Background: Peri-operative pain management around the time of hepato-pancreatic (HP) surgery has been debated.

While immuno-oncotherapy (IO) has significantly improved outcomes in the treatment of systemic cancers, various neurological complications have accompanied these therapies. Treatment with immune checkpoint inhibitors (ICIs) risks multi-organ autoimmune inflammatory responses with gastrointestinal, dermatologic, and endocrine complications being the most common types of complications. Despite some evidence that these therapies are effective to treat central nervous system (CNS) tumors, there are a significant range of related neurological side effects due to ICIs. Neuroradiologic changes associated with ICIs are commonly misdiagnosed as progression and might limit treatment or otherwise impact patient care. Here, we provide a radiologic case series review restricted to neurological complications attributed to ICIs, anti-CTLA-4 and PD-L-1/PD-1 inhibitors. We report the first case series dedicated to the review of CNS/PNS radiologic changes secondary to ICI therapy in cancer patients. We provide a brief case synopsis with neuroimaging followed by an annotated review of the literature relevant to each case. We present a series of neuroradiologic findings including nonspecific parenchymal and encephalitic, hypophyseal, neural (cranial and peripheral), meningeal, cavity associated, and cranial osseous changes seen in association with use of ICIs. Misdiagnosis of radiologic abnormalities secondary to neurological irAEs can impact patient treatment regimens and clinical outcomes. Rapid recognition of various neuroradiologic changes associated with ICI therapy can improve patient tolerance and adherence to cancer therapies.

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Objective: To evaluate the frequency of neoadjuvant therapy (NT) in women with stage I-III breast cancer in Italy and whether it is influenced by biological characteristics, screening history, and geographic area. Methods: Data from the High Resolution Study conducted in 7 Italian cancer registries were used; they are a representative sample of incident cancers in the study period (2009)(2010)(2011)(2012)(2013). Included were 3546 women aged <85 years (groups <50, 50-69, 70-64, and 75+) with stage I-III breast cancer at diagnosis who underwent surgery. Women were classified as receiving NT if they received chemotherapy, target therapy, and/or hormone therapy before the first surgical treatment. Logistic models were built to test the association with biological and contextual variables. Results: Only 8.2% of women (290 cases) underwent NT; the treatment decreases with increasing age (14.5% in age <50 and 2.2% in age 75+), is more frequent in women with negative receptors (14.8%), HER2-positive (15.7%), and triplenegative (15.6%). The multivariable analysis showed the probability of receiving NT is higher in stage III (odds ratio [OR] 3.83; 95% confidence interval [CI] 2.83-5.18), luminal B (OR 1.87; 95% CI 1.27-2.76), triple-negatives (OR 1.88; 95% CI 1.15-3.08), and in symptomatic cancers (OR 1.98;. Use of NT varied among geographic areas: Reggio Emilia had the highest rates (OR 2.29; 95% CI 1.37-3.82) while Palermo had the lowest (OR 0.41; 95% CI 0.24-0.68). Conclusions: The use of NT in Italy is limited and variable. There are no signs of greater use in hospitals with more advanced care.

e17021 Background: Small cell bladder cancer (SCBC) is a rare malignancy with poor prognosis. Previous retrospective studies mainly focused on answering whether radical cystectomy is superior to radiation. Little is known about the disease characteristics and clinical course. Methods: Patients were identified via Geisinger cancer registry from 1991 to 2019, and retrospective chart review was performed through the electronic health records, EPIC. We described patient characteristics and outcomes. OS was measured from time of initial diagnosis to death or last follow up. Kaplan-Meier analyses were done on OS. Results: 50 patients were identified; 7 patients were excluded due lack of information. M: F≈1, 60% patients had pure small cell carcinoma (SCC) histology (≥ 95%), 37% with SCC and urothelial carcinoma mixed histology, MIB-1 index was 80-100%. Median OS for localized disease (IQR) was 22 months (9,73), and 11 months (7,16) for metastatic disease. For localized disease, OS were similar between patients with or without pure small cell history (P = 0.47). 8 patients were alive at 5 years; 3 patients received neoadjuvant chemotherapy followed by radical cystectomy, 2 patients underwent radical cystectomy alone, 2 patients had concurrent chemotherapy with radiation; 1 patient had complete pathological response to Cisplatin and etoposide chemotherapy, did not receive additional therapy and recurred 6 years later. Recurrence ranged from 6 to 79 months. 10 patients had disease progression despite of palliative chemotherapy. Conclusions: Small cell bladder cancer is a heterogenous disease, early stage disease can be curable but late recurrence does occur, continued surveillance is warranted even after 5 years. New treatment modality is in need to improve outcome for patients with metastatic disease.