Introduction: Tumours of the pericardium are infrequently encountered in clinical practice but often represent disseminated malignant disease and confer a poor prognosis.Mesothelioma, melanoma, breast and lung cancer all metastasize to the pericardium.Primary cardiac tumours are much less common.Traditionally, transthoracic echocardiography has been the imaging modality for pericardial disease but complimentary use of cardiac CT and MRI is now more widespread.This case highlights the complementary value of these imaging techniques in the diagnosis and management of pericardial masses.Case Presentation: A 67 year-old man presented with a remote history of 1.4cm melanoma excision from his right thigh in 2012.He had a subsequent groin lymph node recurrence requiring dissection and adjuvant chemotherapy.He was asymptomatic.A routine surveillance PET CT demonstrated a focal area of FDG uptake in the inferior right ventricular wall/interventricular septum on the diaphragmatic surface.TTE demonstrated a solitary lesion in the pericardial space adjacent to the free wall of the right ventricle.Cardiac MRI was performed and revealed multiple discrete pericardial lesions, the largest measuring 3.8cm in length and indenting the inferior aspect of the right ventricle, consistent with metastatic spread from his previous melanoma.There was no pericardial effusion.Discussion: This case highlights the utility of multimodality imaging in pericardial disease.Conventional echocardiography is the imaging modality of choice for initial evaluation.Echo has the advantage of being able to provide measurements of the haemodynamic consequences of any pathology.However, visual resolution tends to be insufficient to fully characterize lesions in the pericardium and the quality of images is highly operator-dependent.CT and MRI provide far superior anatomical delineation of lesions and adjacent tissue.PET CT allows for neoplastic lesions that display FDG-avid properties to be highlighted.MRI has better temporal resolution and thus is superior to both CT and echo.The separation of T1 and T2 weighted images can be employed to accurately characterize tissue composition.Most neoplastic lesions exhibit low-signal intensity on T1 imaging and high intensity on T2 images with the exception of melanoma, which demonstrates high T1 signal intensity.This is due to the unique shortening properties of melanin on MRI.The multiplanar imaging and wide field of view of MRI is superior to CT without the need for ionizing radiation and assessment of LV function and other anthropometric data can be obtained.The complementary value of multi-modality imaging techniques in the management of pericardial disease is important.Echocardiography should remain the initial investigation of choice with appropriate employment of CT and MRI to enhance the diagnostic yield.This case demonstrates the tissue perfusion hierarchy of echo, PET CT and MRI.

10120Background: Identifying prognostic variables that may improve outcome in patients (pts) with cancer is a cornerstone of research. Recently, there has been interest in the prognostic value of n...

10137 Background: Malnutrition negatively impacts clinical outcomes in cancer pts. The prevalence of malnutrition in Irish oncology pts is unknown. Our aim was to assess the nutritional status of this cohort and the impact on quality of life (QOL) and survival. Methods: A cross sectional study of oncology out-pts presenting for chemotherapy between 2012–2016 at 2 university teaching hospitals was performed. A survey was devised, incorporating clinical, nutritional, biochemical and QOL data. Nutritional status was evaluated using cancer cachexia diagnostic criteria and CT assessment of muscle mass to define sarcopenia and myosteatosis. Cox proportional hazards model was used for survival analysis. Results: 726 pts with solid tumors were studied, 60% male with median age of 63 yrs (IQR 56-71yrs). Colorectal cancer was most prevalent (32%) and 45% had metastatic disease; 5% of the cohort was underweight, while the majority were either overweight or obese (56%). On CT analysis of body composition 51% had cancer cachexia, 42% sarcopenia, and 48% myosteatosis; 24% had both sarcopenia and myosteatosis. Regarding QOL, wt loss > 5% and cancer cachexia were associated with poorer global QOL score, and worse physical role, emotional and social function scores (all p < 0.005) and higher symptoms such as fatigue, nausea vomiting, pain, appetite loss and diarrhoea (all p < 0.05). Cancer cachexia, sarcopenia and myosteatosis were significantly associated with reduced survival, with the highest mortality risk in pts with both myosteatosis and sarcopenia. Median survival of these patients was 16.8 mths (95% CI 11.2-22.4 mths) vs 31.4 mths in those with normal body composition (95% CI 22.4 – 40.3 mths p= < 0.001). On multivariate analysis (controlling for age, sex, KPS, treatment intent and BMI) pts with both conditions had increased risk of mortality (HR 1.5, 95% CI 1.2-2.0, p= 0.003). Conclusions: Despite a normal or high BMI the rate of malnutrition and muscle wasting is high in oncology patients and has a significant negative impact on QOL and survival. The combination of sarcopenia and myosteatosis is an independent predictor of mortality.

