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Byline: R. Krishnatry, T. Gupta, V. Murthy, S. Ghosh-Laskar, A. Budrukkar, P. Chaturvedi, S. Nair, D. Nair, P. Kumar, A. Joshi, J. Agarwal Context: Various studies have shown the important [...]

To assess the proportion of patients with rectal adenocarcinoma achieving clinical complete response after neoadjuvant chemoradiation (NACTRT) and MR guided endorectal brachytherapy boost (MR-ERBT) Patients with rectal cancers (T2-T4/N0-N+) treated with concurrent chemoradiotherapy (50Gy/25# with Capecitabine) between June-2017 to April-2022. Post RT, patients having residual non-circumferential lesions <8cm in length were administered escalated-dose MR-ERBT with Ir192 HDR source. A median dose of 12Gy (8-15Gy) in 3 (2-3) fractions at 3-5 day intervals was delivered using MR-ERBT after external radiation. Data on near complete/complete clinical response (nCR/cCR) rates, local regrowth rates and clinical outcome were collected for analysis. Of the 145 patients who received MR-ERBT, majority were staged as T3(78.7%) and N1-2 (77.5%) rectal cancers. Median tumor length was 4cm and 123 (85%) of the tumors were located in the lower rectum (0-5cm from anal verge). Seventy-six (52%) patients achieved cCR or nCR (37 cCR, 39 nCR) and were advised observation or watch and wait (WW) management. The 69 patients having partial response were advised surgery. The patients having nCR 16 (29%) underwent resection, of these 10 (62%) had pathological complete response (pCR). The patients with partial or poor response, 57 underwent resection and of these 11 (19%) had pCR, 12 patients refused surgery due to fear of permanent stoma and continued to be on follow up. Of the 79 patients undergoing resection, 36 (45.5%) had sphincter preserving surgeries. At the median follow up of 30 months, local regrowth was seen in 8 (10.5%) of patients on WW and 6 were surgically salvaged while other 2 had synchronous metastatic relapse. Thus, 56 (41%) achieved organ preservation and continued to be on WW management. Twelve (8,2%) patients developed distant metastasis in the entire cohort, 3 in the WW group and 9 in the resected group. There were no pelvic recurrences seen in the resected patients. The disease-free survival at 3 years were (96.1% vs 89% Observation vs. resected (p_0.05) respectively. The overall survival at 3 years were (93% vs 98% Observation vs. resected (p_0.44) respectively. Late rectal toxicity was observed in 16(11%) patients on observation Dose Escalated MR-EBRT is an effective and safe method to enhance complete clinical response, thus improving the rate of organ preservation for distal rectal cancers. [ABSTRACT FROM AUTHOR]

20-30% of the locally advanced rectal cancer patients undergoing neoadjuvant chemoradiation (NACRT) have complete response (CR) and are suitable for wait and watch approach. This tumor response can be enhanced by radiotherapy dose escalation such as brachytherapy which is typically given at the end of NACRT. However, there is no data so as to which patients are likely to benefit by brachytherapy to achieve CR. We aimed to identify decrease in tumor length following CTRT, as predictor of CR, and eventual organ preservation. Patients diagnosed with T2-T4, N0-N2 distal rectal cancer treated from December 2017 to March 2021 were retrospectively reviewed. All were treated with radiation dose of 50 Gray (Gy) in 25 fractions (#) with concurrent capecitabine. All patients received escalated dose of radiation by high dose rate endorectal brachytherapy of 8-12 Gy in 2-3 #s within 2 to 3 weeks post CTRT. Baseline tumor length (MRI) and residual tumor length after CTRT during brachytherapy (assessed with planning MRI) were compared for response. Statistical analysis was done to determine decrease in tumor length as predictor of CR. One hundred patients records were reviewed. Disease and treatment characteristics are provided in table 1. Median length of tumor at baseline was 4.9 cm (3.8-6 cm). 39 patients had >50% decrement in tumor length (median length 3 cm) from baseline post CTRT, whereas 61 patients had <50% response. Out of 39 patients with>50% response, 26 patients achieved CR (66.7%) while 13 patients had partial or no response (33.3%), while out of 61 patients with <50% decrease in tumor length, 27 achieved CR (44.2%) and 34 had partial or no response (55.8%). The patients who had >50% reduction in tumor length had higher probability of achieving CR than the patients with <50% reduction (66% vs 44% p=0.029). Response assessment at the end of CTRT with respect to decrease in length of tumor may predict CR and thus can lead to better selection of patients for escalated radiation dose via endorectal brachytherapy leading to higher rate of organ preservation. [ABSTRACT FROM AUTHOR]

