Angela Swampillai

Guy's and St Thomas' NHS Foundation Trust · Department of Oncology

BACKGROUND/OBJECTIVE Central nervous system (CNS) haemangiopericytomas (HPC) or solitary fibrous tumours (SFT) are rare aggressive tumours. Surgery is the primary modality of treatment, however, often followed by postoperative radiotherapy due to high tendency for local recurrence. Although rare, extracranial metastases to several sites have been d...

AIMS Review of a single person case study to establish if a personal trainer (PT) could help build a personalised pro- gramme for people with brain tumours going through oncology treatment. The aim being to help manage resilience both physically and psychologically through treatment and improve quality of life. METHOD A young person who has comple...

AIMS Whole genome sequencing is currently being offered to paediatric, teenage and young adult neuro-oncology patients and this was being managed by a genomics practitioner who works cross-site. We found that some patients are being discharged from the hospital without 1 component of the test or the consent. Our aim is to create a solid pathway in...

AIMS People diagnosed with brain tumours are well recognised as needing psychological support. Service provision is limited and can be diffcult to gain engagement. Providing psychology education workshops aims to be inclusive, bring patients and loved ones together and offer an opportunity for peer support. METHOD Patients who had finished or were...

AIMS The case study review will evaluate whether patients on long term steroid would benefit from calcium supplements and if a protocol for a bone density scan should be in place in relation to how long patients have been on steroids for. Duration of steroid use increases patients’ risk to steroid related toxicity when taken more than 3 weeks. Thes...

AIMS The aim of this review is to analyse the need for a specialist nurse role for the TYA patients. Having a new dedicated TYA developmental role implemented can help by identifying areas for improvement from the wider team to ensure optimal support for patient group. METHOD Clinic attendance over a 1-year period has been measured. Looking specif...

BACKGROUND Glioblastoma is an aggressive brain tumour routinely monitored with MRI. However, the potential to use imaging as a prognostic biomarker predicting survival after treatment starts is unclear. This study aims to predict survival within eight months of completing radiotherapy from MRIs using deep learning. MATERIAL AND METHODS The dataset...

MGMT promoter methylation is related to the increased sensitivity of tumour tissue to chemotherapy with temozolomide (TMZ) and thus to improved patient survival. However, it is unclear how the extent of MGMT promoter methylation affects outcomes. In our study, a single-centre retrospective study, we explore the impact of MGMT promoter methylation i...

BACKGROUND Cranial irradiation as part of prophylactic (PCI) or radical treatment for childhood malignancies can be associated with late consequences such as radiotherapy induced meningioma. METHODS We are reporting 5 such patients treated at our institute. RESULTS Case 1: 24y female received PCI for Acute Lymphoblastic Leukemia at the age of 2,...

AIMS There is a gap in supporting patients with sexual relationships and intimacy. The aim of this study is to establish if patients with a brain tumour feel they are able to ask questions and concerns about sex, relationships and intimacy following diagnosis; is there an unmet need and how can this be addressed. METHOD An anonymous survey was sen...

Case reports on adult pilocytic astrocytoma

Background Brain metastases (BM) occur in approximately 10-30% of patients with breast cancer (BC). Patients with advanced breast cancer are living longer, and the incidence of BM are increasing. Stereotactic Radiosurgery (SRS) has emerged as a strategy to treat BM. We evaluated the outcomes and potential prognostic factors of patients with BM trea...

Background Pilocytic astrocytoma (piloA) is a low grade brain tumour and most of the literature is based on paediatric patients with limited data on adults. Surgical resection followed by adjuvant treatment for recurrent lesions is standard of care. While previous literature was mainly based on historical classification, molecular analysis of tumou...

Background Recurrent high grade gliomas (HGG) pose a treatment challenge as no definite guidelines exist. Re-excision could be appropriate in some cases while systemic therapy options are only a handful. We thus need to resort to the option of re-irradiation at some point but there could be a wide variety of techniques, volumes & doses to choose fr...

Background Epithelioid glioblastoma is a rare subtype of Glioblastoma. We examine two cases who presented acutely with symptoms of headache, neck stiffness and an eye squint. The purpose of this case review is to look at their management, the spread of the disease and propose the availability of BRAF inhibiting agents be made readily available for...