BACKGROUND:Body composition may influence clinical outcomes of certain chemotherapeutic agents. We examined the prognostic significance of skeletal muscle mass and adipose tissue on docetaxel toxicity and overall survival in patients with metastatic castrate resistant prostate cancer (mCRPC). METHODS:A retrospective review of patients medical records with mCRPC, treated with docetaxel was conducted. Body composition parameters (skeletal muscle mass, muscle attenuation [MA], visceral and subcutaneous adipose tissue) were measured at L3 by computed tomography (CT) and defined using previously established cut points. Toxicity profile was assessed after 3 cycles of the drug and graded according to the National Cancer Institute Common Toxicity Criteria (version 4). Overall survival was analysed. RESULTS:Overall 63 patients, mean age 69 years (SD 8.3), were included. Sarcopenia was present in 47% (n = 30) and of these 26.7% (8/30) were sarcopenic obese. Common toxicities (all grades) observed included fatigue (80.9%), pain (46%), and constipation (34.9%). DLT occurred in 22 (34.9%) patients; of these 10 patients (15.8%) experienced dose reductions and 12 patients (19%) experienced dose terminations. Measurements of adiposity were not predictive of DLT, however 59.1% patients who had a combination of both sarcopenia and low MA experienced DLT compared to 29.3% of patients without sarcopenia and low MA (p = 0.021). Skeletal muscle index and MA were significantly lower in patients who experienced neutropenia (grade I-II) (46.5 cm2/m2 vs. 51.2 cm2/m2, p = 0.005) compared to their counterparts (24.6 HU vs. 32.2 HU, p = 0.044). Neither sarcopenia nor sarcopenic obesity was associated with overall survival. In multivariate analysis, BMI ≥25 kg/m2 (HR: 0.349, CI: 0.156-0.782, p = 0.010) was a significant predictor of longer overall survival and both visceral fat index ≥ median 58.7 cm2/m2 (HR: 2.266 CI: 1.066-4.814, p = 0.033) and anaemia (HR: 2.81, CI: 1.297-6.091, p = 0.009) were significant predictors of shorter overall survival. CONCLUSIONS:Sarcopenia and low MA are associated with neutropenia (grade I-II). Furthermore, presence of anaemia, high volume of visceral fat and BMI <25 kg/m2 are associated with reduced survival in patients with castrate resistant prostate cancer being treated with docetaxel chemotherapy.

Malnutrition is common in the oncology setting and negatively impacts on clinical outcomes1. The aim of this study was to assess the nutritional status of this cohort and the impact of malnutrition on quality of life (QOL) and survival. A cross sectional study of adult cancer patients undergoing chemotherapy between 2012-2015 was conducted. A survey was devised, incorporating clinical, nutritional, biochemical and QOL data (EORTC). Nutritional status was evaluated using cancer cachexia (CC) diagnostic criteria2 and CT assessment of body composition1. Cox proportional hazards model was used for survival analysis. 822 patients with solid tumours participated in the study, 60% were male with a median age of 64 years (IQR 56-71 years). 44% had a BMI > 25kg/m2, while only 4.6% had visible malnutrition (BMI < 18.5kg/m2). 36% of patients had lost >5% body weight in 6 months, 44% had CC, 40% were sarcopenic, 47% had myosteatosis, 24% had both. In terms of QOL, weight loss >5% and cancer cachexia were significantly associated with a poorer global QOL score, as well as worse physical, role, emotional and social function scores (all p < 0.005) and higher symptoms such as fatigue, nausea and vomiting, pain, appetite and diarrhoea (all p < 0.05). Sarcopenia, myosteatosis and CC were all significantly associated with reduced survival, with the highest risk of mortality seen in those with both myosteatosis and sarcopenia. Median survival was 583 days (95% CI 391-774 days) vs. 1001 days in those without both conditions (95% CI 746-1256 days; log rank p = <0.001). On multivariate analysis, controlling for age, sex, performance status, treatment intent and BMI, patients with both conditions had increased risk of mortality (HR 1.45, 95% CI 1.12-1.87, p = 0.004). Malnutrition and abnormal body composition are common in Irish cancer patients, but are masked by excessive adiposity. Malnutrition can adversely impact on patients QOL and survival. 1. Martin L, Birdsell L, MacDonald N et al. (2013) J Clin Oncol; 31 (12):1539-1547 2. Fearon K, Strasser F, Amler SD et al. (2011) Lancet Oncol; 12 (5):489-95

