8. Post-surgical follow-up for non-small cell lung carcinoma: should we change our practice?

ABSTRACTS 6. Pre-clinical evaluation of oncolytic virotherapy delivered by isolated limb perfusion, alone and in combination with chemotherapy, radiotherapy and surgical resection Michelle Wilkinson1, Timothy Pencavel1, David Mansfield1, Aadil Khan1, Joan Kyula1, Victoria Roulstone1, Grainee McEntee1, Andrew Hayes2, Kevin Harrington1 1 Institute of Cancer Research, London, UK 2 The Royal Marsden NHS Foundation Trust, London, UK Introduction: Advanced extremity melanoma and sarcoma present a significant therapeutic challenge, requiring multimodality therapy to treat or even palliate disease. Amputation does not improve survival and, therefore, limb preservation is the focus of therapy. These aggressive tumours are relatively radiotherapy and chemotherapy-resistant. Therefore, new forms of treatment are urgently needed. Methods: Isolated limb perfusion (ILP) is a surgical procedure enabling intra-arterial delivery of high doses of chemotherapy directly to the limb tumour with negligible systemic side effects. ILP with melphalan and TNFa provides symptomatic relief and is effective in permitting limb salvage in 80e90% of patients, but the effect is neither permanent nor curative.

S263 Results: The efficacy of oncolytic virotherapy (OV) delivered by ILP alone, with standard bio-chemotherapy (melphalan and TNF-a) and in combination with external beam radiation therapy (EBRT) and surgical resection was evaluated. In an in vivo ILP model, ILP significantly increased the delivery of OV to the tumour compared to intravenous delivery, improving survival. The therapeutic efficacy was further enhanced with the addition of EBRT and surgical resection, which was curative in 33% of animals. Conclusion: In vitro, the combination of an oncolytic vaccinia virus (GLV-1h68) and EBRT demonstrated synergistic cytotoxicity. This effect was mediated through induction of intrinsic apoptosis. GLV-1h68 therapy inhibited the anti-apoptotic BCL-2 proteins (MCL-1 and BCL-xL) and the downstream inhibitors of apoptosis (IAP), resulting in cleavage of caspases 3/7. This suggests OVs may be able to reverse the predominantly antiapoptotic balance within the cancer cell, enhancing the efficacy of, and overcoming resistance to, conventional cancer therapies. http://dx.doi.org/10.1016/j.ejso.2015.08.037

Parallel Session 2 e Submitted Papers: Monday 2nd November 2015, 08:35 to 09:35 7. Overall Survival of Gastric Signet-ring Cells Adenocarcinoma: analyses between histopathology and risk of progression Francesco Puccetti1, Christopher J. Peters1,2, Asif Chaudry1, William Allum1 1 The Royal Marsden NHS Foundation Trust, London, UK 2 Imperial College, London, UK Background: Gastric adenocarcinoma (GAC) shows several manifestations in terms of histological features and clinical behaviours. The aim of this prospective study is to evaluate the prognostic implication of Signetring cell (SRC) histology in gastric adenocarcinoma. Methods: All patients undergoing resectional surgery for GAC were enrolled from January 2004 to November 2014 regardless of perioperative treatment. Data were collected in a prospective database and primary endpoints were recurrence rate (RR) and overall survival (OS). The SRC group was compared with other GAC cases and statistical analyses of outcomes performed. Results: A total of 205 patients were included in this study. SRC was present in 39.5 % of patients overall. SRC cases were significantly associated with poor differentiation and diffuse histological type (p < 0.001) as well as worse loco regional staging (N3, p ¼ 0.02). SRC cases were more likely to show a stable disease at the intermediate staging during chemotherapy (p ¼ 0.03) and almost all histological complete responses occurred in the non SRC group (p ¼ 0.03). In contrast a significantly higher proportion of SRC cases showed progression during follow up (8.6% versus 1.4%, p ¼ 0.02). There was a non-specific trend for SRC cases to have worse long term survival (p ¼ 0.32) but no survival differences were found comparing the two groups after stratification by Mandard score and pathological staging. Analyses demonstrated that missing a preoperative diagnosis of SRC did not affect the overall survival after treatment (HR 0.04; p ¼ 0.85). Conclusion: This study shows that SRC gastric cancers are related to specific histological features such as poor differentiation and diffuse type. SRC cases were statistically more likely to progress and pathological complete response to chemo was almost uniquely a feature of non SRC cancers. http://dx.doi.org/10.1016/j.ejso.2015.08.038