Background Anxiety and depression is prevalent in oncology patients and disproportionately high in neuro-oncology. The screening tools are most frequently used when signs of depression are identified later in the patients pathway. The cognitive impact of a brain tumour means coping mechanisms are harder to integrate and retain. Anti-depressants and...

Background As part of enhanced recovery after surgery in neuro oncology, carbohydrate loading drinks were reviewed to see if there were any benefits in administering this pre operatively, in particularly for patients for awake craniotomy electively. This method is currently used in colorectal and spinal teams within the trust. Carbohydrate loading...

Objective To determine inter- and intra-rater reliability of functional performance outcome measures in people with neurofibromatosis 2. To ascertain how closely objective and subjective measures align. Methods Twenty-nine people with neurofibromatosis 2 were recorded performing the modified clinical test of sensory integration and balance, four s...

Objective To report imaging protocol and scheduling variance in routine care of glioblastoma patients in order to demonstrate challenges of integrating deep learning models in glioblastoma care pathways. Additionally, to understand the most common imaging studies and image contrasts to inform the development of potentially robust deep learning mode...

Background: This study aimed to assess the outcome of cancer patients undergoing systemic anti-cancer treatment (SACT) at our centre to help inform future clinical decision-making around SACT during the COVID-19 pandemic. Methods: Patients receiving at least one episode of SACT for solid tumours at Guy's Cancer Centre between 1 March and 31 May...

AIM Not uncommonly, we come across significantly large high grade glioma cases (HGGs). With standard delineation protocols, we end up irradiating a large volume of normal brain. Emami & QUANTEC data define normal brain tolerance doses, however they are often of limited use in clinic practice. Thus, we reviewed our patients with significant tumor vo...

Background Using an updated dataset with more patients and extended follow-up, we further established cancer patient characteristics associated with COVID-19 death. Methods Data on all cancer patients with a positive reverse transcription-polymerase chain reaction swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) at Guy’s Cance...

Background In the phase III OlympiAD trial, olaparib significantly increased progression-free survival (PFS) compared with chemotherapy of physician's choice in patients with germline BRCA-mutated (gBRCAm), human epidermal growth factor 2 (HER2)-negative metastatic breast cancer (mBC). The phase IIIb LUCY trial assessed the clinical effectiveness o...

Very few studies investigating COVID-19 in cancer patients have included cancer patients as controls. We aimed to identify factors associated with the risk of testing positive for SARS CoV2 infection in a cohort of cancer patients. We analyzed data from all cancer patients swabbed for COVID-19 between 1st March and 31st July 2020 at Guy’s Cancer Ce...

Background: The efficacy and safety profiles of vaccines against SARS-CoV-2 in patients with cancer is unknown. We aimed to assess the safety and immunogenicity of the BNT162b2 (Pfizer-BioNTech) vaccine in patients with cancer. Methods: For this prospective observational study, we recruited patients with cancer and healthy controls (mostly healt...

Introduction Breast cancer is the most common malignancy affecting women under the age of 35 and young age at diagnosis is associated with a poor prognosis. Previous studies have shown that these patients have adverse tumour biology including high grade morphology, lymph node involvement and lack of hormone receptor expression. The aim of this stud...

Patients with Glioblastoma Multiforme (GBM) have a poor prognosis with few long-term survivors (>2 years from diagnosis). This review analyses key characteristics of this cohort. METHODS: Retrospective single-centre review of GBM patients treated with the STUPP protocol at a Regional Neuro-oncology centre, Nov-09–Sept-19. Demographics, histology...

BACKGROUND Immunosuppressive treatment increases COVID-19 risk. Neuro-oncology patients may not qualify for ITU if they deteriorate, but without oncological treatment, prognosis is poor. The pandemic has seen the introduction of new guidelines; including alternative treatment schedules which balance risks of contracting COVID-19, against safely del...

INTRODUCTION Stereotactic radiosurgery (SRS) commenced at Guy’s Cancer Hospital in August 2017. We report our first seventeen months’ data (August 2017 to December 2018) for brain metastases SRS. METHOD Patients referred via Neuro Oncology MDT were assessed for suitability for SRS via clinical review and 1mm-slice MRI. Treatment was planned on Ecl...

