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Abstract:Despite rare, metastatic anal carcinoma confers a poor prognosis. Systemic chemotherapy is the mainstay of treatment for advanced disease while the role of biologics and/or surgical resection of metastatic disease are anecdotal. Compared to isolated liver colorectal or neuroendocrine cancer liver metastases, there is far less experience with resection or nonsurgical local ablative procedures for patients with metastatic anal carcinoma to the liver. We report the case of a 67-year-old woman with metastatic anal carcinoma to the liver who was successfully treated with liver resection and remains free of relapse more than one year later. pelvis, which showed a 5.1-cm anal canal lesion as well as enlarged bilateral inguinal lymph nodes (2.0 cm), consistent with a clinical stage IIIB. At that time, the patient was treated with standard chemoradiation (CRT) consisting of mitomycin C (12 mg/m 2 , given on day 1) and Capecitabine (825 mg/m 2 twice daily during the days of radiotherapy). KeywordsThe total radiation therapy dose was 54 Gy in 27 fractions. During CRT, she developed grade 3 cutaneous radiation dermatitis and grade 3 diarrhea. Clinical examination four weeks after finishing CRT revealed complete regression of the anal tumor with no palpable inguinal lymphadenopathy. Nevertheless, 4 months after the completion of CRT, she developed at least three metastatic liver lesions in segments V and VI, measuring approximately 3.6 cm each. She was treated with 6 cycles of weekly Paclitaxel (80 mg/m²) and Cetuximab (400 mg/m² in the first cycle followed by 250 mg/m²). A repeat CT scan as well as a PET-CT scan revealed considerable increase in the size of the larger liver mass, which measured 13.1 cm × 10.7 cm × 10.6 cm, without new metastases (Figures 1 and 2). At that point, the patient was complaining of intense fatigue, anorexia, as well as upper abdominal pain. She was confined to bed with an extremely poor quality of life. Her lactate dehydrogenase (LDH) level was 1,045 U/L (normal values: 180-460 U/L). After extensive discussion with the patient and her family, it was decided to proceed with right hepatectomy. The postoperative period was uncomplicated and the patient was discharged home six days later. Histological findings of the resected specimen demonstrated metastatic squamous cell carcinoma with extensive necrosis, consistent with the known primary tumor of the anal canal, with free margins. Thirteen months after surgery, the patient remains remarkably well and free of recurrence (Figures 3 and 4). DiscussionIn patients with primary tumors of the gastrointestinal tract (especially colorectal adenocarcinoma and small intestine neuroendocrine tumors), the most likely mode of spread to the liver is through portal venous drainage or via direct intra-abdominal lymphatic channels. For other primary malignancies, metastases commonly reach the liver via systemic circulation, implying that extra-hepatic sites may have the same probability of being involved. Based on this rationale, hepatic resection of non-co...

Objectives:The COVID-19 infection was declared pandemic in March 2020. Since then, multiple studies have attempted to correlate clinical factors with the risk of complications from COVID-19. However, cancer patients are underrepresented in clinical trials and the results vary between different cohorts. Our goal is to describe a cohort of cancer patients and COVID-19. Methods: We conducted a multicenter retrospective study, based on a systematic review of medical records, including nine cancer centers, located in five different Brazilian cities. Patients were diagnosed with COVID-19 through RT-PCR between March 15th, 2020, and August 13th, 2020. Poisson regression models were then used to test for an association between clinical characteristics and severity of COVID-19 infections. Results: 102 patients had data collected for analysis, 85 (83.3%) of whom were hospitalized due to complications from COVID-19 infection. The median age was 65.8 years, most were female patients (61.8%) and white (73,5%). 78.4% had a performance status of 0-1, and the most common cancer subtypes were gastrointestinal (30.4%), breast (22.6%), and hematological (13.7%). Almost 40% of the population had stage IV disease. The mortality rate for all hospitalized patients was 36.5%, while that for those admitted to ICU was 68.4%. Key univariable risk factors for mortality included age (RR 1.03), ECOG = 2 (RR 1.83), hypertension (RR 1.72), lung metastasis (RR 1.67), and lymphocytes = 1000 admission (RR 2.40). At the multivariable analysis, the risk factors were also age (RR 1.02), primary lung cancer (RR 2.61), lung metastasis (RR 2.86), and coronary disease (RR 3.76). Conclusions: Despite the high mortality of patients hospitalized with COVID-19, cancer is a heterogeneous disease and some risk factors should be considered as the main responsible for the worst prognosis. Cancer patients should be carefully monitored in pandemic periods of infectious diseases and their management must be individualized.

e13600 Background: The COVID-19 infection was declared pandemic in March 2020. Since then, multiple studies have attempted to correlate clinical factors with risk of complications from COVID-19, including cancer. However, cancer patients are underrepresented in clinical trials and the results vary between different cohorts. Methods: We conducted a multicentre retrospective study, based on systematic review of medical records, including nine cancer centers, located in five different Brazilian cities. Patients were diagnosed with COVID-19 through RT-PCR between March 15, 2020 and August 13 , 2020. Poisson regression models were then used to test for an association between clinical characteristics and severity of COVID-19 infections. Results: 102 patients had data collected for analysis, 85 (83.3%) of whom were hospitalized due to complications from COVID-19 infection. The median age was 65.8 years, most were female patients (61.8%) and white (73,5%). 78.4% had a performance status of 0-1, and the most common cancer subtypes were gastrointestinal (30.4%), breast (22.6%) and hematological (13.7%). Almost 40% of population had stage IV disease. Mortality rate for all hospitalized patients was 36.5%, while for those admitted to the ICU it was 68.4%. Key univariable risk factors for mortality included age (RR 1.03), ECOG ≥ 2 (RR 1.83), hypertension (RR 1.72), lung metastasis (RR 1.67), and lymphocytes ≤ 1000 admission (RR 2.40). At the multivariable analysis, the risk factors were also age (RR 1.02), primary lung cancer (RR 2.61), lung metastasis (RR 2.86), and coronary disease (RR 3.76). Conclusions: Despite the high mortality of patients hospitalized with COVID-19, our data are compatible with other cohorts. Cancer patients must be carefully monitored in pandemic periods of infectious diseases.

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