THE IMPACT OF THE SARS-COV-2 PANDEMIC ON THE EPIDEMIOLOGICAL PICTURE AND CHARACTERISTICS OF COLORECTAL CANCER - A RETROSPECTIVE ANALYSIS OF THE DEPARTMENT OF ONCOLOGY AND RADIOTHERAPY, UH of SPLIT, FOR THE YEAR 2020 IN COMPARISON TO PRE PANDEMIC 2017

Introduction: Colorectal cancer is the third most common cause of cancer in the world, after lung and breast cancer, while in Croatia is the most common malignant disease. Among the EU members, Croatia ranks ninth in terms of the incidence of colon cancer and a high second place by mortality. Since 2007, Croatia has had a National Colon Cancer Early Detection Program, but the response rate is still very low - 36% (25-52% depending on county and year).2 Despite the prevention program, approximately 13% of patients in Croatia is initially diagnosed with metastatic disease.1 According to the results of the CONCORD 3 study3, Croatia is at the bottom of the five-year survival (48%) compared to some other western countries (up to 71%) in the world. Method(s): A retrospective analysis was conducted at the Clinic of Oncology and Radiotherapy, CHC Split. Patients with newly diagnosed colorectal adenocarcinoma enrolled in the clinic from January 1, 2020 to December 31, 2020 were processed. The data were analyzed using descriptive statistics methods, with the use of Microsoft Excel tools. Result(s): A retrospective analysis of the medical history identified 269 patients (compared to 387 in 2017) presented at the multidisciplinary team (MDT) of CHC Split who were diagnosed with colorectal adenocarcinoma in 2020. All patients were presented to the MDT before starting the treatment. The median age of patients was 66 years, and the youngest patient was 22 years old. Patients from other counties who did not undergo the entire treatment/monitoring in our institution were excluded from the analysis. 52 patients (19.3%) were diagnosed in the metastatic stage of the disease, in stage 0 4 patients (1.5%), in stage I 32 (12%), in stage II 91 (34%), and in stage III 88 (33%). In 2 patients, the stage couldn't be precisely determined. There is a significant decrease in the number (81 in 2017 and 52 in 2020) but no percentage wise (20.9% in 2017 and 19.3% in 2020) of patients diagnosed with de novo metastatic colorectal cancer compared to the previous analysis from 2017, when 81 of them were detected. Patients diagnosed with metastatic disease were mostly in good general condition: ECOG 0 status 21 patients (40.3%), ECOG 1 24 patients (46.2%), ECOG 2 7 patients (13.5%), while no patient was ECOG status 3 or 4. 32 (57.7%) patients had a left-sided tumor, while 20 (42.3%) patients had a right-sided tumor. Conclusion(s): The results of our retrospective analysis showed a significant decrease in the number of patients compared to previous years. The effect of the smaller number of newly diagnosed patients will be analyzed and the real consequences will be seen, however, the appearance of patients in the later stages of the disease is to be expected.

Implementing the Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS): a therapeutic radiographer's perspective

Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Possibilities of low-dose radiation therapy in the treatment of intrapulmonary injuries caused by COVID-19 infection.

This paper examines the relevance of the use of a single irradiation of lungs in treatment of pneumonia caused by a new coronavirus infection. Clinical observations are presented that demonstrate perspectives in the treatment of this disease. Patients with severe pneumonia who were prescribed LD-RT (low-dose radiation therapy) at a dose of 0.5-1.5 Gy showed shorter recovery times and no complications. This method of treatment has shown its effectiveness in a number of studies from different countries, predicting success and economic benefits in its further use and study. A literature search containing information on relevant studies was carried out in PubMed, EMBASE, Web of Science and Google Scholar systems. Attention was focused on full-text articles given their general availability in a pandemic.Copyright © 2021 VIDAR Publishing House. All right reserved.

