Six consecutive cases of primary intracranial sarcoma in children in two private institutions from Lima during COVID-19 pandemic.

Objective: The article describes the clinical and neuroimaging characteristics of six children with the diagnosis of brain tumor attended in two private institutions from Lima, during the COVID-19 pandemic. Material(s) and Method(s): Descriptive study of cases of brain tumor in patients aged 18 and younger, followed at two private institutions in in Lima, from March 2020 to December 2021. Result(s): Six consecutive cases of intracranial tumors were detected during a large part of the COVID-19 pandemic's first year (October 2020 to March 2021), all of them with diagnosis of primary intracranial sarcoma. Before the pandemic, the last primary intracranial sarcoma in children, operated in the mentioned institutions, occurred in June 2018 and was the only case that year. Conclusion(s): During the COVID-19 pandemic, an unusual frequency of primary intracranial sarcoma in children was found in two private institutions from Lima.Copyright © 2023 Authors. All rights reserved.

Appropriateness of musculoskeletal soft tissue swelling ultrasound scans

This audit's purpose was to assess the appropriateness of referrals from primary and secondary care for soft tissue lumps and bumps ultrasounds (US) that are being performed in a university teaching hospital imaging department and compare against the British Sarcoma Group (BSG) national guidelines. This is on the background of increasing referrals for ultrasound scans of soft tissue lumps with limited clinical information in the face of increasing workload in the imaging department. This was a retrospective study, analysing data for all US performed for soft tissue swelling - over a one-month period. We focused on all US undertaken in the imaging department for June 2019 (pre-COVID) allowing for a 24 month follow-up period. Indications and findings were recorded. The requests were assessed regarding appropriateness by comparing to NICE and BSG guidelines. 200 ultrasound scans were undertaken during the one month period;14 paediatric patients were excluded from the data. The majority of referrals were from primary care (92%). Of the 186 cases analysed, 102 cases (54%) did not contain any appropriate clinical information as per the guidelines and no descriptive features were mentioned. Of the 81 cases (44%) that did contain relevant clinical information, 14 cases (17%) mentioned clinical features that, according to the guidelines, did not require ultrasound imaging and hence were also inappropriate. This audit shows the significant proportion of inappropriate requests from primary care. There was a lack of relevant clinical information on requests for US soft tissue, making it difficult to ascertain which patients need to be offered a direct access US in the required twoweek time frame. Considerations for improving the quality of referrals include presenting the audit within primary care teams to enhance referrer education and ratifying an US request system with a flowsheet proforma to ameliorate the referral process.

Free-living monitoring of ambulatory activity after treatments for lower extremity musculoskeletal cancers using an accelerometer-based wearable - a new paradigm to outcome assessment in musculoskeletal oncology?

PURPOSE: Ambulatory activity (walking) is affected after sarcoma surgery yet is not routinely assessed. Small inexpensive accelerometers could bridge the gap. Study objectives investigated, whether in patients with lower extremity musculoskeletal tumours: (A) it was feasible to conduct ambulatory activity assessments in patient's homes using an accelerometer-based wearable (AX3, Axivity). (B) AX3 assessments produced clinically useful data, distinguished tumour sub-groups and related to existing measures. METHODS: In a prospective cross-sectional pilot, 34 patients with musculoskeletal tumours in the femur/thigh (19), pelvis/hip (3), tibia/leg (9), or ankle/foot (3) participated. Twenty-seven had limb-sparing surgery and seven amputation. Patients were assessed using a thigh-worn monitor. Summary measures of volume (total steps/day, total ambulatory bouts/day, mean bout length), pattern (alpha), and variability (S2) of ambulatory activity were derived. RESULTS: AX3 was well-tolerated and feasible to use. Outcomes compared to literature but did not distinguish tumour sub-groups. Alpha negatively correlated with disability (walking outside (r=-418, p = 0.042*), social life (r=-0.512, p = 0.010*)). Disability negatively predicted alpha (unstandardised co-efficient= -0.001, R2=0.186, p = 0.039*). CONCLUSIONS: A wearable can assess novel attributes of walking; volume, pattern, and variability after sarcoma surgery. Such outcomes provide valuable information about people's physical performance in their homes, which can guide rehabilitation. Implications for rehabilitationRoutine capture of ambulatory activity by sarcoma services in peoples' homes can provide important information about individuals "actual" physical activity levels and limitations after sarcoma surgery to inform personalised rehabilitation and care needs, including timely referral for support.Routine remote ambulatory monitoring about out of hospital activity can support personalised care for patients, including identifying high risk patients who need rapid intervention and care closer to home.Use of routine remote ambulatory monitoring could enhance delivery of evidence-based care closer to peoples' homes without disrupting their daily routine and therefore reducing patient and carer burden.Collection of data close to home using questionnaires and objective community assessment could be more cost effective and comprehensive than in-hospital assessment and could reduce the need for hospital attendance, which is of importance to vulnerable patients, particularly during the Covid-19 pandemic.

