Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single‐centre retrospective audit of 236 cases

Aims: The role of selected treatments for brain metastases (BM) is well documented; however the prevalence of these is not. We report on the patterns of care in the management of BM in a large Oncology centre. Materials and methods: We retrospectively audited 236 cases of newly diagnosed BM from January 2016 to December 2017 by looking at 2 years of radiology reports and gathered data on primary site, survival, treatment received, palliative care input and brain metastases related admissions. Results Eighty-two percent of cases were related to lung, breast and melanoma primaries. Half of patients received a form of treatment with the other half receiving best supportive care. Of these, whole brain radiotherapy (39%) and stereotactic radiosurgery (40%) were the most common treatment modalities. Most common reasons for admissions were headaches, seizures, weakness and confusion. Conclusion: This is the first study in the UK that gives an in-depth overview of the real world management of brain metastases. We have demonstrated the prevalence of treatment across the spectrum of brain metastases patients. Radiotherapy is the mainstay of treatment in nearly 80% of cases; however care needs to be taken in ensuring that SRS is offered to those who are suitable

An inflammation based score can optimize the selection of patients with advanced cancer considered for early phase clinical trials.

Background: Adequate organ function and good performance status (PS) are common eligibility criteria for phase I trials. As inflammation is pathogenic and prognostic in cancer we investigated the prognostic performance of inflammation-based indices including the neutrophil (NLR) and platelet to lymphocyte ratio (PLR). Methods: We studied inflammatory scores in 118 unselected referrals. NLR normalization was recalculated at disease reassessment. Each variable was assessed for progression-free (PFS) and overall survival (OS) on uni- and multivariate analyses and tested for 90 days survival (90DS) prediction using receiving operator curves (ROC). Results: We included 118 patients with median OS 4.4 months, 23% PS>1. LDH 65450 and NLR 655 were multivariate predictors of OS (p<0.001). NLR normalization predicted for longer OS (p<0.001) and PFS (p<0.05). PS and NLR ranked as most accurate predictors of both 90DS with area under ROC values of 0.66 and 0.64, and OS with c-score of 0.69 and 0.60. The combination of NLR+PS increased prognostic accuracy to 0.72. The NLR was externally validated in a cohort of 126 subjects. Conclusions: We identified the NLR as a validated and objective index to improve patient selection for experimental therapies, with its normalization following treatment predicting for a survival benefit of 7 months. Prospective validation of the NLR is warranted. Copyright: \ua9 2014 Pinato et al

Tuberculosis in badgers where the bovine tuberculosis epidemic is expanding in cattle in England.

Bovine tuberculosis (bTB) is an important animal health and economic problem for the cattle industry and a potential zoonotic threat. Wild badgers (Meles meles) play a role on its epidemiology in some areas of high prevalence in cattle, particularly in the UK and Republic of Ireland and increasingly in parts of mainland Europe. However, little is known about the involvement of badgers in areas on the spatial edge of the cattle epidemic, where increasing prevalence in cattle is seen. Here we report the findings of a study of found-dead (mainly road-killed) badgers in six counties on the edge of the English epidemic of bTB in cattle. The overall prevalence of Mycobacterium tuberculosis complex (MTC) infection detected in the study area was 51/610 (8.3%, 95% CI 6.4-11%) with the county-level prevalence ranging from 15 to 4-5%. The MTC spoligotypes of recovered from badgers and cattle varied: in the northern part of the study area spoligotype SB0129 predominated in both cattle and badgers, but elsewhere there was a much wider range of spoligotypes found in badgers than in cattle, in which infection was mostly with the regional cattle spoligotype. The low prevalence of MTC in badgers in much of the study area, and, relative to in cattle, the lower density of sampling, make firm conclusions difficult to draw. However, with the exception of Cheshire (north-west of the study area), little evidence was found to link the expansion of the bTB epidemic in cattle in England to widespread badger infection

The Neoadjuvant Rectal (NAR) score and a novel MRI-based NAR score are stage independent predictors of long-term outcome in locally advanced rectal cancer

No abstract available

Patient characteristics.

<p>Training and Validation Cohorts.</p

Study flow diagram illustrating patient disposition in the training and validation set.

<p>Study flow diagram illustrating patient disposition in the training and validation set.</p

The relationship between clinicopathological factors and baseline inflammatory scores (NLR, PLR) in patients with advanced solid tumours considered for experimental treatments (Training Set).

<p>Marks an association reaching statistical significance (p<0.05).</p

Integration of the NLR with ECOG PS in the prediction of OS (Training and Validation Set).

<p>Chi-square test of equality of survival distributions for the different NLR categories.</p><p>^# Patients with PS 2 and 3 were considered together due to the small number of patients with PS = 3 (n = 9),</p><p>^## Patients were dichotomized as “favourable PS” (ie. 0–1) versus “poor PS” (ie. 2–3) due to limited sample size.</p><p>Marks an association reaching statistical significance (p<0.05).</p

Univariate and multivariate analysis of prognostic factors of overall and progression free survival (Training Set).

<p>Abbreviations: LDH, Lactate dehydrogenase; ECOG PS, Eastern Cooperative Oncology Group Performance Status; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio: Delta NLR: NLR changes following 2 cycles of treatment as previously categorized by Kao et al. 2010 (Ref. 23). Associations reaching statistical significance (p<0.05) are marked with an asterisk (*). Categorization of LDH, haemoglobin and albumin was carried out using clinically employed cutoff values (Arkenau et al. 2008, Ref. 8). To avoid colinearity bias, the independent effect of NLR and Delta NLR was tested in two independent Cox models.</p

Kaplan Meier curve analysis showing that NLR≥5 predicts for poor OS in the training (Panel A) and in the validation set (Panel B).

<p>NLR normalization calculated at disease reassessment predicts for better OS (<b>Panel C</b>) and PFS (<b>Panel D</b>). Receiver operator curve for comparison of PS, baseline NLR and PLR for predicting 90 day survival (<b>Panel E</b>).</p