High rates of mortality in non-small cell lung cancer lung cancer is due to inherent and acquired resistance to systemic therapies and subsequent metastatic burden. Metastasis is supported by suppression of the immune system at secondary organs and within the circulation. Modulation of the immune system is now being exploited as a therapeutic target with immune checkpoint inhibitors. The tracking of therapeutic efficacy in a real-time can be achieved with liquid biopsy, and evaluation of circulating tumour cells and the associated immune cells. A stable liquid biopsy biomarker for non-small cell lung cancer lung cancer has yet to be approved for clinical use. We performed a cross-sectional single-site study, and collected liquid biopsies from patients diagnosed with early, locally advanced, or metastatic lung cancer, undergoing surgery, or systemic therapy (chemotherapy/checkpoint inhibitors). Evaluation of overall circulating tumour cell counts, or cluster counts did not correlate with patient outcome. Interestingly, the numbers of Pan cytokeratin positive circulating tumour cells engulfed by tumour associated monocytes correlated strongly with patient outcome independent of circulating tumour cell counts and the use of checkpoint inhibitors. We suggest that Pan cytokeratin staining within monocytes is an important indicator of tumour-associated inflammation post-therapy and an effective biomarker with strong prognostic capability for patient outcome.

Frailty is prevalent in older adults with lung cancer, however limited data exists regarding its impact in treatment for stage III NSCLC patients. The frailty index (FI) is an optimum measure of frailty derived from multidimensional geriatric assessment. A 58-item FI has been incorporated in our nurse-led geriatric oncology model of care to define frailty (FI>0.25) prior to initial specialist consultation. We aimed to describe its association with treatment outcomes for older adults with stage III NSCLC at our tertiary institution in Australia.

In KEYNOTE-042 pembrolizumab improved overall survival (OS) versus chemotherapy in patients with advanced/metastatic NSCLC and PD-L1 tumour proportion score (TPS) ≥1% (mOS 16.4m v 12.1m, HR 0.79). Our aim was to audit real-world evidence for pembrolizumab and associations with the lung immune prognostic index (LIPI). LIPI utilises baseline lactate dehydrogenase (LDH>ULN) and derived neutrophil lymphocyte ratio (dNLR≥3) to categorise risk of immunotherapy resistance (good=0 factors; intermediate=1; poor=2).

Consolidation immunotherapy following chemoradiotherapy (CRT) for stage III NSCLC is standard of care since the PACIFIC trial1. However, real-world outcomes often fall short of clinical trial data. Our aim was to audit real-world survival outcomes and post progression therapy at a single Australian institution of stage III NSCLC patients who underwent CRT and consolidation Durvalumab.

A man in his early 50s presented with small bowel obstruction, requiring emergency laparoscopic small bowel resection for the metastatic melanoma of the jejunum with no identifiable primary lesion. One week after his first treatment with ipilimumab and nivolumab, he presented with diffuse abdominal pain, constipation, and fatigue. A computerized tomography scan did not identify a cause for his symptoms. This was rapidly followed by thrombocytopenia on day 11 and then anemia. He commenced intravenous corticosteroids for a suspected diagnosis of immune-related thrombocytopenia. On day 15, a generalized onset motor seizure occurred, and despite plasmapheresis later that day, the patient died from fatal immune-related thrombotic thrombocytopenic purpura (TTP). This was confirmed with suppressed ADAMTS13 (<5%) testing on day 14. Immune-related TTP is a rare and, in this case, fatal immune- related adverse event. Further studies are required to identify additional immunosuppressive management for immune-related TTP.

