Challenges and Advances in Diagnosis and Treatment of Leptomeningeal Disease (LMD)

Leptomeningeal disease (LMD) is a devastating category of CNS metastasis with a very poor prognosis and limited treatment options. With maximal aggressive therapy, survival times remain short and, without treatment, prognosis is measured in weeks. Both LMD diagnosis and treatment are challenging topics within neuro-oncology. In this review, we discuss the advances in LMD diagnosis with a focus on the role of circulating tumor DNA (ctDNA) and discuss the role of targeted and immunotherapy in LMD treatment.

PP283 Living Systematic Reviews In Time Of COVID-19: An Innovative Approach To Decision-making In An Environment Of Changing Evidence

IntroductionThe management of the COVID-19 pandemic is a challenge for Health Technology Assessment (HTA) methodology due to the need to formulate evidence-based recommendations in times of uncertainty in minimal time - for a large number of publications and with changing or even contradictory information. Living systematic reviews (LSRs) are systematic reviews that are continually updated, incorporating relevant new evidence as it becomes available. Since the COVID-19 pandemic fits all criteria to perform LSRs: (i) the Review question is a particular priority for decision-making, (ii) there is an high level of uncertainty about the existing evidence, and (iii) there is likely to be emerging evidence that will impact on the conclusions of the LSR, the aim of which is to analyze the role of LSRs as an innovative approach to HTA in recent years, and its impact on the management of the pandemic.MethodsA systematic search of LSRs (published or protocols) was run on the main biomedical databases (Medline, Embase and Cochrane Library) in November 2020 and it was rerun in June 2021 without time limit. The results will be analyzed and classified by year and category (epidemiology, treatment, prognosis, symptoms, diagnosis and vaccines).ResultsThe literature research has returned a total of 187 publications. The LSR concept emerged in 2014, from which some LSRs began to be published, but an exponential increase has been observed in 2020 with 76 references of which 66 percent were focused on the SARS-CoV-2. By category, 81.8 percent were focused on treatment, 41.8 percent on epidemiology, 20.9 percent on rehabilitation, 15.1 percent on diagnosis, 10.2 percent on prognosis and 2.2 percent on symptoms until June 2021. There wasn't any LSR for vaccines and 28 percent was focused on other fields.ConclusionsLSRs are particularly important during the COVID-19 pandemic, with research evidence emerging rapidly, current evidence being uncertain, and new research changing policy or decisions on health. The majority of LSRs published up to June 2021 were focused on the treatment of COVID-19.

Role of PET/CT in initial evaluation of lymphoma patients

Background Accurate radiologic assessment of treatment response in lymphoma patients is important to evaluate the effectiveness of treatment and consequently predict the relapse; the value of PET/CT for post-treatment prognosis prediction has been recently investigated. The aim of this study is to highlight the prognostic value of PET-CT metabolic volumetric parameters in the evaluation of lymphoma patients. Results Among the included 40 patients, post-treatment SUV, MTV, and TLG were significantly lower in a responsive group than the non-responsive group. % changes of all quantitative PET/CT parameters were significantly higher in the responsive group than the non-responsive group. Conclusions This study suggests that pre-treatment PET/CT quantitative measures (except baseline SUVmax) are not conclusive in the prediction of patient response to treatment; however, the ΔSUVmax, ΔMTV, and ΔTLG% from the baseline to the end of therapy could be used in predicting patient response to treatment, determining patient prognosis, and suggesting the relapse.

Advances in Lymphoma Molecular Diagnostics

Lymphomas encompass a diverse group of malignant lymphoid neoplasms. Over recent years much scientific effort has been undertaken to identify and understand molecular changes in lymphomas, resulting in a wide range of genetic alterations that have been reported across all types of lymphomas. As many of these changes are now incorporated into the World Health Organization’s defined criteria for the diagnostic evaluation of patients with lymphoid neoplasms, their accurate identification is crucial. Even if many alterations are not routinely evaluated in daily clinical practice, they may still have implications in risk stratification, treatment, prognosis or disease monitoring. Moreover, some alterations can be used for targeted treatment. Therefore, these advances in lymphoma molecular diagnostics in some cases have led to changes in treatment algorithms. Here, we give an overview of and discuss advances in molecular techniques in current clinical practice, as well as highlight some of them in a clinical context.

Malignant Melanoma

A review of malignant melanima including epidemiology, risk factors, molecular and immune mechanisms, diagnosis, clinical manifestations, subtypes, dermatoscopy, histology, treatment, prognosis and prevention. Key words: malignant melanoma