Oncology Referral Center Research Articles

Clinical characteristics and treatment adherence among men with testicular germ cell tumors: Real-world data from a referral center in Mexico.

393 Background: Notwithstanding excellent oncological outcomes reported by pivotal trials in patients with testicular germ cell tumors (TGCT), adherence to medical treatment and follow-up remains a major issue in developing countries. Studies that describe the clinical characteristics and treatment adherence of Mexican men with TGCT are lacking. Methods: We performed a retrospective analysis of all men with newly diagnosed TGCT treated at an oncology referral center in Northeast Mexico from 2014 to 2018. Results: In the analysis, 195 patients were included. Median age at diagnosis was 28 years; median time from diagnosis to first evaluation by an oncologist was 26 days. Distribution according to the laterality of the primary tumor was right, 56%; left, 43%; and bilateral, 1%. There were 14 oncological emergencies at presentation; the most frequent was choriocarcinoma syndrome, described in 5 patients. Thirty-five percent of cases were seminomatous germ cell tumors (SGCT) and 65% nonseminomatous germ cell tumors (NSGCT). The clinical stages at diagnosis were I, 36%; IS, 8%; II, 18%; and III, 38%. After risk stratification according to the International Germ Cell Cancer Collaborative Group (IGCCCG), 90% of SGCT had a good risk and 10% an intermediate risk. In NSGCT, the risk distribution was 65, 10, and 25% for good, intermediate, and poor-risk disease, respectively. After proposing treatment, the adherence rate was 81%. Of the total, 58% were lost to medical follow-up with a median time of adherence of 11.5 months. Conclusions: Despite coverage by the Mexican public health insurance system “Seguro Popular”, treatment adherence and medical follow-up abandonment is a problem among men with TGCT, which could negatively impact their prognosis. Measures must be implemented to optimize adherence in this group of patients.

Retrograde ureteric stent exchange in the female oncology patient by interventional radiology: the experience of a single tertiary referral centre.

Double-J stents are used to treat ureteric outflow obstruction. Deployed in antegrade or retrograde fashion, they relieve ureteric obstruction in several conditions including ureteric calculi, strictures and malignancy. Traditionally exchanged in an operating theatre (OT) under general anaesthetic (GA), more recently described is the technique of using fluoroscopic guidance under sedation. To assess the efficacy and safety of retrograde double-J stent exchange in an interventional radiology (IR) setting in a tertiary oncology referral centre over a 7-year period. Clinical data on 460 double-J stent exchanges in 126 female patients was acquired from the hospital electronic patient record. Four fellowship-trained interventional radiologists performed the procedures. A standard approach was used in conjunction with conscious sedation using midazolam and fentanyl. Use of the technique with certain anatomical variations is also described. Technical success rate was 96%. The main reasons for failure included failure to snare the stent (1.8%) and patient discomfort (1.1%). The overall complication rate was 5%: 5 category 1 (minor) and 18 category 3 outcomes, with the latter group requiring further intervention. Average screening time was 9.65min and the average radiation dose was 2018.24mGy/m2. We also demonstrate the successful use of this method in patients with unusual anatomy and ileal conduits. Fluoroscopic-guided retrograde double-J stent exchange is a safe and effective procedure that can be performed with a high degree of success using equipment and techniques used in daily IR practice. This approach precludes the need for GA, reduces OT utilisation and is well tolerated in a patient group for whom this procedure is typically palliative.

The diagnostic significance of pulmonary nodules on CT thorax in chondrosarcoma of bone

To provide a diagnostic approach to pulmonary nodules in patients with chondrosarcoma. A search of the oncology database at a specialist orthopaedic oncology referral centre was performed to identify all patients who were treated surgically for chondrosarcoma between January 2007 and December 2018. Reports from the computed tomography (CT) examinations of the thorax of these patients were reviewed. In patients who had pulmonary nodules/metastases identified on CT, data on the primary chondrosarcoma and pulmonary nodule characteristics were collected. Twenty point two percent of patients had a pulmonary nodule identified on either initial or follow-up staging CT of the thorax, of which 8.1% were pulmonary metastases. Patients with grade 3 and dedifferentiated chondrosarcoma were more likely to have pulmonary metastases than patients with grade 1/2 chondrosarcoma. The time interval to developing metastases was shorter in patients with grade 2/3 and dedifferentiated chondrosarcoma versus patients with grade 1 chondrosarcoma. A low proportion of patients with grade 1 chondrosarcoma developed metastases (12.5%), all of which were identified at the time of a local recurrence. Nodules ≥10mm, nodules with lobulate margins, nodules containing irregular or subtle calcification, and nodules seen bilaterally or both centrally and peripherally were more likely to represent pulmonary metastases than benign nodules. The diagnostic significance of pulmonary nodules (i.e., whether they represent pulmonary metastases or not) can be predicted by taking into account a number of factors, in particular, the histological grade of the patient's chondrosarcoma, the size and margins of the nodules, and the presence of subtle/irregular calcification.