The (derived) neutrophil-to-lymphocyte ratio (dNLR) is a potential predictive biomarker in the era of checkpoint inhibitors (CPI). An elevated dNLR is associated with worse outcomes across several malignancies. However, there is no clearly defined cut-off in the clinical setting. To compare outcomes in patients prescribed CPI with a baseline dNLR0 > 3 and dNLR0 ≤ 3. The dNLR6 was measured 6 weeks later to determine its impact on patient overall survival (OS). Prospectively maintained pharmacy databases in a regional cancer centre were interrogated for patients who were prescribed CPI in the advanced setting between January 2017 and May 2020. There were 121 patients with advanced cancer and a median age of 68 (range 30 to 88) years. Forty-four percent (n = 53) received prior systemic therapy. Patients with an initial dNLR0 > 3 when compared with a dNLR0 ≤ 3 had significantly shorter median progression-free survival (PFS), 3 vs. 14 months (p = 0.001) and median OS, 6.4 vs. 30.2 months (p = 0.001). Patients with an initial dNLR0 > 3 and increased dNLR at 6 weeks (dNLR6) had significantly reduced median PFS (3.5 vs. 14.7 months, p = 0.03) and OS (5.7 vs. 16.3, p = 0.03) when compared with those whose dNLR decreased. In the dNLR0 ≤ 3 cohort, any increased dNLR when compared with decreased dNLR after 6 weeks of CPI had significantly reduced PFS (8.4 months vs. NR, p = 0.01) and OS (24.2 months vs. NR, p = 0.02). Lower pre-CPI treatment dNLR is associated with improved OS. A decrease in dNLR during treatment confers improved OS.

The role of surgical resection in recurrent Glioblastoma Multiforme (GBM) remains unclear. We aimed to investigate survival outcomes and associated prognostic factors in patients undergoing surgical reresection for recurrent IDH-wildtype GBM in a national neuro-oncology center. We evaluated all patients who underwent re-resection for recurrent GBM following adjuvant treatment between 2015 and 2018. 32 patients were eligible for inclusion. 19 (59%) were male, median age at re-resection was 53. Median time from initial surgery to re-resection was 13.5 months. Median overall survival (OS) was 28.6 months from initial surgery and 9.5 months from re-resection. MGMT methylation was significantly associated with improved OS from initial surgery, 40 months versus 19.1 months, (p = 0.004), and from reresection, 9.47 months versus 6.93 months, (p = 0.028). A late re-resection was associated with improved OS compared to an early re-resection, 44.1 months versus 15.7 months, (p = 0.002). There was a trend for improved outcomes in younger patients, median OS from initial surgery 44.1 months for 53 years compared to 21.7 months for patients 53, (p = 0.099). Higher Karnofsky Performance Status (KPS) at reresection was associated with improved median OS, 9.5 months versus 4.1 months for KPS >70 and <70 respectively, (p = 0.013). Furthermore, there was a trend for improved OS with greater extent of re-resection, however this did not reach statistical significance, possibly due to small sample size. Reresection for recurrent GBM was associated with improved OS in those with good performance status and could be considered in carefully selected cases.

Hospitalised cancer patients have a three times higher risk of death (14%) from COVID-19 than the general public. Vaccination provides an unprecedented opportunity to decrease morbidity & mortality, however, there is a limited data regarding cancer patients' attitudes towards COVID-19 vaccination. An anonymised questionnaire was completed by volunteering cancer patients attending the ambulatory care unit of a large tertiary cancer centre (Feb to April 2021), prior to vaccination rollout in this cohort. It assessed patients' acceptance of, and attitudes toward, COVID-19 vaccination. Statistical significance was assessed with Chi-square test (χ2). There was an 80% response rate (143/179). This included 79 females (55%) with a median age range of 51–60 yrs. (n = 35/24%). Most (78%) had a good performance status (PS = 0-1) & lung was the most frequent (28%) cancer type. Eight (6%) had previous COVID-19 infection. Among respondents, 128 (90%) intended on getting vaccinated, 12 (8%) were unsure & three (2%) would refuse. Those intent on vaccination were less concerned with side effects, viewed the pandemic as serious & perceived cancer as a cause for more severe infection compared to the rest (Table). All 101 (71%) patients who received the influenza vaccine were intent on COVID vaccination. Almost 20% (n=28) reported that they were more likely to receive the flu vaccine due to the pandemic. Twelve (8%) identified attending their GP as a barrier, with 97% (n=135) willing to attend hospital for vaccination. While this service is free, 69% (n=99) were willing to pay, with nearly 40% (n=57) up to €50.Table: 1595PComparison of determinants for COVID-19 vaccinationDeterminants for vaccinationYes n (%)No / Unsure n (%)p-value (χ2)Concern re side effects35 (27)11 (73)0.02Pandemic is not serious17 (5)8 (53)<0.01Cancer results in serious infection88 (69)3 (20)0.04Vaccine could deteriorate my cancer9 (7)3 (20)0.13Vaccine ineffective due to cancer13 (10)3 (20)0.32 Open table in a new tab Our study demonstrates a very high acceptance rate of COVID-19 vaccination among Irish cancer patients such that many would be willing to pay & attend hospital to receive it. The barriers to uptake provide an opportunity to improve education. An unexpected consequence, may be a beneficial increased uptake of the influenza vaccine.

