Background: NSCLC harbouring ALK rearrangement has a higher risk of developing brain metastases. Literature on MR Imaging radiogenomics (MRI-R) as predictors of ALK mutation is limited and less investigated. The aim of our study was to evaluate the semantic MRI-R parameters of NSCLC brain metastases and their correlation with ALK status. Methods: We analyzed clinical data on 75 patients who were tested for ALK mutation and underwent MR imaging at diagnosis. Multiparametric MRI was performed in all cases. The associations between ALK mutation status and clinical features specifically age, sex, smoking, histology, TNM stage and imaging variables of brain metastasis, were analyzed using descriptive analysis (chi-square test) and univariate logistic regression analysis. Results: There were 46 ALK positive and 29 ALK negative cases that were subjected to MRI-R analysis. ALK positive were predominantly young (83%) and non-smokers (87%) (p < 0.001). Statistically significant difference (p < 0.001) was observed in lesion morphology and its T2W border, fuzzy and infiltrative border with hypointense peripheral solid rim in ALK positive while well defined border and no solid rim in ALK negative. Predominant signal on T1W imaging was hypointense (p < 0.001) in ALK negative, whereas heterogeneity was marker of ALK positive status on T1W (p < 0.001). Lesions in ALK negative group showed central restriction on DW images (p-0.001) and peripheral restriction of the solid rim was characteristic of ALK positive (p < 0.001). ALK positive showed thick ring enhancement while patchy enhancement favoured ALK negative. Incidence of meningeal involvement was significantly higher in ALK positive and was absent in 80% of ALK negative (p-0.02). On univariate logistic regression analysis, statistically significant association was found between age, smoking history, T2W lesion morphology, T2W border, restricted diffusion, enhancement and meningeal positivity (p < 0.05). Conclusions: ALK positive brain metastases have peculiar MR imaging features that can be non-invasive diagnostic and predictive imaging biomarkers. MR radiogenomics have potential role in individualised management of ALK positive NSCLC brain metastasis.Legal entity responsible for the study: IEC TMH.

Background In our previous experience, a significant proportion of patients who received 5-HT3 antagonist monotherapy with adjuvant temozolomide (150-200 mg/m2) had chemotherapy-induced nausea and vomiting (CINV). This is an audit comparing the multiple antiemetic therapies in the prevention of temozolomide-associated CINV. Methods This was a retrospective audit. Adult glioma patients treated with temozolomide at a dose of 150-200 mg/m2 between October 2017 and June 2018 were selected for this analysis. Three antiemetic prophylaxis were used in this time period: ondansetron (October 2017 to November 2017), ondansetron + domperidone (December 2017 to February 2018), and ondansetron + olanzapine (March 2018 to June 2018). The rates of nausea and vomiting were compared among the 3 cohorts using the chi-squared test with Bonferroni correction. A P value of less than .016 was considered significant. Results A total of 360 patients were selected for this analysis. There were 91 patients in the ondansetron prophylaxis group (25.3%), 113 (31.4%) in the ondansetron plus domperidone group, and 156 (43.3%) in the ondansetron plus olanzapine group. The overall incidence of nausea and vomiting was 25.0% (n = 90) and 7.2% (n = 26). Overall the rates of nausea (P = .052) and vomiting (P = .481) were similar in all 3 cohorts. However, the rates of grade 2 and above nausea (P = .012) and vomiting (P = .015) were significantly lower in the olanzapine group. Conclusion The combination of ondansetron with olanzapine leads to a statistically significant decrease in the rate of moderate-to-severe emesis and nausea and needs to be explored in a prospective study.