EP1.01-90 The Prognostic Role of Mean Platelet Volume in Patients with Advanced Non-Small Cell Lung Cancer

Previous studies suggest the potential correlation between increased mean platelet volume (MPV) and survival in non-small cell lung cancer (NSCLC), but results are often contradictory. We herein aimed to further evaluate the prognostic value of MPV in patients with advanced-stage NSCLC in the real-world setting of a tertiary referral oncology center. Demographic, clinicopathological and laboratory data (including complete blood count parameters) of 30 patients with stage IIIB or IV NSCLC were retrieved from the Lung Cancer registry of the Oncology Clinic of Sotiria Athens General Hospital and analyzed. All the above variables (including MPV) were correlated to each other, as well as with overall survival (OS) and progression-free survival (PFS). Mean patients’ age was 68,5 (SD=7,5) years. The majority of patients were male (76.7%), had positive smoking history (90%), squamous cell carcinoma (53.3%), and stage IV disease (76.7%). No statistically significant correlations between survival and sex, age, smoking history or tumor histology (squamous cell carcinoma versus adenocarcinoma), or between MPV and histology were noted. Worse performance status (p=0.004) and higher white blood cell count (p=0.01) were correlated with reduced OS, while increased MPV was strongly correlated both with OS and PFS (p<0.0001 in both cases). Increased MPV may correlate with improved survival of patients with NSCLC, thus potentially representing a marker of favorable prognosis. Our study findings warrant confirmation in larger prospective series

EP1.05-11 Integrating Radiological Features to CT Guided Lung Biopsy Results; The Experience of an Argentinean University Teaching Hospital

To analyze the radiological findings and the diagnostic accuracy of percutaneous transthoracic needle biopsies (CT- PTNB) performed for the evaluation of patients with lung lesions derived to our center. We describe a retrospective review of 206 consecutive patients undergoing CT- PTNB of lung lesions performed between 2016 and 2019 at a single oncological referral center. Clinico-pathological data, including: age, smoking status, and previous cancer was described. Radiologic lesion's characteristics on CT; multiple or solitary, location, mean diameter (mm), type (mass³30 mm, nodule <30mm, other), mean distance to pleura, presence of consolidation, nodule edge, calcifications, presence of radiologic emphysema, ground glass component and PET-CT SUVmax were used to compare with lung biopsy results. The rate and factors associated with complications was also be reported. From 105 patients who underwent CT- PTNB and fulfilled inclusion criteria; 85 (81%) had pathologic confirmed cancer diagnosis, 3 (3%) had benign findings and 17 (16%) had inadequate samples for accurate diagnosis. The majority of patients were: male (57%) and the mean age was 63 years (32–88). Lung cancer was the main diagnosis (49/85; 58%) achieved through CT-PTNB; 71.2% of these cases had adenocarcinoma histology and 29% (14/49) had previous cancer diagnosis (35%: breast cancer) being the majority of them smokers (86%). Metastatic lesions (36/85; 42%) were: 44% melanoma-sarcoma, 38%: breast, colorectal, renal and cervix cancer and 18%: lymphoma, cervix, head and neck, lung and urothelial cancer. Primary lung cancer compared to lung metastases showed on CT images: mass presentation (63%vs33%; p=0.002), right superior lobe localization (47% vs 33%; p=0,016), solitary lesion (77% vs 53%; p=0,016), consolidation (22% vs 5%; p=0,033), central calcification (12% vs 0%; p=0,024), emphysema (55% vs 28%; p=0,009), mean major diameter (mm) (61±33 vs 36±24; p=0,000), mean distance to pleura (mm)(32±78 vs 86±12.7; p=0,014) and PET-CT mean SUVmax (8.8±10.63 vs 4.7±6.8; p=0.045). The complication rate of CT- PTNB was 18.5% (half of them practiced through right upper lung lobe, being pneumothorax the most common. Mean distance between pleura to CT- PTNB site was 10.54 vs 3.81 mm in complicated and non-complicated cases, respectively. Primary and metastatic lung lesions were safely pathologically evaluated by CT- PTNB. Radiological characteristics of the lesions can help in patient's initial assessment to predict their nature.

Anaplastic Thyroid Cancer: Clinical Picture of the Last Two Decades at a Single Oncology Referral Centre and Novel Therapeutic Options.

