Angiographic complications were seen in only 3% of patients after closure with Mynx or AngioSeal VCDs. There were no clinically significant groin site or vascular complications. These data suggest that both VCDs are safe for use after angiography with a low rate of femoral artery complications.

Transient contrast enhancement on computed tomography following endovascular treatment of stroke is a recognized entity that has been previously reported. Technological advances in brain imaging now have the potential to explore and refine its proposed etiology. We describe three patients in whom the location of contrast enhancement correlates with decreased cerebral blood volume on pre-therapeutic CT perfusion studies and with restricted diffusion on MRI. In this regard, contrast enhancement demarcated areas of completed cerebral infarction. The diagnostic and etiological implications are discussed.

Materials and Methods We selected three acute, large vessel stroke patients presenting to the emergency department between the dates of November 2010 and May 2011 who: 1) experienced a unilateral large vessel stroke, 2) underwent both whole-brain CTP as part of our acute stroke protocol and a follow up MRI or NCCT scan as a part of their standard work up all of technically adequate quality, and 3) had successful pharmacological

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Inoperable or metastatic head and neck squamous cell cancer (HNSCC) is known to be associated with a poor patient prognosis. First line therapies include a Taxol, platinum-based antineoplastic and fluorouracil (FU) treatment regimen (TPF) or a platinum-based antineoplastic, FU and EGFR inhibitor treatment regimen (PFE). The toxicity of these regimens is one of the major limiting factors, particularly for palliative treatment. The present study is a retrospective study of 15 patients with HNSCC, where the treatment goal was palliative. Of the 15 patients, 8 received a TPF, while 7 received a PFE. A total of 129 treatment cycles were administered with a median of 9 cycles (range, 3–14). Chemotherapy began with low doses and was subsequently titrated up based on tolerance and response. Positive responses were noted with the lower doses compared with the conventional doses, and maximal doses were not required. The median dose of cisplatin, paclitaxel and 5-FU administered was 40 mg/m2, 80 mg/m2 and 360 mg/m2/day for 5 days, respectively. Cetuximab was used at a standard dose. At the initial follow-up (mean, 64 days; 3 cycles), a 100% disease control rate (DCR) and 80% overall response rate (ORR) was achieved. A positive response, 60% DCR and 60% ORR, was maintained until the late stages of the study (mean, 217 days; 9 cycles). Following termination of chemotherapy after >9 cycles, 4 patients remained disease free for ~1 year. A total of 3 patients exhibited a pathologic complete response despite radiologically exhibiting residual disease. The median progression-free survival time was 10.03 months and the overall survival time was 15.77 months. The only grade 3 hematologic toxicity noted was neutropenia in 3 (20%) patients. Grade 3 vomiting was noted in 1 (6.67%) patient and grade 3 stomatitis was noted in 1 (6.67%) patient. Due to low toxicity patients exhibited improved tolerance to this approach, particularly in terms of palliative care. Furthermore, these results are in contrast to the axiom that increased doses are more effective.

Background: It is expected that about 65,000 new patients will be diagnosed with head and neck cancer in 2017 in the United States. Patients with recurrent or advanced or metastatic head and neck do not have good survival due to aggressive and recurrent nature of this cancer. Moreover, cumulative and residual toxicities from previous and ongoing treatments significantly impede quality of remaining part of their life. Currently available chemotherapeutic regimens for this group are derived from the treatments used for the potentially curable disease. These regimens and associated toxicity are obviously not the best matches for the treatment with palliative intent. We here present a retrospective study where we used dose-adjusted chemotherapy specifically for palliative treatment this sub-group of head and neck cancer patients.

e17515 Background: Toxicity of the standard regimens is a major limitation in treatment of head/neck cancer which impacted about 61,000 persons in 2016 in USA of which 13,000 died. We present data herein with low dose chemotherapy (metronomic) using commonly used drugs Taxols, Platins, 5-Flurouracil and EGFR inhibitors. We achieved equal or better outcomes as compared to standard dosing with minimal side effects (level 3/4). Methods: This is a retrospective study on squamous cell head and neck cancer patients where standard first line therapies were started at ½ normal dosing and was increased until the emergence of side effects and titrated thereafter. Results: Patient population consisted of 32 patients with 87% males and with median age 65.2 years where 59% had recurrent disease, 71% locally advanced and 28% had metastatic disease. Total 270 chemotherapy cycles were delivered among these 32 patients with median of 9 cycles. Median dose for Cispatin was 45mg/m2, Paclitaxol was 80mg/m2, 5-FU was 360mg/m2/day. Cetuximab was used at standard doses. 6 patients who achieved long-term disease control were then placed on immunotherapy with either Nivolumab (median dose of 3mg/kg) or Pembrolizumab (median dose of 2mg/kg) and got median of 7 cyles. Out of 32, 9 patients (28%) achieved complete remission, 3 patients (9%) achieved near-complete remission with more than 95% reduction in tumor size. Overall disease control rate was 68% and overall response rate was 59%. Out of 9 patients who achieved complete remission 5 underwent surgical exploration and 1 went for cryo-ablation and no residual tumor was found. Measuring tumor volume in patients who achieved disease control showed volume reduction of 53%, 62% and 78% in 1st, 2nd and 3rdfollow up surveillance studies at mean interval of 101 , 186 and 331 days showing steady response. Median Progression free survival was 17.8 months and overall survival at 40 months was 54%. Notable high-grade toxicities were generalized fatigue in 12.5% (n = 4), grade 3 neutropenia in 18% (n = 6) and grade 4 neutropenia in 1 patient. Conclusions: These excellent results, low toxicity and subsequent good quality of life encourage patient tailored approach rather than one-size fits all approach.

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