Past, present and future of RTT training in mainland China: Evaluation of trainee perspectives

Objective: The radiation therapy technologist fundamentals training program (RFTP) facilitates knowledge and skills development of newly employed radiation therapy technologists (RTTs) within our China network. Since its initial implementation in 2019, the RFTP has evolved to address the diversity of RTTs' education and experience, as well as changing local clinical contexts. In particular, a shift to remote delivery and assessment has been required during the COVID-19 pandemic. This quality improvement initiative aimed to evaluate the impact of the RFTP on learning engagement and outcomes, from trainee perspectives. Method(s): Online pre-interview surveys and semi-structured interviews were conducted with 16 RTTs from five China sites in July and August 2022.1 Participants provided verbal informed consent regarding the survey and interview recordings for subsequent analysis. Surveys were reported with descriptive statistics, and interview themes were developed using direct content analysis.2 Results: 15/16 participants qualified in a non-RTT field of study, with most practiced in medical imaging (N = 7);12/12 participants with previous RTT experience reported differences in practice standards. All participants rated the RFTP highly (see Figure), with IGRT (13/16), ARIA (14/16), and SimCT (7/16) most frequently identified as new areas of learning;14 participants who completed the RFTP reported the preparation for IGRT standard workflow was most valuable. Discussion/Conclusion: Results show that the RFTP is an essential on-boarding program that advances RTTs' knowledge and reduces the skills gap to perform our network's established workflows. Additional feedback gained through this initiative will be considered for future development of the RFTP.

Direct to CT screening pilot for patients with COPD in a deprived area: longitudinal analysis of the pulmonary nodule cohort outcomes

Introduction: Lung cancer is third most common cancer and highest cause of cancer death in the UK. COPD and smoking are known cancer risk factors so early intervention is essential. Incidence is higher in areas of deprivation where early presentation is less likely and outcomes poorer. Middlesbrough has some of the highest areas of deprivation. Aim(s): To evaluate diagnostic value of CT screening pilot in detecting lung cancer and follow-up outcomes for patients with incidental finding of pulmonary nodules. Method(s): Between March 2019 - December 2022 17 GP practices in Middlesbrough were invited to offer non-contrast CT thorax to asymptomatic COPD patients eligible for review, aged 50-75 with 20 pack year history and QCancer risk >5%. Pulmonary nodules followed up as per BTS guidelines. This pilot was conducted in partnership and with support from the Northern Cancer Alliance. Result(s): 407 patients referred for CT, 312 met the criteria and enrolled. 5 (1.6% conversion rate) lung cancers, also 1 renal cancer diagnosed. 51 (17%) had features of pulmonary nodules or groundglass opacities and selected for follow up. 2 died from COVID infection before follow-up CT. 32 (62.8%) discharged after followup CT revealed stable appearances or resolution, follow-up CT still outstanding for 2. 4 (7.8%) selected for further follow-up of sub-solid, new or increasing nodules. 2 (3.9%) received radiological diagnosis of lung cancer and referred for radiotherapy, 1 underwent surgical resection revealing lung tumourlets and 1 referred for surgical resection of enlarging nodule. Conclusion(s): Pulmonary nodules consisted significant part of the CT screening pilot findings in COPD patients with significant further conversion rate to lung cancer diagnosis after follow-up. Therefore, CT screening of high-risk population in deprived areas has a role in detecting lung cancer and identifying pulmonary nodules, with a proportion of those later diagnosed as early lung cancer. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

An investigation of radiation therapy peer group supervision in a metropolitan cancer centre