e20629 Background: Malnutrition is a significant factor in predicting cancer patients’ quality of life (QoL), tolerance to treatment, and overall survival. This study aimsto describe the prevalence of malnutrition, cancer cachexia (CC), sarcopenia and their impact on QoL for the first time in Irish cancer patients undergoing chemotherapy. Methods: A prospective study of adult cancer patients undergoing chemotherapy was conducted. Malnutrition Universal Screening Tool scores (MUST) and QoL (EORTC QLQ-C30) were measured. CC was defined as weight loss (WL) > 5% over the past 6 months or WL > 2% in combination with a Body Mass Index (BMI) < 20kg/m2 or sarcopenia. Skeletal muscle was measured by CT scan. Sarcopenia was defined using published cut offs. Results: In total,517 patients receiving chemotherapy (302 male), with a mean age of 61.8 (SD 10.5) were included. The percentage of patients with colorectal cancer was highest (30%) followed by upper gastrointestinal cancer (23%) and lung cancer (12%). 42.1% were treated with curative intent. According to BMI, 4.6% were underweight ( < 18.5kg/m2), 42.4% were normal weight (18.5-24.9 kg/m2) and 53% were overweight or obese (BMI ≥ 25 kg/m2). Sarcopenia was present in 47.3% and CC was present in 44.8 %. The highest rates of muscle wasting were seen in patients with tumours of the genitourinary system (61.7%), oesophagus (53%) and hepatobillary organs (50%). Based on MUST scores, 40% were at medium to high risk of malnutrition and the remainder, (309 patients, 59.7%) were classified as ‘low’ nutritional risk. However, 9.4% of these ‘low risk’ patients had CC and 26% were sarcopenic. CC, sarcopenia and nutritional risk were significantly associated with low global QoL scores (P < 0.05). Conclusions: A significant proportion of Irish cancer patients undergoing chemotherapy experience severe involuntary WL, sarcopenia and CC, however identification of malnourished patients presents challenges in the era of obesity. The routine availability of CT scans in oncology provides a unique opportunity to incorporate body composition into nutrition screening and assessment.

Yasufuku K , Chiyo M , Koh E , Moriya Y , Iyoda A , [3] Sekine Y , et al . Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer . Lung Cancer 2005 ; 50 : 347 – 54 . Herth FJF , Eberhardt R , Vilmann P , Krasnik M , Ernst A . [4] Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes . Thorax 2006 ; 61 : 795 – 8 . Annema JT , Versteegh MI , Veseli ç M , Voigt P , Rabe KF . [5] Endoscopic ultrasound-guided fi ne-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging . J Clin Oncol 2005 ; 23 : 8357 – 61 . Eapen GA , Shah AM , Lei X , Jimenez CA , Morice RC , [6] Yarmus L , et al . Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry . Chest 2013 ; 143 : 1044 – 53 . Asano F , Aoe M , Ohsaki Y , Okada Y , Sasada S , [7] Sato S , et al . Deaths and complications associated with respiratory endoscopy: A survey by the Japan Society for Respiratory Endoscopy in 2010 . Respirology 2012; 17 : 478 – 85 . Asano F , Aoe M , Ohsaki Y , Okada Y , Sasada S , Sato S , [8] et al . Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: A nationwide survey by the Japan Society for Respiratory Endoscopy . Respir Res 2013 ; 14 : 50 . Varela-Lema L , Fern á ndez-Villar A , Ruano-Ravina A . [9] Effectiveness and safety of endobronchial ultrasoundtransbronchial needle aspiration: A systematic review . Eur Respir J 2009 ; 33 : 1156 – 64 . Das A , Sivak MV , Chak A . Cervical esophageal perforation [10] during EUS: A national survey . Gastrointest Endosc 2001 ; 53 : 599 – 602 . Stather DR , Maceachern P , Chee A , Dumoulin E , [11] Tremblay A . Trainee impact on advanced diagnostic bronchoscopy: An analysis of 607 consecutive procedures in an interventional pulmonary practice . Respirology 2013 ; 18 : 179 – 84 . Stather DR , Chee A , Maceachern P , Dumoulin E , [12] Hergott CA , Gelberg J , et al . Evaluation of a novel method of teaching endobronchial ultrasound: Physicianversus respiratory therapist-proctored simulation training . Can Respir J 2013 ; 20 : 243 – 7 .