8. Post-surgical follow-up for non-small cell lung carcinoma: should we change our practice? Fahad Fahad2, Mohammed Haris1, Imran Hussain1, Shilajit Ghosh1 1 Royal Stoke University Hospital, Stoke on Trent, UK 2 University of Keele, Newcastle under Lyme, UK Introduction: Lung cancer has a poor survival rate. No reputable evidence-based guidelines on follow-up (intensity, imaging, and under which speciality) exist. Aim is to determine the benefit of post-surgical follow-up in patients treated for non-small cell lung carcinoma (NSCLC). Methods: All consecutive patients who underwent surgical resection, without initial chemotherapy, for NSCLC from Jan 2010-Dec 2011 and followed up at Royal Stoke Hospital (RSH) were included (N ¼ 78). Current RSH practice follows up at: 6 weeks; 3, 6, 12, 24, 36, 48, and 60 months; chest radiographs (CXR) was performed on all visits apart from 6 weeks and 3 months. Results: Appropriate speciality follow-up was arranged during multidisciplinary team meetings post-surgical resection (fig. 1). Cardiothoracic surgeons (CTS) additionally followed up at: 2e4, 5e7, 11e13 months and intermittently after with yearly follow-up up to 5 years. Oncology team had monthly follow-up up to a year, after which follow-up was 2e4 monthly. In total, 23/78 were discharged, follow-up data was not available for 2 patients. CXRs were performed during follow-up visits with subsequent computerised tomography (CT) scans if their suspicious CXR changes. To date, 17 recurrences were identified (82% local).

S264 Conclusion: Local recurrence was common. Recurrences were approximately at 21 months & were not detected earlier. Earlier visits and CXR may not be required. CT at 2e3 months and again at 18 months may be a suitable alternative. With little surgical re-intervention, could cancer nurse specialist follow-up be more appropriate? http://dx.doi.org/10.1016/j.ejso.2015.08.039

ABSTRACTS ADH, 2 ALH, 21 LCIS, 44 atypia (not otherwise specified)). 9 patients re-presented to the service with invasive carcinoma (6 ipsilateral) and 2 with DCIS (both ipsilateral) between 12 and 80 months. The ipsilateral re-presentation rate was highest for ADH (5/49) and LCIS (2/21). In the absence of ADH or LCIS, the only ipsilateral representation was 1 low grade DCIS, 62 months after VAB. Conclusion: Re-presentation with ipsilateral carcinoma following VAB excision for ADH and LCIS is comparable to surgical excision for ADH and LCIS. National guidance is required. http://dx.doi.org/10.1016/j.ejso.2015.08.041

9. Reliability of magnetic resonance imaging (MRI) in measuring response to neoadjuvant chemotherapy in breast cancer patients and its therapeutic implications James O’Brien, Shaukat Mirza Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK Introduction: This study aims to evaluate the accuracy of contrast enhanced breast MRI (CE-MRI) in delineating residual tumour size, extent and pathological complete response (pCR) following neoadjuvant chemotherapy (NAC) for breast cancer. The application of NAC has been extended to the treatment of operable breast cancers in order to enable breast-conservation. pCR is a key prognostic indicator of overall and disease free survival and aides surgical planning; accurate measurement is mandatory. Methods: 69 cases of invasive cancer had CE-MRI at the start and completion of NAC. Demographics, tumour and MRI findings were compared with final histopathology. The influence of variables on accuracy and the sensitivity, specificity, positive and negative predictive values of CE-MRI in assessing pCR were calculated with corresponding 95% CI (Wilson method). Results: CE-MRI showed complete radiological response (rCR) in 19 (27.5%) cases. The pCR correlated with 12/19 (63%) of these. CE-MRI missed 5/69 (7.3%) who achieved pCR. Overall sensitivity was 70.6% (95% CI: 46.9% to 86.7%), specificity 86.5% (95% CI: 74.7% to 93.3%), PPV 63.2% (95% CI: 40.0% to 80.9%) and NPV 90.0% (95% CI: 78.6% to 95.7%). Conclusions: CE-MRI has shown promising results in evaluating response to NAC and predicting pCR, which needs validating in larger multicentre trials. A stricter definition of pCR (no invasive or in situ residuals) lowers the specificity to 81.0% (95% CI: 69.1% to 89.1%) and PPV to 41.2% (95% CI: 23.1% to 63.7%), but increases the NPV to 94.0% (95% CI: 83.8% to 97.9%). http://dx.doi.org/10.1016/j.ejso.2015.08.040