Objectives: To investigate radiation therapists' perceptions of participating in peer group supervision (PGS) and the effects of the COVID-19 pandemic on PGS. Method(s): Radiation therapists were introduced to PGS at an in-service facilitated by an employee assistance program representative. Nine volunteers were then placed into one of two PGS groups of similar experience levels. Groups met monthly for PGS sessions;and after six and 12 meetings each participant was sent a link to the 14-item Clinical Supervision Evaluation Questionnaire (CSEQ),1 three open-ended and three demographic questions. The study used both quantitative and qualitative methods. Result(s): Survey completion rates were 8/9 (88.9%) pre- and 6/7 (85.7%) post-COVID-19. Analysis of the CSEQ revealed that pre-COVID-19 seven participants (87.5%) and post-COVID-19 five participants (71.4%) had a positive experience with PGS. One (12.5%) and two (28.6%) participants pre- and post-COVID-19, respectively, stated that their experience was neither positive nor negative. The thematic data showed that the participants perceived PGS to assist with (i) feeling supported at work, (ii) developing an element of trust between group members, (iii) encouraging self-reflection, (iv) fostering an awareness of others, and (v) increasing problem-solving skills. Restrictions due to the COVID-19 pandemic led to fewer regular meetings, which had a negative impact on participants. Conclusion(s): Involvement in PGS within a radiation therapist setting has reportedly positively affected those involved. Regular access to a supportive, trusting team has enabled the participants to self-reflect and better troubleshoot work-related experiences.

The Impact of COVID-19 on Breast Cancer Treatment: A Systematic Review

Background: During the COVID-19 pandemic, health resources were stretched, access was impacted by lockdowns and there were concerns about exposure to the virus during visits to hospitals. The purpose of this study was to examine how breast cancer treatments (presentation, surgery, radiotherapy, chemotherapy and/or endocrine therapy) changed or were adapted during the early phase of the pandemic. Methods: A systematic review was conducted using PRISMA guidance. Eligible studies presented original data reporting changes to early breast cancer treatment by comparing ‘pandemic' treatment to a ‘pre-pandemic' cohort or to ‘ideal' treatment of individual cases. Data were extracted into evidence tables and narrative synthesis was used to analyze results. Results: Fifteen studies with paired design were eligible. These reported outcomes for 6,353 people treated for early breast cancer (January 2020–June 2021). All studies reported some change to treatment due to the pandemic. The nature of reported changes was inconsistent. Changes included: more advanced tumours at presentation compared to pre-pandemic, an increase in breast conserving surgery;an increase in simple mastectomy (without breast reconstruction);a trend towards increased wait times, delays to start of treatment, shorter post-operative hospital stay and hypofractionation or omission of radiotherapy. Centres used more or less neoadjuvant chemotherapy or endocrine therapy. Conclusion: In the early stage of the pandemic, fewer early-stage breast cancer cases were treated at many centres. Treatment for breast cancer was impacted and various local solutions were developed. These included less complicated breast surgery, increased use of neoadjuvant therapy, and changes to radiotherapy regimens. Surgery was frequently delayed and breast reconstruction was often unavailable. These results have implications for breast cancer services during the pandemic recovery as a ‘catch-up' increase in cancer diagnoses is expected. Women may wish to access breast reconstruction, unavailable due to COVID-19. The impact of changes to treatment on long-term quality of life should be evaluated. © The Author(s) 2022.

Impact of the COVID-19 pandemic on the treatment of head and neck cancer in Brazil

Introduction: To restrict the spread of COVID-19 infection, billions of people around the world have been quarantined or in social isolation. As a result of these health public measures, only essential services were maintained. Outpatient consultations and non-urgent surgeries were suspended to reduce hospitalizations and the risk of contagion. This context resulted in a delay in the diagnosis of several diseases, including head and neck cancer (HNC). Objective(s): To assess the impact of the COVID-19 pandemic on the treatment of HNC, comparing the number of surgery and radiotherapy, and chemotherapy procedures carried out during the pre-pandemic and pandemic periods in Brazil. Material(s) and Method(s): We compared the mean number of HNC surgeries and the number of radiotherapy and chemotherapy procedures carried out during the pre-pandemic (from March to July 2015-2019) and pandemic period (from March to July 2020) in the five geographic regions of Brazil. Result(s): Between 2015 and 2019, the mean number of surgeries for HNC was 5410. In 2020, during the same period, there were 3522 surgeries, representing a 35% decrease during the pandemic period. The greatest decrease was observed in the Northern region (60.7%). The number of radiotherapy and chemotherapy procedures increased by 50,8% in the pandemic period, with a higher prevalence in the Northeast (75.1%). Conclusion(s): During the peak of the COVID-19 pandemic, the data demonstrate a likely change in the HNC treatment protocol in Brazil.