Anaplastic thyroid cancer (ATC) is a rare tumour but also one of the most lethal malignancies. Therapeutic modalities have usually been limited, but clinical trials with new drugs are now being implemented. The aims of this study were to analyse the clinical presentation, therapeutic modalities and independent prognostic factors for survival. We also reviewed the most recent literature on novel ATC therapies. We performed a retrospective analysis of 79 patients diagnosed between 2000 and 2018. Variables with impact on survival were identified using the Cox proportional-hazard regression model. At presentation, 6.3% had thyroid-confined disease, 30.4% evidenced extrathyroidal extension and 60.8% were already metastatic. Surgery was feasible in 41.8% and radiotherapy was applied to 35.4%, with those receiving >45 Gy having longer estimated survival (p = 0.020). Chemotherapy, either conventional or with tyrosine kinase inhibitors, was performed in 17.7% and 7.6%, respectively. Multimodality therapy with surgery, radiotherapy and chemotherapy/tyrosine kinase inhibitors (TKI) had the greatest impact on disease specific survival (DSS), providing a risk reduction of death of 96.9% (hazard ratio (HR) = 0.031, 0.005–0.210, p < 0.001). We concluded that most of these patients join reference centres at advanced stages of disease and multimodality treatment may offer the best chances for prolonging survival.

Development and validation of a model that includes two ultrasound parameters and the plasma D-dimer level for predicting malignancy in adnexal masses: an observational study

BackgroundPre-operative discrimination of malignant from benign adnexal masses is crucial for planning additional imaging, preparation, surgery and postoperative care. This study aimed to define key ultrasound and clinical variables and develop a predictive model for calculating preoperative ovarian tumor malignancy risk in a gynecologic oncology referral center. We compared our model to a subjective ultrasound assessment (SUA) method and previously described models.MethodsThis prospective, single-center observational study included consecutive patients. We collected systematic ultrasound and clinical data, including cancer antigen 125, D-dimer (DD) levels and platelet count. Histological examinations served as the reference standard. We performed univariate and multivariate regressions, and Bayesian information criterion (BIC) to assess the optimal model. Data were split into 2 subsets: training, for model development (190 observations) and testing, for model validation (n = 100).ResultsAmong 290 patients, 52% had malignant disease, including epithelial ovarian cancer (72.8%), metastatic disease (14.5%), borderline tumors (6.6%), and non-epithelial malignancies (4.6%). Significant variables were included into a multivariate analysis. The optimal model, included three independent factors: solid areas, the color score, and the DD level. Malignant and benign lesions had mean DD values of 2.837 and 0.354 μg/ml, respectively. We transformed established formulae into a web-based calculator (http://gin-onc-calculators.com/gynonc.php) for calculating the adnexal mass malignancy risk. The areas under the curve (AUCs) for models compared in the testing set were: our model (0.977), Simple Rules risk calculation (0.976), Assessment of Different NEoplasias in the adneXa (ADNEX) (0.972), Logistic Regression 2 (LR2) (0.969), Risk of Malignancy Index (RMI) 4 (0.932), SUA (0.930), and RMI3 (0.912).ConclusionsTwo simple ultrasound predictors and the DD level (also included in a mathematical model), when used by gynecologist oncologist, discriminated malignant from benign ovarian lesions as well or better than other more complex models and the SUA method. These parameters (and the model) may be clinically useful for planning adequate management in the cancer center. The model needs substantial validation.

CT-guided Lung Biopsy: Effect of Biopsy-side Down Position on Pneumothorax and Chest Tube Placement

Background Supine or prone positioning of the patient on the gantry table is the current standard of care for CT-guided lung biopsy; positioning biopsy side down was hypothesized to be associated with lower pneumothorax rate. Purpose To assess the effect of positioning patients biopsy side down during CT-guided lung biopsy on the incidence of pneumothorax, chest drain placement, and hemoptysis. Materials and Methods This retrospective study was performed between January 2013 and December 2016 in a tertiary referral oncology center. Patients undergoing CT-guided lung biopsy were either positioned in (a) the standard prone or supine position or (b) the lateral decubitus position with the biopsy side down. The relationship between patient position and pneumothorax, drain placement, and hemoptysis was assessed by using multivariable logistic regression models. Results A total of 373 consecutive patients (mean age ± standard deviation, 68 years ± 10), including 196 women and 177 men, were included in the study. Among these patients, 184 were positioned either prone or supine depending on the most direct path to the lesion and 189 were positioned biopsy side down. Pneumothorax occurred in 50 of 184 (27.2%) patients who were positioned either prone or supine and in 20 of 189 (10.6%) patients who were positioned biopsy side down (P < .001). Drain placement was required in 10 of 184 (5.4%) patients who were positioned either prone or supine and in eight of 189 (4.2%) patients who were positioned biopsy side down (P = .54). Hemoptysis occurred in 19 of 184 (10.3%) patients who were positioned prone or supine and in 10 of 189 (5.3%) patients who were positioned biopsy side down (P = .07). Prone or supine patient position (P = .001, odds ratio [OR] = 2.7 [95% confidence interval {CI}: 1.4, 4.9]), emphysema along the needle path (P = .02, OR = 2.1 [95% CI: 1.1, 4.0]), and lesion size (P = .02, OR = 1.0 [95% CI: 0.9, 1.0]) were independent risk factors for developing pneumothorax. Conclusion Positioning a patient biopsy side down for percutaneous CT-guided lung biopsy reduced the incidence of pneumothorax compared with the supine or prone position. © RSNA, 2019.

