English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

vi33 NEURO-ONCOLOGY • NOVEMBER 2016 expression or amplification and 4 were positive. The median survival of the 16 patients with BM was 15.8 mos. No difference in survival from time of diagnosis was found between HER2 positive (n=4) and Her2 negative group (n=6) (18.5 vs. 14.2 respectively, p=0.67). Median time from diagnosis to development of BM was 13.6 mo. for all the patients, with no difference by HER2 status (pos. 13.1 mo. vs. neg. 14.2 mo.). Median survival from the time of BM diagnosis was 2.4 mos. CONCLUSIONS: BM in GAD are a rare event, found in about 4% of GAD patients. HER2 positivity was slightly more common in the BM group than in the general GAD population. HER2 positivity did not affect survival when compared to the HER2 negative group. Updated results for HER2 status of our series of BM will be presented. BMET-30. TREATMENT OPTIONS OF LONG TERM SURVIVORS WITH LEPTOMENINGEAL METASTASES AND BREAST CANCER Caroline  Chaul-Barbosa1, Aki  Morikawa2, Sujata  Patil1, Adrienne  Boire1, Lilly  Jordan3, Raquel  Rozner4, Andrew  Seidman1 and Elena  Pentsova1; 1Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2University of Michigan, Ann Arbor, MI, USA, 3Wayne State University School of Medicine, Detroit, MI, USA, 4NY Medical College, Valhalla, NY, USA INTRODUCTION: Leptomeningeal metastases (LM) is a devastating complication of cancer. We previously reported a study of 318 breast cancer (BC) patients with LM with a median survival of 3.5 months. However, 63 (20%) of patients were long term survivors (LTS), alive after 1 year. This study describes treatments received after the LM diagnosis by these LTS. METHODS: Clinical, pathologic, and treatment information were collected of LTS, previously identified from MSKCC database from January 1995 to June 2013. RESULTS: Among LTS, median age was 54 years (range 24-80). Median KPS at LM diagnosis was 80 (70-100). Twentytwo patients (35%) were HER2-positive, 51 (81%) hormone receptor positive and 6 (10%) triple-negative. Median survival after LM diagnosis was 20 months (range 12.3-118). After LM diagnosis, 62 patients (98%) received systemic treatment, while only 135/255 (53%) patients who lived less than 1 year received chemotherapy. Hormone therapy was the first regimen in 18% patients; cytotoxic chemotherapy (CC) combined with HER2-directed therapy in 26%; CC alone in 38%; Bevacizumab in combination with CC in 2%; HER2-directed therapy alone in 6%; HT combined with HER2-directed therapy in 3%; and HT with CC in 6% patients. Fifty-two patients (84%) received a second line of chemotherapy and a third line of treatment was given to 41 (66%) patients. LM was also treated with WBRT or focal RT in 53 (84%) patients. Fifteen (24%) patients received IT. Sixteen patients (25%) required a Ventriculoperitoneal Shunt (VPS) for symptom management and 24% were able to continue CC after that. CONCLUSION: RT and VPS are effective for palliation but long term survival of our cohort is associated with systemic treatment. Prospective study to evaluate the efficacy of chemotherapy in LM patients is warranted. BMET-31. DETECTION OF EGFR MUTATIONS IN THE CEREBROSPINAL FLUID OF NON-SMALL CELL LUNG CANCERS Emilie  Le Rhun1,2,3, Valérie  Grégoire4, Edwina  Girard5, Anne  Baranzelli6, Simon Baldacci6, Clotilde Descarpentries4, Claude Alain Maurage4, Alexis B  Cortot6 and Fabienne  Escande4; 1Neuro-Oncology, Neurosurgery Department, Lille University Hospital, Lille, France, 2Lille University, Inserm U1191 PRISM, Villeneuve d’Ascq, France, 3Neurology, Medical Oncology Department, Oscar Lambret Center, Lille, France, 4Pathology Department, University Hospital, Lille, France, 5Medical Oncology, Oscar Lambret Center, Lille, France, 6Thoracic Oncology Department, University Hospital, Lille, France INTRODUCTION: Detection of Epidermal Growth Factor Receptor (EGFR) mutational status is required to determine optimal treatment of non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: In this retrospective cohort, we evaluated EGFR mutational status including the resistance mutation T790M using SNapShot technology in Cerebro-spinal fluid (CSF) in NSCLC patients presenting with leptomeningeal metastasis (LM) between 2012 and 2016. RESULTS: Among 16 patients with LM, 13 had an EGFR mutation (exon 19, n=7; exon 21, n=6), 1 had a KRAS mutation, 1 had an ALK rearrangement, and 1 a HER2 mutation at NSCLC diagnosis. LM were diagnosed after a median of 19 months (range, 0–115) after lung cancer diagnosis. CSF molecular analyses were performed at LM diagnosis (n=12) or for the evaluation of mutations during the management of a known LM (n=4). At the time of molecular CSF analysis, malignant cells were observed in the CSF of 15 patients. The known molecular alteration was found in CSF in all 13 initially EGFR mutated patients. A supplementary EGFR T790M mutation was detected in the CSF of one patient. In another