Implications of COVID-19 Pandemic on Ovarian Cancer Mortality

Ovarian cancers are the most prevalent cancers with the highest mortality among women. Most women with advanced stages require multimodal therapy, including surgery, radiotherapy, and chemotherapy. The advent of the coronavirus disease in the 2019 has affected the entire system of healthcare delivery in majority of patients suffering from cancer. During these tough times, patients suffering from ovarian cancer face mental trauma, which involves delays in diagnosis and prognosis, surgeries, chemotherapy, and radiotherapy. Instead of in-person visits, tele consultations were performed with a fear of being infected with the pandemic. This review, have prioritized the repercussions of COVID-19 on patients with ovarian cancer, Monitoring of CA125 trend in patients of ovarian cancer with COVID-19 and how COVID-19 affects the rate of mortality in cancer patients. © 2023 Bharati Vidyapeeth, New Delhi.

Stereotactic Ablative radiotherapy before resection to avoid delay for early-stage lung cancer or oligometastases during the COVID-19 pandemic: Pathologic outcomes from the SABR-BRIDGE protocol.

BACKGROUND: During coronavirus disease 2019 (COVID-19)-related operating room closures, some multidisciplinary thoracic oncology teams adopted a paradigm of stereotactic ablative radiotherapy (SABR) as a bridge to surgery, an approach called SABR-BRIDGE. This study presents the preliminary surgical and pathological results. METHODS: Eligible participants from four institutions (three in Canada and one in the United States) had early-stage presumed or biopsy-proven lung malignancy that would normally be surgically resected. SABR was delivered using standard institutional guidelines, with surgery >3 months following SABR with standardized pathologic assessment. Pathological complete response (pCR) was defined as absence of viable cancer. Major pathologic response (MPR) was defined as ≤10% viable tissue. RESULTS: Seventy-two patients underwent SABR. Most common SABR regimens were 34 Gy/1 (29%, n = 21), 48 Gy/3-4 (26%, n = 19), and 50/55 Gy/5 (22%, n = 16). SABR was well-tolerated, with one grade 5 toxicity (death 10 days after SABR with COVID-19) and five grade 2-3 toxicities. Following SABR, 26 patients underwent resection thus far (13 pending surgery). Median time-to-surgery was 4.5 months post-SABR (range, 2-17.5 months). Surgery was reported as being more difficult because of SABR in 38% (n = 10) of cases. Thirteen patients (50%) had pCR and 19 (73%) had MPR. Rates of pCR trended higher in patients operated on at earlier time points (75% if within 3 months, 50% if 3-6 months, and 33% if ≥6 months; p = .069). In the exploratory best-case scenario analysis, pCR rate does not exceed 82%. CONCLUSIONS: The SABR-BRIDGE approach allowed for delivery of treatment during a period of operating room closure and was well-tolerated. Even in the best-case scenario, pCR rate does not exceed 82%.

Contouring Workshops - The Beneficial Impact on Radiation Oncology Specialist Training in Ireland