Histologic Features Associated With an Invasive Component in Lentigo Maligna Lesions

Lentigo maligna (LM) presents an invasive component in up to 20% of biopsied cases, but to date the histologic features useful in detecting this invasive component have not been described. Some histologic characteristics are hypothesized to contribute to the progression of LM invasion. To identify the histologic characteristics associated with lentigo maligna melanoma (LMM) in patients with LM diagnosed by a partial diagnostic biopsy. A retrospective cross-sectional study of patients treated between January 1, 2000, and December 31, 2017, was conducted in a referral oncology center in València, Spain. Data and specimens of patients (n = 96) with a diagnosis of primary cutaneous melanoma in the form of either LM or LMM who had undergone surgical treatment, a complete histologic examination of the whole tumor, and an initial diagnostic partial biopsy of LM were included in the study. Histologic assessment was blinded to the presence of an invasive component. All biopsy specimens were evaluated for the presence of certain histologic characteristics. Comparisons between invasive samples and samples without an invasive component were performed. The differences in the distribution of variables between the groups were assessed using the χ2 and Fisher exact tests, and the degree of association of the relevant variables was quantified by logistic regression models. A classification and regression tree analysis was performed to rank the variables by importance. In total, 96 patients had sufficient histologic material that could be evaluated. The patients were predominantly male (56 [58.3%]) and had a mean (SD) age at diagnosis of 72 (12) years. Of these patients, 63 (65.6%) had an LM diagnosis and 33 (34.4%) had an LMM diagnosis (an invasive component). The histologic variables associated with the presence of an invasive component were melanocytes forming rows (odds ratio [OR], 11.5; 95% CI, 1.4-94.1; P = .02), subepidermal clefts (OR, 2.8; 95% CI, 1.0-7.9; P = .049), nests (OR, 3.0; 95% CI, 1.1-8.6; P = .04), and a lesser degree of solar elastosis (OR, 0.4; 95% CI, 0.1-1.1; P = .07). A classification and regression tree analysis of the relevant histologic features was able to accurately identify lentigo maligna with an invasive component (LMM) in more than 60% of patients. These findings may be useful in classifying early LM specimens at higher risk of invasion, which may eventually be relevant in identifying the most appropriate management for LM.

Phyllodes tumor of the breast. Experience and clinical–pathological characteristics of patients treated in a third level oncologic referral center

IntroductionPhyllodes tumors are rare fibroepithelial lesions, with an incidence of 2.1 cases per million. They represent 0.2–2% of all breast tumors. The breast tumor department treats the largest number of patients per year at the Oncology Hospital, National Medical Center Siglo XXI, Mexican Social Security Institute, representing 17.4% of all patients treated in this centre. Material and methodsRetrospective, descriptive study. We assessed clinical and pathological characteristics, recurrences and overall survival at 5 years in patients with phyllodes tumor of the breast treated at the Oncology Hospital, Siglo XXI National Medical Center, from January 2000 to December 2017. ResultsThirty-two patients were included in the analysis. Mean age was 43.5 years, presentation was in the right breast in 66% of the patients and pain was present in 19%. 66% presented in the right breast, presented pain 19%. A total of 41% were benign phyllodes tumors, 41% were borderline and 18% malignant. In all, 18% of the cases were treated with wide resection, 65% with simple total mastectomy and 15% with modified radical mastectomy. Recurrence at 5 years was observed in 12%. Overall survival at 5 years was 94%, 100% for patients with benign histology, 100% for patients with borderline histology, and 66% for those with malignant histology (p=0.09). ConclusionsIn our population, phyllodes tumors show a tendency towards size greater than 5cm, which is reflected in the greater number of mastectomies in contrast to other reports.

Participation in Physical Activity and Physical Education in School Among Children With Acute Lymphoblastic Leukemia After Intensive Chemotherapy.

