Background: The treatment of primary CNS lymphoma (PCNSL) comprises high dose Methotrexate (HDMTX) based chemotherapy followed by whole brain radiotherapy(WBRT), the major drawback of which is long term neurotoxicity. We intended to assess the feasibility of response adapted WBRT in patients with PCNSL. Methods: We screened 35 patients & enrolled 24 patients with PCNSL in a phase II trial. They underwent 5 two-weekly cycles of MVP chemotherapy with HDMTX, Vincristine & Procarbazine. Rituximab was added in 16 patients as per their preference & affordability. Patients with complete response (CR) to induction chemotherapy were given reduced dose WBRT 23.4Gy/13fractions/2.5weeks while those with partial response (PR), stable or progressive disease(PD) were given standard dose WBRT 45Gy/25fractions/5 weeks. Thereafter 2 cycles of consolidation chemotherapy with Cytarabine was given. The primary endpoints of the study were assessment of response rate & progression free survival (PFS). The secondary endpoints were assessment of overall survival (OS), toxicity profile, serial changes in quality of life & neuropsychological parameters. Results: The median age at diagnosis was 50 years. Out of 20 patients who completed induction chemotherapy, 10(50%) achieved CR, 9(45%) had PR & 1 patient had PD. After a median follow-up period of 21.05 months, the median OS and PFS had not been reached. The actuarial rates of 3 year PFS & OS were 51% & 51.4% respectively. 4 patients in reduced dose WBRT arm had recurrence & 2 of them died of PD, whereas there was one recurrence and no cancer related death in standard dose WBRT arm. On univariate analysis of PFS, age60 years(p ¼ 0.004) & use of standard dose WBRT (p ¼ 0.047) led to significantly improved outcome. Serial neuropsychological assessments showed marked improvement in general cognition, verbal fluency & motor speed after induction chemotherapy & treatment completion. Conclusions: In patients with newly diagnosed PCNSL, reduced dose WBRT after CR to HDMTX based chemotherapy may lead to suboptimal clinical outcome due to higher risk of recurrence, progression & early death.

Oral squamous cell carcinoma (OSCC) accounts for a third of the cancer burden in India, with a correspondingly high cancer-specific mortality. Although treatment of OSCC in India mirrors that of high-income nations, extreme burden of disease, late presentation, and the associated advanced stage of disease pose unique challenges in a resource-constrained environment. Despite a multimodal treatment paradigm, survival rates are low. Often the cause for late presentation is the delayed diagnosis, inappropriate investigation and referral, and compromised or incorrect treatment, leading to poor patient outcomes and costs to the health-care provider. To address these issues, the first UK-India Symposium on Advances in Oral Cancer Imaging Symposium was organized in Bangalore, India, in April 2019; participants included radiologists, imaging scientists, clinicians, and data scientists from the United Kingdom, India, Singapore, and the United States. Following the discussions held during this meeting, in this manuscript, we present evidence-based guidance for the role of imaging in OSCC, recommendations for service development, and details of future potential for evolution in head and neck imaging.

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Introduction In India, patients with gastric cancer present at an advanced stage, and there is no standard chemotherapy regimen. Al-Batran's fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy gave us a glimmer of hope. Objectives Hence, we intended to evaluate the efficacy of FLOT chemotherapy in locally advanced and metastatic adenocarcinoma of stomach. Materials and Methods In this single-center, prospective cohort, patients with locally advanced and metastatic gastric adenocarcinoma who required chemotherapy between March 2016 and November 2017 were included in the study. All patients received standard FLOT chemotherapy. The primary objective was to evaluate the safety and efficacy of FLOT chemotherapy in the Indian population. Overall survival (OS) and progression-free survival (PFS) were calculated through the plotted Kaplan–Meier curves. Results In our study, 28 patients received FLOT chemotherapy. Their mean age was 55 years (range, 28–70 years) with a male preponderance (89.3%). Twenty-five patients had metastatic disease (89.3%), and three had locally advanced disease (10.7%). The median number of cycles was 4.5 (range, 1–8), and 75% received at least four cycles (n = 21). The hematological toxicities exhibited were neutropenia (50%) and febrile neutropenia (35.7%). Sixteen (57.1%) patients needed dose modifications due to treatment-related adverse effects (AEs). AEs led to treatment discontinuation in seven (25%) patients after the first cycle. The overall response rate in the intent-to-treat population was 52.7%, with the best-obtained response being a partial response, median PFS of 5 months, and median OS of 13 months. Conclusion FLOT chemotherapy regimens induced excellent responses but with significantly increased toxicity, needing dose modifications, and hence, should be considered only in a young and fit patient.

e12033 Background: There is increasing evidence that obesity is strongly associated with breast cancer (BC) and has a major impact on the patient tolerance, overall survival (OS) and progression free survival (PFS). Chemotherapy dosing as per body surface area (BSA) or the actual body weight is a major dilemma among the oncologists. Moreover, the side effects of chemotherapy in obese patients in an Indian population has not been described previously in literature. We intended to evaluate the major toxicity, OS and PFS in obese BC patients who received adjuvant chemotherapy (ADC) with Adriamycin/cyclophosphamide (AC) and paclitaxel (T). Methods: A retrospective analysis of 331 patients of BC who received 4 cycles of adjuvant AC + T from a single tertiary centre in South India between 2006-2014 were included . All patients were treated as per their BSA which were capped at 2. Body Mass Index (BMI) was divided into normal (18-22.99), Overweight (23-24.99) and Obese ( ≥25 as per Asian guidelines). The toxicity was scored as per NCI-CTCAE criteria. Results: Out of 331 patients, 213 were obese. On comparison of normal and over weight with obese patients, 65 (30.5%) in obese group had significant all grade neuropathy (p = 0.027), 65 (30.5%) had Grade 2 and 3 myelosuppression (p <0.001), 31 (14.5%) had all grade emesis (p = 0.031) and 28 (13.1%) had myalgia (0.001). The 5 year OS and PFS were 93.7% and 82.3% respectively in obese patients, higher than the patients with normal weight with a 5 year OS and PFS of 92.4 % and 76.9% , but was not statistically significant. Conclusions: Higher rates of severe toxicities were seen in obese BC patients who received ADC as per their BSA. The 5 year OS and PFS was better in obese BC patients, but was not statistically significant. [Table: see text]