Background: The 21 gene recurrence score (OncotypeDx ®) is reimbursed in Ireland to guide adjuvant treatment decisions for ER+, LN-negative, human epidermal growth factor receptor 2 (HER2)-negative BC. There is emerging evidence supporting the clinical utility of this test in patients with LN+ disease. Although the exact cut-off for chemotherapy has not been defined in this population, SEER data support the omission of chemotherapy for patients with RS Results: In total, 294 patients were enrolled across the - nine centres. Complete data is available on 123 patients (range 38 to 75, median 54 years), which included two male patients. Of the remaining 121 (98%) patients, 49 (40%) were premenopausal, 26 (21%) perimenopausal and 46 (37%) postmenopausal. The median tumour size was 38 mm (Range 7 to 58 mm). There were 101 (82%) patients with invasive ductal carcinoma, 17 (14%) with lobular carcinoma and 5 (4%) classified as other breast histology. Seventeen patients (14%) had grade 1, 74 (60%) grade 2 and 32 (26%) grade 3 disease. There were 79 (64%) patients with 1 LN+, 35 (29%) with 2 LN+ and 9 (7%) with 3 LN+ status. Overall access to the 21 gene RS test led to a 32% reduction in chemotherapy, 112 (91%) to 72 (59%) patients. This was most notable in patients with ductal histology (91 vs 61) and grade 2 breast cancer (66 vs 41) representing a 24.4% and 20.3% reduction, respectively. Similarly patients with 1 LN+ (71 vs 46) and 2 LN+ (34 vs 21) represented a 20.3% and 9.7% reduction, respectively. This study also identified four patients aged less than 40, for whom chemotherapy was not recommended. The biggest reduction in chemotherapy occurred in women aged over 50 (62 vs 36) at 21.1%. Overall, in 65% of cases, medical oncologists deemed the RS test result significantly changed treatment recommendations. Conclusion: These findings are consistent with results from similar studies in other countries. Broader access to the 21-gene RS could result in a reduction in the use of chemotherapy in Ireland. Citation Format: William J Mullally, Dara Bracken-Clarke, Andrew Padmore, Seamus O9Reilly, Deirdre O’Mahony, Janice Walshe, John Kennedy, Rajnish Gupta, Cathy Kelly, Miriam O9Connor, Karen Duffy, Maccon Keane, Bryan T Hennessy, Patrick G Morris. The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor positive (ER+), lymph node positive (LN+) breast cancer (BC) in Ireland: A national, multi-centre, prospective study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-56.