Background: Low physical activity (PA) level has been reported among survivors of childhood acute lymphoblastic leukemia (ALL). The present study was performed to determine the level of participation in general PA and physical education in school (PES) among children with ALL who completed intensive chemotherapy and identify possible barriers that influence adherence to PA and PES.Methods: A cross-sectional, single-center study was conducted over 1 year in a tertiary pediatric hematology and oncology referral center in Kuala Lumpur, Malaysia. A total of 47 children with ALL aged 7–18 years old who were off-treatment and attended school on a regular basis were recruited. A modified structured questionnaire adapted from the Youth Risk Behavior Surveillance System, Division of Adolescent and School Health, the Centers for Disease Control and Prevention (CDC) was used to assess the children's level of PA and PES participation.Results: Among the 47 children will ALL included herein, 11 (23.4%) were physically active for at least 60 min a day for 5 days or more, following CDC recommendations. The median duration from completion of intensive chemotherapy was 4.95 years (25th, 3.29; 75th, 7.95). Younger age at study entry (median, 8.7 years old vs. 12.2 years old) and younger age at diagnosis (median, 2.9 years old vs. 4.3 years old) were significantly associated with higher PA level. Almost all children (45/47, 95.7%) participated in PES. Barriers to non-participation in PES mainly included exhaustion or fear of injury.Conclusions: Majority of the children with ALL included herein had low levels of daily PA after intensive chemotherapy. Nonetheless, their participation in PES was encouraging. PA should thus be promoted during and after cessation of ALL treatment to prevent long-term health risks and improve overall quality of life.

The prevalence and impact of cervical spine pathologies in patients with nasopharyngeal carcinoma

ObjectivesNasopharyngeal carcinoma (NPC) and its treatment can lead to cervical spine pathologies such as metastases, osteoradionecrosis (ORN) and infection. However, the occurrence rate and relationship between timing of diagnosis and outcomes of the ever-advancing technology of radiation therapy is largely unknown. Hence, the aim of this study is to determine the prevalence and impact of cervical spine pathologies in patients with NPC. Materials and methodsThis was a cross-sectional study of all newly diagnosed cases of NPC from 2007 to 2016 at a tertiary referral oncology and spine centre with minimum 1-year post-treatment follow-up. All cervical spine pathologies, their treatment and outcomes were determined. Presentation, onset time and correlations of the cervical spine pathologies with mortality and risk factors were also analysed. ResultsOut of 605 cases of verified cases of NPC, cervical spine pathologies were seen in 8.9% of patients. New onset neck pain was seen in 5.3%, symptomatic cervical spondylosis in 4.8%, cervical spine metastases in 2.5%, local tumour invasion in 0.8%, cervical ORN in 0.7%, osteomyelitis in 0.7%, radiculopathy in 0.3%, and myelopathy in 0.3%. Cervical spine pathologies were associated with an increased risk (odds ratio: 2.73) in overall mortality. Cervical spine metastases, invasion, ORN and infection were associated with significantly higher risk of mortality (p = 0.01–0.02). ConclusionCervical spine pathologies in patients with NPC are heterogenous but not uncommon. Neck pain is prevalent but is often benign. ORN and osteomyelitis of the cervical spine is uncommon but have large clinical implications including higher mortality with subtle presentations.

Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy

BackgroundSacral chordoma is a locally aggressive malignant tumour originating from ectopic notochordal cells. The natural history of sacral chordoma is a slow growing tumour arising at the midline of the lower sacrum that can invade the sacrum and progressively increase in size expanding cranially and anteriorly. Metastasis is very rare even when the tumour is large. Sacral chordoma affects males more than females and is more commonly found in middle age and elderly patients.Case presentationA 25 years old female had neglected an extremely large midline sacral mass for 2 years. On presentation to hospital, she had been bed bound for the past 2 years. The sacral mass was so large that it prevented her from lying down supine and sitting on the wheelchair comfortably. Clinical examination showed a 40 cm × 30 cm × 20 cm hard mass over the sacrum that involved both buttocks and the gluteal fold. Neurological exam of bilateral lower limb was normal. Computed Tomography Scan of the Pelvis showed a large destructive sacrococcygeal mass measuring 43 cm × 38 cm × 27 cm with extension into the presacral space resulting in anterior displacement of the rectum, urinary bladder and uterus; and posterior extension into the dorsal soft tissue with involvement of the gluteus, piriformis, and left erector spinae muscles. Biopsy taken confirmed Chordoma. This patient was managed by a multidisciplinary team in an Oncology referral centre. The patient had undergone Wide En Bloc Resection and Sacrectomy, a complex surgery that was associated with complications namely bleeding, surgical site infection and neurogenic bowel and bladder. Six months post operatively the patient was able to lie supine and sit on wheelchair comfortably. She required extensive rehabilitation to help her ambulate in future.ConclusionThis is a rare case of neglected sacral chordoma in a young female treated with Wide En Bloc Resection and Sacrectomy associated with complications of this complex surgery. Nevertheless, surgery is still worthwhile to improve the quality of life and to prevent complications secondary to prolonged immobilization. A multidisciplinary approach is ideal and team members need to be prepared to address the complications once they arise.