Purpose/Objective(s) There is a paucity in the literature regarding the concurrent use of cyclin-D kinase 4/6 (CDK 4/6) inhibitors with radiotherapy (RT). Given the well-established role of CDK4/6 inhibitors in metastatic breast cancer (both first and second line) the incidence of patients requiring palliative RT is likely to increase. Although the...

Background: Current precautionary management decisions being made for cancer patients are based on assumptions supported by limited evidence, based on small case series from China and Italy and larger series from New York and a recent consortium of 900 patients from over 85 hospitals in the USA, Canada, and Spain. Hence, there is insufficient evide...

The COVID-19 pandemic has challenged the delivery of care worldwide, with many outpatient clinics changing from face-to-face to telephone consultations [1]. This is particularly challenging in neuro-oncology, where often complex interventions need to be discussed and where communication can be compromised due to tumour-related language/cognitive de...

Background: There is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies. Methods: We used data from a single large UK Cancer Center to assess the demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February and...

Background Effective treatment for patients ≥70 years with newly diagnosed glioblastoma remains challenging and alternatives to conventional cytotoxics are appealing. Autophagy inhibition has shown promising efficacy and safety in small studies of glioblastoma, and other cancers. Methods We conducted a randomized phase II trial to compare radiothe...

Background: The provision of cancer services has been strongly impacted by the outbreak of SARS-CoV-2. Our Cancer Centre in South-East London treats about 8,800 patients annually (incl. 4,500 new diagnoses) and is one of the largest Comprehensive Cancer Centres in the UK. The first COVID-19 positive cancer patient was reported on 29 Feb 2020. Whils...

Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagn...

Background: The Coronavirus disease 2019 (COVID-19) pandemic continues to have a significant impact on the treatment of cancer patients. Understanding the clinical course, potential risk factors for severe infection and excess mortality, is essential to improve patient outcomes. We previously presented preliminary results from 156 SARS-CoV-2 positi...

Routine brain imaging in asymptomatic metastatic breast cancer (m-BC) patients is not standard of care. However, early diagnosis of brain metastases resulting in early intervention with stereotactic radiosurgery/ radiotherapy could reduce the need for significant interventional procedures, such as Whole-Brain Radiotherapy (WBRT) or extensive surgic...

Introduction Literature analysing how patients with a provisional low-grade glioma perceive their own quality of life prior to any surgical or oncological intervention is scarce. This patient group are often highly functioning individuals, able to lead ordinary lives which stresses that their management must be carefully considered in a holistic se...

Introduction Multiple surgeries for recurrent / progressive glioblastomas is a matter of debate within the neuro-oncology community reflecting the higher risk of complications and the limited adjuvant treatment options for patients who recurred after initial treatment. Therefore it is crucial to identify who may benefit of a more aggressive approac...

Single-Neuro-Oncology Surgical Centre (1 neurosurgical and 2 medical neuro-oncology units) retrospective cohort study of patients with more than one craniotomy for resection for intracranial Glioblastoma Multiforme (GBM).

Purpose To compare [¹⁸F]-fluorodeoxyglucose (FDG) and [¹⁸F]-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) with whole-body magnetic resonance with diffusion-weighted imaging (WB-MRI), for endocrine therapy response prediction at 8 weeks in bone-predominant metastatic breast cancer. Patients and methods Thirty-one p...

The challenges of using Radiotherapy for treating a high grade glioma in a pregnant patient a case series and discussion of optimal RT techniques to minimize foetal risk

Background: People with neurofibromatosis 2 (NF2) may have hearing, balance, dizziness and/or visual impairments that lead to functional challenges. Functional challenges may be amenable to medical, surgical or physical interventions and there is a need for robust functional outcome measures in this patient group to assess treatment efficacy, track...

Glioblastoma diagnosis carries a poor prognosis. A combination of surgical resection and chemo-radiotherapy is the current standard of care with median survival rates of 15 months. A 33 year old lady, pregnant at 26 + 3 weeks gestation presented with a left parietal tumour. Complete resection confirmed a grade IV glioblastoma. Foetal health remaine...