Background One of the key components of training in Radiation Oncology is gaining knowledge in contouring tumour volumes and organs at risk for radiotherapy planning. Trainees rotate through different tumour sites during their training and are expected to acquire competencies in contouring skills in tumour sites appropriate to their year of training. These skills are mostly acquired in an unstructured manner during supervised clinical work. We report on our institutional experience of introducing structured contouring workshops and on the feedback obtained from trainees. Methods Eight contouring workshops in different tumour sites - Head & Neck (n=3), Prostate (n=1), SABR Lung (n=2), Breast (n=1) and Oesophagus (n=1) were conducted between April 2019 and March 2022.Six were in-person workshops pre-COVID. Two were run virtually during the pandemic. The workshops were of 2-hour duration, limited to around 12 trainees each with varying degrees of experience in that particular tumour site. All workshops were similar in format with a tutorial on the tumour site followed by a contouring demonstration on an anonymised index case on the Eclipse planning platform referencing published contouring atlases. The trainees had access to a copy of the same case throughout the workshop. Their contours were reviewed individually and collectively. Feedback on the contouring experience was collected through a questionnaire after the workshop from each trainee. This feedback was incorporated into subsequent workshops where relevant. Results An average of 12 trainees (range 10 -14) attended the workshops. All trainees, irrespective of year of training, rated the content, format of the workshops highly and felt that they were relevant to their daily practice. Their reported subjective level of confidence in contouring improved significantly from an average score of 5.6 out of 10 (range 4-7) before the workshop to a score of 8.7 (range 8-9) after, over the 8 workshops. There was no cost associated with conducting these workshops as these were done on our existing planning software. Discussion Based on the feedback obtained from the trainees, the workshops were of definite educational benefit. They favoured the inclusion of this approach to the teaching of contouring skills in their curriculum. In keeping with this feedback and the recent implementation of the new radiation oncology training curriculum in Ireland efforts are currently underway in incorporating these contouring workshops into the training programme on a structured basis. This will ensure that trainees develop progressive expertise in contouring skills in keeping with highest international standards.

Impact of COVID-19 pandemic on delivery of pediatric radiotherapy: A critical review.

The COVID-19 pandemic has prevented the timely diagnosis and treatment of many diseases, including pediatric cancer. Its impact on pediatric oncologic treatments warrants investigation. As radiotherapy is an integral component of cancer care, we reviewed the published data regarding the impact of COVID-19 on the delivery of pediatric radiotherapy to inform actions for future global events. We found that disruptions in radiotherapy were reported amongst interruptions in other therapies. Disruptions were more common in low-income countries (78%) and low middle-income countries (68%) compared with upper middle-income countries (46%) and high-income countries (10%). Several papers included recommendations for mitigation strategies. Altered treatment regimens were common, including increasing the use of active surveillance and systemic therapy to delay local therapies, and accelerated/hypofractionated dose delivery. Our findings suggest that COVID-19 has impacted radiotherapy delivery in the pediatric population globally. Countries with limited resources may be more affected. Various mitigation strategies have been developed. The efficacy of mitigation measures warrants further investigation.

Case Report on a Rare Malignancy: Anorectal Melanoma

Introduction: Melanoma of the rectum is an extremely rare disease. The median survival rate is 2-5 years. Current treatment for this aggressive cancer is resection if possible and consider adjuvant or neoadjuvant radiotherapy;immunotherapy in nonresectable cases. Given the rapid spread of disease due to its submucosal growth and metastasis pattern, there is low success rates with treatments. Case Description/Methods: An 84-year-old male presented to the emergency department with an acute COVID-19 infection. The patient was also found to have gram-negative septicemia on blood cultures, so a CT abdomen/pelvis was performed (Figure 1a). The CT showed rectal wall thickening. A flexible sigmoidoscopy was planned for a future outpatient visit after recovering from his acute infection. The patient, however, developed an acute onset of dyspnea and had a high probability V/Q scan while in the hospital. He was started on anticoagulation, and shortly after starting therapy the patient developed bright red rectal bleeding. Due to the new onset of rectal bleeding it was decided to expedite the sigmoidoscopy. The sigmoidoscopy was performed in the hospital showing an ulcerated partially black pigmented non- obstructing medium-sized mass that was partially circumferential involving one-third of the lumen (Figure 1b). A biopsy of the lesion was taken using cold-forceps. The pathology stained positive for S100 consistent with melanoma. The diagnosis of anorectal melanoma was made, and colorectal surgery was consulted. The patient was deemed not to be a surgical candidate secondary to age and active COVID-19 infection. Oncology was consulted, and it was decided to start the patient on radiation and immunotherapy with a PD-1 inhibitor. Discussion(s): The symptoms of anorectal melanoma can be subtle and in this case report completely asymptomatic. Symptoms to be aware of are rectal bleeding and tenesmus. Diagnosing melanoma on sigmoidoscopy can be challenging as most tumors are not pigmented. Biopsies should be taken and sent for immunohistochemical staining for S100, if positive the patient should have a PET scan. Treatment choices for the tumor are based on staging. In a resectable tumor sphincter-saving local excision with radiotherapy to the site of the tumor and the pericolic and inguinal lymphatics is recommended. For unresectable tumors or tumors with distant metastasis, immunotherapy with PD-1 inhibitors (nivolumab and ipilimumab) is an emerging treatment choice.