Targeted Treatment of Soft-Tissue Sarcoma.

Background: Soft-tissue sarcoma (STS) is a heterogeneous group of sarcomas with a low incidence. The treatment of advanced disease is poor, and mortality is high. We aimed to generate an overview of the clinical experiences with targeted treatments based on a pre-specified target in patients with STS. Methods: A systematic literature search was conducted in PubMed and Embase databases. The programs ENDNOTE and COVIDENCE were used for data management. The literature was screened to assess the article's eligibility for inclusion. Results: Twenty-eight targeted agents were used to treat 80 patients with advanced STS and a known pre-specified genetic alteration. MDM2 inhibitors were the most-studied drug (n = 19), followed by crizotinib (n = 9), ceritinib (n = 8), and 90Y-OTSA (n = 8). All patients treated with the MDM2 inhibitor achieved a treatment response of stable disease (SD) or better with a treatment duration of 4 to 83 months. For the remaining drugs, a more mixed response was observed. The evidence is low because most studies were case reports or cohort studies, where only a few STS patients were included. Conclusions: Many targeted agents can precisely target specific genetic alterations in advanced STS. The MDM2 inhibitor has shown promising results.

Today's Kaposi sarcoma is not the same as it was 40 years ago, or is it?

This review will provide an overview of the notion that Kaposi sarcoma (KS) is a disease that manifests under diverse and divergent circumstances. We begin with a historical introduction of KS and KS-associated herpesvirus (KSHV), highlight the diversity of clinical presentations of KS, summarize what we know about the cell of origin for this tumor, explore KSHV viral load as a potential biomarker for acute KSHV infections and KS-associated complications, and discuss immune modulators that impact KSHV infection, KSHV persistence, and KS disease.

Impact of Covid19 Infection in Patients with Cancer

Background: coronaviral pandemic (COVID-19) induced by severe acute coronaviral syndrome 2 has imminent consequences for COVID-19 patients. To determine the effect of this pandemic on oncological treatment, Netherlands cancer patients performed a national study . Method(s): From 11 April 2020 to 11 Jan 2021, the oncological care perspective was discussed by an online study. The survey included 20 questions on four topics: patient characteristics, hospital engagement, COVID-19 and COVID-19 problems. Result(s): A total of 2418 (64.53%) patients were female and the remainder (57.5%) were <50 years of age. The most prevalent cancer diagnosis were haematological malignancies (26.1%), breast cancer (22.8%) and other cancers (19.2%). Depending on their illness environment, 34.7% of patients had incurable conditions while 21.6% and 31.8% had curable or healed diseases. The (expected) result of their illness was 'unknown' for 11.9% of patients. According to outpatient environment, 1691 (45.1%) patients have been oncologically examined and have taken follow-up, contrasted with 529 (14.1%) and 1527 (40.8%) patients presently or pending for therapy. Conclusion(s): This is the first research exploring cancer patients' experiences after the COVID-19 pandemic in Iraq. The research indicates the major effect of COVID-19 on oncological treatment, showing the need for psycho-oncological assistance during this pandemic.Copyright © 2020 Ubiquity Press. All rights reserved.

Development of High-Grade Sarcoma After Second Dose of Moderna Vaccine.

