Aims: Embryonal and alveolar rhabdomyosarcoma (ERMS, ARMS) are subtypes of RMS that mainly occur in children, with relatively good outcomes. The incidence in adults is extremely low and survival is significantly worse compared with children. Data are scarce and literature generally combines all RMS subtypes, including pleomorphic RMS, which primarily occurs in adults and behaves more like undifferentiated pleomorphic sarcoma. The aim of this study was to evaluate patient and tumour characteristics, outcome and prognostic factors in adult patients with ERMS and ARMS. Materials and methods: All adult (18 years or older) ERMS and ARMS patients (presenting 1990e2016) were identified from a prospectively maintained database and were included in this analysis. Results: Overall, 66 patients were included (42 men, 24 women). The median age at presentation was 28 years (range 18e71). The median overall survival for all ARMS (n ¼ 42) and ERMS (n ¼ 24) patients was 18 months, with a 5-year overall survival rate of 27%. Patients presenting with localised disease (n ¼ 38, 58%) and metastatic disease (n ¼ 25, 42%), had a 5-year overall survival rate of 36% and 11%, respectively. In univariate analysis we found alveolar subtype, fusion gene positivity, infiltrative tumour and metastatic presentation to be negative prognostic factors. Conclusion: Survival in adult ERMS and ARMS patients is poor and the current data may be useful in the design of trials with novel agents. Ideally, paediatric and adult oncologists should set up trials together to get a better understanding of biological, genetic and clinically relevant factors in this disease.

BackgroundThe efficacy and toxicity of first line palliative chemotherapy for soft tissue sarcomas (STS) in the elderly is poorly described.MethodsPatients over the age of 65 years receiving first line chemotherapy for advanced non-GIST STS January 1998 - January 2012 at the Royal Marsden Hospital were identified. Data regarding survival and predictive factors were collected retrospectively.Results120 patients (52 females) with a median age of 72 (range 65–83) were treated. The most common histological subtypes were undifferentiated sarcoma (30%), leiomyosarcoma (27%), angiosarcoma (14%). 42% of patients had high grade tumours. 70% of patients had metastatic disease at presentation; lung metastasis being the most common disease site (72%). 80% received single agent chemotherapy, mostly with doxorubicin (60%). The median number of cycles was 2 (IQR 3). A partial response was reported in 20% of patients with disease stabilisation in a further 20%. 38% of patients were hospitalised for chemotherapy related toxicity. The median overall survival (OS) was 6.5 months (95% CI 4.7-8.3). Anaemia, lymphopenia, hypoalbuminemia, sarcoma subtype and co-morbidities were predictive for overall survival.ConclusionThe overall survival for elderly patients with STS is poor but several predictive factors have been identified. Hospital admissions for chemotherapy related toxicity are common.

Aims and MethodAn audit project was carried out in a mental health trust in North-West London on two successive years to determine the average case-load size of defined severe mental illness for each professional discipline.ResultsThe average case-load for non-consultants varied from 16 (for occupational therapists) through to 98 patients (for senior house officers). Community psychiatric nurses had an average case-load of 21 and consultants had an estimated average case-load of between 185 and 317 patients. The proportion of patients with severe mental illness ranged from 49% to 67%.Clinical ImplicationsThe case-loads of consultants in community health teams are too large to exercise the statutory duties of a responsible medical officer and, therefore, need revision.