Hepatocellular Carcinoma Presenting as a Clival Mass

Introduction: Hepatocellular carcinoma (HCC) comprises the majority of primary liver cancer and has a poor prognosis. Clivus metastasis is rare with only a few reported cases in the medical literature. We report a case of a patient who presented with clival mass found to have metastatic HCC. Case Description/Methods: A 63-year-old woman presented for neurosurgical evaluation after she was found to have a skull base mass on computerized tomography (CT) of the head at an outside hospital. She endorsed dysphagia for three months, however denied headaches or visual disturbances. A magnetic resonance imaging (MRI) revealed a 5.4 cm by 2.9 cm by 3.6 cm mass in the clivus, which was deemed as the cause of dysphagia (Figure 1a). The patient subsequently underwent an endoscopic transsphenoidal resection of the clival mass. Histopathology from the tissue revealed a hepatoid carcinoma, concerning for metastatic HCC (Figure 1b and 2c). Immunohistochemical strains were positive for hepatocytic marker arginase-1 (Figure 1d). Laboratory studies revealed alpha fetoprotein (AFP) of 56,344 ng/mL, CA-125 of 376 ng/mL, normal B-HCG and carcinoembryonic antigen (CEA). Thereafter, a triple phase CT of the liver revealed two LI-RADS 5 lesions suggestive of HCC as the primary malignancy. Patient's case was discussed at multidisciplinary tumor board with recommendations for systemic immunotherapy with atezolimumab plus bevacizumab and radiation therapy to the clivus. Discussion(s): The incidence of HCC has almost tripled since the 1980s making it the fastest rising cause of cancer related deaths. Metastasis to the brain comprises 0.26% to 2.2% of cases and the skull base is the most rarely affected anatomical site. Although CNS presentation is rare, we may see more neurological manifestations of metastatic HCC with the persistence of chronic hepatitis infections, the rise of metabolic diseases such as NASH, and an increase in alcohol-related liver disease during the COVID-19 pandemic. Although exceedingly rare, metastasis to the clivus should be considered in the differential diagnosis of skull base masses. Despite detection and treatment, prognosis remains poor and emphasis should be placed on consistent HCC surveillance. This case emphasizes that skull masses must be evaluated diligently as they can be the first sign of underlying liver malignancy. Given the morbidity and mortality associated with HCC, recognition of atypical manifestations of HCC can lead to a prompt diagnosis and initiation of life-saving treatment. (Figure Presented).