INTRODUCTION Primary brain tumours account for 3% of new cancer cases (2015) but account disproportionately in terms of mortality and morbidity. With radical treatment prognosis is variable; ranging from 80% survival for 5 years or more for benign meningiomas to a dismal 5% for Glioblastoma multiforme (GBM). Understandably, increasing numbers of ca...

Background Treating elderly patients with glioblastoma remains challenging and alternatives to conventional cytotoxics, particularly in patients with unmethylated tumours are required. Pre-clinical data suggest that autophagy inhibition sensitizes gliomas to radiotherapy and chemotherapy Material and Methods We conducted an open-label multicentre...

PURPOSE: The standards of care for patients with a GBM at relapse are not well defined. We sought to establish details of the treatment given to patients at initial relapse, and information about outcomes (PFS, OS) in our patient population in a large regional neuro-oncology centre. The aim was to establish whether rechallenge with TMZ is beneficia...

Kings College Hospital Neuro-oncology have struggled to maintain support group numbers. We have observed that patients/carers usually attend once, at the time of diagnosis and are typically angry, asking ‘why me?’ Core members reported that they felt ‘brought down’ by new attenders displaying anger and felt a ‘pressure to pick them up.’ Group facil...

Introduction: The figures for neuro-oncology patients attending “Health & Wellbeing” events are submitted to the cancer registry on a quarterly basis. The number returned has been zero since records started. One reason patients give for not attending generic cancer events is that they feel the events would not be relevant to them. Studies of patien...

INTRODUCTION Management of low-grade gliomas is evolving. Increasing evidence suggests that radical treatment, including maximal surgical resection, radiotherapy and adjuvant chemotherapy provides patients with a better prognosis compared to a “watch and wait” policy. Despite advances in therapy, there is still limited data to guide health professi...

e12539 Background: ¹⁸ F-FDG (fluorodeoxyglucose) PET/CT scan is widely used for staging and response assessment of metastatic breast cancer. However, the role of early treatment response assessment of bone metastases remains undefined and the optimal method not yet determined. Our hypothesis was that early ¹⁸ F-FDG PET/CT can predict subsequent cli...

Bevacizumab is considered an established part of the treatment strategies available for schwannomas in patients with Neurofibromatosis type 2 (NF2). In the UK, it is available through NHS National Specialized Commissioning to NF2 patients with a rapidly growing target schwannoma. Regrowth of the tumour on suspension of treatment is often observed r...

Objectives The Guy’s BRCA Family Service (brcafs) was established to develop a streamlined model of multidisciplinary care and management of families with mutations in BRCA1 and BRCA2. The primary aims were: 1) Offer every BRCA1/2 carrier in our catchment a clinical review. 2) Devise an individually tailored counselling and risk-management strategy...

INTRODUCTION: Glioblastoma multiforme (GBM) remains a challenge for clinicians due to resistance to conventional treatment with the DNA-damaging agent temozolomide (TMZ) and radiation. Improving outcomes has become imperative and there is a growing interest in targeting cancer cell metabolism. Based on work from our group and others, the metabolic...

BACKGROUND: Glioblastoma multiforme (GBM) remains a challenge for clinicians due to its heterogeneity and resistance to conventional treatment with temozolomide and radiation. This may be due to GBM stem cells which have been implicated in both tumour recurrence and progression. Autophagy is an evolutionarily conserved metabolic process with dual r...

Background: The objective of this retrospective study was to investigate the predictive value of pretreatment serum squamous cell carcinoma antigen (SCCAg) levels in 174 patients with squamous cell carcinoma of the anus who received concurrent chemoradiation between 1997 and 2010. Methods: Pretreatment serum SCCAg measurements in patients with h...

Resisting cell death is one of the six hallmarks of cancer. Autophagy is a highly adaptable metabolic process that plays an important role in stressful conditions, such as nutrient deprivation and hypoxia. In these conditions, it is becoming evident that autophagy protects cells, by providing an alternative energy source and by eliminating dysfunct...

4117 Background: SCCAg is a tumour marker expressed by ECACM, measured by microparticle enzyme immunoassay; normal range 0–150ng/dl. Methods: This retrospective study examined the role of SCCAg in staging and prediction of recurrence in 195 patients (pts); 76 m:119 f with ECACM treated 1997–2007. All 195 were treated with CRT- (50.4Gy in 28 fractio...