Totally implanted venous access-associated adverse events in oncology: Results from a prospective 1-year surveillance programme

During the last decade, most studies on totally implanted venous access-associated adverse events (TIVA-AE) were conducted retrospectively and/or were based on a limited sample size. The aim of our survey was two-fold: to estimate the incidence of TIVA-AE and to identify risk factors in patients with cancer. Data from our routine surveillance of TIVA-AE were collected prospectively between October 2009 and January 2011 in two oncology referral centers in Northern France. The open cohort under surveillance during the same time period was reconstituted retrospectively using data from the hospital information systems. Incidences of first TIVA-AE per 1000 TIVA-days were calculated. Risk factors were identified using multivariate logistic regressions. We included 2286 cancer patients, corresponding to 582,347 TIVA-days. Among the 133 first TIVA-AE observed (incidence 0.23 per 1000 TIVA-days [0.19-0.27]), there were 50 infectious AE (incidence 0.09 [0.06-0.11]) and 83 non-infectious AE (incidence 0.14 [0.11-0.17]). Compared to non-metastatic solid cancers, metastatic cancers (aOR=2.3 [0.9-6.0]), and hematologic malignancies (aOR=3.2 [1.1-8.8]) tended to be associated with a higher risk of infectious TIVA-AE (P=0.087). Solid cancer type was associated with non-infectious TIVA-AE (P=0.030), especially digestive cancers. We report accurate estimations of TIVA-AE incidences in one of the largest populations among previously published studies. As in previous studies, metastatic cancers and hematologic malignancies tended to be associated with a higher risk of infectious TIVA-AE. Further studies are warranted to confirm the effect of digestive cancers.

Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps.

Purpose To determine if there is added benefit of using iodine maps from dual-energy (DE) CT in addition to conventional CT angiography images to diagnose pulmonary embolism (PE). Materials and Methods In this retrospective analysis, 1144 consecutive dual-energy CT angiography examinations performed from January through September 2014 at an oncologic referral center to evaluate for PE were reviewed. The 1144 examinations included 1035 patients (mean age, 58.7 years; range, 15-99 years). First, the location, level, and type (occlusive vs nonocclusive) of PEs on conventional CT angiograms were recorded. Iodine maps were then reviewed for defects suggestive of PE. Last, CT angiograms were rereviewed to detect additional PEs suggested by the iodine map. Consensus reviews were performed for examinations with PEs. The confidence interval of percentages was calculated by using the Clopper-Pearson method. Results On 147 of 1144 (12.8%) CT angiograms, a total of 372 PEs were detected at initial review. After review of the DE CT iodine map, 27 additional PEs were found on 26 of 1144 CT angiograms (2.3%; 95% confidence interval [CI]: 1.5%, 3.3%). Of the 27 additional PEs, six (22.2%) were segmental, 21 (77.8%) were subsegmental, 24 (88.9%) were occlusive, and three (11.1%) were nonocclusive. Eleven of 1144 (1.0%; 95% CI: 0.5%, 1.7%) CT angiograms had a new diagnosis of PE after review of the DE CT iodine maps. Conclusion Dual-energy CT iodine maps show a small incremental benefit for the detection of occlusive segmental and subsegmental pulmonary emboli. © RSNA, 2018.

PS02.021: TOTALLY LAPAROSCOPIC TRANSHIATAL ESOPHAGECTOMY FOR ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION: INDICATIONS, TECH. ASPECTS AND RESULTS, COMPARING TO OPEN ACCESS

Abstract Background Minimally invasive esophagectomy remains with high morbidity and mortality rates. The transhiatal technique has less surgical time, lower morbidity and an acceptable oncological surgical control for patients with adenocarcinoma of the esophagogastric junction (AGEJ), unfortunaly still infrequent by laparoscopy. The aim of this study is to present indications, technical aspects and results of the totally laparoscopic transhiatal esophagectomy (TLTE) comparing to open access (OA) Methods This study retrospectively reviewed esophageal cancer patients that were admitted at an oncology referral center between 2011 to 2016. The studied population was composed of 128 AEGJ, all of them characterized as Siewert I and II classification. Demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival at 60 months, between TLTE and OA. Influence of prognostic variables was assessed by Cox regression. Results The mean age was 63,4 ys (55–80ys), 85,4% were male. The selection of this group of patients was related to good clinical condition, however most of T2-T3 tumors. 90 patients were submitted to OA and 38 to TLTE (p-value for Log-Rank 0.11). Average follow-up was 39.8 months. By univariate analysis, curative intention resection was related to only 22% of patients in 5 ys. By univariate Cox regression, only degree of cellular differentiation was related to poor clinical stage in TLTE (p-value = 0.05). Weight loss (kg), BMI variation (kg/m²) and percentage of weight loss from initial symptoms to the diagnosis of esophageal carcinoma are factors that predict indicate the TLTE. Considering only patients submitted to curative intent surgery, more than 21 node resection could reach a statistically significant improvement in survival rate by univariate analysis, but there were no difference between both groups.There was no mortality and morbidity rate about 7%. Comparing TLTE to OA there were no difference in survival and morbidity and mortality. Conclusion This is a preliminary study about low rate related to both access (TLTE and OA) in patients with AEGJ) with T2-T3 tumors, with low morbidity and no mortality series. TLTE is a safe and feasible alternative to the open approach, with decrease short-term morbidity with comparable oncological outcomes. Disclosure All authors have declared no conflicts of interest.

