enhancing collaboration and networking among oncological referral centers is a main tool for the continuous improvement of healthcare outcomes in a VBH perspective.

Laparoscopic sentinel node mapping with intracervical indocyanine green injection for endometrial cancer: the SENTIFAIL study – a multicentric analysis of predictors of failed mapping

ObjectivesLaparoscopy is commonly used for endometrial cancer treatment, and sentinel lymph node (SLN) mapping has become the standard procedure for nodal assessment. Despite the standardization of the technique, there is...

Reducing Oncologic Disparities by Standardizing Cancer Care

PURPOSE Shortages in oncology-trained health care providers pose a major challenge in low- and middle-income countries (LMICs) and contribute to delays in the diagnosis and treatment of cancer. Presently, the sole oncologist in the public sector at Princess Marina Hospital, Botswana’s largest oncology referral center, is overextended, causing medical officers to be the primary providers for patients with cancer. Medical officers do not possess formal oncology training, which can potentially lead to imprecise management and suboptimal treatment. In addition, there is no standardized patient interview process in the hematology clinic, leading to inadequately captured patient records. These realities highlight the need for the dissemination and implementation of evidence-based guidelines and intake forms to standardize the delivery of cancer care for practitioners with varying degrees of training. METHODS To serve as a reference for medical officers and oncologists, we reviewed clinical guidelines for the most prevalent cancers in Botswana, namely breast, cervical, prostate, colorectal, and head and neck cancer. We incorporated American Joint Committee on Cancer 8th edition staging criteria into the preexisting guidelines approved by Ministry of Health and Wellness Botswana. We further customized them on the basis of radiology, pathology, and pharmaceutical resource availability in Botswana. Finally, to streamline patient visits, we created intake forms to capture comprehensive hematology-pertinent information. As a quality improvement project, we will record the use and impact of these forms as a tool to standardize the medical records. RESULTS Standardized cancer care guidelines were updated and are under review by the Ministry of Health and Wellness Botswana before circulation. In addition, feedback regarding the new intake forms and their use is currently being recorded. CONCLUSION In low- and middle-income countries, the development of cancer-specific treatment guidelines optimizes disease management through incorporation of evidence-based, resource-adjusted recommendations for clinicians and may aid in reducing global oncologic disparities. As the next phase in the implementation of guidelines, we plan to develop quick-reference cancer pathways for use in public institutions without existing oncologic expertise.

Phyllodes tumor of breast, real-world data from a referral center in Mexico.

e19356 Background: Phyllodes tumors of breast (PTB) comprise a wide range of rare fibroepithelial neoplasms representing less than 1% of all breast tumors. Studies that describe the clinical characteristics of Mexican women with PTB are scarce. Methods: We performed a retrospective analysis of all patients with newly diagnosed PTB treated at an oncology referral center in Northeast Mexico from 2013 to 2018. Results: Twenty-three women were included in the analysis. Median age at diagnosis was 51 years. Diagnosis was made by self-detection in all cases, with a median tumor size of 12.8 cm. Approximately 26% of patients had a history of benign breast disease. Regarding treatment received 39% underwent radical mastectomy whereas simple mastectomy and breast-conserving surgery were performed in 39 and 22%, respectively. PTB were classified as benign, borderline, and malignant in 17, 13, and 70% of cases, respectively. Patients with malignant PTB showed a heterologous component in 22% of cases (60% with mixed histology, 20% fibromyxosarcoma, and 20% osteosarcoma). Metastatic disease at diagnosis was documented in 3 patients. Relapse of disease was confirmed in eight patients, two of them corresponded with borderline histology and six to malignant subtype. Recurrence sites by frequency were locoregional only 38%; distant disease to the lungs only 12%; and combined metastases to lung, liver and central nervous system 50%. Regarding management of recurrence, four patients received chemotherapy, two received only radiotherapy, one was treated with radiotherapy and chemotherapy and one woman received surgical treatment with adjuvant radiotherapy. Among all patients analyzed, the median overall survival was 23.6 months. Conclusions: To our knowledge, this is one of the first studies analyzing the clinical-pathological characteristics of phyllodes tumors in the Mexican population.

Access to molecular testing and targeted molecular therapy among Mexican patients with lung adenocarcinoma.

e19296 Background: Precision medicine has led to important changes in the treatment paradigm for patients with lung adenocarcinoma (LA) with mutations in EGFR or rearrangements of ALK or ROS1. The objective of this study is to describe the proportion of patients with LA who had access to molecular testing and targeted molecular therapy at an oncology referral center in Northeast Mexico. Methods: A retrospective study was performed with information gathered from electronic health records of the Hospital Universitario “Dr. José E. González” in Monterrey, Mexico from 2014 to 2019. Patients with LA were identified based on ICD-10 codes (C34) and diagnosis was confirmed with histopathological reports. Results: A total of 316 cases of lung cancer were identified, of which, 194 (64%) were LA, and of those, 117 (60%) had access to molecular testing. Mutations in EGFR were detected in 47%; 38% in men and 59% in women. Rearrangements in ALK were observed in 6.4%, whereas no alterations in ROS1 were seen. Access to molecular testing increased from 2014 to 2019, with a rate of 42% to 67%, respectively. Among patients that were candidates to receive targeted molecular therapy only 37% had access in 2014 versus 66% in 2019. Conclusions: The frequency of mutations in EGFR among our patients with LA showed a high discrepancy with previous studies conducted in countries with a predominantly white population. In Latin America, reports range from 14% to 34% in Argentina and Mexico, respectively. In our study, we identified a higher proportion of mutations in EGFR when compared to what previously reported; however, limited access to molecular testing may bias our results. Despite the advances in treatment for patients with LA, the availability of molecular testing and personalized treatment remains a challenge for developing countries.