An elevated derived neutrophil-to-lymphocyte ratio (dNLR) has been correlated with worse outcomes across several malignancies and is also a known prognostic factor for patients on checkpoint inhibitors (CPI). However, the dNLR cut-off ranges from 3 to 5 and it's unclear if dNLR variation while on CPI affects patient outcomes. Prospectively maintained pharmacy databases in our regional cancer centre were interrogated for patients who were prescribed CPI in the advanced setting between January 2017 - 2020. Baseline patient characteristics were collated including dNLR {neutrophil count/ [white blood cell count – neutrophil count]} upon CPI commencement and repeated six weeks later. There were 102 patients with a median age of 69 years (range 30 - 88). Median follow-up was 7.8 months (Range 0.3 – 55.4 months). Seventy-three patients received prior systemic therapy (0 -3 lines). The median PFS for patients with a baseline dNLR > 3 when compared with a dNLR of ≤3 was 4.1 vs 14.2 months (p=0.001) and a similar comparison of the median OS was 6.4 vs 30.2 months (p=0.001). There were 10 patients who died before the six week dNLR change could be captured.Table: 1045PPatient characteristicsCancernPrevious treatmentPembrolizumabNivolumabAtezolizumabdNLR > 3dNLR ≤3102736126152280Melanoma46341510640Lung4228189151230Squamous2013938713Adeno2215967517Renal & Bladder6615006Head & Neck6606033Others22110111 Combination with ipilimumab. Patients in the dNLR > 3 cohort with a higher dNLR six weeks later had a significantly reduced median PFS when compared with decreased dNLR (3.6 vs 12.2 months, p=0.047). Similar analysis identified a significantly reduced median OS when higher dNLR was compared with decreased dNLR; 5.5 vs 16.3 months, p=0.008. In the dNLR ≤3 cohort, the two median PFS were statistically different (8.4 months vs not reached, p = 0.046). A similar analysis of the median OS identified a difference (24.2 months vs not reached) which approached significance (p=0.061). Open table in a new tab 1 Combination with ipilimumab. Patients in the dNLR > 3 cohort with a higher dNLR six weeks later had a significantly reduced median PFS when compared with decreased dNLR (3.6 vs 12.2 months, p=0.047). Similar analysis identified a significantly reduced median OS when higher dNLR was compared with decreased dNLR; 5.5 vs 16.3 months, p=0.008. In the dNLR ≤3 cohort, the two median PFS were statistically different (8.4 months vs not reached, p = 0.046). A similar analysis of the median OS identified a difference (24.2 months vs not reached) which approached significance (p=0.061). We have a diverse patient population in our study and CPI reponse is likely to be multifactorial. However, patients with lower baseline dNLR have improved outcomes with CPI and therefore a dNLR < 3 could be used to select patients for CPI therapy.

Abstract Background: The 21 gene recurrence score (OncotypeDx ®) is reimbursed in Ireland to guide adjuvant treatment decisions for ER+, LN-negative, human epidermal growth factor receptor 2 (HER2)-negative BC. There is emerging evidence supporting the clinical utility of this test in patients with LN+ disease. Although the exact cut-off for chemotherapy has not been defined in this population, SEER data support the omission of chemotherapy for patients with RS <18 and the WSG Plan B randomised prospective study suggested excellent 5- year outcomes in patients with RS ≤11 treated with hormone therapy alone. However, the RS has not yet been reimbursed for patients with LN+ disease in Ireland. Methods: The Oncotype DX Breast Recurrence Score test N+ Access Programme (PONDx) aimed to collect real-life data on the use of the 21 gene RS in patients with LN+ ER+, HER2- early stage breast cancer. The PONDx study was conducted between March 2018 and May 2019 across the national oncology centres to determine the extent to which use of the RS could alter chemotherapy recommendations. Eligible patients had 1-3 LN+, HR+ and HER2- BC and were deemed possible candidates for chemotherapy. Anonymous questionnaires were completed by a Consultant Oncologist after the RS test was available. Data on patient demographics, tumour characteristics and treatment recommendations were collected. Results: In total, 294 patients were enrolled across the - nine centres. Complete data is available on 123 patients (range 38 to 75, median 54 years), which included two male patients. Of the remaining 121 (98%) patients, 49 (40%) were premenopausal, 26 (21%) perimenopausal and 46 (37%) postmenopausal. The median tumour size was 38 mm (Range 7 to 58 mm). There were 101 (82%) patients with invasive ductal carcinoma, 17 (14%) with lobular carcinoma and 5 (4%) classified as other breast histology. Seventeen patients (14%) had grade 1, 74 (60%) grade 2 and 32 (26%) grade 3 disease. There were 79 (64%) patients with 1 LN+, 35 (29%) with 2 LN+ and 9 (7%) with 3 LN+ status. Overall access to the 21 gene RS test led to a 32% reduction in chemotherapy, 112 (91%) to 72 (59%) patients. This was most notable in patients with ductal histology (91 vs 61) and grade 2 breast cancer (66 vs 41) representing a 24.4% and 20.3% reduction, respectively. Similarly patients with 1 LN+ (71 vs 46) and 2 LN+ (34 vs 21) represented a 20.3% and 9.7% reduction, respectively. This study also identified four patients aged less than 40, for whom chemotherapy was not recommended. The biggest reduction in chemotherapy occurred in women aged over 50 (62 vs 36) at 21.1%. Overall, in 65% of cases, medical oncologists deemed the RS test result significantly changed treatment recommendations. Conclusion: These findings are consistent with results from similar studies in other countries. Broader access to the 21-gene RS could result in a reduction in the use of chemotherapy in Ireland. Citation Format: William J Mullally, Dara Bracken-Clarke, Andrew Padmore, Seamus O'Reilly, Deirdre O’Mahony, Janice Walshe, John Kennedy, Rajnish Gupta, Cathy Kelly, Miriam O'Connor, Karen Duffy, Maccon Keane, Bryan T Hennessy, Patrick G Morris. The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor positive (ER+), lymph node positive (LN+) breast cancer (BC) in Ireland: A national, multi-centre, prospective study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-56.