Plenary Session: Highlights of Proffered papers (latebreaking abstracts) OC-0613: Prostate Only or Pelvic Radiotherapy in High Risk Prostate Cancer: Outcomes of a Randomised Trial V. Murthy, P. Maitre, G. Panigrahi, D. Chaurasia, R. Krishnatry, R. Phurailatpam, G. Prakash, G. Bakshi, M. Pal, S. Menon, U. Mahantshetty. [Extracted from the article]

Background Relapse or progression in glioblastoma is common. Multiple options ranging from local treatment like re-surgery, re-radiation to systemic therapies like bevacizumab, CCNU, etc. are available. Patients with longer progression-free interval (> 2 years), smaller volume of disease and disease in non-eloquent areas are preferably selected for local therapies and while the others receive systemic therapy. There is limited data available on the pattern of care in relapsed gliomas hence we conducted an audit to address this deficiency. Methods A prospective database of all glioma patients has been maintained from June 2015 onwards at neuro-oncology DMG (Disease Management Group) at the Tata Memorial Hospital. We analysed the data of patients with relapsed gliomas treated from June 2015 to December 2017. Results The database had 854 patients of which 749 (87.7%) had disease progression. The treatment received by these 749 patients were best supportive care in 519 (69.3%), local therapy with or without systemic therapy in 85 (11.3%) and systemic therapy in 145 (19.4%) patients. Local therapy consisted of re-surgery (with or without re-radiation) in 63 patients and re-radiation (with or without systemic therapy) in 23 patients. The systemic therapies received were salvage temozolomide in 79 patients, bevacizumab (with or without an additional agent) in 41 patients and CCNU in 25 patients. The factors associated with administration of therapy at relapse were age (p = 0.009) and family income (0.041). The other factors tested were gender (p = 0.311) and performance status at relapse (p = 0.637). Conclusions This data highlights that a large number of patients with recurrent gliomas do not receive any treatment (69%), which is similar to the pattern of care reported from Australia. The pessimism associated with treatment of relapsed glioma is due to dismal prognosis at relapse with the current therapy available. Legal entity responsible for the study Tata Memorial Hospital. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Management of brain metastasis is a complex multidisciplinary venture. Hence, we started a multidisciplinary brain metastasis clinic for opinion on difficult brain metastasis cases. This is the review of the impact of this clinic on the treatment decisions. Methods Brain metastasis clinic (BMC) was started in the month of April 2018 and meets once a week. Data of patients discussed between 27th April 2018 to 28th June 2019 were included for thisanalysis. Treatment decision made by clinicians (before sending the patient to the BMC were compared with the decisions made in BMC. The decisions were broken on a predefined proforma as intent of treatment (curative or palliative), modalities planned (surgery, radiation, chemotherapy), type of therapy planned (details of each therapy) in each modality were collected both pre and post BMC. In addition, compliance of the respective physicians to BMC decision was also calculated. SPSS version 20 was used for analysis. Descriptive statistics was performed. Results Ninety-nine patients were discussed in this time period. The median age was 51 (range 17-68) years. The gender distribution was 70 males (70.7%) and 29 females (29.3%). Lung was thepredominant site of malignancy (79, 79.8%). Thirty-one patients (31.3%) had EGFR TKI domain activating mutation while 17 (17.2%) had ALK rearrangement. The treatment plan was changed in 46 patients (46.5%). The intent of treatment was changed in 5 patients (5.3%). Change in treatment plan with respect to surgery in 9 patients (9.1%), radiation in 37 patients (37.4%), chemotherapy in 15 patients (15.2%), targeted therapy in 11 patients (22.9%) and intrathecal in 6 patients (6.1%) respectively. The compliance to the BMC decision in patients in whom it was changed was 84.8% (39, n = 46). Conclusions Multidisciplinary management of difficult brain metastasis cases in specialized clinics has significant impact on treatment decisions. Legal entity responsible for the study Tata Memorial Hospital, Mumbai. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]