Melissa Eastgate

A prospective study of the impact of fluorodeoxyglucose positron emission tomography with concurrent non‐contrast CT scanning on the management of operable pancreatic and peri‐ampullary cancers

BACKGROUND The role of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) scanning in operable pancreas cancer is unclear. We, therefore, wanted to investigate the impact of PET/CT on management, by incorporating it into routine work-up. METHODS This was a single-institution prospective study. Patients with suspected and potentially operable pancreas, distal bile duct or ampullary carcinomas underwent PET/CT in addition to routine work-up. The frequency that PET/CT changed the treatment plan or prompted other investigations was determined. The distribution of standard uptake values (SUV) among primary tumours, and adjacent to biliary stents was characterised. RESULTS Fifty-six patients were recruited. The surgical plan was abandoned in 9 (16%; 95% CI: 6-26) patients as a result of PET/CT identified metastases. In four patients, metastases were missed and seven were inoperable at surgery, not predicted by PET/CT. Unexpected FDG uptake resulted in seven additional investigations, of which two were useful. Among primary pancreatic cancers, a median SUV was 4.9 (range 2-12.1). SUV was highest around the biliary stent in 17 out of 28 cases. PET/CT detected metastases in five patients whose primary pancreatic tumours demonstrated mild to moderate avidity (SUV < 5). CONCLUSIONS PET/CT in potentially operable pancreas cancer has limitations. However, as a result of its ability to detect metastases, PET/CT scanning is a useful tool in the selection of such patients for surgery.

Rural Oncology Care Via Teleoncology and Outreach Clinics: Patient and Staff Perspectives and Comparisons

Paul A James, Lara Petelin, Ian Campbell, Hugh Dawkins, Stephen Fox, Janet Hiller, Judy Kirk, Geoffrey Lindeman, Finlay Macrae, Lyon Mascarenhas, Julie McGaughran, Bettina Meiser, April Morrow, Cassandra Nichols, Nicholas Pachter, Christobel Saunders, Clare Scott, Nicola Poplawski, Letitia Thrupp, Alison Trainer, Robyn Ward, Mary-Anne Young, Gillian Mitchell

Previous Bevacizumab and Efficacy of Later Anti–Epidermal Growth Factor Receptor Antibodies in Metastatic Colorectal Cancer: Results From a Large International Registry

Micro‐Abstract: The sequencing of biologic agents used in metastatic colorectal cancer can affect the outcomes. We analyzed a multicenter registry to address a question that could not be answered using current clinical trial data. We found that whether or not patients had received previous bevacizumab, the effect of epidermal growth factor receptor antibodies in later lines of therapy was maintained. Background: The FIRE‐3 [5‐fluorouracil, folinic acid, and irinotecan (FOLFIRI) plus cetuximab versus FOLFIRI plus bevacizumab in first line treatment colorectal cancer (CRC)] study reported that first‐line FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab resulted in similar progression‐free survival (PFS) but improved overall survival (OS). A potential explanation is that the initial biologic agent administered in metastatic CRC (mCRC) affects later line efficacy of the other treatments. We sought to test this hypothesis. Materials and Methods: We interrogated our mCRC registry (Treatment of Recurrent and Advanced Colorectal Cancer) regarding treatment and outcome data for RAS wild‐type patients receiving epidermal growth factor receptor inhibitors (EGFRIs) in second and subsequent lines. Survival outcomes from the beginning of EGFRI use were determined as a function of previous bevacizumab use and the interval between ceasing bevacizumab and beginning EGFRI use. Results: Of 2061 patients, 222 eligible patients were identified, of whom 170 (77%) had received previous bevacizumab and 52 (23%) had not. PFS and OS from the start of EGFRIs did not differ by previous bevacizumab use (3.8 vs. 4.2 months; hazard ratio [HR], 1.12; P = .81; 9.0 vs. 9.2 months; HR, 1.19; P = .48, respectively) for the whole cohort or when analyzed by the primary tumor side (HR for left side, 1.07; P = .57; HR for right side, 1.2; P = .52). PFS was significantly shorter with right‐sided primary tumors when the interval between bevacizumab and EGFRI use was < 6 versus > 6 months (median, 2.2 vs. 6 months; HR, 2.23; P = .01) but not with left‐sided tumors (median, 4.2 vs. 5.5 months; HR, 1.12; P = .26). Conclusion: Previous bevacizumab use had no effect on the activity of subsequent EGFRIs. The apparent effect of time between biologic agents in right‐sided tumors might reflect patient selection.