190P Phyllodes tumour of the breast: 10 years of experience in a Mexican oncology reference center

Phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm representing 1% of all breast tumors. The objective of this report is to describe the characteristics of patients in the Hispanic population with PT and describe the clinical and pathological variables of our population. We performed a retrospective analysis of patients with PT treated at an Oncology referral center in North-East Mexico from the years 2013 to 2019. We registered 51 cases; 28 were excluded due to a lack of follow up. We included 23 cases in the final analysis. The mean age of diagnosis was 51 years, the diagnosis was made by self-detection in all cases, with a median time of evolution of 17.5 months and a median tumor size 12.8 cm, approximately 26% had a history of mammary resection with benign pathology. 39.1% were treated with radical mastectomy, simple mastectomy in 39.1% and 21.7% breast conservative surgery. PT were classified as benign 17.3%, borderline 13% and malignant 69.5%. Patients with malignant PT showed a heterologous component in 21.7%, 60% with mixed histology, (chondrosarcoma, liposarcoma, undifferentiated sarcoma, neural cystosarcoma, chondroid and bone), 20% fibromyxosarcoma and 20% osteosarcoma. 13% of the entire population had metastatic lung disease at the beginning of diagnosis; We observed 8 recurrences, 2 in borderline and 6 in malignant subtype. The recurrence-free interval in borderline subtype was 51 months and the main site of the recurrence were local; The recurrence-free interval was 5 months in malignant subtype, and the types of recurrence in order of frequency were in multiple sites 4 cases (lung, nervous central system, bone and liver), 1 case local and 1 case lung metastases. The treatments were chemotherapy (66.6%), radiotherapy (16.6%) and concurrent radiotherapy and chemotherapy (16.6%). The overall survival in the subgroup that developed distance disease was 6.9 months. To our knowledge, this is one of the first studies, analyzing the clinical-pathological characteristics of phyllodes tumors in the North-East of Mexico. We found more cases with malignant subtype, bigger tumors and more heterologous component than other Hispanic reports.

Preoperative Conization and Risk of Recurrence in Patients Undergoing Laparoscopic Radical Hysterectomy for Early Stage Cervical Cancer: A Multicenter Study

To investigate the factors associated with poorer oncologic outcomes in patients undergoing laparoscopic radical hysterectomy (LRH) for early stage cervical cancer. Multicenter retrospective study. Three gynecologic oncology referral centers. Patients with International Federation of Gynecology and Obstetrics 2009 stage IA (positive lymphovascular space invasion)-IB1 cervical cancer between January 2006 and June 2018. LRH (Piver type II-III hysterectomies). Lymph-node dissection was accomplished according to the tumor characteristics. Surgical and oncologic outcomes were analyzed. Overall, 186 patients met the inclusion criteria, 16 (8.6%) experienced a recurrence, and 9 (4.8%) died of the disease (median follow-up period 37.9 months). Surgery-related complications did not influence disease-free survival. All the recurrences (16/16; 100%) occurred in patients with stage IB1 disease (p = .02), and 15 (93.7%) in cases involving tumors ≥2 cm. No association between positive lymph node and recurrence was detected (p =.82). Patients who had a preoperative diagnosis through conization (93; 50%) had a significantly lower rate of recurrence than those who underwent cervical biopsy (93; 50%): 1/93 (1.1%) vs 15/93 (16.1%); p <.001). The subanalysis of patients with International Federation of Gynecology and Obstetrics stage IB1 cervical cancer showed that patients undergoing preoperative conization (vs cervical biopsy) were less likely to experience a recurrence (odds ratio 0.09; 95% confidence interval 0.01-0.55). We confirmed that LRH was associated with a recurrence rate similar to that reported in the Laparoscopic Approach to Cervical Cancer trial. Tumor size ≥2 cm represents the most important risk factor influencing disease-free survival. However, we found that preoperative conization plays a potentially protective role in patients with an IB1 tumor.

HIV-associated multicentric Castleman disease: a report of 19 cases at an oncology institution.

The aim of this study is to describe the clinical characteristics and outcome of multicentric Castleman disease (MCD) in HIV-infected patients at an oncological referral center in Mexico. Clinical records at the HIV-AIDS clinic of all patients diagnosed with MCD from 1994 to 2018 were reviewed. There were 19 patients, mean age was 31.3 ± 8.4 years, and 17 (89.5%) were males. Fifteen patients (79%) had also Kaposi sarcoma (KS). Main clinical characteristics were multiple lymphadenopathy (95%), systemic symptoms (63%), and hepatosplenomegaly (50%). Computed tomography scan and 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography showed multiple lymphadenopathy, inversion of the liver:spleen uptake ratio, with an increase in SUVmax (5.7). The histopathology report described plasma cells in 58%, mixed type in 26%, and hyaline vascular in 16%. Eleven patients (57.9%) received different chemotherapy regimens. Seven patients died (36.8%): four related to MCD progression or chemotherapy complications, median survival was eight months. For those patients who survived, median, follow-up was 28 months (p &lt; 0.001). The incidence of MCD in people living with HIV is probably underestimated. In patients with lymphadenopathy, B symptoms, deranged inflammatory markers, and/or disseminated KS, a biopsy of an enlarged lymph node is warranted, and the histology should be reviewed by an experienced pathologist.