10122 Background: Bone metastases impair function and decrease quality of life due to acute or chronic pain. The standard approach for patients with multiple bone metastases is systemic therapy and palliative radiation therapy (RT) when the metastases become symptomatic. This study aims to understand the characteristics and outcomes for inpatients admitted for painful bone metastases. Methods: An inpatient radiation oncology consult registry was created in 2015 to evaluate patterns of care for patients receiving RT in the inpatient setting. Of the 1151 consults requested between 7/2015 and 6/2016, 28% (n = 323) were for evaluation of symptomatic bone metastases in patients who were hospitalized for acute or chronic pain. Among this cohort, 64% (n = 208) went on to receive RT for 225 bone metastases. Sixty percent of RT courses were initiated while the patient was hospitalized. Clinical characteristics correlated with overall survival (OS) were evaluated through Cox regression analysis. Results: The median follow up for the 208 patients who received RT was 4 months (0.1-9 months). Patient median age was 61 (10-92 years), and the median KPS was 70 (20-90). The most common sites treated were spine (50%), joints such as hip and shoulder (11%), long bones including femur and humerus (11%), and pelvis (10%). Sixty-one percent (n = 138) of the treated metastases were diagnosed ≥4 months prior to RT. The median survival after receiving palliative RT was 4 months (0-19 months). Among the 141 patients who had died at the time of analysis, 92 (65%) died within 2 months, and 128 (91%) within 6 months. Eighteen patients (9%) discontinued RT to transition to hospice care. OS after RT is significantly correlated with KPS (p < 0.0001) at the time of consult but not with patient age or site of treated disease. Conclusions: In this select group of inpatients who were evaluated for palliation of symptomatic bone metastases, we found a short OS after RT. The majority of metastases were present for ≥4 months prior to RT. This study suggests that earlier RT for high-risk metastases should be considered to prevent development of symptomatic disease that requires hospitalization. Risk factors for development of painful bone metastases are being studied prospectively at our institution.

Left atrial (LA) features are altered when diastolic dysfunction (DD) is present. The relations of LA features to the DD severity and to adverse outcomes remain unclear using CMR images. We sought to compare LA features including volumes, emptying fraction, and strains as predictors of left ventricular (LV) DD and adverse outcomes. We compared four groups including normal controls (n = 32), grade I DD (n = 69), grade II DD (n = 42), and grade III DD (n = 21). DD was graded by echocardiography following the current ASE guidelines. Maximum LA volume (LAVmax), minimum LA volume (LAVmin), and LA emptying fraction (LAEF) were assessed using CMR cine images. Phasic LA strains including reservoir, conduit, and booster pump strain were assessed by feature tracking. The outcome was a composite of hospital admissions for heart failure and all-cause mortality analyzed using Cox proportional hazard models. LAVmax and LAVmin were progressively larger while LAEF and LA strain measures were lower with worsening degree of DD (all p < 0.001). Among 132 patients with DD, 61 reached the composite outcome after on average 36-months of follow-up. Each of the LA parameters except for LA conduit strain was an independent predictor of the outcome in the adjusted Cox proportional hazard models (all p < 0.001). They remained significant outcome predictors after the model additionally adjusted for LV longitudinal strain. The AUC of outcome prediction was highest by LAEF (0.760) followed by LA reservoir strain (0.733) and LAVmin (0.725). Among all the LA features, increased LA volumes, reduced LAEF, reduced LA reservoir and booster pump strains were all associated with DD and DD severity. While LA strains are valuable, conventional parameters such as LAEF and LAVmin remain to be highly effective in outcome prediction with comparable performance.

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MAD(TTHP), and MAD(IAUCtthp), and increase in SD(TTP) were associated with significant increase in SUVmax. Conclusion: Association was found between SUVmax of FDG-PET and SD and MAD of DCE-MRI metrics derived during Gd-DTPA uptake phase in NSCLC, reflecting that intratumoral heterogeneity of angiogenesis in wash-in phase is associated with tumor metabolism. MAD(IAUCtthp) was consistently significant in both UVA and MVA, suggesting that lower spatial heterogeneity in intensity and rapidity of contrast wash-in is associated with higher metabolic rate in NSCLC. This study will facilitate better understanding of complex relationship between tumor vascularization and metabolism, and eventually help in guiding targeted therapy.