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CONTEXT: Various studies have shown the important risk factors for distant metastasis in head and neck cancer (HNC) which are present in most of the patients in developing countries. Identification of factors on the basis of time to distant metastasis (TDM) can help in future trials targeting smaller subgroups. AIMS AND OBJECTIVES: To identify the factors that predict TDM in radically treated HNC patients. SETTINGS AND DESIGN: Retrospective audit. MATERIALS AND METHODS: Retrospective audit of the prospectively maintained electronic database of a single HNC radiotherapy clinic from 1990 to 2010 was done to identify radically treated patients of HNC who developed distant metastasis. Univariate and multivariate analysis were done to identify baseline (demographic, clinical, pathological, and treatment) factors which could predict TDM, early time to metastasis (ETM; <12 months), intermediate time to metastasis (ITM; 12-24 months), and late time to metastasis (LTM; >2 years) using Kaplan Meier and Cox regression analysis, respectively. RESULTS: One hundred patients with distant metastasis were identified with a median TDM of 7.4 months; 66 had ETM, 17 had ITM, and 17 had LTM. On multivariate analysis, the nodal stage 2-3 (N2/3) was the only baseline factor independently predicting TDM, ETM, and ITM, whereas none of the baseline factors predicted LTM. CONCLUSIONS: Higher nodal burden (N2/3) is associated with both ETM and ITM, and calls for aggressive screening, systemic therapy options, and surveillance. It is difficult to predict patients who are at a risk of developing LTM with baseline factors alone and evaluation of biological data is needed. [ABSTRACT FROM AUTHOR]

Background: The EORTC QLQ-STO22 (QLQ-STO22) is a firmly established and validated measure of health-related quality of life (HRQoL) for people with gastric cancer (GC), developed over two decades ago. Since then there have been dramatic changes in treatment options for GC. Also, East Asian patients were not involved in the development of QLQ-STO22, where GC is most prevalent and the QLQ-STO22 is widely used. A review with appropriate updating of the measure was planned. This study aims to capture HRQoL issues associated with new treatments and the perspectives of patients and health care professionals (HCPs) from different cultural backgrounds, including East Asia. Methods: A systematic literature review and open-ended interviews were preformed to identify potential new HRQoL issues relating to GC. This was followed by structured interviews where HCPs and patients reviewed the QLQ-STO22 alongside new issues regarding relevance, importance, and acceptability. Results: The review of 267 publications and interviews with 104 patients and 18 HCPs (48 and 9 from East Asia, respectively) generated a list of 58 new issues. Three of these relating to eating small amounts, flatulence, and neuropathy were recommended for inclusion in an updated version of the QLQ-STO22 and covered by five additional questions. Conclusions: This study supports the content validity of the QLQ-STO22, suggesting its continued relevance to patients with GC, including those from East Asia. The updated version with additional questions and linguistic changes will enhance its specificity, but further testing is required. [ABSTRACT FROM AUTHOR]

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]