Background Cancer gene panel testing is available in Ireland. The need for a clear strategy to deal with patient information generated from tumour genomic testing is recognised as a challenge in the National Cancer Strategy. However, the public’s attitude and opinions regarding these results is not known in Ireland. Aims This prospective questionnaire study assessed the knowledge and opinions of patients in a national oncology centre, surrounding cancer gene panel testing. Methods An anonymised modified validated questionnaire was completed by volunteering patients in the medical oncology department. It comprised 14 questions which assessed patient’s familiarity, intention, benefits and concerns associated with tumour genetic testing using a four-point Likert scale. Patients recorded their primary cancer diagnosis and family cancer history. Results Eighty-four patients completed the questionnaire with 77 (92%) patients declaring their primary cancer diagnosis. The median age was 56 (range 26 to 83) years. Overall, 42% ( n = 35) of oncology patients were familiar/somewhat familiar with testing and 90% ( n = 76) stated they would avail of genetic testing if available. Patients with breast cancer were no more likely to avail of genetic testing when compared with the non-breast cancer cohort ( n = 21 vs. 56, p = 0.58) though they identified concerns with potential discrimination. Conclusion This is the first prospective Irish study to assess opinions surrounding cancer gene results. Addressing patient’s lack of information as regards genetic testing is the first step in establishing a national cancer genetics testing programme in Ireland.

Background The COVID-19 pandemic has led to an unprecedented lockdown of Ireland and significant healthcare challenges including outpatient department clinics. As a result, these cancer clinics were conducted virtually by telephone. The aim of this study is to measure cancer patients’ satisfaction with telephone consultations.Methods Cancer patients on active treatment or surveillance in an Irish university hospital were invited to complete a questionnaire issued via “Survey Monkey”. It comprised ten questions and assessed whether patients concerns were adequately addressed and preference to continue with virtual consultations. Patients recorded what was absent from the current environment when compared with previous clinics.Results This survey was issued to 180 cancer patients including 65 (36%) men and 115 females (64%) with a median age of 65 (range 20 – 92) years. Fifty-four patients (30%) completed this anonymised questionnaire. Over 96% (n=52) of cancer patients agreed/strongly agreed their concerns were addressed satisfactorily and similarly 93% (n=50) felt reassured after this consultation. One-third of patients (n=18) would prefer for all out-patient consultations to revert to those in the pre COVID-19 era and 11% agreed all future consultations should continue virtually. The remaining, 30 patients (56%) agreed with the later though only in certain circumstances. Twenty-eight patients missed (56%) missed the face-to-face interaction and reassurance provided by a physical examination. Conclusion This is the first Irish oncology study which examined cancer patients perspective of Health Service Executive directed virtual outpatient clinics. Face-to-face consultations are crucial for optimal cancer patient care and cannot be eliminated completely.

Click here for the corresponding questions to this CME article.