Coronavirus disease 2019 (COVID-19) is a disease characterized by predominantly respiratory symptoms, which can progress to respiratory failure. Due to the novelty of the vaccines, it is difficult to assess if there are any associated long-term side effects. Here, we present a case of an elderly female who received the Moderna COVID-19 vaccine and developed a high-grade sarcoma at the site of the injection. A 73-year-old female with a past medical history of hypertension, hyperlipidemia, and renal angiomyolipoma status post resection in 2019 presented with worsening right upper arm swelling for the past two weeks. She noticed the swelling two to four days after receiving her second dose of the Moderna vaccine within 1 cm from the prior injection site. Physical examination was remarkable for a 6 cm, circular, mobile, soft mass present in the right upper arm. MRI with and without contrast revealed a 5.2 cm soft tissue mass overlying the triceps region with irregular features concerning for malignancy. Fine needle aspiration revealed pathologic characteristics indicative of high-grade sarcoma. The patient ultimately had resection of the mass four months after the initial visit and was diagnosed as having grade 3, stage IIIA undifferentiated, pleomorphic high-grade sarcoma. Herein, we present a case demonstrating the development of high-grade sarcoma at the injection site in an elderly female patient within days of receiving the second dose of the Moderna COVID-19 vaccine. Currently, it is unclear whether there is a true association between the vaccines and malignancy or inflammatory response exacerbating underlying malignancy. This case highlights the necessity to investigate and be aware of such rare, adverse complications that may be associated with the novel COVID-19 vaccinations to guide physicians in their differential diagnosis.

Hiv-Related Kaposi Sarcoma in East Africa: Contemporary Update on Stage and Survival

Background: Stage at time of diagnosis and survival after diagnosis are critical parameters regarding the control of any cancer in any geographical setting. Unlike in resource-rich settings where publicly funded cancer surveillance routinely monitors these parameters, these data are non-existent through routine means in resource-limited areas. This is particularly relevant for Kaposi sarcoma (KS) in East Africa, for which recent changes in HIV treatment and chemotherapy guidelines as well as the COVID-19 pandemic dictate an update regarding stage and survival. Method(s): From October 2021 to August 2022, we evaluated HIV-infected adults (age >= 18 years) with a new diagnosis of KS made in 4 different primary care facilities (or their associated inpatient units) in Kenya and Uganda using a process of rapid case ascertainment. KS diagnosis was confirmed by pathology. Participants were examined, at time of biopsy, to document the extent of lesions and subsequently monitored longitudinally for vital status. Result(s): Among 180 HIV-infected adults identified with new onset KS, 31% were women, and the median (IQR) age was 35 (29-42) years. At time of KS diagnosis, 95% of the participants were taking ART, and the median (IQR) CD4+ T cell count was 197 (46-354) cells/mm3;46%, 20%, 11% and 23% had plasma HIV RNA of < 40, 40-1000, 1001-10,000 and >10,000 copies/ml, respectively. The median number of anatomic sites with KS lesions per participant was 7 (4-11);26% of participants had oral KS lesions that interfered with either eating or speaking, 74% had KS-associated edema, and 86% had ACTG stage T1 (advanced KS). Over a median follow-up of 2.6 months (IQR: 0.75 to 5.5), 56 participants died, and only 3 lost to follow-up. Cumulative incidence of death (95% CI), via Kaplan-Meier estimation, at 2 months, 6 months and 8 months following KS diagnosis was 24% (18%-31%), 33% (26%-42%), and 38% (29- 49%), respectively (Figure). Conclusion(s): In a recently assembled community-based sample of adults with newly-diagnosed HIV-related KS in East Africa, the majority have advanced KS at the time of KS diagnosis, and survival is poor. The findings are stark in absolute terms for the Treat-All era and unchanged from parameters obtained in the 5 years prior, indicating no improvement in these aspects of the control of KS in the region. Along with primary prevention of KS (i.e., reducing its incidence), novel approaches are needed for earlier detection, more efficient linkage to oncologic care, and more potent therapy. Survival Among Adults with HIV-Related Kaposi Sarcoma in East Africa.