11. The safety of Vacuum assisted biopsy (VAB) / mammatome guided, non-operative management of B3 lesions without atypia a 7 year follow-up study Alex Wilkins1,2, Peter Kneeshaw1, Penelope McManus1, Kartikae Grover1, Anne Hubbard1,2 1 Castle Hill Hospital, East Yorkshire, UK 2 Hull and York Medical School, East Yorkshire, UK Introduction: B3 management balances safe treatment of potential malignancy against the morbidity of surgical excision of benign lesions. Vacuum assisted biopsy (VAB) increases diagnostic accuracy, removing some lesions entirely without surgery. Little follow-up data is available to assess the safety and effectiveness of this approach. Methods: 215 patients with B3 biopsies without atypia were identified using Labcentre histopathology codes at a single centre. Hospital and NBSS records were analysed to identify patients who were treated with VAB and mammographic surveillance alone and to determine outcome over a follow-up period of 52e149 months (median 85). Results: 20% had excision biopsy (42/215) of which <5% (2/42) contained carcinoma. 144 patients had VAB which identified 30 high risk cases analysed separately (DCIS , B4 or atypia). 114 B3 lesions without atypia were followed mammographically after VAB with no surgical intervention. 61% (69/114) of individuals were screened locally 2012e2015. 4 patients re-presented to the service with malignancy; 37, 38, 41 and 67 months after VAB. Conclusion: VAB of B3 biopsies without atypia appears to be safe with no representations in the first 3 years and overall carcinoma and DCIS incidence of 3.5% over 7 years (4/114). National guidance on B3 lesion management is required. http://dx.doi.org/10.1016/j.ejso.2015.08.042

10. The safety of Vacuum Assisted Biopsy (VAB) / mammatome guided, non-operative management of B3 lesions with atypia a 7 year follow-up study Alex Wilkins1,2, Peter Kneeshaw1, Penelope McManus1, Kartikae Grover1, Anne Hubbard1 1 Castle Hill Hospital, East Yorkshire, UK 2 Hull York Medical School, East Yorkshire, UK

12. Management of Colorectal Liver Metastases (CRLM) e A Ten Year Single Institutional Experience Michael Durand, Fiona Hand, Justin Geoghegan, Donal Maguire, Emir Hoti St. Vincent’s University Hospital, Dublin, Ireland

Introduction: B3 management balances safe treatment of potential malignancy against the morbidity of surgical excision of benign lesions. Vacuum assisted biopsy (VAB) increases diagnostic accuracy, removing some lesions entirely without surgery. Little follow-up data is available to assess the safety and effectiveness of this approach. Methods: 129 patients with B3 VAB with atypia were identified using Labcentre histopathology codes at a single centre. Hospital and NBSS records were analysed to identify patients treated with VAB and mammographic surveillance alone and to determine outcome over a follow-up period of 52e142 months (median 85). Results: 10% progressed directly to surgery (13/129). 116 were followed mammographically after VAB with no surgical intervention (49

Introduction: The liver is the most frequent site of metastases in colorectal cancer, occurring in up to 55% of cases. Surgical resection is the gold-standard treatment, offering prolonged survival and potential cure. We review our experience managing CRLM. Methods: This was a retrospective cohort study, including consecutive patients undergoing partial hepatectomy for CRLM at our institution between January 2005e2015. Data was retrieved from electronic and hardcopy medical records. Primary outcomes assessed were 30-day mortality and overall survival. Mann-Whitney-Wilcoxon analysis was performed. Results: 523 hepatectomies were performed for CRLM during this period. 62 patients underwent repeat resection for recurrent disease. There was one perioperative death (0.2%). Median overall survival was 24