Predictive Value of Kanagawa Cancer Center Scoring System for Lymph Node Metastasis and Need for Lymphadenectomy in Patients With Endometrial Cancer: A Validation Study.

The objective of this study was to determine the predictive value of Kanagawa Cancer Center (KCC) scoring system for lymph node metastasis and need for lymphadenectomy in patients with endometrial cancer. This cross-sectional study was conducted during a 2-year period in a gynecologic oncology referral center in Southern Iran. We included a total number of 94 patients with endometrial cancer. Preoperative assessment included tumor volume, myometrium invasion, histology, and CA125. The KCC was calculated for all the patients. All the patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy along with dissection of pelvic and para-aortic lymph nodes. The histopathology of the dissected lymph nodes was considered as criterion standard, and the predictive value of KCC was evaluated accordingly. The mean ± SD age of the patients was 56.8 ± 10.2 years. Overall, 26 patients (27.7%) tested positive for lymph node involvement. The sensitivity, specificity, positive predictive value, and negative predictive value of KCC for lymph node involvement was found to be 35.3%, 100%, 100%, and 64.7%, respectively. Overall, the predictive value according to the area under the curve measured by receiver operating characteristic curve was found to be 0.890 (0.823-0.956) indicative of moderate accuracy. Lymph node involvement was associated with higher Federation of Gynecology and Obstetrics stage (P < 0.001), higher tumor volume (P = 0.003), higher histological subtype (P < 0.001), positive CA125 (P < 0.001), and higher KCC score (P < 0.001). The KCC scoring system has a moderate accuracy for predicting the lymph node involvement in patients with endometrial cancer.

Feasibility of systematic poverty screening in a pediatric oncology referral center.

Based on the strong link between poverty and child health outcomes, both the American Academy of Pediatrics (AAP) and national pediatric oncology associations have advocated for routine clinical poverty screening. Systematic implementation of this recommendation in pediatric oncology is not yet standard, and feasibility data are needed. We report the feasibility of routine poverty screening in a pediatric oncology referral center and baseline poverty characteristics of this population. From 2013 to 2017, 448 families with newly diagnosed pediatric cancer at Dana-Farber/Boston Children's Cancer and Blood Disorders Center were offered the Psychosocial Assessment Tool 2.0 (PAT) as part of routine care. The PAT includes a two-item screen for household material hardship (HMH). All families were asked about annual household income by a resource specialist. Data were abstracted with sociodemographic and child/disease characteristics. Descriptive statistics are reported. Four hundred and thirteen families completed the PAT (response rate 92%), of whom 394 (95%) completed specific questions assessing for HMH. Ninety-four percent of families who met with a resource specialist disclosed their annual household income. One quarter (27%) of families was ≤200% federal poverty level at diagnosis, and 44% of families endorsed at least one domain of HMH. The most frequent domains of HMH included housing (24%), utilities (20%), and transportation (20%). Systematic poverty screening per AAP and pediatric oncology psychosocial standards of care is feasible in routine cancer care. There is a high baseline incidence (44%) of HMH in at least one domain in families with newly diagnosed pediatric cancer who may benefit from early identification and resource intervention.