Disseminated disease including intra-cardiac metastasis from intermediate trophoblastic tumor of unspecified subtype, presenting in pregnancy

Highlights • Cardiac metastasis is a rare manifestation of trophoblastic malignancy• Previous cases have exclusively been reported in choriocarcinoma histology• Our case describes cardiac metastasis, as part of disseminated disease, from an intermediate trophoblastic tumor.• Our patient initially responded systemically to chemotherapy for a brief duration• However, she died from CNS failure 4½ months after diagnosis

Assessment of time to commencement of neoadjuvant long course chemoradiotherapy (Lccrt) for locally advanced rectal adenocarcinoma patients in a tertiary referral hospital

Paul A James, Lara Petelin, Ian Campbell, Hugh Dawkins, Stephen Fox, Janet Hiller, Judy Kirk, Geoffrey Lindeman, Finlay Macrae, Lyon Mascarenhas, Julie McGaughran, Bettina Meiser, April Morrow, Cassandra Nichols, Nicholas Pachter, Christobel Saunders, Clare Scott, Nicola Poplawski, Letitia Thrupp, Alison Trainer, Robyn Ward, Mary-Anne Young, Gillian Mitchell

Pathologic response of rectal adenocarcinoma to preoperative long course chemoradiotherapy (Lccrt). An assessment at a tertiary referral hospital

Paul A James, Lara Petelin, Ian Campbell, Hugh Dawkins, Stephen Fox, Janet Hiller, Judy Kirk, Geoffrey Lindeman, Finlay Macrae, Lyon Mascarenhas, Julie McGaughran, Bettina Meiser, April Morrow, Cassandra Nichols, Nicholas Pachter, Christobel Saunders, Clare Scott, Nicola Poplawski, Letitia Thrupp, Alison Trainer, Robyn Ward, Mary-Anne Young, Gillian Mitchell

Assessment of long course chemoradiotherapy (Lccrt) in regards to completion of chemotherapy. The experience of a tertiary referral hospital

Paul A James, Lara Petelin, Ian Campbell, Hugh Dawkins, Stephen Fox, Janet Hiller, Judy Kirk, Geoffrey Lindeman, Finlay Macrae, Lyon Mascarenhas, Julie McGaughran, Bettina Meiser, April Morrow, Cassandra Nichols, Nicholas Pachter, Christobel Saunders, Clare Scott, Nicola Poplawski, Letitia Thrupp, Alison Trainer, Robyn Ward, Mary-Anne Young, Gillian Mitchell

Locally advanced and metastatic pancreatic cancer: an assessment of the provision of chemotherapy at a tertiary referral hospital

Paul A James, Lara Petelin, Ian Campbell, Hugh Dawkins, Stephen Fox, Janet Hiller, Judy Kirk, Geoffrey Lindeman, Finlay Macrae, Lyon Mascarenhas, Julie McGaughran, Bettina Meiser, April Morrow, Cassandra Nichols, Nicholas Pachter, Christobel Saunders, Clare Scott, Nicola Poplawski, Letitia Thrupp, Alison Trainer, Robyn Ward, Mary-Anne Young, Gillian Mitchell

Time from diagnosis of rectal adenocarcinoma to commencement of long course chemoradiotherapy (Lccrt) for metropolitan versus rural patients referred to a Queensland tertiary referral hospital

Paul A James, Lara Petelin, Ian Campbell, Hugh Dawkins, Stephen Fox, Janet Hiller, Judy Kirk, Geoffrey Lindeman, Finlay Macrae, Lyon Mascarenhas, Julie McGaughran, Bettina Meiser, April Morrow, Cassandra Nichols, Nicholas Pachter, Christobel Saunders, Clare Scott, Nicola Poplawski, Letitia Thrupp, Alison Trainer, Robyn Ward, Mary-Anne Young, Gillian Mitchell