Background As an ESMO designated centre of integrated oncology and palliative care it is important to have a range of skill mix and experience across the oncology nursing staff caring for these patients. Within a large acute general hospital, with patients on various wards across the hospital, challenges in achieving these aims may present themselves. The core ward consists of 14 single rooms; the non-core wards have a mix of 1, 2, 4 and 6 bedded rooms. This analysis aimed to assess the nature of hospitalisations and the associated outcomes for the whole cohort of patients on the associated ward. Methods All inpatients who were admitted or were pre-existing patients during the period of 8 weeks of analysis were assessed. The main features considered were the age, gender, cancer diagnosis, co-morbidities, reason for admission, and whether they returned to home, hospice or died in hospital. Whether patients were on the core chemotherapy ward or on outlying wards was assessed. Data from retrieved from the medical and nursing handover records and clinical information system of the Hospital. Results There were 44 patients (37.8%) cared for over the 50 admissions on the Core Therapeutic Ward staffed by oncology nurses over the 8 week period with the remainder cared for over the 92 admissions on outlying wards staffed by non-oncology nurses. The three most common reasons for admission (core/non-core ward) included symptom management with disease progression (42% vs 50%), anti-cancer therapy associated toxicities (18% vs 13%) & decline in activities of daily living (16% vs 15%). The most common oncology primary cancers included CNS (25% vs 20%), Lower GI (16% vs 15%) and GU (11.4% vs 13.5%). Disease related impaired cognition was the most common baseline co-morbidity present in each cohort (27.3%/12.2%). The patient discharge outcomes on each ward (onc/non-onc) were home (56.8%/85.1%), rehabilitation or long term care (10.1% vs 2.7%), hospice (6.8%/4.1%) and death (27.3%/8.1%) reflecting that less well patients tended to be cared for within the specialist ward. Conclusions Balancing the optimal location and nursing skill set is a challenge and remains an important focus and priority within a service ranging from high dose chemotherapy administration for curative intent to palliative and terminal care. Legal entity responsible for the study Beaumont Hospital Cancer Centre. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background: Lung cancer is the leading cause of cancer death in both sexes in Ireland. Studies suggest that lung cancer in younger patients has distinct characteristics. The aim of this study is to define the characteristics of lung cancer in patients 55-year-old or younger in an Irish population. Methods: Data was collected retrospectively from local medical records and the hospital electronic database regarding all patients diagnosed with lung cancer aged 55-year-old and younger, from 2010-2016. Information regarding patient demographics, smoking status, tumour histology, molecular analysis, stage and location, diagnostic modality and initial treatment choice was collected. In all cases the diagnosis of lung cancer was confirmed at the regional lung cancer multidisciplinary team (MDT) meeting. Results: In total, 8% (n=130) of all cases of lung cancer diagnosed from 2010 to 2016 in our center occurred in patients aged 55 years old or younger; 83% (n=108) were 45 to 55-year-old, 15% (n=19) were 35 to 44-year-old and 2% (n=3) were younger than 35-year-old; 88% (n=115) of patients reported a smoking history. There was a female preponderance (58%, n=76), higher rates of NSCLC non-squamous subtype (53%, n=69) and an upper lobe predominance (42%, n=54); 53% (n=68) of patients had IV or extensive disease at presentation. Epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and Kirsten rat sarcoma oncogene (KRAS) mutation rates were 9% (n=4) and 3% (n=1) and 80% (n=4) respectively. Conclusions: Lung cancer in younger patients has distinct characteristics. This study suggests a female preponderance, high smoking rates and a predilection for the upper lobes. Further large-scale multicenter studies are required to verify these results and to clarify the responsible mechanisms.

Abstract BACKGROUND While the treatment of primary Glioblastoma Multiforme (GBM) is well defined, the role of surgical resection in recurrent GBM is not firmly established.1 Treatment options for recurrent GBM include second-line chemotherapy, re-irradiation and surgical re-resection.2 This review examines current practice in a national neuro-oncology centre. AIMS: To investigate survival outcomes in patients undergoing surgical re-resection for recurrent GBM in our institution and to compare our findings to the relevant published literature. METHODS A retrospective review of our institution’s neuro-oncology database was performed. We evaluated all patients who underwent re-resection for recurrent GBM following standard adjuvant treatment between 2015–2018. Patients who did not have an initial diagnosis of Grade 4 GBM and patients who were re-operated on within one month were excluded. We analysed overall survival using Kaplan Meier curves. Patients not known to have died were censored to the last known alive date. We also examined factors which may affect patient outcome, including age, sex, extent of resection, tumour characteristics and tumour location. RESULTS 34 patients were eligible for inclusion into this study, of these 21 (61%) were male. Median age was 52. A radiologically confirmed initial resection of > 80% was achieved in 52% of patients. Median time from initial surgery to re-resection was 13.5 months. Median survival from initial surgery was 28.6 months and median survival after re-resection was 9.5 months. CONCLUSION Re-operation appears to have a role in the management of recurrent GBM in carefully selected cases. Overall survival in this patient cohort remains poor and further studies into the benefit of re-resection in comparison to second-line chemotherapy and re-irradiation would be of value.