Mo1132 CLINICAL AND ENDOSCOPIC FEATURES OF METASTASES TO THE GASTROINTESTINAL TRACT

Occurrence of metastasis to the gastrointestinal tract (GIT) is rare. The studies on the endoscopic findings of metastatic tumors are usually restricted to small case series. As a consequence of the improved in the survival time for cancer patients over recent years, it is expected that progressively more cancer patients could present for diagnosis, by endoscopy, of secondary tumors of the GIT. With this regard, it would be useful to better characterize the endoscopic aspects of metastases to the GIT. observational study conducted in an oncological referral center between January 2009 and August 2017. The study included patients with metastasis to the GIT, submitted to endoscopic exam (upper gastrointestinal endoscopy, colonoscopy, enteroscopy, endoscopic ultrasound) with histological confirmation. Patients with lymphoma, leukemia, multiple myeloma, Kaposi sarcoma or direct invasion from adjacent organs were excluded. From January 2009 to august 2017, 53.675 endoscopic exams were performed. A total of 184 cases were suspected gastrointestinal metastasis. In 94 patients the diagnosis was confirmed. The baseline characteristics of the patients are summarized in Table 1. Common indications for endoscopy were abdominal pain (29 cases – 30.8%), gastrointestinal bleeding (28 cases – 29.8%) and vomiting (18 cases – 19.1%). The most common site of metastasis was the stomach (60 cases – 59.6%), followed by small bowel (29 cases – 29.8%) and colon (7 cases – 7.4%). Eight patients (8.5%) had metastasis in more than one site in the GIT. As indicated in Table 2, the most common primary malignancy was melanoma (25 cases – 26.6%), followed by breast (14 cases – 14.9%) and lung (14 cases – 14.9%). If considered just the gastric metastasis, the most common primary malignancy was melanoma (17 cases – 28.3%), breast (11 cases - 18.3 %) and lung (7 -11.3%). The most common endoscopic presentation of the metastatic lesions in the stomach was a solitary (32 cases – 53.3 %), ulcerated (31 cases – 51.6%) lesion located in the gastric body (75%). If considered just the small bowel metastasis the most common primary malignancy was lung (7 cases – 24.1%) and melanoma (7 cases – 24.1%) followed by breast (3 cases – 10.4%). The most common endoscopic presentation of the metastatic lesions in small bowel was the presence of a solitary (22 cases 84.6 %), polypoid (10 cases – 38.5%) lesion located in the second portion of duodenum (17 cases – 65.4%). Melanoma, breast and lung cancer were the most common metastasis to the GIT. The stomach was the main site of the metastatic lesions and the most common endoscopic presentation of stomach metastasis was solitary, ulcerated lesions in the gastric body. Despite the rarity of this condition, endoscopists should be aware of this differential diagnosis.Tabled 1Table 1 - Patients CharacteristicsNumber of patientsMale4952.1%Age (years)58.523 - 85Symptoms8388.3 %Dysphagia1111.7 %Weight Loss1313.8 %Bleeding2829.8 %Abdominal pain2930.8 %Nausea or vomiting1819.1 %Jaundice11.1 %Constipation11.1 %Asymptomatic1111.7 %Primary TumorNumber of patient%Head and neck55.3 %Esophagus55.3 %Uterus44.2 %Stomach55.3 %Breast1414.9 %Melanoma2526.6 %Ovary33.2 %Colorectal44.2 %Lung1414.9 %Kidney55.3 %Sarcoma33.2 %Merkel’s tumor11.1 %Duodenum11.1 %Indeterminate site11.1 %Hepatocellular11.1 % Open table in a new tab Tabled 1Table 2 – Endoscopic featuresOrganNumber of patients%Esophagus55.3 %Stomach6059.6 %Small Bowel2930.8 %Colorectal77.4 %Number of metastasisNumber of patients%Single6265.6 %2- 4 lesions1617.1 %> 5 lesions1718,1 %Size< 20mm3335.1 %20 - 50mm4042.5 %> 50mm2122.3 %AspectPolypoid2526.6 %Infiltrative2122.3 %Resembling early cancer1010.63 %Subepitelial33.19 %Ulcerated1718.1 %Ulcero-Infiltrative1819.4 % Open table in a new tab

Supportive care needs of multicultural patients with cancer in the United Arab Emirates.

Despite the high prevalence of cancer in the Middle East, there is limited published data reporting the needs of cancer patients in this region of the world. The purpose of this study is to assess the unmet supportive care needs of oncology patients in the United Arab Emirates (UAE). From December 2014 to December 2016, a cross-sectional survey of cancer patients was conducted at a large tertiary care hospital and an oncology referral centre in the UAE, using a validated Arabic translation of the supportive care needs survey––short form (SCNS-SF34-A), assessing cancer-specific perceived needs across five domains: psychological, health system information, patient care and support, physical and daily living and sexuality. Chi-square test and Pearson’s correlation coefficient were used to assess the association between variables. Participant responses were tabulated as mean ± standard error of the mean (SEM). The response rate was 78% (210/268). Five of the 10 items from the psychological domain constituted the 10 most prevalent unmet moderate or high needs, followed by physical and daily living needs (3.04 ± 0.029, p < 0.001), health system information (3.03 ± 0.02, p < 0.001), patient care and support (2.95 ± 0.24, p < 0.001), with low sexuality needs (1.79 ± 0.08, p < 0.001). Women had significantly higher psychological unmet needs. Cultural differences were noted only in the health system information domain. Improvements in mental health services, development of multidisciplinary cancer care teams, introduction of cancer support groups and fully engaging women in all treatment decisions are feasible and easy to implement interventions that can significantly improve the care and wellbeing of oncology patients in the UAE.