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e19619 Background: The management of advanced recurrent malignancy after definitive treatment is challenging. Palliation of pain in these cases by medication alone may not be sufficient. The role of Radiotherapy and hyperthermia were tried in the past with little benefit but side effects of radiation were considerably high due to large volume of disease. This study aims at Concurrent Robotic radiosurgery with hyperthermia for large volume disease for palliation of pain in recurrent advanced malignancy. Methods: Ten cases of recurrent advanced malignancy with Visual analog pain scale (VAS) score of > 8 were treated by concurrent stereotactic robotic radiosurgery and hyperthermia between July 2010 to Jan 2012. All patients underwent PET CT based radiosurgery planning,Sterotactic Robotic Radiosurgery was delivered to Gross Tumor Volume (GTV) to dose of 30Gy in 3-5 fractions using fiducial tracking method.Hyperthermia was delivered using Celsius 42 locoregional hyperthermia device for an hour after stereotactic robotic radiosurgery on alternate day for 3-5 sessions. All patients received premedication and pain medications during treatment. All patients were analyzed for tolerance of treatment, acute toxicity and pain control. Pain control was assessed at the end of treatment and 6 weeks. Results: Among 10 patients 7 were female and 3 were male, age ranged from 40 to 72 years. 4 patients were carcinoma cervix, 2 were carcinoma rectum, 1 cholangiosarcoma, 1 carcinoma pancreas, 1 carcinoma esophagus with supraclavicular lymphnode, 1 mucoepidermoid ca of maxilla. All patients completed the planned treatment of concurrent Sterotactic Robotic Radiosurgery and Hyperthermia without any acute toxicity. At the end of treatment all patients had reduction in the pain. 7 patients had more than 60% reduction. At the end of 6 weeks 8 patients had >80% reduction and off the analgesics. Conclusions: Concurrent Sterotactic Robotic Radiosurgery and hyperthermia is well tolerated and may gives good palliation of pain with improved quality of life in recurrent advanced malignancy. However randomized trial in this regard will be required.

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e14675 Background: This exploratory study assessed the ability of diffusion weighted MRI imaging in identifying small liver metastases as compared to F18- FDG PETCT. Methods: Patients with diagnosis of carcinoma of breast, lung, colorectal, pancreas, neuroendocrine and HCC who were staged for their disease using PET CT and MRI were included in the study. We randomly analyzed and compared PETCT and MRI images of 40 patients with hepatic metastases for sensitivity in detection of metastatic lesions in the liver on PETCT and MRI. Where possible, biopsy was performed if MRI/PET CT showed one or two small lesions in the liver. We performed ANCOVA to detect differences between PETCT and MRI controlling for primary sites of disease as a covariate. Results: The mean number of small lesions detected on PETCT was 0.92 where as it was 3.96 in MRI. There was a significant increase in small (p=0.02) and total number of lesions (p=0.01) seen on MRI compared to PET CT but not in large lesions. MRI was able to detect subcentimeter lesions more accurately than PET CT. Random biopsies done on small lesions found on MRI were positive for disease. MRI was able to detect small subcentimeter lesions three times more accurately than PET CT. Conclusions: MR diffusion is more sensitive in indentifying subcentimeter metastatic deposits in the liver that could help in accurate staging when PET CT is negative for liver metastases or when locoregional treatment for oligometastases is contemplated. However, pixels of DWI MRI (like reduced Signal to noise ratio at high b value, artefacts at liver edges and left lobe due to exaggerated susceptibility weighting and spin dephasing) need to be addressed by using other morphological images.

e14721 Background: In patients with Locally advanced/metastatic HCC, the median survival is 3 months. Most of these patients have altered liver functions which makes them unsuitable for any therapy. In this exploratory study we aim to test the effectiveness of I-131-lipiodol in prolonging survival in these patients. Methods: 15 patients with locally advanced HCC (unresectable) and metastatic HCC with altered liver functions (CHILDS B and C) were given I-131-lipiodol. Patients had received prior chemotherapy, prior TACE therapy, prior sorafenib and had treatment refractory progressive disease. We compared effects of I-131-Lipiodol in prolonging survival beyond three months in these patients. We performed a non parametric one sample kolmogorov Smirnov test comparing survival with I-131-lipiodol to an average 90 days survival reported in patients with advanced HCC. Results: Survival ranged from 46 to 417 days with a median survival of 144 days. However one sample test showed significant improvement in survival with I-131-lipiodol therapy compared to standard of care (z = 1.4, p = 0.04). Conclusions: I-131-lipiodol is a useful local therapy in management of patients with advanced HCC, randomized controlled trials are needed to validate its findings in adjuvant and palliative settings.