No abstract

There are at least 5% of all hypertensive patients whose blood pressure (BP) remains elevated despite adequate treatment. In these cases, the clinician is forced to search for a secondary cause of the chronic BP elevation. Certain environmental factors are known to induce resistant-hypertension. Additionally, there may be pseudo-resistance occurring or the patient may be suffering from a secondary form of hypertension such as renovascular or endocrinological hypertension (phaeochromocytoma, Cushing's syndrome, etc.). We report a case of extra-adrenal phaeochromocytoma who was on adequate antihypertensive medications but remained refractory to treatment prior to the exact diagnosis.

Background: ALK gene rearranged lung cancer is a rare subset of NSCLC. However, treatment with ALK inhibitors leads to a drastic improvement in outcomes. In this study, we have audited the outcomes of patients with ALK-rearranged NSCLC at our institute. Methods: We conducted an audit of patients with ALK-rearranged NSCLC diagnosed between November 2011-December 2017 from a prospective database of lung cancer patients maintained by the authors. The basic demographic characteristics, treatment received, and the outcomes were noted. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan Meier method. This study was approved by the institutional ethics committee and was carried out in accordance with good clinical practice guidelines and the Declaration of Helsinki. Results: We diagnosed 318 ALK-positive patients during November 2011-December 2017. The median age was 50 years (23-77 years); 189 patients (59.4%) were male and 129 (41.6%) were female. Only 57 (17.9%) were smokers. The ECOG PS was 0-1 in 195 patients (61.3%), 2 in 46 (14.5) and 3-4 in 33 (10.4%). Data on PS was missing in 44 patients (13.8%). The median number of sites of metastasis was 2 (0-7); brain metastases were seen in 38 patients (11.9%). The first line treatment received was as follows: crizotinib (either upfront or as a switch after a few cycles of doublet chemotherapy) in 202 patients (63.5%), pemetrexed platinum in 72 (22.6%), taxane platinum in 5 (1.6%), gemcitabine platinum in 5 (1.6%) and others in 33 (10.7%). The median PFS and median OS for the entire cohort was 11.0 months and 34.2 months, respectively. The hazard ratio (HR) favoured using crizotinib upfront (0.5, 95% CI 0.38-0.67, p < 0.001). Patients receiving upfront crizotinib had better PFS compared to those who received crizotinib as a switch after a few cycles of chemotherapy (HR: 0.66 (0.44-0.99) p-0.040). However, the median OS was similar between the two treatment strategies for crizotinib (p-0.964). The median OS in patients who never received crizotinib was 11.0 months while OS was not reached in patients who received crizotinib in any line (p< 0.001). The 5-year OS in patients receiving crizotinib in any line was 50.0%. Conclusions: Crizotinib substantially improves outcomes in patients with ALK-rearranged NSCLC and is a suitable option where other ALK inhibitors are not available.Legal entity responsible for the study: IEC, TMH. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Background Unaddressed high distress leads to noncompliance with treatment, negatively affects quality of life, and may also have a negative impact on the prognosis of cancer patients. Patients with brain tumors have higher levels of distress than the general population and hence we hypothesize that even routine visits during adjuvant treatment or follow-up are likely to be stressful. This analysis was performed to identify the incidence of distress and factors affecting it. Methods This was an audit of 84 consecutive patients seen in an adult neuro-medical oncology outpatient department who were either receiving adjuvant chemotherapy or were on follow-up. Distress screening with the National Comprehensive Cancer Network (NCCN) distress thermometer was performed. Patients in whom distress was scored as 4 or above were considered as having high distress. Descriptive statistics and logistic regression analysis were performed to identify factors affecting distress. Results The median age of the cohort was 40 years (interquartile range, 28.3 to 50 years). Actionable distress defined as a distress score of 4 or more was seen in 52 patients (61.9%, 95% CI 51.2% to 71.5%). Presence of physical deficit (odds ratio [OR] = 3.412, P = .020) and treatment under the private category (OR = 5.273, P = .003) had higher odds of having high distress. Conclusion A high proportion of brain tumor patients either on adjuvant chemotherapy or on follow-up have high distress levels that need to be addressed even during follow-up.

No abstract

No abstract