Anal cancer is a rare tumour accounting for ∼2% of all colorectal cancers between 1997 and 2000 in the UK. Staging is still dominated by DRE (digital rectal examination), computed tomography (CT) and magnetic resonance imaging (MRI) imaging. The role of PET as a definitive modality is still emerging and there are relatively few adequate studies in the literature. We looked at patients treated radically for anal cancer at Mount Vernon Cancer Centre (UK) between 2009 and 2010. Eighty-eight patients underwent treatment according to data-based coding records of which 46 had positron emission tomography (PET)/CT scans. Notes were unavailable for three patients. We compared staging following conventional modalities (DRE, MRI and CT) and PET/CT scans for these 43 patients. In 18 patients, the PET/CT stage differed from MRI. PET/CT altered the stage in 42% of patients but changes in subsequent management were not implemented. Our data show that PET/CT does alter staging in a significant number of cases although it did not lead to change in management under the current guidelines. Furthermore, there is agreement that PET/CT shows greater sensitivity for detection of lymph nodes and our study has demonstrated a distinct trend towards upstaging of anal cancer with PET/CT.

Background: Prehabilitation programmes aim to optimise patients before and after cancer treatment including surgery. Previous studies in surgical patients demonstrate that prehabilitation improves pre-operative fitness and overcomes the negative impact of neoadjuvant chemotherapy on fitness. The aim of this study was to assess the impact of prehabilitation on the tolerance of neoadjuvant chemotherapy in patients with oesophageal cancer. Methods: Patients with oesophageal or gastroesophageal junction (GOJ) cancer from two oncology centres were retrospectively included in the present comparative cohort study; one provided a multimodal prehabilitation programme and one did not offer any prehabilitation. Tolerance of chemotherapy, defined as completion of the full chemotherapy regime as per protocol, was compared between the two groups. Results: In terms of participants, 92 patients were included in this study, 47 patients in the prehabilitation cohort and 45 in the control cohort. Compared with the control group, the prehabilitation group demonstrated an improved rate of chemotherapy completion (p = 0.029). In multivariate analysis, participation in prehabilitation was significantly associated with an improved rate of chemotherapy completion. Conclusion: The findings of this exploratory study suggest that prehabilitation is associated with better tolerance for chemotherapy. Further research is needed to establish the long-term impact of prehabilitation on oncological outcomes.

Pancreatic malignancies account for 3% of all cancer diagnoses in the UK and prognosis is poor with overall 1-year survival rates at 20% and 5-year survival rates at 5%. The majority of these cancers (75%–95%) arise from the exocrine part of the gland and are almost all invasive ductal adenocarcinomas. One per cent of all pancreatic tumours are endocrine tumours. There is limited data regarding the management of such rare neoplasms of the pancreas and some evidence suggests that prognoses and risk factors may be different. Therefore, it is important to report experience of this type of malignancy in order to build a knowledge base to guide the practice of future clinicians. The authors report a case of an intraductal tubulopapillary neoplasm of the pancreas. This is very unusual form of intraductal pancreatic tumour, which is now thought to occupy a distinct histological subcategory and has arisen within a previously irradiated field.

422 Background: The use of ¹⁸flurodeoxyglucose PET or PET/CT in staging of anal cancer is becoming increasingly fashionable. However, evidence endorsing it as a definitive staging modality it is still emerging. The largest published series to date from the UK found sensitivity of PET to be superior for detection of regional nodal metastases and overall PET changed stage in 23% and management in 16% of cases [de Winton E et al. The impact of 18-fluorodeoxyglucose positron emission tomography on the staging, management and outcome of anal cancer. BJR 2009; 100: 693-700]. We initially performed a retrospective pilot feasibility study for the period 2009-2010 and found that PET/CT altered staging in 42% of the 43 patients included, predominantly upstaging nodal status. We continue our analysis and report this prospective series - to assess the usefulness of PET/CT in the staging of anal cancer. Methods: 47 patients were treated radically for anal cancer at Mount Vernon Cancer Centre (UK) between January 2010 and July 2011, of which 27 had PET/CT scans. Staging was compared following conventional modalities and PET/CT. The TNM clinical staging system was used. Results: In 9 patients the PET/CT stage differed from MRI staging. In total, there were 4 ‘T stage’ changes and 8 ‘N stage’ changes. Of these, 1 case showed a difference in ‘T’ staging alone 5 showed a change in ‘N’ staging alone and 3 showed a change in ‘T’ and ‘N’ staging. PET/CT altered staging in 33% of patients. Conclusions: We conclude that PET/CT alters staging in a significant number of cases correlating with the literature and our own retrospective analysis. Furthermore there is agreement that PET/CT shows greater sensitivity for detection of lymph nodes. Although PET/CT cannot replace CT/MRI as the optimal modality for planning, it can reveal useful information regarding tumour extent, nodal involvement and distal metastases. PET/CT can account for greater definition of dose delivery, and more accurately ascertain the need to include/exclude pelvic lymph nodes. With more precise staging, acute and late toxicity profiles will be greatly influenced, especially with more advanced radiotherapy techniques such as Intensity Modulated Radiotherapy (IMRT), whilst maintaining satisfactory outcomes.