patient, the EGFR mutation was detected whereas no malignant cells were observed using standard cytology. Initial treatments for EGFRmutated LM included firstor second-generation tyrosine kinase inhibitors (TKI, n=9) systemic chemotherapy (n=5), immunotherapy (n=1) and intraCSF liposomal cytarabine combined with systemic treatment (n=8) or alone (n=1). Median overall was 4.7 months (range, 0.5-20) in the whole population whereas 5.7 months (range, 0.5-20) in the EGFR mutated population. CONCLUSION: CSF molecular analysis may identify EGFR mutations, including the T790M resistance mutation, even in the absence of malignant cells in the CSF with standard cytology. Specific therapeutic strategies may benefit to EGFR-mutated NSCLC patients with LM. BMET-32. HOSPICE ENROLLMENT PATTERNS IN MEDICARE BENEFICIARIES WITH BRAIN METASTASES Laura  Dover, Gabrielle  Rocque, Caleb  Dulaney, Bradford  Jackson, Paula  Warren and John  Fiveash; University of Alabama at Birmingham, Birmingham, AL, USA INTRODUCTION: Brain metastases (BM) are the most common intracranial tumors with the heaviest incidence occurring in elderly populations. Given their limited survival in conjunction with significant symptom burden and cognitive impairment, patients with BM are likely to benefit from hospice enrollment. This study evaluates regional hospice enrollment patterns in elderly patients with BM. METHODS: Administrative claims were obtained for deceased Medicare beneficiaries with BM (ICD-9 code 198.3) from 20122015 within the UAB Health System Cancer Community Network including AL, FL, GA, MS, and TN. Hospice enrollment patterns were recorded as early (>2 weeks prior to death), late (3-14 days prior to death) or very late (≤2 days prior to death). Logistic regression analysis was performed to determine if demographic factors were associated with hospice enrollment patterns. RESULTS: Among 948 patients with BM who died during the claims period, there were 378 (40%) early, 251 (27%) late, and 99 (10%) very late hospice enrollments. Another 220 patients (23%) were never enrolled prior to death. Mean age was 74 years. Median time from hospice enrollment to death was 16 days. In multivariable analysis controlling for other demographic factors, non-white patients were less likely than their white counterparts to receive any hospice referral (OR 0.43, 95% CI 0.22-0.85, p=0.016), and females were less likely than males to receive a very late referral (OR 0.37, 95% 0.14-0.98, p=0.045). Very late or no enrollment occurred in 34% of BM patients versus 24% (n=383) of patients with primary malignant brain tumors within the same claims period (p=0.001). CONCLUSION: Late hospice enrollment (within the last two weeks of life) in Medicare patients with BM is common (60%). BM patients of male gender and/or non-white race are significantly less likely to have timely hospice enrollments, as are patients with BM versus primary brain tumors. BMET-33. MORBIDITY AND MORTALITY OF OMMAYA RESERVOIR PLACEMENT FOR INTRAVENTRICULAR CHEMOTHERAPY Jonathan C. Lau1, David R. Macdonald2 and Joseph Megyesi3; 1Department of Clinical Neurological Sciences, Western University, London, ON, Canada, 2London Regional Cancer Program, Western University, London, ON, Canada, 3Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada BACKGROUND: In 1963, a Pakistani neurosurgeon by the name of Ayub Ommaya proposed a surgical technique for subcutaneous reservoir and pump placement to allow access to intraventricular cerebrospinal fluid (CSF). Currently, the most common indication for Ommaya reservoir insertion in adults is for patients with hematologic or leptomeningeal disorders. We wished to examine short-and-long-term outcomes in patients treated with Ommaya reservoirs at our institution. METHODS: We retrospectively evaluated all operative cases of Ommaya reservoir insertion from 2000-2014 by the senior author (JFM). Patient demographic data, surgical outcomes, peri-operative complications, and long-term outcomes were collected. RESULTS: 28 patients underwent image-guided Ommaya reservoir insertion by the senior author (JFM) over the study period (43.3 +/17.3 years; 35.7% female). The most common indications for placement were acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There were two complications: one asymptomatic peri-operative intracranial hemorrhage (3.6%), and one early infection (3.6%) requiring catheter removal and intravenous antibiotics. All catheters were accurately placed (100% success rate). Data collection for long-term outcome is currently underway. CONCLUSIONS: Our findings suggest minimal short-term morbidity with improved accuracy and decreased complications using an image-guided approach compared with a traditional approach. There were no peri-operative deaths in our series. Our results support routine use of intra-operative image guidance for proximal catheter insertion in elective Ommaya reservoir placement for intraventricular che