Extended Neoadjuvant Chemotherapy in Delayed Primary Resection of Ewing Sarcoma During the COVID-19 Era: A Case Report

CASE: A 13-year-old adolescent boy visited our hospital with a growing mass on his left leg. Investigations and examinations were performed to obtain a final diagnosis of Ewing sarcoma in the head of the left fibula with lung metastasis. Neoadjuvant chemotherapy was extended to 11 courses with radiation before wide tumor resection could be performed. The final 3 adjuvant chemotherapy courses were administered to complete the original protocol while surgical resection complications were also treated. The pathological report revealed free margin resection with nonviable tumor cells. CONCLUSION: An extended neoadjuvant chemotherapy regimen with additional radiation therapy for Ewing sarcoma provided extra local control and allowed limb salvage. Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.

A historical review of pandemics with a dermatological perspective

We present a literature review of dermatology features in historical pandemics. A pandemic is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and affecting a large number of people. Smallpox was the first documented pandemic, around 10 000 BC, spread by the inhalation of airborne droplets. A few days after an initial high fever, headache and fatigue, a mucocutaneous maculopapular eruption appeared, which then developed pustules and erosions. The last outbreak occurred in the USA in 1949. Smallpox was eradicated in 1980, following a vaccination programme. Mycobacterium tuberculosis is the causative agent of tuberculosis (TB), an ongoing global pandemic. The earliest documentations were 3300 years ago. In 2020, the World Health Organization (WHO) provisionally estimated 1.5 million deaths globally. Most commonly affecting the lungs, cutaneous TB may present with inflammatory papules, plaques, suppurative nodules and chronic ulcers. Requiring long, complex antibiotic regimens, multidrug resistant TB is an increasing problem. Now extremely rare, yet still with recent outbreaks in 2021 in Madagascar, bubonic plague arrived in Europe in 1346 causing 75-200 million deaths. It is caused by the bacterium Yersinia pestis, transmitted through fleas that have fed on infected rodents. Clinical features include papules, pustules, ulcers and eschars, tender lymphadenopathy and systemic symptoms, and it responds to antibiotics. Syphilis, caused by the bacterium Treponema pallidum, is sexually transmitted. The first known outbreak was during warfare in 1494-5 in Naples, Italy. In 2020, the WHO estimated that, globally, seven million people had new infections. Primary syphilis typically produces a painless, genital ulcer (or chancre). Secondary syphilis presents with a nonitchy, maculopapular erythema over the trunk, palms and soles. Early recognition and antibiotic treatment usually lead to good outcomes. Estimated by the WHO to affect 37.7 million people in 2020, HIV is thought to have mutated from simian immunodeficiency virus by the 1960s in sub-Saharan Africa, spreading to the Caribbean and USA by the late 1960s. Initial symptoms include a fever, headache and lymphadenopathy. Dermatological features are common, including opportunistic cutaneous infections, nonspecific exanthemas, seborrhoeic dermatitis and Kaposi sarcoma. Advances in antiretroviral therapies mean people with HIV can have an excellent prognosis, although the WHO estimated in 2020 that more than 200 000 people with HIV died from concomitant TB. Since 2019, COVID-19 has had a considerable global impact on healthcare. With more than 300 million cases and 5.5 million deaths to date, some services have been overwhelmed owing to large case numbers, variable vaccine uptake, workplace changes to reduce transmission and staff shortages. Cutaneous features include perniosis, urticarial, purpuric, vesicular or maculopapular eruptions. Pandemics throughout history have been repeatedly shown to present with an element of skin involvement. We can utilize this to promote education and early recognition of these features, to facilitate diagnosis and raise awareness of the potential complications of serious diseases.