e15566 Background: Sunitinib is a standard first-line option for metastatic renal cell cancer (mRCC). Identification of biomarkers associated with outcome or toxicity is a challenge. Body composition is a prognostic factor in cancer and sarcopenia is associated with treatment toxicity and survival. We investigated if body composition by CT scan predicted dose limiting toxicity (DLT) from sunitinib in mRCC. Methods: Patients (pts) with mRCC receiving sunitinib 50mg as 1stline therapy between 2007-2012 were included. Ethical approval was obtained and prospectively maintained databases analysed. Skeletal muscle cross-sectional area at L3 was measured by CT. Sarcopenia was defined using published cut offs. Toxicity was assessed after 4 cycles of drug (CTCAE, v4.0). Results: 55 pts (43 male), mean age 64yrs (±10.6) were included. 67% were overweight/obese (BMI>25kg/m2). Sarcopenia was present in 33% (56% of normal BMI, 44% overweight group). Overall 40 pts (73%) experienced DLT (51% M, 100% F, p<0.016). DLT occurred in <6 months in 53% (44% M vs 83% F, p<0.016) and these pts were older (mean 68 yrs vs 60 yrs, p<0.01), had lower skeletal muscle mass (51.8 cm2/m2 vs 59.4 cm2/m2, p<0.012), and fat free mass (FFM) (51.4kg vs 57.7kg, p<0.03), and received higher drug dose in mg/kg FFM (1.01 vs 0.89, p<0.02). Common toxicities were GI (65%) and fatigue (47%). Of pts <25th percentile skeletal muscle mass 92% experienced DLT, higher than pts >75th percentile (p<0.05). Pts <25th percentile had an average of 5 toxicities vs 2 in those >75th percentile (p<0.003). All toxicities were more common in muscle wasted patients (p<0.05). 77% (n=10) of pts receiving a drug dose >75th percentile (1.105mg/FFM) experienced DLT in <6 months vs 44% (n=17) receiving a dose <75thpercentile (<1.099mg/FFM; p<0.037). Conclusions: Sarcopenia is prevalent in patients with mRCC, is easily measured, is an occult condition in pts with normal/high BMI, and is a significant predictor of DLT in pts receiving 1st line sunitinib. Our results highlight the potential use of baseline body composition to predict toxicity. The role of sarcopenia in targeted therapy is evolving and its potential to predict toxicity should be further studied.

of a potential role of n-3FA in treatment of cancer requires regular long-term administration. Methods: As part of a phase II trial in patients with advanced pancreatic cancer, up to 100 g of n-3FA (Lipidem, BBraun, Melsungen) was administered with gemcitabine chemotherapy weekly, with a rest every fourth week for up to six months. Pre-treatment serum and erythrocyte cell membrane (ECM) pellet samples were obtained for the entire treatment course of each patient. Post-treatment samples were obtained for the first two cycles only to assess rapid uptake. Fatty acid methyl esters (FAME) were produced by gas chromatography and their proportions as a total of sample lipid composition analysed using a mixed effects linear regression model. Results: Twenty nine patients were evaluated with median treatment length of 3.5 months (range 0 6 months). Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) FAMEs showed rapid uptake into plasma, and EPA into ECM pellets in post-treatment samples (p = 0.03). There was significant sustained uptake of EPA and DHA FAMEs into ECM pellets over the cohort’s pooled treatment course (p < 0.001 and p = 0.04 respectively) with corresponding reduction in the n6:n3 ratio (p = 0.007). Conclusion: Parenteral n-3FA administered in weekly highdose rate regimens results in rapid and sustained cellular uptake over a period of up to six months. This regimen is appropriate for therapies aimed at increasing n-3FA content of cellular membranes and reduction of the n6:n3 ratio.

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