Autoimmune Enteropathy (AIE) in a Patient Diagnosed with Thymoma: A Case Report

Introduction: Autoimmune enteropathy (AIE) is a very rare immune disorder that mainly attacks the gastrointestinal tract by T-cell. The full pathology mechanism is not clear. Typically, characterized by intractable diarrhea and nutritional malabsorption with extra-intestinal manifestations. The proposed diagnostic criteria include small bowel villous atrophy not responding to diet restriction, circulating gut epithelial cell autoantibodies (GECA), and lack of immunodeficiency. We describe a case of AIE with extensive GI involvement, presenting in a 60-year-old patient diagnosed with Type AB thymoma. Case Description/Methods: Our gentleman with a history of Covid-19 complicated with pulmonary embolism and an incidental finding of malignant thymoma. A CT-guided biopsy was consistent with undifferentiated malignant thymoma supported by immunohistochemistry staining. Subsequently, complicated severe diarrhea erupted with significant weight loss. Conservative management, antibiotics, and diet restriction were ineffective. Diagnostic work-up was unremarkable except for anti-enterocytes antibodies (AEA) and anti-goblet cells antibodies (AGA). Bowel biopsy revealed villous blunting, loss of Paneth cells, and minimal intraepithelial lymphocytosis with no evidence of crypt abscesses. Corticosteroid and Octreotide have helped the patient's diarrhea. Thoracoscopy thymectomy performed with radiation therapy due to local and lymphovascular invasion. Discussion(s): AIE characterized by severe villous blunting with the absence of goblet cells and Paneth cells, intraepithelial lymphocytosis, and increased crypt apoptosis. In comparison, graft vs host disease lack crypt abscesses, celiac disease shows increase in the intraepithelial lymphocytosis with intact goblet and Paneth cells, whereas inflammatory bowel disease has intact goblet and Paneth cells, and CVID characterized by absence of plasma cell in the lamina propria. The presences of the GECA are nonspecific but it may help in confirming the diagnosis or may predict the prognosis and recurrence. Only AGA has been reported in IBD. Neither has been observed in celiac disease. The low incidence of AIE and the limited existing literature available on the optimal guidance in management. Oral nutritional supplementation as well as total parenteral nutrition is helpful. The target is to control diarrhea and optimize the nutritional status before surgery. The main treatment is thymectomy.

The experience and inspiration on the prevention and control of coronavirus disease 2019 in the department of radiotherapy

Coronavirus disease 2019 (COVID-19), as a public health emergency, is a serious threat to human health. Cancer patients have a high risk of being infected with COVID-19. As one of important means of cancer treatment, radiotherapy has become an important alternative to surgery during the epidemic of COVID-19. The radiotherapy department of Peking Union Medical College Hospital ensured the smooth development of radiotherapy work on the setup of prevention and control systems for COVID-19 by establishing admission strategies for cancer patients, disinfection, isolation, daily management measures, scientific exploration, and clinical practice. In this paper, the associated strategies are summarized and analyzed, which can provide experience and reference for radiotherapy treatment under public health emergencies.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Esophageal Squamous Cell Carcinoma: An Unfavorable Complication of Achalasia

Introduction: Achalasia is a motility disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter and loss of peristalsis in the distal esophagus. It is a rare condition with an annual incidence of 0.5-1.2 per 100,000 individuals. The etiology of primary achalasia is unknown, however secondary achalasia can be attributed to malignancy, infections or systemic diseases such as amyloidosis. An infrequent complication of achalasia is esophageal squamous cell carcinoma which has a prevalence of 26 in every 1,000 cases. We present a case of interval locoregionally advanced esophageal squamous cell carcinoma only 2 years after a normal upper endoscopy. Case Description/Methods: A 67-year-old female with known achalasia and previous pneumatic dilation in her 30s presented to our outpatient clinic in 2019 with complaints of worsening chronic dysphagia. EGD was performed which revealed a significantly dilated esophagus with candida esophagitis. Despite completing antifungal therapy, she continued to experience dysphagia to solids and liquids. Barium swallow demonstrated absent peristalsis with pooling of contrast within the esophagus. High-Resolution Manometry testing demonstrated absent peristalsis. She opted for surgical myotomy, however due to COVID restrictions, the procedure was delayed. Repeat EGD was performed in 2022 for pre-surgical evaluation and showed a large obstructing friable esophageal mass in the lower third of the esophagus. Pathology was consistent with invasive poorly differentiated squamous cell carcinoma. PET scan showed locoregional disease with FDG-avid esophageal and gastrohepatic node lesions. She was started on chemoradiation with Paclitaxel and Carboplatin (Figure). Discussion(s): The risk of esophageal squamous cell carcinoma in achalasia has significantly increased with incidence of approximately 1 in 300 patients. The presumed mechanism of malignancy in achalasia is poor emptying resulting in food stasis, bacterial overgrowth and inflammation leading to dysplasia and development of carcinoma. Given the relatively low incidence, there are currently no guidelines on routine endoscopic screening to assess for malignancy in patients with achalasia. Survival rates are poor as patients are often diagnosed at advanced stages. This case aims to illustrate the importance and need for interval screening in individuals with long standing achalasia to improve outcomes.