"Inside out" - An exceptional intussusception

Introduction: We present the first case of appendiceal intussusception associated with myeloid sarcoma in a young patient. Minimally invasive techniques used along the clinical course are highlighted. Case description: A 2.5-year-old boy was admitted after three weeks of COVID-19 infection with ongoing symptoms of MIS-C. Due to constipation, distended belly and vomiting, US was done which showed ileocolic intussusception. After unsuccessful hydrostatic reduction laparoscopic exploration was performed, where the vermiform appendix was found to be thickened and partially intussuscepted into the coecum. The ileocecal region was exteriorized transumbilically. After manual reduction of the intussusception, a long, thickened, fragile appendix was removed. Histopathology revealed myeloid sarcoma. Bone marrow investigation identified acute myeloid leukemia. During the oncological treatment, laparoscopic cholecystectomy was necessary due to cholecystitis and cholelithiasis. The child recovered uneventfully in terms of surgical complications, with good cosmetic result. Conclusion(s): No similar case in childhood was found in the English literature. Unusual symptoms and radiological findings of intussusception can conceal unexpected disorders. Minimally invasive technique offered advantages in the treatment of the presented patient and can be recommended to treat intussusception or cholelithiasis, if applicable, during an ongoing oncological treatment as well.Copyright © 2023 The Authors

Pathology Playground: An Interactive Web-Based System for Pathology Unknowns With Immunohistochemistry and Molecular Studies

(Arch Pathol Lab Med. 2023;147:492-495;doi: 10.5858/ arpa.2021 -0516-EP) Interactive, computer-based learning has been used in numerous areas of medicine, and more often than not is more effective than traditional teaching methods.1,2 Patient simulations are even used in the United States Medical Licensing Examination to assess diagnostic decision-making skills, therapeutic intervention skills, and patient management skills.3 Computer-aided learning in pathology has been used in the forms of virtual slides linked to additional content,4 games in which correctly answering questions results in saving a patient or earning virtual prizes,5 and programs that aid the user in following an algorithmic approach to histologic diagnosis.6 Additionally, in the COVID-19 era, Web-based learning is proving more valuable in replacing standard formats.7 Working through a difficult case in pathology typically involves the use of immunohistochemistry and other special studies, including molecular diagnostics, that either confirm a suspected diagnosis or narrow the differential diagnosis and guide further tests. Ideally, a trainee would be able to see the H&E slide, choose what to order, refine the diagnosis, and perhaps order further studies, which would be closer to clinical practice. Images were obtained from in-house cases as well as online sources, primarily the University of Michigan Virtual Slide Box.8 An interface was written in HTML, PHP (PHP Hypertext Preprocessor), and JavaScript. About 50 cases have been presented in this manner in total, such as carcinoid tumor of the pancreas (with synaptophysin and chromogranin), blastic mantle cell lymphoma (with immunohistochemistry, flow cytometry, and fluorescence in situ hybridization [FISH] results), synovial sarcoma (with immunohistochemistry and cytogenetics results), hemochromatosis (with special stains and molecular genetic results confirming the patient's mutation), and histiocytic sarcoma (with immunostains).

Melanized (dematiaceous) fungal infections simulating skin cancer in African organ transplant recipients

Fungi are the most frequent skin infections in organ transplant recipients (OTRs) and usually present as superficial mycoses. Deeper infections are much less common, potentially more serious and the incidence is higher in the first few months post-transplant. We report two African OTRs with deep fungal infections caused by dematiaceous (melanized, pigmented or black) fungi, who both presented with suspected skin malignancies. A 60-year-old Nigerian man developed a painful, ulcerated, amelanotic, bleeding nodule on his right fourth toe 2 months after renal transplantation. Clinical differential diagnoses included Kaposi sarcoma (KS), amelanotic acral melanoma and subungual squamous cell carcinoma (SCC). However, histology showed pseudoepitheliomatous hyperplasia, extensive mixed inflammation, multinucleated giant cells and pigmented septate hyphae with rounded 'budding' forms. Periodic acid-Schiff, Grocott and Masson-Fontana stains were positive, and Alcian blue stain was negative, consistent with infection by a dematiaceous fungus. Fungal 18S polymerase chain reaction (PCR) was positive and culture identified Nigrograna mackinnonii. Treatment with oral itraconazole was supervised virtually during the COVID-19 pandemic. After 6 months there was minimal response and he opted for amputation of the digit. A 61-year-old Nigerian man presented 2 months after renal transplantation with a 2-cm diameter nodule on his left thigh at the site of a previous burn. This failed to respond to antibiotics. Magnetic resonance imaging was suggestive of possible malignancy, but surgery was deferred because of the COVID-19 pandemic. Two months later the lesion was 5 cm in diameter and verrucous with an 8-cm sessile, purplish plaque on his right forearm. Atypical KS, lymphoma and chronic burns-associated SCC were all considered. However, histology from both lesions was similar to the first patient. Fungal culture and 18S PCR confirmed infection with the dematiaceous fungus Alternaria alternata. At his request, the right thigh lesion was excised. The lesion on his forearm has partially responded to 8 months of ongoing oral itraconazole. In our African OTR cohort, KS is more common than deep fungal infection. However, despite this suspicion of skin malignancy, both patients had phaeohyphomycoses caused by dematiaceous fungi. Characterized by the presence of melanin in their cell walls, > 130 species of these plant pathogens and soil saprophytes are implicated in human disease, particularly in immunocompromised individuals. Although localized skin diseases (phaeohyphomycoses, chromoblastomycosis and mycetoma) are the most common manifestations, rare disseminated, central nervous system and pulmonary infections may prove fatal. Although uncommon, deep fungal infection should be considered in atypical skin lesions in OTRs;histology, tissue culture and fungal PCR are critical to confirming this diagnosis.

Detrimental effect of the COVID-19 pandemic on patients with adult extremity bone sarcoma: Reference center experience

Background: The COVID-19 pandemic had a significant impact on the healthcare system globally, including oncology. Which, in turn, led to significant delays in diagnostic and therapeutic procedures. This work aims to evaluate COVID-19 impact on the treatment of bone sarcoma in adult patients based on experience in a single, high-volume institution. Method(s): We have analyzed the early local outcomes (i.e., the possibility of limb-sparing surgery) in all patients with primary bone tumours treated between 2016-01-28 and 2022-11-07 in Polish main sarcoma reference center. Patients treated in the 2016-2019 period were labelled as a "pre-pandemic" group, and patients treated in the 2020-2022 - "pandemic". Mann-Whitney U and Chi-square tests were used in the statistical analysis. Result(s): There were 302 eligible patients identified. The group characteristics are presented in the table. There were no differences in patient-related variables and histological subtypes of tumours between the two groups. The tumour size did not differ (p = 0.053), when all tumour grades were considered, but high-grade tumours were larger in the "pandemic" group (p = 0.034). This was reflected in the percentage of limb-sparing surgeries which dropped from 83.3% to 68.2% ("pre-pandemic" vs "pandemic", p = 0.004). This difference was even more evident in the case of high-grade tumors - 78% vs. 54%, respectively (p = 0.001). [Formula presented] Conclusion(s): To our knowledge, this is the first report of the long-lasting detrimental impact of the COVID-19 pandemic on oncologic treatment outcomes in adult patients with primary malignant bone tumors. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology

Chemokines and chemokine receptors during COVID-19 infection.

Chemokines are crucial inflammatory mediators needed during an immune response to clear pathogens. However, their excessive release is the main cause of hyperinflammation. In the recent COVID-19 outbreak, chemokines may be the direct cause of acute respiratory disease syndrome, a major complication leading to death in about 40% of severe cases. Several clinical investigations revealed that chemokines are directly involved in the different stages of SARS-CoV-2 infection. Here, we review the role of chemokines and their receptors in COVID-19 pathogenesis to better understand the disease immunopathology which may aid in developing possible therapeutic targets for the infection.

Virtual sarcoma disease multidisciplinary team: A jump into the future?

Background: Sarcomas are rare cancers with complex diagnoses, requiring multimodal management in referral Centers with a dedicated Disease Multidisciplinary Team (DMT). COVID-19 pandemic imposed a sudden revolution in care management leading to activation of digital health tools such as virtual DMT meetings. We investigated how transition from face-to-face (FTF) to virtual meetings (VM) impacted clinical practice in a Sarcoma referral Center in Italy. Method(s): An online survey was administered to the participants of the Sarcoma DMT meetings held between 2020 and 2022 at Regina Elena National Cancer Institute of Rome. The survey consisted of 40 questions inquiring the experience of professionals in DMT meetings, opinions about FTF/VM, future perspectives. Moreover, we retrospectively analyzed the registries of DMT meetings held from March 9th 2019 to March 8th 2022 and we defined three 12-months periods by using the date of National lockdown beginning in Italy (March 9th 2020) as cutoff: a pre-covid, a covid, a post-covid phase. Result(s): A total of 22 healthcare professionals answered the survey: 18 medical doctors, 1 psychologist and 3 data/case managers. The most important changes in VM were better quality of clinical approach and research (22%), technological innovation (50%), and better logistical setting (95%). Between participants, 90% were highly/moderately satisfied with the depth of discussion, 100% declared that attendance was similar (68%) or increased (32%) compared to FTF, 86% thought that decision-making process was not affected, and 95% were still able to interact adequately and access relevant patients' data. 91% thought that VM could be approved hereafter and 100% that would facilitate DMT expansion globally. The median participation rate in Institutional Sarcoma DMT meetings was 58% (95% confidence interval (CI) 55%-60%), 62% (95% CI 48%-71%), and 64% (95% CI 61%-68%) respectively in the pre-covid, covid, and post-covid periods (p 0.0159). Compared to the re-discussed cases, the new ones rose from 30.1% in the pre-covid to 37.9% in the covid and 42.3% in the post-covid period (p<0.0001). Conclusion(s): VM guarantees a great standard of effectiveness in health assistance and should be a suitable or additional tool for the management of patients in clinical practice. Legal entity responsible for the study: IRCCS Regina Elena National Cancer Institute (IRE). Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology

ASYNCHRONOUS ONLINE JOURNAL CLUB TO ADDRESS EDUCATION DEFICITS AND COVID-19 SOCIAL DISTANCING RESTRICTIONS

Radiation Oncology is rarely taught in nursing school, and continuing education (CE) opportunities are limited at local, state, and national levels. Registered Nurses (RNs) in radiation oncology are still subject to annual requirements to obtain CEs for the North Carolina Board of Nursing, Commission on Cancer (COC) if not certified, and Oncology Nursing Society/Oncology Nursing Credentialing Center (ONS/ONCC) if certified. The American Nurses Credentialing Center Magnet™ designation requires a percentage of certified RNs. COVID-19 has presented an unprecedented challenge to provide nursing education. The purpose was to create relevant radiation oncology CE for radiation oncology nurses in a large diverse, multi-site academic department. Experienced Radiation Oncology nurses and the Oncology Clinical Nurse Educator formed a team to develop an effective journal club program and its processes. The Continuing Education and Professional Development Department provided free, relevant CEs to our nursing staff. We used Microsoft Teams™ to disseminate articles and provide a discussion board. Questions were asked of participants to obtain CE credit. Participants could participate on their own time using their phone, work, or personal computer. Articles were posted for a one-month duration at the beginning of the month. Providers were invited to participate in presentations and discussions to enrich disease-specific specialty care. The Mergener formula was used to calculate CE credit, which uses word count, degree of difficulty, and number of questions per month. Over 17 months, 34 articles were posted. 40 Nurses signed up from four facilities in three cities. A new graduate nurse who shadowed and participated was subsequently hired. Topics included HPV oropharyngeal cancer dose de-escalation, sarcoma clinical trials, radiation-induced nausea and vomiting guidelines, radiation safety with pacemakers and diabetes management technologies, breast cancer survivorship guidelines, disparities of access based on race and location, financial toxicity, protons, MRI-guided brachytherapy, radiation recall, dermatitis management, abscopal effect, pediatric CNS treatment, and spinal cord compression. Staff were asked for input into the choice of articles and topics. A total of 18.25 CEs was available to staff from May, 2021 to the end of September, 2022. The online asynchronous model was a successful method of providing radiation oncology nursing education to our staff. This project has been expanded to include other facilities and departments. We could respond to staff requests, and provide timely education on new research or unanticipated clinical events.